Encouraging news on intermittent preventive therapy in infancy (IPTi) for malaria
published 14-11-2007
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Times marked as favorite : 288
This study is a meta-analysis, and finds clinically significant effectiveness of IPTi.
The study I'm dying to see is the effect of IPT in HIV-infected infants and children. Is it something that should be added to their routine care?
Abstract:
Purpose of review: This review summarizes recent evidence regarding the efficacy of intermittent preventive treatment with focus on infancy (IPTi) and the rationale behind such a control strategy.
Recent findings: Pooled safety and efficacy analyses of all six trials of IPTi with sulfadoxine-pyrimethamine conducted between 1999 and 2007 have demonstrated a 30% protective efficacy against clinical malaria, a 24% protective efficacy against all-cause hospital admissions, a 37% protective efficacy against malaria-related hospital admissions, and a 15% protective efficacy against anemia, all in the first year of life. Rebound in malaria following discontinuation of the intervention has not been noted in pooled analyses of the IPTi trials.
Summary: Given the efficacy, excellent safety and tolerability of the intervention and the fact that it is inexpensive and easily deliverable if linked to the Expanded Programme on Immunization, IPTi-sulfadoxine-pyrimethamine appears to add a valuable tool to the malaria-control armamentarium in endemic areas of Africa. Routine monitoring of sulfadoxine-pyrimethamine efficacy will be required to guide future IPTi programme implementation. Variations of IPTi that target older children may be required for areas of Africa with highly seasonal malaria transmission.
Epidemiology of congenital malaria in Nigeria: a multi-centre study
published 14-11-2007
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Times marked as favorite : 286
An important article to better understand prevalence and significance of congenital malaria. Read the whole article if you can.
Abstract
Objective To determine the burden of congenital malaria in newborns in Nigeria.
Methods In a prospective multi-centre study, 1875 consecutive mother–baby pairs were enrolled over a continuous 12-month period. Blood smears were prepared from mothers, neonates, placental aspirates and cord blood within 4 h of delivery. Outcome variables were patent parasitaemia in the mother, placenta, cord and neonate in addition to maternal and neonatal haematocrit.
Results Patent parasitaemia was detected in 95 neonates (5.1%). The occurrence varied between study centres, but was found year round in all sites. The mean parasite density among infected neonates was low (48 asexual forms per μl, range 8–200/μl). Maternal and placental parasitaemia were the most important risk factors for patent neonatal parasitaemia (P < 0.0001). Spontaneous clearance of parasitaemia occurred in 62.1% of neonates before day 2. 33.7% were symptomatic within 3 days of birth.
Conclusion Congenital malaria is often asymptomatic, clears spontaneously and may not warrant treatment. However, newborns with unexplained fever and refusal to feed in malaria endemic areas should be tested for malaria.
"Since these antibodies have been found to achieve parasite killing under in vitro and in vivo conditions, and since they can be readily elicited by immunisation in naïve volunteers, our immunoepidemiological findings support the further development of MSP3-based vaccine formulations."
Jet lag: trends and coping strategies (Lancet Seminar)
published 14-11-2007
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Times marked as favorite : 304
"Summary
"The number of travellers undertaking long-distance flights has continued to increase. Such flights are associated with travel fatigue and jet lag, the symptoms of which are considered here, along with their similarities, differences, and causes. Difficulties with jet lag because of sleep loss and decreased performance are emphasised. Since jet lag is caused mainly by inappropriate timing of the body clock in the new time zone, the pertinent properties of the body clock are outlined, with a description of how the body clock can be adjusted. The methods, both pharmacological and behavioural, that have been used to alleviate the negative results of time-zone transitions, are reviewed. The results form the rationale for advice to travellers flying in different directions and crossing several time zones. Finally, there is an account of the main problems that remain unresolved."
Better first line treatment needed for children with severe pneumonia
published 13-11-2007
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Times marked as favorite : 501
This Lancet article reports an important observational study from South Africa. The authors investigated 358 children aged 1–59 months, regardless of HIV status, who presented with WHO-defined severe or very severe pneumonia. Sixty-eight percent of the children were HIV infected. The empiric treatment used was benzylpenicillin, gentamicin and, for those less than a year old, high-dose trimethoprim-sulfamethoxazole.
FIndings included the fact that in the infants, 42% failed therapy by 48 hours and 6% subsequently. Many of those failing had polymicrobial infections (more than one organism). M. tuberculosis,S. aureus and, in infants, PCP were common among those failing treatment. The authors conclude that (in this HIV-prevalent area) existing empiric treatment recommendations for children with severe pneumonia are inadequate, since nearly half the children failed treatment.
Read moreto see a table of organisms isolated from those failing treatment, then see the original article as well.
