Since praziquantel was developed in 1970s, it has replaced other antischistosomal drugs to become the only drug of choice for treatment of human schistosomiases, due to high efficacy, excellent tolerability, few and transient side effects, simple administration, and competitive cost. Praziquantel-based chemotherapy has been involved in the global control strategy of the disease and led to the control strategy shifting from disease control to morbidity control, which has greatly reduced the prevalence and intensity of infections. Given that the drug has been widely used for morbidity control in endemic areas for more than three decades, the emergence of resistance of Schistosoma to praziquantel under drug selection pressure has been paid much attention. It is possible to induce resistance of Schistosoma mansoni and Schistosoma japonicum to praziquantel in mice under laboratorial conditions, and a reduced susceptibility to praziquantel in the field isolates of S. mansoni has been found in many foci. In addition, there are several schistosomiasis cases caused by Schistosoma haematobium infections in which repeated standard treatment fails to clear the infection. However, in the absence of exact mechanisms of action of praziquantel, the mechanisms of drug resistance in schistosomes remain unclear. The present review mainly demonstrates the evidence of drug resistance in the laboratory and field and the mechanism of praziquantel resistance and proposes some strategies for control of praziquantel resistance in schistosomes.

Susceptibility or resistance of praziquantel in human schistosomiasis: a review.

Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People’s Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6–65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

Epidemiology of schistosomiasis in the People's Republic of China, 2004.

Nutritional characterisation and antioxidant capacity of different tissues of Artemisia annua L.

As long as no effective malaria vaccine is available, chemotherapy belongs to the most important weapons fighting malaria. One of the most promising new drug developments is the sesquiterpene artemisinin (ARS) and its derivatives, e.g., artemether, arteether, and sodium artesunate. Large clinical studies and meta-analyses did not show serious side effects, although proper monitoring of adverse effects in developing countries might not be a trivial task. There is a paucity of large-scale clinical trials suitable to detect rare but significant toxicity. Therefore, a final and definitive statement on the safety of artemisinins still cannot be made. In contrast, animal experiments show considerable toxicity upon application of artemisinins. In the present review, the authors give a comprehensive overview on toxicity studies in cell culture and in animals (mice, rats, rabbits, dogs, monkeys) as well as on toxicity reported in human clinical trials. The authors emphasize the current knowledge on neurotoxicity, embryotoxicity, genotoxicity, hemato- and immunotoxicity, cardiotoxicity, nephrotoxicity, and allergic reactions. The lesson learned from animal and human studies is that long-term availability rather than short-term peak concentrations of artemisinins cause toxicity. Rapid elimination of artemisinins after oral intake represents a relatively safe route of administration compared to delayed drug release after intramuscular (i.m.) injection. This explains why considerable toxicities were found in the majority of animal experiments, but not in human studies. In addition, there are drug-related differences, i.e., intramuscular application of artemether or arteether, but not to artesunate, which is safe and gives good profiles after i.m. administration in severe malaria. Although there is no need to increase doses of artemisinins for uncomplicated malaria, this has to be taken into account for cerebellar involvement in severe malaria. It might also be important in determining dose limitations for treatment of other diseases such as cancer.

Toxicity of the antimalarial artemisinin and its dervatives

Watershed management is an ever-evolving practice involving the management of land, water, biota, and other resources in a defined area for ecological, social, and economic purposes. In this paper, we explore the following questions: How has watershed management evolved? What new tools are available and how can they be integrated into sustainable watershed management? To address these questions, we discuss the process of developing integrated watershed management strategies for sustainable management through the incorporation of adaptive management techniques and traditional ecological knowledge. We address the numerous benefits from integration across disciplines and jurisdictional boundaries, as well as the incorporation of technological advancements, such as remote sensing, GIS, big data, and multi-level social-ecological systems analysis, into watershed management strategies. We use three case studies from China, Europe, and Canada to review the success and failure of integrated watershed management in addressing different ecological, social, and economic dilemmas in geographically diverse locations. Although progress has been made in watershed management strategies, there are still numerous issues impeding successful management outcomes; many of which can be remedied through holistic management approaches, incorporation of cutting-edge science and technology, and cross-jurisdictional coordination. We conclude by highlighting that future watershed management will need to account for climate change impacts by employing technological advancements and holistic, cross-disciplinary approaches to ensure watersheds continue to serve their ecological, social, and economic functions. We present three case studies in this paper as a valuable resource for scientists, resource managers, government agencies, and other stakeholders aiming to improve integrated watershed management strategies and more efficiently and successfully achieve ecological and socio-economic management objectives.

