Relapse Contracts

Malaria cases in Sicily exceeded battle casualties. At some West African airbases, personnel averaged an infection and a relapse yearly. The disease was an important factor in the fall of Bataan in the Philippines and in other early Pacific war disasters. For each battle casualty early in the New Guinea campaign, six to eight malaria patients had to be evacuated. An entire division of U.S. Marines was withdrawn from the front after more than half contracted malaria in the summer of 1942. Unless malaria could be controlled, General Douglas MacArthur said that he would have one division of men hospitalized with malaria and another division recuperating from it for every combat-ready division. 

Ghodse (1983), describing the use of time-limited detoxification contracts, states There is obviously a risk of relapse and repeated contracts may be necessary. This raises the question of what is the distinction between repetition of time-limited contracts and longterm or maintenance prescribing. 

QUINIDINE Quinidine is one of the quinoline alkaloids in Cinchona bark. (See POl, Antimalaria-drugs). Thus, quinidine is an antiarrythmic drug, whereas its stereoisomer, quinine, is an antimalarial. In antiarryth-mically effective doses quinidine reduces the contraction capacity of the heart. The minute volume of the heart diminishes through its negative inotropic effect. Quinidine is used clinically for treatment of relapse into auricle fibrillation, and at extrasystohcs and paroxysmal tachycardia and ventricular tachycardia. 

Patients usually need months of treatment (100-200 treatments), with about 70% of patient responding after 1-2 years. The expected response is related to the development of multiple perifollicular macules of repigmentation and contraction in size. Nevertheless, if after 4—6 months or 30-50 treatments, the patient does not respond, PUVA should be discontinued. Stable disease, for at least a year, is usually easier to treat. Completely repigmented areas can be stable for a decade or more without relapse, but if a lesion is not fully repigmented, reversal of acquired pigmentation may occur when treatment is discontinued [104,122]. KUVA and topical PUVA are alternative treatments to oral PUVA in vitiligo patients. KUVA uses an organic biomolecule derivate of 1,4-benzopyrone and furan called khellin as photosensitizer, and this is not phototoxic. Topical PUVA may be suitable for small lesions, while UVA alone is of limited benefit [122]. 

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