This study investigated the implementation of the roll back malaria (RBM) programme at household and at health post levels and examined factors that negatively impact on malaria prevention and control activities. Quantitative, descriptive, analytic crosssectional research, guided by the conceptual framework of the Health Belief Model, was conducted. Structured interviews were conducted with 857 women (for the household survey in phase 1) and 53 health extension workers (HEWs) in phase 2 of the study, in nine malaria endemic districts of Sidama Zone, southern Ethiopia. Data were analysed using SPSS version 20. The study’s findings indicate that 53.3% (n=457) of the household respondents and 24.5% (n=13) of the HEWs had low levels of overall malaria-related knowledge. Household respondents aged 25-34 years, (p<0.01); regularly received malaria-related information, (p<0.001) and the less poor women (p<0.001) had good levels of knowledge. Of the households, 38.9% (n=333) reported poor RBM practices. Wealth, knowledge, perceived threat of malaria and perceived benefits of implementing malaria preventive measures were positively associated with good RBM practices. Indoor residual spraying (63.6%; 422 out of 664), consistent use of insecticide treated bed nets (51.6%; 368 out of 713), and environmental sanitation (38.6%; 331 out of 857) were the most commonly implemented malaria prevention strategies in the study area. Out of the 252 reported malaria cases, 53.6% (n=135) occurred among children under five years of age who also comprised 50.0% (n=16) of 32 reported malaria-related deaths. The RBM practices were poorly implemented in the study area despite malaria prevention and control efforts. Slow progress in behavioural changes among household members, lack of transportation services for referring malaria patients, lack of support given to HEWs and lack of feedback and supervision from higher level health care facilities were identified as potential challenges facing RBM implementation in the study area. Future efforts need to focus on effective behavioural changes based on intervention studies and regular monitoring of the RBM programme. The workloads of the HEWs should also be reconsidered and lay health educators should be used more effectively. Health posts should always have sufficient anti-malaria drugs and other resource such as rapid diagnostic kits. / Health Studies / D. Litt. et Phil. (Health Studies)

This study investigated the implementation of the roll back malaria (RBM) programme at household and at health post levels and examined factors that negatively impact on malaria prevention and control activities. Quantitative, descriptive, analytic crosssectional research, guided by the conceptual framework of the Health Belief Model, was conducted. Structured interviews were conducted with 857 women (for the household survey in phase 1) and 53 health extension workers (HEWs) in phase 2 of the study, in nine malaria endemic districts of Sidama Zone, southern Ethiopia. Data were analysed using SPSS version 20. The study’s findings indicate that 53.3% (n=457) of the household respondents and 24.5% (n=13) of the HEWs had low levels of overall malaria-related knowledge. Household respondents aged 25-34 years, (p<0.01); regularly received malaria-related information, (p<0.001) and the less poor women (p<0.001) had good levels of knowledge. Of the households, 38.9% (n=333) reported poor RBM practices. Wealth, knowledge, perceived threat of malaria and perceived benefits of implementing malaria preventive measures were positively associated with good RBM practices. Indoor residual spraying (63.6%; 422 out of 664), consistent use of insecticide treated bed nets (51.6%; 368 out of 713), and environmental sanitation (38.6%; 331 out of 857) were the most commonly implemented malaria prevention strategies in the study area. Out of the 252 reported malaria cases, 53.6% (n=135) occurred among children under five years of age who also comprised 50.0% (n=16) of 32 reported malaria-related deaths. The RBM practices were poorly implemented in the study area despite malaria prevention and control efforts. Slow progress in behavioural changes among household members, lack of transportation services for referring malaria patients, lack of support given to HEWs and lack of feedback and supervision from higher level health care facilities were identified as potential challenges facing RBM implementation in the study area. Future efforts need to focus on effective behavioural changes based on intervention studies and regular monitoring of the RBM programme. The workloads of the HEWs should also be reconsidered and lay health educators should be used more effectively. Health posts should always have sufficient anti-malaria drugs and other resource such as rapid diagnostic kits. / Health Studies / D. Litt. et Phil. (Health Studies)

Candida albicans gehört zu den für den Menschen fakultativ pathogenen Hefepilzen. Der normalerweise harmlose Begleiter der humanen Mikroflora findet sich hauptsächlich auf Schleimhäuten der Mundhöhle und des Magen-Darm-Trakt sowie in der vaginalen Flora. Menschen, deren Immunsystem geschwächt ist, sind jedoch besonders anfällig für Infektionen, die durch den Pilz hervorgerufen werden können. Neben oberflächlichen kann es dabei auch zu lebensbedrohlichen systemischen Infektionen kommen, die nicht selten zum Tod des Patienten führen. Durch ein zunehmendes Auftreten von Resistenzen gegen gebräuchliche Pharmaka besteht aktuell ein dringender Bedarf an neuen Wirkstoffen gegen Candida. Die zehn vom Hefepilz exprimierten sekretorischen Aspartatproteasen (SAP1-10), die als wichtige Virulenzfaktoren gelten, stellten sich dabei zunehmend als vielversprechende Targets heraus. Das Ziel dieser Arbeit