Efforts to catalogue non-governmental organizations with a role in global burn relief

IntroductionNon-governmental organizations (NGOs) have been instrumental in the treatment of traumatic injuries, including burns, particularly in low- and middle-income counties. The purpose of this project was to catalogue burn injury related NGO activities, describe coordinated efforts, and provide insight to burn health care professionals seeking volunteer opportunities.MethodsEligible burn NGOs were identified through internet searches, literature reviews, and social media. The organizations’ websites were reviewed for eligibility and contact was attempted to confirm details. Global health organizations, including the World Health Organization, were consulted for their viewpoints.ResultsWe identified 27 unique NGOs working in the area of burn care in African countries, all with differing missions, capacities, recruitment methods, and ability to respond to disaster. We also describe 14 global NGOs, some of which accept volunteers. Some NGOs were local, while others were headquartered in western countries.ConclusionsTo our knowledge, this is the first effort towards the establishment of a Burn-NGO catalogue. Challenges included: frequent shifts in geographical regions supported, lack of collaboration among organizations, availability of public information, and austere environments. We invite collaborators to assist in the creation of a comprehensive, interactive and complete catalogue.     

High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus

Setting: Belarus (Eastern Europe) is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). In 2012, rapid molecular diagnostics were prioritised for sputum smear-positive pulmonary tuberculosis (PTB) patients to diagnose MDR-TB, while pulmonary sputum smear-negative pulmonary TB (SN-PTB) patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2–4 months.Objective: To determine the proportion of MDR-TB among SN-PTB patients registered in 2012 and associated clinical and demographic factors.Design: Retrospective cohort study using countrywide data from the national electronic TB register.Results: Of the 5377 TB cases registered, 2960 (55%) were SN-PTB. Of the latter, 1639 (55%) were culture-positive, of whom 768 (47%) had MDR-TB: 33% (363/1084) were new and 73% (405/555) previously treated patients. Previous history of treatment, age, region, urban residence, human immunodeficiency virus (HIV) status and being a pensioner were independently associated with MDR-TB.Conclusion: About half of culture-positive SN-PTB patients have MDR-TB and this rises to over 7/10 for retreatment cases. A national policy decision to extend rapid molecular diagnostics universally to all PTB patients, including SN-PTB, seems justified. Steps need to be taken to ensure implementation of this urgent priority, given the patient and public health implications of delayed diagnosis.     

Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

Purpose of Review

The intersection of tuberculosis (TB) disease and type 2 diabetes mellitus is severely hindering global efforts to reduce TB burdens. Diabetes increases the risk of developing TB disease and negatively impacts TB treatment outcomes including culture conversion time, mortality risk, and TB relapse. Recent evidence also indicates plausible mechanisms by which TB disease may influence the pathogenesis and incidence of diabetes. We review the epidemiology of stress hyperglycemia in patients with TB and the pathophysiologic responses to TB disease that are related to established mechanisms of stress hyperglycemia. We also consider clinical implications of stress hyperglycemia on TB treatment, and the role of TB disease on risk of diabetes post-TB.

Recent Findings

Among patients with TB disease, the development of stress hyperglycemia may influence the clinical manifestation and treatment response of some patients and can complicate diabetes diagnosis.

Summary

Research is needed to elucidate the relationship between TB disease and stress hyperglycemia and determine the extent to which stress hyperglycemia impacts TB treatment response. Currently, there is insufficient data to support clinical recommendations for glucose control among patients with TB disease, representing a major barrier for efforts to improve treatment outcomes for patients with TB and diabetes.

     

Community-acquired group B streptococcal meningitis in adults

IntroductionStreptococcus agalactiae (group B streptococci; GBS) is an uncommon cause of bacterial meningitis in adults.MethodsWe reviewed literature published between 1975 and 2018. Studies were included if they reported age, sex and outcome of patients above 16 years of age with cerebrospinal fluid culture (CSF) positive for GBS.ResultsSixty-seven articles describing 141 patients were included. Median age was 56 years (IQR 41–66); 52% were male. Fifty-three patients (38%) were immunocompromised and CSF leakage was reported in 9 (10%) of 88 immunocompetent patients. Sixty-two patients (44%) had extra-meningeal foci of infection, most commonly endocarditis, which occurred in 14 patients (12%). Twenty-eight patients (23%) were described as previously healthy. Forty-four (31%) of the 141 patients died, after a median duration of 5 days after admission. Death was associated with advanced age and an immunocompromised state.ConclusionGBS meningitis in adults mainly occurs in those with underlying conditions such as immunocompromised state, CSF leakage, and endocarditis. These conditions should be actively sought for in adults with GBS meningitis.     

