Therapeutic efficacy of artemether-lumefantrine in uncomplicated falciparum malaria in India

<p>Abstract</p> <p>Background</p> <p>Artemisinin-based combination therapy (ACT) is the treatment of choice for uncomplicated falciparum malaria. Artemether-lumefantrine (AL), a fixed dose co-formulation, has recently been approved for marketing in India, although it is not included in the National Drug Policy for treatment of malaria. Efficacy of short course regimen (4 × 4 tablets of 20 mg artemether plus 120 mg lumefantrine over 48 h) was demonstrated in India in the year 2000. However, low cure rates in Thailand and better plasma lumefantrine concentration profile with a six-dose regimen over three days, led to the recommendation of higher dose globally. This is the first report on the therapeutic efficacy of the six-dose regimen of AL in Indian uncomplicated falciparum malaria patients. The data generated will help in keeping the alternative ACT ready for use in the National Programme as and when required.</p> <p>Methods</p> <p>One hundred and twenty four subjects between two and fifty-five years of age living in two highly endemic areas of the country (Assam and Orissa) were enrolled for single arm, open label prospective study. The standard six-dose regimen of AL was administered over three days and was followed-up with clinical and parasitological evaluations over 28 days. Molecular markers <it>msp</it>-<it>1 </it>and <it>msp</it>-2 were used to differentiate the recrudescence and reinfection among the study subjects. In addition, polymorphism in <it>pfmdr</it>1 was also carried out in the samples obtained from patients before and after the treatment.</p> <p>Results</p> <p>The PCR corrected cure rates were high at both the sites viz. 100% (n = 53) in Assam and 98.6% (n = 71) in Orissa. The only treatment failure case on D7 was a malnourished child. The drug was well tolerated with no adverse events. Patients had pre-treatment carriage of wild type codons at positions 86 (41.7%, n = 91) and 184 (91.3%, n = 91) of <it>pfmdr1 </it>gene.</p> <p>Conclusion</p> <p>AL is safe and effective drug for the treatment of acute uncomplicated falciparum malaria in India. The polymorphism in <it>pfmdr</it>1 gene is not co-related with clinical outcome. However, treatment failure can also occur due to incomplete absorption of the drug as is suspected in one case of failure at D7 in the study. AL can be a viable alternative of artesunate plus sulphadoxine/pyrimethamine (AS + SP), however, the drug should be used rationally and efficacy needs to be monitored periodically.</p

A Culturally-Tailored Smoking Cessation Intervention for Latinos

Leading causes of death among Latinos in the U.S include cancer (of which, lung cancer is the most frequent cause of cancer death), heart disease, unintentional injuries, and stroke. Three of these four causes have a relationship with smoking. Compared to other ethnic and racial groups, Latinos face low smoking cessation treatment success rates due to low compliance with pharmacotherapy, restricted accessibility to health care, poor smoking cessation treatment outcomes, under-utilization of existing services. Despite making up nearly 20% of the U.S population, few studies have explored smoking cessation interventions among Latino smokers. This study piloted a Culturally Tailored (CT), a CT plus Adherence Enhancing (AE), and a Health Education (HE) intervention for smoking cessation among Latino adults in the Greater Houston area. These treatment conditions were randomized. High levels of counseling session return and retention rates indicated a success of intervention methods. Satisfaction survey results further confirmed the likability of these trials. Additionally, those assigned to the CT+AE group had significantly greater nicotine replacement therapy (NRT) means, suggesting the targeted adherence and cultural sensitivity strategies improved levels of nicotine patch use.Honors CollegePsychological, Health, and Learning Sciences, Department o

Quality of life assessment in children and their caregivers suffering from allergic rhinitis and/or asthma

INTRODUCTION: Asthma and allergic rhinitis (AR) are among the most prevalent diseases worldwide and they frequently persist throughout the life. These have significant effect on physical, financial, and mental wellbeing of patients and caregivers. There have been few attempts previously, assessing the quality of life (QOL) in affected families suffering from these diseases. However, the data from developing countries are scarce. QOL assessment in children and caregivers of patients suffering can help in symptomatic management and provide inputs for the better utilization of resources to achieve optimal treatment. MATERIALS AND METHODS: Patient and caregiver QOLs were ascertained using Mini Pediatric Asthma QOL Questionnaire and Pediatric Asthma Caregiver's QOL Questionnaire, respectively, in the study and correlated with disease severity and chronicity using the parametric and nonparametric statistical tools. RESULTS: There were 246 pairs of children diagnosed with asthma and/or AR and their caregivers attending the pediatric allergy and asthma clinic. Symptom score, emotional domain, and activity limitation in children did not validate a statistically significant difference in QOL in the various grades of AR/asthma/AR with asthma (P = 0.632) (P = 0.772) (P = 0.496) (P = 0.918) (P = 0.384) and (P = 0.561), respectively. In addition, there was no significant correlation between the severity of asthma and caregiver emotional disturbance (P = 0.594) or caregiver activity limitation (P = 0.446). CONCLUSIONS: QOL in children and caregivers where children are suffering from either AR or asthma, or both has not shown any significant difference as per the disease severity or chronicity in various domains. There was no significant difference in QOL noted as per the change in age group, gender of patients, or education status of caregivers