Comparative efficacy of Levamisole, Mebendalzole and Pyrantel Pamoate against common intestinal nematodes among children in Calabar, South-South Nigeria

Introduction: Continued endemicity of intestinal nematodes infestation in children in our environment despite availability of potent and safe anthelmintic drugs is of public health interest.Objective: This study assessed the comparative efficacy of selected anthelmintic drugs namely Mebendazole, pyrantel pamoate and levamisole-against common intestinal nematodes namely Ascaris lumbricoides, Hookworm (Ancylostoma duodenale and Necator amer icanus) and Trichuris trichuria in children in Calabar Municipality, South-South NigeriaMethod: One hundred and thirty eight pupils from four primary schools in Ikot Ishie/Ikot Ansa communities of Calabar with worm infestation (Ascaris, hookworm and Trichuris including mixed infestation) were randomized by simple balloting to one of the following anthelmintic drugs(Mebendazole 500mg, Pyrantel 10mg/kg or Levamisole 2.5mg/kg). The efficacy of the drugs was determined by the level of clearance of worm egg/ova from fresh stool samples of the pupils on post -treatment examination.Result: The study showed the three anthelmintic drugs displaying one hundred percent (100%) efficacy in respect of Ascaris and trichuris worms, but less so for hookworm. Mebendazole displayed 90.48%, Pyrantel 45.16%) and Levamisole (17.86%) efficacy level against hookworm.Conclusion: The overall result indicates that Mebendazole was the most efficacious agent against the three common intestinal worms.Keywords: Anthelminthic, nematodes, children, Nigeri

Artemisinin-naphthoquine versus Artemether-lumefantrine for treating uncomplicated plasmodium falciparum malaria in children: A randomized controlled trial of efficacy and safety

Introduction: Artemether-lumefantrine (AL), the most frequently prescribed ACTs for uncomplicated P. falciparum malaria, requires multiple doses which may militate against adherence. It is necessary to evaluate the efficacy and safety of single dose ACT like Artemisininnaphthoquine (ANQ) to enhance adherence.Methods: This was an open label randomized controlled clinical trial. Eligible children were assigned to receive either a single dose of ANQ or six doses of AL following parental consent. A total of 108 children aged 5 – 14years with uncomplicated falciparum malaria were enrolled and assigned as follows: 58 (ANQ) and 50 (AL). Participants were observed for 28 days and clinical and parasitological assessments carried out. Outcomes were  assessed based on World Health Organization protocol.Results: A total of 97 patients completed the study. Overall 28-day cure  rate was 87.0% (47/54) and 81.4% (35/43) for ANQ and AL respectively. One patient (2.2%) in the AL group had Early Treatment Failure while seven (16.3%) had Late Parasitological Failure (LPF). LPF was also reportedin seven (13.0%) patients in the ANQ group. There was no Late Clinical Failure. A mild selflimiting papular rash was noted in one child in ANQ group. There was no serious adverse event.Conclusions: The therapeutic efficacies of ANQ and AL were comparable.A more robust, adequately powered, dose optimization study with  PCR-confirmed parasitological  outcome measures is needed.Key words: Malaria, artemetherlume f a nt r ine , a r t emi s i nin -naphthoquine, adherence, single and multiple dose therap

Effectiveness of a 6-dose regimen of Artemether-Lumefantrine for unsupervised treatment of uncomplicated childhood malaria in Calabar, Nigeria

