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)

Malaria in the Republic of the Philippines is caused principally by P. falciparum and P. vivax, with the former as predominant species. P. malariae is occasionally reported, while P. ovale is very rare and has been reported only in the island of Palawan. Malaria is widespread in distribution with prevalence varying from one area to the other. In 1970, the malaria morbidity rate was reported to be 77.6 per 100,000 while the mortality rate was 1.8 per 100,000. Case detection activities revealed that, in 1973, the slide parasite rate was 7.2%, the annual parasite index was 6.1% and the annual blood examination rate was 8.4%. The principal vector of malaria in the Philippines is An. minimus flavirostris which breeds in clear, fresh-water streams in foothills and mountain slopes. An. mangyanus and An. maculatus appear to play a secondary role. The vectorial capacity of the former appears to be confined only where conditions are primitive, while the latter is associated with malaria transmission in high altitudes. In the absence of fresh-water streams, the salt-water breeder mosquito, An. litoralis, assumes the vectorial role. The epidemiology of malaria in the Philippines is discussed. Emergence of strains of P. falciparum with diminished sensitivity to the commonly used antimalarial drugs is reported in Palawan and Rizal provinces. The development of malaria control activities in the Philippines are presented. As of 1972, Cagayan Valley, Palawan, Mindoro, Sulu and circumscribed areas in Mindanao are still considered hard-core malarious areas with on-going persistent transmission.
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PMID:Malaria in the Republic of the Philippines. A review. 2 58

Erythromycin inhibits chloroquine-induced pigment clumping in Plasmodium berghei in vitro. The drug was therefore tested against infections of P. berghei in mice and was found to be active at non-toxic doses. Given orally, the stearate salt was more effective than the base, but subcutaneously the base was more effective than the stearate. Erythromycin potentiated the action of chloroquine against two chloroquine-resistant strains of rodent malaria, the mildly resistant NS, and the highly resistant RC strains of P. berghei, but not against the drug-sensitive N strain.
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PMID:The chemotherapy of rodent malaria, XXIV. The blood schizontocidal action of erythromycin upon Plasmodium berghei. 78 56

The pharmacokinetics and effectiveness of three dosage regimens of quinine were studied in a group of 59 children with severe malaria. The children were randomized to receive high-dose intravenous or intramuscular quinine (20 mg salt/kg loading, then 10 mg salt/kg every 12 hr), or low-dose intravenous quinine (10 mg salt/kg loading, then 5 mg salt/kg every 12 hr). In the group receiving the high-dose intravenous regimen, mean high and low quinine concentrations were consistently greater than 10 and 6.5 mg/l, respectively. Peak concentrations as well as the time required to achieve them were similar in the intramuscular and high-dose intravenous groups. The low-dose intravenous quinine regimen resulted in mean peak concentrations greater than 6 mg/l and mean low concentrations greater than 3.5 mg/l. All blood concentrations exceeded the 99% in vitro inhibitory concentration (EC99) of 0.89 mg/l or less of quinine for 60 isolates of Plasmodium falciparum, which were taken from children with malaria during the same period. Judged by a number of clinical criteria, the response was better in patients receiving the high-dose than the low-dose intravenous regimen. The time taken to clear parasites with both the high-dose intravenous and intramuscular regimens were significantly shorter than those obtained in the low-dose group. We have also shown for the first time that the rate of parasite clearance can be directly related to the area under the quinine concentration versus time curve. This applied to all three quinine regimens (r = 0.4252, P less than 0.02; n less than or equal to 35). Five patients, two on the low-dose regimen, two on the intramuscular regimen, and one on the high-dose regimen, developed hypoglycemia after admission, but in these cases, insulin concentrations were correspondingly low. No significant quinine toxicity was observed in any of the cases. The high-dose intravenous quinine regimen described here may be optimal for treatment of severe falciparum malaria in areas of chloroquine resistance in Africa. Our data provide no justification for reducing the dose of quinine in the treatment of severe malaria in Africa. The intramuscular regimen could provide a satisfactory alternative in areas where intravenous administration might be delayed or is impossible.
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PMID:Quinine treatment of severe falciparum malaria in African children: a randomized comparison of three regimens. 176 97

