In Vanuatu malaria is a major killer, especially of young children. As most deaths occur outside the hospital it is very important to have simple, clear guidelines on the management of patients with suspected malaria for the primary health care workers who treat the majority of cases. Despite the encouragement of early treatment, malaria was the major cause of death in children after the neonatal period in 1988. During 1989 and 1990 the treatment of malaria in Vanuatu was reviewed with the aim of trying to reduce the morbidity and mortality from the disease. New guidelines were included in the Vanuatu Health Workers' Manual, issued to all nurses, nurse practitioners and doctors in 1991. The major changes were the introduction of immediate slide microscopy, the use of a combination of chloroquine and sulphadoxine-pyrimethamine for Plasmodium falciparum malaria and for children under 5 years and pregnant women, the discontinuation of single-dose primaquine (previously given as a gametocytocidal agent), and the use of a loading dose of quinine. The constraints of the previous guidelines, the rationale for the changes and the expected improvements resulting from using the new treatments are discussed.
Adolescent ; Adult ; Antimalarials - administration & ; dosage ; Child, Preschool ; Chloroquine - administration & ; dosage ; Practice Guidelines as Topic

Electroretinographic and electro-oculographic studies were made in pigmented rabbits after the administrations of chloroquine hydrochloride (Aralen). Systemic administration of chloroquine, 15 mg/kg daily for 20 days, induced marked general weakness, weight loss and even death of animals. EOG and ERG data obtained in survived 6 animals showed nothing abnormal. Azide sensitive DC potential of the eye increased as normal animals did b- intravenous administration of 1 mg sodium azide. Histopathological studies revealed slight thickening of ganglion cell and nerve fiber layers, with slight irregularity of pigment distribution in pigment epithelium of the retina, photoreceptors and bipolar cells being undisturbed. Acute experiment in 4 animals with intravitreal injection of 5 mg chloroquine in 0.1 ml saline produced marked reduction of scotopic b- potential during the first 2-3 days and this subnormal state remained thereafter. Scotopic a-potential also decreased with lesser degree. Photopic ERG extinguished on the next day, and showed slight recovery after 5 days. EOG data revealed general flattening of EOG curves and reduced light peak/dark trough ratio throughout the experimental period Azide reaction, however, was within normal limits 20 days after the treatment. Histological section disclosed marked destruction of ganglion cell and nerve fiber layers, depigmentation and pigment clumping in pigment epithelium, pigment migration into the inner retinal layers, degeneration of visual cells and bipolar cells. These findings suggest direct toxic action of chloroquine on the retinal tissues with little impairment of functions of pigment epithelium of the retina.
Administration, Intravenous ; Animals ; Chloroquine* ; Electrooculography ; Epithelium ; Ganglion Cysts ; Intravitreal Injections ; Nerve Fibers ; Rabbits* ; Retina ; Retinaldehyde ; Sodium Azide ; Weight Loss

Changing patterns of the reemerging Plasmodium vivax malaria in the Republic of Korea (South Korea) during the period 1993 to 2005 are briefly analyzed with emphasis on the control measures used and the effects of meteorological and entomological factors. Data were obtained from the Communicable Diseases Monthly Reports published by the Korea Center for Disease Control and Prevention, and webpages of World Health Organization and United Nations. Meteorological data of Kangwon-do (Province) were obtained from local weather stations. After its first reemergence in 1993, the prevalence of malaria increased exponentially, peaking in 2000, and then decreased. In total, 21,419 cases were reported between 1993 and 2005 in South Korea. In North Korea, a total of 916,225 cases were reported between 1999 and 2004. The occurrence of malaria in high risk areas of South Korea was significantly (P<0.05) correlated with the mosquito population but not with temperature and rainfall. Control programs, including early case detection and treatment, mass chemoprophylaxis of soldiers, and international financial aids to North Korea for malaria control have been instituted. The situation of the reemerging vivax malaria in the Republic of Korea is remarkably improving during the recent years, at least in part, due to the control activities undertaken in South and North Korea.
Seasons ; Plasmodium vivax/drug effects ; Military Personnel/statistics & numerical data ; Malaria, Vivax/*epidemiology/parasitology/*prevention & control ; Korea/epidemiology ; Incidence ; Humans ; Disease Outbreaks/*prevention & control ; Communicable Diseases, Emerging/*epidemiology/parasitology/*prevention & control ; Chloroquine/administration & dosage ; Antimalarials/administration & dosage ; Anopheles/parasitology ; Animals

Cell-penetrating peptide (CPP) can be used in pharmaceutics as a highly efficient drug delivery transporter. In this study, four tumor cell lines (MCF-7, MDA-MB-231, C6, and B16F10) were used to observe the uptake of fluorescein isothiocyanate (FITC) labeled CPP and the effects of time and concentration of CPP on cell penetration was studied. The CPP exocytosis on C6 cell line was observed, and its exocytosis kinetics was described by zero order equation. In addition, low-temperature condition (4 degrees C) and endocytosis inhibitors were utilized to investigate the mechanism of CPP uptake by cells. Low-temperature condition did not show significantly inhibition on CPP uptake. Heparin, a membrane glycoprotein receptor inhibitor, showed strong inhibition effect (only 3%-10% of the control) on CPP uptake. Chlorpromazine, chloroquine and 5-(N-ethyl-N-isopropyl)-amiloride (EIPA) showed little effect on CPP uptake. This study indicated that CPP penetration had little selectivity on cell type, but the amount and rate of CPP penetration into cells were related to the type of cell lines. The adsorption of CPP on cell membrane induced by sulfate proteoglycan plays an important role on CPP penetration.
Adsorption ; Amiloride ; analogs & derivatives ; pharmacology ; Cell Line, Tumor ; Cell Membrane ; metabolism ; Cell-Penetrating Peptides ; administration & dosage ; metabolism ; pharmacokinetics ; Chloroquine ; pharmacology ; Chlorpromazine ; pharmacology ; Dose-Response Relationship, Drug ; Exocytosis ; Heparin ; analogs & derivatives ; metabolism ; pharmacology ; Humans ; Proteoglycans ; metabolism ; Temperature ; Time Factors