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1.
Ciênc. Saúde Colet ; 25(9): 3517-3554, Mar. 2020. tab, graf
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1133149

ABSTRACT

Resumo O objetivo deste trabalho foi avaliar efeitos de tratamentos medicamentosos para infecções por coronavírus. Revisão sistemática rápida com buscas nas bases MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov e International Clinical Trials Registry Platform. Foram incluídos 36 estudos avaliando alternativas medicamentosas contra SARS, SARS-CoV-2 e MERS. A maioria dos estudos incluídos foi conduzida na China com delineamento observacional para tratamento da COVID-19. Os tratamentos mais estudados foram antimaláricos e antivirais. Nos antimaláricos, a metanálise de dois estudos com 180 participantes não identificou benefício da hidroxicloroquina em relação à negativação da carga viral via reação em cadeia de polimerase em tempo real e o uso de antivirais comparado ao cuidado padrão foi similar em relação aos desfechos. As evidências científicas disponíveis são preliminares e de baixa qualidade metodológica, o que sugere cautela na interpretação dos dados. Pesquisas que avaliem a eficácia comparativa em ensaios clínicos randomizados, controlados, com tempo de acompanhamento adequado e com os métodos devidamente divulgados e sujeitos à revisão científica por pares são necessárias. Recomenda-se atualização periódica da presente revisão.


Abstract This work aimed to evaluate the effects of drug therapies for coronavirus infections. Rapid systematic review with search in the MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov and International Clinical Trials Registry Platform databases. Thirty-six studies evaluating alternative drugs against SARS, SARS-CoV-2 and MERS were included. Most of the included studies were conducted in China with an observational design for the treatment of COVID-19. The most studied treatments were with antimalarials and antivirals. In antimalarial, the meta-analysis of two studies with 180 participants did not identify the benefit of hydroxychloroquine concerning the negative viral load via real-time polymerase chain reaction, and the use of antivirals compared to standard care was similar regarding outcomes. The available scientific evidence is preliminary and of low methodological quality, which suggests caution when interpreting its results. Research that evaluates comparative efficacy in randomized, controlled clinical trials, with adequate follow-up time and with the methods properly disclosed and subject to scientific peer review is required. A periodic update of this review is recommended.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Severe Acute Respiratory Syndrome/drug therapy , Antiviral Agents/administration & dosage , Pneumonia, Viral/virology , Randomized Controlled Trials as Topic , Coronavirus Infections , Coronavirus Infections/virology , Severe Acute Respiratory Syndrome/virology , SARS Virus/isolation & purification , SARS Virus/drug effects , Pandemics , Middle East Respiratory Syndrome Coronavirus/isolation & purification , Middle East Respiratory Syndrome Coronavirus/drug effects , Betacoronavirus , Betacoronavirus/isolation & purification , Betacoronavirus/drug effects , Antimalarials/administration & dosage
2.
Ciênc. Saúde Colet ; 23(7): 2277-2290, jul. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952693

ABSTRACT

Resumo Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.


Abstract This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.


Subject(s)
Humans , Pharmaceutical Services/organization & administration , International Cooperation , Tuberculosis/drug therapy , HIV Infections/drug therapy , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/supply & distribution , Health Policy , Malaria/drug therapy , Mozambique , Antimalarials/administration & dosage , Antimalarials/supply & distribution , Antitubercular Agents/administration & dosage , Antitubercular Agents/supply & distribution
3.
Mem. Inst. Oswaldo Cruz ; 109(5): 525-533, 19/08/2014. tab, graf
Article in English | LILACS | ID: lil-720421

ABSTRACT

In a climate of growing concern that Plasmodium falciparum may be developing a drug resistance to artemisinin derivatives in the Guiana Shield, this review details our current knowledge of malaria and control strategy in one part of the Shield, French Guiana. Local epidemiology, test-treat-track strategy, the state of parasite drug resistance and vector control measures are summarised. Current issues in terms of mobile populations and legislative limitations are also discussed.