war die Weiterentwicklung der literaturbekannten cis-konfigurierten 3-Phenylaziridin-2-carboxylate A-07 und A-08 als irreversible Inhibitoren der SAP-Isoenzyme. Die Variation der Substituenten am Aziridinstickstoff für die Adressierung der S3-Tasche im Enzym erfolgte durch Alkyl-, Aryl- und Acylreste. Die Aminosäureester wurden in Konfiguration und Art der Seitenkette modifiziert, um eine Verbesserung der Anpassung an die S1‘-Tasche zu ermöglichen. Die cis-3-Phenylaziridin-2-carboxylate wurden durch Cromwell-Synthese als Racemate erhalten. Aminosäure- und Peptidkupplungen erfolgten mit gängigen Kupplungsreagenzien (PPA, DPPA). Die stereoselektive Synthese des methylenverbrückten Aziridin-2-carboxylats A-10 erfolgte durch Redoxkondensation nach Mukaiyama. Die synthetisierten Verbindungen wurden in einem fluorimetrischen FRET-Assay auf ihre inhibitorische Wirkung gegen SAP2 getestet. Dabei war das im FRET-Assay bislang an SAP2 verwendete Substrat Dabcyl-Arg-Lys-Pro-Ala-Leu-Phe-Phe-Arg-Leu-Glu(EDANS)-ArgOH auch für Testungen an SAP1, 3 & 8 sowie Cathepsin D geeignet. Neben den jeweiligen Km-Werten konnten für diese Enzyme auch die zugehörigen kcat-Werte bestimmt werden. Zur Bestimmung der Hemmkonstanten wurde für die aktiven Verbindungen ein Verdünnungsassay nach Kitz und Wilson durchgeführt. 20 der 46 Aziridin-2-carboxylate erreichten SAP2 k2nd-Werte von mindestens 7880 M-1min-1. Die mit k2nd-Werten von 60608 bis 118582 M-1min-1 potentesten Verbindungen wurden durch (R)-Aminosäuresubstitution (A-28, A-31) bzw. durch Cyclohexylmethyl-Verknüpfung am Aziridinstickstoff (A-43, A-45) erhalten. Für die einzelnen Diastereomere von A-31, A-31a und A-31b, wurde eine signifikant unterschiedliche Hemmwirkung festgestellt. Die Inhibitoren zeigten eine zeitabhängige Hemmung, die nach ca. 30 min Inkubationszeit jedoch wieder schwächer wurde. LC-MS- und NMR-Studien lassen einen pseudo-irreversiblen Hemmmechanismus vermuten: Der Inhibitor bindet zunächst irreversibel unter Ringöffnung des Aziridins an das Enzym. Der entstehende Ester wird danach unter den sauren Assaybedingungen wieder hydrolysiert. Der resultierende Aminoalkohol bindet anschließend als Übergangszustandsanalogon reversibel an das Enzym. Selektivitätsstudien an Cathepsin D zeigten für 36 der 46 Aziridin-2-carboxylate k2nd-Werte von 10350 bis 936544 M-1min-1. Damit sind die Verbindungen an CathD aktiver als an SAP2. Die 1-Cyclohexylmethyl-verknüpften Aziridine wiesen auch an CathD die höchsten k2nd-Werte auf, wenngleich sich dabei die (R)-Konfiguration der Aminosäurereste (A-57, A-59) als die aktivere Variante herausstellte. Mit dem (R)-Phe-substituierten 1-tert-Butylaziridin A-58 erreichte der potenteste Vertreter der Reihe bereits einen Ki-Wert im dreistelligen nano-molaren Bereich. Ebenso wurden für die (R)-Aminosäure-Analoga von A-07 und A-08 (A-28, A-31) erhöhte Hemmkonstanten erhalten. Wie SAP2 wird auch CathD durch die (an)getrennten Diastereomere A-31a und A-31b signifikant unterschiedlich stark inhibiert. Mit den (R)-Valin-verknüpften Aziridinen A-81, A-82 und A-85 fanden sich aktive verzweigt-Alkyl-substituierte CathD-Inhibitoren. / Candida albicans is one of the most common fungal pathogens of human beings. Usually, Candida species reside as commensal organisms as part of the normal microflora, predomi-nantly colonizing the mucosal surfaces of the oral cavity, the gastrointestinal tract or the va-ginal flora. However, notably in immunosuppressed individuals, C. albicans can evolve into an opportunistic pathogen, causing superficial as well as life-threatening systemic infections with high mortality. Increasing resistances to current drug therapies demand research for new antifungal phar-maceuticals. The secreted aspartic proteases (SAP1-10), encoded by ten different sap genes, were discovered as key virulence factors and hence are considered to be potential targets for new antimycotic drugs. The goal of the present work was the improvement of the known cis-configured 3 phenyl-aziridine-2-carboxylates A-07 und A-08 as irreversible inhibitors of the SAP isoenzymes. In order to address their S3 pocket, the substituent at the aziridine-nitrogen was modified (alkyl, aryl and acyl residues). Furthermore, various amino acid esters (D, L) were included in order to improve their fit into the S1’ pocket. The cis-3-phenylaziridine-2-carboxylates were obtained as racemates via Cromwell synthesis. Amino acid and peptide coupling reactions were performed with common coupling reagents (PPA, DPPA). The stereoselective synthesis of the methylene-bridged aziridine-2-carboxylate A-10 was achieved via redox condensation according to Mukaiyama. The synthesized compounds were tested for inhibition of SAP2 by using a fluorometric FRET assay using Dabcyl-Arg-Lys-Pro-Ala-Leu-Phe-Phe-Arg-Leu-Glu(EDANS)-ArgOH as sub-strate. This substrate, designed for SAP2, was found to be also suitable for assays with SAP1, 3 & 8 and Cathepsin D. Additionally, the corresponding Km- and kcat values were determined. For the determination of the inhibition constants of the active compounds a dilution assay according to Kitz and Wilson was performed. 