G6PD Deficiency and Antimalarial Efficacy for Uncomplicated Malaria in Bangladesh: A Prospective Observational Study

BackgroundThe Bangladeshi national treatment guidelines for uncomplicated malaria follow WHO recommendations but without G6PD testing prior to primaquine administration. A prospective observational study was conducted to assess the efficacy of the current antimalarial policy.MethodsPatients with uncomplicated malaria, confirmed by microscopy, attending a health care facility in the Chittagong Hill Tracts, Bangladesh, were treated with artemether-lumefantrine (days 0–2) plus single dose primaquine (0.75mg/kg on day2) for P. falciparum infections, or with chloroquine (days 0–2) plus 14 days primaquine (3.5mg/kg total over 14 days) for P. vivax infections. Hb was measured on days 0, 2 and 9 in all patients and also on days 16 and 30 in patients with P. vivax infection. Participants were followed for 30 days. The study was registered with the clinical trials website ({"type":"clinical-trial","attrs":{"text":"NCT02389374","term_id":"NCT02389374"}}NCT02389374).ResultsBetween September 2014 and February 2015 a total of 181 patients were enrolled (64% P. falciparum, 30% P. vivax and 6% mixed infections). Median parasite clearance times were 22.0 (Interquartile Range, IQR: 15.2–27.3) hours for P. falciparum, 20.0 (IQR: 9.5–22.7) hours for P. vivax and 16.6 (IQR: 10.0–46.0) hours for mixed infections. All participants were afebrile within 48 hours, two patients with P. falciparum infection remained parasitemic at 48 hours. No patient had recurrent parasitaemia within 30 days. Adjusted male median G6PD activity was 7.82U/gHb. One male participant (1/174) had severe G6PD deficiency (<10% activity), five participants (5/174) had mild G6PD deficiency (10–60% activity). The Hb nadir occurred on day 2 prior to primaquine treatment in P. falciparum and P. vivax infected patients; mean fractional fall in Hb was -8.8% (95%CI -6.7% to -11.0%) and -7.4% (95%CI: -4.5 to -10.4%) respectively.ConclusionThe current antimalarial policy remains effective. The prevalence of G6PD deficiency was low. Main contribution to haemolysis in G6PD normal individuals was attributable to acute malaria rather than primaquine administration.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02389374","term_id":"NCT02389374"}}NCT02389374     

Adaptation to low temperature and regulation of gene expression in antarctic psychrotrophic bacteria

Exposure to extremes of temperatures cause stresses which are sometimes lethal to living cells. Microorganisms in nature, however, are extremely diverse and some of them can live happily in the freezing cold of Antarctica. Among the cold adapted psychrotrophs and psychrophiles, the psychrotrophic bacteria are the predominant forms in the continental Antarctica. In spite of living in permanently cold area, the antarctic bacteria exhibit, similar to mesophiles, ‘cold-shock’ response albeit at a much lower temperatures, e.g., at 0–5°C. However, because of permanently cold condition and the long isolation of the continent, the microorganisms have acquired new adaptive features in the membranes, enzymes and macromolecular synthesis. Only recently these adaptive modifications are coming into light due to the efforts of various laboratories around the world. However, a lot more is known about adaptive response to low temperature in mesophilic bacteria than in antarctic bacteria. Combined knowledge from the two systems is providing useful clues to the understanding of basic biology of low temperature growing organisms. This article will provide an overview of this area of research with a special reference to sensing of temperature and regulation of gene expression at lower temperature.     

Meiosis in double trisomic Brassica campestris

Meiosis in a double trisomic Brassica campestris (2n=20+1+1) found among the progeny of autotriploid B. campestris (3n=30) was studied to detect homologies of duplicate types of chromosomes in the a genome of Brassica. The two extra chromosomes paired with the corresponding homologues and formed two trivalents in 10.5% of nuclei revealing the double trisomic nature. They formed a separate bivalent in 15.6% of nuclei proving the homology of these two chromosomes in the a genome. Anaphase I and II segregations revealed a normal disjunction of chromosomes.Emeritus Professor of Botany & Emeritus Scientist, Indian Council of Agricultural Research.     

First Report of Aster Yellows Phytoplasma (16SrI‐B) Associated with Witches' Broom Disease of Melia azedarach var. japonica in Korea

Melia azedarach var. japonica trees with leaf yellowing, small leaves and witches' broom were observed for the first time in Korea. A phytoplasma from the symptomatic leaves was identified based on the 16Sr DNA sequence as a member of aster yellows group, ribosomal subgroup 16SrI‐B. Sequence analyses of more variable regions such as 16S–23S intergenic spacer region, secY gene, ribosomal protein (rp) operon and tuf gene showed 99.5?100% nucleotide identity to several GenBank sequences of group 16SrI phytoplasmas. Phylogenetic analysis confirmed that the Melia azedarach witches' broom phytoplasma belongs to aster yellows group.     