Subject(s)
Animals , Humans , Antimalarials/administration & dosage , Malaria/epidemiology , Anopheles , Drug Resistance , French Guiana/epidemiology , Insect Vectors , Malaria/drug therapy , Malaria/transmission
4.
Mem. Inst. Oswaldo Cruz ; 109(5): 522-524, 19/08/2014.
Article in English | LILACS | ID: lil-720430

ABSTRACT

In the 1950s, the strategy of adding chloroquine to food salt as a prophylaxis against malaria was considered to be a successful tool. However, with the development of Plasmodium resistance in the Brazilian Amazon, this control strategy was abandoned. More than 50 years later, asexual stage resistance can be avoided by screening for antimalarial drugs that have a selective action against gametocytes, thus old prophylactic measures can be revisited. The efficacy of the old methods should be tested as complementary tools for the elimination of malaria.


Subject(s)
Humans , Antimalarials/administration & dosage , Chloroquine/administration & dosage , Malaria, Vivax/drug therapy , Plasmodium vivax/drug effects , Primaquine/administration & dosage , Brazil , Drug Resistance , Malaria, Vivax/parasitology
5.
Mem. Inst. Oswaldo Cruz ; 109(5): 534-539, 19/08/2014. graf
Article in English | LILACS | ID: lil-720432

ABSTRACT

The global emergence of Plasmodium vivax strains resistant to chloroquine (CQ) since the late 1980s is complicating the current international efforts for malaria control and elimination. Furthermore, CQ-resistant vivax malaria has already reached an alarming prevalence in Indonesia, East Timor and Papua New Guinea. More recently, in vivo studies have documented CQ-resistant P. vivax infections in Guyana, Peru and Brazil. Here, we summarise the available data on CQ resistance across P. vivax-endemic areas of Latin America by combining published in vivo and in vitro studies. We also review the current knowledge regarding the molecular mechanisms of CQ resistance in P. vivax and the prospects for developing and standardising reliable molecular markers of drug resistance. Finally, we discuss how the Worldwide Antimalarial Resistance Network, an international collaborative effort involving malaria experts from all continents, might contribute to the current regional efforts to map CQ-resistant vivax malaria in South America.


Subject(s)
Humans , Antimalarials/administration & dosage , Chloroquine/administration & dosage , Drug Resistance , Malaria, Vivax/drug therapy , Plasmodium vivax/drug effects , Bolivia/epidemiology , Brazil/epidemiology , Colombia/epidemiology , Guyana/epidemiology , Malaria, Vivax/epidemiology , Malaria, Vivax/parasitology , South America/epidemiology
6.
Article in English | IMSEAR | ID: sea-162937

ABSTRACT

Aims: To determine the antiplasmodial activity of methanolic extract of T. avicennioides and its effect on oxidative stress and the lipid profiles in mice infected with Plasmodium berghei. Study Design: Mice used for this study were grouped into five. The first group was not infected with malaria parasite (normal control), the second group was infected with the parasite but not treated with antimalarial drugs (negative control), the third group was infected with the parasite and treated with 5mg/kg body weight of artesunat (positive control), while the fourth and fifth groups were infected with malaria parasite and treated with 100 and 200mg/kg of T. avicennioides respectively. Methodology: The parasitaemia was monitored for five days. The animals were sacrificed on the fifth day and the blood was collected. The serum was used to assess the biochemical parameters using randox kits. Results: While parasite density increases in the negative control per day, there was reduction in parasite density in treated groups. The parasite clearance was significantly higher (P = .05) in those treated with 200mg/kg of T. avicennioides than those treated with 100mg/kg of T. avicennioides and 5mg/kg of artesunat. The malondialdehyde level was significantly higher in the negative control, while superoxide dismutase and catalase levels were significantly reduced when compared with group treated with 200mg/kgbdwt of T. avicennioides. HDL level was significantly higher (P = .05) in those treated with 200mg/kg than in the normal, negative and positive control. The triglycerides level was significantly higher in the negative control when compared with the group treated with the extract of T. avicennioides. Conclusion: This study showed that the methanolic extract of T. avicennioides display dose-related in vivo antiplasmodial and antioxidant activities as well as reduced the serum and liver lipoprotein cholesterol in mice infected with P. berghei.


