Clinical tolerability of artesunate-amodiaquine versus comparator treatments for uncomplicated falciparum malaria: an individual-patient analysis of eight randomized controlled trials in sub-Saharan Africa

ABSTRACT: BACKGROUND: The widespread use of artesunate-amodiaquine (ASAQ) for treating uncomplicated malaria makes it important to gather and analyse information on its tolerability. METHODS: An individual-patient tolerability analysis was conducted using data from eight randomized controlled clinical trials conducted at 17 sites in nine sub-Saharan countries comparing ASAQ to other anti-malarial treatments. All patients who received at least one dose of the study drug were included in the analysis. Differences in adverse event (AE) and treatment emergent adverse event (TEAE) were analysed by Day 28. RESULTS: Of the 6,179 patients enrolled (74 % <5 years of age), 50 % (n = 3,113) received ASAQ, 20 % (n = 1,217) another ACT, and 30 % (n = 1,849) a non-ACT (combination or single-agent) treatment. Overall, 8,542 AEs were recorded. The proportion of patients experiencing at least one gastro-intestinal AE on ASAQ was 43 % (and higher than that with artemetherlumefantrine and dihydroartemisinin-piperaquine at two sites), and was 23 % for any other AEs (not different from other treatments). Specifically, the risk of diarrhoea, vomiting, cough and weakness was lower with artemether-lumefantrine; artemether-lumefantrine and dihydroartemisinin-piperaquine carried a higher risk of pruritus, chloroquine-SP had a higher risk of nausea. Parasitological recurrence increased the risk of occurrence of any AE. No other difference was detected. Comparing AE to TEAE in patients who had pre-treatment occurrence and grades of intensity recorded, AEs were significantly more related to the pretreatment prevalence of the symptom (p = 0.001, Fisher test); AEs overestimated TEAEs by a factor ranging from none to five-fold. The overall incidence of serious AEs (SAEs) with ASAQ was nine per 1,000 (29/3,113) and mortality was one per 1,000 (three deaths, none drug-related); both were similar to other treatments. CONCLUSION: ASAQ was comparatively well-tolerated. Safety information is important, and must be collected and analysed in a standardized way. TEAEs are a more objective measure of treatment-induced toxicity.     

From Pro-nucleotides to Pro-oligonucleotides

Abstract

Consequences of masking the phosphate functions of nucleic acid derivatives by enzyme labile bioreversible protecting groups are discussed.     

Biology and Host Specificity of Chamaesphecia mysiniformis (Lepidoptera: Sesiidae), a Potential Biological Control Agent of Marrubium vulgare (Lamiaceae) in Australia

The biology of the rhizophagous clearwing moth Chamaesphecia mysiniformis Rambur and its specificity to Marrubium vulgare L. (Lamiaceae) (horehound), a serious introduced weed in southern Australia, were studied in France. Adults emerged in late spring during the morning and began mating on the same day, usually in the mid to late afternoon. Eggs were laid among flower clusters, with females laying an average of 96 2.41 (range, 1-268) with an overall hatch success of 79%. In no-choice, host-specificity tests, first instar larvae attacked only four species of Marrubium, along with Ballota nigra L. and Stachys arvensis L. This high level of specificity and the high mortality of the target plant in its native range make this moth a promising biological control agent of horehound in Australia.     

p NMR Studies of Rat Liver Cold Preservation with Histidine-Buffered Lactobionate Solution

The efficiency of a preservation medium, histidine-buffered lactobionate solution (HBLS), was determined by measuring post-ischemic recoveries of ATP and intracellular pH under Krebs-Henseleit buffer (KHB) perfusion. We used NMR spectroscopy to study the effect of 24-h cold ischemia, followed by 4°C then 37°C reperfusion on the isolated rat liver. Three media were compared: University of Wisconsin solution (UW-lactobionate); Bretschneider's solution (HTK); HBLS and HBLS supplemented with 2 mM Gly and 2 mM Cys (HBLSg2) or with 10 mM Gly and 2 mM Cys (HBLSg10). All values were compared to control values measured during pre-ischemic cold perfusion with KHB (ATP = 8.60 ± 0.6 μmol/g of dry weigh and pH_in = 7.41 ± 0.05). The main result from ³¹p NMR data concerned ATP recovery during cold reperfusion, which was significantly higher in the HBLS group (112 ± 10%) as compared to the UW and HTK groups (around 66%). The presence of glycine decreased ATP recovery (88 ± 8% in HBLSg2, 79 ± 15% in HBLSg10). Higher values of recovered pH_in were observed in livers stored in histidine buffered solutions (around 7.30) as compared to UW (around 7.20); histidine was by ¹³C NMR proved to accumulate in the liver cells, thus ensuring a good buffering capacity. The thermal transition induced a decrease in both ATP level and pH_in in all groups. This might be the result of a stimulation of the carbohydrate metabolism (as demonstrated by ¹³C NMR) especially when glycine was present in the storage solution.     

Simulation of bone tissue formation within a porous scaffold under dynamic compression

A computational model of mechanoregulation is proposed to predict bone tissue formation stimulated mechanically by overall dynamical compression within a porous polymeric scaffold rendered by micro-CT. Dynamic compressions of 0.5–5% at 0.0025–0.025 s⁻¹ were simulated. A force-controlled dynamic compression was also performed by imposing a ramp of force from 1 to 70 N. The model predicts homogeneous mature bone tissue formation under strain levels of 0.5–1% at strain rates of 0.0025–0.005 s⁻¹. Under higher levels of strain and strain rates, the scaffold shows heterogeneous mechanical behaviour which leads to the formation of a heterogeneous tissue with a mixture of mature bone and fibrous tissue. A fibrous tissue layer was also predicted under the force-controlled dynamic compression, although the same force magnitude was found promoting only mature bone during a strain-controlled compression. The model shows that the mechanical stimulation of bone tissue formation within a porous scaffold closely depends on the loading history and on the mechanical behaviour of the scaffold at local and global scales.     

Decrease in oxidative phosphorylation yield in presence of butyrate in perfused liver isolated from fed rats

Background  

Butyrate is the main nutrient for the colonocytes but the effect of the fraction reaching the liver is not totally known. A decrease in tissue ATP content and increase in respiration was previously demonstrated when livers were perfused with short-chain fatty acids (SCFA) such as butyrate, or octanoate.