Mefloquine for preventing malaria in pregnant women

Background: The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine for malaria for all women who live in moderate to high malaria transmission areas in Africa. However, parasite resistance to sulfadoxine-pyrimethamine has been increasing steadily in some areas of the region. Moreover, HIV-infected women on cotrimoxazole prophylaxis cannot receive sulfadoxine-pyrimethamine because of potential drug interactions. Thus, there is an urgent need to identify alternative drugs for prevention of malaria in pregnancy. One such candidate is mefloquine. Objectives: To assess the effects of mefloquine for preventing malaria in pregnant women, specifically, to evaluate: • the efficacy, safety, and tolerability of mefloquine for preventing malaria in pregnant women; and • the impact of HIV status, gravidity, and use of insecticide-treated nets on the effects of mefloquine.Search methods: We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS), the Malaria in Pregnancy Library, and two trial registers up to 31 January 2018. In addition, we checked references and contacted study authors to identify additional studies, unpublished data, confidential reports, and raw data from published trials. Selection criteria: Randomized and quasi-randomized controlled trials comparing mefloquine IPT or mefloquine prophylaxis against placebo, no treatment, or an alternative drug regimen. Data collection and analysis: Two review authors independently screened all records identified by the search strategy, applied inclusion criteria, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when required. Dichotomous outcomes were compared using risk ratios (RRs), count outcomes as incidence rate ratios (IRRs), and continuous outcomes using mean differences (MDs). We have presented all measures of effect with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach for the following main outcomes of analysis: maternal peripheral parasitaemia at delivery, clinical malaria episodes during pregnancy, placental malaria, maternal anaemia at delivery, low birth weight, spontaneous abortions and stillbirths, dizziness, and vomiting. Main results: Six trials conducted between 1987 and 2013 from Thailand (1), Benin (3), Gabon (1), Tanzania (1), Mozambique (2), and Kenya (1) that included 8192 pregnant women met our inclusion criteria. Two trials (with 6350 HIV-uninfected pregnant women) compared two IPTp doses of mefloquine with two IPTp doses of sulfadoxine-pyrimethamine. Two other trials involving 1363 HIV-infected women compared three IPTp doses of mefloquine plus cotrimoxazole with cotrimoxazole. One trial in 140 HIV-infected women compared three doses of IPTp-mefloquine with cotrimoxazole. Finally, one trial enrolling 339 of unknown HIV status compared mefloquine prophylaxis with placebo. Study participants included women of all gravidities and of all ages (four trials) or > 18 years (two trials). Gestational age at recruitment was > 20 weeks (one trial), between 16 and 28 weeks (three trials), or ≤ 28 weeks (two trials). Two of the six trials blinded participants and personnel, and only one had low risk of detection bias for safety outcomes. When compared with sulfadoxine-pyrimethamine, IPTp-mefloquine results in a 35% reduction in maternal peripheral parasitaemia at delivery (RR 0.65, 95% CI 0.48 to 0.86; 5455 participants, 2 studies; high-certainty evidence) but may have little or no effect on placental malaria infections (RR 1.04, 95% CI 0.58 to 1.86; 4668 participants, 2 studies; low-certainty evidence). Mefloquine results in little or no difference in the incidence of clinical malaria episodes during pregnancy (incidence rate ratio (IRR) 0.83, 95% CI 0.65 to 1.05, 2 studies; high-certainty evidence). Mefloquine decreased maternal anaemia at delivery (RR 0.84, 95% CI 0.76 to 0.94; 5469 participants, 2 studies; moderate-certainty evidence). Data show little or no difference in the proportions of low birth weight infants (RR 0.95, 95% CI 0.78 to 1.17; 5641 participants, 2 studies; high-certainty evidence) and in stillbirth and spontaneous abortion rates (RR 1.20, 95% CI 0.91 to 1.58; 6219 participants, 2 studies; I2 statistic = 0%; high-certainty evidence). IPTp-mefloquine increased drug-related vomiting (RR 4.76, 95% CI 4.13 to 5.49; 6272 participants, 2 studies; high-certainty evidence) and dizziness (RR 4.21, 95% CI 3.36 to 5.27; participants = 6272, 2 studies; high-certainty evidence). When compared with cotrimoxazole, IPTp-mefloquine plus cotrimoxazole probably results in a 48% reduction in maternal peripheral parasitaemia at delivery (RR 0.52, 95% CI 0.30 to 0.93; 989 participants, 2 studies; moderate-certainty evidence) and a 72% reduction in placental malaria (RR 0.28, 95% CI 0.14 to 0.57; 977 participants, 2 studies; high-certainty evidence) but has little or no effect on the incidence of clinical malaria episodes during pregnancy (IRR 0.76, 95% CI 0.33 to 1.76, 1 study; high-certainty evidence) and probably no effect on maternal anaemia at delivery (RR 0.94, 95% CI 0.73 to 1.20; 1197 participants, 2 studies; moderate-certainty evidence), low birth weight rates (RR 1.20, 95% CI 0.89 to 1.60; 1220 participants, 2 studies; moderate-certainty evidence), and rates of spontaneous abortion and stillbirth (RR 1.12, 95% CI 0.42 to 2.98; 1347 participants, 2 studies; very low-certainty evidence). Mefloquine was associated with higher risks of drug-related vomiting (RR 7.95, 95% CI 4.79 to 13.18; 1055 participants, one study; high-certainty evidence) and dizziness (RR 3.94, 95% CI 2.85 to 5.46; 1055 participants, 1 study; high-certainty evidence). Authors' conclusions: Mefloquine was more efficacious than sulfadoxine-pyrimethamine in HIV-uninfected women or daily cotrimoxazole prophylaxis in HIV-infected pregnant women for prevention of malaria infection and was associated with lower risk of maternal anaemia, no adverse effects on pregnancy outcomes (such as stillbirths and abortions), and no effects on low birth weight and prematurity. However, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women

