Poor Dr Vix having to go to a conference that many of us would have liked to attend. Anyone want to share the documents?
[him] moderator
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Thai-Myanmar border wide infectious disease forum
Thursday, May 27, 2010
"Dr Vix"
tripping the tightrope blog
The last thing I imagined I would be doing in Thailand would be attending a conference, but that is what I’ve been up to the past 2 days. I’ve been surprised at the efficiency and quality. I now have the pre-requisite useless conference bag guaranteed to fall apart within the week, notebook, pen and a who is who in the border region infectious disease control crew. Yeah and a hangover, it all feels so familiar! What Is less familiar is the free registration and crazy introduction. I think one of the first speakers failed to turn up so a microphone went around the room and all participants (100+) introduced themselves to the room. Hideous!
I’m mostly here to get my face around and meet people who I can pick the brains of but there is also an entire day of clinical and laboratory issues of malaria, TB/HIV, vaccinations and other nasties which are common issues along the border. These are all covered by the shoklo malaria research unit which are doing some front line research in Malaria and branch out into vaccination programs and TB treatment also. I am going for a browse around their labs sometime in the next weeks to see how things are done in a well equipped research facility compared to the clinic. SRMU also run training workshops and try and help out the clinic as and when possible. I am deeply jealous, they are doing some really interesting research which I would love to get my hands dirty with…
There are so many issues to get to grips with I’m amazed that anyone can collect data or reduce malaria infections or vaccinate kids. The border NGO’s work in tough conditions and still get things done, it may not be “perfect” but solutions are catered to the situation so yes rapid testing methods will be used in place of PCR identification… (one suggestion by a city NGO) where in the jungle are you going to plug in the PCR machine? Store the enzymes? Are you going to drag pipettes, tips, tubes, ice boxes and 100’s of miles of power cables along with you? My lab in Mae Tao is well kitted out in comparison to most places…. We have microscopes, fridges and centrifuges…
So yeah, the conference was a great way to find out what is being done , how and by who… now to apply some of that new knowledge.
http://drvix.blogspot.com/2010/05/thai-myanmar-border-wide-infectious.html
Primaquine and G8PD deficiency were a subject at this meeting. Two relevant references are;
1. Mitigation of the haemolytic effect of primaquine and enhancement of its action against exoerythrocytic forms of Chesson strain of Plasmodium vivax by intermittent regimens of drug administration.. Alving et al; Bulletin of World Health Organisation 1960, 2, 621-631 (put "primaquine weekly haemolsis" into google)
2. Treatment of vivax malaria on the western border of Thailand. Christine Luxemburger et al, Transactions of the Royal Society of Tropical Medicine and Hygiene (1999) 93, 433-438
Thanks for this comment.
HIV Information for Myanmar [him] readers know nothing else about the conference except for your comment. Would you be so kind as to email documents from the conference to the moderator at hiv.information.for.myanmar@gmail.com. Then your comment can be taken in context.
The important questions unadressed at this conference are
1. Why does SMRU continue to advocate a 3 day treatment for falciparum malaria when 5 days of the same drugs has repeatedly been found to be superior and 7 days even better?
2. Why does SMRU ignore the 15 years of work by Alving, Carson and others on primaquine that includes showing it to be safe and effective in 8 weekly doses in men with G6PD deficiency? They found the problem and then the solution decades ago and it is no less valid for the passage of time.
3 Why does SMRU think patients can not or will not take courses of treatment lasting 7 days (artesunate) or 14 days (primaqine)? Is it really too difficult to explain to patients the importance of taking the full course? How are they going to explain 6 months treatment for their new TB programme patients?
4 Why does SMRU linked vaccine schedule compress doses to the earliest possible first doses and closest possible gaps for follow up doses at the expense of long term immunity and greater benefit to the patients from their activity?
5 Why does SMRU correctly advocate microscopy as the best means of diagnosis for malaria and then use rapid tests so much at their clinics instead?
6 Why is it possible for SMRU to organise weekly follow up for well pregnant women and not weekly dosage of primaquine for patients with pv malaria?