Mefloquine as a prophylaxis for malaria needs to be revisited

Sleep quality of service members and veterans with and without reports of dizziness

BackgroundMilitary duty may place Service members and Veterans at an increased risk of experiencing dizziness. Individuals with dizziness report poor sleep quality as well as abnormal sleep duration, which is associated with increased risk of falling and worse quality of life. The overall pooled prevalence of poor sleep quality in Service members and Veterans was 69%, but it is not known if Service members and Veterans with self-reported dizziness report poorer sleep quality than their counterparts without dizziness.ObjectiveThe purpose of this research study was to evaluate the sleep quality of Service members and Veterans with and without reports of dizziness.MethodsDescriptive statistics were used to explore the prevalence of self-reported dizziness among Service members and Veterans by demographic characteristics. Descriptive statistics were also used to describe the prevalence of participants' dizziness symptoms and the mean age participants first noticed dizziness. Models (unadjusted and adjusted) were created by regressing sleep disorders and daytime sleepiness on dizziness frequency. Potential confounders were chosen a priori through a theoretical framework. Military status (Service member vs Veteran) was explored as an interaction term. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, with statistical significance determined by the 95% CI.ResultsDizziness was reported by 22.4% of Service members (n = 171 of 763) and 31.7% of Veterans (n = 241 of 761). Service members and Veterans with dizziness were 1.7 times more likely to have a sleep disorder than Service members and Veterans without dizziness.ConclusionsService members and Veterans with dizziness were more likely to have poor sleep quality than those without dizziness. Medical providers should screen for sleep disturbances, evaluate for obstructive sleep apnea, treat chronic insomnia disorder, and consider referral for vestibular rehabilitation in Service members and Veterans presenting with dizziness.

Evaluating the Safety and Efficacy of Malaria Preventive Measures in Pregnant Women with a Focus on HIV Status: A Systematic Review and Network Meta-Analysis

Background and Objectives: Malaria poses significant threats to pregnant women, particularly in endemic regions. Preventive measures against it include insecticide-treated bed nets, intermittent preventive treatment, and various supplements. We aimed to assess and compare the safety and effectiveness of malaria preventive measures in pregnant women, considering their HIV status. Methods: We conducted a systematic search of PubMed, the Cochrane Library, Scopus, Embase, and Web of Science through January 2024. A network meta-analysis was performed using R 4.3.3 software on 35 studies (50,103 participants). Results: In HIV-positive pregnant women, Co-trimoxazole with dihydroartemisinin significantly reduced malaria incidence compared to Co-trimoxazole alone (RR = 0.45, 95% CI [0.30; 0.68]) and sulfadoxine-pyrimethamine (SP) (RR = 0.14, 95% CI [0.04; 0.48]). Mefloquine was also effective compared to controls and SP. In HIV-negative women, azithromycin-piperaquine significantly reduced infections compared to SP, bed nets, and controls (RR = 0.03, 95% CI [0.00; 0.83]; RR = 0.03, 95% CI [0.00; 0.86]; and RR = 0.03, 95% CI [0.00; 0.77], respectively). Conclusion: Different combinations of preventive measures show varying effectiveness based on HIV status. Co-trimoxazole with dihydroartemisinin and mefloquine are effective for HIV-infected pregnant women, while azithromycin-piperaquine and mefloquine work well for those without HIV. Customized prevention strategies considering HIV status are crucial for optimal protection.

In vitro synergistic effects of mefloquine combined with other antimicrobial agents on carbapenem-resistant Enterobacterales

PURPOSE

Human health is seriously threatened by carbapenem-resistant Enterobacterales (CRE) due to the lack of effective treatment. The purpose of this study is to examine the efficacy of mefloquine (MEF) together with multiple drugs against 96 clinical CRE isolates including 94 Klebsiella pneumoniae carbapenemase (KPC)-producers or Metallo-β-lactamases (MBLs)-producers and 2 colistin antibiotic resistance enzyme MCR-1-producers.

