The pharmacokinetic properties of oral artesunate (3 mg/kg) were determined in 10 Vietnamese children, aged from 6 to 15 years, with acute falciparum malaria of moderate severity. Plasma concentrations were measured using a bioassay and expressed in terms of antimalarial activity equivalent to dihydroartemisinin, the principal biologically active metabolite. Oral artesunate was absorbed rapidly with a mean time to peak plasma bioactivity of 1.7 h (95% confidence interval [95% CI] 0.8-2.6). There was wide variation in peak plasma concentrations with a mean value equivalent to 664 ng of dihydroartemisinin/mL (95% CI 387-9410, range 179-1395) and a four-fold variation in the area under the plasma concentration-time curves. Elimination from plasma was rapid with a mean (95% CI) half-life of 1.0 h (95% CI 0.8-1.4). Plasma antimalarial levels were below the limit of detection in all cases by 12 h, despite the relatively high dose of artesunate used. Oral artesunate is rapidly absorbed and rapidly eliminated in children with moderately severe malaria but there is considerable variation between individuals.

Severe malaria remains a major cause of mortality and morbidity for children living in many tropical regions. With the emergence of strains of Plasmodium falciparum resistant to both chloroquine and quinine, alternative antimalarial agents are required. The artemisinin group of compounds are rapidly effective in severe disease when given by intramuscular or intravenous injection. However, these routes of administration are not always available in rural areas. In an open, randomized comparison 109 Vietnamese children, aged between 3 months and 14 years, with severe P.falciparum malaria, were allocated at random to receive artemisinin suppositories followed by mefloquine (n = 37), intramuscular artesunate followed by mefloquine (n = 37), or intravenous quinine followed by pyrimethamine/sulfadoxine (n = 35). There were 9 deaths: 2 artemisinin, 4 artesunate and 5 quinine-treated children. There was no difference in fever clearance time, coma recovery, or length of hospital stay among the 3 groups. However, parasite clearance times were significantly faster in artemisinin and artesunate-treated patients than in those who received quinine (P < 0.0001). Both artemisinin and artesunate were very well tolerated, but children receiving these drugs had lower peripheral reticulocyte counts by day 5 of treatment than those in the quinine group (P = 0.011). No other adverse effect or toxicity was found. There was no treatment failure in these 2 groups, but 4 patients in the quinine group failed to clear their parasites within 7 d of starting treatment and required alternative antimalarial therapy. Artemisinin suppositories are easy to administer, cheap, and very effective for treating children with severe malaria. In rural areas where medical facilities are lacking these drugs will allow antimalarial therapy to be instituted earlier in the course of the disease and may therefore save lives.

SummaryOBJECTIVES A positive tourniquet test is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue haemorrhagic fever, but no formal evaluation of the test has been undertaken. As many doctors remain unconvinced of its usefulness, this study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test. METHODSMETHO DS A prospective evaluation of the standard sphygmomanometer cuff tourniquet test, compared with a simple elastic cuff tourniquet test, was carried out in 1136 children with suspected dengue infection admitted to a provincial paediatric hospital in southern Viet Nam. RESULTSRES ULTS There was good agreement between independent observers for both techniques, but the sphygmomanometer method resulted in consistently greater numbers of petechiae. This standard method had a sensitivity of 41.6% for dengue infection, with a specificity of 94.4%, positive predictive value of 98.3% and negative predictive value of 17.3%. The test differentiated poorly between dengue haemorrhagic fever (45% positive) and dengue fever (38% positive). The simple elastic tourniquet was less sensitive than the sphygmomanometer cuff, but at a threshold of 10 petechiae (compared with the WHO recommendation of 20) per 2.5 cm 2 the sensitivity for the elastic tourniquet rose to 45% (specificity 85%). Other evidence of bleeding was frequently present and the tourniquet test provided additional information to aid diagnosis in only 5% of cases.

