ABSTRACT
Con motivo del 20º aniversario del Informe sobre el Desarrollo Mundial 1993, una Comisión de la revista The Lancet reconsideró el argumento a favor de la inversión en salud y desarrolló un nuevo marco de inversión para lograr mejoras dramáticas en materia de salud para el año 2035. El informe de la Comisión contiene cuatro mensajes clave, cada uno acompañado de oportunidades para los gobiernos nacionales de países de ingresos bajos y medios y para la comunidad internacional. En primer lugar, invertir en salud acarrea enormes rendimientos económicos. Las impresionantes ganancias son un fuerte argumento a favor de un aumento en el financiamiento nacional de la salud y de asignar una mayor proporción de la asistencia oficial al desarrollo de la salud. En segundo lugar, en el modelo creado por la Comisión se encontró que es posible lograr para el año 2035 una "gran convergencia" en salud, consistente en la reducción de las tasas de mortalidad materna, infantil y por infecciones a niveles universalmente bajos. Tal convergencia requeriría la ampliación de las herramientas de salud existentes y un incremento agresivo de nuevas herramientas, y podría ser financiada en su mayor parte con recursos derivados del crecimiento económico esperado de los países de ingresos bajos y medios. La mejor manera en que la comunidad internacional puede apoyar la convergencia es financiando el desarrollo y suministro de nuevas tecnologías de salud, y frenando la resistencia a los antibióticos. En tercer lugar, las políticas fiscales -tales como los impuestos al tabaco y al alcohol- son una palanca poderosa y subutilizada que los gobiernos pueden emplear para detener el avance de las enfermedades no transmisibles (ENT) y las lesiones, a la vez que elevan los ingresos públicos para la salud. La acción internacional sobre las ENT y lesiones debería enfocarse en proporcionar asistencia técnica sobre políticas fiscales, en cooperación regional para el combate al tabaquismo y en financiar investigación sobre políticas e implementación para ampliar las intervenciones que enfrenten estos problemas. En cuarto lugar, la universalización progresiva -una vía hacia la cobertura universal de salud (CUS) que incluya desde el comienzo a los pobres- es una manera eficiente de lograr la protección a la salud contra riesgos financieros. Para los gobiernos nacionales, la universalización progresiva produciría elevadas ganancias en salud por cada dólar que se gaste en ésta, y los pobres serían quienes más ganarían en términos tanto de salud como de protección financiera. La mejor manera en que la comunidad internacional puede brindar apoyo a los países para implementar una CUS progresiva es financiando la investigación sobre políticas e implementación, por ejemplo, sobre la mecánica del diseño e instrumentación de la evolución del paquete de beneficios conforme crezca el presupuesto para las finanzas públicas.
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. The Commission's report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. First, there is an enormous economic payoff from investing in health. The impressive returns make a strong case for both increased domestic financing of health and for allocating a higher proportion of official development assistance to development of health. Second, modeling by the Commission found that a "grand convergence" in health is achievable by 2035-that is, a reduction in infectious, maternal, and child mortality down to universally low levels. Convergence would require aggressive scale up of existing and new health tools, and it could mostly be financed from the expected economic growth of low- and middle-income countries. The international community can best support convergence by funding the development and delivery of new health technologies and by curbing antibiotic resistance. Third, fiscal policies -such as taxation of tobacco and alcohol- are a powerful and underused lever that governments can use to curb non-communicable diseases and injuries while also raising revenue for health. International action on NCDs and injuries should focus on providing technical assistance on fiscal policies, regional cooperation on tobacco, and funding policy and implementation research on scaling-up of interventions to tackle these conditions. Fourth, progressive universalism, a pathway to universal health coverage (UHC) that includes the poor from the outset, is an efficient way to achieve health and financial risk protection. For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and financial protection. The international community can best support countries to implement progressive UHC by financing policy and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows.
