MALARIA: FROM CONTROL TO ELIMINATION IN THE WHO EUROPEAN REGION (1999-2014).

Malaria in the WHO European Region has gone from control to elimination thanks to the great efforts of health services in endemic countries. Locally transmitted malaria cases decreased from 90,000 late in the 20th century to 0 in 2015. Currently, there is a real threat to resurgence of malaria in the south of the European and Asian parts of the Region. Neglecting malaria prevention measures in the countries with high malariogenic potential areas where malaria elimination has been achieved may lead to consequences of imported malaria.

[The effect of increased concentration of lipoprotein (a) on identification of sub-faction of lipoproteins using native electrophoresis technique].

The quantitative analysis of sub-fractions of lipoproteins acquires growing significance in diagnostic and prognosis of cardiovascular diseases. It is well known that presence of lipoprotein (a) in high concentrations significantly distorts results of biochemical analysis, in particular detection of level of cholesterol of low-density lipoproteins. The lipoprotein (a) is a heterogeneous particle and its mobility in the systems used for analysis of sub-fractions of lipoproteins can have significant variability that will bring inaccuracy into results. The data concerning relationship between lipoprotein (a) and sub-fractions of lipoproteins and also their differentiation in various systems of determination of lipid spectrum are quite numerous. The given study is considered as actual one because it analyses input of lipoprotein (a) into results of detection of sub-fractions using the technique with diagnostic significance. The study was carried out for evaluating possible input of lipoprotein (a) into results of quantitative estimation of sub-fractions of lipoproteins by technique of native electrophoresis in polyacrylamide gel used for diagnostic of cardio-vascular diseases. To detect concentration of lipoprotein (a) in blood serum the technique of enzyme-linked immunosorbent assay was applied. The qualitative valuation of content of sub-fractions of lipoproteins was implemented using system Lipoprint Quantimetrix (USA). The sub-fractions of lipoproteins were detected in samples of serum of healthy donor and normolipidic patients before and after removal of lipoprotein (a) using technique of affine chromatography in vitro. It turned out that after removal of lipoprotein (a) analysis of sub-fractions of lipoproteins in plasma of healthy donor detects significant decreasing of level of lipoproteins of medium density. The samples of serum of patients with atherosclerosis besides removal of sub-fractions of lipoproteins of medium density, decreasing of level of large sub-fractions of low density lipoproteins was observed. The analysis of samples obtained after procedures of therapeutic lipoprotein (a) apheresis using columns "Lp (a) Lipopak" (Russia) demonstrated that along with removal of lipoprotein (a), decreasing of concentration of sub-fraction C lipoproteins of medium density in all samples that substantiates in vitro data. In patients without affection and with multi-vessel lesion of coronary bloodstream reliable differences in concentration of lipoproteins of medium density were established. The received data testify that high level of lipoprotein (a) can contribute significant inaccuracies into results of detection of subfractions of lipoproteins. Therefore, application of system Lipoprint (Quantimetrix USA) provides no opportunity to unequivocally interpret data concerning input of sub-fractions of lipoproteins into risk of development of cardio-vascular diseases in patients with pathological lipid profile and higher concentration of lipoprotein (a).

Malaria in the WHO European Region (1971-1999).

The number of autochthonous reported cases of malaria fell from 90 506 to 37 170 between 1996 and 1999 in the WHO European Region. There has been, however, an eight-fold increase in imported cases since the 1970s: 1500 cases were reported in 1972, 13 000 cases in 1999. France, Germany, Italy, and the United Kingdom are the west European countries with the largest numbers of cases.

Response of falciparum malaria to different antimalarials in Myanmar.

The purpose of the study was to ascertain the therapeutic efficacy of different treatments for uncomplicated falciparum malaria in the hospitals in Sagaing, northern and eastern Shan, to facilitate updating the existing national antimalarial drug policy. The proposed 14-day trial for monitoring the efficacy of treatments of uncomplicated falciparum malaria is an efficient method for identifying treatment failure patterns at the intermediate level (township hospital) in the Union of Myanmar. Minimal clinical and parasitological data for days 0-14 were required to classify treatment failure and success. Clinical and parasitiological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine is five times more likely to be effective than chloroquine and sulfadoxine pyrimethamine (S-P), whereas chloroquine and S-P treatments have nearly identical failure patterns. The alarming frequency of clinical and parasitological failure (failure rate > 50%) following chloroquine treatment was reported in Sagaing and following S-P treatment in Sagaing and eastern Shan.

PIP: Malaria is a major health problem in Myanmar, a country in which the resistance of Plasmodium falciparum to antimalarial drugs frustrates malaria control efforts and impedes success. Chloroquine and sulfadoxine-pyrimethamine (SP) resistance at various levels is now common throughout the country, while mefloquine resistance currently remains limited to the Thai-Myanmar border. Findings are presented from an assessment of the therapeutic efficacy of treating uncomplicated falciparum malaria in hospitals in Sagaing Division and Shan State with a view to updating the existing national antimalarial drug policy. 118 patients aged 1-58 years with acute uncomplicated falciparum malaria were recruited into the study conducted in the township hospitals of Katha, Hsipaw, and Tachileik, an overall area characterized by endemic and seasonal forest-related malaria. The most prevalent parasite species is P. falciparum. Patients were randomly assigned to receive either chloroquine, SP, or mefloquine in 14-day trials. Minimal clinical and parasitological data for days 0-14 were needed to classify treatment failure and success. Clinical and parasitological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine was found to be 5 times more likely to be effective than chloroquine and SP, while chloroquine and SP treatments have almost identical failure patterns. A higher than 50% failure rate following chloroquine treatment was reported in Sagaing and following SP treatment in Sagaing and eastern Shan.

Hospital-based study of severe malaria and associated deaths in Myanmar.

The present study identifies factors that contribute to malaria deaths in township hospitals reporting large numbers of such deaths in Myanmar. Between July and December 1995, we identified a total of 101 patients with severe and complicated malaria by screening the cases admitted to hospital with a primary diagnosis of falciparum malaria. Unrousable coma and less marked impairment of consciousness with or without other severe malaria complications, in contrast to severe malaria anaemia, were associated with all malaria deaths. Adult patients with severe malaria were 2.8 times more likely to die than child patients, with the higher risk of death among adults probably being associated with previous exposure to malaria, delay in seeking treatment and severity of the illness before admission. In view of this, we consider that malaria mortality could be reduced by improving peripheral facilities for the management of severe malaria and providing appropriate education to communities, without stepping up vector control activities.

PIP: Malaria threatens about 60% of Myanmar's population with morbidity and mortality. Factors are identified which contribute to malaria mortality in township hospitals reporting large numbers of such deaths in Myanmar. During July-December 1995, 101 patients with severe and complicated malaria were identified through the screening of cases admitted to hospital with a primary diagnosis of falciparum malaria. Unrousable coma and less marked impairment of consciousness with or without other severe malaria complications, in contrast to severe malaria anemia, were associated with all malaria deaths. Adult patients with severe malaria were 2.8 times more likely to die than child patients, with the higher risk of death among adults probably associated with previous exposure to malaria, delay in seeking treatment, and the severity of illness before admission. The level of malaria mortality could be reduced by improving peripheral facilities for the management of severe malaria and providing appropriate education to communities, without stepping up vector control activities.