SummaryThe dietary habits and nutritional status of Vietnamese primary school girls were investigated using a cross-sectional survey. We interviewed 348 girls aged 7 to 9 yr old, randomly selected from three rural (n=193) and two urban (n=155) primary schools. The nutritional status of the children was evaluated by anthropometric and biochemical data. Dietary data were calculated based on the results of a 24-h recall interview carried out for three consecutive days. The dietary macronutrient pattern of the rural group showed a deficiency of energy, fat, animal protein, and fiber content. On the other hand, high animal protein ratio, deficiency of fiber consumption, low polyunsaturated fatty acid, and high sat urated fatty acid proportions were typically found in the urban group. A high number of rural children skipped lunches, resulting in low energy consumption; however, frequently skipped breakfast in the urban group did not influence total energy consumption because of extra meals taken. The mean height of rural children was 5.8cm less than that of their urban counterparts. In addition, 11.4% of wasted rural children needed emergency inter vention with energy supplementation. Moreover, a high proportion of children with a high atherogenic index (AI) (41.5%0) and low HDL cholesterol (40.9%) were found in the rural group. In contrast, a tendency toward obesity, high cholesterol, LDL cholesterol, and high AT was observed in a proportion of the urban children (5.2%, 15.5 %, 12.3%, and 2 9.0%, respectively).

Cholesteryl ester transfer protein (CETP) is understood to play a regulatory role in HDL cholesterol (HDLC) metabolism. In this study, the effect of CETP genotypes on plasma lipid and lipoprotein levels in 348 Vietnamese girls (aged 7-9) with different nutritional conditions was analyzed. The two mutations, intron 14 G(ϩ1)-to-A (I14A) and Asp 442 to Gly within exon 15 (D442G), and the TaqIB polymorphism in the CETP gene were identified by an Invader assay. The D442G mutation was present with a frequency of 0.034, while the I14A mutation was absent. HDLC levels were significantly higher in carriers of the D442G mutation than in noncarriers, regardless of the nutritional status. Low-density lipoprotein (LDL) cholesterol and triglyceride levels were not significantly lower in carriers of D442G mutation.The frequency of the TaqIB2 allele was 0.34, which was lower than that observed in other Asian populations. TaqIB2B2 carriers also had significantly higher HDLC levels, but this association was weaker than that of the D442G mutation. Overall, genetic variations at the CETP gene locus may account for a significant proportion of HDLC variation in Vietnamese children. HDLC levels in plasma may be altered by a variety of environmental factors including alcohol consumption, a low fat diet, obesity, smoking, and exercise (1). In the general population, about 50% of plasma HDLC variability derives from genetic factors (2). CETP is a plasma glycoprotein that transfers cholesterol ester from HDLC to triglyceride (TG)-rich lipoproteins and regulates plasma HDLC levels (3,4). Two CETP gene mutations, an intron 14 G(ϩ1)-to-A mutation (I14A) and a missense mutation, Asp442 to Gly within exon 15 (D442G), first described in Japanese population, were found to be associated with a CETP deficiency and increased HDLC levels (5,6). In addition, several common restriction fragment length polymorphisms (RFLPs) have also been reported in the CETP gene locus (7-9). The most studied RFLP to date has been TaqIB, which has been shown to be a silent base change affecting the 277th nucleotide in the first intron of the gene. The B2 allele (in which the TaqIB restriction site is absent) at this polymorphic site has been associated with increased HDLC levels and decreased CETP activities and levels in normolipemic subjects, thus resembling a mild form of CETP deficiency (10 -12). The risk of coronary artery disease is inversely related to plasma HDLC levels. Therefore, identification of the underlying genetic basis of plasma HDLC levels is key to the understanding of atherosclerosis-related diseases, which are among the 10 leading mortality causes in Vietnam (13). The aim of this study was to determine the importance of genetic variants in the CETP gene to predict the HDLC levels for the Vietnamese children under different nutritional statuses. METHODSStudy subjects. The study subjects included 348 schoolgirls, aged 7 to 9 y old, who were randomly selected from two schools in the center of Hochiminh city (an urban area) and three schools in the su...