Subject(s)
Humans , Public Health , Global Health , Preventive Health Services , Community Health Planning , Universal Health Insurance , Developing Countries , Financing, Government , Financing, Organized , Goals , Health Policy , Health Promotion , International Cooperation , InvestmentsABSTRACT
Aim: We aim to describe a case of hyperekplexia in a Saudi neonate due to Novel mutation in GLRB. Case Presentation: One month old Saudi neonate with hypertonicity, repetitive episodes of jitteriness and exaggerated startle reflex. Discussion: Hyperekplexia (OMIM:149400, 138492 & 604159) is considered a rare, autosomal dominant neurological disorder that presents early in life with hypertonicity, exaggerated startle response and life threatening neonatal apnea. It has been caused by mutation in the alpha-1subunit (GLRA1) on chromosome 5q32, Beta subunit (GLRB) gene on chromosome 4q31 of the inhibitory glycine receptor and GLYT2 gene (SLC6A5) on chromosome 11p15 which encodes a presynaptic glycine transporter. Conclusion: Raising awareness of the presence of this treatable disease may prevent unnecessary exposure to anti-epileptic medications, prevent life threatening apneas and improve long term outcome.
ABSTRACT
The aim of our study was to evaluate serum C reactive protein [CRP] levels in acute ischemic stroke and to correlate the values with stroke severity, outcome and other generally known risk factors. We studied 100 patients who were admitted with acute ischemic stroke. All patients underwent a clinical evaluation, laboratory investigations and radiologic examination in the first 12 hours of acute ischemic stroke. Neurological status was evaluated by modified Rankin Scale [m-RS] on admission and after one month. CRP was abnormally increased in 35% of our study patients. Elevated CRP levels were significantly associated with severe disability on admission and were also associated with large cortical and subcortical infarcts. We found a significant correlation between CRP, WBC as well as fibrinogen levels and stroke outcome as measured by m-RS after one month [P <0.0001]. Carotid atherosclerosis was significantly frequent in patients with elevated CRP when compared with those with normal CRP [P <0.0001]. The mean systolic or diastolic blood pressure irrespective to the history of arterial hypertension was significantly higher in patients with increased CRP levels when compared with those with normal CRP [P <0.0001]. We conclude that elevated CRP levels are associated with severe functional disability, poor outcome and predict a larger infarct size. Elevated CRP is a significant index for carotid atherosclerosis and may be one of underlying processes related to the inflammatory response after acute ischemic stroke
Subject(s)
Humans , Male , Female , C-Reactive Protein , Neurologic Manifestations , Leukocyte Count , Fibrinogen , Risk Factors , Treatment Outcome , Diabetes Mellitus , Hypertension , Hyperlipidemias , Blood SedimentationABSTRACT
Ultrasound [US] is a safe and accurate imaging method in the evaluation of urinary tract and its anomalies in neonates. It is helpful in establishing correct diagnosis in the majority of cases and facilitates precise measurement of kidney length. We conducted this work to study the prevalence and types of renal anomalies in Egyptian neonates and to identify their normal renal length. Our study was conducted on 500 Egyptian neonates, at Alexandria University Maternity and Children's Hospitals. Ultrasonographic examination and measurement of both kidneys were done in all neonates. Abnormal renal ultrasonographic findings were found in 15 neonates, with a prevalence of 3%. The abnormalities encountered were severe bilateral hydronephrosis in 8 cases [1.6%], moderate bilateral hydronephrosis in 3 cases [0.6%]. Horseshoe kidney, bilateral hyperechoic renal medulla, polycystic kidney disease [ARPKD], and unilateral renal tumor were detected in equal frequencies of 0.2% each. Further evaluation of the cases with severe hydronephrosis revealed: posterior urethral valve [PUV] in 5 cases, bilateral primary vesicouretral reflux [VUR] in 2 cases, bilateral pelviureteric junction obstruction [PUJO] in one case. Cases with moderate hydronephrosis resolved on follow-up. Sonographic renal appearance in normal neonates was different from that seen in older children. They showed a pattern of increased corticomedullary differentiation with markedly sonolucent medullary pyramids. The mean renal length in normal newborns was 4.7 +/- 0.7cm. There was a positive correlation between renal length and each of body length and weight than with age and head circumference. The high prevalence of renal anomalies in Egyptian neonates justifies early postnatal renal US examination of all neonates; especially those who had abnormal antenatal ultrasonographic findings. Early diagnosis of such anomalies will lead to proper early management and prevention of chronic renal failure