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Biomedical subjects

G Majori

Publications and source records attributed to G Majori.

At least 19 recordsLinked to original sources
PubMed2004

[Combined antimalarial therapy using artemisinin].

The existing armamentarium of drugs for the treatment and prevention of malaria is limited primarily by resistance (and cross-resistance between closely related drugs). However, most of these drugs still have a place and their life-span could be prolonged if better deployed and used, and also by rationally combining them based on pharmacodynamic and pharmacokinetic properties. Newer compounds are also being developed. The nature of malaria disease and its prevalence in the developing world call for innovative approaches to develop new affordable drugs and to safeguard the available ones. According to WHO, the concept of combination therapy is based on the synergistic or additive potential of two or more drugs, to improve therapeutic efficacy and also delay the development of resistance to the individual components of the combination. Combination therapy (CT) with antimalarial drugs is the simultaneous use of two or more blood schizontocidal drugs with independent modes of action and different biochemical targets in the parasite. In the context of this definition, multiple-drug therapies that include a nonantimalarial drug to enhance the antimalarial effect of a blood schizontocidal drug are not considered combination therapy. Similarly, certain antimalarial drugs that fit the criteria of synergistic fixed-dose combinations are operationally considered as single products in that neither of the individual components would be given alone for anti-malarial therapy. An example is sulfadoxine-pyrimethamine. Artemisinin-based combination therapies have been shown to improve treatment efficacy and also contain drug resistance in South-East Asia. However, major challenges exist in the deployment and use of antimalarial drug combination therapies, particularly in Africa. These include: 1) the choice of drug combinations best suited for the different epidemiological situations; 2) the cost of combination therapy; 3) the timing of the introduction of combination therapy; 4) the operational obstacles to implementation, especially compliance. As a response to increasing levels of antimalarial resistance, the World Health Organization (WHO) recommends that all countries experiencing resistance to conventional monotherapies, such as chloroquine, amodiaquine or sulfadoxine/pyrimethamine, should use combination therapies, preferably those containing artemisinin derivatives (ACTs--artemisinin-based combination therapies) for malaria caused by Plasmodium falciparum. There is a promising role of such compounds in replacing or complementing current options. Since 1979, several different formulations of artemisinin and its derivatives have been produced and studied in China in several thousand patients for either P. falciparum or P. vivax malaria. To date, there is no evidence of drug resistance to these compounds. The use of artemisinin, artemether, arteether and artesunate for either uncomplicated or severe malaria is now spreading through almost all malarious areas of the world, although some of they have no patent protection, their development (with few exceptions) has not followed yet full international standards. Both artesunate, artemether and arteether are rapidly and extensively converted to their common bioactive metabolite, dihydroarte-misinin. WHO currently recommends the following therapeutic options: 1) artemether/lumefantrine; 2) artesunate plus amodiaquine; 3) artesunate plus sulfadoxine/pyrimethamine (in areas where SP efficacy remains high); 4) artesunate plus mefloquine (in areas with low to moderate transmission); and 5) amodiaquine plus sulfadoxine/pyrimethamine, in areas where efficacy of both amodiaquine and sulfadoxine/pyrimethamine remains high (mainly limited to countries in West Africa). This non artemisinin-based combination therapy is reserved as an interim option for countries, which, for whatever reason, are unable immediately to move to ACTs.

Amodiaquine↗
PubMed2002

Impact of the malaria control campaign (1993-1998) in the highlands of Madagascar: parasitological and entomological data.

Malaria transmission in the central highlands of Madagascar was interrupted in the 1960s by a national control program that used DDT indoor spraying and mass treatment with chloroquine. At the end of the 1980s in this region, epidemic malaria reappeared. Italian health authorities provided technical assistance to the National Malaria Control Program since the beginning of the resurgence of malaria in the central highlands. Yearly residual house spraying performed for 5 years (1993-1998) and the availability of antimalarial drugs reduced malaria transmission to very low levels, with improvement in parasitologic and entomologic indexes. A significant reduction of malaria prevalence was observed in the villages located at altitudes of 1,000-1,500 m, corresponding to the stratum of unstable malaria that was the main target of the antivector interventions. A significant reduction of malaria prevalence was also observed in the villages located at altitudes of 900-1,000 m, where malaria transmission is stable. The main vector Anopheles funestus was dramatically reduced in abundance and distribution in the sprayed areas.

Adolescent↗
PubMed2001

Malaria incidence and mortality in Italy in 1999-2000.

In 1999-2000, a total of 2060 malaria cases were reported by the ISS. Most of the patients took inappropriate treatments or did not have any prophylaxis. Ninety-three per cent became infected in African malarious countries, 4% in Asian countries, and 3% in Latin America. P. falciparum accounted for 84% of the cases, followed by P. vivax (8%), P. ovale (5%), and P. malariae (2%). Deaths corresponded to an annual case fatality rate of 0.3% in 1999 and 0.5% in 2000. In general, imported malaria cases reflect the number of Italian travellers who underestimate the infection risk in Asian and Latin American malarious countries and permanent residents of African origin who visit their relatives in their native countries.