Ethidium bromide (EB) induced mutants in gingelly (Sesamum indicum L.) cultivar ‘Vinayak’

Theoretical and Applied Genetics -     

Methyl eugenol effects on Bactrocera dorsalis male total body protein,reproductive organs and ejaculate

Methyl eugenol (ME) and inclusion of protein into the adult diet increase the mating competitiveness of the Oriental fruit fly, Bactrocera dorsalis (Hendel). Exposing males to ME or protein is a promising post‐teneral treatment for males being released in the sterile insect technique (SIT). However, the effect of this post‐teneral treatment on male reproductive organs or the male ejaculate is unknown. During mating, males transfer sperm and accessory gland products (AGPs) to females and these compounds are reported to modulate female sexual inhibition. We studied the impact of male exposure to ME and a yeast hydrolysate (YH) diet on the protein reserves of males, male reproductive organ size, and the male ejaculate through sperm and AGPs. We show that males exposed to ME regardless of access to YH accumulated a greater amount of whole body protein. Males fed on YH also had increased total body protein and had bigger reproductive organs than YH‐deprived males, but no apparent effect of ME exposure was observed on reproductive organ size. Females stored less sperm when mated with males fed on YH and ME compared to males not fed on ME. YH and ME had no effect on male AGPs. Females injected with AGPs of males fed on YH and exposed to ME were just as likely to mate as females injected with AGPs of non‐treated males. However, females injected with AGPs of males exposed to ME mated faster than females injected with AGPs of non‐exposed males. We conclude that while exposure to ME increases male copulatory success and protein reserves in the male body, there seem to be some potential trade‐offs such as lower sperm stored by females. We discuss our results in terms of pre‐release protocols that may be used for B. dorsalis in SIT application.     

Hemodynamic Effects of Cardiovascular Medications in a Normovolemic and Hemorrhaged Yorkshire-cross Swine Model

The Yorkshire-cross swine model is a valuable translational model commonly used to study cardiovascular physiology and response to insult. Although the effects of vasoactive medications have been well described in healthy swine, the effects of these medications during hemorrhagic shock are less studied. In this study, we sought to expand the utility of the swine model by characterizing the hemodynamic changes that occurred after the administration of commonly available vasoactive medications during euvolemic and hypovolemic states. To this end, we anesthetized and established femoral arterial, central venous, and pulmonary arterial access in 15 juvenile Yorkshire-cross pigs. The pigs then received a series of rapidly metabolized but highly vasoactive medications in a standard dosing sequence. After completion of this sequence, each pig underwent a 30-mL/kg hemorrhage over 10 min, and the standard dosing sequence was repeated. We then used standard statistical techniques to compare the effects of these vasoactive medications on a variety of hemodynamic parameters between the euvolemic and hemorrhagic states. All subjects completed the study protocol. The responses in the hemorrhagic state were often attenuated or even opposite of those in the euvolemic state. For example, phenylephrine decreased the mean arterial blood pressure during the euvolemic state but increased it in the hemorrhagic state. These results clarify previously poorly defined responses to commonly used vasoactive agents during the hemorrhagic state in swine. Our findings also demonstrate the need to consider the complex and dynamic physiologic state of hemorrhage when anticipating the effects of vasoactive drugs and planning study protocols.

