Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Identifieur interne : 000681 ( Istex/Corpus ); précédent : 000680; suivant : 000682Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Auteurs : Philip E. Thuma ; George F. Mabeza ; Godfrey Biemba ; G. J. Bhat ; Christine E. Mclaren ; Victor M. Moyo ; Stenford Zulu ; Hlosukwazi Khumalo ; Patricia Mabeza ; Abraham M'Hango ; Dean Parry ; Anton A. Poltera ; Gary M. Brittenham ; Victor R. GordeukSource :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 1998.
English descriptors
- Teeft :
- American journal, Asexual forms, Beneficial effect, Blood cells, Blood glucose concentration, Body weight, Cerebral malaria, Chelation, Children deferoxamine placebo, Clearance, Clinical features, Clinical investigation, Coma, Coma resolution, Coma score, Comatose children, Confidence interval, Covariates, Data monitoring committee, Deep coma, Deferoxamine, Deferoxamine group, Entire data, Experimental therapy, Falciparum, Fever clearance, Fever clearance times, Free radicals, Full consciousness, George washington university, Glucose, Gordeuk, Higher mortality, Higher pulse rate, Hospital deferoxamine placebo, Initial loading dose, Iron chelation, Liver size, Loading dose, Logistic regression models, Lower mortality, Malaria, Median time, Odds ratio, Parasitaemia, Parasite, Parasite clearance, Pennsylvania state university, Peripheral blood, Placebo, Placebo group, Plasmodium falciparum parasitaemia, Platelet, Platelet count, Present study, Previous study, Quinine, Quinine loading dose, Rural hospital, Rural study site, Sample size, Separate analyses, Severe malaria, Significant difference, Spleen, Spleen size, Study site, Subsequent analyses, Transferrin saturation, Treatment effect, Treatment period, Tropical medicine, University teaching hospital, Urban hospital, Urban site, Vital signs, White blood cells, Zambia, Zambian children.
Abstract
Abstract: To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% ( 32 175) in the deferoxamine group and 10·7% ( 19 177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% ( 18 117) with deferoxamine compared to 12·7% ( 15 118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% ( 14 58) with deferoxamine and 6·8% ( 4 59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.
Url:
DOI: 10.1016/S0035-9203(98)90753-2
Links to Exploration step
ISTEX:BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06Le document en format XML
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Mabeza</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Biemba, Godfrey" sort="Biemba, Godfrey" uniqKey="Biemba G" first="Godfrey" last="Biemba">Godfrey Biemba</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Bhat, G J" sort="Bhat, G J" uniqKey="Bhat G" first="G. J." last="Bhat">G. J. Bhat</name><affiliation><mods:affiliation>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Mclaren, Christine E" sort="Mclaren, Christine E" uniqKey="Mclaren C" first="Christine E." last="Mclaren">Christine E. 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Moyo</name><affiliation><mods:affiliation>The George Washington University Medical Center, Washington, DC, USA</mods:affiliation></affiliation></author><author><name sortKey="Zulu, Stenford" sort="Zulu, Stenford" uniqKey="Zulu S" first="Stenford" last="Zulu">Stenford Zulu</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Khumalo, Hlosukwazi" sort="Khumalo, Hlosukwazi" uniqKey="Khumalo H" first="Hlosukwazi" last="Khumalo">Hlosukwazi Khumalo</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Mabeza, Patricia" sort="Mabeza, Patricia" uniqKey="Mabeza P" first="Patricia" last="Mabeza">Patricia Mabeza</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="M Hango, Abraham" sort="M Hango, Abraham" uniqKey="M Hango A" first="Abraham" last="M'Hango">Abraham M'Hango</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Parry, Dean" sort="Parry, Dean" uniqKey="Parry D" first="Dean" last="Parry">Dean Parry</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Poltera, Anton A" sort="Poltera, Anton A" uniqKey="Poltera A" first="Anton A." last="Poltera">Anton A. Poltera</name><affiliation><mods:affiliation>Swiss Serum and Vaccine Institute, Berne, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Brittenham, Gary M" sort="Brittenham, Gary M" uniqKey="Brittenham G" first="Gary M." last="Brittenham">Gary M. Brittenham</name><affiliation><mods:affiliation>Case Western Reserve University, Cleveland, Ohio, USA</mods:affiliation></affiliation></author><author><name sortKey="Gordeuk, Victor R" sort="Gordeuk, Victor R" uniqKey="Gordeuk V" first="Victor R." last="Gordeuk">Victor R. Gordeuk</name><affiliation><mods:affiliation>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</mods:affiliation></affiliation><affiliation><mods:affiliation>The George Washington University Medical Center, Washington, DC, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06</idno><date when="1998" year="1998">1998</date><idno