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1.
Indian J Public Health ; 49(4): 241-2, 2005.
Article in English | MEDLINE | ID: mdl-16479908

ABSTRACT

A hospital based study was conducted in the anti-rabies clinic of a medical college of Orissa during April 1988 to May 2002. Of 24 clinically diagnosed and reported rabies cases during the four years study period, 62.5% were children below 15 years of age, 67% were males, 87.5% were victims of stray dogs, 79% had not taken any anti-rabies treatment though all had undergone treatment by traditional systems of medicine.


Subject(s)
Ambulatory Care Facilities/statistics & numerical data , Rabies/epidemiology , Rabies/therapy , Adolescent , Animals , Bites and Stings/complications , Bites and Stings/epidemiology , Child , Dogs , Drug Utilization , Female , Health Education , Hospitals, Teaching , Humans , India/epidemiology , Male , Medicine, Traditional , Rabies/etiology , Rabies Vaccines/therapeutic use , Socioeconomic Factors , Zoonoses/epidemiology
2.
J Assoc Physicians India ; 49: 1155-60, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11996434

ABSTRACT

OBJECTIVE: To evaluate efficacy of alpha;beta arteether in patients of P. falciparum malaria presenting with complications was undertaken in a multicentric clinical trial. METHOD: Each patient who consented to undergo clinical trial with parenteral Arteether was treated with a fixed dose schedule of Arteether given intramuscularly in a dose of 150 mg once a day on three consecutive days. Every patient was followed upto 28 days with clinical, haematological and parasitological monitoring every day upto one week and thereafter at 14, 21 and 28 days. The response was assessed in terms of fever clearance time, parasite clearance time, cure rate and parasite reappearance rate. RESULTS: A total of 211 patients of P. falciparum malaria were included in the study from four centres (Bhilai, Guwahati, Jamshedpur and Rourkela). Results of this study showed that fever clearance time ranged between 24-168 hours, parasite clearance time ranged between 24-120 hours and overall mortality ranged between 4-8.5%. Out of 211, only 14 patients expired during the study, of these, 10 patients expired within first two days i.e. before completing the three day schedule of arteether therapy. Tolerability to arteether injection was good in all these patients and no untoward effects were experienced or reported during the study. Overall cure rate observed in these studies was 93%. CONCLUSION: This study shows a rapid parasite and fever clearance in patients of complicated P. falciparum malaria.


Subject(s)
Antimalarials/adverse effects , Antimalarials/therapeutic use , Artemisinins , Malaria, Falciparum/drug therapy , Plasmodium falciparum/drug effects , Sesquiterpenes/adverse effects , Sesquiterpenes/therapeutic use , Adolescent , Adult , Animals , Female , Humans , Male , Middle Aged , Prospective Studies
4.
Trans R Soc Trop Med Hyg ; 89(3): 299-301, 1995.
Article in English | MEDLINE | ID: mdl-7660441

ABSTRACT

With the emergence of widespread chloroquine resistance and a world-wide scarcity of quinine, a search for newer antimalarial drugs has become imperative. Different derivatives of qinghaosu have been successfully tried. alpha,beta-Arteether, an ethyl derivative of qinghaosu, was administered to 51 patients with Plasmodium falciparum malaria, in a dose of 150 mg intramuscularly once a day on 3 consecutive days. Complete parasite clearance from the peripheral blood was observed in 80% of the patients at 48 h and in 98% at 72 h. The median parasite clearance time was 2 d (range 1-4 d). 65% of the patients became afebrile within 48 h and 81% by 72 h. The mean fever clearance time was 52.04 h (standard deviation 27.09). No side effect was seen. Patients were followed-up for 4 weeks; 7 were readmitted with P. falciparum infection but it could not be ascertained definitely whether these cases were reinfections or recrudescences. alpha-beta Arteether was a safe, effective and convenient drug for treating P. falciparum malaria. This is the first clinical study with arteether in falciparum malaria.