Biomedical research using animals is a critical element in the advancement of human healthcare worldwide. Pigs are an important species for translational research, because their physiologic responses to hemorrhage, traumatic brain injury, and other traumatic injuries simulates the human response more closely than any other nonprimate animal model.¹² Yorkshire-cross swine demonstrate cardiovascular responses to physiologic insult that are similar to the responses of people.^18,24,27,32 These pigs have been used to evaluate several abnormal hemodynamic states, including those found in cardiac disease,^20,29,36 vascular disease,^3,21,25 and shock.^26,30,35 Swine models are particularly important in military and combat research for study of the complex physiology during hemorrhage,^10,17,19 especially given that traumatic hemorrhage remains the leading cause of potentially survivable mortality in both civilian and military populations.^7-9,16The effects of vasoactive medications in healthy swine have been well described and in general are similar to those observed in humans.^6,15 However, the effects of these medications have been less studied during hemorrhagic shock, and those studies have typically been limited to the effects that develop after the administration of vasoactive medications^4,5,22 as compared with medications that have direct inotropic or chronotropic activity. In normovolemic subjects, most vasoconstrictive medications have predictable responses that can be quantified by measuring changes in blood pressure, systemic vascular resistance (SVR), stroke volume, heart rate (HR), and cardiac output. However, hemorrhage can induce significant changes in these indices^28,31 and in how vasoactive medications affect these indices. For example, hemorrhage tends to decrease systemic blood pressure, with a compensatory increase in heart rate.This study sought to expand the utility of the swine model by characterizing the hemodynamic changes observed after the administration of commonly used vasoactive medications during euvolemic and hypovolemic states. All of the study medications are highly selective, with rapid pharmacokinetics, and were chosen to selectively modify isolated components of cardiovascular physiology (e.g., preload, contractility, afterload).The first agent, phenylephrine, is a rapidly metabolized selective α1 adrenergic agonist that we selected for this study because of its broad use in both research and human clinical settings and its selective ability to increase SVR through direct arteriolar vasoconstriction. Previous studies in euvolemic swine with phenylephrine-induced hypertension showed significant increases in mean pulmonary artery pressure, mean arterial pressure (MAP), and SVR, with minimal influence on cardiac output and HR.³⁴ Second, nicardipine is a rapidly metabolized dihydropyridine calcium-channel blocker that is commonly used in human clinical practice. Its primary mechanism of action is direct arteriolar vasodilation. In previous studies of euvolemic swine, nicardipine decreased MAP and SVR.¹¹ Third, dobutamine is a rapidly metabolized β-adrenergic agonist that increases both cardiac ionotropy and chronotropy. Previous investigations in euvolemic swine found profound increases in HR, cardiac output, and MAP after dobutamine administration.² Fourth, esmolol is a highly selective β1 adrenergic antagonist that undergoes extremely rapid metabolism by nonspecific esterases in blood and tissue. It decreases both cardiac inotropy and chronotropy, and its administration leads to overall myocardial depression and decreased HR and MAP. Previous studies in swine showed decreased cardiac excitability and increased thresholds for the onset of malignant arrhythmias.³³ Finally, nitroglycerine increases venous capacitance through venous dilation, thereby causing a functional decrease in preload. The hemodynamic effects of nitroglycerine can vary depending on the subject’s physiologic state. In general, intravenous administration of nitroglycerine decreases MAP due to decreased cardiac output. This effect was demonstrated in euvolemic swine and was accompanied by a compensatory increase in HR.¹     

Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria

Primaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose–6–phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity by reticulocytes and young erythrocytes with higher activity. Aim of this study was to assess the impact of acute malaria on G6PD activity. Selected patients with uncomplicated malaria were recruited in Bangladesh (n = 87), Indonesia (n = 75), and Ethiopia (n = 173); G6PD activity was measured at the initial presentation with malaria and a median of 176 days later (range 140 to 998) in the absence of malaria. Among selected participants (deficient participants preferentially enrolled in Bangladesh but not at other sites) G6PD activity fell between malaria and follow up by 79.1% (95%CI: 40.4 to 117.8) in 6 participants classified as deficient (<30% activity), 43.7% (95%CI: 34.2 to 53.1) in 39 individuals with intermediate activity (30% to <70%), and by 4.5% (95%CI: 1.4 to 7.6) in 290 G6PD normal (≥70%) participants. In Bangladesh and Indonesia G6PD activity was significantly higher during acute malaria than when the same individuals were retested during follow up (40.9% (95%CI: 33.4–48.1) and 7.4% (95%CI: 0.2 to 14.6) respectively), whereas in Ethiopia G6PD activity was 3.6% (95%CI: -1.0 to -6.1) lower during acute malaria. The change in G6PD activity was apparent in patients presenting with either P. vivax or P. falciparum infection. Overall, 66.7% (4/6) severely deficient participants and 87.2% (34/39) with intermediate deficiency had normal activities when presenting with malaria.These findings suggest that G6PD activity rises significantly and at clinically relevant levels during acute malaria. Prospective case-control studies are warranted to confirm the degree to which the predicted population attributable risks of drug induced haemolysis is lower than would be predicted from cross sectional surveys.     

Comparative Calorie Values of Nematodes

Calorie values for a wide biological selection of nematodes, determined with a microbomb calorimeter, ranged from 3.86 to 6.85 Kcal/g. The mean of 5.095 Kcal from 16 species was lower than means recorded in three previous studies of other invertebrate groups. The nematode values were skewed to the lowest limit. Larvae of Ditylenchus dipsaci showed lower calorie values after storage, and the calorie values of separate tissues of Ascaris lumbricoides were highest for eggs and the intestine and lowest for cuticle and body-wall musculature. No clear calorie distinction exists between nematodes with a parasitic or free-living habit or between large and small nematodes.