Relapse/reinfection patterns of Plasmodium vivax infection: a four year study

In an endemic area relapse and reinfection in Plasmodium vivax cases poses serious problems for the malaria control program. We have studied the relapse/reinfection patterns of P. vivax infection in 26 villages of District Shahjahanpur, a malaria endemic area of UP, India for a period of four years (May, 1986 to October, 1988). All the P. vivax cases were given a complete course of radical treatment and were followed-up for relapse/reinfection. There were 8,914, 2,484, 1,439 and 883 P. vivax cases in 1986, 1987 and 1989 respectively, our of which 2,066, 141, 58 and 18 cases in the respective years showed relapse/reinfection. The maximum number of relapse/reinfection was recorded from a 47 year old male patient, who suffered from P. vivax infection eight times. The percentage occurrence of relapse/reinfection was much higher (70.2%) in males compared with females (29.8%). Relapses were more common among 16-30 years old patients. In conclusion it was felt that in 1986 relapse/reinfection in vivax cases was higher due to improper treatment of these cases. This situation may have occurred due to lack of awareness among the public, poor surveillance by the National Malaria Program or higher density of the vector mosquitos in the area.

Culture of Gambusia affinis with food fishes

Culture of Gambusia affinis along with carps in fish culture practice in village ponds in Shahjahanpur distt., U.P., has revealed very little difference in fish productivity (1539 kg/ha in ponds with Gambusia, 1572 kg/ha in ponds without Gambusia). The growth and survival of Gambusia were found to be good in most of the composite fish culture ponds. Culture of Gambusia along with edible fish in village ponds is, therefore, recommended to get the dual benefit of fish production and control of mosquito proliferation in village ponds.

Evaluation of mosquito fish Gambusia affinis in the control of mosquito breeding in rice fields

The mosquito control potential of Gambusia affinis, a mosquito fish, was evaluated in rice fields in the Shahjahanpur district of Uttar Pradesh. This fish, at a stocking rate of 5 fishes/sq m, significantly reduced the larval and pupal densities in experimental fields as compared to control fields during the entire observation period of 42 days. Control of mosquito breeding in rice fields through this fish seems to be promising.

Observations on the breeding of anophelines in rice fields of Shahjahanpur district, Uttar Pradesh

Studies on ecological succession and association of anophelines in selected paddy fields of Dadraul PHC were carried out in 1988 during the paddy cultivation period from June to October. Breeding of five anophelines was observed in paddy fields. Out of the adults that emerged from larval collections the percentage of An. subpictus was the highest followed by An. nigerrimus, An. culicifacies, An. annularis and An. barbirostris. Further, An. culicifacies and An. subpictus breeding occurred in the early stage of rice cultivation and stopped before the breeding of An. nigerrimus started i.e., nearly 30 days after rice transplantation. An. nigerrimus breeding continued till harvesting. An inverse correlation between larval density of both An. culicifacies and An. subpictus and the height of the rice plants was observed.

Bionomics of Anopheles culicifacies giles in riverine tract rural areas of district Shahjahanpur, Uttar Pradesh

Studies on seasonal prevalence, resting behaviour, gonotropic conditions and breeding habits of Anopheles culicifacies were carried out from January 1987 to December 1989 in riverine villages of Dadraul PHC in Shahjahanpur district, Uttar Pradesh. Man hour densities of An. culicifacies varied from 11.3 to 125.1 during the study period. The species showed two peaks of high prevalence: one during March to June and the other during October to December. The first peak was higher than the second. The collection revealed a higher proportion of freshly fed to semi-gravid females thus indicating the outdoor resting behaviour of the species. From the immatures collected from riverbed pools, 7 anopheline species were identified. Of the 955 specimens identified, An. culicifacies constituted the highest number (62.1%). The study indicates that low rainfall and drought did not affect An. culicifacies densities or malaria transmission in riverine areas.

Primaquine: its effect on cellular immune response of normal rhesus monkeys

The effect of primaquine on the cellular immune responses (lymphocyte subpopulations and their proliferative responses with PHA, Con-A and LPS, and phagocytosis by monocytes) of normal rhesus monkeys was studied under both in-vivo and in-vitro conditions. When the lymphocytes and monocytes from normal animals were treated in-vitro with primaquine, at concentration normally attainable during therapy, a significant inhibition in blastogenic response of lymphocytes and phagocytic capacity of monocytes was noticed after 4 hours of treatment. In contrast, the in-vivo effect of primaquine treatment on these cells was innocuous. From this study it is clear that the primaquine does not act as an immunosuppresant and can be given safely to any type of malaria patient.

