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Biomedical subjects

A Sowunmi

Publications and source records attributed to A Sowunmi.

At least 91 records · Page 5Linked to original sources
PubMed1993

Cerebral malaria in non-paediatric subjects resident in southwestern Nigeria.

Seven previously healthy, non-immuno compromised adolescents and adults with cerebral malaria were seen over a nine-month period in an endemic area where the disease was previously thought to be rare in persons above the age of 11 years. Six of these, treated with quinine responded promptly to therapy with mean parasite and fever clearance times of 58.0 +/- 4.9 hrs and 30.0 +/- 16.5. hrs respectively and regained consciousness in 20.0 +/- 14.5 hrs. One patient treated with chloroquine regained consciousness in 28 hrs, with parasite and fever clearance times of 120 hrs and 48 hrs respectively. No neurological deficit was observed on discharge in any of the subjects.

Adolescent↗
PubMed1993

Psychosis after cerebral malaria in children.

A self-limiting psychosis characterized by visual and auditory hallucinations with or without aggressive behavior developed in two children 4 to 5 days after complete recovery from a cerebral malaria coma. Both patients had no family history of psychosis and were neurologically and mentally normal before the acute disease. A long-term prospective study to define the precise clinical spectrum of such manifestations in survivors of childhood cerebral malaria seems necessary.

Child↗
PubMed1992

Disposition of quinine in plasma, red blood cells and saliva after oral and intravenous administration to healthy adult Africans.

The pharmacokinetics of quinine has been studied in ten healthy adult Africans after intravenous infusion and oral ingestion of a 500 mg dose. Blood and saliva samples were collected over 48 h and quinine in plasma, red cells and saliva was determined by HPLC. Quinine was rapidly and almost completely absorbed after an oral dose, with absorption half-life of 0.53 h, a tmax of 1-3 h and a bioavailability of 88%. Analysis of the i.v. data gave an apparent volume of distribution of 3.6 l.kg-1 and a plasma clearance of 0.19 l.kg-1.h-1. The concentration-time curves for plasma, red cells and saliva had declining phases were approximately parallel, giving a similar half-life that in all three media. The half-lives after the i.v. infusion also did not different from those after oral administration. The dose was well tolerated by both methods of administration.

Administration, Oral↗
PubMed1992

Evaluation of the relative efficacy of various antimalarial drugs in Nigerian children under five years of age suffering from acute uncomplicated falciparum malaria.

A parallel group-randomized comparison of the therapeutic efficacy of chloroquine (CQ), amodiaquine (AM), quinine (QN), sulphadoxine-pyrimethamine (S-P), mefloquine 15 mg kg-1 (M15) and mefloquine 25 mg kg-1 (M25) in acute symptomatic uncomplicated falciparum malaria was carried out in 325 children under the age of five years in Ibadan, southwestern Nigeria, using the 28-day in vivo test. The parasitological cure rate, assessed only up to day 14, was 85% in the CQ group and 100% in the other groups. The mean parasite and fever clearance times were, respectively, 2.64 and 1.20 days in the CQ-sensitive subgroup, 2.32 and 1.13 days in the AM group, 2.27 and 1.17 days in the QN group, 2.23 and 1.76 days in the S-P group, 2.13 and 1.10 days in the M15 group, and 2.07 and 1.09 days in the M25 group. The CQ-treatment failures (seven of 46 patients) were successfully treated with 25 mg kg-1 mefloquine, with parasite and fever clearance times of 1.73 and 1.0 days respectively. The study shows that, in Nigeria, CQ is now less effective than AM, S-P, QN and M in acute falciparum malaria in the group most vulnerable to the infection (the under-five-year-olds).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Mefloquine-sulphadoxine-pyrimethamine (Fansimef, Roche) in the prophylaxis of Plasmodium falciparum malaria: a double-blind, comparative, placebo-controlled study.

