Care seeking behaviour and treatment of febrile illness in children aged less than five years: a household survey in Blantyre District, Malawi

Malaria is a leading cause of death in children aged < 5 years in Malawi. As part of the Roll Back Malaria initiative, African heads of state have pledged that by 2005, 60% of children will receive an effective antimalarial drug within 24 h of developing fever. In 1993, Malawi switched from chloroquine to sulfadoxine-pyrimethamine (SP) in its recommendations of home treatment of febrile illness in children. To study care seeking behaviour and home treatment in Blantyre District, and provide valuable follow-up to the chloroquine to SP transition, we performed a 2-stage cluster-sample survey in February 2000. Our sample of 1080 households included 672 households with children aged < 5 years; 292 (32.2%, 95% CI 28.7-35.8%) of the 912 children in these households had completed a febrile episode within the past 14 d. Among recently febrile children, 210 (72.0%, 95% CI 67.0-77.1%) received medication at home during their illness, but only 36 (12.2%, 95% CI 8.4-16.0%) received an appropriate antimalarial drug. Overall, 111 (37.4%, 95% CI 30.9-43.9%) received prompt, appropriate treatment. Only rural location was statistically associated with failure to receive prompt appropriate treatment (risk ratio estimate 1.2, 95% CI 1.01-1.5). A greater effort to improve the quality of malaria home treatment or to expand health facility utilization will be necessary to achieve Roll Back Malaria goals before 2005 in Blantyre District. Current care seeking practices suggest interventions should stress promptness of health facility visits, improved access to appropriate drugs, and accurate dosing for home-based treatments.     

青蒿酯钠静脉注射对犬的亚急性毒性

给犬iv青蒿酯钠每天一次,连续14d,90mg/kg使全部动物中毒死亡,45mg/kg中毒表现明显,2/6犬死亡,22.5mg/kg出现轻度中毒,11.25mg/kg未见明显毒副作用,可视为基本安全剂量。毒性作用的主要症状表现为呕吐、摄食量减少,重者出现粘液血便等;心电图Q-T间期延长,Q-T比值增大;化验及病理检查显示骨髓造血抑制,首先是红系成熟障碍,胆汁淤滞,内脏淤血,45mg/kg以上剂量还出现粒系成熟障碍及心、肝、肾、胃肠道、视网膜等组织实质性损伤及相应的血液学和血液生化变化。血液网织红细胞减少或消失仍是最敏感的指标。停药后28d各种变化基本恢复正常。     

喹啉类药物抗疟作用机制研究进展

喹啉类药物仍是目前主要应用的抗疟药。有关喹啉类药物抗疟作用机制主要有如下理论 :增加疟原虫溶酶体内pH值 ,改变原虫生长环境 ;抑制溶酶体酶的活性 ,减少原虫生长所需的营养成分 ;与DNA双螺旋链相互作用或抑制DNA和RNA聚合酶从而抑制原虫增殖 ;抑制溶酶体内铁释放 ,减少原虫生长所需铁 ;与高铁血红素结合形成复合物或抑制血红素聚合酶使血红素游离 ,并对疟原虫产生毒作用     

青蒿酯钠静脉注射对犬的急性毒性

按Deichmenn,Le Blauc法,给犬单次iv青蒿酯钠,给药后观察14d。结果表明:无毒副反应的最大剂量(MTD)为70mg/kg,近似致死量(ALD)为240mg/kg。毒副作用的主要表现为胃肠道和神经系统症状,致死剂量还引起肉眼血尿。化验检查以网织红细胞减少和血浆ALP升高发生最早,变化明显。病理损伤按出现所需剂量由小到大为红系造血抑制,内脏淤血,胆汁淤滞,胃肠粘膜坏死,肠道出血及肝,肾实质细胞退行性变,量效关系显著。33mg/kg未见任何毒副作用,可视为安全界量。     

Evaluation of clastogenic potential of the antimalarial plant Solanum nudum

Compounds isolated from Solanum nudum have shown in vitro antimalarial activity against the FCB-2 strain of Plasmodium falciparum. Diosgenone (C27H40O3) the main component isolated from the hexane extract and an aqueous extract were evaluated to measure their clastogenic potential using the micronucleus test. Three concentrations (16, 32 and 64 g/kg of weight) of the aqueous extract were administered intraperitoneally into mice, (the highest concentration corresponded to 80% LD50) and diosgenone solubilized in olive oil was inoculated at the highest concentration possible (11.187 g/kg of weight). After administration of the compounds, no induction of micronucleus was observed either in polychromatic or normochromatic erythrocytes. Interestingly, a reduction of 51% in the young/mature erythrocytes ratio was seen in cells treated with aqueous extract. We conclude that neither diosgenone nor the aqueous extract have clastogenic activity, and that the aqueous extract showed some toxicity at the above mentioned concentrations. These results are significant since diosgenone could be a new therapeutic alternative for the treatment of malaria.     