Subject(s)
Animals , Animals, Laboratory , Antimalarials/administration & dosage , Antimalarials/chemistry , Antimalarials/therapeutic use , Lipids/blood , Lipoproteins/blood , Mice , Models, Animal , Oxidative Stress/drug effects , Plasmodium falciparum/drug effects , Terminalia/classification , Terminalia/pharmacology , Terminalia/therapeutic use
7.
Braz. j. infect. dis ; 17(5): 579-591, Sept.-Oct. 2013. ilus, tab
Article in English | LILACS | ID: lil-689884

ABSTRACT

Cerebral malaria is the most severe and rapidly fatal neurological complication of Plasmodium falciparum infection and responsible for more than two million deaths annually. The current therapy is inadequate in terms of reducing mortality or post-treatment symptoms such as neurological and cognitive deficits. The pathophysiology of cerebral malaria is quite complex and offers a variety of targets which remain to be exploited for better therapeutic outcome. The present review discusses on the pathophysiology of cerebral malaria with particular emphasis on scope and promises of curcumin as an adjunctive therapy to improve survival and overcome neurological deficits.


Subject(s)
Humans , Adjuvants, Pharmaceutic/administration & dosage , Antimalarials/administration & dosage , Curcumin/administration & dosage , Malaria, Cerebral/drug therapy
8.
Rev. Soc. Bras. Med. Trop ; 46(4): 525-527, Jul-Aug/2013. tab
Article in English | LILACS | ID: lil-683332

ABSTRACT

Artemisinin-based combination therapy-resistant malaria is rare in Sub-Saharan Africa. The World Health Organization identifies monitoring and surveillance using day-3 parasitaemia post-treatment as the standard test for identifying suspected artemisinin resistance. We report three cases of early treatment failure due to possible artemisinin-based combination therapy-resistant Plasmodium falciparum malaria. All cases showed adequate clinical and parasitological responses to quinine. This study reveals a need to re-evaluate the quality and efficacy of artemisinin-based combination therapy agents in Nigeria and Sub-Saharan Africa.


Subject(s)
Adult , Female , Humans , Middle Aged , Antimalarials/administration & dosage , Artemisinins/administration & dosage , Malaria, Falciparum/drug therapy , Quinine/administration & dosage , Antimalarials/adverse effects , Artemisinins/adverse effects , Drug Resistance , Drug Therapy, Combination/methods , Nigeria , Treatment Failure
10.
Article in English | WPRIM | ID: wpr-155357

ABSTRACT

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.


Subject(s)
Acute Kidney Injury , Hypoxia , Antimalarials/administration & dosage , Extracorporeal Membrane Oxygenation , Humans , Lung/diagnostic imaging , Malaria, Vivax/complications , Male , Middle Aged , Multiple Organ Failure , Plasmodium vivax/isolation & purification , Republic of Korea , Respiratory Distress Syndrome/complications , Treatment Outcome
11.
Rev. Soc. Bras. Med. Trop ; 45(6): 732-738, Nov.-Dec. 2012. mapas, tab
Article in English | LILACS | ID: lil-661076