type="doi">10.1016/S0035-9203(98)90753-2</idno><idno type="url">https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000681</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000681</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title><author><name sortKey="Thuma, Philip E" sort="Thuma, Philip E" uniqKey="Thuma P" first="Philip E." last="Thuma">Philip E. Thuma</name><affiliation><mods:affiliation>The Pennsylvania State University, Hershey Medical Center, Hershey, Pennsylvania, USA</mods:affiliation></affiliation></author><author><name sortKey="Mabeza, George F" sort="Mabeza, George F" uniqKey="Mabeza G" first="George F." last="Mabeza">George F. Mabeza</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Biemba, Godfrey" sort="Biemba, Godfrey" uniqKey="Biemba G" first="Godfrey" last="Biemba">Godfrey Biemba</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Bhat, G J" sort="Bhat, G J" uniqKey="Bhat G" first="G. J." last="Bhat">G. J. Bhat</name><affiliation><mods:affiliation>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Mclaren, Christine E" sort="Mclaren, Christine E" uniqKey="Mclaren C" first="Christine E." last="Mclaren">Christine E. Mclaren</name><affiliation><mods:affiliation>Moorhead State University, Moorhead, Minnesota, USA</mods:affiliation></affiliation></author><author><name sortKey="Moyo, Victor M" sort="Moyo, Victor M" uniqKey="Moyo V" first="Victor M." last="Moyo">Victor M. Moyo</name><affiliation><mods:affiliation>The George Washington University Medical Center, Washington, DC, USA</mods:affiliation></affiliation></author><author><name sortKey="Zulu, Stenford" sort="Zulu, Stenford" uniqKey="Zulu S" first="Stenford" last="Zulu">Stenford Zulu</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Khumalo, Hlosukwazi" sort="Khumalo, Hlosukwazi" uniqKey="Khumalo H" first="Hlosukwazi" last="Khumalo">Hlosukwazi Khumalo</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Mabeza, Patricia" sort="Mabeza, Patricia" uniqKey="Mabeza P" first="Patricia" last="Mabeza">Patricia Mabeza</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="M Hango, Abraham" sort="M Hango, Abraham" uniqKey="M Hango A" first="Abraham" last="M'Hango">Abraham M'Hango</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Parry, Dean" sort="Parry, Dean" uniqKey="Parry D" first="Dean" last="Parry">Dean Parry</name><affiliation><mods:affiliation>Macha Mission Hospital, Choma, Zambia</mods:affiliation></affiliation></author><author><name sortKey="Poltera, Anton A" sort="Poltera, Anton A" uniqKey="Poltera A" first="Anton A." last="Poltera">Anton A. Poltera</name><affiliation><mods:affiliation>Swiss Serum and Vaccine Institute, Berne, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Brittenham, Gary M" sort="Brittenham, Gary M" uniqKey="Brittenham G" first="Gary M." last="Brittenham">Gary M. Brittenham</name><affiliation><mods:affiliation>Case Western Reserve University, Cleveland, Ohio, USA</mods:affiliation></affiliation></author><author><name sortKey="Gordeuk, Victor R" sort="Gordeuk, Victor R" uniqKey="Gordeuk V" first="Victor R." last="Gordeuk">Victor R. Gordeuk</name><affiliation><mods:affiliation>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</mods:affiliation></affiliation><affiliation><mods:affiliation>The George Washington University Medical Center, Washington, DC, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">TRSTMH</title><idno type="ISSN">0035-9203</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998">1998</date><biblScope unit="volume">92</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="214">214</biblScope><biblScope unit="page" to="218">218</biblScope></imprint><idno type="ISSN">0035-9203</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0035-9203</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>American journal</term><term>Asexual forms</term><term>Beneficial effect</term><term>Blood cells</term><term>Blood glucose concentration</term><term>Body weight</term><term>Cerebral malaria</term><term>Chelation</term><term>Children deferoxamine placebo</term><term>Clearance</term><term>Clinical features</term><term>Clinical investigation</term><term>Coma</term><term>Coma resolution</term><term>Coma score</term><term>Comatose children</term><term>Confidence interval</term><term>Covariates</term><term>Data monitoring committee</term><term>Deep coma</term><term>Deferoxamine</term><term>Deferoxamine group</term><term>Entire data</term><term>Experimental therapy</term><term>Falciparum</term><term>Fever clearance</term><term>Fever clearance times</term><term>Free radicals</term><term>Full consciousness</term><term>George washington university</term><term>Glucose</term><term>Gordeuk</term><term>Higher mortality</term><term>Higher pulse rate</term><term>Hospital deferoxamine placebo</term><term>Initial loading dose</term><term>Iron chelation</term><term>Liver size</term><term>Loading dose</term><term>Logistic regression models</term><term>Lower mortality</term><term>Malaria</term><term>Median