Monitoring antimalarial drug resistance in India via sentinel sites: outcomes and risk factors for treatment failure, 2009–2010

Objective

To describe India’s National Antimalarial Drug Resistance Monitoring System, measure the efficacy of first-line malaria treatments, and determine risk factors for treatment failure.

Methods

In 2009–2010, prospective studies with 28 days of follow-up were conducted at 25 sentinel sites. Patients infected with Plasmodium falciparum were given artesunate plus sulfadoxine-pyrimethamine (AS+SP); those infected with P. vivax were given chloroquine. Polymerase chain reaction was used to distinguish post-treatment reinfection from treatment failure. Isolates of P. falciparum were checked for dhfr and dhps mutations.

Findings

Overall, 1664 patients were enrolled. Kaplan–Meier survival analysis showed an efficacy of 98.8% for AS+SP. Most patients with P. falciparum parasitaemia cleared their parasitaemias within 24 hours of treatment initiation, but six, including four with treatment failure, remained parasitaemic after 72 hours. Double mutants in dhfr were found in 68.4% of the genotyped isolates. Triple or quadruple mutants in dhfr and mutations in dhps were rare. A daily dose of artesunate of < 3 mg per kg of body weight, age of less than 5 years, and fever at enrolment were associated with an increased risk of treatment failure. Chloroquine remained 100% efficacious and generally cleared P. vivax parasitaemias within 48 hours. Vomiting (seen in 47 patients) was the most common adverse event.

Conclusion

India’s National Antimalarial Drug Resistance Monitoring System provides wide coverage. The first-line antimalarials used in the country remain safe and efficacious. The treatment of malaria in young children and the relative benefits of age- and weight-based dosing need further exploration.     

糖皮质激素受体基因转染对肺泡巨噬细胞表达炎性因子的影响

目的:分析过量表达的外源性糖皮质激素受体在调控肺泡巨噬细胞表达炎性细胞因子中的作用。方法:实验于2005-10/2006-03在解放军南京军区南京总医院呼吸病实验室完成。①选用成年健康Wistar大鼠10只,雌雄不拘。采用大鼠糖皮质激素受体真核表达质粒pCMV-rGR转染体外培养肺泡巨噬细胞,将肺泡巨噬细胞分为转染组与非转染组,其中转染组细胞在质粒转染24h后用于实验,各组对以下时相点进行观察:正常对照(加等量生理盐水)、脂多糖 地塞米松作用4,8和12h,脂多糖与地塞米松作用浓度分别为100μg/L,1×10-5mol/L,于不同时相点收集细胞。②转染24h后WesternBlotting检测细胞总蛋白和核蛋白中糖皮质激素受体蛋白表达变化。同时收集细胞培养上清,采用酶联免疫吸附法浊定细胞培养上清中肿瘤坏死因子α、白细胞介素1β水平。③多组间比较用方差分析,两两比较用SNK检验。结果:①质粒转染肺泡巨噬细胞后糖皮质激素受体表达变化:转染组细胞总蛋白中糖皮质激素受体表达明显高于非转染组(3.75±0.25,1.21±0.16,P<0.01),转染组细胞核蛋白中糖皮质激素受体表达量与非转染组相近(1.15±0.12,1.09±0.11,P>0.05)。②脂多糖和地塞米松作用后核蛋白中糖皮质激素受体表达变化:脂多糖和地塞米松作用后4,8,12h转染组细胞核蛋白中糖皮质激素受体表达量分别为4.02±0.09,2.13±0.08,1.22±0.15,非转染组细胞核蛋白中糖皮质激素受体表达量分别为4.08±0.13,2.09±0.11,1.19±0.17,两组细胞核蛋白中糖皮质激素受体表达变化趋势一致,均于4h达到峰值,8h显著降低,12h达到最低,两组同时相点比较,差异不明显(P>0.05)。③脂多糖和地塞米松作用后细胞培养上清中细胞因子表达变化:转染组脂多糖和地塞米松作用后4,8,12h肿瘤坏死因子α表达分别为(32.16±3.99),(56.82±8.43),(73.34±9.97)ng/L,非转染细胞分别为(34.28±4.25),(59.82±9.65),(71.41±8.35)ng/L;转染组脂多糖和地塞米松作用后4,8,12h细胞上清中白细胞介素1β质量浓度分别为(67.57±18.37),(83.17±8.55),(97.55±8.27)ng/L,非转染分别为(62.23±15.64),(85.72±9.37),(99.07±9.25)ng/L。两组细胞上清中肿瘤坏死因子α、白细胞介素1β表达随时间逐渐增加,均于12h均达到峰值,同时相点两组比较均无明显差异(P>0.05)。结论:①通过体外糖皮质激素受体基因转染可以有效地在肺泡巨噬细胞中过量表达外源性糖皮质激素受体,并且定位于胞质内。②地塞米松作用后,肺泡巨噬细胞核内糖皮质激素受体表达明显增加,但随后又出现表达下调现象。③体外基因转染后胞质中过量表达的外源性糖皮质激素受体不能发生核移位,所检测的均为内源性糖皮质激素受体。④通过基因转染而过量表达的外源性糖皮质激素受体,不能发挥正常的抑炎生物学活性。     

Angiotensin-converting-enzyme inhibitors in the management of cardiac failure: are we ignoring the evidence?

The benefits of angiotensin-converting enzyme (ACE) inhibition in the management of cardiac failure have been extensively documented. However, little is known about its impact upon the investigation and management of this condition. We assessed how patients diagnosed as having cardiac failure were investigated, which patients were treated with ACE inhibitors and with what dosages. We reviewed the case notes of all 343 patients discharged from Aberdeen Royal Infirmary 1 July-31 December 1992 with a diagnosis of cardiac failure. In addition, a questionnaire was sent to the general practitioners of the 166 patients still alive in October 1994. Only 40% of patients were discharged from hospital on ACE inhibitors. In 58.8%, the diagnosis of cardiac failure was based purely on clinical or radiological grounds. At discharge, 76.1% of patients were on lower doses of ACE inhibitors than those used in the major survival studies; with 68.9% receiving similar doses two years later. The majority of patients with heart failure are under- investigated and under-treated.      

蛇床子素对豚鼠离体回肠和结肠带的作用

以豚鼠离体回肠和结肠带为标本,观察蛇床子素(Ost)的作用与Ca²⁺)的关系。结果表明:Ost和钙拮抗剂Ver产生剂量依赖性抑制乙酰胆碱(ACh)、组胺及KCl所致回肠条或结肠带的收缩;非竞争性拮抗CaCl₂累积量—效曲线,pD₂分别为4.41±0.15,7.0±0.2。Ost 100μmol/L和Ver 1μmol/L均能对抗小剂量Ca²⁺所致结肠带收缩,但被加入较大量Ca²⁺所取消。Ost和Ver均能抑制ACh诱导的依内钙性收缩,不影响依外钙性收缩。结果提示Ost具有钙拮抗作用,其作用方式与Ver类似。