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To describe India's National Antimalarial Drug Resistance Monitoring System, measure the efficacy of first-line malaria treatments, and determine risk factors for treatment failure. In 2009-2010, prospective studies with 28 days of follow-up were conducted at 25 sentinel sites. Patients infected with Plasmodium falciparum were given artesunate plus sulfadoxine-pyrimethamine (AS+SP); those infected with P. vivax were given chloroquine. Polymerase chain reaction was used to distinguish post-treatment reinfection from treatment failure. Isolates of P. falciparum were checked for dhfr and dhps mutations. Overall, 1664 patients were enrolled. Kaplan-Meier survival analysis showed an efficacy of 98.8% for AS+SP. Most patients with P. falciparum parasitaemia cleared their parasitaemias within 24 hours of treatment initiation, but six, including four with treatment failure, remained parasitaemic after 72 hours. Double mutants in dhfr were found in 68.4% of the genotyped isolates. Triple or quadruple mutants in dhfr and mutations in dhps were rare. A daily dose of artesunate of < 3 mg per kg of body weight, age of less than 5 years, and fever at enrolment were associated with an increased risk of treatment failure. Chloroquine remained 100% efficacious and generally cleared P. vivax parasitaemias within 48 hours. Vomiting (seen in 47 patients) was the most common adverse event. India's National Antimalarial Drug Resistance Monitoring System provides wide coverage. The first-line antimalarials used in the country remain safe and efficacious. The treatment of malaria in young children and the relative benefits of age- and weight-based dosing need further exploration.

To discover the cause of acute renal failure in 36 children aged 2 months to 6 years who were admitted to two hospitals in Delhi between 1 April and 9 June 1998. Data were collected from hospital records, parents and doctors of the patients, and district health officials. Further information was obtained from house visits and community surveys; blood and stool samples were collected from other ill children, healthy family members and community contacts. Samples of drinking-water and water from a tube-well were tested for coliform organisms. Most of the children (26/36) were from the Gurgaon district in Haryana or had visited Gurgaon town for treatment of a minor illness. Acute renal failure developed after an episode of acute febrile illness with or without watery diarrhoea or mild respiratory symptoms for which the children had been treated with unknown medicines by private medical practitioners. On admission to hospital the children were not dehydrated. Median blood urea concentration was 150 mg/dl (range 79-311 mg/dl) and median serum creatinine concentration was 5.6 mg/dl (range 2.6-10.8 mg/dl). Kidney biopsy showed acute tubular necrosis. Thirty-three children were known to have died despite being treated with peritoneal dialysis and supportive therapy. Cough expectorant manufactured by a company in Gurgaon was found to be contaminated with diethylene glycol (17.5% v/v), but a sample of acetaminophen manufactured by the same company tested negative for contamination when gas-liquid chromatography was used. Thus, poisoning with diethylene glycol seems to be the cause of acute renal failure in these children.

Hundreds of laboratory-confirmed cholera cases occur every year in Delhi. However from 1965 through 1993, no cases of cholera nor carriers of Vibrio cholerae have been detected in the months January and February of all these years. Nevertheless, two cases occurred in January 1994. Both were children who acquired their infection locally. Six hundred fifty-eight rectal swabs collected from possible contacts were negative for V. cholerae. The next isolations could be made only in April, which is the usual beginning of the cholera season. The study suggests that cholera transmission can occur during the winter months in Delhi, but that it is not sustained.

BackgroundThe level of fractional exhaled nitric oxide (FeNO) correlates with exacerbation risk and lung function decline in asthma and is a well-recognised biomarker of airway IL-13. FeNO has been shown to significantly fall following inhibition of either TSLP with tezepelumab, or IL4R with dupilumab. It remains unclear whether these two biologic agents result in similar falls in FeNO after 4 weeks of treatment despite their different immune targets.MethodsWe performed a retrospective analysis of FeNO levels at baseline and after 4 weeks of dupilumab or tezepelumab in a real world severe eosinophilic asthma (SEA) cohort at a tertiary severe asthma centre in the UK. All patients received these therapies in clinic for the first 4 weeks and the dose of inhaled corticosteroids remained constant. Change in FeNO and the proportion of patients who continued to have an elevated FeNO at 4 weeks despite these therapies was assessed.ResultsEighty-five adults with SEA meeting NICE criteria for biologic therapy with tezepelumab (n=47) and dupilumab (n=38) were included. Baseline FeNO levels were similar in both groups (tezepelumab: 46 ppb [IQR 27–99], dupilumab: 57ppb [IQR 32–92], p=0.61). At week 4, both therapies led to a significant reduction in FeNO (p<0.0001), which was statistically comparable: tezepelumab -15ppb vs dupilumab -27ppb, p = 0.14. At 4 weeks, 62% of tezepelumab and 58% of dupilumab patients still had a FeNO>25ppb (p=0.28), whilst 26% of tezepelumab and 16% of dupilumab treated patients continued to have a FeNO >50ppb (p=0.27). For both therapies, clinical improvements in excess of the MCID for both ACQ6 and mAQLQ were observed at week 4 with no significant difference between groups.ConclusionIn a real-world cohort of SEA with comparable baseline FeNO levels, dupilumab and tezepelumab led to similar reductions in FeNO at 4 weeks post-initiation. In both cohorts, the majority of patients had evidence of persistent T2 inflammation with a FeNO >25ppb. The clinical implications of this residual inflammation and the longer term impact of continued treatment with either dupilumab or tezepelumab on FeNO requires further assessment.