Hopes of at last controlling malaria in Africa could be dashed by the emergence of poor-quality and fraudulent anti-malarial medicines, warn experts. Unless urgent action is taken both within Africa and internationally, they argue, millions of lives could be put at risk. In a study published, an international team of researchers report that some cases of medicines on sale in Africa have been deliberately counterfeited by criminals or are of poor quality because of factory errors. Both types are not only potentially harmful to the patient but also risk promoting the emergence of drug resistance among the parasites that cause malaria.
According to the World Malaria Report 2010, malaria killed an estimated 781 000 people in 2009, mainly young children and pregnant women. It is caused by parasites that are injected into the bloodstream by infected mosquitoes.
The most effective anti-malarial drugs are the artemisinin derivatives, which have the advantages over other anti-malarial drugs (such as chloroquine and mefloquine) of having few side-effects but the fastest action. Although the drugs have been used on their own as monotherapy, fears over the development of resistance mean that they are recommended for use in conjunction with one or more other drugs as artemisinin-based combination therapies, now recommended by the WHO as the first-line treatment for uncomplicated falciparum malaria globally.
There has been a dramatic rise in reports of poor-quality and counterfeit anti-malarials in Africa. To find out more about the different types of medicines circulating and what they contain, and to look for evidence of where they might have come from, the researchers examined anti-malarials – collected in 11 African countries between 2002 and 2010 – that they believed to be either counterfeit or substandard.
Analysis of the medicines showed that some counterfeits contained a mixture of wrong active pharmaceutical ingredients, some of which might initially alleviate malaria symptoms but would not cure malaria. Worse still, these unexpected ingredients could cause potentially serious side-effects, particularly if they were to interact with other medication that a patient was currently taking, such as anti-retroviral therapies for HIV.
Some of the counterfeits also contained small amounts of artemisinin derivatives, perhaps to try to ensure that the drug would pass simple authenticity tests. Taken at such low levels, the drug is unlikely to rid the body of malaria parasites, leading to the emergence of strains of the parasite resistant to artemisinin.
The researchers identified pollen found in some of the tablets, which indicated that the counterfeit medicines originated in eastern Asia. Indeed, in 2001, police in Guangzhou, China, arrested Nigerian and Chinese men for production of counterfeits of the anti-malarial halofantrine. No evidence of counterfeit pharmaceutical production in Africa was found in the pollen analysis; however, production facilities for packaging materials for counterfeit anti-malarials have been seized in Nigeria.
Dr Paul Newton from the Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration in Laos, who led the research, says: ‘Public health organisations must take urgent, co-ordinated action to prevent the circulation of counterfeit and substandard medicines and improve the quality of the medicines that patients receive. We must move finally away from the use of single drugs and towards the exclusive use of combination therapies.
‘The enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure. Malaria can be readily treated with the right drugs of good quality, but poor-quality medicines – as well as increasing mortality and morbidity – risk exacerbating the economic and social impact of malaria on societies that are already poor. Wellcome Trust

People who are seriously injured in a car accident are more than 30 per cent more likely to survive at least 48 hours if they are taken directly to a trauma centre than those who are taken first to a non-trauma centre, new research has found.
However, fewer than half of people seriously injured in car accidents in Ontario are taken directly from the scene to a trauma centre. In addition, only half of those taken to the nearest hospital are later transferred to a trauma centre after being assessed and stabilise.
These findings are by Dr. Avery Nathens, trauma director at St. Michael’s Hospital in Toronto.
Ontario has nine Level 1 or Level 11 adult trauma centres. A trauma centre is a hospital with a trauma team that includes specially trained personnel available 24 hours a day, every day, to provide immediate treatment for the most critically injured patients. Higher levels of trauma centres also have the staff and highly sophisticated medical diagnostic equipment to provide specialised emergency care such as neurosurgery and orthopaedics.
Dr. Nathens and his team looked at data from 6,341 car accidents in Ontario from 2002 to 2010. Of those, 45 per cent were transported from the scene to a trauma centre. Of patients who were taken first to a non-trauma centre, only 57 per cent were transferred to a trauma centre.
Patients are taken to non-trauma centres for one of two reasons, Dr. Nathens said. First, the potential severity of their injuries might not be recognised by EMS personnel, so they might be transported to a non-trauma centre if it is the closest hospital. . Second, transport to a trauma centre might take too long, so patients are taken to a non-trauma centre unless air transportation is available.
When patients are taken first to a non-trauma centre, Dr. Nathens said it’s important that the emergency physician recognises the potential severity of their injuries and transfers them to a trauma centre as soon as possible.
Taken together, he said the findings point to the need to make sure all health care workers, especially EMS personnel and Emergency Department physicians, are trained to recognise who needs to be treated at a trauma centre. In addition, the health care system needs the resources to transport those patients quickly, he said.
‘Minutes matter and severely injured patients can’t advocate for themselves so we have the responsibility to ensure that the system works optimally,’ he said. St. Michael

About one baby is born every hour addicted to opiate drugs in the United States, according to new research from University of Michigan physicians.
In the research, U-M physicians found that diagnosis of neonatal abstinence syndrome, a drug withdrawal syndrome among new-borns, almost tripled between 2000 and 2009.
By 2009, the estimated number of new-borns with the syndrome was 13,539

Researchers in New Zealand have developed a prototype Bluetooth-enabled medical monitoring device that can be connected wirelessly to your smart phone and keep track of various physiological parameters, such as body temperature, heart rate, blood pressure and movements. The prototype could be extended to include sensors for other factors such as blood glucose as well as markers for specific diseases. The connectivity would allow patients to send data directly to their healthcare provider and receive timely advice and medication suggestions.

Helen Zhou and Tim Roberts of the School of Electrical Engineering at Manukau Institute of Technology explain how they have developed a microcontroller-based personal health monitoring unit that can carry medical sensors and a positioning device. The unit can connect to other devices via the short-range wireless networking system known as Bluetooth and so could be readily connected to software on a smart mobile phone for health monitoring.

The team adds that the mobile phone can be used as a gateway to further relay patient health data to a remote database via the mobile network for remote diagnoses. ‘Any medical instructions can be sent back instantly to the mobile users,’ the team says. ‘The use of standard development tools makes it possible for patients to easily use everyday mobile devices for their personal health monitoring and assessment anytime anywhere.’ They add that, ‘Bluetooth and mobile networks enable wireless communications among mobile users, medical professionals and other healthcare givers in an easy, secure and efficient manner.’

The device software is based on the familiar cross-platform Java system and provides user with an easy to use graphical user interface (GUI) on their smart phone that uses the standard navigation buttons on mobile devices.