METHODS

Using the broth microdilution method, MICs of MEF in combination with multiple antimicrobial agents, including colistin (COL), imipenem, aztreonam-avibactam (ATM-AVI), ceftazidime-avibactam (CAZ-AVI) for 96 CRE isolates were determined. Time-kill assays were implemented for 3 colistin-resistant (COL-R) isolates to analyze in vitro synergistic impacts of COL combined with MEF.

RESULTS

MEF alone showed little antibacterial activity with MICs greater than 128 µg/mL for all the 96 clinical CRE isolates. The addition of MEF (32 µg/mL) increased the sensitivity of almost all strains (98.9%, 95/96) to COL, reducing the MICs range of COL from ≤ 0.0625->8 µg/mL to ≤ 0.004-0.5 µg/mL. In particular, we observed that COL-MEF combination therapy had a significant effect on COL-R isolates, reducing their MICs from resistance to susceptibility. Moreover, the MIC50 and MIC90 of imipenem were both reduced by 2-fold in almost all strains with the addition of MEF (32 µg/mL), and in single MBL-producers, the MIC50 (from 16 to 4 µg/mL) and MIC90 (from 128 to 32 µg/mL) were both reduced by 4-fold. In addition, the MIC50 and MIC90 values of 96 CRE isolates of CAZ-AVI and ATM-AVI did not decrease significantly after combined with MEF (32 µg/mL). For the time-kill assays of 3 COL-R isolates, COL or MEF alone had almost no killing effect, however, when MEF was combined with COL, the isolates were completely killed within 4 h, and NDM-5-producing Klebsiella pneumoniae did not regenerate within 24 h.

CONCLUSIONS

According to our study, COL-MEF may offer a potential alternative for treating CRE infections, especially COL-R Gram-negative bacterial infections.

Synthesis of 5-Seleno-Substituted Spirocyclopenta[b]pyridine-2,5-dien-4-ones and Benzo[h]quinolines via Radical Cyclization of Arylethynylpyridines

A practical strategy for obtaining novel 5-seleno-substituted spirocyclopenta[b]pyridines-2,5-dien-4-ones and benzo[h]quinolines via radical cyclization is reported. The synthetic protocol explores the reaction between arylethynylpyridines and diorganyl diselenides in acetonitrile as solvent and Oxone® as oxidant at 82 °C. This easy-to-handle, eco-friendly metal-free approach was carried out under an open atmosphere, affording functionalized organoselenium compounds in good to excellent yields. Control experiments and scale-up test were performed to demonstrate the efficiency of this methodology.

Antimalarial prophylaxis failure: Malaria in a returning traveler despite mefloquine prophylaxis

This case report presents a perplexing case of Plasmodium malariae breakthrough infection despite prophylaxis with appropriate antimalarial prophylactic regimen of mefloquine in a compliant patient. A 78-year-old missionary who travels each year to the African subcontinent for multiple weeks to months, over 25 years, adheres to stringent antimalarial prophylaxis with Mefloquine as prescribed, starting prior to the trip and continuing after the return to the U.S.A. She gave no prior history of malaria during her 25 years of travel to Africa and back. Since she had no prior history of malaria and due to her excellent compliance with antimalarial regiment, despite her presentation which were suggestive of malaria, neither the patient nor her providers recognized the onset of malaria in this case. Infectious diseases physicians approached this case with an open mind, investigated appropriately, requested appropriate tests, found the presence of malarial parasite, identified as P. malariae species thereafter. She was started on antimalarial treatment in a timely fashion and showed an excellent response. This intriguing recovery of malarial parasite and response to treatment despite the patient being on antimalarial prophylaxis raised the possibility of mefloquine failure as an antimalarial prophylactic agent against P. malariae species.

