The Cost of Dengue Vector Control Activities in Malaysia by Different Service Providers.

We examined variations in dengue vector control costs and resource consumption between the District Health Departments (DHDs) and Local Authorities (LAs) to assist informed decision making as to the future roles of these agencies in the delivery of dengue vector control services in Malaysia. Data were collected from the vector control units of DHDs and LAs in 8 selected districts. We captured costs and resource consumption in 2010 for premise inspection for mosquito breeding sites, fogging to destroy adult mosquitoes and larviciding of potential breeding sites. Overall, DHDs spent US$5.62 million or US$679 per case and LAs spent US$2.61 million or US$499 per case. The highest expenditure for both agencies was for fogging, 51.0% and 45.8% of costs for DHDs and LAs, respectively. The DHDs had higher resource costs for human personnel, vehicles, pesticides, and equipment. The findings provide some evidence to rationalize delivery of dengue vector control services in Malaysia.

An evaluation of the tuberculosis control programme of Selangor State, Malaysia for the year 2001.

In the year 2001, 1459 Tuberculosis (TB) cases (43.1/100,000 population) were notified in Selangor. The highest age specific incidence rate was among those aged above 60 years and foreigners accounted for 15% of the cases notified. Fifteen percent of the TB cases were treated in the private sector where treatment efficacy and compliance could not be evaluated. Co- infection of Human Immunodeficiency Virus (HIV) infection with TB accounted for 51% of the TB deaths notified. Screening programmes in prisons and drug rehabilitation centres had detected 11.7% of HIV/TB coinfection among HIV positive inmates screened in these institutions.

Hepatitis A outbreak in Hulu Langat District, Selangor State, Malaysia during April--October 2002.

A Hepatitis A outbreak occurred in Mukim Hulu Langat, Hulu Langat district from April 2002 to October 2002. Of the 51 cases notified, most were among students and the ethnic groups involved were Malays and the Orang Asli (local indigenous community). Epidemiological investigations revealed that the cases were localized along rivers used for recreational activities in this area. River water analysis indicated human faecal contamination and it was believed that the contamination was due to the Orang Asli community living upstream. This occurred due to lack of toilet facilities, water at point of use and the existing traditional practices of the Orang Asli community. Control measures instituted were intense health education to the Orang Asli to avoid using the rivers for defecation, multi agency efforts to provide sanitary toilets and adequate water to the villages affected. Future measures include conducting a sero- prevalence survey to determine the feasibility of Hepatitis A immunization to the susceptible population in this area. The outbreak that began in April 2002 was controlled by October 2002.

A retrospective study of death among patients treated for tuberculosis in the Klang Chest Clinic for the year 1999.

A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.

Antiamoebic activity of 3,3'-fluro-4,4'-di-(pyrrolidine-2-ylidene amino)-diphenyl (liroldine), against experimentally infected intestinal and hepatic amoebiasis.

HL 707, Liroldine, a novel synthetic compound, was found effective against both extraintestinal and intestinal amoebiasis in animal models. Its activity against hepatic infection in golden hamsters is comparable with that of different derivatives of nitroimidazoles used for human treatment. Against intestinal amoebiasis in Wistar rats, the activity was superior to nitroimidazoles and chloroquine. Paramomycin was comparable and diloxanide furoate was marginally superior. The comparative in vitro and in vivo studies with standard marketed drugs and Liroldine indicate an excellent profile of the compound against experimental amoebiasis. LD50 of Liroldine determined in mice is 910 mg/kg x 1, po and 940 mg/kg x 1 ip).

Antimalarial activity of novel ring-contracted artemisinin derivatives.

Bromoacetal 2 undergoes a novel ring-contracted reaction to give the aldehyde 3 in the presence of DBU or triethylamine. The aldehyde 3 is reduced to the alcohol 4 and oxidized to the carboxylic acid 5. The alcohol 4 reacts with dihydroartemisinin to give the two diastereoisomers 38 and 39. All the compounds were tested for antimalarial activity in mice infected with chloroquine sensitive Plasmodium berghei. If the activity of a compound was comparable to that of the standard compound, such as arteether, it was tested against chloroquine resistant NS strain infection in mice. Initially the compounds were administered subcutaneously, and if found to be active, they were tested by oral route. The antimalarial activity of compounds 19, 38, and 39 was found to be comparable to that of arteether when tested in K-173-infected mice. They were also active against chloroquine resistant NS strain infection in mice.

Arteether, a new antimalarial drug: synthesis and antimalarial properties.

Arteether (6) has been prepared from dihydroquinghaosu (3) by etherification with ethanol in the presence of Lewis acid and separated from its chromatographically slower moving alpha-dihydroqinghaosu ethyl ether (7). The absolute stereochemistry at C-12 has been determined by 1H NMR data (J11,12, NOESY). Ethyl ethers 6 and 7 showed potent in vitro inhibition of Plasmodium falciparum, and both compounds were highly potent antimalarials in mice infected with a drug-sensitive strain of Plasmodium berghei. Crystalline arteether (6) and its oily epimer 7 were 2-3 times more potent schizontocides than quinghaosu (1), but deoxy compounds 8, 9, and 11 were 100-300 times less potent in vitro than their corresponding peroxy precursors. Pharmacological studies have shown arteether(6) to have antimalarial activity in animals comparable to artesunate (2) and artemether (4), both of which are fast-acting blood schizontocides in humans. Arteether (6) has now been chosen for a clinical evaluation in high-risk malaria patients.