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Communications through mobile phones and mass media have shown to be useful for health promotion activities in developing nations. This study explored the potential association of mothers' mobile phone ownership and mass media exposure on maternal health care services in a developing nation setting: urban Bangladesh. The Urban Health Survey 2013 was examined for antenatal care, delivery assistance, and postnatal care of both mothers and children through multiple regression models, adjusting for sociodemographic factors. Among 8987 ever-married female respondents, 64.1% owned mobile phones and 88% were exposed to mass media (TV, radio or newspaper) at least once a week. Mobile phone ownership was associated with a 48% greater likelihood of access to antenatal care, 34% greater delivery assistance and 31% greater postnatal care of the mother, but no differences were found for postnatal care of children. Similarly, frequent media exposure was associated with increased access to antenatal care (38%) and delivery assistance (46%), but not associated with postnatal care of mothers or children. The results suggested that mobile phones and mass media could be valid avenues for promoting access to maternal health services, and thus, support for mobile phone access and investment in awareness campaigns targeting relevant communities are worthwhile. [ABSTRACT FROM AUTHOR]

Tuberculosis is a major public health problem in developing countries. It is one of the most widely spread human diseases globally. While the new diagnostics for tuberculosis (TB) have created greater interest, their full impact on global propaganda against tuberculosis is yet to be evaluated. Most of the TB cases are prevalent in the underdeveloped and developing regions of the world where the means to diagnose and to treat TB cases are limited. As a result, the infectious TB cases might remain undiagnosed or diagnosed late. So, the need of the hour is to launch a rapid but simple, inexpensive, sensitive and specific test to diagnose TB cases at the earliest. The abundant presence of glutamine synthetase (GS) in the culture filtrate of pathogenic mycobacteria has correlation with the occurrence of poly L-glutamate/glutamine component in the cell wall of these pathogenic mycobacteria but not in non-pathogenic mycobacteria. The GS seems to be stable in the infected host and also is present in host tissues and fluid. GS is demonstrated to be present in the serum of subjects suffering from pulmonary or extra-pulmonary tuberculosis; but not detectable at all in normal control and disease control (lung disease control) subjects. With anti-tubercular (A-TB) drug therapy in pulmonary and extra-pulmonary tubercular subjects, the serum GS levels fall significantly. To confirm that only the Mycobacterium tuberculosis (M. tuberculosis) GS is being assayed, the serum GS activity may be assayed in the presence of L-methionine-S, R-sulfoximine (MSO), a selective inhibitor of M. tuberculosis GS. The concentration of this inhibitor is so selected that it is sufficient to inhibit mycobacterial GS activity but not the human (mammalian) GS activity. It increases the specificity of the test. Thus, an ELISA or latex agglutination test might be inducted to assay the serum GS activity for the rapid and reliable detection of active or latent tubercular subjects and also detecting the presence of drug sensitivity or the emergence of resistance against A-TB drugs. Nevertheless, for rapid field study, the card assay technique might be implemented; where when a drop of serum from a suspected subject be placed on the substrate for GS; a definite colour change would mark the test positive. The assay for serum GS requires only a sample of serum from the patient and takes only few minutes to perform. Therefore, the results will be available instantaneously when the patient is at the medical facility centre or even at home and this will curtail the number of visits to the medical facility centre. This is really advantageous in developing and underdeveloped countries where in many cases the patients do not have the capability of making multiple visits to the medical facility centre. The test procedure can also be used as an assay to monitor the response and success of antitubercular drug therapy. The procedure can very well indicate whether the treatment is successful or a change in the antibiotic drug therapy would be needed. [ABSTRACT FROM AUTHOR]

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Allergic conditions affect more than a quarter of the population in developed countries, but currently available treatments focus more on symptom relief than treating the underlying atopic condition. α-Galactosylceramide (α-GalCer) is a potent immunomodulating compound that has been shown to have a regulatory effect when delivered systemically in nanoparticles. Parenteral delivery is not preferred for chronic conditions, such as allergy, and therefore, the aim of this study was to determine whether a regulatory response could be induced through oral administration in a model of atopy through incorporation of α-GalCer into stable particulate formulations (cationic liposomes, polymerized liposomes and poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs)). The formulations showed only minor changes in particle size, polydispersity index and retention of the model antigen ovalbumin (OVA) during incubation in simulated gastrointestinal (GI) conditions. Oral delivery of α-GalCer in cationic liposomes could induce immunostimulating effects systemically, as seen through increases in serum IgG antibody levels, whereas delivery of α-GalCer in polymerized liposomes and PLGA NPs induced local cytokine changes in the mesenteric lymph nodes (MLNs). The generated responses did not exhibit tolerogenic traits which could be useful for immunoregulation, but the responses generated varied between formulations and suggests that further characterization and optimization could lead to the desired immune response. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Nosocomial infections due to poor hand hygiene are a major cause of increasing morbidity, mortality, and health care costs among hospitalized patients worldwide. Hand hygiene is mandatory to prevent the transmission of health care associated infections especially where infectious diseases are common like Sub-Saharan Africa. Hand washing compliance among health professionals in general is unacceptably low especially in developing countries like Ethiopia. Method. Institution-based cross-sectional study design was used to assess the knowledge and practice of hand washing among health professionals working in Dubti Referral Hospital. Structured self-administered pretested questionnaires were used. The data obtained were analyzed using SPSS version 23. Result. Out of 91 respondents, majority, 60 (65.9%), of them were knowledgeable and 31 (34.1%) were not knowledgeable. However, the majority of health professionals, 51 (56.0%), had poor practice and 40 (43.0%) of them had good practice of hand washing. Conclusion. Majority of health professionals were knowledgeable. However, they had poor practice of hand washing. [ABSTRACT FROM AUTHOR]

Background: Worldwide, intestinal parasitic infections are major cause of human mortality and morbidity especially among developing countries wherein public health standards are not much better like developed countries. Intestinal parasitic infections are linked with poor sanitation, lack of safe drinking water, inadequate dietary and cultural habits and climate conditions. Objective: To assess the frequency, risk factors and clinical manifestations related to intestinal parasite infections in patients with gastrointestinal disorders. Study Design: Cross-sectional multi-centre study. Setting: Department of Medicines, Chandka Medical College Larkana and Civil Hospital, Khairpur Mirs. Period: 1st January 2017 to 31st December 2017. Method: 260 patients, the patients with gastrointestinal disorders presenting one or more symptoms (e.g. diarrhea, dysentery, abdominal pain, nausea and vomiting, cramping and constipation) were included. Results: Frequency of intestinal parasites was 32.3%. The most common parasites were Entamoeba histolytica (10.4%), Giardia lamblia (8.5%) and Hymenolepis nana (6.9%). Age, education, monthly income and contact with animal were significantly associated with intestinal parasite infections. Concerning symptoms, the presence of intestinal parasites infection was significantly associated with diarrhea and dysentery. Conclusion: Study concluded that most prevalent parasites were Entamoeba histolytica, Giardia lamblia and Hymenolepis nana. Significant association was found in age, education and monthly income. [ABSTRACT FROM AUTHOR]

