Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: An in silico pharmacological model

Objective: To explore the efficacy of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine and pyrimethamine (SP) against sensitive parasites. Methods: A pharmacological model was used to investigate the effectiveness of the previous recommended at least two-dose regimen, currently recommended three-dose regimen and 4, 6, 8-weekly regimens with specific focus on the impact of various non-adherence patterns in multiple transmission settings. Results: The effectiveness of the recommended three-dose regimen is high in all the transmission intensities, i.e. >99%, 98% and 92% in low, moderate and high transmission intensities respectively. The simulated 4 and 6 weekly IPTp-SP regimens were able to prevent new infections with sensitive parasites in almost all women (>99%) regardless of transmission intensity. However, 8 weekly interval dose schedules were found to have 71% and 86% protective efficacies in high and moderate transmission areas, respectively. It highlights that patients are particularly vulnerable to acquiring new infections if IPTp-SP doses are missed. Conclusions: The pharmacological model predicts that full adherence to the currently recommended three-dose regimen should provide almost complete protection from malaria infection in moderate and high transmission regions. However, it also highlights that patients are particularly vulnerable to acquiring new infections if IPTp doses are spaced too widely or if doses are missed. Adherence to the recommended IPTp-SP schedules is recommended.

Effectiveness of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: An in silico pharmacological model

Objective: To explore the efficacy of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine and pyrimethamine (SP) against sensitive parasites. Methods: A pharmacological model was used to investigate the effectiveness of the previous recommended at least two-dose regimen, currently recommended three-dose regimen and 4, 6, 8-weekly regimens with specific focus on the impact of various non-adherence patterns in multiple transmission settings. Results: The effectiveness of the recommended three-dose regimen is high in all the transmission intensities, i.e. >99%, 98% and 92% in low, moderate and high transmission intensities respectively. The simulated 4 and 6 weekly IPTp-SP regimens were able to prevent new infections with sensitive parasites in almost all women (>99%) regardless of transmission intensity. However, 8 weekly interval dose schedules were found to have 71% and 86% protective efficacies in high and moderate transmission areas, respectively. It highlights that patients are particularly vulnerable to acquiring new infections if IPTp-SP doses are missed. Conclusions: The pharmacological model predicts that full adherence to the currently recommended three-dose regimen should provide almost complete protection from malaria infection in moderate and high transmission regions. However, it also highlights that patients are particularly vulnerable to acquiring new infections if IPTp doses are spaced too widely or if doses are missed. Adherence to the recommended IPTp-SP schedules is recommended.

A Study of Lipid Parameters in Malarial Patients Attending a Tertiary Health Care Centre in Mangaluru

Aims:The study aims to estimate the lipid parameters among Plasmodium vivaxand mixed malaria (P.falciparum and P. vivax) infected patients. Study Design:This was a prospective observational and comparative study.Place and Duration of Study:The present study was undertaken in the Departments of Medicine and Biochemistry at A.J. Institute of Medical Sciences and Research (AJIMS), Mangaluru, Karnatakabetween Dec 2017 and May 2018.Methods:It was a prospective observational comparative study. A total of 100 patients (50 P. vivaxand 50 mixed malaria cases) were consecutively taken in the study. The lipid profiles of the cases were compared with that of100 healthy volunteers (control group). Data was collected and analysed. Results:Serum total cholesterol, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) levels were significantly low(p<0.001) in cases and serum Triglycerides (TG) andVery Low-Density Lipoprotein levels (VLDL) were higher in cases (p<0.001) than in control. There were no significant changes in mean serum lipids profiles between P. vivaxand Mixed Malaria groups. Conclusion:The derangement in lipid profiles in falciparum malaria was characteristic and specific for the disease. Characteristic changes were lower HDL, LDL and total cholesterol levels with higher TG and VLDL levels in comparison to control groups. These findings may be of diagnostic and prognostic value.

