Medical Research

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Medical Research

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This essay outlines how open source methods of working could be applied to the discovery and development of new medicines. It summarises that there are many potential advantages of an open source approach, such as improved efficiency, the quality and relevance of the research, and wider participation by the scientific and patient communities; a blend of traditional and innovative financing mechanisms will have to be adopted. In order to properly evaluate the effectiveness of an open source methodology and its potential as an alternative model of drug discovery and development, we recommend that new projects be trialled and existing projects scaled up.

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In Uzbekistan, despite stable and relatively high tuberculosis (TB) treatment success rates, relatively high rates of recurrent TB have recently been reported. This requires closer analysis to identify possible causes and recommend interventions to improve the situation. Using countrywide data, this nation-wide retrospective study aimed to analyse trends in recurrent TB cases and describe their associations with socio-demographic and clinical factors. The study compared recurrent TB patients with all new TB patients registered within the National TB Programme (NTP) between January 2006 and December 2010 using routinely collected data. It was concluded that despite signs of declining national TB notifications between 2006 and 2010, the relative proportion of recurrent cases appears to have increased. These findings, together with the identification of possible risk factors associated with recurrent TB, highlight various areas where Uzbekistan needs to focus its TB control efforts, particularly in light of the country’s rapidly emerging multi-drug resistant TB (MDR-TB) epidemic.

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Overuse of antibiotics contributes to the development of antimicrobial resistance. This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. The authors conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2–14 years with upper respiratory infections (URI).  The study concludes that inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significantly high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.

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The burden of hepatitis C (HCV) infection in Pakistan is among the highest in the world, with a reported national HCV prevalence of 6.7% in 2014. In specific populations, such as in urban communities in Karachi, the prevalence is suspected to be higher. Interferon-free treatment for chronic HCV infection (CHC) could allow scale up, simplification and decentralisation of treatment to such communities. This study presents an interim analysis over the course of February-December 2015 of an interferon-free, decentralised CHC programme in the community clinic in Machar Colony, Karachi, Pakistan. It was concluded that the outcomes of HCV treatment with all oral combination in an integrated, decentralised model of care for CHC in a primary care setting, using simplified diagnostic and treatment algorithms, are comparable to the outcomes achieved in clinical trial settings for Sofosbuvir-based regimens. The study suggests the feasibility and the pertinence if interferon-free treatment regimens are included in the national programme, at both provincial and national levels.

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Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology, and antimicrobial resistance are lacking. This is a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care. It was found that women in rural Uganda with postpartum fever have a high rate of antibiotic resistance among cultured urinary and bloodstream infections. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities.

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