From July 1987 to June 1988 a randomized, double-blind, comparative placebo-controlled field trial was conducted in a group of villages near Ibadan, Nigeria. The aim of the study was to assess the suppressive tolerability and efficacy of four antimalarials (Fansimef, Lariam, Fansidar, chloroquine) given for 24 weeks. Fansimef and Lariam were given with loading and maintenance doses, Fansidar and chloroquine as one tablet per week for 24 weeks. Of 567 enrolled subjects, 114 (20%) had parasitaemia on entry. Eight episodes of symptomatic falciparum malaria occurred during the trial, seven in the placebo group, and one in the Fansimef group. Compared with placebo, parasitaemia was effectively suppressed by all four drug regimens. Adverse event data were not significantly different between groups: six adverse events per 114 participants in the Fansimef group, six/113 in the mefloquine group, five/111 in the Fansidar group, 17/115 in the chloroquine group and eight/114 in the placebo group. Safety of Fansimef for 24 weeks in endemic areas was comparable for standard antimalarials in this trial and provides support for the use of this drug for the treatment of resistant malaria in indigenous African populations.

Adolescent↗
PubMed1992

Hyperparasitaemia: not a reliable indicator of severity or poor prognosis in falciparum malaria in children in endemic African countries.

Hyperparasitaemia as an indicator of severity or poor prognosis in falciparum malaria and response to oral antimalarial therapy were evaluated in an outpatient study of 77 consecutive African children from an endemic area. At presentation, clinical illness was graded as mild in 37, moderate in 14 and severe in 26. There was no evidence of renal, hepatic or cerebral complications. Clinical response to oral antimalarial drugs was characterized by rapid and uneventful recovery from illness in all but one patient who required hospital admission with prompt clearance of parasitaemia and fever within 96 hours. It is concluded that greater than 5% parasitaemia may be well tolerated by semi-immune African children. Semi-immune subjects with hyperparasitaemia and no other evidence of severe or complicated disease in an endemic area may well be treated with oral antimalarials providing the infecting strain is fully sensitive to the drug chosen and the drug is rapidly absorbed.

Africa↗
PubMed1992

Effects of amlodipine on plasma lipid and lipoprotein levels in hypertensive patients.

Lipids and lipoprotein levels were determined in the plasma of 20 adult hypertensive patients, after 12 weeks treatment with amlodipine. No significant variation was observed in the mean values of the lipids and lipoprotein fractions before and after amlodipine treatment for the patients on either 5 mg or 10 mg of amlodipine. A further long-term study has been suggested in order to confirm the inertness of amlodipine on lipids and lipoprotein metabolism.

Adult↗
PubMed1992

Severe falciparum malaria: survival with oral therapy.

A case of severe falciparum hyperparasitaemia with trophozoites in greater than 35% of the patient's erythrocytes, relative lack of clinical symptoms and no organ complication is described. The patient, a 26-month old African child, was treated with oral mefloquine with prompt clearance of fever and parasitaemia in 24 and 48 hours respectively. No untoward sequelae was observed during 75 days of periodic clinical assessment.

Administration, Oral↗
PubMed1991

Body temperature in the Nigerian neonate--comparison of axillary and rectal temperatures.

Body temperature was measured in 104 healthy full-term neonates of appropriate weights using the rectal and axillary routes simultaneously at 1, 2, 3, 5 and 7 min after placement of the thermometer. Normal body temperature in the Nigerian newborn, irrespective of the site where it was obtained, ranged from 35.9 degrees C to 37.5 degrees C. There was a strong positive correlation between axillary and rectal temperatures (r = 0.9). Prior to stabilization, mean rectal temperatures at every minute were significantly higher than axillary temperatures, (P less than 0.001). Although rectal temperatures stabilized earlier than axillary temperatures (3 min and 5 min respectively), the difference between mean stabilized temperature taken at the two sites was not significant (P greater than 0.05). This study provides normal reference data on body temperature in the Nigerian newborn. It is suggested that the axillary route be used more frequently when taking temperature in the newborn because of its safety and its good correlation with the rectal temperature readings.

Axilla↗
PubMed1991

Body temperature in apparently healthy African children under 10 years of age.

Body temperature was determined weekly for a period of 3 weeks in 346 healthy children aged 5 months to 10 years. Individual axillary temperatures in the 346 children ranged from 35.05 degrees C to 37.28 degrees C and fell into normal distribution curve. This study has thus determined normal body temperatures in Nigerian children and will serve as reference data for future comparison.