During the study in the anti-salt dam area in Bignona, we noted that malaria was mesoendemic (IP = 45.2%), with a high transmission during the rainy season. Prevalence rate of schistosomiasis was low. Intestinal parasites were frequent (74.4%). It is to be feared with the putting salt out, the prevalence rate of the parasitic diseases would increase, so it is important to create an unity of follow up.
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PMID:[Endemic parasitic epidemiology in the anti-salt dam area of Bignona (Senegal)]. 184 73

Plasma quinine concentrations following oral quinine sulphate 10 mg salt/kg have been measured by HPLC in 15 adult Thai patients with uncomplicated falciparum malaria. In 10 of the same patients the study was repeated in convalescence. In acute malaria plasma concentrations were approximately 50% higher than in convalescence; the mean acute peak plasma quinine concentration was 8.4 mg.l-1 compared to 5.7 mg.l-1 in convalescence. There was considerable variation in the rate of drug absorption, particularly in acute malaria. The mean time to peak plasma concentration was 5.9 h in acute malaria and 3.2 h in convalescence. The apparent clearance of oral quinine (CL/f) during the illness was 1.51 ml.kg-1.min-1, which was significantly lower than in convalescence--2.67 ml.kg-1.min-1. Estimated free quinine clearance was also lower in the acute phase: 30.6 compared to 49.0 ml.kg-1.min-1 in convalescence. Mean (SD) plasma protein binding of quinine was 94.7% in acute malaria and 92.8% in convalescence. Binding was significantly correlated with the plasma concentration of alpha 1 acid glycoprotein (r = 0.5), which was significantly higher in the acute phase; 1.48 g.l-1 compared to 1.05 g.l-1 during convalescence. Oral quinine sulphate was well absorbed in uncomplicated falciparum malaria. High blood concentrations following the administration of oral quinine in acute malaria are probably related to increased plasma protein binding, lower apparent volume of distribution, and a reduction in its systemic clearance.
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PMID:Disposition of oral quinine in acute falciparum malaria. 206 May 45

Plasma quinine concentrations were measured in 21 Gambian children with severe falciparum malaria after intramuscular administration of a 20 mg (salt) per kg loading dose of quinine dihydrochloride followed by 10 mg/kg at 12 h intervals. Quinine was well absorbed reaching mean peak concentrations of 15.6 (standard deviation [SD] 4.5) mg/litre in a median time of 3 h (range 1-6 h). A one compartment model was fitted to the plasma concentration-time profile. The mean estimated systemic clearance (Cl/F) was 0.89 (SD 0.81) ml/kg/min and the mean elimination half life was 18.8 (SD 8.0) h. Two patients, one of whom died, had low plasma quinine levels which remained below 10 mg/litre. Mean peak and trough plasma concentrations after subsequent intramuscular doses ranged between 11.1 and 15.1 mg/litre. In most cases this dose regimen provided a satisfactory profile of blood concentrations for the treatment of severe malaria in children.
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PMID:The pharmacokinetic properties of intramuscular quinine in Gambian children with severe falciparum malaria. 209 34

The safety and kinetics of intramuscular quinine (10 mg salt/kg every 8 h for 3 doses) were assessed in Malawian children suffering from uncomplicated falciparum malaria, who were unable to take oral antimalarial drugs. Treatment was completed with oral pyrimethamine-sulfadoxine. The mean (+/- SD) peak plasma quinine concentration after the first injection was 9.0 (+/- 2.3) micrograms/ml, at 1.1 (+/- 0.7) h. Mean plasma concentrations increased further after the second and third doses to a maximum of 11.5 (+/- 2.6) micrograms/ml at 16.1 (+/- 3.2) h. No hypotension, hypoglycaemia or electrocardiographic abnormalities developed during quinine treatment. These results provide further evidence for the safety of intramuscular quinine in children with moderately severe malaria. Plasma concentrations of alpha 1-acid glycoprotein (AGP) were higher, and the degree of protein binding of quinine was greater, in acute malaria than in convalescence. There was a significant correlation between AGP concentration and the fraction of plasma quinine bound to plasma protein. These findings suggest a role for AGP in the binding of quinine in plasma in vivo and are of interest since unbound quinine is responsible for both the efficacy and toxicity of the drug.
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PMID:The safety and kinetics of intramuscular quinine in Malawian children with moderately severe falciparum malaria. 209 33

