Fatores de risco para óbito e tempo de internação em pacientes com COVID-19 em uso de cloroquina e hidroxicloroquina: estudo de coorte retrospectivo / Risk factors for death and length of stay in patients with covid-19 using chloroquine and hydroxychloroquine: a retrospective cohort study

Objetivos: Comparar os desfechos clínicos e a sobrevida de pacientes adultos com COVID-19 expostos e não expostos a tratamento medicamentoso com cloroquina e hidroxicloroquina. Método: Trata-se de um estudo de coorte retrospectiva com dados coletados em um hospital de Vitória. Foram incluídos todos os pacientes de enfermarias e Unidade de Terapia Intensiva (UTI) com idade igual ou superior a 18 anos, com diagnóstico confirmado de COVID-19, ou seja, com PCR positivo para a infecção, atendidos no hospital entre 26 de fevereiro a 31 de dezembro de 2020, e com registro de alta hospitalar por motivo de óbito ou não óbito. Aplicou-se a estatística descritiva (frequência absoluta e relativa) e teste do Qui-quadrado e Exato de Fisher para verificar associação entre as variáveis dependentes e independentes, considerando o índice de confiança (IC) de 95%. As variáveis contínuas foram analisadas por meio de medidas de tendência central (mínimo, máximo, média, mediana e desvio padrão). Para avaliar a existência de diferença nas médias com relação ao desfecho do tratamento medicamentoso para as variáveis contínuas, utilizou-se o teste não paramétrico de Mann-Whitney. Aplicou-se o método de Kaplan Meier para comparar o tempo de tratamento e demais variáveis independentes de interesse. Por fim, para analisar o tempo de internação até a ocorrência de óbito, utilizou-se o modelo de regressão de Cox com os respectivos riscos bruto e ajustado. As análises foram realizadas no programa R versão 4.1.2. e, em todas, considerado o nível de significância de 5% e intervalo de confiança de 95% (IC95%). Resultados: A amostra foi composta por 896 indivíduos; a maioria com idade média de 53,4 anos, do sexo feminino, etnia parda, casada, com ensino médio completo, não tabagista. O tempo médio de internação foi de 9,77 dias e 7,13 dias de tratamento medicamentoso para COVID-19. Cerca de 42,1% apresentaram mais de duas comorbidades e as mais prevalentes foram diabetes mellitus tipo 2 (45%), hipertensão arterial (44,9%) e doença pulmonar obstrutiva crônica (14,6%). Durante a internação, 16,4% dos indivíduos precisaram de ventilação mecânica e 51,3% utilizaram cloroquina ou hidroxicloroquina durante a internação. Evoluíram para óbito 99 indivíduos. Ainda, houve a utilização de mais de três medicamentos por 873 pessoas. Na análise bivariada, estiveram associados ao tratamento com cloroquina ou hidroxicloroquina a idade (p=0,0045), ventilação mecânica (p=0,0010), parada cardiorrespiratória (p=0,0010), hipoglicemia (p=0,0310), polifarmácia (p=0,0010) e número de comorbidades (p=0,0010). A taxa de ocorrência de óbitos em pessoas divorciadas (OR: 2,4904; p=0,398; IC 95% 0,9125-0,4438) e viúvas (OR: 1,9823; p=0,0277; IC 95% 0,6842-0,3108) foi maior do que em pessoas casadas. A taxa de ocorrência de óbito entre pessoas com escore qSOFA positivo foi 2,70 (OR: 2,7018; p=0,0009; IC 95% 0,9939-0,2981) vezes maior do que as com escore qSOFA negativo. Na análise de associação entre ventilação mecânica e demais variáveis independentes, entre os indivíduos que não faziam o uso da ventilação mecânica, os viúvos e os que apresentavam qSOFA positivo apresentaram mais chance de óbito. O índice de massa corporal (IMC) elevado apresentou-se como fator protetor, tido que a chance de óbito reduziu em 10,97% para cada aumento de 1 unidade no IMC entre os indivíduos em ventilação mecânica. Por fim, no modelo completo do ajuste de efeitos principais com base nos estratos de ventilação mecânica, para analisar a homogeneidade dos grupos, os resultados encontrados acerca do risco em divorciados, viúvos e qSOFA positivo permaneceram conforme análises anteriores. Conclusão: dos 11% dos pacientes com COVID-19 que evoluíram para o óbito, 6,8% fizeram uso de cloroquina ou hidroxicloroquina. As taxas de sobrevivência apresentaram-se menores em pacientes indígenas, do sexo masculino, viúvos e que fizeram uso de ventilação mecânica. Ainda, o baixo IMC foi considerado fator de risco para a mortalidade em pacientes com COVID-19 em ventilação mecânica, já o estado civil destacou-se como fator protetor em pessoas casadas

