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Biomedical subjects

T Harinasuta

Publications and source records attributed to T Harinasuta.

At least 91 records · Page 5Linked to original sources
PubMed1984

Opisthorchis viverrini: clinical experience with praziquantel in Hospital for Tropical Diseases.

Praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]++ +isoquinolin- 4-one, EMBAY 8440, Biltricide) has been used in 4853 patients with Opisthorchis viverrini infection. 786 patients were treated as inpatients with extensive clinical evaluation and the rest were out-patients. A cure rate (evaluated with 5 faecal samples) of 100% was obtained in groups given 6 X 25 mg/kg on 2 days and 3 X 25 mg/kg on 1 day, while in groups given 2 X 25 mg/kg, 1 X 25 mg/kg and 1 X 40 mg/kg all on 1 day the cure rates were 88, 44 and 91%, respectively. With one sample evaluation the parasitological cure rate was 96% in further 96 patients excreting the geometric mean (GM) of 5394 eggs per gram (EPG) and receiving 1 X 40 mg/kg. Another 68 patients with an egg output of 26044 (GM/EPG) and treated with 1 X 50 mg/kg showed a cure rate of 97% by similar evaluation. Side effects were mild and transient and were more frequent in higher dosage groups. They included anorexia, nausea, vomiting, abdominal pain, epigastric pain, rumbling in the abdomen, diarrhoea, lassitude, myalgia, headache, dizziness, sleeplessness, sleepiness, "hot sensation", shortness of breath, and skin rash in a few cases. Headache (30.7%) was most common in the 6 X 25 mg/kg group. In 53 patients with severe jaundice the side effects were similar. There was no evidence of toxicity. Remarkable was one patient treated with 1 X 50 mg/kg who expelled 5636 O. viverrini worms, most of which were elongated and damaged. When a single dose is prescribed it should be given at bed time to reduce the side effect of sedation.

Adult↗
PubMed1984

Roentgenographically controlled healing of gallbladder lesions in opisthorchiasis after praziquantel treatment.

In a study, gallbladder lesions due to Opisthorchis viverrini infection were controlled roentgenographically after treatment with praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin- 4-one, EMBAY 8440, Biltricide). The place of study was the Khon Kaen Hospital, Northeast Thailand. Included in the study were 20 patients with impairment of gallbladder function; 7 of them were males and 13 females. Their age ranged from 27 to 60 years (mean 47.4), eggs per gram (EPG) ranged from 800 to 30,000 (geometric mean 4321). The laboratory parameters were within normal limits. Praziquantel 3 X 25 mg/kg per kg body weight was given on Day 0 and all patients were parasitologically cured within 60 days. Oral cholecystography was performed to evaluate the function and size of the gallbladder and intravenous cholangiography for the common bile duct on Days 0, 14, 60, 120 and 180. The results were: (a) very large and severe dysfunction of gallbladder seen in three patients returned to normal in 60, 60 and 180 days; (b) moderate dysfunction was present in 13 patients, all but one returned to normal: 6 in 14 days, 1 in 21 days, 2 in 60 days, 1 in 120 days and 2 in 180 days. The only patient who showed no change had diabetes mellitus and moderate dysfunction of the gallbladder for one year prior to treatment; (c) mild dysfunction: all 4 patients were normal in 14 days. The common bile duct was enlarged in 3 patients (1.2, 1.3, 1.5 cm); no significant changes were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Paragonimus heterotremus and other Paragonimus spp. in Thailand: pathogenesis, clinic and treatment.

