Motivations and perceptions of community advisory boards in the ethics of medical research: the case of the Thai-Myanmar border.

Background: Community engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary.

Introducing the concept of a new pre-referral treatment for severely ill febrile children at community level: a sociological approach in Guinea-Bissau.

Background: Innovative strategies are needed to tackle childhood mortality in the rural tropics. Artesunate suppositories were developed to bring emergency treatment closer to severely ill children with malaria in rural areas where injectable treatment is not possible for several hours. Adding an antibacterial rectal drug would extend this strategy to treat non-malarial febrile illness as well.

Mass primaquine treatment to eliminate vivax malaria: lessons from the past.

Recent successes in malaria control have put malaria eradication back on the public health agenda. A significant obstacle to malaria elimination in Asia is the large burden of Plasmodium vivax, which is more difficult to eliminate than Plasmodium falciparum. Persistent P.

Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.

Background: Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone.

Population pharmacokinetic assessment of the effect of food on piperaquine bioavailability in patients with uncomplicated malaria.

Previously published literature reports various impacts of food on the oral bioavailability of piperaquine. The aim of this study was to use a population modeling approach to investigate the impact of concomitant intake of a small amount of food on piperaquine pharmacokinetics. This was an open, randomized comparison of piperaquine pharmacokinetics when administered as a fixed oral formulation once daily for 3 days with (n=15) and without (n=15) concomitant food to patients with uncomplicated Plasmodium falciparum malaria in Thailand.

Pharmacokinetics of orally administered oseltamivir in healthy obese and nonobese Thai subjects.

Oseltamivir is the most widely used anti-influenza drug. In the 2009 H1N1 pandemic, in which the influenza viruses were oseltamivir sensitive, obesity was identified as a risk factor for severe disease and unfavorable outcomes. The aim of this study was to investigate the pharmacokinetic properties of oseltamivir and its active metabolite, oseltamivir carboxylate, in obese and nonobese healthy subjects.

Hysteretic spin crossover in iron(II) complexes of a new pyridine-triazole-pyrazine ligand is tuned by choice of NCE co-ligand.

A family of three new mononuclear complexes of the general form [Fe(L(pz))2(NCE)2] has been prepared (L(pz) = 4-p-tolyl-3-(2-pyrazinyl)-5-(2-pyridyl)-1,2,4-triazole; E = S, Se, BH3). All three exhibit spin crossover, in two cases with hysteresis, with T1/2 being predictably tuned by varying the coordinated anion.

The effect of carbohydrate ingestion on performance during a simulated soccer match.

Aim: This study investigated how performance was affected after soccer players, in a postprandial state, ingested a 7% carbohydrate (CHO) solution compared to a placebo (0% CHO) during a simulated soccer match.

Methods: Using a double-blind placebo-controlled design, 22 trained male league soccer players (age: 24 ± 7 years, wt: 73.4 ± 12.

Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes.

Background:  Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies to improve outcomes.

Methods:  Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa.

Increased halide recognition strength by enhanced intercomponent preorganisation in triazolium containing [2]rotaxanes.

Three triazolium-based [2]rotaxanes containing different sized axle and macrocycle components were synthesised in good yields (40-57%) through chloride anion templation. The anion recognition properties of the interlocked receptor systems were investigated using (1)H NMR titration experiments: all three rotaxanes display impressive selectivities for halide anions over the more basic oxoanion acetate. The rotaxanes incorporating shorter, more rigid axle components with aryl-substituted triazolium groups display substantially higher anion binding affinities than those with longer, bis-alkyl-substituted heterocycles, which is attributed to the increased intercomponent preorganisation afforded by the smaller axle component.

Single dose primaquine for clearance of Plasmodium falciparum gametocytes in children with uncomplicated malaria in Uganda: a randomised, controlled, double-blind, dose-ranging trial.

Background: Primaquine is the only available drug that clears mature Plasmodium falciparum gametocytes in infected human hosts, thereby preventing transmission of malaria to mosquitoes. However, concerns about dose-dependent haemolysis in people with glucose-6-phosphate dehydrogenase (G6PD) deficiencies have limited its use. We assessed the dose-response association of single-dose primaquine for gametocyte clearance and for safety in P falciparum malaria.