小柴胡汤及其与青蒿素配伍用药的抗疟作用研究

在伯氏鼠疟原虫感染的小鼠体内试验中研究了小柴胡汤及其与青蒿素配伍的抗疟作用，单用小柴胡汤醇提取物的抗疟作用甚微，当它和青蒿素联合用药时，二药并无疟增效作用，而且对伯氏鼠疟的复燃也无影响。     

Azithromycin‐containing intermittent preventive treatment in pregnancy affects gestational weight gain,an important predictor of birthweight in Papua New Guinea – an exploratory analysis

In Papua New Guinea, intermittent preventive treatment with sulphadoxine‐pyrimethamine and azithromycin (SPAZ‐IPTp) increased birthweight despite limited impact on malaria and sexually transmitted infections. To explore possible nutrition‐related mechanisms, we evaluated associations between gestational weight gain (GWG), enrolment body mass index (BMI) and mid‐upper arm circumference (MUAC), and birthweight. We investigated whether the increase in birthweight associated with SPAZ‐IPTp may partly be driven by a treatment effect on GWG. The mean GWG rate was 393 g/week (SD 250; n = 948). A 100 g/week increase in GWG was associated with a 14 g (95% CI 2.6, 25.4) increase in birthweight (P = 0.016). Enrolment BMI and MUAC also positively correlated with birthweight. SPAZ‐IPTp was associated with increased GWG [58 g/week (26, 900), P < 0.001, n = 948] and with increased birthweight [48 g, 95% CI (8, 880), P = 0.019] when all eligible women were considered (n = 1947). Inclusion of GWG reduced the birthweight coefficient associated with SPAZ‐IPTp by 18% from 44 to 36 g (n = 948), although SPAZ‐IPTp was not significantly associated with birthweight among women for whom GWG data were available (P = 0.13, n = 948). One month post‐partum, fewer women who had received SPAZ‐IPTp had a low post‐partum BMI (<18.5 kg m^?2) [adjusted risk ratio: 0.55 (95% CI 0.36, 0.82), P = 0.004] and their babies had a reduced risk of wasting [risk ratio 0.39 (95% CI 0.21, 0.72), P = 0.003]. SPAZ‐IPTp increased GWG, which could explain its impact on birthweight and maternal post‐partum BMI. Future trials of SPAZ‐IPTp must incorporate detailed anthropometric evaluations to investigate mechanisms of effects on maternal and child health.     

Therapeutic options for cutaneous lupus erythematosus: recent advances and future prospects

Introduction: Treatment and prevention are of critical importance in patients with cutaneous lupus erythematosus (CLE), as the disease can have a devastating effect on patient well-being and quality of life.

Areas Covered: We conducted a selective search of the PubMed database for articles published between December 2010 and November 2015. This review encompasses both non-pharmaceutical (photoprotection, smoking cessation, drug withdrawal, and vitamin D replacement) and pharmaceutical (topicals, antimalarials, immunosuppressives, biologics, etc.) interventions used in the treatment of CLE.

Expert Commentary: Recent work has expanded our understanding of established therapies as well as introduced new treatments for consideration, though existing medications still prove inadequate for a subset of patients. Changes in trial design may help to alleviate this issue.     

青蒿素类药物抗肿瘤作用的基础与临床研究

青蒿素类(Art)抗疟药具有多种药理活性,近年来对其抗肿瘤作用的基础研究较多,相关的临床研究也逐渐开展。大量体外和动物体内实验结果显示:Art可抑制或杀伤肿瘤细胞;诱导肿瘤细胞凋亡:阻滞细胞周期;抑制血管生成;延缓或逆转肿瘤细胞的多药耐药性;与铁制剂合用或与转铁蛋白结合可提高对肿增细胞的选择性杀伤作用。临床探索提示Art对肿瘤具有治疗或辅助治疗作用。Art对人体毒性低,与传统化学治疗药物有协同增效作用且无交叉耐药性。应加强Art抗肿瘤的临床研究以明确其抗肿瘤性质、范围、剂量、疗程及不良反应。     

The risk of antimalarials in patients with renal failure

We present here a patient with end stage renal failure who received two weeks antimalarial prophylaxis at full dose leading to life threatening toxicity with severe acute megaloblastic anaemia, symptomatic pancytopenia and exfoliative dermatitis. Prompt recognition and treatment can rapidly reverse these fatal effects but more importantly, education of patients before travel is imperative in preventing such events.