ABSTRACT

INTRODUCTION: In Colombia, there are no published studies for the treatment of uncomplicated Plasmodium falciparum malaria comparing artemisinin combination therapies. Hence, it is intended to demonstrate the non-inferior efficacy/safety profiles of artesunate + amodiaquine versus artemether-lumefantrine treatments. METHODS: A randomized, controlled, open-label, noninferiority (Δ≤5%) clinical trial was performed in adults with uncomplicated P. falciparum malaria using the 28‑day World Health Organization validated design/definitions. Patients were randomized 1:1 to either oral artesunate + amodiaquine or artemether-lumefantrine. The primary efficacy endpoint: adequate clinical and parasitological response; secondary endpoints: - treatment failures defined per the World Health Organization. Safety: assessed through adverse events. RESULTS: A total of 105 patients was included in each group: zero censored observations. Mean (95%CI - Confidence interval) adequate clinical and parasitological response rates: 100% for artesunate + amodiaquine and 99% for artemether-lumefantrine; the noninferiority criteria was met (Δ=1.7%). There was one late parasitological therapeutic failure (1%; artemether-lumefantrine group), typified by polymerase chain reaction as the MAD20 MSP1 allele. The fever clearance time (artesunate + amodiaquine group) was significantly shorter (p=0.002). Respectively, abdominal pain for artesunate + amodiaquine and artemether-lumefantrine was 1.9% and 3.8% at baseline (p=0.68) and 1% and 13.3% after treatment (p<0.001). CONCLUSIONS: Uncomplicated P. falciparum malaria treatment with artesunate + amodiaquine is noninferior to the artemether-lumefantrine standard treatment. The efficacy/safety profiles grant further studies in this and similar populations.


INTRODUÇÃO: Na Colômbia não existem estudos publicados sobre o tratamento da malária não complicada por Plasmodium falciparum comparando as terapias combinadas com artemisinina. Destarte, quer se demonstrar a não inferioridade dos perfis de eficácia/segurança dos tratamentos com artesunato+amodiaquina versus artemeter-lumefantrina. MÉTODOS: Foi realizado um estudo clínico de não inferioridade (∆≤5%), aleatório, controlado, aberto, em adultos com malária não complicada por P. falciparum usando o desenho validado de 28 dias e os desenhos validados/definidos pela Organização Mundial da Saúde. Os pacientes foram aleatorizados (1:1) para ambos artesunato+amodiaquina ou artemeter-lumefantrina orais. Critérios primários de eficácia: resposta clínica e parasitológica adequada; Criterios de eficácia secundários: as falhas de tratamento definidos pela Organização Mundial da Saúde. A segurança: avaliada através de eventos adversos. RESULTADOS: Foram incursos 105 pacientes em cada grupo: zero observações censuradas. As taxas médias da resposta clínica e parasitológica adequada (95% IC - intervalo de confiança): 100% para artesunato+amodiaquina e 99% para artemeter-lumefantrina; atingiu-se o critério de não inferioridade (∆=1.7%). Houve uma falha terapêutica parasitológica tardia (1%; grupo artemeter-lumefantrina), caracterizada mediante reação em cadeia da polimerase como o alelo MAD20 MSP1. Tempo de remissão da febre (grupo artesunato+amodiaquina), foi significativamente mais curto (p=0.002). Dor abdominal, para artesunato+amodiaquina e artemeter-lumefantrina, respectivamente, 1.9% e 3.8% (p=0.68) na linha de base, 1% e 13.3% pós-tratamento (p<0.001). CONCLUSÕES: O tratamento com artesunato+amodiaquina da malária não complicada por P. falciparum é não inferior ao tratamento normal com artemeter-lumefantrina. Os perfis de eficácia/segurança justificam estudos adicionais nesta e outras populações semelhantes.