Six species of Paragonimus have been reported in Thailand: P. siamensis in cat, bandicoot and rat; P. bangkokensis in mongoose; P. harinasutai in cat and dog (experiment); P. macrochis in bandicoot and rat; P. westermani in tiger and P. heterotremus in cat, dog and man. It is interesting to note that in 1965 two immature P. heterotremus worms were recovered for the first time in man, namely in subcutaneous swellings in a boy; in 1981 nine mature P. heterotremus worms were expectorated after praziquantel treatment. P. heterotremus has been postulated to be the main cause of human paragonimiasis in Thailand. The clinical manifestation of paragonimiasis heterotremus is similar to paragonimiasis westermani. In the 1960's and 1970's bithionol was used to treat paragonimiasis, the cure rate was only 50-60%, and side effects including urticaria, rash, abdominal pain, nausea, vomiting, diarrhoea and dizziness were common. In the past 4 years, niclofolan and praziquantel (2-cyclohexyl-carbonyl-1,2,3,6,7,11b-hexahydro - 4H - pyrazino [2,1-a]isoquinolin-4-one, EMBAY 8440, Biltricide) have been used. A single dose of 2 mg/kg body weight of niclofolan yielded 100% cure rate. Praziquantel at dosages of 3 X 25 mg/kg body weight daily for one day and two days gave 80% and 100% cure rates, respectively. The eggs disappeared in 2-3 weeks with improvement of symptoms and signs, but radiologically lesions took a few months or more to clear, depending on size and severity. Side effects in the niclofolan group were higher; in the praziquantel group side effects were minimal and no toxic effects were detected.

Anthelmintics↗
PubMed1984

Efficacy of praziquantel on fasciolopsiasis.

A therapeutic study with praziquantel (2-cyclohexylcarbonyl - 1,2,3,6,7, 11b - hexahydro - 4H - pyrazino [2,1-a] isoquinolin-4-one, EMBAY 8440, Biltricide) was carried out in a primary school in Central Thailand. 72 children harbouring Fasciolopsis buski were randomized and were then given single dose of 40, 25 and 15 mg/kg bwt, respectively. Unwanted side effects were mild and transient. They were more frequent after the higher dosages. F. buski flukes with damaged tegument were excreted in stools. Cure rates in all regimens were 100%. The authors recommend a single dose of 15 mg/kg of praziquantel at bed time for the treatment of fasciolopsiasis.

Adolescent↗
PubMed1984

Radiological findings in pulmonary paragonimiasis heterotremus.

The routine chest roentgenogram of pulmonary paragonimiasis heterotremus were evaluated in 93 Thai and Laotian patients. They were 44 males and 49 females; the ages ranged from 12 to 79 years; the history of illness ranged from 4 months to 14 years and the egg output per day was 400 to 300,000. Twelve patients, 12.9% had normal roentgenologic films and 81 patients (87.1%) had abnormalities with 316 lesions; 22.2% had one lesion and 77.7% had multiple lesions. The common lesions were cystic formation, multiple or single and linear infiltration. Both lower lobes of the lungs and the left upper lobe were the common sites but any part of the lung may be affected. There were correlation between the duration of illness, number of eggs output per day and the extent of the lesions. The longer the duration of illness or the higher number of eggs output per day the more extensive lesions in the X-ray films have been observed.

Adolescent↗
PubMed1984

Alterations of the surface tegument of Opisthorchis viverrini exposed to praziquantel in vitro and in vivo.

The in vitro and in vivo effects of praziquantel on the ultrastructural surface of Opisthorchis viverrini were investigated using scanning electronmicroscopy. For the in vitro study, adult flukes were collected from experimentally infected hamsters, and were incubated for various time intervals at 37 degrees C in Earle's basal medium containing praziquantel at final concentrations of 0.01-100 micrograms/ml. For the in vivo study, flukes were collected from the biliary system of experimentally infected hamsters that had been treated 4 hours previously with 350 mg of praziquantel per kg body weight (mg/kg). Flukes were also obtained from the feces of a patient with opisthorchiasis who had been given praziquantel once at a dose of 40 mg/kg 4-6 hours previously and from the bile of a patient at the time of operation 24 hours after praziquantel treatment. Scanning electronmicroscopic analyses of the surface teguments of flukes exposed to praziquantel either in vitro or in vivo showed similar changes. Tegumental bubbles of different sizes appeared on the surface; they later ruptured and resulted in the formation of crater-like lesions. These lesions might be so extensive as to result in the peeling of the entire areas. On occasions, "micronodules" appeared later in these areas and those at the periphery of the lesions; these micronodules may represent an attempt by the worm to regenerate new tegument. The possibility that these ultrastructural changes may represent a generalized response of the tegumental surface to an obnoxious agent was discussed.

