Absence of malaria mortality in villagers with chloroquine-resistant Plasmodium falciparum treated with chloroquine

We carried out a series of malaria studies in Robek , Flores, Indonesia, a coastal village of 900 farmers and fishermen where malaria is hyperendemic by parasite rate and holoendemic by spleen rate. The studies showed that: (i) 28 of 31 isolates (90%) of Plasmodium falciparum were resistant to chloroquine in vitro, (ii) 3 of 12 isolates (25%) were resistant at the R-11 level in vivo, (iii) 376 P. falciparum infections occurred in 301 individuals during one year, (iv) no villagers who were treated with chloroquine for P. falciparum infections during the year died, and (v) increasing the dosage of chloroquine base from 15 to 25 to 37.5 mg/kg led to improved clearing of parasitaemia. We conclude that chloroquine can still be used as the primary antimalarial in Robek , but the dosage may have to be increased to clear parasitaemia.     

Suppression of mitogenic lectin-induced blast transformation of human peripheral blood mononuclear cells by pyrimethamine

The anti-malarial drug pyrimethamine suppresses in vitro mitogenic lectin-induced blast transformation by human peripheral blood mononuclear cells (MNC) when the drug is added to cells (1 X 10(-5) M/culture). Sulphadoxine, a second widely used anti-malarial drug has no suppressive effect on the MNC. MNC responsiveness in the mixed leucocyte reaction and cellular viability are not altered by either pyrimethamine or sulphadoxine. In addition, no significant suppression is found when serum obtained from individuals on pyrimethamine-sulphadoxine chemoprophylaxis is added to MNC in the assays. The data, however, do not totally rule out any clinically significant suppressive effect by the anti-malarial drugs on human cellular immune responses.     

Standardization of the indirect fluorescent antibody test for malaria.

Methods are described whereby results of malarial immunofluorescence tests can be evaluated objectively. The IFA test was quantitated by standardizing the physical system against a fluorescent standard and preparation of biological standards of malarial antisera and fluorescein labelled conjugates. Using these known standards the reactivity of antigens was characterized. It was found that antigen preparations are best when they include mature schizonts, and keep best when they are stored in a dry condition at or below -20 degree C. However, even under carefully controlled conditions of storage, antigens showed considerable variation of reactivity between individual batches.     

Mefloquine, sulfadoxine, and pyrimethamine in the treatment of symptomatic falciparum malaria: a double-blind trial for determining the most effective dose

A total of 89 adult male Thai patients who had acute, uncomplicated falciparum malaria were treated in a double-blind randomized trial with a single oral dose of two or three tablets, each consisting of 250 mg mefloquine, 500 mg sulfadoxine, and 25 mg pyrimethamine (MSP). The two-tablet regimen produced a cure rate (S response) of 93%, the three-tablet regimen a cure rate of 98%. The mean duration of parasitaemia for the two- and three-tablet groups was 50 and 29 hours, respectively, while the mean duration of fever was 43 and 40 hours, respectively. Differences between the groups were not statistically significant. Tolerance was good at both dose levels. The main side-effects were abdominal discomfort, nausea, vomiting, dizziness, and diarrhoea, but these were mild, transient, and required no specific treatment. The results of haematological and biochemical investigations and of urinalysis revealed no drug-related changes following administration of MSP. The electrocardiograms of some patients revealed sinus bradycardia or sinus arrythmia, but these conditions were transient, symptomless, and clinically not significant.     

The lethal effects of the cibarial and pharyngeal armatures of mosquitoes on microfilariae.

Microfilariae of Wuchereria bancrofti and Brugia pahangi were killed by the chewing action of the cibarial and pharyngeal armatures and other papillae and spines in the fore-gut of mosquitoes. The proportion of ingested microfilariae that were killed was largely dependent on the presence and shape of the cibarial armature. Anopheles farauti No. 1 and Anopheles gambiae species A and B have well developed cibarial armatures and killed 36 to 96% of the ingested microfilariae. Culex pipiens fatigans has a poorly developed cibarial armature and killed only 6% of the microfilariae. Aedes aegypti and Aedes togoi lack cibarial armatures but have the remaining fore-gut structures. They killed only 2 to 22% of the microfilariae. The significance of these observations in relation to the control of filariasis with diethylcarbamazine is discussed.     