Influenza Surveillance: Why?

Surveillance is also one of the few bright spots in influenza preparedness in Europe. A sentinel network of 13,500 physicians provides an early warning in the event of an influenza outbreak. The network is part of the European Influenza Surveillance Scheme (EISS). Germany has one of the most advanced surveillance networks in Europe, and has made the reporting of laboratory-confirmed cases of influenza mandatory. Monitoring avian influenza is a good way to anticipate human influenza outbreaks. Coordinated surveillance of influenza in humans and animals is needed, and the human and veterinary surveillance systems should be linked to exchange information, diagnostic tools and antigens. Although not perfect, the current surveillance network managed by EISS functions effectively, and can play a key role in the early identification and ongoing monitoring of a pandemic influenza virus as well as the annual epidemics.     

Molecular analysis of isolates from influenza B outbreaks in the U.S. and Nepal, 2005

Summary. Currently circulating influenza B viruses can be divided into two antigenically and genetically distinct lineages referred to by their respective prototype strains, B/Yamagata/16/88 and B/Victoria/2/87, based on amino acid differences in the hemagglutinin surface glycoprotein. During May and July 2005, clinical specimens from two early season influenza B outbreaks in Arizona and southeastern Nepal were subjected to antigenic (hemagglutinin inhibition) and nucleotide sequence analysis of hemagglutinin (HA1), neuraminidase (NA), and NB genes. All isolates exhibited little reactivity with the B/Shanghai/361/2002 (B/Yamagata-like) vaccine strain and significantly reduced reactivity with the previous 2003/04 B/Hong Kong/330/2001 (B/Victoria-like) vaccine strain. The majority of isolates were antigenically similar to B/Hawaii/33/2004, a B/Victoria-like reference strain. Sequence analysis indicated that 33 of 34 isolates contained B/Victoria-like HA and B/Yamagata-like NA and NB proteins. Thus, these outbreak isolates are both antigenically and genetically distinct from the current Northern Hemisphere vaccine virus strain as well as the previous 2003–04 B/Hong Kong/330/2001 (B/Victoria lineage) vaccine virus strain but are genetically similar to B/Malaysia/2506/2004, the vaccine strain proposed for the coming seasons in the Northern and Southern Hemispheres. Since these influenza B outbreaks occurred in two very distant geographical locations, these viruses may continue to circulate during the 2006 season, underscoring the importance of rapid molecular monitoring of HA, NA and NB for drift and reassortment.     

Tobacco use among serving army personnel: An epidemiological study

BackgroundIndia has consequential burden of tobacco related disease and death. Though there are surveys conducted at national and regional level yet the information about tobacco consumption among army personnel is scarce. Thus an epidemiological study was conducted to estimate the prevalence and assess determinants of tobacco consumption amongst army personnel.MethodsA community based cross sectional study was conducted using simple random sampling to enroll 380 personnel. Data was collected using a pretested and validated questionnaire with relevant domains.ResultsThe age of participants was 33 + 7 years. The prevalence of ever tobacco users was 47.90% (95% CI: 42.78–53.05) and of current tobacco users was 35.00% (95% CI: 30.21–40.03). No association was found between ever users and age group, monthly income, occupation, length of service, family member usage (p > 0.05). Among smokeless tobacco forms, Khaini was most preferred (49.45%) followed by Gutkha. Majority of them (41.21%) were moderate tobacco chewers. Tobacco user friends (53.85%) were the main stimulants, which induced respondents to start tobacco. The important source of tobacco procurement was local vendor. 91.76% ever user were aware of the ill-effects of the tobacco use. There was statistically significant association for knowledge regarding tobacco use being harmful to family members between current users and ever users (p = 0.036).ConclusionThe study highlights a high prevalence of tobacco user amongst army personnel. Reduction of easy accessibility, Behaviour Change Communication activities and stricter implementation of regulations are urgently required.