Objectives: To compare clinical outcomes and survival of adult patients with COVID19 exposed and not exposed to drug treatment with chloroquine and hydroxychloroquine. Method: This is a retrospective cohort study with data collected in a hospital in Vitória. All patients in wards and Intensive Care Units (ICU) aged 18 years or over, with a confirmed diagnosis of COVID-19, that is, with a positive PCR for the infection, treated at the hospital between February 26th and December 31, 2020, and with a record of hospital discharge due to death or non-death. Descriptive statistics (absolute and relative frequency) and the Chi-square test and Fisher's exact test were applied to verify the association between the outcome and independent variables, considering the confidence index (CI) of 95%. Continuous variables were analyzed using measures of central tendency (minimum, maximum, mean, median and standard deviation). To assess the existence of a difference in means in relation to the outcome of drug treatment for continuous variables, the non-parametric Mann-Whitney test was used. The Kaplan Meier method was applied to compare treatment time and other independent variables of interest. Finally, to analyze the length of hospital stay until death, the Cox regression model was used with the respective crude and adjusted risks. The analyzes were carried out using the R program version 4.1.2. and, in all cases, a significance level of 5% and a confidence interval of 95% (95% CI) were considered. Results: The sample consisted of 896 individuals; the majority with an average age of 53.4 years, female, mixed race, married, with completed high school, non-smokers. The average length of stay was 9.77 days and 7.13 days of drug treatment for COVID-19. Around 42.1% had more than two comorbidities and the most prevalent were type 2 diabetes mellitus (45%), hypertension (44.9%) and chronic obstructive pulmonary disease (14.6%). During hospitalization, 16.4% of individuals required mechanical ventilation and 51.3% used chloroquine or hydroxychloroquine during hospitalization. 99 individuals died. Furthermore, more than three medications were used by 873 people. In the bivariate analysis, age (p=0.0045), mechanical ventilation (p=0.0010), cardiorespiratory arrest (p=0.0010), hypoglycemia (p=0.0310) were associated with treatment with chloroquine or hydroxychloroquine, polypharmacy (p=0.0010) and number of comorbidities (p=0.0010). The rate of death in divorced people (OR: 2.4904; p=0.398; 95% CI 0.9125-0.4438) and widows (OR: 1.9823; p=0.0277; 95% CI 0 .6842-0.3108) was higher than in married people. The rate of death among people with a positive qSOFA score was 2.70 (OR: 2.7018; p=0.0009; 95% CI 0.9939-0.2981) times higher than those with a negative qSOFA score. In the analysis of the association between mechanical ventilation and other independent variables, among individuals who did not use mechanical ventilation, widowers and those with a positive qSOFA were more likely to die. High BMI was a protective factor, as the chance of death reduced by 10.97% for each increase of 1 unit in BMI among individuals on mechanical ventilation. Finally, in the complete main effects adjustment model based on the mechanical ventilation strata, to analyze the homogeneity of the groups, the results found regarding the risk in divorced, widowed and positive qSOFA remained in line with previous analyses. Conclusion: The results demonstrate that the use of chloroquine and hydroxychloroquine by patients with COVID-19 may be related to the occurrence of deaths and did not reduce the chance of mechanical ventilation. Survival rates were lower in indigenous, male, widowed patients who used mechanical ventilation and drug treatment with chloroquine or hydroxychloroquine. Furthermore, the results indicate that chloroquine/hydroxychloroquine are not beneficial in the treatment of COVID-19, however, further studies are necessary

Systemic lupus erythematosus: Pharmacological differences between women and men and among age groups and geographical regions