Subject(s)
Adult , Female , Humans , Male , Amodiaquine/administration & dosage , Antimalarials/administration & dosage , Artemisinins/administration & dosage , Ethanolamines/administration & dosage , Fluorenes/administration & dosage , Malaria, Falciparum/drug therapy , Amodiaquine/adverse effects , Antimalarials/adverse effects , Artemisinins/adverse effects , Colombia , Drug Combinations , Drug Therapy, Combination/methods , Ethanolamines/adverse effects , Fluorenes/adverse effects , Treatment Outcome
12.
Indian J Pathol Microbiol ; 2011 Jul-Sept 54(3): 594-596
Article in English | IMSEAR | ID: sea-142053

ABSTRACT

Hemophagocytic syndrome (HPS) has been associated with infections, hematological malignancies and autoimmune conditions. Malaria is rarely reported to cause HPS. We report a case of an 11-month-old infant with fever, hepatosplenomegaly, pancytopenia, high serum ferritin, hypertriglyceridemia, and bone marrow hemophagocytosis, consistent with hemophagocytic syndrome. Gametocytes of plasmodium falciparum were identified on bone marrow aspiration. Rapid recovery was observed after treatment with antimalarials.


Subject(s)
Antimalarials/administration & dosage , Bone Marrow/parasitology , Bone Marrow/pathology , Humans , Infant , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/etiology , Malaria, Falciparum/complications , Malaria, Falciparum/drug therapy , Malaria, Falciparum/pathology , Male , Microscopy , Plasmodium falciparum/cytology , Treatment Outcome
13.
Rev. Soc. Bras. Med. Trop ; 44(1): 113-115, Jan.-Feb. 2011. tab
Article in Portuguese | LILACS | ID: lil-579845

ABSTRACT

INTRODUÇÃO: A primaquina pode acarretar sérios eventos adversos, com destaque para a toxicidade ao sangue. O objetivo deste trabalho é determinar a metemoglobinemia de 20 pacientes com malária por Plasmodium vivax tratados com primaquina, comparando-os segundo o sexo e a expressão da glicose-6-fosfato desidrogenase. MÉTODOS: Quantificação da metemoglobina por espectrofotometria visível e avaliação qualitativa da glicose-6-fosfato desidrogenase. RESULTADOS: A metemoglobinemia variou de 2,85 a 5,45 por cento nos pacientes do sexo masculino e de 3,77 a 7,34 por cento no feminino. CONCLUSÕES: A instituição da terapia aumentou de maneira significativa os teores de metemoglobina, sem manifestação clínica evidente e independente do sexo e da atividade enzimática.


INTRODUCTION: Primaquine can produce adverse reactions as toxicity to blood when used in the treatment of vivax malaria. This work aimed to determine methemoglobinemia in patients with vivax malaria receiving oral therapy with primaquine. METHODS: Spectrophotometric quantification of methemoglobinemia and qualitative assay for glucose-6-phosphate dehydrogenase. RESULTS: Methemoglobinemia ranged from 2.85 to 5.45 percent in male patients and 3.77 to 7.34 percent in female patients. CONCLUSIONS: A statistically significant increase in methemoglobinemia was observed following oral therapy with primaquine, with no clinical manifestations, and independent of sex and the qualitative expression of glucose-6-phosphate dehydrogenase.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Antimalarials/adverse effects , Glucosephosphate Dehydrogenase/blood , Malaria, Vivax/drug therapy , Methemoglobinemia/chemically induced , Primaquine/administration & dosage , Antimalarials/administration & dosage , Malaria, Vivax/enzymology , Prospective Studies , Primaquine/adverse effects , Sex Factors , Spectrophotometry
14.
Salud pública Méx ; 53(supl.3): s333-s348, 2011. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-625713

ABSTRACT

Desarrollar un plan de fortalecimiento del control de la mala-ria hacia su eliminación. En 2009, bajo la coordinación del Instituto Nacional de Salud Pública, se integró un equipo técnico transdisciplinario para hacer un diagnóstico situacional de la malaria y de los programa de control y para la selección de prácticas efectivas de intervención que serían incorporadas al plan, en el marco de un ejercicio de teoría de cambio. Se establecieron criterios de estratificación de las localidades con base en sus condiciones de transmisión. Se identificaron limitaciones estructurales y operativas de los programas de control. Se elaboró un plan de intervenciones para mejorar la cobertura de vigilancia epidemiológica, intervenciones antimaláricas y diagnóstico y tratamiento oportunos de casos. El plan delinea con fases progresivas de implementación: reorganización, intensificación de intervenciones y evaluación de la factibilidad de eliminación. La adopción de un plan estratégico único brindará lineamientos y elementos administrativos para conformar un sistema que coordine las actividades de los programas nacionales de control y facilite la eliminación de la malaria en la región.