‘Saluda’, a programme to prevent the drug consumption: a evaluation of a new version in Spanish adolescents

En la actualidad se han evaluado numerosas intervenciones preventivas de drogodependencias en el medio escolar. Sin embargo, en España son pocos los estudios que analizan la influencia precisa de cada uno de los componentes específicos a los programas con el fin de determinar cuáles se consideran cruciales para el cambio de conducta de consumo. El objetivo del presente estudio fue evaluar los efectos de una nueva versión del programa de prevención del consumo de drogas Saluda en la que se prescinde del componente fomento del ocio saludable y las tareas para casa. Esta versión reducida fue dirigida a una muestra de 106 escolares (44.6 % chicos) entre 14 y 17 años (M = 15.20; DT = 0.92) de un centro de Educación Secundaria. Se trata de un estudio exploratorio de tipo cuasi experimental y un diseño pre-post de un único grupo. Se realizó diferencia de proporciones mediante la prueba Z y diferencia de medias mediante la prueba T para muestras relacionadas. Los resultados muestran una reducción en el porcentaje de episodios de embriaguez, así como un efecto de mejora significativa sobre las variables protectoras del consumo. Se discuten estos hallazgos y se realizan propuestas para la mejora de futuras intervenciones.In Spain, as in the majority of countries in the world, drug use is a public health problem. Adolescence is considered to be a period at risk for the onset of drug use; thus, it becomes essential to intensify efforts and reduce the demand for drugs. For this purpose, numerous interventions have been evaluated, finding several sources of deficiency: among them, it is worth mentioning the lack of studies that analyzing the most effective components on drug prevention programs. In Spain, only Saluda program provides empirical evidence on the contribution of its components to the program. The objective of this study was to evaluate the effects of a new version of Saluda program on a sample of 106 students (44.6% boys) between 14 and 17 years (M = 15.20, SD = 0.92). A pilot study was conducted, in which the components “healthy leisure promotion” and “homework” were omitted. Concerning intragroup comparisons, analyses of variance on repeated measures and difference of proportions were performed. The results showed a reduction in alcohol consumption and cannabis as well as a significant improving effect on consumption protective variables. These findings were made in order to improve future preventive interventions

Electromyographic Activity Evolution of Local Twitch Responses During Dry Needling of Latent Trigger Points in the Gastrocnemius Muscle: A Cross-Sectional Study