Background: The six dose regimen of Artemether- Lumefantrine (AL), has high efficacy in clinical trials and is the first -line drug for treating uncomplicated malaria in Nigeria. The complex dosage schedule could militate against its effectiveness.Objective: To assess the effectiveness of AL prescribed under routineoutpatient conditions in the treatment of uncomplicated malaria.Methods: An open label, noncomparative trial to assess the effectivenessof AL in children 6 to 59 months with uncomplicated P. falciparum and parasite density between 1,000 and 250,000/ìL. Enrolled children received 6-dose course of AL (20/120mg tablets). The first dose was administered in the health facility and caregivers were instructed on how to administerthe remaining five doses at home.Results: Of the 1035 screened, 215 eligible children were enrolled and193 completed the study. Twenty two (22) patients withdrew from thestudy (18 were lost to follow-up, 3 violated protocol and 1 withdrewconsent). Adequate clinical and parasitological response (ACPR) was observed in 90.7%; late clinical failure in 7 (3.6%) and late parasitologicalfailure in 11 (5.7%).Conclusion: This study showed high efficacy of AL in treating uncomplicatedP. falciparum malaria in under-fives in Nigeria. Adherence by caregivers to the treatment regimen was quite good and so, should continue to be used in the home setting.Key words: Artemetherlumefantrine, effectiveness, adherence, uncomplicated malaria

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: a protocol for a systematic review of human experimental studies

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE: Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA: We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS: Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: a protocol for a systematic review on human observational studies

BACKGROUND: Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES: To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS: We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA: Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES: We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD: Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS: The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL: To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING: This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION: PROSPERO CRD42021239432

Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) Study: formative protocol for mHealth platform development and piloting

BACKGROUND: There is a high unmet need for sexual and reproductive health (SRH) information and services among youth (ages 15-24) worldwide (MacQuarrie KLD. Unmet Need for Family Planning among Young Women: Levels and Trends 2014). With the proliferation of mobile technology, and its popularity with this age group, mobile phones offer a novel and accessible platform for a discreet, on-demand service providing SRH information. The Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) formative study will inform the development of an intervention, which will use the popular channel of SMS (text messages) to deliver SRH information on-demand to youth. METHODS/DESIGN: Following the development of potential SMS message content in partnership with SRH technical experts and youth, formative research activities will take place over two phases. Phase 1 will use focus group discussions (FGDs) with youth and parents/caregivers to develop and test the appropriateness and acceptability of the SMS messages. Phase 2 will consist of ‘peer piloting’, where youth participants will complete an SRH outcome-focused pretest, be introduced to the system and then have three weeks to interact with the system and share it with friends. Participants will then return to complete the SRH post-test and participate in an in-depth interview about their own and their peers’ opinions and experiences using ARMADILLO. DISCUSSION: The ARMADILLO formative stage will culminate in the finalization of country-specific ARMADILLO messaging. Reach and impact of ARMADILLO will be measured at later stages. We anticipate that the complete ARMADILLO platform will be scalable, with the potential for national-level adoption

Overexpression of activated ampk in the anopheles stephensi midgut impacts mosquito metabolism, reproduction and plasmodium resistance

Mitochondrial integrity and homeostasis in the midgut are key factors controlling mosquito fitness and anti-pathogen resistance. Targeting genes that regulate mitochondrial dynamics represents a potential strategy for limiting mosquito-borne diseases. AMP-activated protein kinase (AMPK) is a key cellular energy sensor found in nearly all eukaryotic cells. When activated, AMPK inhibits anabolic pathways that consume ATP and activates catabolic processes that synthesize ATP. In this study, we overexpressed a truncated and constitutively active α-subunit of AMPK under the control of the midgut-specific carboxypeptidase promotor in the midgut of female Anopheles stephensi. As expected, AMPK overexpression in homozygous transgenic mosquitoes was associated with changes in nutrient storage and metabolism, decreasing glycogen levels at 24 h post-blood feeding when transgene expression was maximal, and concurrently increasing circulating trehalose at the same time point. When transgenic lines were challenged with Plasmodium falciparum, we observed a significant decrease in the prevalence and intensity of infection relative to wild type controls. Surprisingly, we did not observe a significant difference in the survival of adult mosquitoes fed either sugar only or both sugar and bloodmeals throughout adult life. This may be due to the limited period that the transgene was activated before homeostasis was restored. However, we did observe a significant decrease in egg production, suggesting that manipulation of AMPK activity in the mosquito midgut resulted in the re-allocation of resources away from egg production. In summary, this work identifies midgut AMPK activity as an important regulator of metabolism, reproduction, and innate immunity in An. stephensi, a highly invasive and important malaria vector species. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]