To develop a plan to strengthen the control of malaria towards its elimination. In 2009, under the coordination of the National Public HealthInstitute ofMexico, atransdisciplinary equipment of technical and operative experts was conformed to carry out a situational analysis of malaria and control programs and for the selection of effective practices of intervention that would be incorporated to the plan, within the framework of an exercise in Theory of Change. Criteria for thestratificationof thelocalities, based ontheirtransmission characteristics were established. The structural and operative limitations of the control programs were identified. A plan of interventions was elaborated to improve the coverage of epidemiological surveillance, anti-malaria interventions and opportune diagnosis and treatment of cases. The plan delineates progressive phases of implementation: reorganization, intensification of interventions and evaluation of elimination feasibility. The adoption of a regional strategic plan will provide guidance and administrative elements to conform a system that coordinates the activities of the national control programs and facilitate the elimination of malaria in the region.


Subject(s)
Animals , Humans , Health Promotion/organization & administration , Malaria/prevention & control , Public Health , Antimalarials/administration & dosage , Antimalarials/therapeutic use , Community Participation , Central America/epidemiology , Chloroquine/administration & dosage , Chloroquine/therapeutic use , Developing Countries , Endemic Diseases , Goals , Health Plan Implementation , Health Services Needs and Demand , Health Promotion/economics , Insect Vectors , International Cooperation , Laboratories/statistics & numerical data , Laboratories/supply & distribution , Malaria/epidemiology , Mexico/epidemiology , Mosquito Control/organization & administration , Primaquine/administration & dosage , Primaquine/therapeutic use , Risk Management
15.
Rev. Soc. Bras. Med. Trop ; 43(6): 749-750, Nov.-Dec. 2010.
Article in English | LILACS | ID: lil-569451

ABSTRACT

Two cases of malaria by Plasmodium vivax relapsed after treatment with drugs in doses recommended by the Ministry of Health are presented. Both patients were overweight and were followed in the Federal District, an area considered free from vector transmission of the disease. Radical cure was obtained after medication with the same drugs in weight proportional doses.


São apresentados dois casos de pacientes com malária por Plasmodium vivax que apresentaram recaídas após tratamento com medicamentos em doses indicadas pelo Ministério da Saúde. Ambos os pacientes tinham pesos elevados e foram acompanhados no Distrito Federal, área considerada sem transmissão vetorial da doença. A cura radical foi obtida após medicação em dose proporcional ao peso corpóreo dos pacientes.


Subject(s)
Humans , Male , Middle Aged , Antimalarials/administration & dosage , Malaria, Vivax/drug therapy , Overweight/complications , Primaquine/administration & dosage , Malaria, Vivax/complications , Recurrence , Treatment Failure
16.
Arch. méd. Camaguey ; 14(1)ene.-feb. 2010. tab
Article in Spanish | LILACS | ID: lil-577888

ABSTRACT

Con el propósito de ofrecer una panorámica sobre las drogas antimaláricas desde su surgimiento hasta la situación actual, se realiza una revisión actualizada que incluye una breve reseña histórica sobre la evolución que ha experimentado el tratamiento antipalúdico desde antes de Nuestra Era hasta la fecha actual. Se reflejó la introducción de las principales drogas en el manejo terapéutico de la enfermedad. También se describió el fenómeno de la resistencia a las drogas antimaláricas como problema para alcanzar el control de dicha afección, haciendo referencia a su definición, clasificación, factores y mecanismos que intervienen en la misma, así como su desarrollo cronológico y la situación mundial actual referente a la drogoresistencia. Además se mostraron las principales drogas antimaláricas usadas actualmente con sus dosis y vías de administración, y cuáles son las tendencias contemporáneas que recomiendan su utilización. Finalmente se relacionaron las perspectivas que tiene para el futuro el tratamiento antimalárico acorde con el nivel actual de conocimientos y las últimas investigaciones realizadas. Se concluyó que las estrategias terapéuticas deben fundamentarse en los niveles de resistencia existente en las diferentes zonas geográficas, utilizando combinaciones de drogas antipalúdicas, sobre todo aquellas que incluyan algún derivado del artemisinín, y si esto no es posible al menos usar racionalmente combinaciones de otras acorde al nivel de resistencia de la región.


