Treatment of Malaria In India - Update part 1

I had posted treatment guidelines for malaria in 2014, as per the existing guidelines. 

Newer guidelines have been introduced since. Hence, this update. 

1. Treatment of Uncomplicated Plasmodium Falciparum Malaria 

Artemisinin combination therapy (ACT) is the drug of choice for all confirmed cases of uncomplicated PF cases. This should be combined with primaquine (PQ) (0.75 mg/kg body weight or 45 mg) on day-2. The ACT recommended in the National Program in India is artesunate (AS) + sulfadoxine and pyrimethamine (SP). Oral AS monotherapy is banned in India.

2. Treatment of Uncomplicated Plasmodium Vivax malaria

Chloroquine is the drug of choice of Plasmodium vivax (PV) cases. It is given at a dose of 10 mg/kg (600 mg) on day-1 and day-2 and 300 mg on day-3. Primaquine at a dose of 0.25 mg/kg (15 mg/day) for 14 days is tobe added to prevent relapse. Primaquine is contraindicated in G6PD deficiency cases, infants and pregnant women.

Post CoViD complex

Post CoViD complex is a cluster of conditions which may effect a person convalescing from active CoViD infection, 4 or more weeks after the initial infection. The initial may or may not be clinically detectable. As this is an evolving disease and not much definitive research has been done, we are still finding newer and varied conditions, causation of which  is not otherwise explainable. 

According to the information on the CDC USA website, there can be 2 types of symptoms

1. New symptoms

2. Ongoing symptoms

New Symptoms - These are the symptoms which were not present during the initial infection period and have arisen 4 weeks after that. 

Ongoing Symptoms - These are the symptoms which started during the initial infection and never completely went away after the initial infection. 

Following is a list of common symptoms 

1. Difficulty breathing or shortness of breath
2. Tiredness or fatigue
3. Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
4. Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
5. Cough
6. Chest or stomach pain
7. Headache
8. Fast-beating or pounding heart (also known as heart palpitations)
9. Joint or muscle pain
10. Pins-and-needles feeling
11. Diarrhea
12. Sleep problems
13. Fever
14. Dizziness on standing (lightheadedness)
15. Rash
16. Mood changes
17. Change in smell or taste
18. Changes in menstrual period cycles

Prevention

The best way to prevent post-CoViD conditions is to prevent COVID-19 illness.

Source - National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

Radiation Terrorism Part 2

Types of Contamination

It can be of 3 types

• Whole body exposure
• External
• Internal

1. Whole body exposure
• Gamma rays, x-rays and neutrons which can penetrate through the body and cause severe tissue damage.
2. External contamination
• Effects body surface, clothing, skin, and hair.
• This is the main thing to be concerned about in a radioactive terrorist strike.
• These consist mainly of alpha and beta radiation.
• Alpha particles cause surface burns only.
• Beta particles can cause cutaneous burns and scarring.

More on Internal contamination in my next post. 

Radiation Terrorism Part 1

Types of Radio-isotopic Radiation

4 main types viz.

• alpha
• beta
• gamma
• neutrons.

1. Alpha radiation - 
• These are positively charged particles, with 2 protons and 2 neutrons.  
• Large particles, so they have limited penetrating power.
• If internalized, they can cause significant cellular damage.
2. Beta radiation - 
• Negatively charged particles consisting of electrons.
• Penetrating power depends on their energy.
• A good example is radioactive iodine released in nuclear plant accidents.
• They can cause a burn (similar to a thermal burn and is treated as such)
3. Gamma rays and x-rays (both photons) - 
• Gamma rays are uncharged electromagnetic radiation discharged from a nucleus as a wave or photons of energy.
• X-rays are the product of abrupt mechanical deceleration of electrons striking a heavy target such as tungsten.
• Both travel easily through matter, high penetrating power.
4. Neutron particles - 
• These are heavy and uncharged, often emitted during nuclear detonation.
• Ability to penetrate tissues is variable, depending on their energy.

Treatment of Malaria in India

1. Uncomplicated Malaria (sensitive to chloroquine)
P. vivax – chloroquine 25 mg/kg over 3 days + Primaquine 0.25 mg/kg OD for 14 days
P. falciparum - chloroquine 25 mg/kg over 3 days + Primaquine 45 mg single dose

2. Uncomplicated Malaria (chloroquine resistant)
Artemisinin Combination Therapy (ACT) i.e Artesunate 50 mg + Sulfadoxine 500 mg + Pyrimethamine 25 mg for 3 days

3. Severe Malaria
Artesunate- 2.4 mg/kg @ 0 hrs, 1.2 mg/kg @ 12 hrs, 24 hrs, then OD, IV/IM
Quinine- LD:20 mg/kg, MD:10 mg/kg, both in 5% Dextrose
Artemether- 3.2 mg/kg IM on day 1, then 1.6 mg/kg IM OD
ab Arteether- 150 mg daily i.m. for 3 days in adults only
Switch to oral anti-malarials as soon as condition improves