Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Identifieur interne : 000778 ( Main/Exploration ); précédent : 000777; suivant : 000779Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria
Auteurs : Philip E. Thuma [États-Unis] ; George F. Mabeza [Zambie] ; Godfrey Biemba [Zambie] ; G. J. Bhat [Zambie] ; Christine E. Mclaren [États-Unis] ; Victor M. Moyo [États-Unis] ; Stenford Zulu [Zambie] ; Hlosukwazi Khumalo [Zambie] ; Patricia Mabeza [Zambie] ; Abraham M'Hango [Zambie] ; Dean Parry [Zambie] ; Anton A. Poltera [Suisse] ; Gary M. Brittenham [États-Unis] ; Victor R. Gordeuk [États-Unis]Source :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 1998.
English descriptors
- KwdEn :
- 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:
- https://api.istex.fr/document/BE8CFEB01839FCBE1CF37DED1AE54C86CACC6E06/fulltext/pdf
- https://api.istex.fr/document/FD61516A26CD648CAAA807941E856DE36A81237A/fulltext/pdf
DOI: 10.1016/S0035-9203(98)90753-2
Affiliations:
- Suisse, Zambie, États-Unis
- Canton de Berne, District de Columbia, Minnesota, Ohio, Pennsylvanie
- Berne, University Park (Pennsylvanie)
- Université d'État de Pennsylvanie
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Gordeuk</name><affiliation></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>The George Washington University Medical Center, Washington, DC</wicri:regionArea><placeName><region type="state">District de Columbia</region></placeName></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="KwdEn" xml:lang="en"><term>chemotherapy</term><term>deferoxamine</term><term>iron chelation</term><term>malaria</term><term>quinine</term></keywords><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><affiliations><list><country><li>Suisse</li><li>Zambie</li><li>États-Unis</li></country><region><li>Canton de Berne</li><li>District de Columbia</li><li>Minnesota</li><li>Ohio</li><li>Pennsylvanie</li></region><settlement><li>Berne</li><li>University Park (Pennsylvanie)</li></settlement><orgName><li>Université d'État de Pennsylvanie</li></orgName></list><tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Thuma, Philip E" sort="Thuma, Philip E" uniqKey="Thuma P" first="Philip E." last="Thuma">Philip E. Thuma</name></region><name sortKey="Brittenham, Gary M" sort="Brittenham, Gary M" uniqKey="Brittenham G" first="Gary M." last="Brittenham">Gary M. Brittenham</name><name sortKey="Gordeuk, Victor R" sort="Gordeuk, Victor R" uniqKey="Gordeuk V" first="Victor R." last="Gordeuk">Victor R. Gordeuk</name><name sortKey="Mclaren, Christine E" sort="Mclaren, Christine E" uniqKey="Mclaren C" first="Christine E." last="Mclaren">Christine E. Mclaren</name><name sortKey="Moyo, Victor M" sort="Moyo, Victor M" uniqKey="Moyo V" first="Victor M." last="Moyo">Victor M. Moyo</name></country><country name="Zambie"><noRegion><name sortKey="Mabeza, George F" sort="Mabeza, George F" uniqKey="Mabeza G" first="George F." last="Mabeza">George F. Mabeza</name></noRegion><name sortKey="Bhat, G J" sort="Bhat, G J" uniqKey="Bhat G" first="G. J." last="Bhat">G. J. Bhat</name><name sortKey="Biemba, Godfrey" sort="Biemba, Godfrey" uniqKey="Biemba G" first="Godfrey" last="Biemba">Godfrey Biemba</name><name sortKey="Khumalo, Hlosukwazi" sort="Khumalo, Hlosukwazi" uniqKey="Khumalo H" first="Hlosukwazi" last="Khumalo">Hlosukwazi Khumalo</name><name sortKey="M Hango, Abraham" sort="M Hango, Abraham" uniqKey="M Hango A" first="Abraham" last="M'Hango">Abraham M'Hango</name><name sortKey="Mabeza, Patricia" sort="Mabeza, Patricia" uniqKey="Mabeza P" first="Patricia" last="Mabeza">Patricia Mabeza</name><name sortKey="Parry, Dean" sort="Parry, Dean" uniqKey="Parry D" first="Dean" last="Parry">Dean Parry</name><name sortKey="Zulu, Stenford" sort="Zulu, Stenford" uniqKey="Zulu S" first="Stenford" last="Zulu">Stenford Zulu</name></country><country name="Suisse"><region name="Canton de Berne"><name sortKey="Poltera, Anton A" sort="Poltera, Anton A" uniqKey="Poltera A" first="Anton A." last="Poltera">Anton A. Poltera</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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