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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malaria as a threat to health has remained undaunted in Sub-Saharan Africa (SSA). It has been mathematically modelled, vertically attacked and continuously appraised and yet it continues unabated. Malaria is an acute and chronic disease caused by intracellular protozoa of the genus Plasmodium which are transmitted by the bite of female Anopheles mosquitoes. Approximately 2.6 billion people are at risk worldwide resulting in at least 100 million clinical cases and of the order of 1 million fatalities. The social and economic consequences of such morbidity and mortality have not been adequately documented.
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PMID:Malaria in Sub-Saharan Africa. 223 9

Anemia is responsible for an estimated 20% of maternal deaths in West Africa and contributes to still more deaths through obstetric hemorrhage. Anemia during pregnancy has been linked to iron and folate dietary deficiencies, the secondary effects of malaria and hookworm infestations, infections such as human immunodeficiency virus, and hemoglobinopathies. Parasitic infestations interfere with the normal increase (given a balanced diet) in iron absorption during pregnancy. An understanding of locally salient etiologic factors should form the basis of public health programs aimed at addressing anemia during pregnancy. There is a need for basic prevalence statistics, especially from West Africa's rural areas. Finally, reliable laboratory parameters that can be used in the assessment of iron and folate status and the degree of anemia attributable to malaria must be established. Although there is emerging evidence that serum transferrin receptor concentration is not affected by chronic disease or the physiological changes of pregnancy, further studies are needed to validate this measure.
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PMID:The aetiology of anaemia in pregnancy in West Africa. 913 12

In high endemicity areas, malaria is a chronic disease: examination of blood films reveals that up to half of the population, particularly children, harbour parasites at any one given time. The parasitological status of the remainder was addressed using the polymerase chain reaction, a technique 100 to 1000 times more sensitive than microscopy, on a series of samples from Dielmo, a holoendemic area of Senegal. Two-thirds of the microscopically negative individuals were found to harbour subpatent levels of Plasmodium falciparum, suggesting that more than 90% of the exposed population at any one time, i.e. in a cross-sectional survey, are chronically infected. This also means that the range of parasite loads harboured by humans with various degrees of exposure is remarkably large, probably reflecting a large range of effectiveness of the defence mechanisms against malaria parasites, none of which is fully efficient.
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PMID:Malaria: even more chronic in nature than previously thought; evidence for subpatent parasitaemia detectable by the polymerase chain reaction. 873 Mar 1

Quinine has been marketed in the United States (U.S.) both over-the-counter (OTC) and by prescription for numerous purposes, including malaria and muscle spasms. In 1994 and 1995, the U.S. Food and Drug Administration (FDA) acted to limit the marketing of quinine based on the conclusion that no data supported its safe and efficacious use in these settings. This report includes clinical attributes from the largest case series to date of apparently isolated thrombocytopenia in association with quinine and trends in the receipt of spontaneous adverse event reports to FDA's Center for Drug Evaluation and Research (CDER) for this drug-event combination in relation to regulatory action. In this study, we reviewed reports of spontaneous adverse drug events received by CDER. From 1974 through December 2000, CDER received 397 adverse event reports for quinine. Based on crude, unreviewed counts, 141 (35.5%) of these reports described apparently isolated thrombocytopenia. Reporting for this event peaked in 1995, coincident with regulatory action, and has subsequently declined. After elimination of cases confounded by acute or chronic disease or concomitant drug therapy, 64 reports of quinine-associated thrombocytopenia were used to form a case series. This case series, including 11 cases since January 1996, supports the potential for rapid time-to-onset (median 7 days) and clinical severity (hospitalization reported in 55 of the 64 cases). Although the number of reports since regulatory action is limited, CDER continues to receive reports of thrombocytopenia in association with quinine in use for nocturnal leg cramps. Extrapolation of spontaneous adverse event reports for a product with substantial OTC use precludes estimates of rates/incidence. Therefore, the effect of regulatory actions in 1994/1995 is difficult to measure using this approach. Although reports have decreased since regulatory actions on quinine, quinine remains available in the U.S. by prescription and in food products/dietary supplements. This case series confirms previous smaller series that suggest quinine-associated thrombocytopenia may present rapidly with symptoms of profound thrombocytopenia. Clinicians evaluating patients with new-onset and apparently idiopathic thrombocytopenia should maintain clinical vigilance for ingestion of quinine and elicit a detailed food/dietary supplement history from the patient.
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PMID:Spontaneous reports of thrombocytopenia in association with quinine: clinical attributes and timing related to regulatory action. 1221 Aug 13

Schistosomiasis is a disease caused by parasitic trematode worms (schistosomes) that currently affects 200 million people living in tropical and subtropical environments. It is a chronic disease and the latest estimates for sub-Saharan Africa are that it kills > 200000 people every year. Soil-transmitted helminthiasis (STH) is caused by intestinal nematodes. More than 2 billion people are infected worldwide and the disease burden might approach that of malaria. Recognising the enormous public health significance of schistosomiasis and STH, particularly among the poor, and in view of readily available drugs that are safe, efficacious and inexpensive, the World Health Assembly recently set forth a resolution for a combined approach for morbidity control of both diseases. This review briefly summarises the geographical distribution, life cycle and global burden of schistosomiasis and STH. The current arsenal of drugs available for morbidity control, including discovery, chemistry, pharmacological properties and aspects of therapeutic efficacy and adverse events in clinical human use is then discussed. The emphasis is on praziquantel, oxamniquine and artemisinin derivatives (against schistosomes) and albendazole, mebendazole, levamisole, pyrantel pamoate and other compounds (against intestinal nematodes). The experience gained with combination chemotherapy in schistosomiasis and STH is briefly discussed. Finally, current research needs and the critical importance for development of novel anthelmintic drugs, so that chemotherapy can continue to serve as the backbone of integrated and sustainable control of schistosomiasis and STH, is highlighted.
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PMID:Schistosomiasis and soil-transmitted helminthiasis: common drugs for treatment and control. 1499 24

In many human infections, hosts and pathogens coexist for years or decades. Important examples include HIV, herpes viruses, tuberculosis, leprosy, and malaria. With the exception of intensively studied viral infections such as HIV/AIDs, little is known about the extent to which the clonal expansion that occurs during long-term infection by pathogens involves important genetic adaptations. We report here a detailed, whole-genome analysis of one such infection, that of a cystic fibrosis (CF) patient by the opportunistic bacterial pathogen Pseudomonas aeruginosa. The bacteria underwent numerous genetic adaptations during 8 years of infection, as evidenced by a positive-selection signal across the genome and an overwhelming signal in specific genes, several of which are mutated during the course of most CF infections. Of particular interest is our finding that virulence factors that are required for the initiation of acute infections are often selected against during chronic infections. It is apparent that the genotypes of the P. aeruginosa strains present in advanced CF infections differ systematically from those of "wild-type" P. aeruginosa and that these differences may offer new opportunities for treatment of this chronic disease.
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PMID:Genetic adaptation by Pseudomonas aeruginosa to the airways of cystic fibrosis patients. 1671 89

Vaccination against infectious agents represents a success of immunology, although many infectious diseases still evade the immune system, including chronic infections, such as tuberculosis, malaria, and HIV. Further progress is expected through rational design based on increased understanding of how the immune system works, and how the induction of protective immunity is regulated. The same principle applies to cancer vaccines, particularly because cancer is a chronic disease. Owing to their capacity to regulate cellular and humoral immunity, dendritic cells are increasingly used as vaccines; the immunogenicity of antigens delivered on dendritic cells has been shown in cancer patients. A better understanding of how dendritic cells regulate immune responses would allow clinicians to exploit them better to induce effective immunity against cancer.
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PMID:Dendritic cell-based vaccination against cancer. 1676 30

Parkinson's disease (PD) is said to be less common in Africa than elsewhere in the world, but previous studies have been based on small numbers. Also, the differences may be due to the diagnostic criteria used, case finding methods and different population age structures. Developing countries have few facilities for chronic disease management and non-communicable diseases, although on the increase, tend to play second fiddle to malaria and HIV/AIDS. Previous reports suggest that, at least from anecdotal information, under-diagnosis of PD is common and long-term availability of medication, follow-up, patient education and multidisciplinary input is lacking. Published literature is scarce and there is a lack of recent information. We are currently conducting a door-to-door prevalence study in northern Tanzania in a population of 161,162. We have reviewed previous literature on PD in Africa and illustrate our personal experience of PD and its management in Africa with three cases.
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PMID:The challenge of Parkinson's disease management in Africa. 1725 91

One of the great demands and challenges for vaccination is to successfully target the pathogens responsible for much of mankind's chronic disease burden including: AIDS, infectious hepatitis, tuberculosis and malaria. Another is realizing the potential of therapeutic immunization to cure diseases such as cancer, allergy and inflammatory autoimmunity. To achieve these objectives, the fundamental insights gained from immunology, genomics, molecular-cellular biology and vaccinology must be implemented in order to develop more effective, better defined and safer vaccines. As an illustrative example of this we examine the key features of viruses that are known to be responsible for eliciting superb host immune responses. These insights have formed a basis for understanding the effectiveness of existing vaccines and provide a framework for designing and developing new vaccines better able to meet pressing unmet medical needs. The key immunogenic properties of viruses that are understood to date and are currently being applied include: their particulate nature, their highly repetitive and ordered structures, their ability to induce innate immunity with consequent conditioning of adaptive responses and the kinetics and distribution of viral antigens during infection. Vaccines and vaccine-formulations recently registered for use in humans already incorporate some of these elements. Of great anticipation is the progress of the next-generation vaccines now advancing through the various stages of research and development. Vaccines which, by way of rational design, incorporate viral properties to induce tailored responses and thus have the potential to provide safer and more effective prophylaxis and therapies.
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PMID:Designing recombinant vaccines with viral properties: a rational approach to more effective vaccines. 1734 67

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.
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PMID:No health without mental health. 1780 63


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