Axilla↗
PubMed1990

Malaria in Nigeria: a revisit.

The frequency of asymptomatic malaria parasitaemia was investigated in rural and urban school-children aged six to 12 years in southwestern Nigeria between January 1987 and October 1988. Asymptomatic parasitaemia was detected in the rural school-children all year round with the lowest parasite rate in January and the highest in July, corresponding to the mid-dry and wet seasons respectively. Asymptomatic parasitaemia was also common amongst urban school-children, but the frequency was lower than in the rural children. Parasite density was less than or equal to 1000 microliters-1 in 42% of parasite-positive asymptomatic children and was greater than 10,000 microliters-1 in only 20% of them. Mass treatment with chloroquine, to which the parasites were fully sensitive, was followed by the same rate of re-infection in the parasite-positive and parasite-negative groups. Of 7713 patients clinically diagnosed as having malaria 4425 were found to have parasitologically-proven malaria, and of these 4239 had pure Plasmodium falciparum malaria. Of the patients with falciparum malaria only 4.6% were below the age of one year. In 47% the parasite count was less than or equal to 1000 microliters-1, and it was over 10,000 microliters-1 in 37% and over 250,000 microliters-1 in 16%. There was no significant difference between the asymptomatic children and the acutely ill patients in the percentage with parasite densities less than or equal to 1000 microliters-1, but the percentage with parasite densities greater than 10,000 microliters-1 was significantly greater in the acute malaria patients than in those with asymptomatic parasitaemia.

Age Factors↗
PubMed1989

Pharmacokinetics of quinine in African children suffering from kwashiorkor.

The pharmacokinetics of quinine were studied in seven normal African children and in six African children suffering from kwashiorkor, after an oral dose of 10 mg kg-1 of quinine hydrochloride. The two groups were similar in age but the children with kwashiorkor weighed significantly less than the control children (P less than 0.001). The children with kwashiorkor further differed from the control children in having significantly lower packed cell volume (P less than 0.001), total plasma protein and plasma albumin (P less than 0.001), and higher serum SGOT (P less than 0.05). The apparent absorption half-life was significantly longer in kwashiorkor than in controls (P less than 0.05). Similarly, the Cmax was significantly lower (P less than 0.01) in kwashiorkor than in controls. Quinine was eliminated more slowly in children with kwashiorkor, the elimination half-life being significantly longer (P less than 0.001) and the oral clearance significantly less (P less than 0.001) than in controls. It is concluded that kwashiorkor significantly affects the pharmacokinetics of quinine, and that the effect may be due to the pathological changes in the intestine and liver in this condition.

Child, Preschool↗
PubMed1988

Evaluation of the sensitivity in vivo and in vitro of Plasmodium falciparum malaria to quinine in an area of full sensitivity to chloroquine.

The sensitivity of Plasmodium falciparum to quinine in Nigeria was examined in vivo and in vitro prior to the re-introduction of the drug into malaria therapy in that country in the face of spreading chloroquine resistance in Africa. The parasites showed full sensitivity in vivo to quinine, with a mean parasite clearance time of 2.4 d and a mean fever clearance time of 1.4 d. Using the in vitro microculture technique, the Nigerian isolates were found to have a minimum inhibitory concentration (IC) of 1.28 mumol quinine/litre blood-medium mixture. The IC50 and IC99 were 0.25 mumol/litre and 0.8 mumol/litre respectively. The study afforded an opportunity to compare the sensitivity of P. falciparum to quinine and chloroquine in a population in which chloroquine resistance was not a problem and the results showed slower parasitological and clinical response to quinine than to chloroquine.

Animals↗
PubMedDate not supplied

Clinical efficacy of mefloquine in children suffering from chloroquine-resistant Plasmodium falciparum malaria in Nigeria.