Humans↗
PubMed1999

Current status of Aedes albopictus and Aedes atropalpus in Italy.

Eight years after the 1st record in Italy, scattered foci of Aedes albopictus are reported in 9 regions and 107 municipalities belonging to 22 provinces, mainly located in the northeastern part of the country (Veneto region). In almost all infested areas the species is well controlled and at low levels of density, through source reduction and antilarval treatments. Aedes atropalpus, 1st recorded in 1996, remains limited to the original focus in the province of Treviso. Surveillance and control of both species are carried out by local health agencies within a national program coordinated by Istituto Superiore di Sanità (national Institute of Public Health).

Aedes↗
PubMed1999

[Control of congenital toxoplasmosis in Italy: The project of the Istituto Superiore di Sanità].

Toxoplasma gondii infection during pregnancy is a public health concern; many resources are used in diagnostic and therapeutic activities, sometime with a low benefit/cost due to lack of standardization in practices. In the lack of suitable epidemiological knowledge at national level regarding the congenital toxoplasmosis trend in Italy, an evaluation of the public health impact of this pathology is required. The Istituto Superiore di Sanità (ISS) has worked out a project on a prevalence-incidence study at national level, performing standard reference methods for diagnosis and both case definition and case management. Furthermore, the ISS urges all the involved centers on congenital toxoplasmosis to set up a network for an active collaboration to this project.

Female↗
PubMed1996

Age-related prevalence of Plasmodium falciparum circumsporozoite antibody in an hyperendemic area of Madagascar, and its relationship with parasite prevalence.

An epidemiologic survey on malaria endemicity levels, including entomologic, parasitologic, and immunologic indicators, was carried out in a village of the Madagascar highlands (Analaroa) at the end of the 1990-1991 rainy season. The results indicate that malaria is hyperendemic and Anopheles funestus is the main vector in the area. The prevalence of parasitemia decreased with age from a maximum level of about 60% in children less than five years of age to a minimum of about 16% among those more than 29 years of age. The prevalence of Plasmodium falciparum circumsporozoite antibodies (Ab-Cs) increased with age from a minimum level of about 10% in children less than five years of age to a maximum of 71.7% among those more than 29 years of age. An inverse correlation was observed between P. falciparum prevalence and levels of Ab-Cs and parasite prevalence. The study confirmed that prevalence and Ab-Cs levels are reliable indicators of malaria endemicity in hyperendemic areas. Schoolchildren between five and 14 years of age are considered the most practical and susceptible group for this kind of epidemiologic study.

Adolescent↗
PubMed1996

Occurrence and spread in Italy of Aedes albopictus, with implications for its introduction into other parts of Europe.

Aedes albopictus is considered second only to Ae. aegypti in its importance to man as a disease vector of dengue and dengue hemorrhagic fever. The first sighting in 1979 of the vector species in Europe came from Albania; however, it was only when Ae. albopictus was introduced into Italy in 1990, through the importation of used tires, followed by its subsequent spread, that the species was considered as a threat to public health. At the close of 1995, Ae. albopictus infestations have been reported from 10 Italian regions and 19 provinces. The risk for greater distribution of Ae. albopictus in Europe can potentially be projected, based on well-established criteria such as: where the winter monthly mean temperature is 0 degree C, where at least 50 cm of mean annual rainfall occurs, and where the mean summer temperature is approximately 20 degrees C. Those countries where climatic conditions meet such criteria and that may be vulnerable to a potential introduction of Ae. albopictus include Spain, Portugal, Greece, Turkey, France, Albania, and the former Republic of Yugoslavia. The Italian plan of action, established for the surveillance and control of Ae. albopictus, is presented in detail.

Aedes↗
PubMed1994

Malaria epidemiological trends in Italy.

Based on the official reports received from local health laboratories, an epidemiological analysis of malaria cases reported in Italy from 1989 to 1992 is presented. A total of 1,941 cases were reported, 1,287 among Italians and 654 among foreigners. The incidence of cases was on average 500 per year with a maximum in 1990. A slight, but constant decrease of incidence of malaria cases was recorded in this period among Italian citizens (-21.5%), while the incidence among foreigners increased (+80%). Plasmodium falciparum accounted for 74.2% of total infections, followed by P. vivax (19%). The highest number of cases was imported from Africa (86.5%), followed by Asia, South America, and Oceania. 11 cases were contracted in Europe (transfusion, airport and cryptic malaria). 26 people died from malaria during the four years, with a fatality rate of 2.3% among Italians. Other epidemiological features concerning incidence in the different categories of travellers, countries of infection, clinical and therapeutic aspects of cases, are also discussed.

Adult↗
PubMed1994

Plasmodium falciparum circumsporozoite antibody prevalence in Madagascar: a longitudinal study in three different epidemiologic areas.

