The effect of antimalarials on reticulocyte count of patients with falciparum malaria

One hundred and eleven adult patients who attended North Okkalapa General Hospital for uncomplicated falciparum malaria were chosen for the study. They were treated with dihydroartemisinine (Cetexin), quinine, artesunate tablets and artemether injection. Fifty nine adult male and female without malaria were chosen as controls. They were treated with sulfadoxine-pyrimethamine, quinine and artesunate. Thick and thin blood films were taken from the patients daily and were stained and counted for malaria parasites. Packed cell volume (PCV), WBC count and reticulocyte count were also done. Among the patients treated with drugs, there was a significant fall in the mean reticulocyte count (number concentration and number fraction) at day 3. But the reticulocytes were raised back to normal at days 7 and 14. There was no significant changes in the mean packed cell volume (PCV) and mean level of total WBC count of the patients in all 4 groups. Among normal controls treated with artesunate tablets, there was also a significant fall in the mean reticulocyte count at day 3 but the mean reticulocytes count was also raised back to normal at days 7 and 14. Among normal controls treated with quinine and sulfadoxine-pyrimethamine tablets, there was no significant fall in the mean reticulocyte count. And there was no significant changes in PCV and WBC count in all 3 groups of controls. The fall in reticulocyte counts can be due to part of the disease malaria as well as to the drug including quinine and not singly to artemisinine therapy alone.

Comparison of the effect of combinations of parentral artemisinin derivatives (I/M artemether, I/V artesunate) plus oral mefloquine with intravenous quinine plus oral tetracycline on patients with cerebral malaria: A multicentre trial (Preliminary Report)

In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.

The effect of combination of chloroquine with sulfadoxine pyrimethamine on patients with uncomplicated falciparum malaria

The effect of chloroquine, sulfadoxine- pyrimethamine and chloroquine plus sulfadoxine-pyrimethamine were studied on 97 patients with uncomplicated falciparum malaria. 53. 1 per cent of the patients were resistant to chloroquine at R2 and R3 level. Among patients treated with sulfadoxine- pyrimethamine, 25 per cent were resistant to the same level. But, when chloroquine is combined with sulfadoxine-pyrimethamine only 12.1 per cent of the patients were resistant at R2 level. There were no patients who were resistant at R3 level to the combined drugs. All the patients were free from toxicity that can be related to the two drugs. Apart from simple additive effect, there may also have the potentiating effect of combining two drugs. Hence for a developing country like Myanmar with the problem of multidrug resistance, this method of treatment may be considered for semi-immune patients with uncomplicated falciparum malaria.

The Effect of oral artesunate versus quinine on patients who are resistant to chloroquine and sulfadoxine pyrimethamine

The patients who attended the out patients cllinic of Thayarwaddy Civil Hospital and North Okkalapa General Hospital were treated with chloroquine (600 mg base at days 0 and 1 and 300 mg base at day 2). To those who failed to clear the parasites at 72 hours were treated with 3 tablets of sulfadoxine pyrimethamine (each containing 500 mg sulfadoxine and 25 mg pyrimethamine). To those who failed again to clear the parasites at 72 hours were treated with one of the following drugs at alternate sequence. (1) 50 mg Artesunate tablets were given twice a day for 5 days orally. The initial dose was double. (2) Quinine sulphate tablets 600 mg 3 times per day given orally for 7 days. Total 60 patients were studied.In both groups of patients parasites were cleared at 72 hours and at day 4. The parasite clearance time and fever clearance time of the patients treated with the two different drugs were not statistically different. All patients treated with artesunate can tolerate the drug and were free from side effects that can be related to the drug. Out of 18 patients who were followed till day 28,6 patients recrudesced at days between 21 and 28. Among the patients treated with quinine 50 percent failed to complete the drug course. Out of 10 patients who were followed till day 28, one patient recrudesced at day 21. We conclude that Artesunate or quinine alone are effective but may not be useful for treatment of drug resistant malaria.