Human Zn deficiency is prevalent in developing countries, and staple grains are commonly bio-fortified to increase their Zn contents. We measured Zn content, distribution, and bioavailability in calcareous soil and in wheat plants ( Triticum aestivum L.) in Shaanxi Province, China, when either an organic Zn-ethylenediaminetetraacetate (Zn-EDTA) or an inorganic zinc sulfate heptahydrate (ZnSO 4 ·7H 2 O) Zn source was banded below the seedbed or broadcasted into soil. Compared with ZnSO 4 ·7H 2 O, Zn-EDTA fertilization produced higher Zn concentration and uptake in wheat plants. However, Zn bioavailability in grain remained low, with [phytate]/[Zn] ratio >15 and the resulting estimated dietary total absorbed zinc (TAZ) < 3 mg Zn/d. ZnSO 4 banded into soil had little short-term effect on grain Zn concentration but had a high residual effect and promoted the maintenance of a high concentration of the Zn fraction bound to loose organic matter (LOM-Zn) in rhizosphere soil. Both ZnSO 4 and Zn-EDTA were more efficient if uniformly mixed through the soil than if banded to soil. Both ZnSO 4 and Zn-EDTA had limited effects on Zn bioavailability in wheat plants due to the high rate of Zn fixation in this calcareous soil. [ABSTRACT FROM AUTHOR]

E. histoloytica is one of the most common protozoa that cause severe diarrhea in humans, leading to significant health problems over the world, particularly in developing countries. To date, the pathogenicity mechanism of this parasite is still incompletely understood. The current study was carried out to investigate the role of IL-17 alongside IFN-γ/IL-4 ratio in immunopathogenesis of E. histolytica infection. Enzyme Linked-Immunosorbant Assay (ELISA) technique was used to assess the level of interleukins in patients who consulted some Babylon Hospitals and private clinics. The results revealed that the mean of the interleukin-17, interleukin-4, IFN-γ levels and IFN-γ/IL-4 ratio were (93.59±25.40, 49.44±11.38, 12.22±13.71, 12.22, respectively) in patients group infected with E. histolytica in comparison to their levels (55.48±18.62, 29.28±11.52, 42.35±17.52 and 42.35) in the control group with statistically significant values (P value <0.05). This finding suggests that there was predominance of Th2 and Th17 over Th1 immune response in patients infected with E. histolytica. [ABSTRACT FROM AUTHOR]

The article discusses research in physical activity (PA) and public health, with a focus on self-report measures of PA in low- and middle-income countries (LMICs). Topics include the use of accelerometers for PA measurement in high-income countries, development and administration of questionnaires, and distinguishing between physical fitness and PA.

Both obesity and DENV infections are growing public health concerns that have far-ranging socioeconomic effects, especially in developing countries. Despite the increasing prevalence of these conditions, there is a scarcity of data investigating the potential relationships between these two entities. Our study aims to examine the influence of obesity on various clinical and laboratory parameters amongst patients with DENV infections. A total of 335 hospitalized patients aged >12 years who were DENV non-structural protein 1 (NS1) antigen-positive were enrolled in this study. Clinical and laboratory variables were compared between patients with and without obesity. Multivariate analysis showed that the following admission clinical findings and laboratory results were independently associated with obesity; chills and rigors (AOR:2.653, 95% CI: 1.286–5.474), higher temperature (AOR:1.485, 95% CI: 1.080–2.042), higher systolic BP (AOR:1.057, 95% CI:1.037–1.078), raised haematocrit (AOR: 1.953, 95% CI: 1.010–3.778), elevated creatinine (AOR:3.504, 95% CI:1.351–9.008) and elevated ALT (AOR: 4.146, 95% CI:1.878–9.154). Obesity was found to be significantly associated with hospitalization >3 days (AOR: 1.990, 95% CI: 1.134–3.494) and the presence of increasing haematocrit with decreasing platelets (AOR: 2.134, 95% CI = 1.235–3.688). Serial assessment of laboratory data revealed that peak haematocrit was significantly higher and nadir platelets levels were significantly lower in obese patients. Both peak and admission levels of leukocyte counts, AST, ALT and creatinine were significantly higher in the obese group. Conversely, both admission and nadir albumin levels were lower for the obese group, although only nadir albumin levels achieved statistical significance. These findings support closer clinical monitoring of obese patients who present with DENV infections, as this patient cohort may possess an increased tendency towards developing more severe clinical manifestations of DENV infections as compared to non-obese patients. [ABSTRACT FROM AUTHOR]

Purpose: To describe long-term mortality and hospital readmissions of patients admitted to Brazilian intensive care units (ICU).Methods: Retrospective cohort study of adult patients admitted to Brazilian hospitals affiliated to the Public Healthcare System from 10 state capitals. ICU patients were paired to non-ICU patients by frequency matching (ratio 1:2), according to postal code and admission semester. Hospitalization records were linked through deterministic linkage to national mortality data. Primary outcome was mortality up to 1 year. Other outcomes were mortality and readmissions at 30 and 90 days and 3 years. Multiple Cox regressions were used adjusting for age, sex, cancer diagnosis, type of hospital, and surgical status.Results: We included 324,594 patients (108,302 ICU and 216,292 non-ICU). ICU patients had increased hospital length of stay [9 (5-17) vs. 3 (1-6) days, p < 0.001] and mortality (18.5 vs. 3.6%, p < 0.001) versus non-ICU patients. One year after discharge, ICU patients were more frequently readmitted to hospital (25.4 vs. 17.4%, p < 0.001) and to ICU (31.4 vs. 7.3%, p < 0.001) than controls. Mortality up to 1 year was also higher for ICU patients (14.3 vs. 3.9%, p < 0.001). A significant interaction between surgical status and mortality was found, with adjusted hazard ratios (HRs) up to 1 year of 2.7 [95% confidence interval (CI) 2.5-2.9] for surgical patients, and 3.4 (95%CI 3.3-3.5) for medical patients. The risk for death and readmission diminished over time up to 3 years.Conclusions: In a public healthcare system of a developing country, ICU patients have excessive long-term mortality and frequent readmissions. The ICU burden tended to reduce over time after hospital discharge. [ABSTRACT FROM AUTHOR]

