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Background: People living in malaria endemic areas are at risk of suffering from the recurrent malaria episodes. The recurrent episode of malaria can be determined by various factors and will bring some serious impacts on all life aspects. This study aims to identify malaria demographics and factors associated with the recurrent episodes of malaria in Timika, Papua. Methods: This observational study used medical record data from the Naena Muktipura Sub-District Health Center, Timika Papua in 2020. Plasmodium infection was identified based upon microscopic examination. Subjects were then categorized into positive and negative malaria followed by the determination of the positivity rate. Each case of malaria was traced regarding frequency, time, and type of Plasmodium. The recurrent episodes of malaria were defined as Plasmodium infections occurred more than once in a year. Demographic data including age, sex, and ethnicity were then analyzed using Chi square. Results: The incidence of recurrent malaria in Timika Papua was 16% with the highest positivity rate occurred in June. The most recurrent episodes of malaria were 2 episodes (77.2%) in which men were more at risk (OR 2.512). Meanwhile, ethnicity and age were not associated with recurrent episodes. Most of recurrent episodes of malaria are caused by the similar plasmodium species, particularly Plasmodium falciparum (82.25%) with the shortest interval between episodes of 14 days. Conclusion: Malaria is mostly experienced by men, of productive age and Javanese ethnicity. Men were found more at risk of experiencing recurrent episodes of malaria. The identification of these demographic factors is important to issue the policies on malaria elimination and malaria transmission termination in Timika, Papua.

Introduction There is a considerable association between major depressive disorder (MDD) and cardiovascular disease, most possibly relying on abnormalities in the autonomic nervous system (ANS)-related cardiac reactivity, although the exact underlying pathophysiological pathway is unclear. Objectives This study tends to shed some additional light on this background by investigating ANS reactivity in MDD with respect to previous depression history through an objective stress challenge paradigm. Methods The study assessed the effects of an overnight hypothalamus-pituitary-adrenal (HPA) axis stimulation with metyrapone (MET) on baseline ANS activity through linear and non-linear heart rate variability (HRV) measures in the morning of two continuous days in a group of 14 physically healthy, antidepressant-free patients with clinical, non-psychotic MDD, to investigate differences in autonomic reactivity with respect to prior MDD history. Results The main findings of this study include statistically significant time x group interactions with respect to several HRV measures, suggesting substantial differences on autonomic reactivity between patients with and without depression history. Hereby, recurrent-episode MDD patients showed lower vagal activity, while first-episode MDD patients increased PNS activity after HPA axis stimulation. Conclusions These findings indicate that HPA axis stimulation in MDD patients leads to inverse vagal response according to MDD history. We suggest that chronic stress system overactivation, as found in MDD, might lead to a progressive inversion of the original stress response through HPA axis and ANS divergence over the course of a recurrent illness. HRV could, thus, represent a significant biomarker in MDD with temporal sensitivity.

