Comparison of Plasmodium falciparum infectivity to Anopheles dirus D using direct and indirect blood feeding methods

Membrane feeding method (indirect blood feeding) using defibrinated blood has been established and was found to be as good as the direct feeding method with no singificant differences in the production of oocysts and sporozoites in Anopheles dirus D (p > 0.05). However, lsuccessful feeding was greater in the direct feeding method (69.4 per cent) when compared to the membrane feeding method (46.7 per cent) (p <0.0001). Based on 19 malaria patients who had > 400 gametocytes per ul of blood, the effect of antimalarial drugs on oocyst and sporozoite rates was also studied and it was found that mefloquine treated patients produced reduced infection and infectivity in an. dirus D than those who received antimalarial drugs other than mefloquine. Patients who had gametocytes and have been treated for causes other than malaria and who did not receive any antimalarial drugs were found to produce the highest infection and infectivity rates in An. dirus D (p < 0.0001).

Comparative multiple-dose pharmacokinetics of chloroquine in P. vivax malaria patients and healthy volunteers

Recent evidence of the emergence of resistance of P. vivax to chloroquine in Myanmar has increased the importance and urgency of understanding the cause of resistance as well as the need for devising the strategies to limit its spread. A comparative multiple-dose pharmacokinetic study was conducted on 5 clinically healthy volunteers and 10 malaria patients with P. vivax, admitted to the No. 2 Miliysty Hospital, Yangon, with the object to study whether there is any pharmacokinetic-dynamic relationship underlying the response of patients to standard chloroquine (1500 mg given over 3 days) therapy. Serum chloroquine concentrations reached well above the MIC level in all subjects with the patients' serum concentration (both peak and trough) and the AUC being significantly (2-3 times) higher than jnormal volunteers (p < 0.02). Both the clearance and the volume of distribution were also significantly lower in the malaria patients as compared to the healthy volunteers (p < 0.05). The elimination half-life (T1/2el) was shorter in malaria patients but the difference was not statistically significant. No significant difference was seen with other pharmacokinetic parameters, between normal volunteers and patients and between patients who do and do not recrudescenced. The study supports the emergence of chloroquine-resistant P. vivax in Myanmar and also excludes the possibility of apparent resistance due to pharmacokinetic causes, especially reduced bioavailability.

Potential use of Kyethingha-thee (Momordica charantia L. fruit) in the treatment of maturity onset diabetes mellitus

The hypoglycemic efficacy of Kyethingha-thee dired powder capsule was conducted on five uncomplicated type II non insulin dependent diabetes mellitus patients, who were admitted to the No. 2 Military Hospital, Yangon. Preliminary study revealed that it has hypoglycaemic effect with minimum effective dose of 3 grams for each patient and the time of maximum effect was 4 to 6 hours respectively. Kyethingha-thee was found to be 79.94 percent as effective as tolbutamide and 154.53 percent as effective as TMF 32. So far no adverse side effects were observed in any of these patients.

Pharmacokinetics of mefloquine in uncomplicated plasmodium falciparum malaria patients in Myanmar

With the aim to study the pharmacokinetic basis underlying the therapeutic outcome of mefloquine in malaria patients, a single oral dose of 1000 mg mefloquine hydrochloride (Mepha) was administered to 24 patients with acute uncomplicated falciparum malaria and 10 healthy volunteers and was followed-up till day 42. The drug serum levels at various time intervals were analysed by a Waters HPLC and the pharmacokinetic profile studied. The study shows that although Myanmar malaria patients had a slower rate of absorption (T1/2ab = 6.38 + 0.60 hour; Tmax =1.31 + 0.12 days), the peak serum level reached was much higher (Cmax = 2.24 + 0.05 ug/ml) than those of the westerners.

Comparison between efficacy of oral artemether 480mg and combination of oral artemether 480mg and mefloquine 1000mg in acute uncomplicated p. falciparum malaria

A prospective study comparing the efficacy of Artemether capsule (160 mg. tat and 80 mg. 12 hourly for four doses with a total dose of 480 mg.) as a single drug regimen and a combination drug regimen of Artemether capsule 480 mg. as above together with oral Mefloquine two equal split doses (500 mg 6 hours apart) was carried out at the No. 2, Military Hospital, Yangon during January 1993 and September, 1993. 30 patients were included in oral Artemether single drug regimen and 35 patients were included in oral Artemether and Mefloquine combination drug regimen. The mean age of two groups were 25.82 years and 25.37 years respectively. The initial parasite counts were 13736 and 16879 per microlitre respectively. All patients cleared the parasites initially in both groups. However, 12 patients (40 percent) recrudesced as RI cases in Artemether single drug regimen and thus cure rate was 60 percent. In combination drug regimen group 2 patients (5. 71 percent) recrudesced and cure rate was 94.29 percent. The parasite clearance time (PCT), fever clearance time (FCT) and 50 percent reduction time were compared in both groups and the results were 44.85*** 19.01 hours, 26.56*** 14.14 hours, 40.25*** 16.76 hours, 23.77*** 18.69 hours and 14.28*** 10.11 hours, 12.94*** 6.86 hours respectively. Significant side effects were not noted among patients in both groups. This study showed that Artemether capsule and Mefloquine combination drug regimen has higher efficacy interms of PCT, FCT and 50 percent reduction time than Artemether capsule single drug regimen for patients with acute uncomplicated falciparum malaria in Myanmar.

Different dosage regimens of artemisinin and its derivatives as single agents and in combination with mefloquine in uncomplicated falciparum malaria

To compare the efficacy of Artemisinin tablet, Artesunate tablet and Artemether capsule, randomized uniblind clinical trials using 9 different dosage regimens of the drugs as single agents and also in combination with mefloquine was carried out between January 1991 and December 1993. A total of 480 patients suffering from acute uncomplicated falciparum malaria with asexual parasitaemia ranging from 500-100,000 per microlitre were tried on the various drug regimens. The response rates (according to the WHO in vivo extended 28 days trial) showed that all 3 forms of the drug used as single agents had rapid initial parasite clearance but had high recrudescence rates. Combining either artesunate or Artemether with mefloquine gave cure rates above 95 percent. Artemisinin in combination with Mefloquine had better cure rates than Artemisinin alone too. Hence artemisinin or its derivatives need to be combined with a synergistic drug like mefloquine to achieve satisfactory cure rates.

Thyroid dysfunction following irradiation to the neck

Thyroid functions (serum T3, T4 and TSH) were studied among 35 patients who had external radiation of the neck involving the thyroid gland within the past 10 years, and 10 control patients who had radiation else where in the body but not in the thyroid region. Findings were presented, compared with previous reports and discussed. Routine TFTs one year after radiotherapy was recommended and replacement therapy for patients with raised serum TSH is encouraged.

Incidence of malaria in medical wards at D.S.G.H.During 1976

Incidence of malaria in Medical Wards, D.S.G.H. has been studied during the year 1976. 1034 cases were M.P. Positive out which 70.78 per cent were P. falciparum, 27.98 per cent P. vivax and 1.27 per cent mixed F & V. Thirty four Falciparum cases had complications and 5 died. One case of vivax presented with coma and the other with features of acute intravascular haemolysis.There is seasonal variation in incidence of malaria and regarding geographical distribution it is found wide-spread throughout Burma.