/pdf/integrated-watershed-management-evolution-development-and-555oqb14we.pdf

Integrated watershed management: evolution, development and emerging trends

La Chine mene une lutte a grande echelle contre la schistosomiase depuis le milieu des annees 50, mais au debut des annees 90, cette maladie etait encore endemique dans huit provinces. Un projet de pret de la Banque mondiale a permis la realisation de progres importants sur la periode 1992-2001. La strategie de lutte contre la maladie etait axee sur l'utilisation a grande echelle de la chimiotherapie dans l'objectif principal de maitriser davantage la morbidite, tout en agissant simultanement sur la transmission dans le but ultime de l'interrompre. La chimiotherapie etait completee par une education sanitaire, une lutte chimique contre les escargots et des modifications de l'environnement le cas echeant. Une evaluation finale realisee en 2002 a montre que les taux d'infection chez l'homme et les animaux d'elevage avaient diminue respectivement de 55 et 50 %. Le nombre d'infections aigues et d'individus a un stade avance de la maladie avait aussi notablement diminue. Bien que les taux de contamination des escargots continuent de fluctuer a un faible niveau, les densites d'escargots infectes ont diminue de plus de 75 % dans l'ensemble des zones d'endemie. Les objectifs de depart du Projet de pret de la Banque mondiale en faveur de la lutte contre la schistosomiase ont ete remplis. Une province, le Zhejiang, etait parvenu a satisfaire les criteres d'elimination de la schistosomiase des 1995. Le projet a donc ete un succes et a fourni a la Chine une base solide pour poursuivre la lutte.

/pdf/schistosomiasis-control-in-china-the-impact-of-a-10-year-1ljevgphd2.pdf

Schistosomiasis control in China: the impact of a 10-year World Bank Loan Project (1992-2001)

China has been carrying out large-scale schistosomiasis control since the mid-1950s, but in the early 1990s, schistosomiasis was still endemic in eight provinces. A World Bank Loan Project enabled further significant progress to be made during the period 1992-2001. The control strategy was focused on the large-scale use of chemotherapy -- primarily to reinforce morbidity control -- while at the same time acting on transmission with the ultimate goal of interrupting it. Chemotherapy was complemented by health education, chemical control of snails and environmental modification where appropriate. A final evaluation in 2002 showed that infection rates in humans and livestock had decreased by 55% and 50%, respectively. The number of acute infections and of individuals with advanced disease had also significantly decreased. Although snail infection rates continued to fluctuate at a low level, the densities of infected snails had decreased by more than 75% in all endemic areas. The original objectives of the China World Bank Loan Project for schistosomiasis control had all been met. One province, Zhejiang, had already fulfilled the criteria for elimination of schistosomiasis by 1995. The project was therefore a success and has provided China with a sound basis for further control.

Schistosomiasis control in China : the impact of a 10-year World Bank Loan Project (1992-2001) / Chen Xianyi . [et al.]

Human schistosomiasis, a chronic and debilitating parasitic disease of the tropics, is ranked second after malaria in terms of public health importance. At present, there is no vaccine available, and chemotherapy is the cornerstone of schistosomiasis control. Praziquantel is the drug of choice. Oxamniquine has become difficult to obtain and metrifonate has recently been withdrawn from the market. Rapid re-infection following treatment and concern about praziquantel resistance called for the search of novel drugs for prevention and cure of schistosomiasis. Significant progress has been made with artemether, the methyl ether of dihydroartemisinin, already widely used for the treatment of malaria. The present article reviews the literature that led to the development of artemether for chemoprophylaxis in schistosomiasis, and it summarises the experiences so far obtained with its use to control schistosomiasis in different endemic settings. Topics covered include an overview of the global burden of schis tosomiasis and approaches for its control; the nature and features of artemisinin and related derivatives, initially discovered as antimalarials, other bioactivities, and their recent discovery of antischistosomal properties a historic account disclosing the antischistosomal activity of artemether in vivo assessment of drug susceptibility of different developmental stages of schistosome parasites; artemether-induced pathology evidenced by scanning and transmission electron microscopy; the possible mechanism of action; in vivo studies with combination therapy of artemether and praziquantel results of randomised controlled clinical trials of oral artemether for the prevention of patent infection and morbidity and, ultimately the translation of this knowledge into public health action in different endemic settings towards a more integrated approach of schistosomiasis control.

Current progress in the development and use of artemether for chemoprophylaxis of major human schistosome parasites.

Recent investigations of artemether, a novel agent for the prevention of schistosomiasis japonica, mansoni and haematobia.

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Schistosomiasis control in China: the impact of a 10-year World Bank Loan Project (1992-2001)

Schistosomiasis control in China : the impact of a 10-year World Bank Loan Project (1992-2001) / Chen Xianyi . [et al.]

Current progress in the development and use of artemether for chemoprophylaxis of major human schistosome parasites.

Recent investigations of artemether, a novel agent for the prevention of schistosomiasis japonica, mansoni and haematobia.