High-throughput virtual screening approach of natural compounds as target inhibitors of plasmepsin-II

Plasmepsin II is a key enzyme in the life cycle of the Plasmodium falciparum parasite responsible for malaria, a disease that is causing deaths on a worldwide scale. Recently, plasmepsin II enzyme has gained much importance as an attractive drug target for the investigation of antimalarial drugs. In this sense, structure-based virtual screening have been utilized as tools in the process of discovering novel natural compounds based on quinoline as potential plasmepsin II inhibitors. Among the 58 quinoline derivatives isolated from different plants was screened by utilizing docking molecular, ADMET approaches, molecular dynamics simulation and MM-PBSA binding free energy. The first step in this work is building the 3 D structures of the plasmepsin II enzyme by using the SWISS-MODEL software. The optimized structures were subjected to virtual screening by Autodock Vina, an entity implicated in PyRx software. 21 were selected based on their binding affinity. The binding modes and interactions of the top-21 selected compounds were evaluated using AutoDock 4.2. Then, the pharmacokinetic proprieties and toxicity of these compounds were evaluated using ADMET analysis. Ten compounds were predicted to have ADMET characteristics with no side effects. Compounds M49 and M53 were found to be potential inhibitors. The stability of the selected two compounds was confirmed by MD simulation and MM/PBSA calculation during 200 ns. This study can be used to predict and to design new antimalarial drugs.Communicated by Ramaswamy H. Sarma.

Novel Baicalein-Derived Inhibitors of Plasmodium falciparum

Malaria, a life-threatening mosquito-borne disease caused by Plasmodium parasites, continues to pose a significant global health burden. Despite notable progress in combating the disease in recent years, malaria remains prevalent in many regions, particularly in Southeast Asia and most of sub-Saharan Africa, where it claims hundreds of thousands of lives annually. Flavonoids, such as the baicalein class of compounds, are known to have antimalarial properties. In this study, we rationally designed and synthesized a series of baicalein derivatives and identified a lead compound, FNDR-10132, that displayed potent in vitro antimalarial activity against Plasmodium falciparum (P. falciparum), both chloroquine-sensitive (60 nM) and chloroquine-resistant (177 nM) parasites. FNDR-10132 was evaluated for its antimalarial activity in vivo against the chloroquine-resistant strain Plasmodium yoelii N67 in Swiss mice. The oral administration of 100 mg/kg of FNDR-10132 showed 44% parasite suppression on day 4, with a mean survival time of 13.5 ± 2.3 days vs. 8.4 ± 2.3 days of control. Also, FNDR-10132 displayed equivalent activity against the resistant strains of P. falciparum in the 200-300 nM range. This study offers a novel series of antimalarial compounds that could be developed into potent drugs against chloroquine-resistant malarial parasites through further chemistry and DMPK optimization.

Versatile applications of transition metal incorporating quinoline Schiff base metal complexes: An overview

Since the last decade, research on quinoline Schiff base metal complexes has risen substantially due to their versatile applications across many significant fields. Schiff bases are also known as azomethines, aldimines, and imines. Quinoline Schiff base-derived metal complexes are intriguing to study topics. These complexes are employed in biological, analytical, and catalytic fields. Researchers have found that Schiff bases are more biologically active when coordinated with metal ions. Research in the biological sciences has shown that heterocyclic compounds like quinoline and its derivatives are important. Because of their broad spectrum of activity, quinoline derivatives have been discovered to be effective therapeutic agents for various disorders. Even though various classical synthetic pathways mentioned in the literature are still in use, there is an urgent need for a new, more effective method that is safer for the environment, has a higher yield, generates less hazardous waste, and is easier to use. This highlights the critical need for a safe, eco-friendly approach to quinoline scaffold synthesis. This review focuses exclusively on Schiff base metal complexes derived from quinoline, fabricated and studied in the past ten years, and having anticancer, antibacterial, antifungal, antioxidant, antidiabetic, antiproliferative, DNA-intercalation, and cytotoxic activities.