One hundred and thirteen children with symptomatic uncomplicated falciparum malaria were treated with either chloroquine 25 mg/kg body weight over 3 d (51 subjects) or mefloquine 25 mg/kg body weight single dose (62 subjects). The cure rate in the chloroquine group was 65% and in the mefloquine group 100%. 14 patients with chloroquine-resistant falciparum malaria (7 RI, 6 RII and one RIII) were successfully treated with mefloquine. The clearance times of parasitaemia and fever were 60 +/- 21.5 h and 24.7 +/- 10.1 h respectively in the chloroquine-sensitive group and 52.3 +/- 18.2 h and 24.5 +/- 23.7 h respectively in the mefloquine group. In the chloroquine-resistant group treated successfully with mefloquine, these clearance times were 44.0 +/- 8.9 and 24.0 h respectively. The only remarkable adverse reaction in the chloroquine group was pruritus which occurred in 7 subjects. Abdominal pain and diarrhoea (8 subjects) and dizziness (3 subjects) were the only important adverse reactions in the mefloquine group. It is concluded that, despite previous reports of primary reduced susceptibility to mefloquine in vitro of some West African isolates of Plasmodium falciparum, this drug may be useful in the treatment of both chloroquine-sensitive and chloroquine-resistant falciparum malaria in West Africa.

Animals↗
PubMedDate not supplied

Combination of quinine, quinidine and cinchonine for the treatment of acute falciparum malaria: correlation with the susceptibility of Plasmodium falciparum to the cinchona alkaloids in vitro.

Thirteen patients with acute symptomatic uncomplicated falciparum malaria were enrolled in an open, randomized, phase 2, dose-finding clinical trial of a fixed dosage combination of quinine, quinidine and cinchonine (LA40221, Sanofi Recherche, France), which contained equal parts of the 3 alkaloids and was administered orally every 8 h in doses of 400 mg (7 patients) or 500 mg (6 patients) for 7 d. There was prompt clearance of parasitaemia and fever in all patients. The mean clearance times (+/- standard deviation) of parasitaemia, fever and other symptoms were 29 +/- 11.0 h, 10.7 +/- 4.1 h and 14.9 +/- 9.7 h respectively for the 400 mg dose group, and 35 +/- 20.0 h, 16 +/- 7.0 h and 17.6 +/- 8.7 h respectively for the 500 mg dose group. There was no recrudescence of parasitaemia during the 28 d observation period. Minor gastrointestinal side effects occurred in 2 patients, but there was no major side effect. Haematological, biochemical and other measurements were not adversely altered by treatment. QTc prolongation occurred in 3 patients--2 from the 400 mg and 1 from the 500 mg dose group. Testing in vitro against Plasmodium falciparum isolates from 47 patients (including the 13 patients enrolled in the trial) of the combination and its individual components suggested that the relative potencies in vitro, in decreasing order, were quinidine, LA40221, cinchonine and quinine. The minimum inhibitory concentrations were 0.32, 0.64, 0.64 and 1.28 mumol/litre of blood-medium mixture respectively, and the 50% inhibitory concentrations were 0.083, 0.11, 0.12 and 0.22 mumol/litre of blood-medium mixture. The respective 99% inhibitory concentrations were 0.27, 0.45, 0.50 and 1.20 mumol/litre of blood-medium mixture.

Acute Disease↗
PubMedDate not supplied

Parenteral sulphadoxine-pyrimethamine (Fansidar): an effective and safe but under-used method of anti-malarial treatment.

One hundred and eighteen patients with acute falciparum malaria were randomized into treatment with either intramuscular or oral sulfadoxine-pyrimethamine (Fansidar, Roche) and the results were compared with those from 68 patients treated in parallel with chloroquine. Parasitological cure rate was 97% with oral sulfadoxine-pyrimethamine, 95% with the injection, and only 63% with chloroquine. The time for the disappearance of parasitaemia in sensitive cases was the same with oral and intramuscular sulfadoxine-pyrimethamine and shorter than with chloroquine. Side effects occurred in only 3 of the patients treated with intramuscular sulfadoxine-pyrimethamine compared with 8 of those treated with the tablets and 13 of those treated with chloroquine. The results showed that intramuscular sulfadoxine-pyrimethamine is as effective as, and probably better tolerated than, the oral drug. Increasing failure of response to chloroquine in Nigeria was also demonstrated.

Acute Disease↗