By K. Fabio. University of the Pacific.
The safety of the agent in the particular patient must be carefully evaluated before continuing with the medication once a side effect has been noted purchase 120 mg silvitra visa erectile dysfunction jason. Reasons that more than one medication purchase 120mg silvitra with amex erectile dysfunction treatment in delhi, each from a different class of agents order silvitra 120mg amex erectile dysfunction drugs in kenya, might be prescribed include patients with complex comorbid conditions or those with partially-responsive 58 discount silvitra 120mg otc erectile dysfunction doctors in chandigarh,160 or treatment resistant cases. In clinical practice it is not unusual to have a patient on multiple psychotropic medications from different classes of drugs. It appears that a substantial number of hospitalized children and adolescents receive more than one psychotropic medication. Unfortunately, there are limited data regarding the long-term use of combinations of medications in youths. Due to the possibility of significant risks associated with these agents, the use of more than one agent is not recommended and is not supported in the scientific literature. While these medications fall within the same general class, it is clear they are not interchangeable. Significant differences in side effect profiles and mechanism of action exist and switching among these agents should be done with clear and precise reasoning reflective of current empirical data. Re-evaluation of the initial diagnosis, assessment for comorbid conditions, and the redefining of targeted symptoms may lead to try a trial of a different class of medication in these patients. Increased vigilance in the monitoring of the potential side effects is therefore needed, recognizing practical limitations. Obesity is associated with an increased risk of cardiovascular disease, diabetes, knee and joint injury, hyperlipidemia and hypertension. Developmentally normed growth charts can be found at the Center for Disease Control web site (www. There is also evidence to suggest that the 125 development of diabetes is not only directly related to weight gain. Therefore, careful monitoring for diabetes, through close attention to the clinical signs and symptoms of diabetes, and regular monitoring of blood glucose levels and, as needed, hemoglobin A1C is 121,161,162 warranted. Studies have shown that elevated lipid levels, even early in life, may have a role in the 134 development of cardiovascular disease throughout the lifespan. For patients whose family history is not available, particularly careful consideration regarding medication choice and monitoring is recommended. In youths who have significant weight changes, further evaluation or intervention should also be considered. As some of the most concerning short and long-term associated side effects with these agents are movement disorders, careful attention to their development is warranted. As the relationship between prolactin levels and clinical outcome has yet to be more precisely defined, prolactin measurement during antipsychotic pharmacotherapy does not appear to be warranted in the absence of possible prolactin-related side effects. Clozapine: Labeling for clozapine provides guidelines regarding the monitoring of hematological parameters for patients being treated with this agent. Although not developed for use in youths, per se, these monitoring parameters should be employed in children and adolescents treated with clozapine. For those patients who gain a substantive amount of weight, monitoring of liver enzymes should also be considered. Quetiapine: There are data from animals-based studies to suggest the possibility that quetiapine is associated with a risk of cataract formation. For this reason, a baseline ophthalmologic examination with periodic re-assessment is recommended by the manufacturer. The determination of treatment duration should be based on multiple factors including the severity of symptoms, the psychosocial settings, and the natural course of the illness being treated. Risks are associated with the abrupt discontinuation of these agents, including withdrawal dyskinesia. The abrupt withdrawal of a medication that has been ameliorating symptoms may also clinically destabilize a patient as a result of symptom exacerbations. Except in cases where a severe and/or dangerous side effect has developed, these agents should not be abruptly discontinued. As such, the parameters should not be deemed inclusive of all proper methods of care nor exclusive of other methods of care directed at obtaining the desired results. The ultimate judgment regarding the care of a particular patient must be made by the clinician in light of all of the circumstances presented by the patient and his or her family, the diagnostic and treatment options available, and available resources. