Therapeutic responses of Plasmodium vivax and P. falciparum to chloroquine, in an area of western India where P. vivax predominates

In 2003-2005, following an increase in the local incidence of human malaria, the therapeutic efficacy of chloroquine (CQ) in the treatment of Plasmodium vivax and P. falciparum malaria was evaluated in the Anand district of Gujarat state, in western India. After oral administration of CQ, clinical and parasitological responses were measured over a follow-up period of 28 days, following the standard protocol of the World Health Organization. Most of the recurrent infections were checked, by genotyping, to see whether they were the result of treatment failure or re-infection during the follow-up. At the primary health centre (PHC) in Deva, all 57 P. vivax cases included in the study responded to CQ within 3 days. At the Pansora PHC, however, only 59 [90.8%, with a 95% confidence interval (CI) of 83.7%-97.8%] of the 65 P. vivax cases appeared to respond completely, recurrent infections being observed in the other six cases (9.2%; CI=2.2%-16.3%). Of the four recurrent infections checked by genotyping, however, only two appeared to be the result of true treatment failure. Twenty-seven (81.8%; CI=67.2%-94.4%) of the 33 P. falciparum cases who were enrolled in the study, all from Pansora PHC also showed apparent treatment failure, with one early failure, 17 late clinical failures and nine late parasitological failures. All 23 P. falciparum cases that showed apparent treatment failure and were investigated by genotyping appeared to be true cases of failure, none showing any evidence of re-infection during follow-up. The mean parasite-clearance times for those infected with P. falciparum, both those considered CQ-sensitive and the treatment failures, exceeded 2 days. These results indicate the presence of CQ-resistant P. vivax and P. falciparum in Anand district. The high frequency of CQ failure against P. falciparum observed in this study led to a change in the drug policy at the Pansora PHC, with artemisinin-based combination therapy now being used for the first-line treatment of P. falciparum malaria. Chloroquine remains the recommended first-line treatment for P. vivax infections in the area but the treatment failure seen in at least two P. vivax cases indicates a need for further monitoring of the therapeutic efficacy of CQ against such infections, in central Gujarat and elsewhere.

Allelic polymorphism in the Plasmodium vivax dihydrofolate reductase gene among Indian field isolates

In total, 129 Plasmodium vivax isolates from different geographical areas in India were analysed for point mutations in the P. vivax dihydrofolate reductase gene that were associated with pyrimethamine resistance. A gradual increase in the frequency of mutant genotypes was observed from north to south (p <0.0001). In the northern region (Delhi, Panna and Nadiad), the wild-type genotype was most prevalent, while the mutant genotype predominated in the coastal regions of southern India (Navi Mumbai, Goa and Chennai). Isolates from the Car-Nicobar islands showed only mutant genotypes. The differential geographical pattern of mutations may be associated with the transmission pattern.

Hyperhomocysteinemia masquerading as pulmonary embolism

We describe a 30-year-old male who presented with acute onset of breathlessness, tachycardia, and palpitations associated with distension of jugular vein and clear lungs on physical examination. The chest X-ray was normal and ECG was showing S1Q3T3 and right ventricular strain pattern. His 2-D echocardiography was showing dilated right atrium, right ventricular dilatation and moderate pulmonary arterial hypertension. He was found to have thrombosis involving left side of deep venous system with normal superficial venous system (Doppler proved). All routine blood investigations for etiology of recurrent DVT were normal except serum homocyteine level, which was significantly raised. Megaloblastic anemia on peripheral smear and hyperhomocysteinemia prompted us to search for its cause, which was subsequently found to be vitamin B12 deficiency. Such an association of megaloblastic anemia due to vitamin B12 deficiency leading to hyperhomocysteinemia and subsequent thrombosis in left venous system presenting as acute pulmonary embolism has not been described earlier in the medical literature.