Burden of tuberculosis still persists in developing countries despite major advances in its treatment strategies. Cutaneous tuberculosis which is a form of extra-pulmonary tuberculosis is seen in a small but significant subset of patients visiting dermatology outpatient services. Cutaneous tuberculosis is characterized by a spectrum of multiple distinct clinical and histopathology presentations. A significant proportion of patients with cutaneous tuberculosis are seen in paediatric age group. Clinical features in children remain mostly the same as that in adults with cutaneous tuberculosis. However, systemic and lymph node involvement and incidence of disseminated disease is observed more commonly in paediatric age group . Awareness among clinicians of the clinical manifestations of cutaneous tuberculosis is of paramount importance for early diagnosis and management of cases with paediatric cutaneous tuberculosis. This would significantly prevent morbidity and complications of the disease . This review aims to discuss the epidemiology, clinical and histopathological features, diagnosis, differential diagnosis and treatment options in children with tuberculosis, especially in the Indian context. [ABSTRACT FROM AUTHOR]

In high-income countries, there is an increased tendency to replace inactivated seasonal trivalent influenza (TIV) vaccines with quadrivalent (QIV) vaccines as these are considered to give a greater public health benefit. In addition, several recent studies from the USA and Europe indicate that replacement with QIV might also be cost-effective; however, the situation in low- and middle-income countries (LMIC) is less clear as few studies have investigated this aspect. The paper by de Boer et al. (2008) describes a dynamic modelling study commissioned by WHO that suggests that in LMICs, under certain conditions, QIV might also be more cost-effective than TIV. In this commentary, we discuss some important aspects that policymakers in LMICs might wish to take into account when considering replacing TIV by QIV. Indeed, from the data presented in the paper by de Boer et al. it can be inferred that replacing QIV for TIV would mean a 25–29% budget increase for seasonal influenza vaccination in South Africa and Vietnam, resulting in an incremental influenza-related health impact reduction of only 7–8% when a 10% symptomatic attack rate is assumed. We argue that national health budget considerations in LMIC might lead decision-makers to choose other investments with higher health impact for a budget equivalent to roughly a quarter of the yearly TIV immunization costs. In addition to an increased annual cost that would be associated with a decision to replace TIV with QIV, there would be an increased pressure on manufacturers to produce QIV in time for the influenza season requiring manufacturers to produce some components of the seasonal vaccine at risk prior to the WHO recommendations for influenza vaccines. Unless the current uncertainties, impracticalities and increased costs associated with QIVs are resolved, TIVs are likely to remain the more attractive option for many LMICs. Each country should establish its context-specific process for decision-making based on national data on disease burden and costs in order to determine whether the health gains out-weigh the additional cost of moving to QIV. For example, immunizing more people in the population, especially those in higher risk groups, with TIV might not only provide better value for money but also deliver better health outcomes in LMICs. Countries with local influenza vaccine manufacturing capacity should include in their seasonal influenza vaccine procurement process an analysis of the pros- and cons- of TIV versus QIV, to ensure both feasibility and sustainability of local manufacturing. [ABSTRACT FROM AUTHOR]

Objectives: Malnutrition in children under five years is a serious public health problem in developing countries, particularly in Africa and Asia regions. Child malnutrition has contibuted to 54% of deaths among children under five. This systematic review aimed to identify the determinants of malnutrition in children under five years in developing countries. Method: This study searched several electronic databases, namely Proquest, Scopus, Web of Science, Pubmed, and Medline Ovid. The final rearch obtained 36 articles and were reviewed. Results: Malnutrition in children under five years were determined by parental education, drinking water sources, toilet facilities, and income. Conclusions: Child malnutrition is generated by no single factors, so dealing with child malnutrition will need comprehencive strategies. [ABSTRACT FROM AUTHOR]

The Trypanosoma and Toxoplasma spp, are etiological agents of diseases capable of causing significant morbidity, mortality and economic burden, predominantly in developing countries. Currently, there are no effective vaccines for the diseases caused by these parasites; therefore, therapy relies heavily on antiprotozoal drugs. However, the treatment options for these parasitic diseases are limited, thus underscoring the need for new anti-protozoal agents. Here, we investigated the anti-parasite action of nanoparticles. We found that the nanoparticles have strong and selective in vitro activity against T. b. brucei but moderate in vitro activity against T. congolense and T. evansi. An estimation of the in vitro anti-Trypanosoma efficacy showed that the nanoparticles had ≥200-fold selective activity against the parasite versus mammalian cells. Moreover, the nanoparticle alloys moderately suppressed the in vitro growth of T. gondii by ≥60%. In our in vivo study, the nanoparticles appeared to exhibit a trypanostatic effect, but did not totally suppress the rat parasite burden, thereby failing to appreciably extend the survival time of infected animals compared with the untreated control. In conclusion, this is the first study to demonstrate the selective in vitro anti-Trypanosoma action of nanoparticles and thus supports the potential of nanoparticles as alternative anti-parasitic agents. [ABSTRACT FROM AUTHOR]

Current approaches to the development of water services such as water supply, sanitation, and hygiene in the Global South are driven by the aim to secure people's rights to access such services. In this literature-based paper, we illustrate how such an interpretation of access limits the ability of development efforts in the sector to (i) address power inequities mediating access to water services, and; (ii) acknowledge and strengthen wellbeing factors implicated with water services beyond basic health. We argue that maintaining the current interpretation of access limits the ability of development initiatives in the water sector to address pressing issues mediating people's ability to benefit from water services. To address these limitations, we propose a reinterpretation of the goal of securing access in international development frameworks grounded in Ribot and Peluso's (2003) theory of access and Amartya Sen’s (1999, 2008, 2013) Capability Approach to human development. Such a reinterpretation strengthens the capacity of global efforts to improve water services to not only foster good health, but also address inequity and other dimensions of human wellbeing such as livelihoods and education. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs). Design: Nationally representative, cross‐sectional, community‐based study. Setting: Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health. Participants: Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female). Measurements: The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI. Results: The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1–51.5%) and of MCI was 15.3% (95% CI=14.4–16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03–1.42; ≥4 conditions: OR=2.07, 95% CI=1.70–2.52). Conclusion: These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs. [ABSTRACT FROM AUTHOR]

