Malaria - JAMA 297(20) - 23-MAY-07 - whole issue

70s-80s overlander

An entire issue of JAMA (Journal of the American Medical Association) has been devoted to articles on malaria. In my judgment, the following two are the best articles (but the entire issue is of interest):

Chen LH, Wilson ME, Schlagenhauf P.
Controversies and misconceptions in malaria chemoprophylaxis for travelers.
JAMA. 2007 May 23;297(20):2251-63.

Abstract ... EVIDENCE ACQUISITION: We searched scientific publications in MEDLINE via PubMED for relevant articles with a cutoff date of December 2006 .... Additional references were obtained from bibliographies of the selected articles. There were no language restrictions. EVIDENCE SYNTHESIS: Gaps and conflicts exist among current guidelines. Health authorities vary in the chemoprophylaxis drugs they recommend, the indications for continuous prophylaxis vs no prophylaxis, and the use of standby emergency treatment. Despite widespread reports on the adverse effects of mefloquine, controlled studies found that serious neuropsychiatric adverse events occur at rates comparable with or lower than other chemoprophylaxis drugs. Moreover, mefloquine does not appear to impair performance while driving, flying, or diving. Vivax malaria causes significant illness in travelers, but current first-line chemoprophylaxis agents do not prevent relapses of vivax malaria. Although not licensed in most countries as primary prophylaxis, primaquine effectively prevents relapses of vivax malaria. [***available in US as "off label" use; available in Canada***] CONCLUSIONS: Prevention of malaria in travelers requires detailed knowledge of malaria epidemiology and host-vector-parasite interactions. Decisions are complicated by a lack of standardized recommendations, controversies, and misconceptions. Improved international consensus is indicated to minimize conflicting guidelines, clarify controversies, and promote adherence to preventive measures.
***

Griffith KS, Lewis LS, Mali S, Parise ME.
Treatment of malaria in the United States: a systematic review.[note that this is on TREATMENT -- not prophylaxis]
JAMA. 2007 May 23;297(20):2264-77.

Abstract ... EVIDENCE ACQUISITION: Systematic MEDLINE search from 1966 to 2006 .... Additional references were obtained from searching the bibliographies of pertinent articles and by reviewing articles suggested by experts in the treatment of malaria in North America. EVIDENCE SYNTHESIS: ...  Chloroquine remains the treatment of choice for Plasmodium falciparum acquired in areas without chloroquine-resistant strains. In areas with chloroquine resistance, a combination of atovaquone and proguanil or quinine plus tetracycline or doxycycline or clindamycin are the best treatment options. Chloroquine remains the treatment of choice for all other malaria species, with the exception of P vivax acquired in Indonesia or Papua New Guinea, in which case atovaquone-proguanil is best, with mefloquine or quinine plus tetracycline or doxycycline as alternatives. Quinidine is currently the recommended treatment for severe malaria in the United States because the artemisinins are not yet available. Severe malaria occurs when a patient with asexual malaria parasitemia, and no other confirmed cause of symptoms, has 1 or more designated clinical or laboratory findings. The only adjunctive measure recommended in severe malaria is exchange transfusion. ...

machadinha

Link, please?

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Reading tips, all picked up at IndiaMike : INDAX's A Comprehensive Guide To India / Dinoj Surendran's Desi Humor / ITHVC on Culture Shock & Travel Health / JetLag Travel Guides For the Undiscerning Traveller / India Travel Links

70s-80s overlander

While ABSTRACTS of the WORLD medical literature are available for free courtesy of the US government [ www.pubmed.gov ][yes, they are working on the non-English Indian literature], some full articles are free but some require either membership in the organization or payment of a fee to the organization [in this case the American Medical Association]. The first article is not for free but can be ordered through ones local library or photocopied at a local medical school/hospital or purchased online at http://pubs.ama-assn.org/misc/access.dtl .

The second article is for free at the following url: http://jama.ama-assn.org/cgi/content/full/297/20/2264 .

The table of contents of this entire fantastic issue is as follows:

THEME ISSUE: MALARIA
JAMA (Journal of the American Medical Association) [vol 297 no 20, May 23, 2007]

Sulfadoxine-Pyrimethamine, Chlorproguanil-Dapsone, or Chloroquine for the Treatment of Plasmodium vivax Malaria in Afghanistan and Pakistan: A Randomized Controlled Trial

Combination Therapy for Uncomplicated Falciparum Malaria in Ugandan Children: A Randomized Trial

Hemoglobin Variants and Disease Manifestations in Severe Falciparum Malaria

Improved Diagnostic Testing and Malaria Treatment Practices in Zambia

Burden, Features, and Outcome of Neurological Involvement in Acute Falciparum Malaria in Kenyan Children

Controversies and Misconceptions in Malaria Chemoprophylaxis for Travelers

Estimating the Number of Insecticide-Treated Nets Required by African Households to Reach Continent-wide Malaria Coverage Targets

Treatment of Malaria in the United States: A Systematic Review

Improving Surveillance for Antimalarial Drug Resistance: Global Malaria Control in the 21st Century: A Historic but Fleeting Opportunity

Malaria 2007—Progressing Research, Persisting Challenges