Optimal sampling designs for estimation of Plasmodium falciparum clearance rates in patients treated with artemisinin derivatives.

Background: The emergence of Plasmodium falciparum resistance to artemisinins in Southeast Asia threatens the control of malaria worldwide. The pharmacodynamic hallmark of artemisinin derivatives is rapid parasite clearance (a short parasite half-life), therefore, the in vivo phenotype of slow clearance defines the reduced susceptibility to the drug. Measurement of parasite counts every six hours during the first three days after treatment have been recommended to measure the parasite clearance half-life, but it remains unclear whether simpler sampling intervals and frequencies might also be sufficient to reliably estimate this parameter.

Liquid chromatographic-mass spectrometric method for simultaneous determination of small organic acids potentially contributing to acidosis in severe malaria.

Acidosis is an important cause of mortality in severe falciparum malaria. Lactic acid is a major contributor to metabolic acidosis, but accounts for only one-quarter of the strong anion gap. Other unidentified organic acids have an independent strong prognostic significance for a fatal outcome.

Towards a self-assembled honeycomb structure via diaminotriptycene metal complexes.

We illustrate a new approach toward the synthesis of a porous supramolecular honeycomb based on triptycene. A coordination polymer has been prepared where the triptycene groups are linked through triptycenesemiquinonediimine platinum complexes, but the product is disordered rather than the intended honeycomb structure. A model platinum complex and its (15)N-labeled isotopomer have been prepared and characterized.

Entomological determinants of insecticide-treated bed net effectiveness in Western Myanmar.

Background: In a large cluster randomized control trial of insecticide-treated bed nets (ITN) in Western Myanmar the malaria protective effect of ITN was found to be highly variable and, in aggregate, the effect was not statistically significant. A coincident entomological investigation measured malaria vector abundance and biting behaviour and the human population sleeping habits, factors relevant to ITN effectiveness.

Methods: Entomological surveys were carried out using different catching methods to identify potential malaria vector species and characterise their biting habits.

The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar.

Background: Insecticide-treated bed nets (ITN) reduce malaria morbidity and mortality consistently in Africa, but their benefits have been less consistent in Asia. This study's objective was to evaluate the malaria protective efficacy of village-wide usage of ITN in Western Myanmar and estimate the cost-effectiveness of ITN compared with extending early diagnosis and treatment services.

Methods: A cluster-randomized controlled trial was conducted in Rakhine State to assess the efficacy of ITNs in preventing malaria and anaemia in children and their secondary effects on nutrition and development.

The reliability of the physical examination to guide fluid therapy in adults with severe falciparum malaria: an observational study.

Background: Adults with severe malaria frequently require intravenous fluid therapy to restore their circulating volume. However, fluid must be delivered judiciously as both under- and over-hydration increase the risk of complications and, potentially, death. As most patients will be cared for in a resource-poor setting, management guidelines necessarily recommend that physical examination should guide fluid resuscitation.

Genetic marker suitable for identification and genotyping of Plasmodium ovale curtisi and Plasmodium ovale wallikeri.

We present a seminested PCR method that specifically discriminates between Plasmodium ovale curtisi and P. ovale wallikeri with high sensitivity. The test is based on species-specific amplification of a size-polymorphic fragment of the tryptophan-rich antigen gene, potra, which also permits discrimination of intraspecific sequence variants at this locus.

Halogen- and hydrogen-bonding triazole-functionalised porphyrin-based receptors for anion recognition.

Iodotriazole and triazole anion recognition groups have been integrated into a picket-fence zinc(ii)-metalloporphyrin scaffold to produce receptors for anion recognition and sensing applications. (1)H NMR and UV/visible spectroscopic investigations reveal both host systems exhibit strong anion binding affinities in a range of solvent media. Importantly, the halogen-bonding iodotriazole-containing porphyrin-based host displays halide binding affinities substantially larger than the protic-functionalised analogue concomitant with a reduced strength of oxoanion complexation.

