A Randomised Controlled Trial of Artemether-Lumefantrine Versus Artesunate for Uncomplicated Plasmodium falciparum Treatment in Pregnancy

Rose McGready and colleagues show that an artemether-lumefantrine regimen is well tolerated and safe in pregnant Karen women with uncomplicated falciparum malaria, but efficacy is inferior to artesunate, probably because of low drug concentrations in later pregnancy

Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study

ObjectiveThe antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.MethodsFrom August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.ResultsSeroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.ConclusionAs HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies

Malaria in the Post-Partum Period; a Prospective Cohort Study

Background: Several studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent. Methods: In an area of low seasonal malaria transmission on the Thai-Myanmar border pregnant women attending antenatal clinics were matched to a non-pregnant, non-post-partum control and followed up prospectively until 12 weeks after delivery. Results: Post-partum women (n = 744) experienced significantly less P.falciparum episodes than controls (hazard ratio (HR) 0.39 (95%CI 0.21-0.72) p = 0.003) but significantly more P.vivax (HR 1.34 (1.05-1.72) p = 0.018). The reduced risk of falciparum malaria was accounted for by reduced exposure, whereas a history of P.vivax infection during pregnancy was a strong risk factor for P.vivax in post-partum women (HR 13.98 (9.13-21.41), p <0.001). After controlling for effect modification by history of P.vivax, post-partum women were not more susceptible to P.vivax than controls (HR: 0.33 (0.21-0.51), p <0.001). Genotyping of pre- and post-partum infections (n circle plus = circle plus 10) showed that each post-partum P.falciparum was a newly acquired infection. Conclusions: In this area of low seasonal malaria transmission post-partum women were less likely to develop falciparum malaria but more likely to develop vivax malaria than controls. This was explained by reduced risk of exposure and increased risk of relapse, respectively. There was no evidence for altered susceptibility to malaria in the post-partum period. The treatment of vivax malaria during and immediately after pregnancy needs to be improve

Ergodicity of Traffic Flow with Constant Penetration Rate for Traffic Monitoring via Floating Vehicle Technique

Traffic congestion in Asian megacities has become extremely worse, and any means to lessen the congestion level is urgently needed. Building an efficient mass transportation system is clearly necessary. However, implementing Intelligent Transportation Systems (ITS) have also been demonstrated effective in various advanced countries. Recently, the floating vehicle technique (FVT), an ITS implementation, has become cost effective to provide real-time traffic information with proliferation of the smartphones. Although many publications have discussed various issues related to the technique, none of them elaborates the discrepancy of a single floating car data (FCD) and the associated fleet data. This work addresses the issue based on an analysis of Sugiyama et al's experimental data. The results indicate that there is an optimum averaging time interval such that the estimated velocity by the FVT reasonably representing the traffic velocity

Hazard ratios for different factors for <i>P.falciparum</i> and <i>P.vivax</i> during the 12 weeks post-partum follow-up.

<p>Hazard ratios for different factors for <i>P.falciparum</i> and <i>P.vivax</i> during the 12 weeks post-partum follow-up.</p

Characteristics of post-partum women and controls.

<p>Data presented as mean ± standard deviation, median (inter quartile range), [min-max] or n (%). NS; not significant</p

Schematic flow diagram of the enrolment process and study follow-up during pregnancy and post-partum.

<p>Schematic flow diagram of the enrolment process and study follow-up during pregnancy and post-partum.</p

Observations during study follow-up in post-partum mothers and controls.

<p>Data presented as n (%). NS; not significant</p