Blastocystis is an enteric Straminopile in tropical, subtropical and developing countries. Metronidazole has been a chemotheraputic for blastocystosis. Failures in its regimens were reported and necessitate new studies searching for alternative therapeutic agents. Aim of current study is to investigate potential effects of Atorvastatin (AVA) compared to the conventional chemotherapeutic MTZ in experimentally Blastocystis-infected mice. Anti-Blastocystis efficacy of AVA was evaluated parasitologically, histopathologically and by transmission electron microscopy using MTZ (10 mg/kg) as a control. Therapeutic efficacy of AVA was apparently dose-dependent. Regimens of AVA (20 and 40 mg/kg) proved effective against Blastocystis infections with high reduction in Blastocystis shedding (93.4-97.9%) compared to MTZ (79.3%). The highest reductions (98.1% and 99.4%) were recorded in groups of combination treatments AVA 20-40 mg/kg and MTZ 10 mg/kg. Blastocystis was nearly eradicated by the 20th day post infection. Genotype analysis revealed that genotype I was most susceptible, genotype III was less. Histopathologic and ultrastructural studies revealed apoptotic changes in Blastocystis and significant improvement of intestinal histopathological changes more remarkable in combinational therapy groups. Thus, the present study offers AVA as a potential candidate for Blastocystis therapy combined with MTZ. [ABSTRACT FROM AUTHOR]

Observed changes in eating and drinking behaviors in economically developing countries are associated with increase of obesity and related chronic diseases. Researchers from field of public health (PH) have attributed this problem to food processing and have created new food classification systems to support their thesis. These classifications conceptually differ from processing level concepts in food science, and state to people that food processing is directly related to nutritional impact of food. Our work aims to compare the concept of food processing from the standpoint of food science and technology (FST) and public health and to discuss differences related to formulation or level of processing of products and their impact on nutritional quality. There is a misconception between food processing/unit operation/food technology and formulation or recipes. For the public health approach, classification is based on food products selection and the use of ingredients that results in higher consumption of sugar, sodium, fat, and additives, whereas in FST, processing level is based on the intensity and amount of unit operations to enhance shelf life, food safety, food quality, and availability of edible parts of raw materials. Nutritional quality of a product or preparation is associated with formulation/recipe and not with the level of processing, with few exceptions. The impact of these recommendations on the actual comprehension of food processing and quality must be considered by the population. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminth infections are among the most common infections in developing countries. Globally, as many as 2 billion people are considered to be at risk for soil-transmitted-helminth (STH) infections. Preschool children (PSAC), school-age children (SAC) and women of reproductive age (WRA) are at high risk of STH-attributable morbidity and preventive chemotherapy (PC) for STH is recommended by the World health Organization (WHO). Methodology/Principal findings: Over the last five years, PC coverage in PSAC and SAC has gradually increased, while coverage in WRA has lagged. Estimating the numbers of WRA in each endemic country would inform scale-up in this group. A two-step process was used: 1) total numbers of girls and women between 15 and 49 years of age were obtained from the United Nations World Population Prospects 2015 database; and 2) the proportion in need of PC was obtained primarily from extrapolation from the WHO PC Databank. WRA were divided into four sub-groups reflecting different reproductive life stages, each having a potentially different interface with the health care system and, consequently, presenting different opportunities for intervention strategies. Worldwide, we estimated that 688 million WRA in 102 countries were in need of PC for STH in 2015. The South-East Asia (49%) and Africa regions (26%) had the highest numbers. Adolescent girls accounted for 16%, while pregnant and lactating women each represented 10%. Over 25 million pregnant women alone were estimated living in areas where the prevalence of hookworm and T. trichiura infection was ≥ 20%. Approximately 20% of at-risk WRA had received deworming with albendazole through the Global Programme to Eliminate Filariasis. Conclusions/Significance: To close current gaps in coverage, numbers of WRA in need of PC for STH are essential for operational strategies to control STH infection. [ABSTRACT FROM AUTHOR]

Introduction: Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries. Methods: A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). Results: Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231–3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395–4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs. Conclusion: ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations. [ABSTRACT FROM AUTHOR]

Intestinal parasitic infections (IPIs) represent a major public health problem in children worldwide, especially in the developing countries. The impact of these infections on the health status of children depends on the parasite species, the intensity and course of infection, and nutritional and immunological status of the children. Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum, Enterobius vermicularis, Hymenolepis nana, Ascaris lumbricoides, and Ancylostoma duodenale are the most frequent intestinal parasites found among children. This review discussed themain consequences resulting from IPIs as diarrhea, anemia, malnutrition, impaired growth, and learning disabilities. [ABSTRACT FROM AUTHOR]

Toxocariasis, a parasitic infection, carries a major health risk in children, especially in the developing countries. Children are the most infected group because of their undeveloped immune system, their higher exposure to infection, and the frequency of reinfections depending on the factors related to their hygienic and behavioral habits. Many human infections are asymptomatic, with only eosinophilia and positive serology. However, several complications were associated with this neglected disease. These complications depend on the organs invaded by migrating Toxocara larvae, the degree of the larvae burden, and the strength of the host immune response. This review aims at giving an update on clinical manifestations, diagnosis, and treatment of toxocariasis in children. The pediatricians should merge this information into their clinical diagnosis to defeat this neglected disease by establishing the correct diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Among the causes of corneal blindness in developing countries, infectious keratitis tops the list. Corneal ulceration results in 1.5-2 million new cases of corneal blindness annually posing a major public health problem, according to the World Health Organization (WHO) reports.1 Fungi are the most common etiological agents which account for 30-40% whereas bacteria account for 13-48% of all cases of suppurative keratitis varying by the geographical area. An intact corneal epithelium doesn't allow majority of the microorganisms to enter the eyeball. This study was conducted at the Department of Ophthalmology, National Institiute of Medical Sciences (NIMS), Jaipur, Rajasthan over a period of 15 months. Study was conducted on 60 patients who came in Ophthalmology OPD of Department of Ophthalmology, National Institiute of Medical Sciences (NIMS) with the clinical presentation suggestive of fungal keratitis and microbiologically proven fungal infection. Hence, it can be stated that Voriconazole is comparable to Natamycin in coverage of fungal spectrum but may be more useful in controlling the fungal corneal infection with deeper infiltration of the corneal layers and into the anterior chamber. Voriconazole may decrease the chances of complications of deeper fungal corneal infections such as perforation and endophthalmitis and helps in faster control of fungal keratitis. [ABSTRACT FROM AUTHOR]