Hepatic structure and function in Papua New Guineans with leprosy

Hepatic function, including plasma bromsulphthalein (BSP) clearance was studied in 20 Papua New Guineans with leprosy: 11 lepromatous (LL) (6 had erythema nodosum leprosum (ENL)) (group A), and 9 tuberculoid or borderline (BT or BB) (group B); 12 controls (group C) were also studied. Four of five with abnormal BSP results had significant complicating or additional factors (hepatic amyloidosis, pustular ENL, hepato-cellular carcinoma and a pyogenic abscess), compared with two of 15 with normal results (tuberculous osteitis and pyogenic osteomyelitis). In nine (five from group A, and four from group B) needle liver biopsy histology was assessed: foci of vacuolated phagocytes and histiocytes, and tuberculoid granulomata were the most frequent lesions; none had cirrhosis.Leprosy is not associated with impaired hepatocellular function unless a severe complication or coincident disease is concurrently present. In this limited study therapeutic agents were not associated with abnormal liver structure or function. When liver function is abnormal in leprosy, another cause (e.g. secondary amyloidosis, sepsis or malignancy) should be searched for.     

Chloroquine sensitivity of Plasmodium falciparum in Ibadan,Nigeria: II. Correlation of in vitrowith in vivo sensitivity

Plasmodium falciparum malaria was treated in 82 children with 25 mg/kg chloroquine orally over three days. They were observed for 28 days during which blood films were examined periodically for malaria parasites. Asexual forms of P. falciparum, present in the blood films of all the patients before commencing treatment, disappeared rapidly and by the third day no parasites were seen in blood films from any of them. Among the patients observed for more than three days, blood films remained negative throughout the observation period. In vitro tests of sensitivity of blood samples from 10 patients showed chloroquine concentrations of 0·5 to 0·8 nmol/ml to inhibit completely maturation from ring forms to schizonts.This suggests that P. falciparum in the Ibadan area is probably still fully sensitive to chloroquine.     

Modifying the snack food consumption patterns of inner city high school students: the Great Sensations Study

The Great Sensations Program is a nutrition-education project developed for high school students. It was designed to (a) decrease students' consumption of salty snacks and (b) increase students' consumption of fresh fruit snacks. The overall programs were designed following principles of social learning: informative instruction, participatory classroom activities, personal goal setting, feedback, and reinforcement. The program was delivered in six lessons during regular health-education classes. A parental involvement program consisted of mailers and telephone calls to parents to teach them to encourage changes in student snacking habits. A schoolwide program was designed to provide out-of-class peer support for student modifications in salty snack foods. The program was evaluated in one high school using a 2 X 2 design. A second high school served as a no-treatment control. Program assessments were made at both schools before and after the classes, at the end of the school year, and the following fall the next school year following summer vacation. The schoolwide media program was effective in decreasing consumption of salty snack foods and in increasing consumption of target snack foods. However, only those students receiving classroom instruction maintained those changes until the end of the school year. No changes were maintained across summer vacation. These outcomes suggest that school programs developed using principles of social learning may be effective in facilitating important behavior changes at home and at school.     

Field epidemiology: Methodological constraints and limitations in the developing world

Effective planning for health services and facilities requires knowledge of not only theillnesses prevalent in a community but also of the quantity, distribution and the factors affecting their occurrence. In many developing countries, such information is not readily available because of gross inadequacies in the demographic, vital and health statistics collection system. In the absence of a reliable data source, well designed epidemiological surveys may provide clues on the health status of the community. However, the conduct of epidemiological surveys in this part of the world is subject to setbacks, limitations and constraints. Some of the limitations and constraints confronting epidemiologists are discussed. Their implications in the possible malpractice of epidemiology in developing countries should be of much concern.     

A comparison of the in vivo antibacterial effects of 'OpSite', 'Tegaderm' and 'Ensure' dressings

Three semi-permeable polyurethane dressings, 'Ensure', 'OpSite' and 'Tegaderm', were tested for their ability to prevent the increase in bacterial population under naturally hydrated, occluded volar forearm skin. Only 'OpSite' inhibited the bacterial multiplication in these tests. It is concluded that in the practical situation, 'OpSite' could well confer a greater margin of safety.     

Comparison of ELISA,radioimmunoassay and stool examination for Schistosoma mansoni infection

A comparison was made of the sensitivity and specificity of four diagnostic tests for Schistosoma mansoni infection in a community of 516 untreated persons in St. Lucia, West Indies. Prevalence of infection as obtained by: (i) the Bell filtration technique was 44·4% (one filter) and 63·2% (three filters); (ii) the Kato thick smear, 60·2%; (iii) by radioimmunoassay (RIA), 73·3%; and (iv) enzyme-immunoassay (ELISA) 70·9%. The age distribution of persons serologically positive but parasitologically negative showed these to be mostly children and persons 40 years old and over. By means of a statistical test due to Cochrane, it was concluded that there was no evidence to indicate a difference between paired serological tests and paired parasitological tests in their diagnostic capability. There was a very significant difference between the Bell technique and the other three tests. The ELISA emerged as a less satisfactory test than the RIA or the Kato thick smear. The levels of sensitivity and specificity of each test were measured by Armitage's “J” index. The reliability of the Bell filtration technique was 64%, of the ELISA 68%, of the RIA 78% and of the Kato 85%.     

