Evaluation of the national tuberculosis surveillance system in Afghanistan.

Afghanistan has 2 tuberculosis surveillance systems, the National Tuberculosis Control Programme (NTP) and the Health Management Information System (HMIS). An evaluation of these surveillance systems in January/ February 2010 was done to identify their strengths and weaknesses and to formulate recommendations. Attributes of the programmes were evaluated using US Centers for Disease Control and Prevention guidelines. Usefulness and flexibility of the NTP system were good; stability, representativeness and data quality were average. Simplicity, acceptability and timeliness were poor. Reporting delays regularly exceeded 3 months. Positive predictive value and sensitivity were 11% and 70% respectively. The HMIS system was simple, acceptable and stable, with timely reporting. Reporting and feedback were good, as this system has strong government support. Flexibility, data quality and representativeness were average. Positive predictive value and sensitivity were 10% and 68% respectively. No outbreaks were detected by ther system. The NTP and HMIS surveillance systems are duplicative and neither covers the private sector.

Public health surveillance at a mass gathering: urs of Baba Farid, Pakpattan district, Punjab, Pakistan, December 2010.

The objective of this study was to identify health related problems encountered during an annual mass gathering in Pakpattan, Pakistan, the anniversary of the death (urs) of Baba Farid, and to make recommendations for planning and prevention activities. A surveillance system was established to capture health related data for the event. A list of reportable diseases was developed. Data were collected pre-, during, and post-event by health care workers trained for the purpose. A total of 5918 people reported to the 15 health care facilities providing services during the event; 58% of consultations were because of communicable diseases, 21% of which were respiratory tract infections and 26% gastrointestinal illness. Injuries accounted for 31% of cases and noncommunicable diseases for 11%. Prevalence of reportable disease during the event showed sizeable increases. No major disease outbreak was observed.

Evaluation of national tuberculosis surveillance system in Afghanistan

Aighanistan has 2 tuberculosis surveillance systems/ the Natiohal Tuberculosis Control Programme [NTP] and the Health Management Information System [HMIS]. An evaluation of these surveillance systems in January/February 2010 was done to identify their strengths and weaknesses and to formulate recommendations. Attributes of the programmes were evaluated using US Centers for Disease Control and Prevention guidelines. Usefulness and flexibility of the NTP system were good; stability, representativeness and data quality were average. Simplicity, acceptability and timeliness were poor. Reporting delays regularly exceeded 3 months. Positive predictive value and sensitivity were 11% and 70% respectively. The HMIS system was simple, acceptable and stable, with timely reporting. Reporting and feedback were good, as this system has strong government support. Flexibility, data quality and representativeness were average. Positive predictive value and sensitivity were 10% and 68% respectively. No outbreaks were detected by either system. The NTP and HMIS surveillance systems are duplicative and neither covers the private sector

Pathways of fluid transport and reabsorption across the peritoneal membrane.

The three-pore model of peritoneal fluid transport predicts that once the osmotic gradient has dissipated, fluid reabsorption will be due to a combination of small-pore reabsorption driven by the intravascular oncotic pressure, and an underlying disappearance of fluid from the cavity by lymphatic drainage. Our study measured fluid transport by these pathways in the presence and absence of an osmotic gradient. Paired hypertonic and standard glucose-dwell studies were performed using radio-iodinated serum albumin as an intraperitoneal volume marker and changes in intraperitoneal sodium mass to determine small-pore versus transcellular fluid transport. Disappearance of iodinated albumin was considered to indicate lymphatic drainage. Variability in transcellular ultrafiltration was largely explained by the rate of small-solute transport across the membrane. In the absence of an osmotic gradient, fluid reabsorption occurred via the small-pore pathway, the rate being proportional to the small-solute transport characteristics of the membrane. In most cases, fluid removal from the peritoneal cavity by this pathway was faster than by lymphatic drainage. Our study shows that the three-pore model describes the pathways of peritoneal fluid transport well. In the presence of high solute transport, poor transcellular ultrafiltration was due to loss of the osmotic gradient and an enhanced small-pore reabsorption rate after this gradient dissipated.

Can WHO therapy failure criteria for non-severe pneumonia be improved in children aged 2-59 months?

SETTING: In the recent past, there have been reports of rising treatment failure rates for non-severe pneumonia. It is felt that World Health Organization (WHO) criteria for therapy failure are too sensitive and that many children are unnecessarily classified as failures. We studied alternative, less sensitive therapy failure criteria. METHODS: In this nested study we followed the clinical course of non-severe pneumonia in children aged 2-59 months using alternative therapy failure criteria. All children received amoxicillin and were followed up on days 3, 5 and 14 after enrollment. On day 3, children were labelled as therapy failure only if their condition had deteriorated. These failure rates were compared with those using WHO definitions. RESULTS: During the study period, 876 children with non-severe pneumonia were followed up until day 14. On day 3, using alternative therapy failure criteria, 31 (3.5%) children were labelled as therapy failure compared to 95 (10.8%) using current WHO criteria. The difference was statistically significant (P = 0.001). CONCLUSIONS: The alternative therapy failure criteria work reasonably well, without causing any higher risk to children with non-severe pneumonia. Antibiotics should be changed only in those children who show signs of deterioration on day 3. This would prevent unnecessary changes in antibiotic treatment in many children.

Condom use after voluntary counselling and testing in central Mozambique.

