The use of parasite lactate dehydrogenase isoenzyme-based visual test for the speciation of Plasmodium Falciparum and Plasmodium vivax infections

Parasite specific lactate dehydrogenase (LDH) isoenzyme coated OptiMAL test strips were used to diagnose Plasmodium falciparum and p. vivax infections in one hundred clinically suspected malaria patients attending the Clinical Research Unit for Malaria, Defence Services General Hospital, Mingaladon during May to September 1999. Traditional microscopic examination was carried out in parallet to observe the sensitivity and specificity of the LDH-based OptiMAL test. the interpretation of the results by LDH-based test strips took only five minutes, whereas microscopic examination took thrity minutes. The sensitivities and specificities of pLDH-based OptiMAL test were 89.47 per cent and 100.0 per cent for P. falciparum; 100.0 per cent and 96.43 per cent for P.vivax respectively. Due to the rapid detection and speciation, prompt treatment was made without any delay.

Comparative study of effectiveness of different dihydro-artemisinin (Cotecxin)tablet regimens in uncomplicated falciparum malaria

Dihydroartemisinin, one of the artemisinin derivatives is getting into ferquent use for its lower price and higher efficacy.In this study 32 and 21patients with uncomplicated falciparum malaria were treated with dihydroartemisinin tablet produced as Cotecxin, 480 mg over 3 days and 480 mg over 7 days respectively. The initial cure rates in both treatment groups were 100

but 34.37

recurred in 3 day treatment group and 19.05

in 7 day treatment. The resistance was only at R1 level and the recrudescence rates in both groups were not significantky different (P=0.37). The paarasite clearance times PCTs were 29.1-+1 hours in 3 day treatment and 26.62-+ 12.77 hours in 7 day treatment. All patients in both groups were free of side effects. The results support the previous findings that shorter course of artemisinin derivatives brung higher recrudescence.

Efficacy of two different short coure regimens of artemether plus mefloquine in acute uncomplicated falciparum malaria

One of the factors affecting the compliance in chemotherapy i duration of therapy. It is sseen in treatment of malaria with quinine in which its long course and side effects limit the patient's compliance. In this study two different short courses of artemether mefloquine were deployed. 27 patients in Group 1 received oral artemether 320 mg stat dose followed by mefloquine 750 mg after 24hours. In Group 2,28 patietns received same dose of Artemether followed by mefloquine 750 mg and 500 mg after 24 and 30 hours. Short parasite clearance times were observed a 28.74 + or - 15.16 hours in Group land 35.82 + or - 23.62 hours in Group 2. The cure rates were 74.07 per cent in firt group and 92.86 per cent in the latter. (p=0.06.Firsher xact test) The short course brought no side effects.

Efficacy of two different short course regimens of artemether plus mefloquine in acute uncomplicated falciparum malaria

One of the factors affecting the compliance in chemotherapy is duration of therapy. It is seen in treatment of malaria with quinine in which its long course and side effects limit the patient's compliance. In this study two different short courses of artemether mefloquine were deployed. 27 patients in Group 1 received oral artemether 320 mg stat dose followed by mefloquine 750 mg after 24 hours. In Group 2, 28 patients received same dose of Artemether followed bymefloquine 750 mg and 500 mg after 24 and 30 hours. Short parasite clearance times were observed as 28.74 + or - 15.16 hours in Group 1 and 35.82 + or - 23.62 hours in Group 2. The cure rates were 74.07

in first group and 92.86

in the latter. (P=0.06. Firsher exact test) The short course brought no side effects.

Comparative study of effectiveness of different dihydroartemisinin (cotecxin) tablet regimens in uncomplicated falciparum malaria

Dihydroartemisinin, one of the artemisinin derivativesis getting into frequent use for its lower price and higher efficacy. In this study 32 and 21 patients eith uncomplicated falciparum malaria were treated with dihydroartemisinin tablet produced as Cotecxin, 480 mg over 3 days and 480 mg over 7 days respectively. The initial cure rates in both treatment groups were 100 per cent but 34.37 per cent recurred in 3 day treatment group and 19.05 per cent in 7 day treatment. The resistance was only at R1 level and the recrudescence rates in both groups were not significantly different (P=0.37). The parasite clearance times PCTs ere 29.1 + or - 1hours in 3 day treatment and 26.62 + or - 12.77 hours in 7 day treatment. All patients in both groups ere free of side effects. The results support the previous findings that shorter course of artemisinin derivatives bring higher recrudescence.

