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Five-Year Field Results and Long-Term Effectiveness of 20 mg/kg Liposomal Amphotericin B (Ambisome) for Visceral Leishmaniasis in Bihar, India
No full textVisceral Leishmaniasis (VL; also known as Kala-azar) is an ultimately fatal disease endemic in Bihar. A 2007 observational cohort study in Bihar of 251 patients with VL treated with 20 mg/Kg intravenous liposomal amphotericin B (Ambisome) demonstrated a 98% cure rate at 6-months. Between July 2007 and August 2012, Médecins Sans Frontières (MSF) and the Rajendra Memorial Research Institute (RMRI) implemented a VL treatment project in Bihar, India-an area highly endemic for Leishmania donovani-using this regimen as first-line treatment
Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan
No full textThe aim of this study was to use E-Health to report on 12-month, 24-month and 36-month outcomes and late-stage complications of a cohort of Palestine refugees with diabetes mellitus (DM) registered in the second quarter of 2010 in a primary healthcare clinic in Amman, Jordan
Directly-observed and self-administered tuberculosis treatment in a chronic, low-intensity conflict setting in India
No full textLimited data are available about tuberculosis treatment models of care for internally displaced populations in chronic, low-intensity conflict zones. This study aimed to detail experiences of a Médecins Sans Frontières tuberculosis programme in Andhra Pradesh-Chhattisgarh border area, India, from January to December 2012
Médecins Sans Frontières Experience in Orthopedic Surgery in Postearthquake Haiti in 2010
No full textIntroduction During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting. Problem There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program
Global practices of meningococcal vaccine use and impact on invasive disease
Get PDFA number of countries now include meningococcal vaccines in their routine immunization programs. This review focuses on different approaches to including meningococcal vaccines in country programs across the world and their effect on the burden of invasive meningococcal disease (IMD) as reflected by pre and post-vaccine incidence rates in the last 20 years. Mass campaigns using conjugated meningococcal vaccines have lead to control of serogroup C meningococcal disease in the UK, Canada, Australia, Spain, Belgium, Ireland, and Iceland. Serogroup B disease, predominant in New Zealand, has been dramatically decreased, partly due to the introduction of an outer membrane vesicle (OMV) vaccine. Polysaccharide vaccines were used in high risk people in Saudi Arabia and Syria and in routine immunization in China and Egypt. The highest incidence region of the meningitis belt initiated vaccination with the serogroup A conjugate vaccine in 2010 and catch-up vaccination is ongoing. Overall results of this vaccine introduction are encouraging especially in countries with a moderate to high level of endemic disease. Continued surveillance is required to monitor effectiveness in countries that recently implemented these programs
Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique
Get PDFTo improve retention in antiretroviral therapy (ART), lessons learned from chronic disease care were applied to HIV care, providing more responsibilities to patients in the care of their chronic disease. In Tete--Mozambique, patients stable on ART participate in the ART provision and peer support through Community ART Groups (CAG). This article analyses the evolution of the CAG-model during its implementation process
Multiple relapses of visceral leishmaniasis in a patient with HIV in India: a treatment challenge
Get PDFVisceral leishmaniasis (VL) is an opportunistic infection of HIV-infected people in several endemic countries, and the management of this co-infection poses numerous challenges. We describe a patient with HIV infection and visceral leishmaniasis who failed to respond to miltefosine monotherapy and subsequently relapsed following two further different regimens of liposomal amphotericin B. He was then successfully treated with a combination of 30 mg/kg liposomal amphotericin B and 14 days of 100 mg/day oral miltefosine
Research Protocol - The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort
No full textResearch protocol.\ud
These materials can be used, adapted and copied as long as citation of the source is given including the direct URL to the material. This work is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/ https://i.creativecommons.org/l/by/4.0/88x31.pngPrimary objective of this study:\ud
To determine if the application of a tick-sheet after four hour training on its use and on CXR interpretation, improves the interpretation accuracy of CXRs for active TB, by non-specialists, in an HIV-positive cohort.\ud
Secondary objective:\ud
To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group
Research Protocol - Effectiveness and safety of a simplified short regimen for Multidrug Resistant Tuberculosis treatment in Manzini Region, Swaziland
No full textResearch protocolMultidrug resistant tuberculosis (MDR TB) is a growing problem and few people have access to adequate diagnosis and treatment. The current recommended treatment regimen for MDR TB has a minimum of 20 months duration. Evidence from Bangladesh in 2010 showed that a 9-month short-course regimen could achieve a relapse free-cure rate of 88%. Several countries in West Africa started implementing similar regimens with similar outcomes. Evidence of effectiveness of this shortened regimen amongst HIV co-infected population is still limited. We propose an observational study to evaluate the effectiveness of a shortened course MDR TB regimen in the high HIV prevalence and high MDR TB prevalence setting of Manzini Region, Swaziland.\ud
Main objective\ud
To describe outcomes at end of treatment and relapse rate at 1 year and safety following treatment completion of a short course (9-12 month) MDR TB treatment in HIV co-infected patients in programmatic conditions in Manzini region, Swaziland.\ud
Secondary objectives\ud
1. To describe sputum smear microscopy and culture conversion rates at 6 months and time to sputum conversion in both: HIV/MDR TB co-infected patients and MDR TB/HIV negative patients.\ud
2. To describe outcomes at end of treatment and relapse after 1 year of treatment completion of MDR TB treatment in HIV negative patients.\ud
3. To describe the adverse events of the treatment regimen in both: HIV/MDR TB co-infected patients and MDR TB/HIV negative patients.\ud
4. To evaluate risk factors for unfavorable outcomes (death, lost-to-follow up and failure) and relapse as a combined cohort.\ud
5. To describe proportion of inhA and katG mutations for H and correlation with DST for high dose at MIC 1.0 mg/ml amongst MDR TB cases and examine whether genetic mutations for H are risk factors for favorable or unfavorable outcomes (including description of outcomes 10\ud
per baseline level of resistance to H), to increase understanding of the role of high dose H in the regimen.\ud
6. To describe the proportion of relapse and re-infection amongst the patients developing TB at 1 year after treatment completion by genotyping.\ud
7. To describe the correlation of smear microscopy with culture to assess the safety of a simplified monitoring with smear microscopy for MDR TB treatment.\ud
8. To describe the rate of resistance amplification amongst patients with outcome failure
Polymorphisms in Plasmodium falciparum Chloroquine Resistance Transporter and Multidrug Resistance 1 Genes: Parasite Risk Factors that Affect Treatment Outcomes for P. falciparum Malaria after Artemether-Lumefantrine and Artesunate-Amodiaquine
Get PDFAdequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001: were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine