Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis.

BACKGROUND: The burden of tuberculosis is compounded by drug-resistant forms of the disease. This study aimed to analyse data on antituberculosis drug resistance gathered by the WHO and International Union Against Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance. METHODS: Data on drug susceptibility testing for four antituberculosis drugs--isoniazid, rifampicin, ethambutol, and streptomycin--were gathered in the third round of the Global Project (1999-2002) from surveys or ongoing surveillance in 79 countries or geographical settings. These data were combined with those from the first two rounds of the project and analyses were done. Countries that participated followed a standardised set of guidelines to ensure comparability both between and within countries. FINDINGS: The median prevalence of resistance to any of the four antituberculosis drugs in new cases of tuberculosis identified in 76 countries or geographical settings was 10.2% (range 0.0-57.1). The median prevalence of multidrug resistance in new cases was 1.0% (range 0.0-14.2). Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia, Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia reported prevalence of multidrug resistance above 6.5%. Trend analysis showed a significant increase in the prevalence of multidrug resistance in new cases in Tomsk Oblast (p<0.0001). Hong Kong (p=0.01) and the USA (p=0.0002) reported significant decreasing trends in multidrug resistance in new cases of tuberculosis. INTERPRETATION: Multidrug resistance represents a serious challenge for tuberculosis control in countries of the former Soviet Union and in some provinces of China. Gaps in coverage of the Global Project are substantial, and baseline information is urgently required from several countries with high tuberculosis burden to develop appropriate control interventions.

Street children in Pakistan: a situational analysis of social conditions and nutritional status.

This paper examines the social conditions and nutritional status of street children in Pakistan. Nutritional status is evaluated by an assessment of height and weight relative to age. A heterogeneous sample of 108 street children in the twin cities of Rawalpindi and Islamabad was studied. One hundred and one of them were children "on the street" having regular family contact; seven were "of the street", without any family contact. Most street children came from large families which had recently moved to the city in search of economic opportunities. Their parents had low education levels and were either unemployed or employed in unskilled occupations. Poverty clearly was an important factor. The majority of the children moved to the street to augment family income. Most of the children were males (81%) and the average age at beginning life on the street was under 10 years. The majority was working 8-12 h daily with an average income of Rs. 40-60 per day (USD 1 = Rs. 60). Important issues were parental exploitation, police harassment, abuse, and the impact of other street peers in their lives. The distribution of height-for-age relative to the National Center for Health Statistics (NCHS) reference standard showed that 20% were stunted and 12% had wasting. Wasting was equal between sexes, while fewer girls than boys were stunted. The study concludes that the issue of street children in Rawalpindi and Islamabad is mainly one of "children on the street," while "children of the street" are an exceptional phenomenon. It was noted that, with some exceptions, street children in other world regions share similar risk factors and backgrounds. Findings from this study will facilitate both the identification of high-risk families, i.e. those whose children are likely to take to the street, and timely preventive and rehabilitative measures.

Internal and external validation of the NOSEP prediction score for nosocomial sepsis in neonates.

OBJECTIVE: To evaluate the performance of a scoring system (NOSEP) to predict nosocomial sepsis in neonates at the hospital where the score was developed (internal validation) and in an independent data set from other centers (external validation). DESIGN: Multiple center prospective cohort study. SETTING: Six neonatal intensive care units from the Flanders in Belgium. PATIENTS: We analyzed two groups of patients: 62 episodes of presumed nosocomial sepsis in the internal validation cohort and 93 episodes of presumed nosocomial sepsis in a multiple center external validation cohort. INTERVENTIONS: Assessment of the predictive power of the NOSEP score 24 hrs preceding sepsis workup and the patients' basic demographic characteristics and co-morbidity was performed. Diagnosis of nosocomial sepsis and the microbiology results were registered. MAIN RESULTS: The NOSEP score's discriminative capability was very good in the internal validation (area under receiver operating characteristic curve = 0.73 +/- 0.08 [sem]). The NOSEP score performed satisfactory in the external validation (area under receiver operating characteristic curve = 0.66 +/- 0.06). The calibration capability in both validation sets as measured by goodness-of-fit tests (internal validation, p =.56; external validation, p =.48) was good. An improvement of the NOSEP score was obtained for the external centers by redefining the cut-off of the items of the NOSEP score (area under receiver operating characteristic curve for NOSEP-NEW-I = 0.71 +/- 0.05) or adding co-morbidity factors (area under receiver operating characteristic curve for NOSEP-NEW-II = 0.82 +/- 0.04), with good calibration performance (goodness-of-fit test, p >.50). Finally, the fit of the NOSEP score demonstrated no significant variation across subgroups of patients. CONCLUSIONS: The predictive power of the original NOSEP score is very good in neonates at the original neonatal intensive care unit. In other neonatal intensive care units, its discriminatory performance is satisfactory but could be improved after modification of the variables in the model or adding additional variables. To use such a NOSEP score in other neonatal intensive care units, its accuracy has to be validated and adjusted if necessary.

Actitudes y creencias de los indios quechuas de la provincia de Zudáñez, departamento de Chuquisaca, Bolivia, frente al vector de la enfermedad del Chagas / Beliefs and attitudes of quechua people in province Zudañez, departament of Chuquisaca, Bolivia, facing the vector of chagas disease

Este estudio fue inspirado por 2 observaciones; la primera fue realizada por el Dr. Carvallo quien afirmó que los indígenas del norte de la Argentina, prefirieron no tomar acciones en contra del vector de la enfermedad del Chagas (llamado Vinchuca), pues consideran que éstos atraen o son portadores de buena suerte, la otra observación fue realizada por el Dr. Aimé De Muynck en el Chaco Boliviano, donde muchas familias de indígenas Guaraníes no permitieron que sus casas fuesen fumigadas con insecticidad una campaña de fumigación gratuita, a pesar de que sus hogares estuviesen altamente infestados con vinchucas