20 of the 46 aziridine-2-carboxylates yielded k2nd values of at least 7880 M-1min-1 against SAP2. With k2nd values between 60608 and 118582 M-1min-1, the most potent compounds were achieved with (R)-amino acids (A-28, A-31) and by cyclohexylmethyl substitution of the aziridine-nitrogen (A-43, A-45). Significantly different inhibition potencies were found for the single diastereomers of A-31, A-31a and A-31b. The inhibitors showed a time-dependent inhibition that decreased after 30 min incubation time. LC-MS and NMR studies suppose a pseudo-irreversible mechanism of inhibition: First, the inhibitor irreversibly binds to the enzyme under ring opening of the aziridine. Then the generated ester is hydrolyzed under the acidic assay conditions. The resulting amino alcohol subsequently could bind as a transition-state mimetic inhibitor to the enzyme. In selectivity studies on CathD 36 of the 46 aziridine-2-carboxylates showed k2nd values be-tween 10350 and 936544 M-1min-1. Thus, the compounds show higher activity against CathD than against SAP2. Again, the 1-cyclohexylmethyl-substituted aziridines show the highest k2nd values. However, in these cases the compounds with (R)-configured amino acid residues are the more active ones (A-57, A-59). With the (R)-Phe-substituted 1-tert-butylaziridine A-58, the most active compound reached a Ki value in the nanomolar region. Similarly to the results obtained for SAP2, the (R)-amino acid analogues to A-07 und A-08 (A-28, A-31) show higher inhibition constants. Again, the separated diastereomers A-31a and A-31b display significantly different inhibition potencies. With the (R) valin linked aziridines A-81, A-82 and A-85 a highly active group of alkyl-substituted inhibitors with branched side-chains was found.

L'objectif de cette thèse est d'une part l'étude de la stabilité des équilibres de certains modèles épidémiologiques et d'autre part la construction d'un observateur pour l'estimation des états non mesurés et d'un paramètre clé pour un modèle intra-hôte. Nous proposons des extensions des modèles du type SIR, SIRS et SIS et nous étudions la stabilité globales de leur équilibres. En présence de plusieurs souches de pathogène d'un modèle SIS, on montre que le principe de compétition exclusive est vérifié: la souche qui maximise un seuil remporte la compétition en éliminant les autres souches. Il se trouve aussi que la souche gagnante est celle qui donne à l'équilibre le minimum de population hôte susceptible. Ceci peut être interprété comme étant un principe de pessimisation. En considérant ce modèle avec cette fois une loi de contact de type fréquence-dépendante, on montre que la dynamique change et qu'un équilibre de coexistence existe et qui est globalement asymptotiquement stable sous certaines conditions. Le comportement asymptotique des deux équilibres frontières est aussi prouvé. L'étude de la stabilité des états d'équilibres est essentiellement faite par la construction des fonctions de Lyapunov combiné avec le principe d'invariance de LaSalle. On considère un modèle intra-hôte structuré en classe d'âge du parasite Plasmodium falciparum avec une force d'infection général. Nous développons une méthode d'estimation de la charge parasitaire totale dont on ne sait mesurée par les méthodes actuellement connues. Pour cela nous utilisons les outils de la théorie du contrôle, plus particulièrement les observateurs à entrées inconnues, pour estimer les états non mesurés à partir des états mesurés (données). De cela nous déduisons une méthode d'estimation d'un paramètre inconnu qui représente le taux d'infection des globules rouges saines par les parasites / The purpose of this thesis is on the one hand to study stability of equilibria of some epidemic models and secondly to construct an observer to estimate the non-measured states and a key parameter in a within host model. We propose extensions of classical models SIR, SIRS and SIS and we study the global stability of their equilibria. In presence of multiple pathogen strains, we proved that competitive exclusion principle holds: the strain having the largest threshold wins the competition by eliminating the others. It turns out that the winning strain is the one for which the equilibrium gives the minimum of the susceptible host population. This can be interpreted as pessimization principle. By considering the same model with two strains and a frequency-dependent type of the contact law, we prove that dynamics changes and a coexistence equilibrium exists and it is globally asymptotically stable under some conditions. The asymptotic behavior of the two other boundary equilibria is also established. The stability study of equilibrium states is mainly done by construction Lyapunov functions combined with LaSalle's invariance principle. We consider an age-structured within-host model of the Plasmodium falciuparum parasite with a general infection force. We develop a method to estimate the total parasite burden that cannot be measured by the current methods. To this end, we use some tools from control theory, more precisely observers with unknown inputs, to estimate the non measured states from the measured ones (data). From this, we deduce a method to estimate an unknown parameter that represents infection rate of healthy reed blood cells by the parasites

Submitted by JACIARA CRISTINA ALMEIDA DO AMARAL (jaciaramaral@ufpa.br) on 2018-06-25T17:31:15Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) / Approved for entry into archive by JACIARA CRISTINA ALMEIDA DO AMARAL (jaciaramaral@ufpa.br) on 2018-06-25T17:31:41Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) / Made available in DSpace on 2018-06-25T17:31:41Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) Previous issue date: 2018-05-17 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / FAPESPA - Fundação Amazônia de Amparo a Estudos e Pesquisas / A malária cerebral (MC) é uma das complicações mais severas atribuídas à infecção pelo protozoário Plasmodium falciparum, ganhando destaque nas taxas de mortalidade infantil em áreas endêmicas. Esta enfermidade apresenta uma patogênese complexa e ainda pouco elucidada, estando associada a alterações cognitivas, comportamentais e motoras. Visando ampliar os conhecimentos a respeito desta patologia e procurando os benefícios atribuídos ao consumo diário de antioxidantes, o principal objetivo deste trabalho é avaliar o possível efeito