Role of the European Pharmacist in the Implementation of the Latest WHO Guidelines for Malaria

Following the publication a few months ago of the new WHO guidelines for malaria, the European pharmacist, even out of endemic areas, as a health care professional and advisor, has a major role to play in their effective implementation and in the interest of public health. The pharmacist is central in the health care system to ensure the correct application of these recommendations and to perform a decisive role in the prevention of malaria infections, both in the adapted pharmaceutical advice on personal protection against biting vector insects on the one hand, and in the pharmaceutical analysis and recommendations concerning antimalarial chemoprophylaxis prescriptions on the other hand. Physicians and pharmacist biologists, as well as hospital pharmacists, are also important for the analysis and treatment of effective malaria cases, particularly in the management of the diagnostic and therapeutic emergency that a P. falciparum infection represents.

Recent Advances in Imported Malaria Pathogenesis, Diagnosis, and Management

Purpose of Review

Malaria is an important human parasitic disease affecting the population of tropical, subtropical regions as well as travelers to these areas.The purpose of this article is to provide clinicians practicing in non-endemic areas with a comprehensive overview of the recent data on microbiologic and pathophysiologic features of five Plasmodium parasites, clinical presentation of uncomplicated and severe cases, modern diagnostic methods, and treatment of malaria.

Recent Findings

Employment of robust surveillance programs, rapid diagnostic tests, highly active artemisinin-based therapy, and the first malaria vaccine have led to decline in malaria incidence; however, emerging drug resistance, disruptions due to the COVID-19 pandemic, and other socio-economic factors have stalled the progress.

Summary

Clinicians practicing in non-endemic areas such as the United States should consider a diagnosis of malaria in returning travelers presenting with fever, utilize rapid diagnostic tests if available at their practice locations in addition to microscopy, and timely initiate guideline-directed management as delays in treatment can lead to poor clinical outcomes.

Chloroquine-Induced Psychosis: A Case Report

The use of antimalarial drugs for prophylaxis is a widespread practice while traveling to underdeveloped nations, particularly those with a high malaria prevalence. Chloroquine is still one of the most commonly recommended antimalarials, either alone or in combination with others, for prophylaxis. However, its increased use over the past few decades has been associated with many adverse effects, including headaches, dizziness, vomiting, and diarrhea, as well as neuropsychiatric symptoms such as psychosis. Here, we discuss the case of a 30-year-old Asian man who, after starting a 500-milligram (mg) prophylactic dosage of chloroquine per week, developed psychotic symptoms. This case highlights the need to use chloroquine and other antimalarials with care, especially when beginning as a prophylactic measure with the lowest suggested dosage.

Hybrids of 1,4-Quinone with Quinoline Derivatives: Synthesis, Biological Activity, and Molecular Docking with DT-Diaphorase (NQO1)

Hybrids 1,4-quinone with quinoline were obtained by connecting two active structures through an oxygen atom. This strategy allows to obtain new compounds with a high biological activity and suitable bioavailability. Newly synthesized compounds were characterized by various spectroscopic methods. The enzymatic assay used showed that these compounds were a suitable DT-diaphorase (NQO1) substrates as evidenced by increasing enzymatic conversion rates relative to that of streptonigrin. Hybrids were tested in vitro against a panel of human cell lines including melanoma, breast, and lung cancers. They showed also a high cytotoxic activity depending on the type of 1,4-quinone moiety and the applied tumor cell lines. It was found that cytotoxic activity of the studied hybrids was increasing against the cell lines with higher NQO1 protein level, such as breast (MCF-7 and T47D) and lung (A549) cancers. Selected hybrids were tested for the transcriptional activity of the gene encoding a proliferation marker (H3 histone), cell cycle regulators (p53 and p21) and the apoptosis pathway (BCL-2 and BAX). The molecular docking was used to examine the probable interaction between the hybrids and NQO1 protein.