time</term><term>Odds ratio</term><term>Parasitaemia</term><term>Parasite</term><term>Parasite clearance</term><term>Pennsylvania state university</term><term>Peripheral blood</term><term>Placebo</term><term>Placebo group</term><term>Plasmodium falciparum parasitaemia</term><term>Platelet</term><term>Platelet count</term><term>Present study</term><term>Previous study</term><term>Quinine</term><term>Quinine loading dose</term><term>Rural hospital</term><term>Rural study site</term><term>Sample size</term><term>Separate analyses</term><term>Severe malaria</term><term>Significant difference</term><term>Spleen</term><term>Spleen size</term><term>Study site</term><term>Subsequent analyses</term><term>Transferrin saturation</term><term>Treatment effect</term><term>Treatment period</term><term>Tropical medicine</term><term>University teaching hospital</term><term>Urban hospital</term><term>Urban site</term><term>Vital signs</term><term>White blood cells</term><term>Zambia</term><term>Zambian children</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% ( 32 175) in the deferoxamine group and 10·7% ( 19 177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% ( 18 117) with deferoxamine compared to 12·7% ( 15 118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% ( 14 58) with deferoxamine and 6·8% ( 4 59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>deferoxamine</json:string><json:string>coma</json:string><json:string>placebo</json:string><json:string>study site</json:string><json:string>deferoxamine group</json:string><json:string>cerebral malaria</json:string><json:string>parasitaemia</json:string><json:string>quinine</json:string><json:string>placebo group</json:string><json:string>chelation</json:string><json:string>covariates</json:string><json:string>liver size</json:string><json:string>present study</json:string><json:string>gordeuk</json:string><json:string>malaria</json:string><json:string>zambia</json:string><json:string>glucose</json:string><json:string>iron chelation</json:string><json:string>platelet</json:string><json:string>spleen size</json:string><json:string>falciparum</json:string><json:string>fever clearance</json:string><json:string>parasite clearance</json:string><json:string>parasite</json:string><json:string>platelet count</json:string><json:string>loading dose</json:string><json:string>urban hospital</json:string><json:string>full consciousness</json:string><json:string>urban site</json:string><json:string>confidence interval</json:string><json:string>clearance</json:string><json:string>median time</json:string><json:string>clinical investigation</json:string><json:string>deep coma</json:string><json:string>lower mortality</json:string><json:string>rural hospital</json:string><json:string>separate analyses</json:string><json:string>experimental therapy</json:string><json:string>asexual forms</json:string><json:string>rural study site</json:string><json:string>body weight</json:string><json:string>severe malaria</json:string><json:string>tropical medicine</json:string><json:string>coma score</json:string><json:string>spleen</json:string><json:string>peripheral blood</json:string><json:string>vital signs</json:string><json:string>university teaching hospital</json:string><json:string>sample size</json:string><json:string>subsequent analyses</json:string><json:string>initial loading dose</json:string><json:string>free radicals</json:string><json:string>treatment period</json:string><json:string>white blood cells</json:string><json:string>transferrin saturation</json:string><json:string>logistic regression models</json:string><json:string>blood cells</json:string><json:string>treatment effect</json:string><json:string>data monitoring committee</json:string><json:string>clinical features</json:string><json:string>beneficial effect</json:string><json:string>blood glucose concentration</json:string><json:string>higher pulse rate</json:string><json:string>entire data</json:string><json:string>odds ratio</json:string><json:string>plasmodium falciparum parasitaemia</json:string><json:string>coma resolution</json:string><json:string>hospital deferoxamine placebo</json:string><json:string>children deferoxamine placebo</json:string><json:string>fever clearance times</json:string><json:string>comatose children</json:string><json:string>george washington university</json:string><json:string>significant difference</json:string><json:string>previous study</json:string><json:string>pennsylvania state university</json:string><json:string>quinine loading dose</json:string><json:string>zambian children</json:string><json:string>american journal</json:string><json:string>higher mortality</json:string></teeft></keywords><author><json:item><name>Philip E. Thuma</name><affiliations><json:string>The Pennsylvania State University, Hershey Medical Center, Hershey, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>George F. Mabeza</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Godfrey