Lipid profiles among Plasmodium falciparum infected, non malarial febrile patients and volunteers

Background: Acute falciparum Malaria infected patients show wide ranges of metabolic derangement including changes in serum lipid profiles. The exact mechanisms of this derangement in serum lipid profiles are still poorly understood. Objective was to study the lipid profiles among acute plasmodium falciparum infected patients.Methods: It was a Prospective observational comparative study. A total of 100 patients were consecutively taken in the study. Fifty Non- malaria febrile cases and 50 healthy volunteers were taken as control group. Baseline lipid profiles were estimated in all cases at the time of admission and at the end of one week. Data were collected and analyzed.Results: There were 100 diagnosed cases of falciparum malaria and 50 non malarial febrile and 50 healthy volunteers taken as control group. Complications was present in 50 and 50 were uncomplicated. Serum total cholesterol, HDL and LDL levels were significantly low in falciparum malaria patients, and serum TG and VLDL levels were higher than control. There were no significant changes in mean serum lipids profiles in survived and deaths cases.Conclusions: The derangement in lipid profiles in falciparum malaria was characteristic and specific for the disease. Characteristic changes were lower HDL, LDL and total cholesterol levels and higher TG and VLDL levels in comparison to control groups. Changes are more pronounced in complicated falciparum Malaria and persisting till the end of the week. These findings may be of diagnostic and prognostic value.

Knowledge, Attitude and Practice Regarding Awareness of Malaria Infection among the Adult Population of Rural and Urban Areas.

Background: Malaria remains one of the most serious global health problems and is not only a major cause of suffering and death, but also the cause of many socioeconomic problems. The present study was done to study knowledge, attitude and practice of general public towards malaria infection. Methods: A total of 576 individuals had taken participation in this particular study. The study was done at SMBT medical college, Ghoti, Nashik. Out of these, 258 were from rural area and 318 from urban area. A total of 20 questionnaires were formulated for this study. Responses of all the participants were collected, tabulated and analyzed using IBM SPSS statistics version 20 using student’s t test. Results: On comparison of the knowledge, attitude and practice scores of the urban and rural population, it was found that the scores of urban population was higher than that of the rural population and the difference was found to be statistically significant. (Student’s t test, p<0.001). Conclusion: The findings of this study indicate that rural communities have less knowledge on malaria transmission, symptoms, and preventive measures. There is also a need for district health departments to improve availability of information about malaria through rural dispensaries and primary health centers.

Malaria Parasitaemia Association with ABO Blood Types among Students of a Private University in Western Delta, Nigeria.

Aim: The focus of this work was to investigate any relationship between ABO blood types and malaria parasitaemia among students of a private University based in Western Delta, Nigeria. Study Design: Whole blood samples were obtained from a randomly sampled number of students and dispensed into ethylene-diamine-tetra-acetic acid (EDTA) containers which were appropriately labelled. Collected blood samples were tested for ABO blood types and malaria parasites by standard methods. Data obtained were statistically analyzed. Place and Duration of Study: The study was carried out in the Microbiology and Biotechnology laboratory of Western Delta University, Oghara, Nigeria between May, 2013 to October, 2013. Methods: Venous blood of 2ml volume was obtained by venepuncture from 360 students made up of 150 (41.7%) males and 210 (58.3%) females of 28years average and who were both symptomatic and asymptomatic for malaria due to Plasmodium falciparum. Malaria parasite screening was done by both P. falciparum antigen rapid (Micropoint, USA) test and Giemsa staining. ABO blood typing was done using Monoclonal Antisera A, B and D. Results obtained were analyzed for any association by chi-square statistical method. Results: One hundred and forty one (41.6%) male and 198 (58.4%) female samples were rhesus positive. Nine (42.9%) and 12 (57.1%) males and females respectively were rhesus negative. ABO blood group frequency occurrence was 55.8 %( O), 22.5 %( A), 18.3 %( B) and 3.4 %(AB). A total of 255 (70.8%) students were infected with P. falciparum parasites of which 55.3% and 44.7% were females and males respectively. ABO blood group malaria parasitaemia frequencies were 76.4 %(O), 56.3% (B), 52.4% (A) and O.O% (AB) for non-severe malaria and 70.5% (O), 58.3% (A), 55.6% (AB) and 50.0% (B) for severe plasmodiasis. Whereas there was significant association between malaria infection and gender (P<0.05), there was no significant association between severe and non-severe malaria parasitaemia in relation to ABO blood types (P>0.05). Conclusion: The presence of rhesus negative factor up to 5.8% suggested a gradual and steady rise in the frequency occurrence of the factor when compared to reports of earlier studies. ABO blood groups O and AB recorded the highest and lowest frequencies respectively. The highest parasitaemia rate was observed among group O individuals and also among female O individuals compared to male O individuals. More female than male students suffered from both severe and non-severe forms of plasmodiasis. There was no significant association of all ABO blood types with severe and non-severe malaria parasitaemia clinically implying that all ABO blood types are equally at risk and therefore, available malaria prophylactic and therapeutic strategies should be directed at subjects of all groups.