With the purpose of offering a panoramic on antimalarial drugs from their emergence until the current situation, an up-to-date review was carried out that includes a brief historical review on the evolution that has experienced the antimalarial treatment from before Christ to date. The introduction of the main drugs in the therapeutic handling of the disease was reflected. The phenomenon of the resistance to the antimalarial drugs as problem to reach the control of this affection was also described, making reference to its definition, classification, factors and mechanisms that intervene, as well as its chronological development and the current world situation concerning to the drug-fast. The main antimalarial drugs currently used with their doses and administration pathways were also shown, and which are the contemporary tendencies that recommend their use. Finally the perspectives that have for the future the antimalarious treatment with the current level of knowledge were related and the last carried out investigations. We concluded that the therapeutic strategies should be based in the existent resistance levels in the different geographical areas, using combinations of antimalarial drugs, mainly those that include some derived of the artemisinin, and if this is not possible at least to use some other combinations rationally according to the resistance level of the region.


Subject(s)
Antimalarials/administration & dosage , Malaria/therapy , Therapeutics
17.
Bull. W.H.O. (Online) ; 88(11): 807­814-2010. ilus
Article in English | AIM, AIM | ID: biblio-1259853

ABSTRACT

Objective To develop a decision-support tool to help policy-makers in sub-Saharan Africa assess whether intermittent preventive treatment in infants (IPTi) would be effective for local malaria control. Methods An algorithm for predicting the effect of IPTi was developed using two approaches. First; study data on the age patterns of clinical cases of Plasmodium falciparum malaria; hospital admissions for infection with malaria parasites and malaria-associated death for different levels of malaria transmission intensity and seasonality were used to estimate the percentage of cases of these outcomes that would occur in children aged 10 years targeted by IPTi. Second; a previously developed stochastic mathematical model of IPTi was used to predict the number of cases likely to be averted by implementing IPTi under different epidemiological conditions. The decision-support tool uses the data from these two approaches that are most relevant to the context specified by the user. Findings Findings from the two approaches indicated that the percentage of cases targeted by IPTi increases with the severity of the malaria outcome and with transmission intensity. The decision-support tool; available on the Internet; provides estimates of the percentage of malaria-associated deaths; hospitalizations and clinical cases that will be targeted by IPTi in a specified context and of the number of these outcomes that could be averted. Conclusion The effectiveness of IPTi varies with malaria transmission intensity and seasonality. Deciding where to implement IPTi must take into account the local epidemiology of malaria. The Internet-based decision-support tool described here predicts the likely effectiveness of IPTi under a wide range of epidemiological conditions


Subject(s)
Africa South of the Sahara , Antimalarials/administration & dosage , Decision Support Techniques , Infant , Malaria/diagnosis , Malaria/epidemiology , Plasmodium malariae
18.
Arq. bras. oftalmol ; 72(3): 313-320, May-June 2009. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-521464