Biemba</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>G.J. Bhat</name><affiliations><json:string>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</json:string></affiliations></json:item><json:item><name>Christine E. McLaren</name><affiliations><json:string>Moorhead State University, Moorhead, Minnesota, USA</json:string></affiliations></json:item><json:item><name>Victor M. Moyo</name><affiliations><json:string>The George Washington University Medical Center, Washington, DC, USA</json:string></affiliations></json:item><json:item><name>Stenford Zulu</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Hlosukwazi Khumalo</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Patricia Mabeza</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Abraham M'Hango</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Dean Parry</name><affiliations><json:string>Macha Mission Hospital, Choma, Zambia</json:string></affiliations></json:item><json:item><name>Anton A. Poltera</name><affiliations><json:string>Swiss Serum and Vaccine Institute, Berne, Switzerland</json:string></affiliations></json:item><json:item><name>Gary M. Brittenham</name><affiliations><json:string>Case Western Reserve University, Cleveland, Ohio, USA</json:string></affiliations></json:item><json:item><name>Victor R. Gordeuk</name><affiliations><json:string>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</json:string><json:string>The George Washington University Medical Center, Washington, DC, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Chemotherapy and chemoprophylaxis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>malaria</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Plasmodium falciparum</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>chemotherapy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>iron chelation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deferoxamine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>quinine</value></json:item></subject><arkIstex>ark:/67375/6H6-FCS90HJ8-8</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age >6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% ( 32 175) in the deferoxamine group and 10·7% ( 19 177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% ( 18 117) with deferoxamine compared to 12·7% ( 15 118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% ( 14 58) with deferoxamine and 6·8% ( 4 59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</abstract><qualityIndicators><score>9.304</score><pdfWordCount>4472</pdfWordCount><pdfCharCount>28549</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>5</pdfPageCount><pdfPageSize>576 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>236</abstractWordCount><abstractCharCount>1442</abstractCharCount><keywordCount>7</keywordCount></qualityIndicators><title>Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title><pmid><json:string>9764337</json:string></pmid><pii><json:string>S0035-9203(98)90753-2</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Anonymous</title><language><json:string>unknown</json:string></language></serie><host><title>Transactions of the Royal Society of Tropical Medicine and Hygiene</title><language><json:string>unknown</json:string></language><publicationDate>1998</publicationDate><issn><json:string>0035-9203</json:string></issn><pii><json:string>S0035-9203(00)X0069-7</json:string></pii><volume>92</volume><issue>2</issue><pages><first>214</first><last>218</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1998</json:string></date><geogName></geogName><orgName><json:string>Ethical and Research Committee of the University of Zambia</json:string><json:string>Macha Mission Hospital, Choma, Zambia</json:string><json:string>The George Washington University</json:string><json:string>Moorhead State University</json:string><json:string>Jniversity Teaching Hospital, The University of Zambia, Lusaka, Zambia</json:string><json:string>Ciba-Geigy, Ltd, Basel, Switzerland</json:string><json:string>Hershey Medical Center</json:string><json:string>Boehringer-Mannheim Diagnostics</json:string><json:string>US National Institutes of Health International Collaboration for Infectious Disease Research</json:string><json:string>Division of Hematology</json:string><json:string>US Food and Drug</json:string><json:string>Western Reserve University</json:string><json:string>Committee on Human Investigation of the Hershey Medical Center, Pennsylvania State University</json:string><json:string>Department of Medicine, The George Washington University Medical Center, Suite</json:string><json:string>Medical Center, Washington</json:string><json:string>Vaccine Institute, Berne, Switzerland</json:string><json:string>Ciba-Geigy Ltd</json:string><json:string>Basel</json:string><json:string>Switzerland</json:string></orgName><orgName_funder><json:string>Ciba-Geigy Ltd</json:string><json:string>Basel</json:string><json:string>Switzerland</json:string></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Christine