INTODUCTION: Chronic liver diseases (CLD) are characterized by liver injury, chronic inflammation and finally by progressive substitution of liver parenchyma by scar tissue. Vitamin-D insufficiency and deficiency are prevalent in almost half the healthy population of developed countries. The scores used to assess the prognosis of CLD are the Child-Pugh (CP) score and the Model for end-stage liver disease (MELD) score. To understand the relationship between vitamin-D levels and prognosis of CLD, it has to be compared with prognostic scores like CP and MELD.The objective of this study is to compare the levels of vitamin-D with the severity scores of liver disease like Child-Pugh (CP) score and Model for End-stage Liver Disease (MELD). METHOD: After obtaining approval of human ethics committee, in a sample size of 100 CLD patients, data such as age, gender, etiology of CLD, vitamin-D, CP score, MELD score, and liver function tests were obtained. Data was entered in Microsoft Excel. Analysis was done and expressed in Mean±SD, percentages and frequencies. OBSERVATION AND RESULTS: A total of 100 chronic liver disease patients of various etiologies were included in the study, out of which 88% were males. The mean age group of the subjects was 50.36±20.48 years. Among the study population, 91% had low vitamin D levels. 56% of the cases were alcoholic liver disease and the remaining etiologies included NAFLD, Viral, autoimmune and others. Among the vitamin D deficient cases (n=82), 56 belong to the Child Pugh- C score (45% of one year survival). There was no significant correlation between the MELD score and vitamin-D levels in the study population. CONCLUSION: It is found that patients with very low vitamin-D levels had the worst prognosis measured using Child Pugh score. Maintenance of normal vitamin-D levels will provide a better prognosis and a better quality of life for CLD patients under treatment. [ABSTRACT FROM AUTHOR]

Genomic medicine has greatly matured in terms of its technical capabilities, but the diffusion of genomic innovations worldwide faces significant barriers beyond mere access to technology. New global development strategies are sorely needed for biotechnologies such as genomics and their applications toward precision medicine without borders. Moreover, diffusion of genomic medicine globally cannot adhere to a 'one-size-fits-all-countries' development strategy, in the same way that drug treatments should be customized. This begs a timely, difficult but crucial question: How should developing countries, and the resource-limited regions of developed countries, invest in genomic medicine? Although a full-scale investment in infrastructure from discovery to the translational implementation of genomic science is ideal, this may not always be feasible in all countries at all times. A simple 'transplantation of genomics' from developed to developing countries is unlikely to be feasible. Nor should developing countries be seen as simple recipients and beneficiaries of genomic medicine developed elsewhere because important advances in genomic medicine have materialized in developing countries as well. There are several noteworthy examples of genomic medicine success stories involving resource-limited settings that are contextualized and described in this global genomic medicine innovation analysis. In addition, we outline here a new long-term development strategy for global genomic medicine in a way that recognizes the individual country's pressing public health priorities and disease burdens. We term this approach the 'Fast-Second Winner' model of innovation that supports innovation commencing not only 'upstream' of discovery science but also 'mid-stream,' building on emerging highly promising biomarker and diagnostic candidates from the global science discovery pipeline, based on the unique needs of each country. A mid-stream entry into innovation can enhance collective learning from other innovators' mistakes upstream in discovery science and boost the probability of success for translation and implementation when resources are limited. This à la carte model of global innovation and development strategy offers multiple entry points into the global genomics innovation ecosystem for developing countries, whether or not extensive and expensive discovery infrastructures are already in place. Ultimately, broadening our thinking beyond the linear model of innovation will help us to enable the vision and practice of genomics without borders in both developed and resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: Caesarean section (CS) wound infections represent a substantial burden to the health system and the prevention of such infections should be a healthcare priority in developing countries. Aim and objectives: Prospective study aimed to evaluate all postoperative wound sepsis or fever cases at KGH, VSP during 6 months period of time January and June 2017. Materials and methods: All postoperative cases with wound sepsis were evaluated. Detailed clinical data, investigations, bacteriological evaluation, sensitivity to antibiotics noted. Results: A total no of 1000 cases with postoperative sepsis in a 6months period of time was followed and results were analyzed. Conclusion: All postoperative cases with wound sepsis and fever were analyzed for etiological factors, associated co morbid factors and their sensitivity to antibiotics noted. [ABSTRACT FROM AUTHOR]

Detection and control of infectious diseases is a major problem, especially in developing countries. Lateral flow immunoassays can be used with great success for the detection of infectious diseases. However, for the quantification of their results an electronic reader is required. This paper presents an optimized handheld electronic reader for developing countries. It features a potentially low-cost, low-power, battery-operated device with no added optical accessories. The operation of this proof of concept device is based on measuring the reflected light from the lateral flow immunoassay and translating it into the concentration of the specific analyte of interest. Characterization of the surface of the lateral flow immunoassay has been performed in order to accurately model its response to the incident light. Ray trace simulations have been performed to optimize the system and achieve maximum sensitivity by placing all the components in optimum positions. A microcontroller enables all the signal processing to be performed on the device and a Bluetooth module allows transmission of the results wirelessly to a mobile phone app. Its performance has been validated using lateral flow immunoassays with influenza A nucleoprotein in the concentration range of 0.5 ng/mL to 200 ng/mL. [ABSTRACT FROM AUTHOR]

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The protozoan parasite Entamoeba histolytica causes amoebiasis, a major public health problem in developing countries. Motility of E. histolytica is important for its pathogenesis. Blebbing is an essential process contributing to cellular motility in many systems. In mammalian cells, formation of plasma membrane blebs is regulated by Rho-GTPases through its effectors, such as Rho kinase, mDia1, and acto-myosin proteins. In this study, we have illuminated the role of EhRho1 in bleb formation and motility of E. histolytica. EhRho1 was found at the site of bleb formation in plasma membrane of trophozoites. Overexpression of mutant EhRho1 defective for Guanosine triphosphate (GTP)-binding or down-regulating EhRho1 by antisense RNA resulted in reduced blebbing and motility. Moreover, serum-starvation reduced blebbing that was restored on serum-replenishment. Lysophosphatidic acid treatment induced bleb formation, whereas wortmannin inhibited the process. In all these cases, concentration of GTP-EhRho1 (active) and Phosphatidylinositol 4,5-bisphosphate (PIP2) inversely correlated with the level of plasma membrane blebbing. Our study suggests the role of EhRho1 in blebbing and bleb-based motility through PI3 kinase pathway in E. histolytica. [ABSTRACT FROM AUTHOR]