Subject(s)
Antimalarials/therapeutic use , Artemisinins , Malaria, Falciparum/drug therapy , Sesquiterpenes/therapeutic use , Adolescent , Adult , Aged , Animals , Female , Humans , India , Male , Middle Aged , Plasmodium falciparum
5.
Am J Trop Med Hyg ; 51(5): 642-7, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7985757

ABSTRACT

To document histopathologic evidence on the pathogenic mechanism of human cerebral malaria, we used light microscopy to study brain specimens from 23 patients who died of central nervous system involvement with Plasmodium falciparum. Sequestration of parasitized red blood cells (PRBCs) leading to cerebral capillary clogging was seen. In a few specimens, vascular clogging by PRBCs was associated with margination of mononuclear cells. In others, capillaries were virtually empty and lymphocytes and monocytes were seen in apposition (marginated) to the capillary endothelial surface. The endothelial cells appeared plump, hypertrophied, and prominent. The capillary wall appeared thickened by fibrinous material. Massive intercellular brain edema along with extravasated red blood cells, mononuclear cells, and plasmatic fluid was also noticed. In addition to hypoxia induced by PRBC-mediated vascular clogging, marginating mononuclear cells may contribute to the pathogenesis of cerebral malaria. The precise role played by this phenomenon needs further evaluation.


Subject(s)
Blood Coagulation , Brain/pathology , Capillary Permeability , Leukocytes, Mononuclear/metabolism , Malaria, Cerebral/etiology , Adolescent , Adult , Brain/blood supply , Brain Edema/etiology , Brain Edema/pathology , Cell Adhesion , Child , Endothelium, Vascular/metabolism , Erythrocytes/parasitology , Female , Humans , Malaria, Cerebral/blood , Malaria, Cerebral/pathology , Male , Middle Aged
6.
Am J Trop Med Hyg ; 49(6): 720-5, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8279640

ABSTRACT

To investigate the influence of Plasmodium falciparum malaria on plasma antioxidants and lipid peroxidation, plasma ascorbate, urate, total protein and albumin, ceruloplasmin and malondialdehyde (MDA) were determined in two groups of 42 patients each, one with mild and the other with severe falciparum malaria, and in an equal number of age- and sex-matched control subjects. Plasma MDA was found to be significantly higher in malaria patients, and the increase was proportional to the severity of the disease. Of the antioxidants, ascorbate and albumin decreased with severity of disease while urate and ceruloplasmin increased. Only ascorbate correlated inversely with MDA both in mild (r = -0.341, P < 0.05) and severe malaria (r = 0.545, P < 0.01). While plasma albumin correlated inversely (r = -0.442, P < 0.01), urate and ceruloplasmin correlated directly (r = 0.419, P < 0.01 and r = 0.349, P < 0.05, respectively) only in patients with severe malaria. These antioxidants also correlated well with markers of disease severity, indicating the influence of disease severity in regulating their levels in plasma. The presence of significant quantities of ascorbate and albumin, along with increases in some of the other antioxidants and MDA, indicates ineffectiveness of the antioxidant defense system in controlling plasma lipid peroxide content. Increased amounts of thiobarbituric acid-reactive material could have been the result of spillover from increased tissue peroxidation or the presence of pro-oxidants in malarial plasma.


Subject(s)
Lipid Peroxidation , Malaria, Falciparum/blood , Analysis of Variance , Ascorbic Acid/blood , Bilirubin/blood , Blood Proteins/analysis , Ceruloplasmin/analysis , Cholesterol/blood , Hemoglobins/analysis , Humans , Malaria, Falciparum/metabolism , Malondialdehyde/blood , Serum Albumin/analysis , Triglycerides/blood , Uric Acid/blood
8.
Ann Trop Med Parasitol ; 86(6): 601-6, 1992 Dec.
Article in English | MEDLINE | ID: mdl-1304701

ABSTRACT

Plasma levels of HDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0.001). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0.001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0.001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0.001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r = 0.715 and r = 0.895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results if lipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.


Subject(s)
Lipids/blood , Malaria, Falciparum/blood , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Follow-Up Studies , Humans , Serum Albumin/analysis , Triglycerides/blood
9.
Indian J Malariol ; 29(3): 167-71, 1992 Sep.
Article in English | MEDLINE | ID: mdl-1286732

ABSTRACT

Liver function tests were performed in 165 hospitalized patients suffering from P. falciparum malaria with complications. Serum bilirubin was found increased in 33 patients, and 22 of them had unconjugated hyperbilirubinaemia. Serum alanine aminotransferase was increased in 5 patients, but only to mild to moderate levels. Serum alkaline phosphatase was increased in 11 patients, gamma-glutamyl transpeptidase in 3 patients. Serum total protein and albumin were significantly decreased but these were considered more as indicator of acute phase response. Liver cell necrosis was observed in one patient, and oedema and mononuclear cell infiltration in two patients. Though hepatomegaly and mild elevation of enzymes can be observed in a significant proportion of patients, involvement of liver leading to acute hepatitis or liver cell necrosis is a relatively uncommon complication in P. falciparum malaria.