Trigger points (TrPs) are hypersensitive spots within taut bands of skeletal muscles that elicit referred pain and motor changes. Among the variety of techniques used for treating TrPs, dry needling is one of the most commonly applied interventions. The question of eliciting local twitch responses (LTRs) during TrP dry needling is unclear. Our main aim was to investigate the evolution of the electromyographic (EMG) peak activity of each LTR elicited during dry needling into latent TrPs of the gastrocnemius medialis muscle. Methods. Twenty asymptomatic subjects with latent TrPs in the gastrocnemius medialis muscle participated in this cross-sectional study. Changes in EMG signal amplitude (root mean square [RMS]) with superficial EMG were assessed five minutes before, during, and five minutes after dry needling. The peak RMS score of each LTR was calculated (every 0.5 sec). Results. Analysis of variance revealed a significant effect (F ¼ 29.069, P <0.001) showing a significant decrease of RMS peak amplitude after each subsequent LTR. Differences were significant (P <0.001) during the first three LTRs, and stable until the end of the procedure. No changes (P ¼0.958) were found for mean RMS data at rest before (mean ¼ 65.2 mv, 95% confidence interval [CI] ¼ 47.3–83.1) and after (61.0 mv, 95% CI ¼ 42.3–79.7) dry needling. Conclusions. We found that, in a series of LTRs elicited during the application of dry needling over latent TrPs in the medial gastrocnemius muscle, the RMS peak amplitude of each subsequent LTR decreased as compared with the initial RMS peak amplitude of previous LTRs. No changes in superficial EMG activity at rest were observed after dry needling of latent TrPs of the gastrocnemius medialis muscle.Ciencias de la Actividad Física y del Deport

Aceptación/rechazo social infantil: relación con problemas emocionales e inteligencia emocional

The aim of this study was to analyse the relationship of social acceptance/rejection whit anxiety-depressive symptomatology and emotional intelligence in Spanish children. The sample consisted of 94 students of Elementary School between 8 and 12 years. Results revelled the significant relationship between rejection index and symptomatology of social phobia, dysphoria and low self-stem, while the model for choices index is related whit social skills. In resume, social rejection is related whit emotional problems, whereas social acceptance does with emotional intelligence. This study suggests the relevance of developing socio-emotional competences programs to promote social acceptance and to prevent emotional disorders related with social rejection in childhood.El objetivo del estudio fue analizar la relación de la aceptación/rechazo social con la sintomatología ansioso-depresiva y la inteligencia emocional en niños españoles de 8 a 12 años. La muestra estuvo compuesta por 94 alumnos (45.7% varones, edad media = 9.76; DT = 1.09). Los resultados indicaron que el rechazo social se relaciona con la sintomatología de fobia social, disforia y baja autoestima, mientras que la aceptación social se relaciona con habilidades sociales. En resumen, el rechazo social se relaciona con problemas emocionales, mientras que la aceptación social lo hace con inteligencia emocional. Este estudio sugiere la importancia de desarrollar programas de competencias socio-emocionales para promover la aceptación social y prevenir los trastornos emocionales asociados al rechazo social en la infancia

Microsatellite Genotyping of Plasmodium vivax Isolates from Pregnant Women in Four Malaria Endemic Countries

Plasmodium vivax is the most widely distributed human parasite and the main cause of human malaria outside the African continent. However, the knowledge about the genetic variability of P. vivax is limited when compared to the information available for P. falciparum. We present the results of a study aimed at characterizing the genetic structure of P. vivax populations obtained from pregnant women from different malaria endemic settings. Between June 2008 and October 2011 nearly 2000 pregnant women were recruited during routine antenatal care at each site and followed up until delivery. A capillary blood sample from the study participants was collected for genotyping at different time points. Seven P. vivax microsatellite markers were used for genotypic characterization on a total of 229 P. vivax isolates obtained from Brazil, Colombia, India and Papua New Guinea. In each population, the number of alleles per locus, the expected heterozygosity and the levels of multilocus linkage disequilibrium were assessed. The extent of genetic differentiation among populations was also estimated. Six microsatellite loci on 137 P. falciparum isolates from three countries were screened for comparison. The mean value of expected heterozygosity per country ranged from 0.839 to 0.874 for P. vivax and from 0.578 to 0.758 for P. falciparum. P. vivax populations were more diverse than those of P. falciparum. In some of the studied countries, the diversity of P. vivax population was very high compared to the respective level of endemicity. The level of inter-population differentiation was moderate to high in all P. vivax and P. falciparum populations studied