Detection of multiple invasion of erythrocytes by Plasmodium vivax

An attempt was made to detect multiple invasion of erythrocytes by Plasmodium vivax in district Shahjahanpur, India. Out of 33,027 P. vivax cases examined, 84 showed multiple invasion of erythrocytes. There were 14 cases who showed more than five rings in an erythrocyte. Maximum invasion of an erythrocyte was observed in a 50 year old male patient, a single erythrocyte was harbouring 12 rings. In 5 patients more than one schizonts were present in single erythrocyte. The number of merozoites per schizont varied from 2-28. In some of the cases erythrocytes were having more than one stage of the malarial parasite. Such variations are probably related to the P. vivax strain found in this area.

A comparative therapeutic trial of sucralfate and ranitidine in initial healing and relapse rate of duodenal ulcer

The present study was carried out to examine the comparative efficacy of sucralfate and ranitidine in the treatment of duodenal ulcer. Sixty-six patients with endoscopically diagnosed duodenal ulcer were studied in a 4-6 weeks randomised, single blind trial comparing sucralfate 1 gm T.D.S. one hour before meal and 1 gm nocte (34 pts) with ranitidine 300 mg nocte (32 pts). Six patients (four on sucralfate and 2 on ranitidine) failed to complete the study. Endoscopy after four weeks of treatment showed an ulcer healing rate of 57% in the sucralfate group compared with 73% in ranitidine group (p greater than 0.1). At six weeks these figures had risen to 87% and 90% respectively (p less than 0.5). After one year followup study 69% of sucralfate treated ulcers relapsed whereas the relapse rate was 82% in ranitidine treated ulcer group (p less than 0.1). It was observed that the relapse was earlier in the ranitidine group as compared to sucralfate group (p less than 0.01 at 3 months and p less than 0.05 at 6 months). Asymptomatic recurrence was seen in 15% (6/40) patients. Sucralfate was not only as effective as ranitidine in short term healing of duod. ulcer but also delayed the relapse of ulcer in long term followup after initial healing with the drug.

Kupffer cell functions during intestinal amoebiasis in guinea pigs

Kupffer cells play an important role in all alimentary tract infections. Their role in intestinal amoebiasis is not clear. Hence, the present study examined Kupffer cell functions--phagocytic capacity and levels of a key lysosomal enzyme, N-acetyl-beta-glucosaminidase -- in guinea pigs infected with Entamoeba histolytica intracaecally. Animals were sacrificed on days 0, 3, 7, 14 and 21 post-infection. During intestinal amoebiasis the phagocytic capacity in Kupffer cells was depressed, whereas lysosomal enzyme levels were highly elevated. Maximum alteration in Kupffer cell functions was observed on the 14th post-infection day (P less than 0.01). Animals which survived until 21 days post-infection did not show any significant (P greater than 0.05) change in their Kupffer cell functions compared with controls and day zero values. Phagocytic capacity was inversely correlated with severity of caecal lesions. In contrast, enzyme levels were directly correlated with degree of caecal lesions. Similar trends were observed in blood monocytes. The depressed phagocytic capacity of mononuclear phagocytes and the increased enzyme release by these cells accompanying intestinal amoebic infection may contribute to the establishment of the infection and the tissue damage that accompanies it.

Reactive oxygen species generation by Kupffer cells and blood monocytes of mice infected with Plasmodium berghei and the chloroquine treatment

Generation of reactive oxygen species (ROS) by blood monocytes and Kupffer cells of normal and Plasmodium berghei infected mice treated at different levels of parasitaemia with chloroquine, were studied. Cells isolated at lower level of parasitaemia (less than 2%) produced ROS within the range of normal animals, whereas ROS production by the cells isolated from the animals at higher level of parasitaemia (greater than 20%), was significantly higher even without stimulation with latex particles. The ROS generation capacity of both normal and infected animals was less after the chloroquine treatment. This inhibitory effect of chloroquine may be beneficial in protecting the host from the adverse effect of reactive oxygen species by controlling their overproduction.

Application of a simplified in-vivo test system for determining chloroquine resistance in Plasmodium falciparum

A simplified in-vivo test system was applied to detect chloroquine resistance in malaria patients in Shahjahanpur district (Uttar Pradesh) in India. In 27.6% of cases RIII resistance was observed. This in-vivo method is a simple and useful test for the early detection of chloroquine-resistant falciparum infections and for the management of these patients with alternative therapy.

Cerebral malaria in pregnancy

Three cases of cerebral malaria during pregnancy are described. One patient had intrauterine foetal death and died, one patient delivered a dead baby and the other had severe postpartum haemorrhage. Cerebral malaria worsens the outlook both for the mother and for the foetus.

