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Paragonimiasis in tuberculosis patients in Nagaland, India

December 26, 2016

One of the infections that mimic tuberculosis (TB) is paragonimiasis (PRG), a foodborne parasitic disease caused by lung flukes of the genus Paragonimus. In the northeastern states of India, TB and PRG are endemic; however, PRG is rarely included in the differential diagnosis of TB.

This is a cross-sectional study of patients receiving TB treatment in the Doctors Without Borders/Médecins Sans Frontiéres (MSF)-supported TB programme in Mon district, in collaboration with the Regional Medical Research Centre (RMRC), Dibrugarh, Assam, between November 2012 and December 2013. The aim of the study was to address limited evidence on the dual burden of TB and PRG in northeastern India, and we aimed to document the prevalence of PRG among TB patients using sputum smear, stool examination for children B15 years and ELISA. 

Superior virologic and treatment outcomes: Comparison at 3 months…

December 25, 2016

Routine viral load (VL) monitoring is utilised to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. This study aims to assess the optimal timing of first VL measurement after initiation of ART. It is a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. It was concluded that the first VL at three months rather than six months with targeted adherence interventions may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation.

Emergency department care for trauma patients in settings of…

December 24, 2016

Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Doctors Without Borders/Médecins Sans Frontières (MSF) delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in a similar performance in these very different contexts. This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.

Three Steps to Improve Management of Non-communicable Diseases in…

December 23, 2016

Treatment of non-communicable diseases (NCDs) is particularly challenging in settings affected by humanitarian crises, where insecurity and damaged health systems reduce access to treatment. The evidence base is negligible: a systematic review on the effectiveness of interventions for NCDs in humanitarian settings found just eight studies published over the last 35 years, four of which came from the same refugee camp in Jordan. The diversity of the epidemiology of NCDs and health system characteristics in humanitarian crises preclude a simple “one size fits all” approach. Here, we highlight the key gaps in knowledge and the actions that we believe are required for ensuring NCD care is available to populations in humanitarian crises. 

Ebola, fragile health systems and tuberculosis care: a call…

November 01, 2016

The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; nonpayment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stock outs due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities. This paper highlights that providing tuberculosis (TB) care and achieving favourable treatment outcomes require a fully functioning health system, accurate patient tracking and high patient adherence to treatment. Furthermore, as Ebola is easily transmitted through body fluids, the use of needles – essential for TB diagnosis and treatment— needs to be avoided during an outbreak. We highlight ways in which a sustained Ebola outbreak could jeopardise TB activities and suggest pre-emptive preventive measures while awaiting operational research evidence.

Linezolid-Associated Optic Neuropathy in Drug-Resistant Tuberculosis Patients in Mumbai,…

Patients on linezolid-containing drug-resistant TB (DR-TB) regimen often develop adverse events, particularly peripheral and optic neuropathy. Programmatic data and experiences of linezolid-associated optic neuropathy from high DR-TB burden settings are lacking. The study aimed to determine the frequency of and risk factors associated with linezolid-associated optic neuropathy and document the experiences related to treatment/care of DR-TB patients on linezolid-containing regimens.

The importance of post-partum family planning

The increase in caesarean section rates led the World Health Organization (WHO) to review the guidance from 1985 which stated that there is no justification for any region to have a rate higher than 10–15%. The WHO statement on caesarean section rates from 2015 highlights that caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons; that at population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates; and that the effects of caesarean section rates on other outcomes, such as maternal and perinatal morbidity, paediatric outcomes, and psychological or social well-being, are still unclear and more research is needed to understand the health effects of caesarean section on immediate and future outcomes. In addition, caesarean sections that are medically unjustified increase health care costs unnecessarily. This editorial provides an overview of necessary steps that can be taken by countries world- wide to avert maternal and childhood deaths.

Lessons learnt from TB screening in closed immigration centres…

Between June 2012 and December 2013 Médecins Sans Frontières (MSF) launched a pilot project with the aim of testing a strategy for improving timely diagnosis of active pulmonary TB among migrants hosted in four centres of identification and expulsion (CIE) in Italy. This is a descriptive study. For active TB case finding MSF used an active symptom screening approach among migrants at admission in four CIE’s. It was found that TB screening with symptom screening questionnaires of migrants at admission in closed centres is feasible. However, to improve the yield, follow-up of patients with symptoms or signs suggestive for TB needs to be improved. 

Building Global Capacity for Conducting Operational Research Using the…

Research capacity is weakest in low and middle-income countries (LMICs) where operational research is highly relevant and needed. Structured Operational Research and Training Initiative (SORT IT) courses have been developed to train participants to conduct and publish operational research and influence policy and practice. Twenty courses were completed in Asia, Africa, Europe and the South Pacific between 2009 and 2014 with an objective to assess where the research was conducted, who was trained, who became facilitators in subsequent courses and course outcomes. It was concluded that the SORT IT model has been effective in training personnel to produce relevant operational research in LMICs. It merits continued commitment and support for further scale-up and development.

The Methanol Poisoning Outbreaks in Libya 2013 and Kenya…

September 01, 2016

Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. The researchers, through this paper, describe findings from the first three large outbreaks of methanol poisoning where MSF responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. For this purpose, data were collected from MSF field personnel, local health personnel, hospital files, and media reports. It was interpreted that recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in challenging contexts.

Addressing diabetes mellitus as part of the strategy for…

While this paper is focused predominately on addressing diabetes mellitus (DM) as part of the strategy for ending TB, its content must also be viewed within the wider context of the Sustainable Development Goals (SDGs), which explicitly aim for the first time to reduce morbidity and mortality from both communicable and non-communicable diseases. The SDGs will now drive the international development agenda for the next 15 years. The SDGs, which were first formally discussed at the United Nations Conference on Sustainable Development held in Rio de Janeiro, Brazil, in 2012 (Rio+20), have replaced the eight Millennium Development Goals (MDGs) when these expired at the end of 2015. The MDGs had three health-related goals: MDG 4 (to reduce child mortality), MDG 5 (to improve maternal health) and MDG 6 (to combat AIDS, malaria and other diseases, including TB). The SDGs in contrast have 17 goals and 169 targets, but there is just one overarching health goal (SDG 3: ensure healthy lives and promote well-being for all at all ages) that has 13 health-related targets

Experimental Treatment with Favipiravir for Ebola Virus Disease (the…

Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomised Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumours and distrust of Ebola treatment centres, using a randomised design at the outset might lead even more patients to refuse to seek care. Therefore, the researchers chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardised care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was aimed at quickly gathering standardised preliminary data to optimise the design of future studies.

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