Defining the cost of the Egyptian lymphatic filariasis elimination programme

BACKGROUND: Lymphatic filariasis (LF) is targeted for global elimination. LF elimination programmes in different countries, including Egypt, are supported financially by national and international agencies. The national programme in Egypt is based on mass drug administration (MDA) of an annual dose of a combination of 2 drugs (DEC and albendazole) to all endemic villages. This study aimed primarily to estimate the Total and Government costs of two rounds of MDA conducted in Egypt in 2000 and 2001, the average cost per person treated, and the cost share of the different programme partners. METHODS: The Total costs reflect the overall annual costs of the MDA programme, and we defined Government costs as those expenditures made by the Egyptian government to develop, implement and sustain the MDA programmes. We used a generic protocol developed in coordination with the Emory Lymphatic Filariasis Support Center. Our study was concerned with all costs to the government, donors and other implementing parties. Cost data were retrospectively gathered from local, regional and national Ministry of Health and Population records. The total estimates for each governorate were based on data from a representative district for the governorate; these were combined with national programme data for a national estimate. RESULTS: The overall Total and Government costs for treating approximately 1,795,553 individuals living in all endemic villages in the year 2000 were US $3,181,000 and US$2,412,000, respectively. In 2001, the number of persons treated increased (29%) and the Total costs were US $3,109,000 while Government costs were US$2,331,000. In 2000, the average Total and Government costs per treated subject were US $1.77 and$1.34, respectively, however, these costs decreased to US $1.34 and$1.00, respectively in 2001. The coverage rate was 86.0% in 2000 and it increased to 88.0% in 2001. CONCLUSION: The Egyptian government provided 75.8% of all resources, as reflected in the Total cost estimates, and international agencies contributed the rest. Such data highlight both the commitment of the Egyptian government and the significance of the contributions of international bodies toward the LF elimination programme

Breast cancer resistance protein (BCRP) gene expression in a cohort of adult Egyptian patients with acute myeloid leukemia

Background: Acute myeloid leukemia (AML), an aggressive clonal disease, is genetically heterozygous. The prognostic role of expression of Breast Cancer Resistance Protein (BCRP) gene, which behaves as a multidrug transporter, in adult AML is ambiguous. Objective: The objective is to assess the level of mRNA expression of BCRP gene in newly diagnosed cytogenetically normal adult Egyptian AML patients; and to clarify its potential influence and association between therapeutic responsiveness and disease free survival.Methods: The BCRP gene expression was evaluated by quantifying its mRNA using real time RT-PCR in fifty newly diagnosed cytogenetically normal adult AML patients and 20 healthy normal controls. The expression was evaluated in relation to clinical and prognostic factors, response to treatment and the survival rate. Results: BCRP mRNA was over expressed in adult AML patients compared to controls. This study showed a positive statistical correlation between BCRP gene expression and the percent of CD34 expression. Statistical analysis did not reveal  any association between BCRP expression level and chemotherapeutic responsiveness or disease free survival rate. Conclusion: The significance of BCRP gene expression and its function in AML is very complicated, therefore more standardized clinical studies are needed.Keywords: BCRP, adult AML, gene expression, prognosis, Egypt

COMPARATIVE TOXICITY STUDY OF CHLOROQUINE AND HYDROXYCHLOROQUINE ON ADULT ALBINO RATS

Expanded use of Chloroquine and hydroxychloroquine drugs for non-malarial disease entities has resulted in prolonged duration of therapy and higher daily dosages leading to cumulative doses greater than those used in antimalarial therapy. The aim of the study is to evaluate and compare the toxic effects of chloroquine and hydroxychloroquine on different organs of albino rats. The study was conducted on 60 normal albino rats divided into 3 groups, the 1st group is the control group that received only distilled water, the 2nd and the 3rd group were given a single daily oral doses equivalent to 1/10th of LD50 chloroquine and hydroxychloroquine respectively. Assessment of liver and kidney functions, and histopathological changes in liver, kidney, and heart in different groups was done. The chloroquine treated group showed significant elevation of serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), total bilirubin (TB), serum creatinine-urea (Cr-U), Creatine Kinase-MB, C-reactive protein and Malonic dialdehyde levels as compared to control and hydroxychloroquine treated group. The histopathological evaluation showed marked hydropic degeneragtion, vascular congestion, interstitial hemorrhage, and necrosis in the liver, kidney and heart of chloroquine treated group, while hydroxychloroquine treated group showed mild congestion and slight cellular degeneration. Thus, hydroxychloroquine is less toxic and physicians should prescribe it better than chloroquine. Chloroquine if prescribed for therapeutic uses should be taken for short periods