Place and personal circumstances in a multilevel account of women's long-term illness

This paper investigates geographical variations in women's reports of limiting long-term illness in terms of individual inequalities and the contribution of area characteristics among wards and county districts. We use multilevel modelling of linked census data from the Office for National Statistics Longitudinal Study for England and Wales. We follow a random sample of 76.374 women aged between 16 and 45 at the time of the 1971 Census for 20 years to observe their reported limiting long-term illness (LLTI) at the 1991 Census. Car and home ownership were useful markers of social and material advantage, apparently protecting against the risk of reporting LLTI. Migration into the South-East region appeared beneficial, but otherwise there was little difference between those who moved home and those who did not. Differences between county districts persist after adjustment for individual circumstances (education and ethnicity), but almost all of these differences are explained by the social profile of wards in these areas. Geographical differences in LLTI are not, therefore, entirely explained by the distribution of individual characteristics: a woman with the same history may face a different risk of illness in different kinds of area. For women, the social composition of the locality (using the ward as a proxy) is more relevant than the broader economic and industrial classification of the surrounding county district, which is more important for health inequalities among men.

Flexible sigmoidoscopy in general practice

OBJECTIVE: Flexible sigmoidoscopy (FS) is increasingly being accepted as the method of choice for initial investigation of rectal bleeding and other lower gastrointestinal symptoms. The aim of this study was to assess the feasibility of FS in general practice and to compare the yield, cost and efficiency of a service provided by a consultant surgeon and a General Practitioner (GP). SUBJECTS AND METHODS: A prospective study of FS was undertaken on 430 unsedated patients with symptoms suggestive of lower bowel disease in two general practices. RESULTS: The yield was comparable to hospital based data. Fifteen (3.5%) cancers were detected, of which 40% were Dukes A, and 46 (10.7%) adenomatous polyps. Cost per patient examination by a GP including capital costs, depreciation of equipment, and training was calculated to be cheaper or at least equivalent to a hospital-based service but inefficient due to the low numbers examined per month. There were no complications and no missed cancers after a minimum follow up of 2 years. CONCLUSIONS: The results suggest that FS can be safely performed by a suitably trained GP in health centres, but better utilization of equipment and value for money would be obtained by providing the service for a group of practices rather than a single practice as in this study.

Children's family change: reports and records of mothers, fathers and children compared

Family change, when adults depart or arrive around children, raises policy issues. Its measurement depends upon the evidence collected and from whom. This paper compares British children's histories obtained from fathers and mothers. The evidence, on one birth cohort of parents, comes from two sources: the National Child Development Study and the ONS Longitudinal Study. The resulting account of family change is not substantially different between parents. There is some under-reporting of children not living with their fathers. This is due to under-reporting by those included in the studies and to under-representation in them of absent fathers and lone parents.

In vitro immunity of rat peritoneal macrophages to Candida albicans

Phagocytic, germ tube inducing and candidacidal activities were investigated in monolayers of peritoneal macrophages of rats. The phagocytic activities observed in macrophages of the healthy rats in the presence of normal serum, those in the presence of immune serum and of immunized rats in the presence of normal serum were 40%, 45.3% and 44.8% respectively. The percent of macrophages in which intracellular Candida formed germ tubes in the above three situations were 10, 9.59 and 10.19, respectively and the percent of intracellular Candida that formed germ tubes were 6.6, 3.7 and 4.1, respectively. The candidacidal activity observed in the above three sets of macrophages were 5.33%, 22.66% and 19.88%, respectively. Induction of germ tube in C. albicans in supplemented tissue culture medium containing normal serum was 15 per cent. These observations indicate that immunisation/sensitisation of individuals with C. albicans organisms does provide some degree of cell mediated immunity by activating macrophages. This may partly be due to the appearance of specific antibodies. It is likely that this type of immunity can be produced by subclinical infections during invasion by the commensal organism thus preventing further invasion establishment of infection and keeping the organism (C. albicans) in a state of commensalism. However, the degree of immunity so produced is so low that predisposing factors suppress it and allow establishment of infection.

Studies on Anopheles fluviatilis and Anopheles culicifacies sibling species in relation to malaria in forested hilly and deforested riverine ecosystems in northern Orissa, India

In a malaria-endemic region in northwestern Orissa, India, a longitudinal study was undertaken to delineate information on the sibling species of Anopheles fluviatilis and Anopheles culicifacies and their bionomics and role in malaria transmission in forested and deforested ecosystems. In forested villages, An. fluviatilis sibling species S (97.97%) and T (2.02%) were present. The former was highly anthropophagic (human blood index 0.88). Among the sibling species of An. culicifacies, species B (27.96%), C (71.1%), and B/C heterozygotes (0.94%) were present and were highly zoophagic. In deforested riverine villages An. fluviatilis was nearly absent and An. culicifacies sibling species A (0.48%), B (21.1%), C (77.94%), and B/C heterozygotes (0.48%) were present. In forested villages, the annual parasite incidence (269 cases/1,000) and the slide positivity rate (45%) were significantly higher than those in deforested areas, which had values of 39 cases/1,000 and 27%, respectively. The study showed that the high endemicity of malaria in the forested villages was due primarily to 2 vectors, the high rate of anthropophagy of An. fluviatilis species S, and also the more favorable ecological conditions for this vector.