protetor do fruto da Euterpe oleracea (açaí) durante a evolução do quadro de malária cerebral experimental (MCE) induzida em modelo murino por meio da inoculação da cepa ANKA de Plasmodium berghei (PbA). Para tal, utilizaram-se camungondos da linhagem albino suíço, os quais foram inoculados intraperitonealmente (i.p.) com 10⁶ de eritrócitos parasitados. Os animais (fêmeas e machos entre 4 a 6 semanas) foram divididos em quatro grupos, dentre os quais os grupos Açaí e PbA+Açaí foram mantidos com uma dieta exclusiva com ração enriquecida com açaí, e aos grupos Controle e PbA foram proporcionadas somente ração padrão durante os 22 dias de experimento. Para caracterização do quadro de MCE foram avaliados diversos parâmetros como o surgimento dos sinais clínicos, curva de sobrevivência, parasitemia (%), ganho de massa corpórea e permeabilidade vascular. Para avaliação das alterações comportamentais e locomotoras dos animais foi utilizado o protocolo SHIRPA. Observamos prolongamento de sobrevida dos animais infectados e tratados com dieta enriquecida com açaí, além de diminuição das alterações neurológicas decorrentes da exposição do parênquima cerebral. Este trabalho nos permitiu validar o desenvovimento do quadro de malária cerebral experimental (MCE) em modelo murino e avaliar o efeito neuroprotetor do açaí (Euterpe oleracea) no decorrer da doença. / Cerebral malaria (CM) is one of the most severe complications attributed to protozoal infection by Plasmodium falciparum, gaining prominence in infant mortality rates in endemic areas. It´s a complex pathogenesis and still little elucidated, being associated with cognitive, behavioral and motor changes. Aiming to broaden the knowledge about this pathology and looking for the benefits attributed to the daily consumption of antioxidants, the objective of this work is to evaluate the possible protective effect of Euterpe oleracea fruit (açaí) during evolution of experimental cerebral malaria (ECM) induced in murine model by means of inoculation of Plasmodium berghei (PbA), ANKA stain. For this, we used the Swiss line, which were inoculated intraperitoneally (i.p.) with 10⁶ of parasited erythrocytes. The animals (females and males between 4 and 6 weeks) were divided into four groups, among which Açaí and PbA+Açaí groups were maintained on a ration-exclusive diet enriched with açaí and the Control and PbA groups were given only standard ration during 22 days of experiment. To characterize the ECM framework, several parameters were evaluated such as the appearence of clinical signs, survival curve, parasitemia, body mass gain and vascular permeability. The SHIRPA protocol was used to evaluate the behavioral and locomotor changes in animals. We observed an extension of survival of the infected animals and treated with a diet enriched with acai berry, and decreased the neurological changes arising from the exposure of the cerebral parenchyma. This work allowed us to validate the development of the experimental brain malaria framework in murine model and evaluate the neuroprotective effect of Acai (Euterpe oleracea) in the course of the disease.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-03-15T21:45:45Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoDoseAdequada.pdf: 56337427 bytes, checksum: d66ac37cc5f1fd1fae3a15f78c189a48 (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-03-18T13:42:37Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoDoseAdequada.pdf: 56337427 bytes, checksum: d66ac37cc5f1fd1fae3a15f78c189a48 (MD5) / Made available in DSpace on 2013-03-18T13:42:37Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_EstudoDoseAdequada.pdf: 56337427 bytes, checksum: d66ac37cc5f1fd1fae3a15f78c189a48 (MD5) Previous issue date: 1997 / FUNASA/PA - Fundação Nacional de Saúde / A resistência crescente do P. falciparum aos antimaláricos habitualmente empregados, torna urgente a avaliação de novas drogas. O Ro 42-1611 é um antimalárico derivado da planta chinesa Arlabotrys uncinatus. Usado apenas na África em três trabalhos no tratamento da malária por P. falciparum, tem sua ação desconhecida em sul-americanos com esta doença. Apesar do efeito antimalárico ter sido comprovado, ainda não se encontrou a dose adequada para o tratamento supressivo do P. falciparum. Avaliar a tolerância, a toxicidade e a eficácia de três diferentes doses do Ro 42-1611 no tratamento da malária por P. falciparum é o que objetiva este trabalho. O estudo foi realizado em Marabá-Pará, caracterizando-se por ser aberto, prospectivo e randomizado; incluiu pacientes voluntário s, adultos, masculinos, de peso corporal até 80 kg; febris ou com outros sintomas constitucionais de malária e com gota espessa positiva para P. falciparum ( ≥ 200 e ≤ 50.000 parasitas/mm³ de sangue). Grupos de estudo: I -1.500 mg de 12/12 horas por 1 dia; II -1.500 mg de 12/12 horas por2 dias e III -1.500 mg de 12/12 horas por 3 dias. Todos os pacientes foram tratados em regime hospitalar, sendo avaliados no pré-tratamento através de: dados pessoais e biométricos, sinais e sintomas, uso de medicação concomitante, temperatura axilar, freqüência respiratória, pressão arterial, eletrocardiograma, parasitemia, exames hematológicos e bioquímicos. A partir do início da terapêutica, a avaliação destes parâmetros foi feita seguindo protocolo próprio, incluindo a anotação de efeitos colaterais. A análise de variância de Friedman foi usada para avaliar os valores obtidos nos exames hematológicos e bioquímicos. Foram selecionados 16 pacientes, sendo 5 alocados no grupo I, 6 no II e 5 no III. Idade variou de 17 a 41 anos (média: 26,6), peso corporal de 44 a 72 kg (média: 54,9), parasitemia assexuada inicial de 200 a 40.000 formas/mm³ de sangue, sendo os grupos homogêneos quanto a estas variáveis. A febre desapareceu no mínimo com 9 e no máximo com 48 horas a partir do início da terapêutica. A avaliação do traçado eletrocardiográfico e da pressão arterial não mostrou alterações significativas. O desaparecimento da parasitemia assexuada ocorreu em média com 53,6 horas, não se evidenciando diferenças estatísticas i significantes entre os grupos (p=0,7264). Houve uma diminuição significativa entre o pré-tratamento (D0) e o terceiro (D2) e oitavo (D7) dias de acompanhamento quanto os níveis de hematócrito (p=0,0046), um aumento no número de leucócitos entre D2 e D7 (p=0,0171) e plaquetas entre D0 e D7, assim como entre D2 e D7 (p< 0,0001). Entre D0 e D7 detectou-se diminuição nos níveis de bilirrubina total (p=0,0024), fosfatase alcalina (p=0,0195) e uréia (p=0,0168). Efeitos colaterais foram em geral leves ou moderados e de curta duração. Do total de pacientes, 87,5% obtiveram desaparecimento da parasitemia assexuada, porém apenas 2 (12,5%) curaram, ambos incluídos no grupo III. Nenhum dos esquemas posológicos usados foi adequado para a cura desta doença. Talvez em estudos posteriores usando a droga em maior dose ou por maior número de dias ou ainda associando-a a outros antimaláricos, possa obter-se eficácia adequada. / The increasing resistance of P. falciparum strains to the current antimalarial drugs makes the searching of new drugs an urgent task. The compound Ro 42-1611 is an antimalarial drug that arises from a chinese herb Artabotrys uncinatus. Since its synthesis, Ro 42-1611 was used in three different clinical trials to treat falciparum malaria in Africa, but how it works in the South America malaria patients is obscure. Althouh being an effective antimalarial, a proper therapeutic dose to achieve the supressive cure of falciparum malaria has not been established yet. The purpose of this study is to evaluate the tolerance, the toxicity and the efficacy of 3 different dose schedules of Ro 42-1611 in the treatment of falciparum malaria. It was an open, prospective and randomized trial carried out in Maraba/Para State in male patients with maximum 80 kg bodyweight. All patients had fever or another constitutional malaria symptom and had a positive thick blood smear to P. falciparum (≥ 200 and ≤ 50,000 parasites/mm³). In a hospital, they were assigned into 3 groups according to drug administration time: Group I - 1,500 mg twice a day for 24 hours; Group II - 1,500 mg twice a day for 48 hours and Group III - 1,500 mg twice a day for 72 hours. Before treatment, the following procedures were recorded from all patients: personal data, height and weight, malarial signs and symptoms, history of simultaneous drug intake, body temperature, vital functions (respiratory rate, blood pressure), parasite count, haematology and blood chemistry assesments and electrocardiogram. Ouring the treatment, all those parameters were followed, including adverse reactions to Ro 42-1611. Statistical analysis (Friedman variance test) were performed on laboratory tests results. Sixteen patients were enrolled in the study: 5 patients in Group I; 6 in Group II and 5 patients in Group III. Among patients, age ranged from 17 to 41 years old (mean 266). body weight from 44 to 72 kg (mean 54.9). The assexual parasite count ranged from 200 to 40,000 parasites/mm³ . Regarding those variables, there were homogeneity in 3 groups. According to the protocol, clinical and laboratory data were evaluated, with the following results: the minimum and the maximum fever clearence time was 9 to 48 hours respectively. The mean assexual parasite clearence was 53.6 hours, without any statistical significance among the groups (p=0.7264). There were statistical significative difference (p=0.0046) in the hematocrit values before treatment (00), and the third (02) and the eighth (07) day of the follow-up. It was observed an increase in the leukocyte count between 02 and 07, also of statistical significance (p=0.0171), as well in the platelets of 00 and 07/02 and 07 (p=0.0001). Between DO and 07, statistical significative reduction ocurred in the values of total bilirrubin (p=0.0024), alkaline phosphatase (p=0.0195) and urea (p=0.0168). There were no statistical significative difference nor in the evalution of electrocardiogram results neither in the blood pressure. Short adverse reactions were mild to moderate. In the end of the treatment, 87,5% of patients were completely free of parasites, but just 2 achieved a radical cure (12,5%), both included in Group III. Any of the schedule treatment showed efficacy. Perhaps such efficacy might be attained using Ro 42-1611 in a superior dose, for a longer period of time or in association with other antimalarial in further studies.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-04-18T19:48:19Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_CorrelacaoConcentracoesSerica.pdf: 660562 bytes, checksum: 34550c76626622dc26d807aa54719832 (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-04-22T15:00:59Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_CorrelacaoConcentracoesSerica.pdf: 660562 bytes, checksum: 34550c76626622dc26d807aa54719832 (MD5) / Made available in DSpace on 2013-04-22T15:00:59Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_CorrelacaoConcentracoesSerica.pdf: 660562 bytes, checksum: 34550c76626622dc26d807aa54719832 (MD5) Previous issue date: 2007 / A correlação entre as concentrações séricas e eritrocitárias de quinina foi estudada em crianças e indivíduos adultos com malária por Plasmodium falciparum não complicada no Município de Cachoeira do Piriá, Estado do Pará. Os pacientes receberam esquema terapêutico oral de quinina (3 dias) + Doxiciclina (5 dias) + primaquina (6º dia). As concentrações de quinina nas amostras de soro e eritrócitos foram mensuradas por Cromatografia