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. A retrospective chart review of risperidone use in treatment- resistant children and adolescents with psychiatric disorders. Atypical antipsychotics in the treatment of children and adolescents: clinical applications. Physician specialty associated with antipsychotic prescribing for youths in Texas Medicaid Program. Trends in the use of typical and atypical antipsychotics in children and adolescents. Broadened use of atypical antipsychotic drugs: safety, effectiveness, and policy challenges. Prevalence of atypical antipsychotic drug use among commercially insured youths in the United States. Open-label, 8-week trial of olanzapine and risperidone for the treatment of bipolar disorder in preschool-age children. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision). Use of pharmacotherapy for insomnia in child psychiatry practice: a national survey. Phenomenology and epidemiology of childhood psychiatric disorders that may necessitate treatment with atypical antipsychotics. Benefit-risk assessment of atypical antipsychotic treatment of schizophrenia and comorbid disorders in children and adolescents. Childhood-onset schizophrenia: a double-blind, randomized clozapine-olanzapine comparison. Clozapine treatment of children and adolescents with bipolar disorder and schizophrenia: a clinical case series. Clozapine: its impact on aggressive behavior among children and adolescents with schizophrenia. Clozapine treatment of adolescents with posttraumatic stress disorder and psychotic symptoms. Risperidone for the core symptom domains of autism: results from the study by the Autism Network of the Research Units on Pediatric Psychopharmacology. Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Double-blind comparison of antipsychotics in early onset schizophrenia and schizoaffective disorder. Effectiveness, safety, and tolerability of risperidone in adolescents with schizophrenia: an open-label study. Risperidone treatment in children and adolescents with autism: short and long-term safety and effectiveness. Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. A randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. Risperidone in the treatment of tourette syndrome: a double-blind placebo-controlled trial. Tic reduction with risperidone versus pimozide in a randomized, double-blind, crossover trial. Risperidone treatment for juvenile bipolar disorder: a retrospective chart review. Differential response of psychotic and obsessive symptoms to risperidone in an adolescent. Risperidone augmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder. Risperidone in children with disruptive behavior disorders and subaverage intelligence: a 1-year, open-label study of 504 patients. Efficacy and safety of olanzapine in adolescents with schizophrenia: results from a double-blind, placebo controlled trial. Open- label study of olanzapine in children with pervasive developmental disorder. Olanzapine versus haloperidol in children with autistic disorder: an open pilot study. Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. A double-blind placebo-controlled pilot study of olanzapine in childhood/adolescent pervasive developmental disorder. Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports. Olanzapine in children and adolescents with chronic anorexia nervosa: a study of five cases. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. Efficacy of quetiapine in children and adolescents with bipolar mania: a 3-week, double-blind, randomized, placebo-controlled trial. Efficacy and safety of quetiapine in adolescents with schizophrenia: a 6-week, double-blind, randomized, placebo-controlled trial. Effectiveness, safety, and pharmacokinetics of quetiapine in aggressive children with conduct disorder. Open-label quetiapine in the treatment of children and adolescents with autistic disorder. Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders. A retrospective analysis of quetiapine in the treatment of pervasive developmental disorders. Long-term safety, tolerability, and clinical efficacy of quetiapine fumarate: an open-label extension trial. Improvement in behavior and attention in an autistic patient treated with ziprasidone. The effectiveness and tolerability of aripiprazole for pediatric bipolar disorders: a retrospective chart review. Aripiprazole in the treatment of pediatric bipolar disorder: a systematic chart review. Pharmacokinetic effects of aripiprazole in children and adolescents with conduct disorder. Tolerability and pharmacokinetics of aripiprazole in children and adolescents with psychiatric disorders: an open-label, dose escalation study. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia.
Some medical professionals may misunderstand us and attempt to treat our addiction cheap silvitra 120 mg fast delivery erectile dysfunction ulcerative colitis. Or buy 120mg silvitra with visa erectile dysfunction pills in south africa, they may be overly cautious and reluctant to prescribe medication when they learn that we are addicts order 120mg silvitra visa erectile dysfunction over 60. If we feel like we don’t have enough information silvitra 120mg online erectile dysfunction injection medication, or that the doctor does not seem to be respectful of our situation, we can seek another medical opinion. As a result of neglecting my teeth, I have had to make numerous visits to the dentist for procedures that caused intense pain. My dentist, on several occasions, offered me pain medication to take at home which I didn’t ﬁnd necessary. Instead, I accepted the practical experience of other members and found relief with ice packs, rides to and from appointments, and nonprescription medication. Having another person listen while the doctor describes proposed procedures or treatments can offer us support and reassurance. If necessary, their presence can be explained to the doctor by 8 saying that the support of others is an integral part of our program of recovery. The person who accompanies us can hear the details with an open mind, while our own minds may be clouded with fear, anger, or self-pity. She felt shame and was afraid that the medical personnel would treat her differently if she told them she was an addict. I helped her to see that it was important to walk through the fear and inform the medical personnel of her addiction. Maintaining rigorous honesty and remaining open to the suggestions of other addicts allows us to avoid self-deception or secrecy. Our experience shows that we are especially vulnerable to our addiction when we are dealing with illness and injury. We consider asking for a limited supply of medication and we talk to our sponsor before ﬁlling a prescription for mind- or mood-altering medication. They remind us that taking medication as prescribed for an illness is not the same as using. Medication in Recovery “For all the diversity of individual opinion among our members, Narcotics Anonymous itself is united in having no opinion on any issues apart from its own program. As a fellowship, we agree to take positions only on those ideas that have drawn us together, our principles of recovery, not on the many personal opinions that might divide us. Our collective experience shows that rigorous application of the program is our best defense against relapse. However, we may face a situation in our recovery where we have to make choices about medication. When treatment of an illness requires medication, the concept of abstinence can be confusing. Until I was faced with this situation in my own recovery, it didn’t dawn on me that I might have to take medication. I can remember going to meetings and having people ask me if I’d relapsed, and telling me to pick up a white chip. I felt rejected and very alone because no one seemed to understand that I needed strength and hope. We can look to their example and listen to their experience to help us face our fears about medication. We remember that we are especially vulnerable to our old ways of thinking when we are in pain. Addicts are often surprised to discover how much pain we can tolerate without medication. Reaching out and sharing honestly with those we trust can help us keep our priorities in order. However, the guidance and support of members who have faced similar situations is often available if we reach out. In addition to consulting medical professionals, we may use other members’ experience and information to help us make knowledgeable decisions. With the support of others in Narcotics Anonymous, we ﬁnd the strength we need to make healthy choices for our own recovery. I discussed my illness with informed medical professionals and obtained second and third opinions. The important thing is that someone who has speciﬁc 12 knowledge of the disease of addiction can help us to avoid isolation and secrecy. Members facing illness and injury may face intense feelings of loneliness, despair, and self-pity. By listening to the experience, strength, and hope in meetings we are able to experience collective empathy. We fulﬁll our primary purpose by offering our support to other addicts with an attitude of care, love, and concern. Any addict, regardless of clean time, should be able to pour out his or her pain in an atmosphere free of judgment. The Basic Text warns us that our disease is cunning, and tells us that honesty is the solution. When we are in pain, we are highly susceptible to self-deception, fear, denial, and anger. Our thinking and actions may be affected by any mind- and mood-altering medications. We strive for the willingness to avoid our self-will and follow the suggestions of others who have our best interests at heart. Communicating honestly with our sponsor, medical care providers, and loved ones is vital to our recovery. An unfortunate reality in our fellowship is that some members abuse their prescribed medication and relapse. Members who relapse on prescribed medication may be reluctant to return to meetings for fear of being judged. Encouraging these members to share honestly and admit when they have abused their medication can remind other addicts to be vigilant in protecting their own recovery. When facing a situation where we may be prescribed medication, we should seek out the experience of these members. When we are confronted with a medical condition where we may have to take medication, our initial fear may be of taking too much, but we also may go to the other extreme. The urge to allow ourselves to suffer unnecessarily rather than take medication may be great. We resist this urge to stubbornly insist that we know better than the doctor, refuse all medications, or neglect problems that require medical attention. When a professional tells us that pain is not conducive to healing, we should listen. Likewise, ignoring health problems because of fear or pride may, in fact, make matters worse for us. Once again, we remind ourselves of the importance of making a conscious decision not to medicate ourselves or treat our own illnesses. My sponsor told me not to be a martyr and to go to my doctor, who knows that I am a recovering addict. I didn’t listen, and as a result I was hospitalized for ﬁve days, in traction and on strong medication. If I had followed my sponsor’s suggestion, I would have been on a milder medication for a much shorter period of time. Any medication may unleash the craving and the compulsion that haunted us while we were using. Even if we have not seen the doctor, we can practice vigilance and responsibility for our recovery by checking 15 our motives and seeking the suggestions of our sponsor before we take anything. It is important that we consider their use as carefully as the use of any other medication. This is another way in which we can exercise responsibility for our recovery, even during illness. Many of these methods require little or no medication or the use of medication that doesn’t alter our moods or our thinking. We seek solutions in our recovery when we are faced with an illness or injury by asking questions and doing research. Asking members what worked for them can be a powerful way to utilize the support of the fellowship. I refrain from activities that result in pain, and have found new activities that are relatively pain-free. I practice surrendering to my physical limitations so I do not aggravate my condition and create more pain. Fortunately, I have found alternatives that usually provide me the relief that I need to get through my day. Alternative methods reduce my pain so that I don’t need to try to manage with mood-altering medication. We apply the principles of the program to help us ﬁnd spiritual well-being when we are ill. Sharing openly with our doctor and our sponsor, relying on a Higher Power, and practicing the Twelve Steps are important tools. These can help each member ﬁnd a sense of balance that is comfortable and appropriate. Life in recovery can be complicated by illness and the possibility that we may need to take prescribed medication. Regardless of how we work our mental and spiritual program of recovery, we may react to medication like we did when using drugs. It’s helpful to remember the importance of making a conscious decision not to medicate ourselves or treat our own illnesses. Cleantime is an issue for each of us to resolve individually with our sponsor and our Higher Power. While being of service to our fellowship, there may be times when we begin to feel that taking mind-changing and mood-altering medication has affected our ability to serve effectively. In some cases, members may share with us that they think our behavior and attitude have been impaired by our illness and treatment. Even though our temptation may be to rebel against the opinions of our fellow trusted servants, we remember that they are our eyes and ears. Being honest with ourselves about our strengths and weaknesses is an important part of any inventory. Some members have found that they were fully capable of fulﬁlling their service commitments while taking medication to treat an illness or injury, while others have made the choice to step down. Informing fellow members that we need to step down for a period of time for health reasons illustrates recovery principles in action. This can be viewed as the fulﬁllment of a personal commitment to our health, rather than a failure. We can remind ourselves that we live this way of life just for today, and the decisions we make are not forever. We come to accept today’s health issues, and we can seek other ways to be of service. We may consider a group-level commitment, or we may be a committee member rather than committee chair.
Garner silvitra 120 mg mastercard impotence at 80, Liverpool School of Tropical Medicine silvitra 120 mg with amex erectile dysfunction pump rings, Liverpool buy generic silvitra 120mg online impotence and alcohol, United Kingdom Professor O discount silvitra 120mg online erectile dysfunction kolkata. Gaye, Service de Parasitologie, Faculté de Médicine, Université Cheikh Anta Diop, Dakar-Fann, Senegal Dr S. Juma, Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya Dr A. McCarthy, Tropical Medicine and International Health Clinic, Division of Infectious Diseases, Ottawa Hospital General Campus, Ottawa, Canada Professor O. Mokuolu, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria Dr D. Sinclair, International Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom Dr L. Tjitra, National Institute of Health and Development, Ministry of Health, Jakarta, Indonesia 126 Dr N. White (co-Chair), Faculty of Tropical Medicine, Mahidol University, A Bangkok, Thailand 1 Members of the sub-group on dose recommendations Professor K. Barnes, (co-chair), Division of Clinical Pharmacology, University of Cape Town, South Africa