Summary Background Artemisinin and partner-drug resistance in Plasmodium falciparum are major threats to malaria control and elimination. Triple artemisinin-based combination therapies (TACTs), which combine existing co-formulated ACTs with a second partner drug that is slowly eliminated, might provide effective treatment and delay emergence of antimalarial drug resistance. Methods In this multicentre, open-label, randomised trial, we recruited patients with uncomplicated P falciparum malaria at 18 hospitals and health clinics in eight countries. Eligible patients were aged 2–65 years, with acute, uncomplicated P falciparum malaria alone or mixed with non- falciparum species, and a temperature of 37·5°C or higher, or a history of fever in the past 24 h. Patients were randomly assigned (1:1) to one of two treatments using block randomisation, depending on their location: in Thailand, Cambodia, Vietnam, and Myanmar patients were assigned to either dihydroartemisinin–piperaquine or dihydroartemisinin–piperaquine plus mefloquine; at three sites in Cambodia they were assigned to either artesunate–mefloquine or dihydroartemisinin–piperaquine plus mefloquine; and in Laos, Myanmar, Bangladesh, India, and the Democratic Republic of the Congo they were assigned to either artemether–lumefantrine or artemether–lumefantrine plus amodiaquine. All drugs were administered orally and doses varied by drug combination and site. Patients were followed-up weekly for 42 days. The primary endpoint was efficacy, defined by 42-day PCR-corrected adequate clinical and parasitological response. Primary analysis was by intention to treat. A detailed assessment of safety and tolerability of the study drugs was done in all patients randomly assigned to treatment. This study is registered at ClinicalTrials.gov , NCT02453308 , and is complete. Findings Between Aug 7, 2015, and Feb 8, 2018, 1100 patients were given either dihydroartemisinin–piperaquine (183 [17%]), dihydroartemisinin–piperaquine plus mefloquine (269 [24%]), artesunate–mefloquine (73 [7%]), artemether–lumefantrine (289 [26%]), or artemether–lumefantrine plus amodiaquine (286 [26%]). The median age was 23 years (IQR 13 to 34) and 854 (78%) of 1100 patients were male. In Cambodia, Thailand, and Vietnam the 42-day PCR-corrected efficacy after dihydroartemisinin–piperaquine plus mefloquine was 98% (149 of 152; 95% CI 94 to 100) and after dihydroartemisinin–piperaquine was 48% (67 of 141; 95% CI 39 to 56; risk difference 51%, 95% CI 42 to 59; p<0·0001). Efficacy of dihydroartemisinin–piperaquine plus mefloquine in the three sites in Myanmar was 91% (42 of 46; 95% CI 79 to 98) versus 100% (42 of 42; 95% CI 92 to 100) after dihydroartemisinin–piperaquine (risk difference 9%, 95% CI 1 to 17; p=0·12). The 42-day PCR corrected efficacy of dihydr...

Background:National Malaria Control Programmes (NMCPs) currently make limited use of parasite genetic data. We have developed GenRe-Mekong, a platform for genetic surveillance of malaria in the Greater Mekong Subregion (GMS) that enables NMCPs to implement large-scale surveillance projects by integrating simple sample collection procedures in routine public health procedures.Methods:Samples from symptomatic patients are processed by SpotMalaria, a high-throughput system that produces a comprehensive set of genotypes comprising several drug resistance markers, species markers and a genomic barcode. GenRe-Mekong delivers Genetic Report Cards, a compendium of genotypes and phenotype predictions used to map prevalence of resistance to multiple drugs.Results:GenRe-Mekong has worked with NMCPs and research projects in eight countries, processing 9623 samples from clinical cases. Monitoring resistance markers has been valuable for tracking the rapid spread of parasites resistant to the dihydroartemisinin-piperaquine combination therapy. In Vietnam and Laos, GenRe-Mekong data have provided novel knowledge about the spread of these resistant strains into previously unaffected provinces, informing decision-making by NMCPs.Conclusions:GenRe-Mekong provides detailed knowledge about drug resistance at a local level, and facilitates data sharing at a regional level, enabling cross-border resistance monitoring and providing the public health community with valuable insights. The project provides a rich open data resource to benefit the entire malaria community.Funding:The GenRe-Mekong project is funded by the Bill and Melinda Gates Foundation (OPP11188166, OPP1204268). Genotyping and sequencing were funded by the Wellcome Trust (098051, 206194, 203141, 090770, 204911, 106698/B/14/Z) and Medical Research Council (G0600718). A proportion of samples were collected with the support of the UK Department for International Development (201900, M006212), and Intramural Research Program of the National Institute of Allergy and Infectious Diseases.

Introduction: A study was conducted for six randomly selected designated Microscopy Centre areas of West Tripura District of India with objectives to assess the knowledge regarding Pulmonary Tuberculosis (PTB) and DOTS among the PTB patients and to identify the factors determining the knowledge.Methodology: This cross-sectional study was conducted among 220 PTB patients registered for treatment with DOTS therapy during July 2011 to June 2012.Results: The study showed that 29.10% of the patients had satisfactory knowledge of the disease and its treatment. Only 14.10% patients had the correct knowledge regarding the cause of the disease and 53.60% of the patients had the knowledge regarding the mode of transmission and measures for prevention. Again, 6.40% of the patients had the knowledge regarding the drug dosage schedule and 52.70% patients knew the duration of treatment. Satisfactory knowledge was found to be significantly higher among patients with education level of Higher Secondary or above, and patients who had prior knowledge of tuberculosis [OR-17.60(1.68-183.90)]. Again patients who had less income had 86% [OR-0.14 (0.03-0.64)] less chance of having satisfactory knowledge.Conclusion: The overall knowledge level among the patients is unsatisfactory and there is urgent need of advocating educational activities among the patients.SAARC J TUBER LUNG DIS HIV/AIDS, 2015; 12(1), Page: 1-7

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Background: The major cause of blindness in India is cataract. Blindness leads to poverty due to reduced productive activity and this leads to reduced quality of life. This study was aimed at evaluating the visual acuity (VA) change pre and post cataract surgery, the post-surgical quality of life (QOL) outcomes and level of satisfaction estimation.Methods: This was a cross sectional, hospital based study carried out in a tertiary care centre in Tripura. It included 200 patients over a period of 1.5 years to compare the VA, QOL, psychosocial status and satisfaction level pre and post cataract surgery. Indian vision function questionnaire 33 (INDVFQ33) was used to assess QOL.Results: Out of 200 patients, in 53% preoperative VA ranged from >20/400 - <20/200 while in 5% patients it was only perception of light. Postoperatively 80% of the patient achieved best corrected VA (BCVA) of 20/30 or better, 18% patient attained BCVA ranging from 20/40 to 20/60. Only 2% had a BCVA of 20/60 or worst.  QOL parameters like mean pre and post -operative general function score, psychosocial scale and visual function scale showed improvement following cataract surgery. 69% of the patients were satisfied with the cataract surgery, whereas 31% were not completely satisfied.Conclusions: The study revealed that there was a marked improvement in VA post cataract surgery and it also influenced the QOL in all scales.