Líquida de Alta Eficiência no terceiro dia de tratamento. A concentração média de quinina no soro de crianças com malária falciparum não complicada foi de 0,723 ± 0,6 μg/mL, e a eritrocitária de 0,537 ± 0,38 μg/mL. A relação entre as concentrações séricas e eritrocitária de quinina no soro de crianças foi de 1,89 ± 1,25 μg/mL, não houve diferença estatisticamente significativa entre estas concentrações. A média da concentração sérica de indivíduos adultos foi de 1,27 ± 1,12 μg/mL, e a eritrocitária de 0,63 ± 0,48 μg/mL. A relação entre essas concentrações foi de 2,27 ± 1,06 μg/mL. Os resultados mostraram que não houve diferença estatística significativa entre as médias da relação dos teores de quinina no soro e nos eritrócitos das crianças e dos indivíduos adultos. / The correlation between the serum and red blood cells concentrations of quinine was studied in children and adults with falciparum malaria uncomplicated in Cachoeira of the Piriá, in the State of Pará. The patients had received the oral scheme of quinine (3 days) + doxycyclina (5 days) + primaquine (6º day). Quinine concentration in the serum and the red blood cells samples was measured by High Performance Liquid Chromatography in the third day of treatment. The average of the serum concentration of the quinine in children with uncomplicated falciparum malaria was of 0,723 ± 0,6 μg/mL, and 0,537 ± 0,38 μg/mL for the red blood cells. And the relationship between the serum and red blood cells concentration was 1,89 ± 1,25 μg/mL, had not difference statistical significant between those concentrations. The average of the serum concentration of adult individuals was of 1,27 ± 1,12 μg/mL, and 0,63 ± 0,48 μg/mL for the red blood cells. The relationship between those concentration was of 2,27 ± 1,06 μg/mL. The results had shown that it did not have significant statistical difference between the averages of the relation of quinine levels in the serum and the red blood cells of the children and the adults.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-05-20T22:18:00Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 647101 bytes, checksum: 9ac4ae0c678d90b0ac188167bf3d7edb (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-05-22T14:33:17Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 647101 bytes, checksum: 9ac4ae0c678d90b0ac188167bf3d7edb (MD5) / Made available in DSpace on 2013-05-22T14:33:17Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 647101 bytes, checksum: 9ac4ae0c678d90b0ac188167bf3d7edb (MD5) Previous issue date: 2010 / Dentre os principais desafios para o controle da malária no Brasil e no mundo, o advento da resistência do plasmódio, em especial do Plasmodium falciparum, se apresenta como o de maior relevância. A mefloquina é o fármaco de primeira linha para o tratamento da malária falciparum, e a disponibilidade de métodos sensíveis e baixo custo para monitorização das concentrações sanguíneas do fármaco e da carboximefloquina auxilia na otimização dos esquemas terapêuticos. Neste sentido, foi validada metodologia analítica, de acordo com parâmetros sugeridos pelos órgãos regulamentadores oficiais, para determinação de mefloquina e seu derivado carboxilado em amostra de sangue total adsorvida em papel de filtro. Foi empregado cromatografia líquida de alta eficiência após extração líquido-líquido dos analitos de interesse. A detecção foi realizada em λ = 222nm. Não foi observada interferência de outros antimaláricos comumente utilizados. O método foi linear em intervalo de concentração de 0,25 a 2,5 μg/mL, para mefloquina e seu derivado carboxilado. O limite de detecção foi de 35 ng/mL e do de quantificação de. 70 ng/mL, para mefloquina e carboximefloquina, respectivamente. A precisão intra ensaio média foi 31±4 % para mefloquina e de 21±5 % para carboximefloquina. A precisão inter ensaio média foi de e 38±4% para mefloquina e de 25±7% para carboximefloquina. A recuperação média para concentrações de mefloquina variando de 0,25 a 2,5 μg/mL foi de 83± 14%, e de carboximefloquina nas concentrações de 0,375 a 3740 μg/mL foi de 88±11%. O fármaco foi estável nas amostras adsorvidas em papel de filtro pelo período de um mês. O método foi robusto para pequenas variações de pH da fase móvel. Para avaliar a aplicabilidade do método foi realizada determinação dos analítos em amostras de sangue adsorvidas em papel de filtro de pacientes com malária falciparum. A concentração média de mefloquina foi de 0,861±0,723 μg/mL e de carboximefloquina de 0,472±0,086 μg/mL. Os parâmetros de validação da metodologia analítica seguem as recomendações propostas pelos órgãos oficiais sendo o método adequado para determinação de mefloquina e carboximefloquina em amostras de sangue total adsorvidas em papel de filtro. / Among the main challenges for malaria control in Brazil and in the world, the advent of resistance to the Plasmodium, particularly Plasmodium falciparum, is presented as the most relevant. Mefloquine is a drug of first line for the treatment of falciparum malaria, and the availability of sensitive methods and low cost for monitoring of blood concentrations of the drug and carboxymefloquine assists in the optimization of drug regimens. In this sense, analytical methodology was validated in accordance with the parameters suggested by official regulatory agency for determination of mefloquine and its carboxylated derivative on the whole blood sample adsorbed on filter paper. The method was employed using High Performance Liquid Chromatography after liquid-liquid extraction of the analytes. The detection was performed at 222nm. No interference was observed in other antimalarials commonly used. The method was linear in concentration range from 0.25 to 2.5 μg/mL for mefloquine and its carboxylated derivative. The detection