Professor F. Juma, Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya Professor O. Mokuolu, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria Dr S. Tarning, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Dr D. Terlouw, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi Professor N. White (co-Chair), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Guideline Steering Group Dr A. McGready, Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Professor F. Nosten, Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand External contributors to Annex 5 (Pharmacology of Antimalarial Drugs) C. Brunschwig, Department of Chemistry, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa. Chigutsa, WorldWide Antimalarial Resistance Network, University of Cape Town, South Africa L. Barnes reported being a recipient of grants from the Malaria Medicine Venture to undertake clinical trials to evaluate novel antimalarial medicines. Valecha reported serving as an investigator for clinical trial supported by the Department of Science and Technology India, and Ranbaxy Laboratories Limited. White reported being an advisor to all pharmaceutical companies developing new antimalarial medicines. This is done on a pro-bono basis, it does not include consultancy fees nor any form of remuneration. The female mosquito is infected by gametocytes, the sexual stages of the malaria parasite, when they take a blood meal from an infected person. Male and female gametocytes then fuse to form zygotes (ookinetes), which embed in the gut wall A as oocysts and then undergo further development in the insect for 6–12 days. The intensity of malaria transmission in an area is the rate at which people are inoculated with malaria parasites by infected mosquitoes. The proportion of infected mosquitoes in a locality refects the capacity of the vectors to transmit malaria (vectorial capacity) and the number of infected and infectious humans in the area. Lowering the infectivity of infected persons to mosquito vectors contributes to reducing malaria transmission and eventually to reducing the incidence and prevalence of the disease. Experience with major interventions, such as use of insecticide-treated nets and artemisinin-based combination therapy, suggests that effective transmission-reducing interventions reduce mortality and even morbidity in most situations (1–4). Relation between entomological inoculation rate and parasite prevalence (on the assumption that no infections are treated) Parasite prevalence (%) 100 80 60 40 20 0 0. Early, effective treatment of a malaria blood infection with any antimalarial medicine will reduce gametocytaemia by eliminating the asexual blood stages from which gametocytes derive. The faster the clearance of asexual blood parasites, the greater the reduction in infectivity. The potent anti-infective properties of artemisinins result partly from rapid clearance of parasites. Effective treatment of the asexual blood infection alone abolishes infectivity to mosquitoes. Infectivity can be lowered either by a direct effect on gametocytes (gametocytocidal effect; primaquine) or on the parasite developmental stages in the mosquito (sporontocidal effect; antifols, atovaquone) or by killing feeding mosquitoes (endectocidal effect; avermectins). Sulfadoxine–pyrimethamine in fact increases gametocyte carriage, but it also reduces the infectivity of drug-sensitive parasites. Artemisinins are the most potent gametocytocidal drugs of those currently used to treat acute malaria (6–11). They kill young gametocytes, preventing new infective gametocytes from entering the circulation, but they have less effect on mature gametocytes that may 130 be present in the circulation at the time of treatment (6). The 8-aminoquinoline primaquine acts on mature gametocytes rapidly, reducing their transmissibility to mosquitoes and accelerating gametocyte clearance (12–20). Dose–response relations for primaquine in reducing the infectivity of Plasmodium falciparum-infected individuals to anopheline mosquitoes A 2 Oocyst positive (%) Assessed < 48 hrs 100 29 after primaquine 80 7 60 15mg 30mg 40 10 45mg 20 48 13 4 13 26 0 6 0 0. Vertical axes show the proportions of fed anopheline mosquitoes that were infected. Oocyst formation (upper graph) and sporozoite formation (lower graph) assessed from blood sampled 48 h after a dose of primaquine. Primaquine given with an artemisinin derivative is shown in green, and primaquine given with no antimalarial medicine or a non-artemisinin derivative is shown in red. The size of the circle is proportional to the number of patients in each group (shown within). In areas of low-to-moderate transmission The most direct consequences of lowering parasite infectivity by the use of medicines are seen in areas of low transmission, where symptomatic patients contribute signifcantly to the infectious reservoir. Reducing infectiousness has a signifcant impact on malaria transmission and thus the prevalence of infection and the incidence of disease. In areas of high-transmission In high-transmission areas, infected but asymptomatic people constitute an important part of the infectious reservoir. Even though treated cases (mainly children) have higher densities of gametocytes and infectivity is positively related to gametocyte density, symptomatic patients comprise only a minority of the infective reservoir (21–23). In high-transmission settings, a considerable reduction in transmission rates is required to reduce parasite prevalence (and incidence of disease). Adding transmission-blocking drugs to antimalarial treatment is not cost–effective. As malaria control intensifes in highly endemic countries, however, transmission rates are declining; infectivity-reducing drug regimens may therefore further reduce transmission and play an important role in sustaining achievements. Thus, the use of antimalarial medicines specifcally to reduce infectivity: • is justifed in low-transmission settings and • will be benefcial in high-transmission settings when transmission rates have been lowered by effective malaria control. Strategies to reduce the transmission of drug-resistant parasites Continued use of an antimalarial drug to which parasites are partially resistant will confer a selective advantage to resistant parasites and favour their transmission. In the presence of the drug, partially resistant infections are accompanied by more gametocytaemia than those that are sensitive (6, 7, 24). Furthermore, drug resistance leads to recrudescence associated with higher rates of gametocyte carriage than primary infections. Thus, cumulatively drug-resistant infections generate more gametocytaemia and therefore greater transmission potential than sensitive ones (25, 26). Secondly, under some circumstances, gametocytes carrying resistant genes may be more infectious to mosquitoes, producing greater numbers of oocysts and infecting a higher proportion of mosquitoes than those carrying sensitive genes (27). There is some evidence that mosquito control measures preferentially eliminate drug-resistant parasites (28). This evidence is supported by feld experience in: 132 • Zimbabwe, where house spraying with insecticides to reduce malaria transmission was associated with a decrease in drug resistance (29), and • focal regions in India and Sri Lanka, where a combination of intense vector- control measures and switching to an effective medicine led to signifcant reductions and, in some instances, even elimination of chloroquine-resistant P. As one of the earliest features of drug resistance is increased gametocyte carriage, addition of a transmission-blocking drug such as primaquine will negate this transmission advantage and slow the spread of resistance. A Summary and conclusions 2 Antimalarial medicines play an important role in reducing malaria transmission and in curtailing the spread of drug-resistant parasites. Good access to diagnosis and early, effective treatment will reduce malaria transmission. Epidemiology and infectivity of Plasmodium falciparum and Plasmodium vivax gametocytes in relation to malaria control and elimination. Gametocytemia and infectivity to mosquitoes of patients with uncomplicated Plasmodium falciparum malaria attacks treated with chloroquine or sulfadoxine plus pyrimethamine. Artesunate reduces but does not prevent post treatment transmission of Plasmodium falciparum to Anopheles gambiae. Addition of artesunate to chloroquine for treatment of Plasmodium falciparum malaria in Gambian children causes a signifcant but short-lived reduction in infectiousness for mosquitoes. Activities of artesunate and primaquine against asexual- and sexual-stage parasites in falciparum malaria. A randomized open-label trial of artesunate-sulfadoxine-pyrimethamine with or without primaquine for elimination of sub-microscopic P. Primaquine clears submicroscopic Plasmodium falciparum gametocytes that persist after treatment with sulphadoxine-pyrimethamine and artesunate. Single dose primaquine for clearance of Plasmodium falciparum gametocytes in children with uncomplicated malaria in Uganda: a randomised, controlled, double-blind, dose-ranging trial. Effectiveness of fve artemisinin combination regimens with or without primaquine in uncomplicated falciparum malaria: an open-label randomised trial. Assessment of therapeutic responses to gametocytocidal drugs in Plasmodium falciparum malaria. The reservoir of Plasmodium falciparum malaria in a holoendemic area of western Kenya. Predicting mosquito infection from Plasmodium falciparum gametocyte density and estimating the reservoir of infection. Substantial contribution of submicroscopical Plasmodium falciparum gametocyte carriage to the infectious reservoir in an area of seasonal transmission. Features of recrudescent chloroquine-resistant Plasmodium falciparum infections confer a survival advantage on parasites, and have implications for disease control. Host heterogeneity is a determinant of competitive exclusion or coexistence in genetically diverse malaria infections. Association of house spraying with suppressed levels of drug resistance in Zimbabwe. Malaria cannot be diagnosed accurately with any one set of clinical criteria, as the signs and symptoms (fever, chills, headache and anorexia) are non-specifc and are common to many diseases and conditions.