OBJECTIVE: To evaluate the efficacy of voluntary counselling and testing (VCT) for HIV/AIDS in changing risky sexual behaviour in central Mozambique. METHOD: Longitudinal cohort study of men and women aged at least 18 years from October 2002 to June 2003. We interviewed 622 participants in VCT groups and 598 in non-VCT groups. The interviews occurred before counselling and 4 and 6 months afterwards. RESULTS: Reported use of condoms while having sex with a friends/prostitute increased over each time period in the VCT group and between baseline and first visit in the non-VCT group. Both men and women in the VCT group increased their condom use over time, but the women in the non-VCT group did not. Reported always/sometimes use of condoms for both literate and illiterate subjects was higher and rose over time in the VCT group. CONCLUSION: People who undergo voluntary counselling and testing fro HIV/AIDS change their behaviour, presumably as a result of their counselling.

Comparison of clinical outcome with oral and inhaled bronchodilators in the management of wheezy children aged 1-59 months in the community: a randomised trial in Pakistan.

BACKGROUND: Wheeze is a significant problem in children. There is a gradual trend of switching from oral to inhaled bronchodilator therapy. No randomised trials have been carried out in the community to compare the clinical outcome of two modes of therapy. If outcome with oral and inhaled bronchodilators is the same in young wheezers in developing countries, it will be easier to manage them. METHODS: In a randomised multicentre trial, wheezy children aged 1-59 months with fast breathing and/or lower chest indrawing received oral or inhaled salbutamol at home after responding to up to three cycles of inhaled bronchodilators. They were re-assessed on days 3 and 5 for clinical outcome. RESULTS: From May 2001 to August 2002, 780 children were enrolled; 390 each were randomised to oral and inhaled salbutamol. On day 5, 324 (83.1%) children in the oral and 328 (84.1%) in the inhaled group were completely well. There were no differences in clinical outcome of both modes of therapy. CONCLUSIONS: The clinical outcome of children aged 1-59 months with wheeze is similar when treated with oral or inhaled salbutamol. Acute respiratory infection control programmes in developing countries should continue to use oral bronchodilators for the management of wheeze to save both time and money.

Assessment and management of children aged 1-59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan.

BACKGROUND AND AIMS: Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap. METHODOLOGY: In a multicentre prospective study, children aged 1-59 months with auscultatory/audible wheeze and fast breathing and/or lower chest indrawing were screened. Response to up to three cycles of inhaled salbutamol was recorded. The responders were enrolled and sent home on inhaled bronchodilators, and followed up on days 3 and 5. RESULTS: A total of 1622 children with wheeze were screened from May 2001 to April 2002, of which 1004 (61.8%) had WHO defined non-severe and 618 (38.2%) severe pneumonia. Wheeze was audible in only 595 (36.7%) of children. Of 1004 non-severe pneumonia children, 621 (61.8%) responded to up to three cycles of bronchodilator. Of 618 severe pneumonia children, only 166 (26.8%) responded. Among responders, 93 (14.9%) in the non-severe and 63 (37.9%) children in the severe pneumonia group showed subsequent deterioration on follow ups. No family history of wheeze, temperature >100 degrees F, and lower chest indrawing were identified as predictors of subsequent deterioration. CONCLUSIONS: Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.

Helicobacter pylori and risk for gastric adenocarcinoma.

Gastric cancer is the second most common cause of cancer death in the world. Helicobacter pylori infection is now a well-accepted cause of this malignancy; in some parts of the world, up to eighty percent of all gastric cancers are at least in part caused by H. pylori infection. H. pylori infection typically starts in childhood as an inflammatory process in the stomach. The changes in the gastric microenvironment facilitate gastric cancer over time. Among infected individuals, genotype of H. pylori, coincident environmental exposures, and genetic factors of host seem to play roles in determining who will get gastric cancer and who will not. Unfortunately, it remains unknown whether treatment of H. pylori prevents gastric cancer. Thus, screening for H. pylori to prevent cancer is not yet widely recommended. Some consensus groups, however, have recommended screening for and treating H. pylori infection in individuals with family histories of gastric malignancy. In high-risk countries, screening programs for early gastric cancer itself may improve therapeutic outcome for this highly lethal disease.

A new approach to immunosuppression at the complement level-hypothesis.

A conceptual hypothesis for the possibility of treatment of certain immunological diseases in which the classical pathway (CP) of complement (c) plays a role in the pathogenesis is presented. It is proposed that in the clinical situations in which CP activation primarily contributes to the disease activity, administration of F(ab)2 fragment of human monoclonal antibodies directed against the active site of human Cls may suppress the disease. The F(ab)2 fragment should be specific for the active site of Cls and should not be reactive with the rest of the molecule. Such a treatment is not likely to effect Cls or total CP levels, as the F(ab)2 fragment will react only when and as soon as the active site has been generated on a Cls molecule. The interaction of a F(ab)2 fragment with Cls is also not likely to cause activation of the C. Specific inhibition of Cls in this way is expected to prevent, in CP mediated diseases, the increase in vascular permeability due to Cls and generation of C fragments responsible for anaphylactic, chemotactic and exocytosis activities and thus suppression of tissue destruction and disease activity. The validity of this hypothesis could be tested in experimental models of C mediated diseases in rats using F(ab)2 fragments of rat monoclonal antibodies directed against rat Cls. These studies could also be carried out in mouse system. F(ab)2 fragments of monoclonal antibodies against the active site of Clr may also be used instead of those against Cls.