ABSTRACT

OBJETIVOS: Avaliar diferentes métodos diagnósticos para a avaliação de pacientes portadores de lúpus eritematoso sistêmico, usuários crônicos do difosfato de cloroquina (DFC) e, portanto, com alto risco para retinopatia tóxica. MÉTODOS: Foram analisados 72 olhos de 36 pacientes consecutivos, seguidos no Serviço de Reumatologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, de julho de 2007 a abril de 2008. Dados demográficos e clínicos foram avaliados com o intuito de estudar os fatores de alto risco e comparar os seguintes métodos oftalmológicos: acuidade visual, biomicroscopia da córnea, biomicroscopia do fundo, retinografia, angiofluoresceinografia da retina, campo visual macular com mira branca. RESULTADOS: Dos 36 pacientes, 34 (94,4 por cento) eram mulheres. A média de idade foi 39,9 ± 9,8 anos, com tempo de doença igual a 13,9 ± 6,6 anos. Além do uso crônico da cloroquina, os pacientes apresentaram altas doses diárias (>3 mg/kg) e cumulativas. Não foi observada relação entre estes fatores de alto risco e maior prevalência de retinopatia. Foi encontrada prevalência de retinopatia igual a 38,9 por cento, confirmada por alterações bilaterais, centrais ou paracentrais e reprodutíveis no exame de campo visual. Outros exames indicados para seguimento, como acuidade visual, biomicroscopia de fundo e angiofluoresceinografia não foram capazes de diagnosticar a maioria das alterações confirmadas pelo campo visual. CONCLUSÃO: Foi observada alta prevalência de retinopatia por cloroquina entre os pacientes com alto risco, usuários crônicos do DFC, segundo os achados do campo visual. A avaliação desses pacientes deve considerar a realização do exame de campo visual em intervalos menores que os propostos, mesmo quando não há suspeita clínica.


PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. Methods: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4 percent) were female. The mean age was 39.9 ± 9.8 years and the disease duration was 13.9 ± 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9 percent of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Antimalarials/adverse effects , Chloroquine/analogs & derivatives , Diagnostic Techniques, Ophthalmological/standards , Lupus Erythematosus, Systemic/drug therapy , Retinal Diseases/chemically induced , Antimalarials/administration & dosage , Body Weight/physiology , Chi-Square Distribution , Chloroquine/administration & dosage , Chloroquine/adverse effects , Cornea/drug effects , Cornea/pathology , Diagnostic Techniques, Ophthalmological/classification , Fluorescein Angiography , Prevalence , Risk Factors , Retina/drug effects , Retina/pathology , Retinal Diseases/diagnosis , Retinal Diseases/epidemiology , Time Factors , Visual Fields/drug effects , Young Adult
19.
Rev. Inst. Med. Trop. Säo Paulo ; 51(2): 109-110, Mar.-Apr. 2009.
Article in English | LILACS | ID: lil-511832

ABSTRACT

We determined the relationship between plasma and red blood cell concentrations of quinine in children with uncomplicated falciparum malaria from an endemic area of Amazonian region. Quinine was determined by high performance liquid chromatography with ultraviolet detection. In the steady state the ratio between plasma and red blood cell quinine concentration was 1.89 ± 1.25 ranging from 1.05 to 2.34. This result demonstrated that quinine do not concentrate in red blood cell of Brazilian children and characterize the absence of interracial difference in this relationship.


Neste estudo foi determinada a relação entre as concentrações plasmáticas e eritrocitárias de quinina em crianças com malária falciparum não complicada, oriundas de área endêmica da Região Amazônica. A quinina foi detrminada por cromatografia líquida de alta eficiência. No estado de equilíbrio, a relação foi 1,89 ± 1,25 variando de 1,05 a 2,34. Estes resultados demonstraram que a quinina não se concentra nos eritrócitos das crianças e caracterizaram a ausência de diferença racial nesta relação.


Subject(s)
Adolescent , Child , Child, Preschool , Humans , Antimalarials/blood , Erythrocytes/chemistry , Malaria, Falciparum/blood , Quinine/blood , Administration, Oral , Antimalarials/administration & dosage , Chromatography, High Pressure Liquid , Malaria, Falciparum/drug therapy , Prospective Studies , Quinine/administration & dosage , Time Factors
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