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Malaria infection confounds inflammation-adjusted micronutrient biomarker concentrations in children and women in Malawi: a secondary analysis of the 2015/2016 Malawi micronutrient survey.
Get PDFInflammation and infections such as malaria affect concentrations of many micronutrient biomarkers and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi and examine the potential role of malarial immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell folate and vitamin B12 were estimated using multivariable linear regression. Factors related to malarial immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68 % (95 % CI 51, 86), 28 % (18, 40) and 34 % (13, 45) greater inflammation-adjusted ferritin in PSC, SAC and WRA, respectively (P < 0·001 for each). In PSC, the positive association was stronger in younger children, high altitude and children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25 % (16, 29) and + 15 % (9, 22) respectively, P < 0·001). Serum folate and erythrocyte folate were elevated in WRA with malaria (+ 18 % (3, 35) and + 11 % (1, 23), P = 0·01 and P = 0·003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations, and examining factors related to malarial immunity may be informative
Leishmaniasis in Syria - A call for action of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Groups for Infections in Travellers and Migrants (ESGITM) and for Clinical Parasitology (ESGCP).
Get PDFLeishmaniasis is a neglected, vector-borne disease caused by parasitic protozoa from the genus Leishmania, transmitted by the bites of sandflies from the genus Phlebotomus (in the ‘Old World’) or Lutzomyia (in the ‘New World’) [1,2]. It is endemic in tropical and subtropical regions, affecting millions worldwide [3,4]. Clinical presentations, including cutaneous, mucosal, and visceral forms, vary by species, geography, and host factors. Leishmaniasis can be either anthroponotic (caused by Leishmania tropica or L. donovani) or zoonotic (caused by L. major, L. infantum, and others) [5]. As with many other vector-borne diseases, risk factors include poverty, malnutrition, conflict, forced displacement, climate change, and other environmental changes that influence vector distribution [6]. In non-endemic settings, leishmaniasis has been reported among travellers, migrants, and refugees [2,[7], [8], [9], [10], [11], [12]]. In areas where sandflies are endemic, combined with imported cases, may pose a significant public health risk for autochthonous transmission [2,[7], [8], [9], [10], [11], [12]]. Globally, a well-established association exists between intense armed conflict, climate, and cutaneous leishmaniasis (CL) [[9], [10], [11]]
The future of nephrology in 2050.
Get PDFAs medicine advances at an unprecedented pace, the field of nephrology is poised for transformative change. By 2050, breakthroughs in kidney disease prevention, dialysis, transplantation, and omics-driven precision medicine could redefine patient care and outcomes. Here, we share our perspectives on the challenges faced and how changes in health policy, emerging technologies, novel therapies, and data-driven approaches might shape the future of nephrology. From innovative dialysis solutions to xenotransplantation and AI-powered diagnostics, we explore the possibilities that could revolutionise kidney health in the decades to come
Nutrition Education Interventions for the d/Deaf and Hard-of-Hearing: A Systematic Scoping Review.
No full textThe d/Deaf and hard-of-hearing (DHH) population, of all ages, is at increased risk for poor dietary habits that may lead to health complications, given the lack of accessible and inclusive nutrition education from a range of providers. Given these challenges and the urgent need for inclusive health education, this systematic scoping review critically assessed the nature, scope, effectiveness, and best practices of nutrition-focused interventions tailored for the general DHH population. Using the PICOS search method of 16 bibliographic databases for articles between 2000 and 2024 focusing on nutrition-related interventions tailored to the DHH population, eight studies were identified. Studies employed various intervention approaches, focus areas of nutrition, location, and participants. One study used a theoretical framework. Most interventions addressed multiple aspects of dietary behavior, while others focused on specific concerns such as healthy food choices and exercise. Interventions were delivered through in-person educational sessions by public health professionals and nutritionists. Only one of the eight studies reviewed did not report statistically significant improvements in dietary behavior or health outcomes following the intervention. Future research should integrate established behavior change theories to strengthen the design, implementation, and longer-term follow-up and evaluation of nutrition interventions for DHH populations. There is a surprising lack of research in this area, exacerbated by additional challenges in reaching the DHH population. Improving nutrition education for DHH individuals requires interventions that address communication barriers, cultural inclusivity, and accessibility by all types of providers, and reaching such groups in a range of places
Schistosoma mansoni Presenting as a Zosteriform Papular Eruption.
Get PDFA 27-year-old man was seen for a pruritic rash on the lower back that had been present for 2 days. He had been troubled by diffuse, intermittent pruritus requiring antihistamines for the previous 6 months. He had no other medical history. On examination, firm erythematous papules were present on the left side of the back in the distribution of the T8–T10 dermatomes (Figure 1A). There was no lymphadenopathy. A clinical diagnosis of herpes zoster was made, and 7 days of oral acyclovir (400 mg five times per day) were prescribed. Blood tests showed mild leukocytopenia without eosinophilia (3.7 × 103 cells/µL; reference range: 4.0–11.0 cells/µL) and elevated creatine kinase (460 IU/L; reference range: 40–320 IU/L). Total immunoglobulin E (IgE) was normal. Specific IgE testing was negative for a range of allergens
SARS-Cov-2 vaccination strategies in hospitalized recovered COVID-19 patients: a randomized clinical trial (VATICO Trial).
