Microsoft word - document

Malaria is a serious disease caused by one of five species of Plasmodium (a parasite). It is a medical emergency, treatable, and largely preventable. P falciparum - one of the two most common types of malaria, primarily found in Africa. It can cause severe disease and can be rapidly fatal. P vivax - the other most common type of malaria. It can stay in the body for years and cause relapses. P ovale - can also cause relapses. P knowlesi - primarily an animal disease, but can infect humans (particularly in Malaysia and other countries in Southeast Asia). How it Spreads
Malaria is spread to humans via the bite of an infected mosquito. The
parasite lives in the anopheles mosquito, which usually bites at night (from
dusk until dawn). Malaria cannot move from person to person, except from
a mother to her fetus during pregnancy or via a transfusion using infected
Symptoms can develop within days. Alternatively, it could take several
months to a year for symptoms to appear. This is why it is important to
notify your doctor of your travel history
whenever you develop 'flu like'
symptoms, for up to a year after visiting a malarial area.
Early malaria symptoms are flu like, such as head/body aches and generally feeling tired and unwell. Later symptoms can be episodic (come and go) and may include fever, sweating, shaking (rigors), chills, fatigue, nausea, vomiting, diarrhea and jaundice. "Classical" malaria attacks sometimes occur, though they are not present in every patient. These attacks last about 6 to 10 hours and repeat every two to three days. They start with feeling cold and shivering. A high fever, headache, and sometimes vomiting follow. The attack ends with sweating and a return to normal body temperature. The patient is left fatigued. If not promptly treated, the malaria caused by Plasmodium falciparum can also cause anemia, seizures, mental confusion, kidney failure, coma and death. Travelers are more likely to suffer these complications than local inhabitants. Risk to travelers
Malaria generally occurs in tropical and subtropical areas where humidity
and rainfall levels are high. This includes large areas of Central and South
America, Africa, Asia (including the Indian Subcontinent, Southeast Asia
and the Middle East), Eastern Europe and the South Pacific. Risk is usually
reduced in areas of higher altitude (over 1,500 meters / 5,000 feet).
In some countries, the risk is nationwide. In others, the risk is limited to specific areas. It is important to determine whether an area you visit has malaria. If it does, it is imperative you understand what type is present and how to protect yourself. Treatment
If treated promptly, malaria is curable. Malaria is treated with antimalarial
medications, such as chloroquine, mefloquine, atovaquone-proguanil,
primaquine and artemisinin derivatives. These should be started as soon as
possible. Severe or potentially severe cases require hospitalization. Mild
cases can be treated as outpatients.
There is currently no vaccination to prevent malaria. All people in
malarious areas should take precautions to prevent mosquito bites. Some
people in higher risk situations are also advised to take anti-malarial drugs
to prevent infection (chemoprophylaxis). Your travel health professional
will advise you individually, based on your risk profile.
Chemoprophylaxis is not 100% effective, and people who take antimalarial medicine should still be alert for symptoms of the disease. Chloroquine is the appropriate antimalarial drug to take if your destination has chloroquine sensitive malaria. In other areas, malaria has become resistant to chloroquine, and alternative medications are required, such as: Atovaquone plus proguanil (Malarone® and generics) Summary of how to prevent insect bites:
Wear light-colored clothing that covers most of the body (long sleeves and long pants). Consider treating clothing with an insecticide. These are available as both soaks and sprays, and usually last through several washings. Always follow the manufacturer's instructions. Use an effective insect repellent, such as one containing DEET, Picaridin, PMD, or IR3535. In general, the higher the concentration of the active ingredient in a product, the longer it lasts and hence the more effective it is. Reapply after swimming or excessive sweating. Use "knock-down" aerosol spray or electric insecticide vaporizers to kill insects in your room. Unless you are staying in air-conditioned, well-screened accommodations, consider using a bed net impregnated with permethrin. Despite these protective measures, travelers may still contract malaria. Seek medical help quickly if you develop symptoms and have been in a malarial area within the past year.


R e v i e w s / C o m m e n t a r i e s / A D A S t a t e m e n t s A Systematic Review of Drug Therapy to Delay or Prevent Type 2 Diabetes AJ PADWAL, MD JANICE VARNEY, MLIS potentially limiting factors to widespread UMIT R. MAJUMDAR, MD FINLAY A. MCALISTER, MD EFF A. JOHNSON, PHD type 2 diabetes may be an important ther-apeutic modality in those patients in OBJECTIVE — To

Microsoft word - econ loss & designliability dco 2nd draft 24th sep 2006.doc

Developments in the Law of Economic Loss and Liability under Design & Build Situations ORGANISED BY Society of Construction Law (Singapore) 15th – 17th October 2006, Grand Copthorne Waterfront Hotel, Singapore by COLIN Y.C. ONG 1 General Introduction to the Law of Economic Loss The current position depicting the law of economic loss even among Commonwealth coun

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