and quantification limits were 35 ng/mL and 70 ng/mL for mefloquine and carboxymefloquine, respectively. The average intra assay precision was 31±4% for mefloquine and 21±5% for carboxymefloquine. The average inter assay precision was 38±4% for mefloquine and 25±7% for carboxymefloquine. The average of recovery for concentrations of mefloquine ranging from 0.25 to 2.5μg/mL was 83±14% and carboxymefloquine varying from 0.375 to 3740 μg/mL was 88±11%. The drug was stable in samples adsorbed on filter paper for a period of a month. . The method showed to be robust for small changes on pH of the mobile phase. To evaluate the applicability of the method was performed determination of analytes in blood samples adsorbed on filter paper from patients with falciparum malaria. The average concentration of mefloquine was 0.861±0.723 μg/mL and carboxymefloquine 0.472±0.086 μg/mL. The validation parameters of the analytical methodology followed the recommendations proposed by the official agencies and the method showed to be appropriate for determination of mefloquine and carboxymefloquine in whole blood samples adsorbed on filter paper.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-05-20T22:18:44Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 1357135 bytes, checksum: 0ddefd417c885b4db3c7d39d75f34b15 (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-05-27T12:30:07Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 1357135 bytes, checksum: 0ddefd417c885b4db3c7d39d75f34b15 (MD5) / Made available in DSpace on 2013-05-27T12:30:07Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_ValidacaoMetodologiaAnalitica.pdf: 1357135 bytes, checksum: 0ddefd417c885b4db3c7d39d75f34b15 (MD5) Previous issue date: 2010 / FAPESPA - Fundação Amazônia de Amparo a Estudos e Pesquisas / Dentre as ferramentas para alcançar o tratamento ótimo para a malária, se destaca a monitorização das concentrações dos antimaláricos nos fluídos biológicos. Ao se considerar que o Coartem® é empregado na terapia de primeira linha para o tratamento da malária falciparum, justifica-se a realização deste estudo que objetivou validar metodologia analítica para determinação de lumefantrina em amostras de sangue total, adsorvidas em papel de filtro, e em plasma, por cromatografia líquida de alta eficiência (CLAE), em pacientes com malária por Plasmodium falciparum não complicada, empregando-se extração líquido-líquido. Foram realizados estudos de seletividade, linearidade, curva de calibração, limites de detecção e quantificação, recuperação, precisão intra e inter-ensaio, estabilidade e robustez. As amostras, para o estudo de aplicabilidade do método proposto, foram coletadas de pacientes com malária falciparum utilizando Coartem® (arteméter-20mg + lumefantrina- 120mg) no D3. As condições cromatográficas otimizadas foram: comprimento de onda de 335nm, fluxo 1,2mL/min. e fase móvel composta por acetonitrila-água (60:40, v/v) pH=3,5. A extração líquido-líquido demonstrou ser eficiente, pois a recuperação média foi de 101,3% para plasma e 84,3% para sangue total. O método foi seletivo e linear em intervalo de concentração de 160 a 1760ng/mL. Os limites de detecção e de quantificação foram 32ng/mL e 160ng/mL. O coeficiente de variação médio intra-ensaio, do plasma e sangue total, respectivamente, foram 10,88 e 8,38% e inter-ensaio de 13,21 e 11,78%. O analito demonstrou ser estável em sangue total adsorvido em papel de filtro por até 70 dias. Modificações no pH, fluxo e composição da fase móvel não alteraram significativamente a resolução do analito de interesse, sugerindo uma robustez adequada. O método demonstrou ser eficaz na quantificação de lumefantrina em amostras de sangue total de pacientes com malária falciparum bem como os parâmetros de validação estão de acordo com as recomendações dos órgãos regulamentadores no Brasil. / Among the tools to achieve the optimal treatment for malaria, it highlights the concentration monitoring of antimalarials in biological fluids. Considering that Coartem ® is used in first-line therapy for treatment of falciparum malaria, it is appropriate that this study aims to validate an analytical methodology for determination of lumefantrine in whole blood samples, adsorbed on filter paper, and in plasma by high performance liquid chromatography (HPLC) in patients with falciparum malaria uncomplicated, using liquid-liquid extraction. Were carried out studies of selectivity, linearity, calibration curve, limits of detection and quantification, recovery, intra and inter assay precision, stability and robustness. The samples for study of applicability of the proposed method, were collected from patients with falciparum malaria using Coartem ® (artemether-20mg + lumefantrine-120mg) on D3. The optimized chromatographic conditions were: wavelength 335nm, flow 1.2 mL / min. and a mobile phase consisting of acetonitrile-water (60:40, v / v) pH = 3,5. The liquid-liquid extraction can be efficient, because the average recovery was 101.3% for plasma and 84.3% for whole blood. The method was selective and linear in the concentration range of 160 to 1760ng/mL. The limits of detection and quantitation was 32ng/mL and 160ng/mL. The average coefficient of variation intra assay, plasma and whole blood, respectively, were 10.88 and 8.38% and inter assay of 13.21 and 11.78%. The compound proved to be stable in whole blood absorbed onto filter paper for 70 days. Modification of pH, flow and mobile phase composition did not significantly alter the resolution of the analytes, suggesting an adequate strength. The method proved effective in quantifying lumefantrine in whole blood samples from patients with falciparum malaria and the validation parameters are consistent with the recommendations of regulatory agencies in Brazil.