Concentration method of detecting Plasmodium falciparum using microcentrifuge and heparinised capillary tubes

Sixty malaria patients were studied. Thick blood films were prepared from the finger tips of the patients as usual to detect malaria parasites in blood. A sample of blood is also collected from the same finger tip with heparinised capillary tubes at the same time. The tubes were centrifuged at 10,000 rpm for 5 minutes. The capillary tube was then broken into 3 pieces. One at upper part of the red cell column just below the white cells and another at the base of the red cell column. Blood collected from these two samples were stained together with samples from finger tips using usual standard procedure for the detection of malaria parasites. Blood collected from the uppermost part of red cell column yield the highest parasite density. The use of capillary tube is not an extraburden to the work load of the malaria unit and special instruments are also not necessary. This method may help in the detection of patients with low level of parasites in peripheral blood.

A study on the prevalence of ischaemic heart disease among individuals admitted to the medical unit of the North Okkalapa General Hospital and the distribution of risk factors

This study was conducted with the purpose to find out the prevalence of IHD among individuals admitted to the Medical Unit of NOGH, the distribution of risk factors and their correlation with IHD. It is a cross-sectional clinical study of one hundred patients with or without symptoms of IDH selected from every 10th admission of each day, aged between 35-75 years of both sexes from the period of 1st July 1991 to 30 June 1992. Among the 100 patients, 15 out of 72 males (68 percent) and 7 out of 28 females (32 percent) had IHD and the highest prevalence was found in 51 years and above age group. Hypertensive patients were found to have IHD (prevalence ratio 7.05), smokers (3.35-17.0), obesity (7.78), diabetes mellitus (3.48), hypercholestrolaemia (5.5), family history of IHD (5.78), patient with sedantary life style (2.23). In conclusion, IHD had 22 percent prevalence rate in NOGH and there was preponderance in males and older age group. Hypertension and smoking were major risk facors and also obesity is found to be a significant contributing factor in this study.

The effect of cardiac risk factors in coronary heart disease (CHD) among diabetic patients

To compare the effect of 4 cardiac risk factors namely, hypertension, smoking, hypercholestrolaemia and obesity on coronary heart disease among diabetic patients, a retrospective study was carried out between August 1991 and September 1992. A total of 60 patients with diabetes mellitus were studied. 40 patients had CHD and 20 did not. The average age of the study group was 54.04 years. It was found that in diabetics who had hypertension, hypercholesterolaemia or smoked, had a two-fold risk of developing CHD compared to those who did not have the above risk factors. There was no difference found between those patients who were obese and those who were not.

The effect of halofantrine versus quinine on patients with uncomplicated falciparum malaria in Myanmar

Sixty patients with uncomplicated falciparum malaria (less than 5 Percent of RBCs parasitised) were studied. Patients were alternatively assinged to treat with Halofantrine or Quinine. Halofantrine was given orally 500 mg six hourly for three doses. Quinine 10 mg/kg was given orally three times a day for 7 days. All the patients were admitted to the hospsital for 7 days and were followed up on days 14, 21 and 28. There were no differences in parasite clearance time and fever clearance time between two groups of patients. Among the apatients treated with Quinine two faile to complete the durg course. In one patient who was treated with Halofantrine, the initial parasite count was 171429 cumm at O hour of admission to hospital. The parasites were cleared at 42 hours and he became unconscious at 48 hours. He was put on standard dose of Artemether plus Mefloquine, but the patient became deeply jaundice and expired at 72 hours of admission to hospital. We concluded that further studies are needed to evaluate the efficacy of Halofantrine on Myanmar patients with complicate fallciparum malaria.

Manifestions of heat stress disorders in Monywa township during the summer months of 1979

The unusually prolonged climatic heat wave of the summer of 1979 has caused an unusually high incidence of heat stress disorders and many were admitted into Monywa Civil Hospital. The clinical manifestations were studied and reported. An outline of managements as practised in Monywa Civil Hospital is also suggested. Epidemiological studies were also carried out and correlated with the weather charts.