Do attitude and area influence health? A multilevel approach to health inequalities

This paper demonstrates an area effect on health and suggests improvements in research practice for work in this field. We use an area classification which can be related clearly to factors that influence the health of individuals and take account of people's differing propensities to draw influence from their area. Multilevel analysis demonstrates that the degree of deindustrialisation which an area experienced in Britain, in the 1980s, has an independent association with the health of resident individuals. A significant relationship between a person's attitude to their community and their health is shown to be independent of individual and area characteristics. We conclude that both individual and area characteristics influence health.

Beta-adrenergic and fibroblast growth factor receptors induce neuronal process outgrowth through different mechanisms

The mechanisms that initiate and direct neuronal process formation remain poorly understood. We have recently described a neuronal progenitor cell line, AS583-8.E4.22 (AS583-8) which undergoes neurite formation in response to beta2-adrenergic and basic fibroblast growth factor (bFGF) receptor activation [Kwon, J.H. et al., (1996) Eur. J. Neurosci., 8, 2042-2055]. In the present study, a comparison of these responses revealed that isoproterenol (ISO), a beta-adrenergic receptor agonist, induces multiple, highly branched processes within 30 min while bFGF induces fewer, unbranched processes within 24 h. In contrast to the ISO response, bFGF induces mitogen-activated protein kinase activation and c-fos expression in the cell line and results in neurite outgrowth that is dependent on new mRNA and protein synthesis. Two-dimensional isoelectric focusing-sodium dodecyl sulphate-polyacrylamide gel electrophoresis of cytoskeletal preparations revealed different patterns following ISO vs. bFGF exposure suggesting selective changes in protein expression and/or post-translational modifications. Immunoblot analysis of these preparations for beta-tubulin, tyrosinated alpha-tubulin and acetylated alpha-tubulin also revealed different patterns following each type of treatment. Follow-up confocal microscopy revealed that following ISO, the distribution of tyrosinated tubulin extends to the distal ends of processes whereas acetylated alpha-tubulin is diminished within distal ends. This pattern has been reported to be associated with enhanced microtubule dynamics, a state in which process outgrowth is facilitated. In contrast, following bFGF treatment the distributions of tyrosinated and acetylated alpha-tubulin were identical, a state associated with a diminution of microtubule dynamics. These results, a different time course of neurite formation, dependency on new gene expression and differential expression and cellular distribution of major cytoskeleton proteins suggest that neurite outgrowth induced by ISO vs. bFGF is mediated by two distinct intracellular effector mechanisms in AS583-8 cells. In addition, studies, using the differential distribution of post-translational modified alpha-tubulins in neurites of primary neuronal cultures as marker for the two distinct processes of neurite formation suggest, that similar mechanisms are present in vivo. Therefore, the AS583-8 cell line provides a useful model to study these signalling mechanisms that couple neurotransmitter and growth factor receptor activation to the cytoskeletal changes that mediate neurite formation.

Epidemiology of echinococcosis in Nepal

Echinococcosis and hydatidosis is a parasitic zoonotic disease of human and animals. This disease has created public health and environment problems in all urban areas of Nepal. Based on the three year study (1993-1995) it has been revealed that the epidemiological cycle (indigenous) of Echinococcus granulosus parasite is dog-pig-dog cycle and human acquire infection accidentally through infected dog stool. However, this study has proved also the epidemiological cycle like dog-sheep-dog, dog-goat-dog and dog-buffalo-dog. This study was supported by International Development Research Centre (IDRC), Ottawa, Canada.

Studies on bionomics of Anopheles fluviatilis and its sibling species in Nainital district, U.P

A study on the bionomics of Anopheles fluviatilis sensu lato was carried out in two physiographic regions, viz. Bhabar and Terai of District Nainital, Uttar Pradesh. In both areas, An. fluviatilis was found resting indoors predominantly in cattlesheds. Cytological examination of An. fluviatilis revealed that species T and U were sympatric in Bhabar and Terai villages with predominance of species T. These two sibling species appear to be poor vectors of malaria.

Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study

STUDY OBJECTIVE

To investigate the association between the level of social deprivation in electoral wards and various life events. Life events include mortality, self reported long term illness, and for women: still-birth, underweight birth, birth while a teenager, and sole registered birth. Associations with area deprivation are tested before and after allowing for levels of personal deprivation.

DESIGN

Prospective census follow up using the Office for National Statistics Longitudinal Study.

SETTING

England and Wales.

PARTICIPANTS

A random sample of more than 300,000 people enumerated at the 1981 census, and aged 10 to 64 in 1981. Some analyses are necessarily restricted to certain age/sex groups.

OUTCOME MEASURES

Several outcomes in the decade 1981-1992 are investigated: risk of premature death (before age 70, all cause), risk of long term limiting illness in 1991, and risk of inauspicious fertility outcomes in women.

MAIN RESULTS

Without adjusting for personal circumstances all outcomes, except risk of stillbirth, show a clear, significant, and approximately linear association with social deprivation of ward of residence in 1981. Associations are much stronger for outcomes where a greater "social" component can be constructed (teenage birth, sole registered birth) than for outcomes that are probably more physiologically determined (mortality, stillbirth, low birth weight). When adjustment is made for personal disadvantage the simple associations with local area deprivation are all attenuated, especially for those living in the more deprived areas.

CONCLUSIONS

A variety of adverse or "inauspicious" life events show association with residence in more deprived areas. These are particularly strong for teenage birth and sole registered birth, but are also stronger for long term illness than mortality. These associations seem to be largely because residence in more deprived areas is associated with personal disadvantage, which is more damaging to life chances than area of residence. For some outcomes there is evidence that the personally disadvantaged fare less well if living in relatively advantaged areas, than if living in more homogenously deprived areas.

The opportunity costs of childbearing: more than mothers' business

"This paper is an argument about gender relations. It takes the entwined themes of men's interests in parenthood, the sex division of labour and its evolution, policy for gender equity and policy to support the level of social reproduction. The emphasis on women's employment as a determinant of low fertility has to be supplemented by an examination of the assumption that only women's time use is affected by child-rearing.... Descriptive evidence about the paid and unpaid work of couples and parents is presented, largely secondary material from the UK."

Genetic structure of Plasmodium vivax isolates in India

Variations in the allelic composition of glucose phosphate isomerase (GPI), NADP-dependent glutamate dehydrogenase (GDH) and adenosine deaminase (ADA) enzyme systems of Plasmodium vivax were observed in isolates of Indian origin in 1985-1993. No significant difference was observed in allelic frequencies in different years. The data indicated random distribution of GPI, GDH and ADA alleles among the isolates, suggesting that loci for these enzymes were not linked. A high proportion of the isolates comprised at least 2 genetically distinct clones, the mean number of clones per isolate being 1.4. There was no significant difference in the number of oocysts in Anopheles stephensi fed on uniclonal and multiclonal isolates. No difference was observed in the proportions of uniclonal and multiclonal isolates during low and high transmission periods.

Women's health: dimensions and differentials

This paper is concerned with the social patterning of ill-health amongst women in Britain. It uses the various health measures available in the Health and Lifestyle Survey (self-assessed health, disease/disability, illness, psycho-social well-being and fitness) to explore whether there are particular aspects of health systematically associated with social advantage and disadvantage, as measured by current or last occupation, employment status, household composition and household income. Among women aged 18-59, after controlling for age, number of psychological symptoms experienced in the past month showed the greatest social variation. Number of physical illness symptoms in the last month showed the least. Lone mothers with dependent children were found to have particularly poor psycho-social health, although this was confined to those in full-time employment. The presence of a long-standing disease/disability proved useful as a control for the influence of health selection in to and out of both employment and motherhood.

Anopheles fluviatilis complex: host feeding patterns of species S, T, and U

The host feeding specificity of Anopheles fluviatilis sibling species S, T, and U was determined by analyzing blood meal source using countercurrent immunoelectrophoresis. A distinct difference in the feeding patterns was observed among these species. Species S was found to be predominantly anthropophagic with 91% of the population having fed on human blood. In contrast, species T and U were either exclusively or primarily zoophagic.