A critical appraisal of molecular xenomonitoring as a tool for assessing progress toward elimination of lymphatic filariasis

We used molecular xenomonitoring (MX, detection of filarial DNA in mosquitoes) to evaluate the impact of mass drug administration (MDA) in sentinel locations in Egypt with high (11.5%) and low (4.1%) baseline microfilaria prevalence rates. Blood-fed Culex pipiens were pooled by household and tested for Wuchereria bancrofti DNA by PCR. There was no significant relationship between the infection status of household residents and parasite DNA status of mosquitoes from the same houses. After 5 MDA rounds, parasite DNA rates in mosquitoes in high- and low-prevalence areas were reduced by 93.8% and 100% to 0.19% (95% CI: 0.076–0.382%) and 0% (95% CI: 0–0.045%), respectively. These changes were consistent with decreases in microfilaria prevalence rates in these sites; they provide insight regarding the minimal mosquito DNA rates necessary for sustained transmission of filariasis in Egypt. We conclude that MX is a powerful tool for monitoring the impact of MDA on filariasis endemicity and transmission

Detection of Wuchereria bancrofti L3 Larvae in Mosquitoes: A Reverse Transcriptase PCR Assay Evaluating Infection and Infectivity

Lymphatic filariasis is a disabling and disfiguring disease caused by a parasite that is transmitted by a mosquito. The life cycle of the parasite requires two hosts: the mosquito vector and the human host. Part of the developmental life cycle of the parasite occurs in the mosquito and the other part in the human host. The parasite develops through four stages in the mosquito, only the last of which is infectious to humans. The third larval stage (L3) is the infective stage that initiates human infections when infective mosquitoes bite humans. There is currently a global program attempting to eliminate this disease by administering drugs to affected communities with the goal of interrupting transmission of the parasite. The new diagnostic tool described in this paper uses molecular techniques to specifically detect the infective stage of the parasite in mosquitoes. Many mosquitoes can be tested at one time to assess the risk of ongoing transmission of filariasis in communities. In addition, this new L3-detection assay can simultaneously detect whether the mosquitoes contain ‘any-stage’ of the parasite. This provides information on infection rates in humans in the community. Both pieces of information can be used in assessing the progress of disease elimination efforts

COMPARATIVE TOXICITY STUDY OF CHLOROQUINE AND HYDROXYCHLOROQUINE ON ADULT ALBINO RATS

Expanded use of Chloroquine and hydroxychloroquine drugs for non-malarial disease entities has resulted in prolonged duration of therapy and higher daily dosages leading to cumulative doses greater than those used in antimalarial therapy. The aim of the study is to evaluate and compare the toxic effects of chloroquine and hydroxychloroquine on different organs of albino rats. The study was conducted on 60 normal albino rats divided into 3 groups, the 1st group is the control group that received only distilled water, the 2nd and the 3rd group were given a single daily oral doses equivalent to 1/10th of LD50 chloroquine and hydroxychloroquine respectively. Assessment of liver and kidney functions, and histopathological changes in liver, kidney, and heart in different groups was done. The chloroquine treated group showed significant elevation of serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), total bilirubin (TB), serum creatinine-urea (Cr-U), Creatine Kinase-MB, C-reactive protein and Malonic dialdehyde levels as compared to control and hydroxychloroquine treated group. The histopathological evaluation showed marked hydropic degeneragtion, vascular congestion, interstitial hemorrhage, and necrosis in the liver, kidney and heart of chloroquine treated group, while hydroxychloroquine treated group showed mild congestion and slight cellular degeneration. Thus, hydroxychloroquine is less toxic and physicians should prescribe it better than chloroquine. Chloroquine if prescribed for therapeutic uses should be taken for short periods