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-02-13T12:58:00Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao_SusceptibilidadeExperimentalAnopheles.pdf: 428229 bytes, checksum: abd7aec5037cb5ccb35ee10d8bd4e6ee (MD5) / Approved for entry into archive by Ana Rosa Silva (arosa@ufpa.br) on 2014-04-22T17:03:57Z (GMT) No. of bitstreams: 2 Dissertacao_SusceptibilidadeExperimentalAnopheles.pdf: 428229 bytes, checksum: abd7aec5037cb5ccb35ee10d8bd4e6ee (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-04-22T17:03:58Z (GMT). No. of bitstreams: 2 Dissertacao_SusceptibilidadeExperimentalAnopheles.pdf: 428229 bytes, checksum: abd7aec5037cb5ccb35ee10d8bd4e6ee (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2006 / A importância do An. nuneztovari como vetor primário de malária já foi comprovado em países da América do Sul como Venezuela, Colômbia e Peru. Na Amazônia brasileira, embora tenha sido encontrado naturalmente infectado com Plasmodium vivax e P. falciparum e em alta densidade, é ainda considerado vetor secundário desta doença. O objetivo deste presente trabalho foi avaliar a susceptibilidade do An. nuneztovari à infecção por plasmódios humanos. Para isso exemplares da geração F1, obtida em laboratório, de An. nuneztovari e An. darlingi (espécie controle) foram alimentados, em alimentador artificial, com sangue de pacientes com diagnóstico inicial de malária causada por P. falciparum, cuja revisão resultou no diagnóstico de infecção mista. Todas as amostras sangüíneas dos pacientes infectaram espécimes das duas espécies, não mostrando diferença significativa entre elas quanto à susceptibilidade. Para detecção de infecção malárica nos mosquitos foi usado o teste ELISA (Enzime – Linked Imunosorbent Assay) cujos resultados foram discordantes do diagnóstico laboratorial, já que o teste detectou infecções pelo P. falciparum, P. vivax VK210 ou P. vivax VK247entre os mosquitos positivos sugerindo que os pacientes apresentavam infecção mista. Também foi observado o curto período de desenvolvimento de oocistos e esporozoítos, de quatro a cinco dias, o que pode ser explicado pela alta temperatura (>30°C) que os mosquitos foram expostos. Assim nossos resultados sugerem possível envolvimento do An nuneztovari na transmissão de malária humana na área estudada e alertam para o papel deste, como possível vetor principal de malária humana na região amazônica brasileira. / The importance of the An. nuneztovari as malaria primary vector had already been confirmed in different South America countries such as Venezuela, Colombia and Peru. In the Brazilian Amazonian, although this specie had been found naturally infected by Plasmodium vivax and P. falciparum and in high densities, it is considered a secondary vector of this disease. The aim of this study was to evaluate the susceptibility of the An. nuneztovari to the infection by human Plasmodium species. For that, mosquitoes specimens of F1 progeny, obtained under laboratory conditions, of the An. nuneztovari and An. darlingi (control) were fed on an artificial feeding apparatus, using human blood that had been found carrying the malaria parasite, P. falciparum, whose revision had resulted as mixed infection. All blood samples from patients had infected specimens of both mosquitoes species tested, and no significant statistical difference was found related to the susceptibility. For the detection malaria infection in mosquitoes specimens it was conducted the ELISA (Enzime – Linked Imunosorbent Assay) test, whose results were divergent from the diagnostic one, since it has identified mosquitoes specimens infected by P. falciparum, P. vivax VK210 and/or P. vivax VK247, which suggests that the donors patients had mixed infection. It was also observed the short period of development of the oocysts and sporozoites, from four to five days, fact that can be explained by the high temperature (>300C) that the mosquitoes were exposed. Thus, our results suggest the probable enrollment of the An. nuneztovari in the human malaria transmission in the study area and point out the role of this mosquito specie as human malaria primary vector in the Brazilian Amazon region.