E. McLaren</json:string><json:string>Anton A. Poltera</json:string><json:string>Abraham M’Hang</json:string><json:string>Nancy F. Olivieri</json:string><json:string>Victor R. Gordeuk</json:string><json:string>R. Gordeuk</json:string><json:string>George F. Mabeza</json:string><json:string>Macha Hospital</json:string><json:string>G. J. Bhat</json:string><json:string>Except</json:string><json:string>Patricia Mabeza</json:string><json:string>Terrie E. Taylor</json:string><json:string>Dean Parry</json:string><json:string>Raymond Bergeron</json:string><json:string>Victor M. Moyo</json:string><json:string>David Wypij</json:string></persName><placeName><json:string>Washington</json:string><json:string>Lusaka</json:string><json:string>DC</json:string><json:string>Glasgow</json:string><json:string>Zambia</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>!iNONYMOUS, 1996</json:string><json:string>COX, 1972</json:string><json:string>WHO, 1974</json:string><json:string>AIKAWA, 1988</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-FCS90HJ8-8</json:string></ark><categories><wos><json:string>1 - social science</json:string><json:string>2 - public, environmental & occupational health</json:string><json:string>1 - science</json:string><json:string>2 - tropical medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - tropical medicine</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Infectious Diseases</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Public Health, Environmental and Occupational Health</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - General Medicine</json:string><json:string>1 - Life Sciences</json:string><json:string>2 - Immunology and Microbiology</json:string><json:string>3 - Parasitology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>1998</publicationDate><copyrightDate>1998</copyrightDate><doi><json:string>10.1016/S0035-9203(98)90753-2</json:string></doi><id>BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1998</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title><author xml:id="author-0000"><persName><forename type="first">Philip E.</forename><surname>Thuma</surname></persName><affiliation>The Pennsylvania State University, Hershey Medical Center, Hershey, Pennsylvania, USA</affiliation></author><author xml:id="author-0001"><persName><forename type="first">George F.</forename><surname>Mabeza</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Godfrey</forename><surname>Biemba</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0003"><persName><forename type="first">G.J.</forename><surname>Bhat</surname></persName><affiliation>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Christine E.</forename><surname>McLaren</surname></persName><affiliation>Moorhead State University, Moorhead, Minnesota, USA</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Victor M.</forename><surname>Moyo</surname></persName><affiliation>The George Washington University Medical Center, Washington, DC, USA</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Stenford</forename><surname>Zulu</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Hlosukwazi</forename><surname>Khumalo</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0008"><persName><forename type="first">Patricia</forename><surname>Mabeza</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0009"><persName><forename type="first">Abraham</forename><surname>M'Hango</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0010"><persName><forename type="first">Dean</forename><surname>Parry</surname></persName><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation></author><author xml:id="author-0011"><persName><forename type="first">Anton A.</forename><surname>Poltera</surname></persName><affiliation>Swiss Serum and Vaccine Institute, Berne, Switzerland</affiliation></author><author xml:id="author-0012"><persName><forename type="first">Gary M.</forename><surname>Brittenham</surname></persName><affiliation>Case Western Reserve University, Cleveland, Ohio, USA</affiliation></author><author xml:id="author-0013"><persName><forename type="first">Victor R.</forename><surname>Gordeuk</surname></persName><affiliation>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</affiliation><affiliation>The George Washington University Medical Center, Washington, DC, USA</affiliation></author><idno type="istex">BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06</idno><idno type="DOI">10.1016/S0035-9203(98)90753-2</idno><idno type="PII">S0035-9203(98)90753-2</idno></analytic><monogr><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">TRSTMH</title><idno type="pISSN">0035-9203</idno><idno type="PII">S0035-9203(00)X0069-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998"></date><biblScope unit="volume">92</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="214">214</biblScope><biblScope unit="page" to="218">218</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1998</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% ( 