Minerva

Vomiting Larry and other stories . . .

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5886 (Published 01 October 2014) Cite this as: BMJ 2014;349:g5886

When extracts of Artemisia annua were first found to cure malaria, rejoicing was tempered with anxiety that the wily old parasites might quickly develop resistance. But although the suboptimal use of artemisinin drugs in Cambodia has led to the emergence of partially resistant strains of Plasmodium falciparum, they can still be killed by adequate regimens containing artesunate. And so far these strains do not seem to be spreading widely, according to a study in the Journal of Infectious Diseases (2014, doi:10.1093/infdis/jiu491). The main determinant of resistance, a mutation in a kelch protein encoded on chromosome 13, has not yet been seen in malaria parasites in Myanmar (Burma), which neighbours the endemic area.

After a first episode of unprovoked venous thromboembolism (VTE), most patients take anticoagulants for a few months and then stop. In the WARFASA and ASPIRE trials, the annual rate of recurrent VTE thereafter was 7.5%. Looking at the trials separately, 100 mg of aspirin daily failed to have …

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