Systemic lupus erythematosus (SLE) is a chronic and potentially fatal autoimmune disease. There are clinical differences between women and men and among age groups. Its treatment involves a heterogeneous group of drugs. The objective was to determine the pharmacological treatment patterns in a group of patients with SLE and compare them according to sex, age group and geographic region. This was a cross-sectional study that identified outpatient drugs used in patients with SLE from a population database of Colombians affiliated with the Colombian Health System. Sociodemographic and pharmacological variables were considered. Descriptive and bivariate analyses were performed. A total of 4307 patients with SLE were identified (median age, 44.2 years; 89.4% women). Disease-modifying antirheumatics were the most prescribed drugs (90.5%), especially chloroquine (54.4%), which predominated in all age groups and geographical regions. Hydroxychloroquine and methotrexate were the predominant prescribed drugs for women, while corticosteroids, chloroquine, azathioprine, and mycophenolate were the predominant prescribed drugs for men. The use of corticosteroids (prednisolone and prednisone) decreased with increasing age. Differences were found in the prescription of drugs for patients with SLE between women and men and among geographic regions and age groups. The use of chloroquine predominated over hydroxychloroquine, contrasting with clinical practice guidelines.

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune crónica y potencialmente mortal. Existen diferencias clínicas entre mujeres y hombres, y entre grupos de edad. Su tratamiento involucra un grupo heterogeneo de medicamentos. El objetivo fue determinar los patrones de tratamiento farmacológico de un grupo de pacientes con LES y compararlos según el sexo, los grupos de edad y las regiones geograficas. Estudio de corte transversal que identifico los medicamentos de uso ambulatorio empleados en pacientes con LES, a partir de una base de datos poblacional de colombianos afiliados al Sistema de Salud de Colombia. Se consideraron variables sociodemográficas y farmacologicas. Se realizo un análisis descriptivo y bivariado. Se identificó a 4.307 pacientes con LES, con una mediana de edad 44,2 an˜ os y un 89,4% mujeres. Los medicamentos modificadores de enfermedad reumatica fueron los mas prescritos (90,5%), en especial cloroquina (54,4%), el cual predomino en todos los grupos de edad y las regiones geográficas. La hidroxicloroquina y el metotrexato predominaron en mujeres, mientras que los corticosteroides, la cloroquina, la azatioprina y el micofenolato, en hombres. Con el aumento de la edad disminuyo el uso de corticoides (prednisolona y prednisona). Se encontraron diferencias en la prescripción de los medicamentos empleados en los pacientes con LES entre mujeres y hombres, regiones geográficas y grupos etarios. El uso de cloroquina predomino sobre la hidroxicloroquina, en contraste con lo recomendado por las guías de practica clínica.

Cloroquina e hidroxicloroquina: medicamentos potencialmente inapropriados a idosos? / Chloroquine and hydroxychloroquine: potentially inappropriate medications for older adults?

INTRODUÇÃO: Medicamentos potencialmente inapropriados a idosos (MPII) provocam mais efeitos adversos do que benefícios. Os critérios de Beers (CB) da American Geriatrics Society 2019 (CB2019) consideraram cinco situações clínicas como MPII. A análise de medicamentos por essas situações pode auxiliar na prescrição a idosos? Procurando exemplo prático dessa questão, optou-se por análise de fármacos atualmente questionados quanto ao seu uso seguro em idosos. OBJETIVO: Verificar se cloroquina e hidroxicloroquina se enquadram como MPII e se essa análise é aplicável clinicamente. METODOLOGIA: Sistematizou-se o objetivo pelas cinco situações clínicas definidas como MPII pelos CB2019. RESULTADOS: Ambos os fármacos preenchem respectivamente quatro (cloroquina) e cinco (hidroxicloroquina) dessas situações clínicas. Esta análise permitiu a provável definição de MPII para esses medicamentos de forma simples, por intermédio de breve análise de literatura acessível. CONCLUSÃO: Cloroquina e hidroxicloroquina podem ser considerados MPII. Espera-se replicar essa análise para outros medicamentos e reduzir iatrogenias em idosos.

