Therapeutic Assessment of Primaquine for Radical Cure of Plasmodium vivax Malaria at Primary and Tertiary Care Centres in Southwestern India

Acquaintance is scanty on primaquine (PQ) efficacy and Plasmodium vivax recurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to prevent P. vivax recurrence. Microscopically, aparasitemic adults (≥18 years) after acute vivax malaria on day 28 were re-enrolled into 15 months’ long follow-up study. A peripheral blood smear examination was performed with participants at every 1–2 month interval. A nested PCR test was performed to confirm the mono-infection with P. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2–5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24–5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved that P. vivax mono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.

Effects of combined early in-patient cardiac rehabilitation and structured home-based program on function among patients with congestive heart failure: a randomized controlled trial

To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life. Tertiary care, university teaching hospital, randomized controlled trial. Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life [SF36] was assessed at admission, discharge, and follow-up. Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis. At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group [310 m vs. 357 m, respectively; P = 0.001]. Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group [514 m vs. 429 m; P < 0.001]. Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference [P < 0.05] in the experimental group for both the mental and physical components. Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure