Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to study maternal mortality in Ilala District, Dar es Salaam, Tanzania, all female deaths in the 12-44 year age group were registered from February 1991 to January 1993. After a follow-up, a relative of the deceased was interviewed to classify the death as associated with pregnancy or not. Eight data collectors were employed to collect information. The team visited each of the 72 areas at least once in 2 weeks. The team also visited mortuaries, grave yards, and religious premises to get information on deaths. All hospitals in the district were regularly visited. A detailed history was taken from a relative of the deceased woman according to a structured questionnaire. 645 female deaths were identified and 117 (18%) were maternal deaths. Most of the interviews (73%) were made at home. In 32% of the cases the interviewee was the mother, in 26% the sister, and in 4-9% the husband, aunt, uncle, father or daughter. Only 10% of the deceased women did not seek any medical treatment prior to death. Three out of 4 women had had fever before death. The second most common symptom was shortness of breath (56%) with a median duration of 6 days. About half of the women had lost weight, complained of abdominal pain, or had been pale or vomiting. Medical records were available in only 44% of the cases. According to the physicians, in 22 (3.5%) women the cause of death was not possible to determine. AIDS (27%), tuberculosis (13%), and malaria (12%) were the most common causes of death. God's will and witchcraft were mentioned as the cause of death for 48 (7.6%) cases. AIDS is a major cause of death in women of reproductive age, therefore AIDS preventive measures must be employed along with more aggressive treatment of malaria and tuberculosis.
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PMID:Female mortality in reproductive ages in Dar es Salaam, Tanzania. 806 68

Although most studies on the effect of vitamin A supplementation have reported reductions in childhood mortality, the effects on morbidity are less clear. We have carried out two double-blind, randomised, placebo-controlled trials of vitamin A supplementation in adjacent populations in northern Ghana to assess the impact on childhood morbidity and mortality. The Survival Study included 21,906 children aged 6-90 months in 185 geographical clusters, who were followed for up to 26 months. The Health Study included 1455 children aged 6-59 months, who were monitored weekly for a year. Children were randomly assigned either 200,000 IU retinol equivalent (100,000 IU under 12 months) or placebo every 4 months; randomisation was by individual in the Health Study and by cluster in the Survival Study. There were no significant differences in the Health Study between the vitamin A and placebo groups in the prevalence of diarrhoea or acute respiratory infections; of the symptoms and conditions specifically asked about, only vomiting and anorexia were significantly less frequent in the supplemented children. Vitamin-A-supplemented children had significantly fewer attendances at clinics (rate ratio 0.88 [95% CI 0.81-0.95], p = 0.001), hospital admissions (0.62 [0.42-0.93], p = 0.02), and deaths (0.81 [0.68-0.98], p = 0.03) than children who received placebo. The extent of the effect on morbidity and mortality did not vary significantly with age or sex. However, the mortality rate due to acute gastroenteritis was lower in vitamin-A-supplemented than in placebo clusters (0.66 [0.47-0.92], p = 0.02); mortality rates for all other causes except acute lower respiratory infections and malaria were also lower in vitamin A clusters, but not significantly so. Improving the vitamin A intake of young children in populations where xerophthalmia exists, even at relatively low prevalence, should be a high priority for health and agricultural services in Africa and elsewhere.
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PMID:Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality. Ghana VAST Study Team. 810 78

During November-December, 1991, clinicians administered either 15 mg/kg mefloquine or 25 mg/kg mefloquine to 57 and 53 patients, respectively, to treat falciparum malaria. The patients were at the referral hospital in Site 8, a Khmer refugee camp on the border between Thailand and Cambodia. The 2 groups responded essentially the same, except the 15 mg/kg group had a lower mean hemoglobin level than the 25 mg/kg group (9.4 g/dl vs. 10 g/dl; p = .03). Parasitological failure rates on day 28 and 42 were not significantly different between the 2 groups. On day 28, they were 50% for the 15 mg/kg group and 43.4% for the 25 mg/kg group. They were especially high at day 42 (62% and 56%, respectively). Patients in the 25 mg/kg group were more likely to experience adverse effects of mefloquine (13% vs. 7% for vomiting, 26% vs. 19% for diarrhea, and dizziness 74% vs. 70%), but the differences were not significant. The mean serum mefloquine level was basically the same for both groups (2165 mcg/l in 15 mg/kg group and 2284 mcg/l in the 25 mg/kg group). 13 of 19 patients tested had serum mefloquine concentrations greater than 2000 mcg/1 on day 2, yet they experienced parasitological failure. This concentration traditionally indicated successful treatment. People who vomited within an hour of receiving mefloquine had much lower serum mefloquine levels than those who did not vomit (1289 mcg/l vs. 2300 mcg/l; p = .03). Patients who experienced dizziness on day 2 had much higher serum mefloquine levels than those who were not dizzy (2394 mcg/l vs. 1371 mcg/l; p = .006). On day 2, the mean ratio between the levels of the (SR)-(-) and (RS)-(+) enantiomers of mefloquine stood at 3.37, suggesting that differences exist in their pharmacokinetics. The 7-day retreatment regimen with quinine and tetracycline was successful in 93% of the 50 patients who experienced parasitological failure.
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PMID:Falciparum malaria in eastern Thailand: a randomized trial of the efficacy of a single dose of mefloquine. 813 Dec 53

At the Bangkok Hospital for Tropical Diseases in Thailand, health workers collected blood samples from male patients with acute uncomplicated falciparum malaria so researchers could compare the efficacy of artesunate (700 mg over 5 days) with the standard antimalarial treatment (600 mg quinine at 8 hour intervals plus 250 mg tetracycline at 6 hour intervals for 7 days). All 31 patients in the artesunate group had a much more rapid initial response than the 33 in the quinine-tetracycline group (mean parasite clearance time [PCT] = 37 hours; mean fever clearance time [FCT] = 31 vs. 73 and 55 hours, respectively) (p = 0.000001 for PCT; p = 0.000041 for FCT). In both groups, the mean PCT and mean FCT did not differ with level of pretreatment parasitemia. The cure rates on day 28 did not differ significantly (96.7% for the artesunate group, 100% for the quinine-tetracycline group). Five men in the artesunate group and nine in the quinine-tetracycline group had Plasmodium vivax in the peripheral blood between days 13 and 24, suggesting that these two regimens are not effective during the intrahepatic stage of plasmodia. 29 patients in the quinine-tetracycline group had tinnitus, while no one in the artesunate group did (p = 0.000001). Nausea and dizziness were common in both groups (45% for the artesunate group and 60% for the quinine-tetracycline group; 52% and 48%, respectively). Vomiting was more common in the quinine-tetracycline group (91% vs. 26%; p = 0.000005). Seven patients in the artesunate group had bradycardia, mostly during days 2-7. Convulsions occurred in one patient in the artesunate group 21 days after the first dose. They may have been caused by malaria, but artemisinin compounds have had central nervous system effects. These findings suggest that 700 mg artesunate is an effective antimalarial in areas with multiple-drug resistant parasites. Health workers should monitor its side effects, especially neurotoxicity, closely.
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PMID:Comparison of oral artesunate and quinine plus tetracycline in acute uncomplicated falciparum malaria. 820 43

A retrospective analysis of all malaria cases admitted to the Nairobi Hospital was performed by reviewing patient records. Six hundred and three cases were recorded between the period of January 1987 and July 1990 (43 months). The mean age of the patients was 32.5 years and 57.5% were male. Although 81.4% were permanent residents of Kenya, only 18.2% could be said to have lived in a malarial zone. One-quarter of the patients (25.6%) admitted having had a previous episode of malaria, and 57.7% were taking regular chemoprophylaxis. The most common presenting symptoms were fever, headache, vomiting and myarthralgia; the most commonly recorded accompanying signs were jaundice and splenomegaly. Sixty patients met the criteria for severe malaria. During their hospital stay, six patients (1%) died; five of whom were severely ill from the time of for the USA and UK, especially as it represents a selected population of the more serious malarial cases admitted to the hospital. Therefore, it may indeed represent clear evidence to support the hypothesis that a high index of suspicion combined with early diagnosis and treatment will result in improved outcome. Comparative features illustrating these points are presented. As the malaria parasite, P. falciparum, has dynamic antimalarial sensitivity and as more travelers are under threat from this disease, it is vital that ignorance of this danger should not be allowed to put individuals at risk for death. Continuing education of both the traveling public and the medical profession is the only way that both parties will shoulder their respective responsibilities.
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PMID:Nairobi Hospital, Kenya: the management of nonimmune P. falciparum malaria abroad. 825 8

The percentage of peripheral blood mononuclear cells (PBMC) bearing the CD3+ phenotype and the alpha/beta and gamma/delta T cell receptors (TCR) in PBMC were examined in Plasmodium vivax malaria patients and convalescents. The cells were labeled with monoclonal antibodies, stained with either fluorescence or phycoerythrin, and examined by ultraviolet (UV) microscopy. A highly significant increase in both the proportion and the absolute numbers of gamma/delta T cells (p < 0.005 and < 0.001, respectively, Student's t test) was observed in nonimmune P. vivax patients during clinical paroxysms compared to nonmalarial controls. These T cells, which normally constitute not more than 3-5% of PBMC, constituted < or = to 30% of PBMC during paroxysms in these nonimmune patients in whom the clinical symptoms were severe. A less significant increase of gamma/delta T cells were also observed in these nonimmune patients during infection, between paroxysms and during convalescence. In contrast, in an age-matched group of semi-immune patients resident in a malaria-endemic region of the country, in whom the clinical disease was comparatively mild, there was no increase in gamma/delta T cells either during infection, even during paroxysms, or convalescence. The severity of disease symptoms in patients as measured by a clinical score correlated positively with the proportion of gamma/delta T cells in peripheral blood (r = 0.53, p < 0.01), the most significant correlation being found between the prevalence and severity of gastrointestinal symptoms, nausea, anorexia, and vomiting, and the proportion of gamma/delta T cells (r = 0.49, p = 0.002). These findings suggest that gamma/delta T cells have a role to play in the pathogenesis of malaria, possibly in the general constitutional disturbances and particularly in gastrointestinal pathology in malaria.
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PMID:Transient increase in circulating gamma/delta T cells during Plasmodium vivax malarial paroxysms. 827 Aug 75

Clinical trial of halofantrine was conducted in 32 cases of acute malaria. Twenty four patients with P. vivax and eight patients with P. falciparum infection were treated with 3 doses of halofantrine (500 mg each) orally, after food, at intervals of 6 hours. Mean parasite clearance time of P. vivax was 57.75 h and for P falciparum 75 h and mean defervescence time was 31.08 h and 34 h respectively. Post treatment followup was for 28 days. Clinical symptoms related to malaria cleared within the first 48 h. Mild adverse reactions of abdominal pain in one patient and vomiting in one patient were encountered which did not require any treatment. Halofantrine was found to be very effective and free from significant adverse events when used for the treatment of acute malaria.
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PMID:Efficacy and safety of halofantrine in acute malaria. 782 50

One hundred and forty seven cases of acute malaria were diagnosed at autopsy between 1988 and 1991 at the Lagos University Teaching Hospital (LUTH). In 67 (46.5%) cases death was attributed to cerebral malaria (CM). There was a gradual increase in the incidence of CM during the period under review. Both sexes were affected equally but more children than adults succumbed. The highest death rate was recorded in the age group 1-5 years with a peak in the 2nd and 3rd year. There were seven adults out of which one was intenerant white lady. Only one of the six adult Nigerians had travelled outside Africa and stayed away for about four years. The commonest presenting symptoms were: fever only, fever with convulsions and/or coma and fever with gastrointestinal symptoms such as vomiting and diarrhoea. The majority of the adults were comatose (five out of seven) without fever on admission. A review of the English literature on the diagnosis, pathogenesis and management of CM is also presented. The possible reasons of the rising incidence of CM in a holoendemic region such as Nigeria are discussed.
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PMID:Rising incidence of cerebral malaria in Lagos, Nigeria: a postmoterm study. 830 9

The antimalarial efficacy of halofantrine was compared with mefloquine in an open-label, randomized comparative trial in adult male patients with acute uncomplicated falciparum malaria. Twenty-eight patients received halofantrine and 27 received mefloquine. Halofantrine was administered in 3 doses of 500 mg at 6 hour intervals and mefloquine was administered in divided doses of 1,250 mg or 1,500 mg depending on whether the patients weighed less than or more than 60 kg. The patients were followed for 42 days and observed for drug tolerance and evidence of recrudescence. Response to treatment was favorable with both drugs, but three patients (two treated with halofantrine and one with mefloquine) did not completely eliminate malaria parasites from peripheral blood films in seven days. The parasite and fever clearance times were 75.6 and 55.7 hours, and 80.1 and 61.3 hours, respectively for halofantrine and mefloquine. However, 12 patients recrudesced during the 42 day follow-up period. Nine of these had been treated with halofantrine and three with mefloquine. The 42-day cure rate for the two drugs was 56% and 84%, respectively. The side-effects of halofantrine and mefloquine were comparable and transient. These are diarrhea, dizziness, orthostatic hypotension and black out. However, vomiting was found to be more common in mefloquine group (41% vs 22%).
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PMID:Clinical trials with halofantrine in acute uncomplicated falciparum malaria in Thailand. 836 5

Thirty-three female patients suffering from acute uncomplicated falciparum malaria were treated with intramuscular artemether for 5 days during May-October 1990. Fourteen patients received 160 mg as an initial dose, followed by 80 mg daily for 4 days. Nineteen patients with low body weight (mean weight of 36.5 kg) were given artemether at 3.2/kg as a loading dose and followed by 1.6 mg/kg/dose for another 4 days. The geometric mean of parasitemia was 17,378/microliters (range 640-234,720). The mean fever (FCT) and parasite clearance time (PCT) were 41.8 and 49.4 hours, respectively. Two patients had probable intercurrent infection with FCT of over 7 days. Thirty-one patients had completed the 28-day follow-up. The cure rate was 90.3% (28/31). Three patients had RI type of response. Mild and transient adverse effects were experienced in eleven patients; these consisted of pain at the injection sites, vomiting, dizziness, abdominal pain, palpitation and diarrhea. These symptoms may in part be due to symptom complex of malaria. The MIC of chloroquine, quinine, quinidine and mefloquine was performed in all patients but only 25 isolates were successfully cultured and tested. The MIC of all tested drugs were shown to be higher than that of previous studies, suggesting that there is a rapid increase of mefloquine resistant strains of falciparum malaria. In conclusion, artemether proves to be effective against multiple drug resistant falciparum malaria (including mefloquine resistant strains) and can be considered as an alternative antimalarial to mefloquine. The drug was well tolerated in female patients with mild and transient side-effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intramuscular artemether in female patients with uncomplicated falciparum malaria. 836 6


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