Subject(s)
Liver Diseases/etiology , Malaria, Falciparum/complications , Adolescent , Adult , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Aspartate Aminotransferases/blood , Female , Hospitalization , Humans , Hyperbilirubinemia/etiology , Liver Function Tests , Male , Middle Aged
10.
Indian J Med Res ; 95: 79-83, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1601475

ABSTRACT

To determine the incidence of hypoglycaemia in children suffering from severe falciparum malaria, 23 patients from Rourkela (Orissa), were investigated. Plasma glucose and immunoreactive insulin were estimated before and at hourly intervals during quinine infusion. No child had hypoglycaemia at the time of admission. Correlation between parasite count and prequinine plasma glucose was not significant. In the period of quinine infusion, 20 patients showed fall in plasma glucose during all the three hours (P less than 0.05, P less than 0.01, P less than 0.01 at the end of 1st, 2nd, and 3rd h respectively) but the decrease to hypoglycaemic level (plasma glucose less than or equal to 40 mg/dl) was observed in only one child. Concomitant increase in plasma insulin was noticed in 18 of these patients. Decrease in plasma glucose and increase in plasma insulin was found to correlate well (r-0.78, P less than 0.001). Hypoglycaemia was found to be an infrequent complication of severe falciparum malaria in children from the area studied. Though decrease in plasma glucose was observed after quinine infusion, it was less severe and did not reach the hypoglycaemic level.


Subject(s)
Hypoglycemia/etiology , Malaria, Cerebral/complications , Malaria, Falciparum/complications , Blood Glucose/analysis , Child , Child, Preschool , Female , Humans , Hypoglycemia/epidemiology , Incidence , India/epidemiology , Insulin/blood , Male
11.
Trans R Soc Trop Med Hyg ; 85(6): 733-4, 1991.
Article in English | MEDLINE | ID: mdl-1801339

ABSTRACT

Membrane lipid peroxidation by reactive oxygen species leading to increased capillary permeability is considered an important event in the pathogenesis of severe malaria. A significant decrease in plasma albumin and increases in cerebrospinal fluid (CSF) protein and malondialdehyde (MDA) were observed in 73 patients with cerebral malaria, compared to values in 23 control patients. The greatest effect was noticed in the most severely ill patients. The ratio of CSF protein to plasma albumin was increased in the patients compared to the controls, and in fatal cases of cerebral malaria compared to non-fatal cases. Brain necropsies showed oedema, fibrin deposits and mononuclear cell infiltration. It is proposed that cerebral oedema due to enhanced permeability of vascular endothelium induced by increased lipid peroxidation plays a crucial role in the causation of cerebral malaria.


Subject(s)
Cerebrospinal Fluid Proteins/metabolism , Lipid Peroxidation/physiology , Malaria, Cerebral/cerebrospinal fluid , Capillary Permeability/physiology , Endothelium, Vascular/metabolism , Humans , Malondialdehyde/cerebrospinal fluid , Serum Albumin/metabolism
12.
Am J Clin Nutr ; 51(5): 859-63, 1990 May.
Article in English | MEDLINE | ID: mdl-2185624

ABSTRACT

Plasma lipid peroxides were measured as malonyldialdehyde (MDA) by the thiobarbituric acid (TBA) method in 75 children suffering from Plasmodium falciparum malaria. Their riboflavin status was assessed by measuring erythrocyte glutathione reductase activation coefficients (EGRACs), and values greater than 1.40 were regarded as indicating biochemical deficiency. Plasma MDA was higher (p less than 0.001) in patients than in control subjects; the concentrations were 3.65 +/- 0.70 and 1.77 +/- 0.45 mumol/L (means +/- SD), respectively. The riboflavin-deficient group had higher plasma MDA values (3.98 +/- 0.70 mumol/L) than did the nondeficient group (3.30 +/- 0.68 mumol/L, p less than 0.001). Plasma MDA concentrations correlated with EGRACs (r = 0.46, p less than 0.01) in the patients. It is proposed that riboflavin deficiency restricts regeneration of reduced glutathione making the parasitized erythrocytes more vulnerable to destructive lipid peroxidation and increasing plasma lipid hydroperoxides.