M Sigrid Mac Donald-Ottevanger,1 Malti R Adhin,2 Jeetendra Kumar Jitan,3 Gustavo Bretas,4 Stephen GS Vreden1 1Foundation for Scientific Research Suriname (SWOS), 2Department of Biochemistry, Anton de Kom University of Suriname, 3Department of Public Health, Ministry of Health, Paramaribo, Suriname; 4Independent consultant, Rio de Janeiro, Brazil Background: Recurrent episodes of Plasmodium vivax are caused by dormant liver stages of the parasite, which are not eradicated by choloroquine. Therefore, effective treatment also includes the use of primaquine (PQ). However, this secondary preventive therapy is often not effective, mostly due to poor adherence to the relatively long treatment course, justifying a comparative study of the efficacy of different durations of PQ treatment. Materials and methods: We included patients presenting with an acute and documented P. vivax infection from January 2006 to February 2008. All patients received chloroquine 25 mg/kg over a 3-day period. Subsequently, patients in group 7D received PQ 30 mg/day for 7 days, and patients in group 14D received standard PQ 15 mg/day for 14 days. All doses were given under supervision and patients were followed up for at least 6 months. The Kaplan–Meier method was used to estimate cumulative probability of recurrence up to 12 months after treatment initiation stratified by treatment group. Cox regression was used to assess possible determinants for recurrent parasitemia. Results: Forty-seven of the 79 included patients (59.5%) were allocated to group 7D and 32 patients (40.5%) were allocated to group 14D. Recurrent parasitemia was detected in 31.9% of the cases in group 7D compared to 12.5% of the cases in group 14D (hazard ratio [HR] =3.36, 95% CI 1.11–10.16). Cumulative probability for recurrent parasitemia at 3, 6, and 12 months was 0.201 (95% CI 0.106–0.362), 0.312 (95% CI 0.190–0.485), and 0.424 (95% CI 0.274– 0.615) for group 7D and 0.100 (95% CI 0.033–0.279), 0.100 (95% CI 0.033–0.279), and 0.138 (95% CI 0.054–0.327) for group 14D, respectively. When adjusted for possible confounders, differences in recurrent parasitemia remained significant between the two regimens in Cox regression analysis. Conclusion: More than 30% of the patients receiving shorter treatment course had recurrent parasitemia, suggesting that the standard dose of 15 mg/day PQ for 14 days is more efficacious than 30 mg for 7 days in preventing P. vivax recurrent episodes. Furthermore, we suggest that P. vivax treatment in Suriname should be changed to PQ 30 mg/day for 14 days, as per Center for Disease Control and Prevention recommendation, in light of a recurrence rate of over 10%, even in group 14D. Keywords: malaria, vivax, recurrent episode, primaquine, treatment duration, efficacy

Recurrent Guillain-Barré syndrome (RGBS) episodes appear in up to 6% of Guillain-Barré syndrome (GBS) patients. The purpose of this study was to identify patients with previous episodes of GBS and to assess their clinical features in a large cohort of adult GBS patients. GBS patients hospitalized at tertiary centers in three Balkan countries were included in the study (n = 404). We identified 13 (3.2%) patients with recurrent GBS (RGBS). The male to female ratio was 3: 1. All RGBS patients had two episodes of the disease. The most common GBS subtype in both episodes of the disease was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) (77%, first episode; 85%, second episode). Around 23% of patients presented with a different variant during the second GBS attack. Disability seems to be equally severe at both episodes (P > 0.05). Recurrent GBS was registered in 3% of our GBS patients. The majority of them were younger males. Different GBS subtypes were found to recur. [ABSTRACT FROM AUTHOR]

Introduction: There is a considerable association between major depressive disorder (MDD) and cardiovascular disease, most possibly relying on abnormalities in the autonomic nervous system (ANS)-related cardiac reactivity, although the exact underlying pathophysiological pathway is unclear. Objectives: This study tends to shed some additional light on this background by investigating ANS reactivity inMDDwith respect to previous depression history through an objective stress challenge paradigm. Methods: The study assessed the effects of an overnight hypothalamus-pituitary-adrenal (HPA) axis stimulationwith metyrapone (MET) on baselineANS activity through linear and non-linear heart rate variability (HRV) measures in the morning of two continuous days in a group of 14 physically healthy, antidepressant-free patients with clinical, non-psychoticMDD, to investigate differences in autonomic reactivity with respect to prior MDD history. Results: The main findings of this study include statistically significant time x group interactions with respect to several HRV measures, suggesting substantial differences on autonomic reactivity between patients with and without depression history. Hereby, recurrent-episodeMDDpatients showed lower vagal activity, while first-episode MDD patients increased PNS activity after HPA axis stimulation. Conclusions: These findings indicate that HPA axis stimulation in MDD patients leads to inverse vagal response according to MDD history. We suggest that chronic stress system overactivation, as found in MDD, might lead to a progressive inversion of the original stress response through HPA axis and ANS divergence over the course of a recurrent illness. HRV could, thus, represent a significant biomarker in MDD with temporal sensitivity. [ABSTRACT FROM AUTHOR]