A longitudinal study on the prevalence of Plasmodium falciparum circumsporozoite antibodies (Ab-CS) was carried out in 15 villages of three epidemiologic areas of Madagascar: the highlands, east coast, and the southwest region. A total of 3,967 blood samples were collected from November 1989 to April 1991 from cohorts of resident schoolchildren. The prevalence of Ab-CS in the examined population varied greatly according to the different ecoepidemiologic areas of the country. A correlation analysis was made between Ab-CS and P. falciparum parasite prevalence in the same population. High Ab-CS prevalence rates (25-75%) and levels (optical density = 0.28-0.76) were observed in the villages of the east coast (mesoendemic stable malaria). The Ab-CS prevalence rates varied from 0 to 37% in the highlands and southwest region villages (unstable malaria). The use of Ab-CS prevalence is proposed to be a useful and reliable seroepidemiologic marker of malaria endemicity in those areas of Madagascar in which malaria transmission is high and continues for more than four months a year.

Adolescent↗
PubMed1993

Field trials of Bacillus thuringiensis H-14 and Bacillus sphaericus (strain 2362) formulations against Anopheles arabiensis in the central highlands of Madagascar.

Malaria is highly endemic and unstable in the central Highlands plateau of Madagascar. The infection is seasonally transmitted by Anopheles funestus and An. arabiensis. The latter species is abundant especially in rice-growing areas. The field efficacies of commercial formulations of Bacillus thuringiensis H-14 and B. sphaericus (strain 2362) were assessed against An. arabiensis in 5 types of larval habitats. The granular formulation of B. thuringiensis (Vectobac GR) provided very good control in small ponds and rainwater ditches. In ricefields complete larval control was achieved with Vectobac GR and the flowable concentrate (Vectobac 12AS) at 2.5 kg/ha and 0.6 liter/ha, respectively. The granular formulation of B. sphaericus (ABG 6185) showed activity similar to that of Vectobac GR in small pools and ricefields. ABG 6185 was less effective in rainwater ditches where it gave satisfactory control at rates not lower than 6 kg/ha.

Animals↗
PubMed1992

[Anopheles in Italy: distribution on rice lands in the provinces of Grosseto and Siena].

The Laboratory of Parasitology of Istituto Superiore di Sanità acts as a coordinating centre for anophelism data collection in Italy, and collaborates with the health local authorities. This specific investigation takes into consideration several areas in the provinces of Grosseto and Siena, focusing attention on the rice fields, which are today the most important anopheline breeding sites in Maremma. The records collected in collaboration with the Department of Environmental Zoology (USL 28 Grosseto), show a high density of A. labranchiae, the potential malaria vector, in the coastal areas of Grosseto province, and a decreased susceptibility to some insecticides. Among the other anopheline species found, only A. atroparvus (the species most present on the inland hills of the provinces of Grosseto and Siena) show a remarkable density.

Animals↗
PubMed1992

First record of Aedes albopictus establishment in Italy.

In September 1991, the first breeding populations of Aedes albopictus were discovered in Veneto Region, Italy. Larvae were collected in a wide variety of peridomestic containers and in used tires. Attempts were made to eradicate this species from infested areas. No larvae or adults of Ae. albopictus were found from October 1991 onwards. It is not yet assessed if this was because of the control measures taken or due to the low fall temperatures and the short critical photoperiod prevailing in the area (L:D, 12:45). Since tire casings are believed to be the primary mode of introduction and dispersal of Ae. albopictus, an investigation of tire retreading operations was initiated to determine the source and mode of introduction of Ae. albopictus into Italy.

Aedes↗
PubMed1991

[Impact of the use of larvivorous fish Poecilia reticulata on the transmission of malaria in FIR of Comoros].

Field tests were conducted in the Grande Comore Island, Federal Islamic Republic of Comoros, in order to evaluate the potential of the larvivorous fish Poecilia reticulata for the control of the malaria vector Anopheles gambiae s.s. Due to the high permeability of soil, Anopheles breeding sites in all island occurs only in the man-made water reservoirs. The study was carried out from November 1987 to November 1988 within a framework of a malaria and filariasis control programme, supported by WHO and UNDP in collaboration with the Government of the FIR of Comoros. All larval breeding places of An. gambiae existing in the village of Hantsambou were recorded (59 ablutions basins and 61 cisterns) and provided initially with 3-5 specimens of P. reticulata/m3 in November 1987, after the importation of the larvivorous species from Mayotte Island. The percentage of breeding places positive for An. gambiae decreased from 41% to 6% after one year. Pyrethrum spray catch showed a reduction of indoor resting density from 5.5 to 0.3, while the ma value, number of Anopheles bites/man/night, obtained by night-biting catches, decreased from 6.3 to 1.2. At the same time of the reduction of entomological indices parasite index for P. falciparum and spleen rate drop steadily in 5-9 years school children. The tested vector control method, well accepted by the community, could be implemented in malaria control through primary health care, being the ecological conditions in the entire island very peculiar.

Animals↗