32 175) in the deferoxamine group and 10·7% ( 19 177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% ( 18 117) with deferoxamine compared to 12·7% ( 15 118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% ( 14 58) with deferoxamine and 6·8% ( 4 59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</p></abstract><textClass><keywords scheme="keyword"><list><head>article-category</head><item><term>Chemotherapy and chemoprophylaxis</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>malaria</term></item><item><term>Plasmodium falciparum</term></item><item><term>chemotherapy</term></item><item><term>iron chelation</term></item><item><term>deferoxamine</term></item><item><term>quinine</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1997-10-30">Modified</change><change when="1998">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>TRSTMH</jid><aid>98907532</aid><ce:pii>S0035-9203(98)90753-2</ce:pii><ce:doi>10.1016/S0035-9203(98)90753-2</ce:doi><ce:copyright type="unknown" year="1998"></ce:copyright><ce:doctopics><ce:doctopic><ce:text>Chemotherapy and chemoprophylaxis</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:title>Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</ce:title><ce:author-group><ce:author><ce:given-name>Philip E.</ce:given-name><ce:surname>Thuma</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>George F.</ce:given-name><ce:surname>Mabeza</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Godfrey</ce:given-name><ce:surname>Biemba</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>G.J.</ce:given-name><ce:surname>Bhat</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Christine E.</ce:given-name><ce:surname>McLaren</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>4</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Victor M.</ce:given-name><ce:surname>Moyo</ce:surname><ce:cross-ref refid="AFF7"><ce:sup>7</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Stenford</ce:given-name><ce:surname>Zulu</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Hlosukwazi</ce:given-name><ce:surname>Khumalo</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Patricia</ce:given-name><ce:surname>Mabeza</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Abraham</ce:given-name><ce:surname>M'Hango</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Dean</ce:given-name><ce:surname>Parry</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Anton A.</ce:given-name><ce:surname>Poltera</ce:surname><ce:cross-ref refid="AFF5"><ce:sup>5</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Gary M.</ce:given-name><ce:surname>Brittenham</ce:surname><ce:cross-ref refid="AFF6"><ce:sup>6</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Victor R.</ce:given-name><ce:surname>Gordeuk</ce:surname><ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF7"><ce:sup>7</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>1</ce:label><ce:textfn>The Pennsylvania State University, Hershey Medical Center, Hershey, Pennsylvania, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>2</ce:label><ce:textfn>Macha Mission Hospital, Choma, Zambia</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>3</ce:label><ce:textfn>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>4</ce:label><ce:textfn>Moorhead State University, Moorhead, Minnesota, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF5"><ce:label>5</ce:label><ce:textfn>Swiss Serum and Vaccine Institute, Berne, Switzerland</ce:textfn></ce:affiliation><ce:affiliation id="AFF6"><ce:label>6</ce:label><ce:textfn>Case Western Reserve University, Cleveland, Ohio, USA</ce:textfn></ce:affiliation><ce:affiliation id="AFF7"><ce:label>7</ce:label><ce:textfn>The George Washington University Medical Center, Washington, DC, USA</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="4" month="8" year="1997"></ce:date-received><ce:date-revised day="30" month="10" year="1997"></ce:date-revised><ce:date-accepted day="30" month="10" year="1997"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, <ce:italic>Plasmodium falciparum</ce:italic> parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% (<math altimg="si1.gif"><fr shape="sol"><nu>32</nu><de>175</de></fr></math>) in the deferoxamine group and 10·7% (<math altimg="si2.gif"><fr shape="sol"><nu>19</nu><de>177</de></fr></math>) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; <ce:italic>P</ce:italic> = 0·074). At the rural study site, mortality was 15·4% (<math altimg="si3.gif"><fr shape="sol"><nu>18</nu><de>117</de></fr></math>) with deferoxamine compared to 12·7% (<math altimg="si4.gif"><fr shape="sol"><nu>15</nu><de>118</de></fr></math>) with placebo (<ce:italic>P</ce:italic> = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% (<math altimg="si5.gif"><fr shape="sol"><nu>14</nu><de>58</de></fr></math>) with deferoxamine and 6·8% (<math altimg="si6.gif"><fr shape="sol"><nu>4</nu><de>59</de></fr></math>) with placebo (<ce:italic>P</ce:italic> = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; <ce:italic>P</ce:italic> = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>malaria</ce:text></ce:keyword><ce:keyword><ce:text><ce:italic>Plasmodium falciparum</ce:italic></ce:text></ce:keyword><ce:keyword><ce:text>chemotherapy</ce:text></ce:keyword><ce:keyword><ce:text>iron chelation</ce:text></ce:keyword><ce:keyword><ce:text>deferoxamine</ce:text></ce:keyword><ce:keyword><ce:text>quinine</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria</title></titleInfo><name type="personal"><namePart type="given">Philip E.