Effect of N4-substituent choice on spin crossover in dinuclear iron(II) complexes of bis-terdentate 1,2,4-triazole-based ligands.

Seven new dinuclear iron(II) complexes of the general formula [Fe(II)2(PMRT)2](BF4)4·solvent, where PMRT is a 4-substituted-3,5-bis{[(2-pyridylmethyl)-amino]methyl}-4H-1,2,4-triazole, have been prepared in order to investigate the substituent effect on the spin crossover event. Variable temperature magnetic susceptibility and (57)Fe Mössbauer spectroscopy studies show that two of the complexes, [Fe(II)2(PMPT)2](BF4)4·H2O (N(4) substituent is pyrrolyl) and [Fe(II)2(PM(Ph)AT)2](BF4)4 (N(4) is N,N-diphenylamine), are stabilized in the [HS-HS] state between 300 and 2 K with weak antiferromagnetic interactions between the iron(II) centers. Five of the complexes showed gradual half spin crossover, from [HS-HS] to [HS-LS], with the following T(1/2) (K) values: 234 for [Fe(II)2(PMibT)2](BF4)4·3H2O (N(4) is isobutyl), 147 for [Fe(II)2(PMBzT)2](BF4)4 (N(4) is benzyl), 133 for [Fe(II)2(PM(CF3)PhT)2](BF4)4·DMF·H2O (N(4) is 3,5-bis(trifluoromethyl)phenyl), 187 for [Fe(II)2(PMPhT)2](BF4)4 (N(4) is phenyl), and 224 for [Fe(II)2(PMC16T)2](BF4)4 (N(4) is hexadecyl).

Pharmacokinetic and pharmacodynamic considerations in antimalarial dose optimization.

Antimalarial drugs have usually been first deployed in areas of malaria endemicity at doses which were too low, particularly for high-risk groups such as young children and pregnant women. This may accelerate the emergence and spread of resistance, thereby shortening the useful life of the drug, but it is an inevitable consequence of the current imprecise method of dose finding. An alternative approach to dose finding is suggested in which phase 2 studies concentrate initially on pharmacokinetic-pharmacodynamic (PK-PD) characterization and in vivo calibration of in vitro susceptibility information.

Neonatal intensive care in a Karen refugee camp: a 4 year descriptive study.

Background: A third of all deaths in children aged <5 years occur in the neonatal period. Neonatal intensive care is often considered too complex and expensive to be implemented in resource poor settings. Consequently the reductions that have been made in infant mortality in the poorest countries have not been made in the neonatal period.

Microscopy ambient ionization top-down mass spectrometry reveals developmental patterning.

There is immense cellular and molecular heterogeneity in biological systems. Here, we demonstrate the utility of integrating an inverted light microscope with an ambient ionization source, nanospray electrospray desorption ionization, attached to a high-resolution mass spectrometer to characterize the molecular composition of mouse spinal cords. We detected a broad range of molecules, including peptides and proteins, as well as metabolites such as lipids, sugars, and other small molecules, including S-adenosyl methionine and glutathione, through top-down MS.

Evaluation of the phenotypic test and genetic analysis in the detection of glucose-6-phosphate dehydrogenase deficiency.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is particularly prevalent in historically malaria-endemic countries. Although most individuals with G6PD deficiency are asymptomatic, deficiency can result in acute haemolytic anaemia after exposure to oxidative agents. A reliable test is necessary for diagnosing the deficiency to prevent an acute haemolytic crisis following, for example, anti-malarial treatment.

Malaria.

Although global morbidity and mortality have decreased substantially, malaria, a parasite infection of red blood cells, still kills roughly 2000 people per day, most of whom are children in Africa. Two factors largely account for these decreases; increased deployment of insecticide-treated bednets and increased availability of highly effective artemisinin combination treatments. In large trials, parenteral artesunate (an artemisinin derivative) reduced severe malaria mortality by 22·5% in Africa and 34·7% in Asia compared with quinine, whereas adjunctive interventions have been uniformly unsuccessful.