Paroxysms are sharp episodes of high fever accompanied by chills and rigors that occur periodically, once in every 48 hr in Plasmodium vivax infections. We have measured the changing levels of serum tumor necrosis factor (TNF) during paroxysms in non-immune patients infected with P. vivax malaria. The changes in TNF levels closely paralleled the rise and fall in temperature during the paroxysms but tended to precede them by 30-60 min. These observations suggest that the rise and fall in temperature during P. vivax paroxysm may be directly related to the periodic changes in TNF levels induced during these infections. The peak TNF levels reached duringP. vivax infections were much higher than even those which have been recorded during severe and fatal P. falcikarm infections in which TNF has been postulated to contribute to the severe manifestations of this disease.The most characteristic clinical features of malarial infections are the acute paroxysmal and febrile episodes that typically recur at intervals of 48 hr in infections due to the two main human malaria parasites, Plasmodium vivax and Plasmodium falciparum. The detailed symptoms associated with these periodic paroxysms, including their severity and threat to life, are specific to the infections by each species of parasite (1). In infections of P. falciparum, paroxysms are typically poorly delineated and may extend irregularly over >24 hr; severe complications including cerebral involvement and coma may arise in nonimmune individuals, often leading to death. Infections of P. vivax in nonimmune patients are very rarely fatal and do not involve the severe complications of P. falciparum infections. Compared with those in P. falciparum infections, paroxysms in P. vivax infections are generally short and sharply delineated within a period of usually <8 hr. The feature most consistently associated with infections by either parasite is a sharp rise in temperature at the onset of a paroxysm, reaching peak values of up to about 41'C within the first 1-2 hr from onset.There has been some experimental observation and much speculation on the involvement of cytokines and especially tumor necrosis factor (TNF) in the symptoms and effects of malarial infections (2-4). Speculation on the possible role of TNF in the severe complications ofP. falciparum infections, particularly cerebral malaria, rests mainly on the evidence of a strong correlation between serum TNF levels and the severity of disease and mortality in P. falciparum-infected children (5,6). Evidence has also been presented for TNF acting as a mediator of malarial fever (7,8). Here we report observations of serum TNF changes during febrile paroxysms in P. vivax malaria. Our results demonstrate high TNF levels without any cerebral involvement or lethality associated with P. falciparum infections. They also show that the rise and fall in serum TNF levels closely parallel but slightly precede the rise and fall of temperature during a paroxysm in an infection of P. vivax malaria. MATERIALS AND METHODSPatie...

BackgroundBody Mass Index (BMI) is used as a useful population-level measure of overweight and obesity. It is used as the same for both sexes and for all ages of adults. The relationship between BMI and body fat percentage (BF %) has been studied in various ethnic groups to estimate the capacity of BMI to predict adiposity. We aimed to study the BMI–BF% relationship, in a group of South Asian adults who have a different body composition compared to presently studied ethnic groups. We examined the influence of age, gender in this relationship and assessed its’ linearity or curvilinearity.MethodsA cross sectional study was conducted, where adults of 18–83 years were grouped into young (18–39 years) middle aged (40–59 years) and elderly (>60 years). BF% was estimated from bioelectrical impedance analysis. Pearsons’ correlation coefficient(r) was calculated to see the relationship between BMI-BF% in the different age groups. Multiple regression analysis was performed to determine the effect of age and gender in the relationship and polynomial regression was carried out to see its’ linearity. The relationships between age-BMI, age-BF % were separately assessed.ResultsOut of 1114 participants, 49.1% were males. The study sample represented a wide range of BMI values (14.8-41.1 kg/m2,Mean 23.8 ± 4.2 kg/m2). A significant positive correlation was observed between BMI-BF%, in males (r =0.75, p < 0.01; SEE = 4.17) and in females (r = 0.82, p < 0.01; SEE = 3.54) of all ages. Effect of age and gender in the BMI-BF% relationship was significant (p < 0.001); with more effect from gender. Regression line found to be curvilinear in nature at higher BMI values where females (p < 0.000) having a better fit of the curve compared to males (p < 0.05). In both genders, with increase of age, BMI seemed to increase in curvilinear fashion, whereas BF% increased in a linear fashion.ConclusionsBMI strongly correlate with BF % estimated by bioelectrical impedance, in this sub population of South Asian adults. This relationship was curvilinear in nature and was significantly influenced by age and gender. Our findings support the importance of taking age and gender in to consideration when using BMI to predict body fat percentage/obesity, in a population.

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ObjectivesTo conduct a document and content analysis of exertional heat illness (EHI)-related documents published by sports organisations in Victoria, Australia, in order to determine their scope and evidence base against current international best practice recommendations.MethodsA qualitative document and content analysis. Official documents relating to EHI were identified through a search of 22 Victorian sport organisation websites, supplemented by a general internet search. The content of these documents was evaluated against recommendations presented in three current international position statements on prevention and management of EHI.ResultsA range of document types addressing EHI were identified (n=25), including specific heat policies, match day guides, rules and regulations. Recommendations about prevention measures were the most common information presented, but these were largely focused on event modification/cancellation guidelines only (n=22; 88%). Most documents provided information on hydration as a preventive measure (n=20; 80%), but the emphasis on the importance of cooling strategies (n=7; 28%) and heat acclimatisation (n=5; 20%) was inadequate. Details on EHI, including its definition, symptoms/signs to look out for, and common risk factors (beyond humidity/high temperatures) were lacking in most documents.ConclusionThere is considerable variation in formal documents with regard to their content and quality of information. Continued efforts to bridge the evidence to practice gap in sports safety are therefore important. This study highlights the challenge for community sport, which relies on high-level policy and governance, across settings and populations that can differ substantially in their needs.

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