G6PD enzyme activity was directly related to susceptibility to malaria in the Brazilian Amazon, where P. vivax predominates. Severe G6PDd was associated with considerable higher risk of malaria-related transfusions.
BackgroundThere is a paucity of information regarding glucose-6-phosphate dehydrogenase (G6PD) deficiency in endemic areas for malaria in Latin America.Methodology/Principal FindingsThis study determined the prevalence of the G6PD deficiency in 200 male non-consanguineous individuals residing in the Ismail Aziz Community, on the outskirts of Manaus (Brazilian Amazon). Six individuals (3%) were deficient using the qualitative Brewer's test. Gel electrophoresis showed that five of these patients were G6PD A−. The deficiency was not associated with the ethnic origin (P = 0.571). In a multivariate logistic regression analysis, G6PD deficiency protected against three or more episodes of malaria (P = 0.049), independently of the age, and was associated with a history of jaundice (P = 0.020) and need of blood transfusion (P = 0.045) during previous treatment for malarial infection, independently of the age and the previous malarial exposure.Conclusions/SignificanceThe frequency of G6PD deficiency was similar to other studies performed in Brazil and the finding of a predominant G6PD A− variant will help the clinical management of patients with drug-induced haemolysis. The history of jaundice and blood transfusion during previous malarial infection may trigger the screening of patients for G6PD deficiency. The apparent protection against multiple malarial infections in an area primarily endemic for Plasmodium vivax needs further investigation.
Abstract. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human genetic abnormalities, and it has a significant prevalence in the male population (X chromosome linked). The purpose of this study was to estimate the frequency of impaired fasting glucose and diabetes among G6PD-deficient persons in Manaus, Brazil, an area in the Western Brazilian Amazon to which malaria is endemic. Glucose-6-phosphate dehydrogenasedeficient males had more impaired fasting glucose and diabetes. This feature could be used as a screening tool for G6PD-deficient persons who are unable to use primaquine for the radical cure of Plasmodium vivax malaria.
This report describes the development of hemolysis in eighteen glucose-6-phosphate dehydrogenase defi cient patients treated for Plasmodium vivax malaria with chloroquine and primaquine. The most frequent fi ndings accompanying hemolysis were fever and leukocytosis, in addition to anemia requiring red blood cell transfusion, and development of acute renal failure. Hemolysis in patients using primaquine is not infrequent and contributes to the morbidity of infection caused by Plasmodium vivax.
This transdisciplinary literature review paper aims at addressing the literature lacuna in community engagement and water, sanitation and hygiene (WASH) in sub-Saharan countries. By responding to a set of identified WASH-related questions to community engagement, it explores through different disciplinary lenses the challenges and opportunities in this significant area that impacts human health. This transdisciplinary review brought together the disciplines of water engineering, environmental microbiology, public health and infectious disease, design research, women and gender studies, and developmental studies. It examined over 430 papers with 29 papers included in the final review. The main findings suggest integrating women into leadership roles in community water management and water and sanitation programmes can lead to more sustainability and can make water projects more effective. Second, cultural preferences should be a key factor when planning and implementing WASH technologies and interventions. Third, for community engagement to be effective, it should be done with intentionality and over a longer period; and employ existing culturally embedded leadership structures, such as schoolteachers, religious leaders and train change agents.
Allantoin is the main product of uric acid oxidation and was found to be augmented in atherosclerotic plaque in human autopsy and in animal models of atherosclerosis. Uric acid is abundant in human plasma and is prone to oxidation in inflammatory conditions such as atherosclerosis. In this study, we found a significant increase in plasma uric acid (P=0.002) and allantoin (P=0.025) in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) that presented common carotid intima-media thickness (c-IMT) within the 75th percentile (c-IMT≥P75). Multiple linear regression showed an association of c-IMT with uric acid (β=0.0004, P=0.014) and allantoin (β=0.018, P=0.008). This association was independent of age, the traditional risk factor LDL/HDL ratio, and non-traditional risk factors: pulse pressure, neck circumference, and the inflammatory marker myeloperoxidase. The independent and strong association of allantoin with c-IMT shows that it might be a useful marker, along with other traditional risk factors, to evaluate an early stage of atherosclerosis.
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