(3) take “the pill” (3) Proguanil (Paludrine®):
There are several dangerous myths regarding
Chloroquine (Nivaquine® or Daramal® or
• Prophylaxis does not make the diagnosis
• Dosage: Two tablets every day starting one
• It does protect against the development of
week prior to exposure until four weeks after.
• Contra-indications: Known allergy to
• Prophylaxis is not 100% effective - hence the
Proguanil. Interactions with Warfarin (An
anti-coagulant/blood thinning agent that is
• Not all anti-malaria medication is safe with
• Side effects: Heartburn (Tip: take after a
• Malaria is often fatal – making prophylaxis
meal, with a glass of water and do not lie
down shortly after taking Proguanil); mouth
Anti-malaria drugs, like all drugs, have potential
ulcers (Tip: take folic acid tablets, 5 mg per
side effects. The majority of side effects
day, if this occurs); loose stools (self limiting
decrease with time. Serious side effects are
rare and can be avoided by careful selection
• Use in pregnancy: Safe, but must be taken
of a tablet or combination of tablets to suit your
with a folic acid supplement: 5 mg per day.
requirements (country, region and season).
(Note: scuba diving is not considered safe
The following drugs are available for the
The combination of Chloroquine and Proguanil
(1) Doxycycline (Vibramycin® or
is about 65% effective for resistant falciparum
Cyclidox® or Doryx®, etc.):
malaria. Although not a first choice, its relative
• Used extensively in the prevention of
safety and limited side effects may justify its use
chloroquine resistant malaria. About 99%
effective. Not officially recommended for
(4) Atovaquone/Proguanil (Malarone ®;
use in excess of eight weeks for malaria
prevention, but it has been used for as long
• Registered in South Africa as a causal
prophylaxis in February 2004. Safety in diving
have used it with no adverse effects. Use
• Dosage: 100 mg daily after a meal starting
with caution. Additional sensitivity to motion
one - two days before exposure until four
weeks after exposure. Doxycycline should
Preliminary data suggests it is safe for pilots.
be taken with plenty of non-alcoholic liquid.
• Effective against malaria isolates that are
breasfeeding, children < eight years.
• Controlled studies have shown a 98% overall
• Side effects: Nausea, vomiting, diarrhoea,
prevention of P. falciparum malaria.
vaginal thrush and may reduce the efficacy
• Dosage: One tablet daily for adults, starting
24 - 48 hours prior to arrival in endemic
• Use in pregnancy: Unsafe (as is scuba
area, during exposure in endemic area and
for seven days after leaving the endemic
Doxycycline is DAN-SA’s agent of choice
time each day with food or a milky drink.
(2) Chloroquine (Nivaquine® or Daramal®
impairment (i.e. significant renal disease
is likely to be incompatible with diving).
• Contains only chloroquine. Must be taken in
Safety in children < 11 kg has not been
combination with Proguanil (Paludrine®).
• Dosage: Two tablets weekly starting one
• Side effects: Heartburn (Tip: take after
week before exposure until four weeks after
lie down shortly after taking Atovaquone/
• Contra-indications: Known allergy, epilepsy.
photosensitivity (sunburn; prevention – apply
• Use in pregnancy: Safety in pregnancy and
• Use in pregnancy: Safe. (Note: scuba diving
lactating women has not been established.
is not considered safe during pregnancy.)
(Note: scuba diving is not considered safe during pregnancy.)
Autumn 2009 ALERTDiver 37
Chapter 10:Study Guide Concept Questions: 1. Which tissues comprise total body fat and which comprise fat- free mass? 2. Discuss conditions in which fat cells can increase in size and number. 3. Why is it necessary to have some body fat? 4. List three roles for subcutaneous fat. 5. What is visceral fat? 6. What is cellulite? 7. Describe at least two differences between brown fat tissues an
The new england journal of medicineAlan Kadish, M.D., Alan Dyer, Ph.D., James P. Daubert, M.D., Rebecca Quigg, M.D., N.A. Mark Estes, M.D., Kelley P. Anderson, M.D., Hugh Calkins, M.D., David Hoch, M.D., Jeffrey Goldberger, M.D., Alaa Shalaby, M.D., William E. Sanders, M.D., Andi Schaechter, B.S.N., R.N., and Joseph H. Levine, M.D., for the Defibrillators in Non-Ischemic Cardiomyopathy T