</namePart><namePart type="family">Thuma</namePart><affiliation>The Pennsylvania State University, Hershey Medical Center, Hershey, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">George F.</namePart><namePart type="family">Mabeza</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Godfrey</namePart><namePart type="family">Biemba</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.J.</namePart><namePart type="family">Bhat</namePart><affiliation>University Teaching Hospital, The University of Zambia, Lusaka, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Christine E.</namePart><namePart type="family">McLaren</namePart><affiliation>Moorhead State University, Moorhead, Minnesota, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Victor M.</namePart><namePart type="family">Moyo</namePart><affiliation>The George Washington University Medical Center, Washington, DC, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stenford</namePart><namePart type="family">Zulu</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hlosukwazi</namePart><namePart type="family">Khumalo</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Patricia</namePart><namePart type="family">Mabeza</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Abraham</namePart><namePart type="family">M'Hango</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dean</namePart><namePart type="family">Parry</namePart><affiliation>Macha Mission Hospital, Choma, Zambia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anton A.</namePart><namePart type="family">Poltera</namePart><affiliation>Swiss Serum and Vaccine Institute, Berne, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gary M.</namePart><namePart type="family">Brittenham</namePart><affiliation>Case Western Reserve University, Cleveland, Ohio, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Victor R.</namePart><namePart type="family">Gordeuk</namePart><affiliation>Address for correspondence: Victor R. Gordeuk, MD, Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Suite 3-428, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA; phone +1 202 994 3556, fax +1 202 994 4524.</affiliation><affiliation>The George Washington University Medical Center, Washington, DC, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1998</dateIssued><dateModified encoding="w3cdtf">1997-10-30</dateModified><copyrightDate encoding="w3cdtf">1998</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age <6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18·3% ( 32 175) in the deferoxamine group and 10·7% ( 19 177) in the placebo group (adjusted odds ratio 1·8; 95% confidence interval 0·9–3·6; P = 0·074). At the rural study site, mortality was 15·4% ( 18 117) with deferoxamine compared to 12·7% ( 15 118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24·1% ( 14 58) with deferoxamine and 6·8% ( 4 59) with placebo (P = 0·061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1·2; 95% confidence interval 0·97–1·6; P = 0·089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.</abstract><subject><genre>article-category</genre><topic>Chemotherapy and chemoprophylaxis</topic></subject><subject><genre>Keywords</genre><topic>malaria</topic><topic>Plasmodium falciparum</topic><topic>chemotherapy</topic><topic>iron chelation</topic><topic>deferoxamine</topic><topic>quinine</topic></subject><relatedItem type="host"><titleInfo><title>Transactions of the Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>TRSTMH</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199803</dateIssued></originInfo><identifier type="ISSN">0035-9203</identifier><identifier type="PII">S0035-9203(00)X0069-7</identifier><part><date>199803</date><detail type="volume"><number>92</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue-pages"><start>129</start><end>240</end></extent><extent unit="pages"><start>214</start><end>218</end></extent></part></relatedItem><identifier type="istex">BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06</identifier><identifier type="ark">ark:/67375/6H6-FCS90HJ8-8</identifier><identifier type="DOI">10.1016/S0035-9203(98)90753-2</identifier><identifier type="PII">S0035-9203(98)90753-2</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/metadata/json</uri></json:item></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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