Get PDFThe impact on immunogenicity and efficacy of SARS-CoV-2 vaccination in people with prior COVID-19 could differ depending on timing of vaccination and number of doses. The VATICO study randomized 66 hospitalized recovered COVID-19 individuals to receive either immediate or deferred vaccination, with one or two doses of mRNA SARS-CoV-2 vaccines. We measured binding and neutralizing antibodies against SARS-CoV-2 at enrollment and longitudinally. Median (IQR) time from SARS-CoV-2 infection to first vaccination was 68 (53-75) days in the immediate group, and 151 (137-173) days in the deferred group. At week 48, timing or number of vaccine doses did not influence the change in antibody levels relative to baseline. Adherence to the assigned vaccine regimen was lower in the deferred group, particularly in participants receiving two doses. Although the study ultimately lacked adequate power to draw firm conclusions, these results suggest possible benefits of prompt vaccination after recovery from COVID-19
Protocol to develop and pilot a primary mental healthcare intervention model to address the medium- to long-term Ebola associated psychological distress and psychosocial problems in Mubende District in Central Uganda (the Ebola+D project).
Get PDFClinicalTrials.gov NCT06093646
Improving Implementation of NCD Care in Low- and Middle-Income Countries: The Case of Fixed Dose Combinations for Hypertension in Kenya.
Get PDFHealth systems in low- and middle-income countries face the challenge of addressing the growing burden of non-communicable diseases (NCDs) with scarce resources to do so. There are cost-effective interventions that can improve management of the most common NCDs, but many remain poorly implemented. One example is fixed dose combinations (FDCs) of medications for hypertension. Included in WHO's Essential Medicines List, FDCs combine two or more blood pressure lowering agents into one pill and can reduce burden on patients and the health system. However, implementation of FDCs globally is poor. We aimed to identify health systems factors affecting implementation of evidence-based interventions for NCDs, and opportunities to address these, using the case study of FDCs in Kenya. We conducted semi-structured interviews with 39 policy-makers and healthcare workers involved in hypertension treatment policy and identified through snowball sampling. Interview data were analyzed thematically, using the Access Framework to categorize themes. Our interviews identified factors operating at the global, national, county, and provider levels. These include lack of global implementation guidance, context specific cost-effectiveness data, or prioritization by procurement agencies and clinical guidelines; perceived high cost; poor data for demand forecasting; insufficient budget for procurement of NCD medications; absence of prescriber training and awareness of clinical guidelines; and habitual prescribing behavior and understaffing limiting capacity for change. We propose specific strategies to address these. The findings of this work can inform efforts to improve implementation of other evidence-based interventions for NCDs in low-income settings
Life cycle assessment of a clinical malaria trial in Mali reveals large environmental impacts of electricity consumption and international travel
Get PDFClimate change may be the single largest threat facing humanity and ecosystems, necessitating reductions in carbon emissions across all sectors, including healthcare and academia. With the aim of informing and supporting sustainable research practices, we performed a life cycle assessment of a clinical malaria trial conducted in Mali. The trial involved 80 malaria-infected participants in Ouélessébougou who were treated with antimalarials and monitored to determine clinical and transmission-blocking efficacy. Data on consumables, transportation, travel, and electricity use were collected in Mali and the Netherlands, where additional laboratory analyses and sample storage occurred. Data were analysed using the ReCiPe 2016 method for midpoint impact assessment. The trial involved 3 intercontinental shipments of materials and samples, 59,900 km of travel by research staff, and ~55 kg of plastic consumables. Trial conduct and reporting resulted in approximately 20.5 metric tons of CO2-equivalent (CO2e) emissions. Major carbon contributors were international travel (50%), electricity in Mali (28%), and air-transportation of materials (14%). Laboratory consumables, while contributing up to 20% of the trial’s impact on land and water use, were less important sources of emissions (2% of CO2e). The formation of fine particulate matter was another important contributor to human health damage, which was mainly attributed to electricity in Mali. Main contributors to ecosystem damage were carbon emissions, terrestrial acidification and ozone formation, with electricity in Mali and international travel as the two major contributors. With an eye on energy efficiency and sustainability, we observed no loss in stability of parasite genetic material (mRNA) in protective buffers when stored for 12 months at -20°C, compared to conventional -70°C. Switching to energy-efficient equipment settings could reduce electricity consumption of equipment by over 30%. Implementing solar panels could reduce overall CO2e emissions substantially. Immediate CO2e reductions can further be achieved through online conference attendance and alternative sample transportation; the latter would allow 10% CO2e emission reduction. These results form a starting point for improving the environmental sustainability of clinical trials in Africa
Drivers of food acquisition practices among adolescents in suburban food environments of Lao People's Democratic Republic.
Get PDFBACKGROUND: Dietary shifts among adolescents in low- and middle-income countries are exacerbating the double burden of malnutrition. Understanding the drivers of adolescent food acquisition and consumption practices and their lived experiences of the food environment is crucial for the effective development of targeted interventions and policies.
OBJECTIVE: To explore drivers of food acquisition and consumption practices among adolescents from two suburban schools in the food environments of Phonhong District, Lao People's Democratic Republic.
METHODS: We implemented a Qualitative-Geographical Information System methodology, featuring participatory photography, follow-up photo-elicitation interviews and focus group discussions with 30 adolescents from April to July 2022. Thematic analysis triangulated key themes from photos, maps, and transcripts.
RESULTS: Drivers of food acquisition and consumption included interactions across external, interpersonal, and intrapersonal domains. The six key themes were food availability and accessibility, product properties and convenience, peers and social media, caregivers and household practices, affordability, desirability, and autonomy, and perceptions, beliefs, and social norms. Consumption of ultra-processed foods was driven by the availability and accessibility of these affordable products in schools. By contrast, consumption of fruits and vegetables was driven by parental food practices at home.
CONCLUSION: A comprehensive multi-scalar approach is required to improve adolescent diets and nutrition in the suburban food environment of Lao PDR. This includes restricting the sale of ultra-processed foods in schools, promoting home gardening, increasing caregivers' awareness and engagement with adolescents about the benefits of healthy food choices, and leveraging social media to encourage healthy eating behaviors