Termination of early human pregnancy with RU 486 (mifepristone) and the prostaglandin analogue sulprostone: a multi-centre, randomized comparison between two treatment regimens

A multi-centre, randomized trial was conducted to compare the efficacy and side-effects of two combination regimens of the antiprogestin RU 486 and the intramuscular PGE2 analogue sulprostone for termination of early pregnancy (amenorrhoea up to 49 days). Women in the 3-day group (n = 125) received 25 mg RU 486 twice daily for 3 days plus a single injection of 0.25 mg sulprostone in the morning of the third day of antiprogestin treatment. In the 4-day group (n = 126), RU 486 was given for 4 days and the sulprostone injection in the morning of the fourth day. Treatment outcome in the two groups was similar. Overall, 88.8% had a complete abortion, 6.8% an incomplete abortion and 2.4% were treatment failures; in the remaining 2% treatment outcome could not be determined. Only three of the six women with treatment failure still had detectable fetal heart activity when the pregnancy was terminated by vacuum aspiration two weeks after the start of treatment. Five of the 17 interventions for incomplete abortion were carried out as emergency procedures because of heavy bleeding; two of these five women were given a blood transfusion. The majority of the curettages (10/17) were performed in one centre. If the data from this centre and the women with undetermined treatment outcome were excluded, the rates for complete abortion, incomplete abortion and treatment failure in the remaining six centres were 93.6, 3.7 and 2.7%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Fatal pancytopenia in falciparum malaria

Various pernicious syndromes in Plasmodium falciparum infection are being reported with increasing frequency from tropical countries. A rare case of fatal pancytopenia associated with falciparum malaria is described. The patient developed fulminant aspiration bronchopneumonia which was unresponsive to antibiotic therapy and contributed to the development of adult respiratory distress syndrome. He also had severe uncontrolled gastrointestinal bleeding and possibly an intracerebral haemorrhage. Anaemia and thrombocytopenia are well known in malaria but severe leucopenia is very rare and pancytopenia has not been reported.

Preinduction cervical priming with PGE2 vaginal film in primigravidae--a randomised, double blind, placebo controlled study

Previous reports with an 850 micrograms prostaglandin E2 film for cervical ripening before induction of labour in term pregnancy have been favourable. These studies however had no controls. The present study compares this PGE2 vaginal film with a nonmedicated similar vaginal film (placebo) for preinduction cervical ripening in primigravid women at term. A total of 69 women with modified Bishop's cervical scores 1-5 were assigned randomly to either the PGE2 group (33 women) or placebo group (36 women). Cervical score assessments were made at 12 and 24 hours after which labour was induced by amniotomy and oxytocin infusion. Although the cervical scores between placebo and PGE2 groups at 12 and 24 hours were not significantly different, the scores were marginally better with the prostaglandin film. Pregnancy outcome was satisfactory in both groups with no perinatal or maternal mortality and morbidity. The caesarean rate was 30.6% in the placebo group and 24.2% in the PGE2 group. This study emphasizes the need for a control group when studying the success of agents used for ripening the pregnant cervix at term.

Effects of three types of combined O.C. pills on blood coagulation, fibrinolysis and platelet function

The results of a prospective longitudinal controlled study comparing the coagulation effects of a standard low-dose combined oral contraceptive (Microgynon 30), a desogestrel-containing pill (Marvelon) and a triphasic preparation (Triquilar) after one year's treatment in ethnic Chinese women is presented in this paper. In general the changes in coagulation parameters are similar to those seen in Caucasian women. The rise in Factor VII levels seen at 6 and 12 months in Marvelon users was not present to a significant degree in the other pill users. Antithrombin III levels remained unchanged in Microgynon and Marvelon users but with Triquilar there was a significant fall at 6 and 12 months of use. Whether these differences have any clinical relevance in the local Chinese population with low incidence of thromboembolism remains to be seen.

Comparative metabolic effects of three types of combined oral contraceptive pills in Chinese women

The results of a prospective longitudinal controlled study comparing some metabolic effects of a low-dose levonorgestrel-ethinyl oestradiol combined oral contraceptive (Microgynon 30), a desogestrel-ethinyl oestradiol-containing pill (Marvelon) and a levonorgestrel-ethinyl oestradiol triphasic preparation (Triquilar) after one year of treatment in ethnic Chinese women are presented. Serum cholesterol levels are similar for the three pills at 6 and 12 months of treatment. Marvelon and Triquilar users showed rises in triglyceride levels while Microgynon 30 users had no change after one year of treatment. Lipoprotein fractions showed favourable changes in Triquilar and Marvelon users with significant rise in HDL fractions at 6 and 12 months; Microgynon 30 users had equivocal changes in HDL fractions. Carbohydrate metabolism as reflected by glucose tolerance showed deterioration with all 3 pills, being least with Microgynon 30 and greatest with Marvelon at 12 months.

Spontaneous and quinine induced hypoglycaemia in severe falciparum malaria

Four of 21 patients with cerebral malaria developed hypoglycaemia, defined as plasma glucose concentration below 40 mg/dl (2.2 mmol/l). Two patients had spontaneous hypoglycaemia at admission and the other two developed it subsequent to quinine therapy. All recovered with continuous intravenous glucose infusion. Spontaneous hypoglycaemia in malaria has not earlier been reported from India.