Ingestion and development of Wuchereria bancrofti in Culex quinquefasciatus, Anopheles gambiae and Aedes aegypti after feeding on humans with varying densities of microfilariae in Tanzania

Laboratory observations were made on the transmission of Wuchereria bancrofti by Culex quinquefasciatus and Anopheles gambiae, natural vectors in East Africa, and by Aedes aegypti, an experimental vector. Mosquitoes were fed on human carriers with one to 2,667 microfilariae (mff/ml) of peripheral blood and the numbers of mff ingested were determined. The mosquitoes demonstrated a ‘concentrating effect’ and ingested 8.6 to 12-fold more mff than the expected number based on the density of mff in the carrier and the size of the blood meal. Studies on Culex showed that only 2.7 to 13% of the ingested mff developed into infective larvae (L3s). Emphasis was given to the transmission of Wuchereria from low density carriers with less than 10 mff/ml of peripheral blood—a value that approximates the threshold level of microfilaraemia detectable with conventional diagnostic techniques. By combining our laboratory data with published field data on the biting rates and longevity of mosquitoes in East Africa, we estimate that each low density carrier could serve as a source for nil to 15 L3s/year in Cx quinquefasciatus and 0.3 to 8 L3s/year in An. gambiae depending on the particular community. These estimates are relevant when formulating strategy to control bancroftian filariasis by mass chemotherapy with diethylcarbamazine. Experience with this drug has shown that a proportion of the carriers in a community continue to circulate mff at low levels after treatment. The present data demonstrate that these carriers serve as a reservoir of infection for mosquitoes.     

Allopurinol in the treatment of visceral leishmaniasis

Allopurinol was used in the treatment of 10 patients with kala-azar. Of six patients who had previously failed to respond satisfactorily to Pentostam, “cures” were achieved in four. However, it was necessary to add Pentostam to the allopurinol in one, and another relapsed after apparent “cure” but again responded to allopurinol. The response of four patients who had had no previous treatment for kala-azar was less satisfactory.     

Institutional structures: Catalysts of or barriers to quality care for the institutionalized aged in Scotland and the U.S.

The care of the elderly in two long-term care institutions, one in Scotland and one in the United States, is described, compared, and analyzed. In Scotland three institutional structures, the National Health Service, the Geriatric Service, and the specialty of geriatrics are identified as catalysts of quality care. In the U.S. Medicare and Medicaid, the absence of geriatrics as a specialty, and the nursing home are identified as barriers to quality care for the institutionalized aged. The findings suggest that three components, an adequate government insurance program, professionals who specialize in the care of the aged, and a structure to provide continuing comprehensive care, are essential for a successful program of care for the institutionalized elderly.     

Social bonds in a healthy elderly sample: characteristics and associated variables

Social bonds were examined in 256 healthy, independent-living elderly men and women using the Interview Schedule for Social Interaction (ISSI). Multivariate techniques were used to test for relationships between six dimensions of social bonds, as measured by the ISSI, and demographic characteristics as well as scores from the Kellner-Sheffield Symptom Questionnaire, the Jacobs Cognitive Screening Exam, the Halstead Category Test and the Wechsler Memory Scale. The study participants reported involvement in a range of satisfying, supportive, interpersonal relationships. Significant associations were found between social bonds and income, marital status, work status and health status. Emotional status, cognitive functioning, and memory were found to be independent of social bonds in our statistical model.     

A systematic review and meta-analysis of the effect of curcuminoids on adiponectin levels

IntroductionCurcuminoids are known anti-inflammatory molecules with multiple mechanisms of action while adiponectin is an anti-inflammatory molecule secreted by the adipocytes. Curcuminoids may upregulate the expression of adiponectin and thus modulate their levels in serum. A meta-analysis was performed to identify randomized controlled trials evaluating the effect of curcuminoids on adiponectin concentrations.Materials and MethodsThe search included PubMed-Medline, Scopus, ISI Web of Science and Google Scholar databases (from inception to October 20, 2018) and the quality of studies was assessed according to Cochrane criteria. Quantitative data synthesis was conducted using a random-effects model and sensitivity analysis by the leave-one out method. Additional analysis was performed to assess the impact of potential confounders on adiponectin levels.ResultsThe meta-analysis of five randomized clinical trials (n = 686) showed a significant elevation of plasma adiponectin concentrations following supplementation with curcuminoids (WMD: 6.47 ng/mL, 95% CI: 1.85, 11.10, p = 0.010; I² = 94.85%). The effect size was robust in the leave-one-out sensitivity analysis and the effect size was not driven by a single study in the meta-analysis.ConclusionThis meta-analysis showed a significant increase in plasma levels of adiponectin following curcuminoids therapy, which may be one of the mechanisms of anti-inflammatory activity of curcumin.