Animals↗
PubMed1983

An economical regimen of human diploid cell strain anti-rabies vaccine for post-exposure prophylaxis.

Vaccine regimens using 0.1 ml human diploid cell strain vaccine (HDCSV) given intradermally (id) in single and multiple sites, or with aluminum hydroxide adjuvant given subcutaneously (sc), were compared with the regimens of HDCSV and Semple vaccine currently suggested by WHO. Some groups were also given human rabies-immune globulin (HRIG). Neutralising antibody titres were monitored for 3 months. Antibody was detected earliest in subjects given 0.1 ml HDCSV id at each of eight sites. The highest antibody titres from day 14 onwards were found after intramuscular (im) administration of HDCSV, but the multiple-site id regimen, which requires only one quarter of the volume of vaccine required for the im regimen, gave similar results, provided that a booster was given on day 91. This finding suggests that a treatment schedule based on this regimen would be suitable for post-exposure prophylaxis. Adjuvanted vaccine gave similar results to the same amount of antigen given id. Semple vaccine produced the lowest titres. HRIG, given at the high dose of 40 IU per kg, suppressed the antibody response to some of the regimens.

Adolescent↗
PubMed1983

Do patients with cerebral malaria have cerebral oedema? A computed tomography study.

Computed tomography of the brain in 10 patients with severe cerebral malaria, 5 of whom died, showed evidence of cerebral oedema in only 2 fatal cases. Small areas of altered density were seen in 4 cases; these were not associated with focal neurological signs and were still visible in convalescent scans in 2 survivors. 4 patients, including 1 of the fatalities, had completely normal scans. Cerebral oedema may occur in severe cerebral malaria but is not a consistent feature of living patients and cannot, therefore, always be the cause of their coma.

Acute Disease↗
PubMed1983

Quinine loading dose in cerebral malaria.

In cerebral malaria, the use of currently recommended doses of intravenous quinine may result in subtherapeutic plasma concentrations during the critical first 24 hours of treatment. A loading dose of quinine (20 mg/kg quinine dihydrochloride, equivalent to 16.7 mg/kg base, infused over 4 hours) proved a rapid and safe method of achieving plasma concentrations above the high minimum inhibitory concentrations for Plasmodium falciparum prevalent in Eastern Thailand.

Adolescent↗
PubMed1983

Anti-sporozoite antibodies induced by natural infection.

Serum samples from 120 individuals living in a malaria-endemic area, 31 patients with Plasmodium falciparum infection, and 58 healthy blood donors were tested for antibodies against P. falciparum and P. vivax sporozoites. Specific antibodies were determined by the circumsporozoite precipitation (CSP) reaction and indirect immunofluorescent (IFA) tests for IgG and IgM antibodies. It was found that a high proportion of adults living in the endemic area had IFA anti-sporozoite antibodies, usually IgG. Children and healthy donors were either negative or had low antibody titers. A positive correlation was found between IgG antibody titers against P. falciparum sporozoites and those against P. vivax sporozoites. CSP reactivity was demonstrated in 5 of 31 sera from patients with falciparum malaria, and was always associated with a high level of IFA antibodies. The anti-sporozoite antibodies were found to be stage- and species-specific.

Adolescent↗
PubMed1983

Human serum proteins indicative for the nutritional status and serum proteinase inhibitors in uncomplicated falciparum malaria.