Recommended initial treatment of severe chloroquine-resistant falciparum malaria consists of a 4-h loading infusion of 20 mg of quinine dihydrochloride (salt)/kg of body weight. To achieve and maintain therapeutic blood quinine concentrations (10 mg/l) safely and rapidly, a consecutive-infusion regimen (7 mg of salt/kg of body weight over 30 min followed by 10 mg of salt/kg of body weight over 4 h) based on pharmacokinetic parameters in cerebral malaria has been suggested. This regimen was evaluated in 16 adults (6 male, 10 female; mean age, 25.9 years) with severe falciparum malaria. Plasma quinine concentrations (mean +/- SE) were 8.7 +/- 1.2 mg/l at 30 min and 11.0 +/- 1.8 mg/l at 4.5 h. There was no electrocardiographic evidence of serious cardiotoxicity during the 4.5-h infusion period, and systolic blood pressure fell by greater than 10 mm Hg in only one patient. Parasite clearance in 13 surviving patients (median count on admission, 438 x 10(3)/microliters; range, 500-122 x 10(4) took an average of 71 h (range, 9-115). This regimen is safe, effective, and suitable for use in an intensive care unit.
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PMID:A safe and effective consecutive-infusion regimen for rapid quinine loading in severe falciparum malaria. 218 12

Mefloquine, a quinoline-methanol antimalarial, is effective single dose therapy for all species of malaria infecting humans, including multi-drug-resistant Plasmodium falciparum. It is used both in prophylaxis and treatment. Mefloquine is available either as the hydrochloride salt alone, or in a combined preparation with sulfadoxine and pyrimethamine. There is no parenteral formulation. Several assay methodologies have been developed, but high performance liquid chromatography has been the most used in recent pharmacokinetic studies. These have shown in healthy volunteers that mefloquine is absorbed with a half-life of 1 to 4 hours and a time to peak concentration of 7 to 24 hours (median 16.7 hours). Mean peak blood concentrations have ranged between 50 and 110 (median 83) ng/ml/mg/kg. Estimates of total apparent volume of distribution (Vd/f) have ranged from 13.3 to 40.9 (median 19.2) L/kg, systemic clearance (CL/f) from 0.022 to 0.073 L/h/kg (median 0.026 L/h/kg), and terminal elimination half-life from 13.8 to 40.9 days (median 20 days). Systemic clearance appears to be increased in late pregnancy. In uncomplicated falciparum malaria, peak blood concentrations are 2 to 3 times higher than those in healthy subjects ranging from 112 to 209 (median 144) ng/ml/mg/kg because of contraction in the total apparent volume of distribution. Systemic clearance is usually reduced but elimination rates are increased (possibly because of reduced enterohepatic recycling). Mefloquine absorption appears to be reduced in severe falciparum malaria; plasma protein binding exceeds 98% in both healthy subjects and patients. No important drug interactions have been identified as yet, but the potential for serious interactions with quinine has not been adequately investigated. More studies are needed on the disposition of mefloquine in children.
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PMID:Clinical pharmacokinetics of mefloquine. 220 97

This overview of health programs and conditions in India reveals that health is related to economic development antipoverty measures, food production and distribution, drinking water supply, sanitation, housing, environmental protection, and education. There are urgent requirements for effective intersectorial coordination. Unprecedented growth of 1 million a year has resulted in slums and shanties--a place of epidemics; urbanization has contributed to environmental pollution impacting on health, and water pollution to water-born diseases. Health services are still insufficient to meet the needs. Sanitation practices contribute to cholera, dysentery, diarrhea, enteric fevers, and malaria. Indian Systems of Medicine and Homeopathy must be active in preventive and health care. Accomplishments include in 1987/8 a decline in leprosy cases attributed to the existence of leprosy control units. 40 AIDS Surveillance Units are actively treating and screening. The Naval Goitre Control Programme's goal is replacement of iodized salt for edible salt by 1992, thereby reducing mental retardation and low birth weight babies. The Family Welfare Programme, targets a New Production Rate of Unity before 2000. A National Technology Mission on immunization and the Universal Immunization Programme plans to be operational in all districts by 1990. Oral rehydration therapy programs dispense free packets to fill the needs of 1 million children under 5 who suffer from diarrhea 3 times a year with 3 million facing death. The Primary Health Care Programme provides iron and folic acid to women with nutritional anemia and Vitamin A to children. Health service developments have been increased.
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PMID:Status of health in India and its future prospects. 226 69


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