The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Jan 1996
Developing effective strategies for malaria prevention programs for pregnant African women.
The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. ⋯ The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.
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Am. J. Trop. Med. Hyg. · Sep 1995
Randomized Controlled Trial Clinical TrialEfficacy of antivenom in the treatment of severe local envenomation by the hump-nosed viper (Hypnale hypnale).
In Sri Lanka, the usual treatment for severe local envenomation by the hump-nosed viper (Hypnale hypnale) is with polyspecific snake antivenom. We carried out a prospective, randomized, placebo-controlled, single-blind clinical trial to determine the efficacy and safety of polyspecific snake antivenom in the treatment of severe local envenomation by this snake. Sixty-three patients with signs and symptoms of local envenomation by the hump-nosed viper Lanka were randomized to receive either polyspecific snake antivenom or normal saline. ⋯ There was no significant difference between the antivenom and placebo groups in the time taken for complete resolution of the local envenomation (5.52 days versus 4.77 days; P = 0.53, by the Mann-Whitney U test). There was a 44.82% incidence of adverse reactions associated with treatment with antivenom. We conclude that polyspecific snake antivenom is not indicated for severe local envenomation by the hump-nosed viper.
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Am. J. Trop. Med. Hyg. · Jun 1995
Snake bites by the Papuan taipan (Oxyuranus scutellatus canni): paralysis, hemostatic and electrocardiographic abnormalities, and effects of antivenom.
One hundred sixty-six patients with enzyme immunoassay-proven bites by taipans (Oxyuranus scutellatus canni) were studied in Port Moresby, Papua New Guinea. One hundred thirty-nine (84%) showed clinical evidence of envenoming: local signs were trivial, but most developed hemostatic disorders and neurotoxicity. The blood of 77% of the patients was incoagulable and 35% bled spontaneously, usually from the gums. ⋯ However, early antivenom treatment was associated statistically with decreased incidence and severity of neurotoxic signs. The low case fatality rate of 4.3% is attributable mainly to the use of mechanical ventilation, a technique rarely available in Papua New Guinea. Earlier use of increased doses of antivenoms of improved specificity might prove more effective.
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Am. J. Trop. Med. Hyg. · Mar 1995
Efficacy of antivenom therapy for neutralizing circulating venom antigens in patients stung by Tityus serrulatus scorpions.
Enzyme-linked immunosorbent assays for detection of Tityus serrulatus venom antigen and of horse anti-T. serrulatus venom antibodies were carried out before antivenom treatment and at 1, 6, 12, and 24 hr after antivenom therapy in 18 patients with systemic manifestations following T. serrulatus scorpion sting. Increased levels of circulating venom antigens were detected in the patients before antivenom treatment, but were no longer detected 1 hr after specific antivenom therapy. ⋯ The cardiorespiratory manifestations disappeared 6-24 hr after the administration of antivenom and all patients recovered completely. This study demonstrates the efficacy of antivenom therapy in neutralizing circulating venom antigens and supports the prompt administration of a potent antivenom to patients with systemic manifestations of envenoming.