With recent economic development in Southeast Asia, there have been improvements in medical services and healthcare provision. This has led to increased numbers of dialysis patients and increased numbers of dialysis facilities in the region. To assist economically developing countries in managing this change, support projects from Japan have been conducted in the region since around 2007. This article summarizes and discusses Japan's support activities, in which some of the authors were directly involved, in Vietnam, Cambodia, and Myanmar. Initial support was mainly organized by the non-governmental organization Ubiquitous Blood Purification International (NGO UBPI), and currently several organizations in the field of blood purification work together to offer ongoing support in the region. Many positive changes have resulted from these activities in Southeast Asia, but challenges remaining for the future are to establish an educational system for each dialysis specialty and develop dialysis techniques ensuring high treatment quality and safety. [ABSTRACT FROM AUTHOR]

Objective To summarize information on Neurogenic Bladder (NB) epidemiology, management and access to patient treatment in developing countries and emerging regions of the world in order to propose future interventions and help governmental as well as non-governmental organizations design their action plans. Methods Different search methods were used to gather the maximum available data. They included strategic searches; reference checks; grey literature searches (reports, working papers, government documents, civil society information); contacting professional societies, registries, and authors; requesting unpublished data from organizations; and browsing related websites and journals. Results The incidence and prevalence rates of NB in developing countries are difficult to establish because epidemiological reports are few and far between. The frequency of bladder dysfunction in neurologically impaired populations can be approximately estimated in some of these countries. Similar information paucity affects diagnostic and therapeutic approaches to NB patients living in less-developed regions of the world. The assessment and management of NB seems to vary markedly between countries, and care of patients from emerging regions of the world is often inadequate. Conclusion Strong concerted efforts are needed on the part of international scientific societies, non-governmental organizations and local governments to work together to change the prognosis for these patients and to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: Tuberculous meningitis is a life-threatening manifestation resulting from infection by Mycobacterium tuberculosis, especially in the developing countries. The molecular aspects of pathogenesis of tuberculous meningitis remain poorly understood. We evaluated the correlation of cerebrospinal fluid (CSF) and serum cytokine levels with the clinical outcome of 15 HIV-negative patients with tuberculous meningitis. We also assessed the association of CSF and serum cytokines with neuroimaging of brain findings in the patients. Methods: The prospective longitudinal study was conducted at the University Malaya Medical Centre between 2012 and 2014. Neuroimaging of the brain was performed and the findings of leptomeningeal enhancement, hydrocephalus, tuberculoma, infarcts and vasculopathy were recorded. The CSF and serum specimens were analyzed for IL-1ß, IL-8, IL-10, IL-18, IP-10, IFN-γ, MCP-1, TGF-ß, VEGF, TNF-α, IL-18BPa and MMP-9. The clinical outcome was graded at 3 months based on Modified Rankin scale (mRS). Results: On admission and at one month of anti-tuberculosis treatment, the CSF levels of IL-8, IL-1β, IP-10, IFN-γ and VEGF were elevated in all of the patients. Serum IP-10, MCP-1, IL-1β and IL-8 levels were increased on admission and at one month of anti-tuberculosis treatment. There were statistically significant differences between good and poor outcome (mRS at 3 months) for CSF IFN-γ (p=0.033), CSF IL-10 (p=0.033) and serum VEGF (p=0.033) at one month of treatment. None of the patients showed any association between CSF and serum cytokines on admission and at one month of anti-tuberculosis treatment with neuro-radiological findings. Conclusion: The CSF cytokine levels were not related to TBM disease severity on admission, and changes on MRI/CT scans. CSF levels of IFN-γ and IL-10 at one month of anti-tuberculosis treatment were associated with clinical outcome at 3 months. CSF cytokine levels on admission were not associated with the clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis remains a public health problem in developing countries and is associated with lethal central nervous system complications. Intracranial tuberculomas occur in 13% of children with neurotuberculosis. Patients with trisomy 21 have an increased risk for stroke, which usually stems from cardiovascular defects.Case Presentation: We report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness. The results of neuroimaging and histopathological examinations were consistent with cerebral tuberculoma. The patient had a good initial response to antituberculosis drugs and steroids. To the best of our knowledge, this is the first case report of multiple brain tuberculomas described in a child with trisomy 21.Conclusions: Patients with trisomy 21 have an increased risk for stroke. Our patient had an exceptional case of stroke caused by tuberculoma. The present case emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurological symptoms living in areas of high tuberculosis incidence. [ABSTRACT FROM AUTHOR]

This study contributes to existing research on the relative effectiveness of aid initiatives in addressing food insecurity in India. Specifically, it compares the effects of crop, livestock, credit, and WASH interventions implemented by a development NGO with the impacts of a public direct-transfer scheme on food security among communities in Uttar Pradesh. The NGO’s agricultural and WASH interventions and the government’s Antyodaya ration-card scheme appear to have the largest positive influence. Their positive impact can be enhanced by the presence of good governance and by the simultaneous application of several beneficial initiatives.ABSTRACT FROM PUBLISHER [ABSTRACT FROM AUTHOR]

A growing body of evidence demonstrates that incorporating approaches to address gender inequality in programmes can lead to improved health outcomes. This article aims to deconstruct the various dimensions of gender and identify how programmes address these domains to improve health. This study draws on a broader systematic review examining the impact of gender-integrated programmes on health outcomes in low- and middle-income countries. We identified 68 programmes meeting our criteria for inclusion. Our analysis found considerable variation in gender domains addressed across programmes, suggesting that more evidence is needed to understand the pathways through which gender-integrated programmes influence health.ABSTRACT FROM PUBLISHER [ABSTRACT FROM AUTHOR]

Poor infrastructure in developing countries, combined with challenging geographical characteristics, is associated with problems of limited access to resources, poor transportation and environmental health issues. In some developing countries, there are no heating systems during the winter season, which causes problems for both people and livestock. The most common heating source is from open fires using biomass from animal and plant residue, which are also used for cooking. Fireplaces are typically located inside the house, which can lead to respiratory health problems because of limited ventilation. Thus, heating systems with proper ventilation are desirable to mitigate health problems and improve living conditions. Here we describe the application of ‘Ondol’, a traditional Korean heating system that was redesigned for improved efficiency, in remote villages in a mountainous region of Nepal. Total 10 models of Ondol were designed and fabricated, and the temperature profile and uniformity were characterized to select the optimal design. The height and type of the ‘Gorae’ were the most important factors in determining the efficiency. The optimal design was provided to local people, who were trained to replicate and build the Ondol on their own. A post-installation survey was carried out to evaluate the effectiveness of the system. [ABSTRACT FROM AUTHOR]

