14 research outputs found
The position of mefloquine as a 21st century malaria chemoprophylaxis
BACKGROUND: Malaria chemoprophylaxis prevents the occurrence of the symptoms of malaria. Travellers to high-risk Plasmodium falciparum endemic areas need an effective chemoprophylaxis. METHODS: A literature search to update the status of mefloquine as a malaria chemoprophylaxis. RESULTS: Except for clearly defined regions with multi-drug resistance, mefloquine is effective against the blood stages of all human malaria species, including the recently recognized fifth species, Plasmodium knowlesi. New data were found in the literature on the tolerarability of mefloquine and the use of this medication by groups at high risk of malaria. DISCUSSION: Use of mefloquine for pregnant women in the second and third trimester is sanctioned by the WHO and some authorities (CDC) allow the use of mefloquine even in the first trimester. Inadvertent pregnancy while using mefloquine is not considered grounds for pregnancy termination. Mefloquine chemoprophylaxis is allowed during breast-feeding. Studies show that mefloquine is a good option for other high-risk groups, such as long-term travellers, VFR travellers and families with small children. Despite a negative media perception, large pharmaco-epidemiological studies have shown that serious adverse events are rare. A recent US evaluation of serious events (hospitalization data) found no association between mefloquine prescriptions and serious adverse events across a wide range of outcomes including mental disorders and diseases of the nervous system. As part of an in-depth analysis of mefloquine tolerability, a potential trend for increased propensity for neuropsychiatric adverse events in women was identified in a number of published clinical studies. This trend is corroborated by several cohort studies that identified female sex and low body weight as risk factors. CONCLUSION: The choice of anti-malarial drug should be an evidence-based decision that considers the profile of the individual traveller and the risk of malaria. Mefloquine is an important, first-line anti-malarial drug but it is crucial for prescribers to screen medical histories and inform mefloquine users of potential adverse events. Careful prescribing and observance of contraindications are essential. For some indications, there is currently no replacement for mefloquine available or in the pipeline
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Complex Modulation of Rapidly Rotating Young M Dwarfs: Adding Pieces to the Puzzle
New sets of young M dwarfs with complex, sharp-peaked, and strictly periodic
photometric modulations have recently been discovered with Kepler/K2 (scallop
shells) and TESS (complex rotators). All are part of star-forming associations,
are distinct from other variable stars, and likely belong to a unified class.
Suggested hypotheses include star spots, accreting dust disks, co-rotating
clouds of material, magnetically constrained material, spots and misaligned
disks, and pulsations. Here, we provide a comprehensive overview and add new
observational constraints with TESS and SPECULOOS Southern Observatory (SSO)
photometry. We scrutinize all hypotheses from three new angles: (1) we
investigate each scenario's occurrence rates via young star catalogs; (2) we
study the features' longevity using over one year of combined data; and (3) we
probe the expected color dependency with multi-color photometry. In this
process, we also revisit the stellar parameters accounting for activity
effects, study stellar flares as activity indicators over year-long time
scales, and develop toy models to simulate typical morphologies. We rule out
most hypotheses, and only (i) co-rotating material clouds and (ii) spots and
misaligned disks remain feasible - with caveats. For (i), co-rotating dust
might not be stable enough, while co-rotating gas alone likely cannot cause
percentage-scale features; and (ii) would require misaligned disks around most
young M dwarfs. We thus suggest a unified hypothesis, a superposition of
large-amplitude spot modulations and sharp transits of co-rotating gas clouds.
While the complex rotators' mystery remains, these new observations add
valuable pieces to the puzzle going forward