Determinación de la mutación K76T de la proteína transportadora resistente a Cloroquina de Plasmodium falciparum (PFCRT) en individuos con malaria en una zona de transmisión moderada del Caribe colombiano / Determination of K76T mutation in the Plasmodium falciparum Chloroquine resistance transporter (PFCRT) in people with malaria in a zone of moderate transmission of the Colombian Caribbean

Introducción: La resistencia de Plasmodium falciparum a los antimalaricos, está relacionada con mutaciones puntuales en proteínas esenciales en la biología del parásito. La mutación K76T en la proteína transportadora resistente a Cloroquina (CRT) es un marcador molecular de resistencia a este fármaco. En Colombia se ha reportado una frecuencia del 100% a esta mutación. Objetivo: Determinar la frecuencia de la mutación K76T de CRT en Plasmodium falciparum, infectando sangre de individuos con malaria adquirida en una zona del Caribe Colombiano con transmisión moderada. Materiales y métodos: El ADN del parásito se extrajo de láminas diagnósticas usando Chelex-100. Un fragmento de 148 pb de Pfcrt se amplificó por PCR, la mutación K76T fue determinada por análisis de Polimorfismos en Longitud de Fragmentos de Restricción (RFLP) usando la endonucleasa Apo I, los productos fueron separados por electroforesis en geles de poliacrilamida (PAGE). Resultados: Se estudiaron 66 muestras de individuos con malaria adquirida en seis municipios del Magdalena. Se logró amplificación de Pfcrt en 56 y la mutación T76 fue detectada en 55 (98,2%). La presencia de una muestra con el alelo K76 silvestre indicaría la existencia de reversión de la mutación K76T en Colombia, este fenómeno se ha observado en algunos países del continente africano, donde se reportó recuperación de la sensibilidad a Cloroquina. Conclusión: Este estudio es un primer acercamiento hacia el conocimiento de la resistencia a los antimaláricos en zonas de transmisión moderada en Colombia.

Introduction: The antimalarial drugs resistance from Plasmodium falciparum is related to point mutations in the essential proteins to the parasite biology. The K76T mutation in the Plasmodium falciparum Chloroquine resistance transporter (PFCRT) is a molecular marker resistance to Chloroquine. In Colombia the frequency of this mutation is 100%. Objective: To determine the frequency of K76T mutation in the Plasmodium falciparum CRT, infecting blood from people with malaria in the Colombia Caribbean zone with moderate transmission. Materials and methods: The DNA of the parasite was extracted from diagnostic slide using Chelex-100. A fragment of 148 pb of Pfcrt was amplified by PCR, the K76T mutation was evaluated by Restriction Fragment Length Polymorphism (RFLP) using endonuclease Apo I, the products were separated by polyacrylamide gel electrophoresis (PAGE). Results: Sixty six samples from people with malaria of six municipalities of Magdalena were studied. Fifty six DNA samples amplified of Pfcrt gene, T76 mutation was detected in 55 (98.2%). Occurrence of one sample carried the wild allele K76 would indicated the reversion of K76T mutation in Colombia, this phenomenon has been observed in some countries of the African continent, where recovery of sensitivity to Chloroquine was reported. Conclusions: This study is the first approach towards the knowledge of the antimalarials resistance in zones with moderate transmission in Colombia.

Investigation of malaria infection in Krongpac district, Dak Lak province, 2003

Malaria infection rate and epidemiological factors were investigated in 2003 in Krongpac district. A cross-sectional study (3000 samples) was carried out by Giemsa staining microscopy. A total malaria infection rate of 7.8%, out of this 9.6% and 6.4% were found in male and female samples, respectively. The infection rate also varied from the permanently settled ethnic minority groups of Ede, Van Kieu, Se Dang (9.6%) to the newly settled Tay group (7.2%). The infection rate was different between age groups above 15 years old (11.1 %) and under 15 years old (3.3%). P. falciparum was found much higher than P. vivax (76.5% vs 23.5%, respectively). All the comparisons were statistic significant with P < 0.01. Other species or mixed infection were not found. Mixed infection of single trophozoite was 76.5%, The mixed trophozoite and gametocyte was 23.5%. Schizontes were not found.