Introduction: Salmonellosis, a zoonotic and foodborne disease, is a public health problem in developing countries. With the aim of identifying human carriers of Salmonella, a survey was performed in five regions of Colombia with reported salmonellosis outbreaks. Methodology: The general population and cholecystectomy surgical patients were included in this study. Stool samples from 667 volunteers and gallbladder bile samples from 199 surgical patients were examined. Detection of Salmonella from cultured stool and bile samples was determined by polymerase chain reaction (PCR). Multiplex PCR and biochemical and serological tests were performed to identify the serovars of the isolates. Results: Nine (1.35%) stool samples were positive for Salmonella: two S. Newport, two S. Anatum, one S. Sinstorf, and four Salmonella spp. A total of 11 gallbladder bile samples were positive: S. Enteritidis was isolated from 3 bile cultures (1.5%), and 8 samples (4%) were positive for Salmonella spp. Conclusions: Our results show the presence of Salmonella carriers in the inhabitants of regions with reported outbreaks and suggest that these carriers are potential sources of infection in endemic and epidemic cases. Carriers also suggest Salmonella zoonotic transmission, since broiler and beef cattle are hosts to the Salmonella serotypes isolated. It is important to establish the source of infection in regions where salmonellosis is endemic in order to control transmission. [ABSTRACT FROM AUTHOR]

Protein malnutrition (PM) is a major public health problem in developing countries, affecting the inflammatory response and increasing susceptibility to opportunistic infections. For this reason, an adequate nutritional intervention can improve the quality of life of patients. Glutamine (GLN) is a nonessential amino acid, but can be considered 'conditionally essential' for macrophage function in stress situations, in which it plays a role in the improvement of the inflammatory response. Concerning this issue, in the current study, it was of interest to evaluate some biological aspects of peritoneal cells from a protein malnutrition (PM) mouse model challenged with lipopolysaccharide (LPS) and treated intravenously with GLN. Two-month-old male Balb/c mice were subjected to a low-protein diet (2 % protein) and stimulated intravenously with LPS 1 h prior to the injection of 0.75 mg/kg GLN. Malnourished animals showed a reduced number of total peritoneal cells. Malnourished animals stimulated with LPS or LPS plus GLN did not show differences in peritoneal cell counts; however, the control group showed increased cellularity after LPS stimulus, which was reversed after GLN injection. Further, in the animals from both groups stimulated with LPS, GLN decreased the circulating levels of TNF-α and the levels of TNF-α produced by peritoneal cells; additionally, GLN decreased the IL-10 circulating levels in the malnourished animals stimulated with LPS. In addition, peritoneal cells of the control and malnourished groups stimulated with LPS showed a negative modulation of the NFkB signaling pathway after GLN injection. In conclusion, this study shows that GLN has the capacity to reduce TNF-α synthesis as well as to act as a negative regulator of NFkB phosphorylation, leading to a positive outcome in the control of TNF-α production. [ABSTRACT FROM AUTHOR]

Brucellosis is a transmissible disease between humans and animals through infected animals and their products. The disease exists in most parts of the world especially in developing countries. Because of the serious impact of the disease in public health and socio-economical status, controlling the disease is very important in developing countries. The purpose of this article is to identify hidden patterns and relations between brucellosis patients which can be beneficial for physicians in diagnosis process. This study is a retrospective study of data collected from brucellosis patients of Razavi Khorasan province recorded at the health center, have been used. Due to differences in format and number of features collected during different years, before processing operations carried out in several stages to the same data. Fields associated with different methods and with expert opinion was converted into discrete fields and fields lost was estimated using the EM algorithm. APPIORI algorithm analysis was performed using the hidden relationships between data found that significant relationships were infected with expert opinion. Among the 163 relationship with over 7.0 Confidence rate which Weka software was discovered, by the application in consultation with an infectious disease expert, 10 clinically significant relationships were reported. Diagnosing brucellosis is really difficult to physicians because of its vague nature and symptoms. Because many unknown relationships between risk factors and demographic characteristics of the patients, the use of data mining concepts, especially in the medical data is beneficial because usually high volume assumptions are available. Further studies can test the validity of these rules like Randomize Control Trial studies. [ABSTRACT FROM AUTHOR]

Background: Developing countries have an estimate of ten times more approved biosimilars than developed countries. This disparity demands the need of an objective regulation that incorporates health policies according to the technological and economical capabilities of each country. One of the challenges lies on the establishment of comparability principles based on a physicochemical and biological characterization that should determine the extent of additional non-clinical and clinical studies. This is particularly relevant for licensed biosimilars in developing countries, which have an extensive clinical experience since their approval as generics, in some cases more than a decade. To exemplify the current status of biosimilars in Mexico, a characterization exercise was conducted on licensed filgrastim biosimilars using pharmacopeial and extended characterization methodologies. Results: Most of the evaluated products complied with the pharmacopeial criteria and showed comparability in their Critical Quality Attributes (CQAs) towards the reference product. These results were expected in accordance with their equivalent performance during their licensing as generics. Accordingly, a rational approval and registration renewal scheme for biosimilars is proposed, that considers the proper identification of CQAs and its thoroughly evaluation using selected techniques. Conclusions: This approach provides support to diminish uncertainty of exhibiting different pharmacological profiles and narrows or even avoids the necessity of comparative clinical studies. Ultimately, this proposal is intended to improve the accessibility to high quality biosimilars in Latin America and other developing countries. [ABSTRACT FROM AUTHOR]

The aim of this study is to propose a territorial measure of maternal and child health in the least developed countries of Asia based on the criteria established in the United Nations Millennium Development Goals 4 and 5 , in a context in which international progress between countries has been uneven up to 2013. Pena's DP method is used to compose a synthetic indicator of MDGs 4 and 5 levels for 2013, the last year for which data are available. The index includes information on different variables defined in the Millennium Declaration, as well as a study of the impact of each individual indicator on the outcome of the synthetic indicator of MDGs 4 and 5 levels, and enables classification of these countries in terms of these variables. [ABSTRACT FROM AUTHOR]

