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Card Consolidation Credit Debt       Mahidol University Annual Research Abstracts 2000 39

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Merchant Credit Guide Co                     Thalassemia is common in Southeast Asia, where artemisinin derivatives are now commonly used in the treatment of malaria. It has been previously reported that artemisinin derivatives can be concentrated by uninfected thalassemic erythrocytes in vitro but not by normal erythrocytes. As a follow-up to these studies, the antimalarial kinetics of intravascular artesunate (2.4 mg/kg body weight) was studied in 10 persons with normal hemoglobins and in 10 patients with thalassemia (2 with a-thal₁/Hb CS and 8 with a-thal₁/a-thal₂). Plasma concentration of artesunate and its active metabolites were measured by bioassay and expressed in terms which equivalent to antimalarial activity of dihydroartemisinin, the major biologically active metabolite. The antimalarial kinetic properties were determined. Time to peak plasma concentration of intravascular artesunate in both normal and thalassemics were 15 min. after injection. However, drug concentration at all time intervals, except at 1 hrs., were significantly higher in thalassemics than in normal (P < 0.05). Pharmacokinetic parameters were analysed using a computer software. All of the analysed parameters (C_max, C_last, T_max, AUC_all, l and MRT) excetp T_1/2 and l are significantly different (P < 0.05) in thalassemics from those of normal subjects. In light of the potential neurotoxicity of artemisinin derivatives, these results suggest that thalassemics may need different drug administration regimens. THE EFFECT OF QUININE AND ARTESUNATE TREATMENT ON PLASMATUMOR NECROSIS FACTOR LEVELS IN MALARIA-INFECTED PATIENTS Wanida Ittarat¹, Rachanee Udomsangpetch², Kesinee T. Chotivanich², and Sornchai Looarresuwan ^{3 1}Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand. ²Department of Experimental Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand. ³Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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By Card Credit Debt Debt Guide Key words : Tumor necrosis factor (TNF), malaria, antimalarial, artemisinin, qinghaosu, endoperoxide, quinene

Additional studies have found that tumor necrosis factor, inflammatory cytokine, is increased in insomniacs during the daytime and that levels of these two cytokines are closely related to the level of fatigue experienced (Vgontzas AN et al 2002).

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Active Credit Credit Guide Address correspondence to : Wanida Ittarat, Ph.D., Department of Clinical Microscopy, Faculty of Medical Technology, Siriraj Hospital, Mahidol University. Bangkok, 10700, Thailand. e-mail address : mtwit@mahidol.ac.th

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Bad Car Credit Guide Loan                     Tumor necorsis factor-alpha (TNF-a) is an endogenous mediator of shock and inflammation including malaria. Many lines of evidence suggest that cytoadherence, the life-threatening pathologies associated with complicated and cerebral malaria, result from the overproduction of TNF in response to malarial parasites. Quinine has been shown to inhibit TNF synthesis and cytoadherence in vitro suggesting and additional beneficial effects of quinine is its anti-TNF action. On the other hand, artesunate inhibit cytoadherence better than quinine but does not suppress TNF production in vitro. The present study compares the effects of artesunate and quinine on TNF levels in malaria patients. Suprisingly, plasma TNF levels increased dramatically after quinine administration but did not increase after artesunate administration. This difference may be explained by previous observations showing that artesunate kills parasites in vitro and clears parasitemias in vivo far more rapidly than quinine. The rapid clearance of plasma TNF in quinine-treated patients might be due to the drug's TNF -supressive activity.

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