INTRODUCTION: Potentially inappropriate medications (PIMs) for older adults cause more adverse effects than benefits. The 2019 American Geriatrics Society Beers Criteria (2019BC) considered five clinical situations as PIM use in older adults. Can drug analysis, according to these situations, assist in the act of making prescriptions for older people? Seeking a practical example for this question, we assessed drugs currently questioned as to their safe use among older people. OBJECTIVE: To check if chloroquine and hydroxychloroquine fit the PIM criteria for older adults and whether this analysis is clinically applicable. METHODS: We systematized the objective based on the five clinical situations defined as PIM use in older adults by the 2019BC. RESULTS: Chloroquine and hydroxychloroquine fulfill, respectively, four and five of these clinical situations. This evaluation allowed the likely definition of these drugs as PIMs for older adults in a simple way, based on a brief analysis of the available literature. CONCLUSION: Chloroquine and hydroxychloroquine may be considered PIMs for older adults. We expect that this analysis can be replicated with other drugs and reduce iatrogenesis in older people.

Diez años de eficacia terapéutica de la cloroquina en malaria no complicada por Plasmodium vivax , Turbo, Antioquia, años 2002 y 2011 / Ten years of chloroquine efficacy for uncomplicated Plasmodium vivax malaria treatment, Turbo, Antioquia, 2002 and 2011

Introducción. La eficacia terapéutica de los antipalúdicos debe ser vigilada permanentemente debido al problema de resistencia. En Colombia existen pocos estudios que evalúen la eficacia de la cloroquina en la malaria no complicada por Plasmodium vivax . Objetivo. Evaluar la respuesta terapéutica de la cloroquina en el tratamiento del paludismo no complicado por P. vivax en el año 2011 en Turbo, Antioquia, y comparar estos resultados con los del estudio realizado en el año 2002 en el mismo municipio. Materiales y métodos. Se llevaron a cabo dos estudios en los que se incluyeron 152 participantes (50 en el año 2002 y 102 en el año 2011), todos mayores de cinco años, con malaria no complicada e infección simple por P. vivax , según los criterios de la Organización Mundial de la Salud (OMS). Se evaluó la eficacia terapéutica de la cloroquina, según los protocolos vigentes de la Organización Panamericana de la Salud (1998) y la OMS (2009); se dio tratamiento estándar supervisado con 1.500 mg de cloroquina en tres días y se hizo seguimiento clínico y parasitológico los días 0, 1, 2, 3, 7, 14 y 21 en el año 2002 y, además, el día 28 en el año 2011. Al finalizar el seguimiento se suministró primaquina a una dosis diaria de 0,25 mg/kg durante 14 días en todos los participantes. Resultados. Los resultados clínico y parasitológicos fueron adecuados en el 100 % de los participantes de ambos estudios. Conclusiones. La cloroquina continúa siendo eficaz para el tratamiento de la malaria no complicada por P. vivax en Turbo, Antioquia.

Introduction: The therapeutic efficacy of antimalarial drugs should be monitored continuously because of the emergence of drug resistance. In Colombia, there are few studies evaluating the efficacy of chloroquine in uncomplicated malaria by Plasmodium vivax . This study evaluated the therapeutic efficacy of chloroquine at two different times, with an interval of ten years, in the same municipality. Objective: To evaluate the therapeutic response to chloroquine for the treatment of uncomplicated P. vivax malaria in Turbo, Antioquia, in 2002, and to compare these results with those observed in 2011 in the same municipality. Materials and methods: Two studies included 152 volunteers (50 in 2002 and 102 in 2011), older than 5 years old, with uncomplicated malaria according to the World Health Organization (WHO) criteria and simple infection with P. vivax. The efficacy of chloroquine, according to the current standard treatment of the Pan American Health Organization (PAHO) (1998) and WHO (2009), was monitored with 1,500 mg of chloroquine in 3 days and was followed clinically and parasitologically on days 0, 1, 2, 3, 7, 14 and 21 in 2002, and also on day 28 in 2011. At the end of the follow-up a dose of 0.25 mg/kg/day of primaquine was administered to each patient for 14 days. Results: A hundred percent of the volunteers had adequate clinical and parasitological response in both studies. Conclusions: Chloroquine continues to be highly effective for the treatment of uncomplicated P. vivax malaria in Turbo, Antioquia, Colombia.