Subject(s)
Lipid Peroxidation , Malaria/complications , Malonates/blood , Malondialdehyde/blood , Riboflavin Deficiency/complications , Animals , Child , Child, Preschool , Humans , Infant , Plasmodium falciparum , Riboflavin Deficiency/blood
13.
Int J Lepr Other Mycobact Dis ; 57(2): 499-505, 1989 Jun.
Article in English | MEDLINE | ID: mdl-2746077

ABSTRACT

Liver function tests and liver biopsies were studied in 23 leprosy patients in reaction and 10 without reaction. The liver biopsies in leprosy patients with reaction showed exudative lesions, epithelioid and tuberculoid granulomas, and foam-cell granulomas. Portal vasculitis was encountered in a few cases. Neutrophilic infiltration into the foam-cell granulomas was seen in a few cases of lepromatous (LL) leprosy with reaction. In six cases of borderline (BL, BB and BT) leprosy with reaction, a spectrum of lesions bearing footprints of exudative lesions were seen evolving into epithelioid-cell granulomas. Foam-cell granulomas and tuberculoid and epithelioid granulomas along with exudative lesions were encountered in two cases on individual biopsy strips. An altered albumin-to-globulin ratio was the chief functional derangement observed in these cases. The spectrum of changes observed in borderline leprosy with reaction could be discrete steps in the evolution of upgrading reaction.


Subject(s)
Leprosy, Borderline/pathology , Leprosy, Lepromatous/pathology , Leprosy, Tuberculoid/pathology , Liver/pathology , Adolescent , Adult , Aged , Child , Female , Granuloma/etiology , Granuloma/pathology , Humans , Leprosy, Borderline/complications , Leprosy, Lepromatous/complications , Leprosy, Tuberculoid/complications , Liver Diseases/etiology , Liver Diseases/pathology , Male , Middle Aged
14.
Eur J Clin Nutr ; 42(4): 277-83, 1988 Apr.
Article in English | MEDLINE | ID: mdl-3293996

ABSTRACT

The riboflavin status of 64 children suffering from malarial infection was assessed by measuring the activation coefficient of erythrocyte glutathione reductase. Thirty-five children were found to be deficient in riboflavin whereas in 29 children riboflavin status was within the normal range. The median parasite count and its range on admission in the deficient group (2.7 per cent, range 0.3-13.6) was lower than that in the non-deficient group (5.3 per cent, range 0.6-30.2). The correlation between activity coefficient and parasite count was significant (R = -0.49). The recovery process was slower in the deficient group even though they had a relatively lower parasite count. It is inferred that riboflavin deficiency leads to inhibition of growth and multiplication of plasmodia. Its beneficial effects in malaria infection needs further evaluation.


Subject(s)
Malaria/metabolism , Riboflavin Deficiency/metabolism , Animals , Child , Child, Preschool , Female , Glutathione Reductase/blood , Humans , India , Malaria/enzymology , Male , Parasite Egg Count , Plasmodium falciparum
15.
Trans R Soc Trop Med Hyg ; 82(2): 197-201, 1988.
Article in English | MEDLINE | ID: mdl-3055451

ABSTRACT

The incidence of hypoglycaemia and the role of quinine in its causation was assessed in 46 patients with severe Plasmodium falciparum malaria. Plasma glucose and immunoreactive insulin were estimated before, during and after quinine therapy. In 5 patients the plasma glucose was in the hypoglycaemic range, the lowest value being 0.67 mmol/litre (12 mg/dl) in a pregnant patient. Most of the remaining patients showed a significant fall in plasma glucose (P less than 0.05), but not to the hypoglycaemic range, and an increase in plasma insulin after quinine (P less than 0.01). A good correlation was found between these changes (r = 0.79, P less than 0.01). Patients with severe P. falciparum malaria, particularly those on quinine therapy, should be watched carefully for developing hypoglycaemia.


Subject(s)
Hypoglycemia/complications , Malaria/complications , Adolescent , Adult , Animals , Blood Glucose/analysis , Female , Humans , Hypoglycemia/etiology , Insulin/blood , Malaria/blood , Male , Middle Aged , Plasmodium falciparum , Quinine/adverse effects
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