The serum proteins supposed to be indicative of the nutritional status, albumin, prealbumin and transferrin, as well as the serum proteinase inhibitors alpha 1-protease inhibitor (alpha 1-antichymotrypsin (Ach) and alpha 2-macroglobulin (alpha 2M) were measured in 14 Thai males suffering from uncomplicated falciparum malaria on the day of admission and after treatment with mefloquin on the 2nd, 28th and 63rd day. The same serum proteins had been determined from 31 healthy Thai males. Upon admission albumin and prealbumin concentrations had been lower and Ach higher in malaria patients compared with healthy Thai males. A significantly higher alpha 1 PI value was observed on the day of admission compared with the 28th day of the malaria patients. Only on the day of admission and only for the patients was a statistically significant negative linear regression found for albumin and prealbumin with Ach and a positive correlation for prealbumin with alpha 2 M as well as for albumin and transferrin correlated with alpha 1 PI. In well-nourished malaria patients the synthesis of the "acute phase reactants", alpha 1 PI and Ach, might be enhanced and in a reverse relationship the synthesis of albumin, pre-albumin and transferrin depressed.

Animals↗
PubMed1983

A phase II clinical trial of mefloquine in patients with chloroquine-resistant falciparum malaria in Thailand.

A double-blind, randomized, dose-finding, phase II mefloquine trial was carried out in 147 adult male patients suffering from acute, uncomplicated, falciparum malaria and admitted to the Hospital for Tropical Diseases, Bangkok, between January 1980 and April 1981. Mefloquine was administered as a single oral dose of 500, 750, or 1000 mg (base) in the form of the hydrochloride. The clinical and parasitological responses were satisfactory with all three dosage regimens. The cure rates for the 1000-, 750-, and 500-mg doses were 100%, 92.5%, and 95% respectively, over an observation period of 63 days.The side-effects, which were transient and generally mild, included nausea, vomiting, and diarrhoea. No significant changes were noted in haematological or biochemical parameters in any of the three groups. Sinus bradycardia, which started 4-7 days after drug administration and lasted for a few weeks, was seen in 10 patients. It was symptomless and needed no treatment.Acute brain syndrome was observed in one patient on day 21 after receiving a 1000-mg dose of mefloquine.Mefloquine was well tolerated in one case of acute renal failure, in 10 cases of moderately severe malaria with jaundice, in 13 cases with glucose-6-phosphate dehydrogenase deficiency, and in one case of thalassaemia.Mefloquine showed no effect on either gametocytes of Plasmodium falciparum or tissue forms of P. vivax.Mefloquine hydrochloride was found to be an effective drug for the treatment of falciparum malaria and tended to produce a more rapid clinical and parasitological response at the highest tested dose of 1000 mg (base).

Adolescent↗
PubMed1983

Field trial on the treatment of fasciolopsiasis with praziquantel.

Eight-five of 816 (10.7%) students attending a primary school in Central Thailand were examined and found infected with Fasciolopsis buski. All of students ate fresh water lily stems and most ate other fresh water plants including caltrop, water cress and morning glory. The 85 students were given praziquantel in randomized single doses of 15, 25 or 40 mg/kg body weight. Side effects were mild and transient and consisted of headache, dizziness, nausea, sleepiness, abdominal discomfort, anorexia, diarrhea, epigastric pain, vomiting and lassitude. Those receiving the highest dosages had more side effects than students in the other 2 groups. Large blisters were observed on the tegument of F. buski passed in feces and this was believed to be caused by the drug. The authors recommend a single dose of praziquantel in a dosage of 15 mg/kg of body weight for the treatment of parasitosis.

Adolescent↗
PubMed1983

Clinical and laboratory evaluation of praziquantel in opisthorchiasis.

A total of 122 patients were treated with a single dose of praziquantel 40 mg per kilogramme body weight, with 96 patients completing the follow up period of 60 days. The parasitological cure rate was 95.8% by single faecal examination. These patients had mild clinical manifestations. The hematological, biochemical and the liver function tests were within the normal limits. High eosinophilia was observed in 84.5% but there were no significant difference after eradication of the flukes. No significant changes were observed in the laboratory investigation at day 60 post treatment.

Adolescent↗
PubMed1982

Dexamethasone proves deleterious in cerebral malaria. A double-blind trial in 100 comatose patients.

High-dose dexamethasone was compared with placebo in a double-blind trial involving 100 comatose patients with strictly defined cerebral malaria. The two treatment groups, whose members were six to 70 years old, proved comparable on admission. There were eight deaths in the dexamethasone group and nine in the placebo group (no significant difference; P = 0.8); at post-mortem examination the brain showed features diagnostic of cerebral malaria in all but one patient who died. Dexamethasone prolonged coma among the survivors: the interval between the start of treatment and the full recovery of consciousness was 63.2 +/- 5.9 hours (mean +/- S.E.M.) in the dexamethasone group, as compared with 47.4 +/- 3.2 hours in the placebo group (P = 0.02). Complications, including pneumonia and gastrointestinal bleeding, occurred in 26 patients given dexamethasone and 11 given placebo (P = 0.004). Only five patients had neurologic sequelae. Results were similar in a subgroup of 28 children six to 14 years old. Dexamethasone is deleterious in cerebral malaria and should no longer be used.

Adolescent↗
PubMed1982

Quinine pharmacokinetics and toxicity in cerebral and uncomplicated Falciparum malaria.

Acute pharmacokinetics of intravenously infused quinine were studied in 25 patients with cerebral malaria and 13 with uncomplicated falciparum malaria. In patients with cerebral malaria receiving the standard dose of 10 mg/kg every eight hours, plasma quinine concentrations consistently exceeded 10 mg/liter, reaching a peak 60 +/- 25 hours (mean +/- 1 S.D.) after treatment was begun and then declining. Quinine total clearances (Cl) and total apparent volumes of distribution (Vd) were significantly lower than in uncomplicated malaria (Cl, 0.92 +/- 0.42 compared with 1.35 +/- 0.6 ml/min/kg, p = 0.03; Vd, 1.18 +/- 0.37 compared with 1.67 +/- 0.34 liter/kg, p = 0.0013). There was no significant difference between the two groups in elimination half-times (t/2) or renal clearances (Cu) (t/2, 18.2 +/- 9.7 compared with 16 +/- 7.0 hours; Cu, 0.21 +/- 0.16 compared with 0.21 +/- 0.08 ml/min/kg). In nine patients studied following recovery, Cl (3.09 +/- 1.18 ml/min), Vd (2.74 +/- 0.47 liter/kg), and Cu (0.53 +/- 0.22 ml/min/kg) were significantly greater (p less than or equal to 0.0004), and t/2 was significantly shorter (11.1 +/- 4.1 hours, p = 0.006) than during the acute illness. Cu accounted for approximately 20 percent of Cl in all groups. Renal failure did not alter the disposition kinetics in cerebral malaria. There was no clinical or electrocardiographic evidence of cardiotoxicity and no permanent neurotoxicity. Quinine toxicity in cerebral malaria has probably been overemphasized. The benefits of high plasma concentrations in the acute phase of this life-threatening disease appear to outweigh the risks, particularly in view of the increasing resistance of Plasmodium falciparum to quinine in Southeast Asia.

Acute Disease↗
PubMed1982

Clinical trial of albendazole in hookworm infection.

A clinical trial of albendazole (Zentel R) was carried out at the Hospital for Tropical Diseases in 1981. Thirty-five patients with hookworm infection were divided into 2 groups A, B and treated with a single dose of albendazole 400 mg and 600 mg respectively. The age of the patients ranged from 12 to 66 years and their weights ranged from 25 to 62 kilograms. Concentration and Stoll egg count methods were done at pretreatment, day 14 and day 21. At each interval two aliquots from each of the two faecal specimens were collected. The geometrical mean of EPG in Group A and B were 5406 and 5617 respectively. The cure rate in patients with less than 5000 EPG was 75% on day 21 in Group A and 67% in Group B. The mean percentage egg reduction was 95% in Group A and 99% in Group B. In patients with a higher egg out-put, the cure rate on day 21 was 50% in Group A and 29% in Group B. The mean percentage egg reduction was 91% in Group A and 93% in B. The side effects were mild and transient.

Adolescent↗