Background: Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions, particularly in low- and middle-income countries (LMICs). Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions. Current CRT reporting guidelines offer no guidance on IF assessment. We will systematically review the scientific literature to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs. Methods: We will include CRTs of public health interventions in LMICs that planned or assessed IF in either the trial protocol or the main trial report (or an associated document). Search strategies use Medical Subject Headings (MESH) and text words related to CRTs, developing countries, and public health interventions. The electronic database search was developed first for MEDLINE and adapted for the following databases: EMBASE, CINAHL, PubMed, and EMB Reviews, to identify CRT reports in English, Spanish, or French published on or after January 1, 2012. To ensure availability of a study protocol, we will include CRTs reporting a registration number in the abstract. For each included study, we will compare planned versus reported assessment of IF, and consider the dimensions of IF studied, and data collection methods used to evaluate each dimension. Data will be synthesised using quantitative and narrative techniques. Risk of bias for individual studies will be assessed using the Cochrane Collaboration Risk of Bias Tool criteria and additional criteria related to CRT methods. We will investigate possible sources of heterogeneity by performing subgroup analysis. This review was not eligible for inclusion in the PROSPERO registry. Discussion: Fidelity assessment may be a key tool for making studies more reliable, internally valid, and externally generalizable. This review will provide a portrait of current practices related to the assessment of intervention fidelity in CRTs and offer suggestions for improvement. Results will be relevant to researchers, those who finance health interventions, and for decision-makers who seek the best evidence on public health interventions. [ABSTRACT FROM AUTHOR]

Background: We investigated predictors of in-hospital mortality and length of hospital stay among adults with community-acquired pneumonia (CAP) in Nigeria in order to provide recommendations to improve CAP outcomes in developing countries. Methods: This was a multi-centre case control study of patients ≥18 years who were admitted with CAP between 2008 and 2012. Case notes of 100 consecutive patients who died (cases) and random sample of 300 patients discharged (controls) were selected. Results: Mean ages were 55.4±19.6 (cases) and 49.3±19.2 (controls). Independent predictors of mortality were CURB-65 score ≥3: adjusted odds ratio (aOR) 24.3, late presentation: aOR 8.6, co-morbidity: aOR 3.9, delayed first dose antibiotics (>4 hours): aOR 3.5, need for supplemental oxygen: aOR 4.9, multilobar pneumonia: aOR 4.0, non-pneumococcal aetiology: aOR 6.5, anaemia: aOR 3.8 and hyperglycemia: aOR 8.6. CURB-65 ≥3 predicted mortality with a high specificity (96.1%) but low sensitivity (75%); positive predictive value of 88.2% and negative predictive value of 90.8%. Care in hospital A and B: aOR 3.3 and 2.2 respectively, male gender aOR 2.1, co-morbidity aOR 3.0, anaemia aOR 2.1 and elevated serum creatinine aOR 6.3 independently predicted length of hospital stay >10 days among survivors. Conclusions: Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries. [ABSTRACT FROM AUTHOR]

In India and some other developing countries tuberculosis is the first differential diagnosis for a patient who presents with chronic lymph node enlargement. This is the commonest form of extra pulmonary tuberculosis in both HIV and Non-HIV patients.HIV infected patients usually have evidence of pulmonary disease but only 25 - 30% HIV negative patients have evidence of pulmonary involvement. Childhood tuberculosis accounts about 10%of all tuberculosis. Extra pulmonary tuberculosis appears to be increasing in children and lymphadenopathy is the most, among all extra pulmonary tuberculosis. Traditionally we are using FNAC OR lumphnode biopsy for diagnosing lymphnode tuberculosis but the Gene Xpert(CBNAAT) Assay is a major breakthrough in diagnosis of Lymphnode Tuberculosis.WHO recommends Gene Xpert to be used as initial diagnostic test in patients suspected of having tuberculosis. We use FNAC, lymphnode biopsy and CBNAAT for diagnosing lymphnode tuberculosis and increased our case notification rates of extra pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

We analyzed an attempt to develop and clinically test a pneumococcal conjugate vaccine for the developing world, undertaken by public health institutions from the Netherlands, Sweden, Denmark, Norway and Finland: the Dutch Nordic Consortium (DNC), between 1990 and 2000. Our review shows that the premature termination of the project was due less to technological and scientific challenges and more to managerial challenges and institutional policies. Various impeding events, financial and managerial challenges gradually soured the initially enthusiastic collaborative spirit until near the end the consortium struggled to complete the minimum objectives of the project. By the end of 1998, a tetravalent prototype vaccine had been made that proved safe and immunogenic in Phase 1 trials in adults and toddlers in Finland. The planned next step, to test the vaccine in Asia in infants, did not meet approval by the local authorities in Vietnam nor later in the Philippines and the project eventually stopped.The Dutch DNC member, the National Institute of Public Health and the Environment (RIVM) learned important lessons, which subsequently were applied in a following vaccine technology transfer project, resulting in the availability at affordable prices for the developing world of a conjugate vaccine against Haemophilus influenzae type b. We conclude that vaccine development in the public domain with technology transfer as its ultimate aim requires major front-end funding, committed leadership at the highest institutional level sustained for many years and a competent recipient-manufacturer, which needs to be involved at a very early stage of the development.At the national level, RIVM's policy to consolidate its national manufacturing task through securing a key global health position in support of a network of public vaccine manufacturers proved insufficiently supported by the relevant ministries of the Dutch government. Difficulties to keep up with high costs, high-risk innovative vaccine development and production in a public sector setting led to the gradual loss of production tasks and to the 2009 Government decision to privatize the vaccine production tasks of the Institute. [ABSTRACT FROM AUTHOR]

Group A Streptococcus (GAS) infections cause substantial worldwide morbidity and mortality, mostly associated with suppurative complications such as pharyngitis, impetigo, and nonsuppurative immune syndromes such as acute rheumatic fever, rheumatic heart disease, and acute post-streptococcal glomerulonephritis. Deaths occur mostly in children, adolescents, and young adults in particular pregnant women in low- and middle-income countries. GAS strains are highly variable, and a GAS vaccine would need to overcome the issue of multiple strains. Several approaches have been used multivalent vaccines using N-terminal polypeptides of different M protein; conserved M protein vaccines with antigens from the conserved C-repeat portion of the M protein; incorporation selected T- and B-cell epitopes from the C-repeat region in a synthetic polypeptide or shorter single minimal B-cell epitopes from this same region; and non-M protein approaches utilizing highly conserved motives of streptococcal C5a peptidase, GAS carbohydrate and streptococcal fibronectin-binding proteins. A GAS vaccine represents urgent need for this neglected disease and should therefore deserve the greatest attention of international organizations, donors, and vaccine manufacturers. [ABSTRACT FROM AUTHOR]