Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

ABSTRACT: BACKGROUND: Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of [greater than or equal to]6 mg/kg, i.e. [greater than or equal to]420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse. METHODS: A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011. Primaquine dosing was classified as no dose, low dose (<420 mg), high dose ([greater than or equal to]420 mg), or unknown. The dose of primaquine prescribed to patients who subsequently relapsed was compared to patients who did not relapse. RESULTS: Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%). Relapses were confirmed among 3/21 (14.2%), 9/50 (18.0%), 1/54 (1.9%)and 7/18 (38.9%) of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with significantly lower rates of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5- 519, p = 0.005). CONCLUSIONS: Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax.     

Paired assessment of volatile anesthetic concentrations with synaptic actions recorded in vitro

The volatile anesthetic isoflurane poses a number of experimental challenges in the laboratory. Due to its rapid evaporation, the open conditions of most in vitro electrophysiological recording systems make the determination of actual isoflurane concentrations a challenge. Since the absolute anesthetic concentration in solution is directly related to efficacy, concentration measurements are important to allow comparisons between laboratory and clinical studies. In this study we quantify the sources of isoflurane loss during experimentation and describe a method for the measurement of isoflurane concentrations using gas chromatography and mass spectrometry simultaneous to in vitro electrophysiological measurements. Serial samples of perfused bath solution allowed correlation of isoflurane concentrations with ongoing biological effects. Saturated physiological solutions contained 13.4 +/- 0.2 mM isoflurane and were diluted to desired "nominal" concentrations for experiments. The perfusion system established stable isoflurane concentrations within the bath by 2 minutes. However, bath isoflurane concentrations varied substantially and unpredictably between experiments. The magnitudes of such discrepancies in isoflurane concentrations spanned clinically important levels. Our studies suggest that, despite countermeasures, solution handling significantly impacted the isoflurane content in the tissue bath. The magnitude of these discrepancies appears to necessitate systematic direct measurement of bath isoflurane concentrations during most in vitro conditions.     

Plant invasions in treeless vegetation of the Australian Alps

A total of 128 invasive plant species have been recorded in treeless vegetation in the Australian Alps. Most of these are forbs and most are uncommon. Cover of invasive species is generally minimal unless there has been gross disturbance to natural vegetation and soils. Although there is a significantly positive correlation between invasive and native species diversity, suggesting that conditions that allow numerous native species to co-exist also permit more plant invasions, altitude is the most important determinant of invasive species diversity. Only 22 of the 128 species have been recorded above 1800 m. Some plant communities (e.g. those with high pH or relatively nutrient-rich soils), however, seem to be vulnerable to invasions regardless of altitude. Most invasive species appear to have been introduced unintentionally (e.g. as seed attached to vehicles, animals and humans) but a few were introduced to assist with revegetation of disturbed soils and for amenity plantings in ski resorts, and have subsequently established in native vegetation. Treeless communities in the Australian Alps are likely to face increasing pressure from invasive species as a result of global warming and continued introduction of non-native plants to ski resort gardens. Whilst it may be difficult to prevent invasive species of low elevations migrating to higher elevations as temperatures rise, the risk of invasion from garden plants could be minimised through regulation. Non-native plants in ski resort gardens pose a far greater risk than most invasive species currently present in the Alps because they have been chosen for their capacity to survive at high altitudes.     

Immunolocalization of MMP-19 in the human intervertebral disc: implications for disc aging and degeneration

Matrix metalloproteinases (MMPs) degrade components of the extracellular matrix of the disc, but the presence of MMP-19 has not been explored. In other tissues, MMP-19 is known to act in proteolysis of the insulin-like growth factor (IGF) binding protein-3, thereby exposing this protein to make it available to influence cell behavior. MMP-19 also has been shown to inhibit capillary-like formation and thus play a role in the avascular nature of the disc. Using immunohistochemistry, normal discs from six subjects aged newborn through 10 years and 20 disc specimens from control donors or surgical patients aged 15-76 (mean age 40.2 years) were examined for immunolocalization of MMP-19; six Thompson grade I discs, five Thompson grade II, eight Thompson grade III, five Thompson grade IV, and one Thompson grade V discs were analyzed. The results indicate that in discs from young subjects, MMP-19 was uniformly localized in the outer annulus. In discs from adult donors and surgical patients, outer and inner annulus cells only occasionally showed MMP-19 localization. The greatest expression of MMP-19 was observed in young discs, and little expression was seen in older or degenerating discs. Because MMP-19 has been shown to regulate IGF-mediated proliferation in other tissues, its decline in the aging/degenerating disc may contribute to the age-related decrease in disc cell numbers.     

Adenovirus 12 uncoiler regions of human chromosome 1 in relation to the 5S rRNA genes

Two uncoiler regions, induced by adenovirus 12, have been identified on human chromosome 1 at 1q42 and 1p36. In situ hybridization with [¹²⁵I-5S]-rRNA places the 5S genes more accurately at 1q42–43 immediately distal to the uncoiled site, 1q42.     

In vitro traits of adenovirus-transformed cell lines and their relevance to tumorigenicity in nude mice

Six independently isolated adenovirus 2-transformed rat cell lines and one adenovirus 5-transformed human cell line have been examined in vitro for serum growth requirements, saturation density, anchorage-independent growth, proteolytic enzyme activity and the presence of LETS glycoprotein and T antigen. This series of adenovirus-transformed cell lines exhibits an oncogenic spectrum ranging from being tumorigenic in immunocompetent rats through to nontumorigenic in adult nude mice. The relevance of the in vitro findings to growth potential in vivo is discussed.