Tela de Amsler e campo visual no rastreamento da retinopatia por cloroquina / Amsler grid and visual field on screening for chloroquine retinopathy

OBJETIVOS: Comparar a tela de Amsler modificada com o campo visual Humphrey® 10-2 vermelho nos usuários de cloroquina, na detecção da maculopatia precoce, e correlacionar com as variáveis de risco. MÉTODOS: Foram analisados 116 olhos de 58 pacientes, acompanhados no Serviço de Oftalmologia do Hospital do Servidor Público Estadual de São Paulo, entre abril de 2006 e abril de 2008. Todos os usuários tinham fundo de olho normal e mais de dois anos de terapia com cloroquina. Os participantes tiveram seus dados clínicos avaliados e foram submetidos ao exame da acuidade visual corrigida, biomicroscopia de fundo, campimetria macular automatizada e tela de Amsler. RESULTADOS: A incidência da maculopatia precoce foi de 7 a 10%, dependendo do exame considerado. A concordância entre a tela de Amsler e o campo visual foi baixa. Para o grupo de olhos que apresentaram ambos os exames alterados, houve significância estatística com a alta dose diária, dose cumulativa elevada e baixa acuidade visual; a idade do paciente e a duração do tratamento não mostraram boa correlação nestes casos, mas suas médias (67,4 anos e 8,4 anos, respectivamente) situaram-se dentro da faixa dos fatores de alto risco. CONCLUSÕES: O estudo sugere que a tela de Amsler pode ser útil na complementação das informações do campo visual no rastreamento periódico da retinopatia por cloroquina, sobretudo naqueles com fatores de alto risco bem estabelecidos, selecionando melhor os candidatos à realização de testes objetivos, como o OCT de alta resolução e o ERG multifocal.

PURPOSE: To compare the modified Amsler grid to the Humphrey® 10-2 red visual field in chloroquine users for the detection of early maculopathy, and to correlate with the risk variables. METHODS: The study included 116 eyes of 58 patients followed at the Department of Ophthalmology of Hospital do Servidor Público Estadual de São Paulo, from April, 2006 to April, 2008. All users had normal fundus and more than 2 years of chloroquine therapy. Their clinical data were evaluated and they underwent visual acuity examination, fundus biomicroscopy, visual field and Amsler grid. RESULTS: The incidence of early maculopathy was 7 to 10%, depending on the examination considered. The agreement between the Amsler grid and visual field was low. There was statistical significance with the use of high daily dose, elevated cumulative dose and low visual acuity in patients whose eyes had both abnormal tests; patient age and duration of treatment did not show good correlation in these cases, but their averages (67.4 years and 8.4 years, respectively) were within the range of high risk factors. CONCLUSIONS: The study suggests that Amsler can be useful in complementing the information on the visual field for chloroquine retinopathy periodic screening, especially for those patients who present high risk factors well established, selecting better candidates for objective tests, such as HD OCT and mfERG.

Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico / Diagnostic methods for chloroquine diphosphate induced retinopathy in systemic lupus erythematosus

OBJETIVOS: Avaliar diferentes métodos diagnósticos para a avaliação de pacientes portadores de lúpus eritematoso sistêmico, usuários crônicos do difosfato de cloroquina (DFC) e, portanto, com alto risco para retinopatia tóxica. MÉTODOS: Foram analisados 72 olhos de 36 pacientes consecutivos, seguidos no Serviço de Reumatologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, de julho de 2007 a abril de 2008. Dados demográficos e clínicos foram avaliados com o intuito de estudar os fatores de alto risco e comparar os seguintes métodos oftalmológicos: acuidade visual, biomicroscopia da córnea, biomicroscopia do fundo, retinografia, angiofluoresceinografia da retina, campo visual macular com mira branca. RESULTADOS: Dos 36 pacientes, 34 (94,4 por cento) eram mulheres. A média de idade foi 39,9 ± 9,8 anos, com tempo de doença igual a 13,9 ± 6,6 anos. Além do uso crônico da cloroquina, os pacientes apresentaram altas doses diárias (>3 mg/kg) e cumulativas. Não foi observada relação entre estes fatores de alto risco e maior prevalência de retinopatia. Foi encontrada prevalência de retinopatia igual a 38,9 por cento, confirmada por alterações bilaterais, centrais ou paracentrais e reprodutíveis no exame de campo visual. Outros exames indicados para seguimento, como acuidade visual, biomicroscopia de fundo e angiofluoresceinografia não foram capazes de diagnosticar a maioria das alterações confirmadas pelo campo visual. CONCLUSÃO: Foi observada alta prevalência de retinopatia por cloroquina entre os pacientes com alto risco, usuários crônicos do DFC, segundo os achados do campo visual. A avaliação desses pacientes deve considerar a realização do exame de campo visual em intervalos menores que os propostos, mesmo quando não há suspeita clínica.

PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. Methods: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4 percent) were female. The mean age was 39.9 ± 9.8 years and the disease duration was 13.9 ± 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9 percent of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.

Gametocitemia de Plasmodium falciparum según la respuesta terapéutica a sulfadoxina-pirimetamina y cloroquina en dos municipios de Antioquia, Colombia / Gametocyte levels in response to differing malaria treatments in two municipalities of Colombia

Se ha informado que el número de gametocitos circulantes de Plasmodium falciparum está influenciado por aspectos como el nivel de endemicidad de la zona, la clase de esquizonticidas sanguíneos usados y la respuesta terapéutica a ellos. En Colombia son muy pocos los trabajos que han evaluado estas relaciones. Mediante un diseño experimental, se evaluó la gametocitemia (variable efecto) en función del nivel endémico de dos municipios de Antioquia, del tratamiento (sulfadoxina-pirimetamina y sulfadoxina-pirimetamina más cloroquina) y de la respuesta terapéutica (adecuada y fallida). Se estudiaron 148 pacientes con malaria por P. falciparum no complicada. La gametocitemia varía en función del tiempo de padecimiento de la malaria actual (mayor en Turbo que en Zaragoza) y esta variable debe controlarse para eliminar la aparente diferencia en las gametocitemias por municipio. No se hallaron diferencias estadísticamente significativas en la gametocitemia (porcentaje de pacientes con gametocitos circulantes y cantidad de ellos por microlitro) según el tratamiento y la respuesta terapéutica, aunque los niveles de gametocitos son mayores en los pacientes tratados sólo con sulfadoxinapirimetamina, respecto a quienes recibieron sulfadoxina-pirimetamina más cloroquina. Tampoco hubo diferencias en la gametocitemia según el sexo ni la edad de los pacientes, ni se halló correlación de ella con la parasitemia asexual. La diferencia en el nivel de gametocitemia encontrada entre los municiios de Turbo y Zaragoza parece estar influida por el tiempo transcurrido entre el inicio de los síntomas y la instauración del tratamiento.

Plasmodium falciparum gametocyte levels are influenced by level of regional endemicity, the antimalarial treatment, and the therapeutic response of patients. Few previous studies have related these factors in Colombia. Here, gametocytaemia was evaluated with respect to two treatment schemes (sulfadoxine/pyrimethamine and sulfadoxine/pyrimethamine plus chloroquine), the patient response (adequate or failure), and the locality (two areas of varying case frequency). One hundred forty-eight residents of Turbo and Zaragoza (Antioquia), all with uncomplicated malaria, were evaluated. The gametocytaemia and the rates of clinical malaria at the beginning of treatment were greater in Turbo than in Zaragoza. No statiscally significant differences in the gametocytaemia by treatment schemes or therapeutic responses were noted, although the patients who received SP had more gametocytes than those treated with SP+CQ. Gametocytaemia was not correlated with asexual parasitemia or sex and age of patient. The difference in the level of gametocytaemia between Turbo and Zaragoza appears to be influenced by the time elapsed between the appearance of symptoms and the beginning of treatment.

Antimalarial drug resistance in the Eastern Mediterranean Region

Studies done between 1997 and 2003 are reviewed to give an overall picture of antimalarial drug resistance in the Eastern Mediterranean Region of the World Health Organization [WHO]. The situation in 8 countries where resistance has been reported is detailed. It has been difficult to abandon chloroquine as first-line treatment even though resistance to it is widespread. Resistance to sulfadoxine-pyrimethamine has also been detected. The spread of resistance could be slowed down by the adoption of effective national policies and control programmes. Coordination between counties and with other WHO regions, as opposed to working in isolation, could further reduce the spread of resistance