Comparing the efficacy of mefloquine-artesunate combination with that of mefloquine and artesunate as single agents in uncomplicated falciparum malaria

To find out whether the combination regimen of mefloquine and artesunate tablets improves the cure rate in uncomplicated falciparum malaria compared to the use of mefloquine and artesunate as single agents, a prospective, randomised, uniblind controlled study was done between May and November 1991, on one hundred and eighty cases of acute uncomplicated falciparum malaria. The patients were randomised to the following three frug regimens: - (1) Mefloquine - 1000 mg stat, (2) Tab Artesunate 600 mg over 48 hours, (3) Mefloquine 1000 mg plus tab Artesunate 600 mg over 48 hours. The regimen of mefloquine as a single agent gave a cure rate of 83.3 percent (with R1 = 15 percent and R2 = 1.7 percent), PCT = 52.15 + 55.2 hours and FCT = 23.98 + 59.87 hours. Tab artesunate gave a cure rate of 75 percent (with R1 = 25 percent), PCT = 33.16 + 5.15 and FCT = 23.4 + 22.7 hours. The combination regimen gave a cure rate of 98.27 percent with only one patient recrudescing at R1 level, PCT = 35.11 + 29.16 and FCT = 8.15 + 10.34 hours. The side effects were not much increased by using the combination. No cardiovascular effects were noted. The combination is superior to that of the single agents.

Different dosage regimens of artemisinin and its derivatives as single agents and in combination with mefloquine in uncomplicated falciparum malaria

To compare the efficacy of Artemisinin tablet, Artesunate tablet and Artemether capsule, randomized uniblind clinical trials using 9 different dosage regimens of the drugs as single agents and also in combination with mefloquine was carried out between January 1991 and December 1993. A total of 480 patients suffering from acute uncomplicated falciparum malaria with asexual parasitaemia ranging from 500-100,000 per microlitre were tried on the various drug regimens. The response rates (according to the WHO in vivo extended 28 days trial) showed that all 3 forms of the drug used as single agents had rapid initial parasite clearance but had high recrudescence rates. Combining either artesunate or Artemether with mefloquine gave cure rates above 95 percent. Artemisinin in combination with Mefloquine had better cure rates than Artemisinin alone too. Hence artemisinin or its derivatives need to be combined with a synergistic drug like mefloquine to achieve satisfactory cure rates.

Trial of beclomethasone dipropionate aerosol in Burmese asthmatic

Twelve asthmatic patients were selected for this trial. Clinical al1d spirometric lung function assessments were carried out weekly before, during and after (4) weeks of Beclomethasone therapy. Symptom diary score charts were provided to the patients and were ins ructed to note their symptoms and bronchodilator usage daily. In 55.5 percent of patients there were statistically significant Improvements in pulmonary function para-meters which were accompanied by clinical improvement in 66 percent of patients during Beclomethasone therapy. There were reduction ill bronchodilator requirements together with reduction in diary scores in 66 percent of patients. None required systemic steroids during Beclomethasone therapy. 87 percent of patients claimed benefit except one in whom there was no remarkable improvement in clinical as well as in spirometric lung function assessments No side effects attributable to Beclomethasone dipropionate therapy were noted. Beclomethasone dipropionate aerosol is valuable in the treatment of asthma especially in those becoming worse and who are no longer responding adequately to bronchodilators, because of its topical potency and lack of systemic side effects and so enabling us to avoid the use of. systemic steroid therapy.

Scrub typhus in Burma

Forty-one cases of scrub typhus in the Defence Services General Hospital, Mingaladon and the No. I, Base Military Hospital, Maymyo were studied between November 1965 and December 1966. The frequency of primary eschar was found to vary with different series. Analysis of the clinical features not attributable to CNS revealed that 73.4 per cent had eschars, 90 per cent had lymphaodenpathy, 41.5 per cent had splenomegaly and 65.9 per cent had hepatomegaly. All the 41 cases showed a prompt response to chloramphenicol and tetracycline.