Task Sharing of Injectable Contraception Services in Pakistan: A Randomized Controlled Trial

Provision of injectable contraceptive services by lay health workers is endorsed by normative bodies, but support for this practice is not universal. We assessed whether lay providers (lady health workers, LHWs) could perform as well as clinically trained providers (family welfare workers, FWWs) on appropriate screening, counseling, and injection of intramuscular and subcutaneous depot medroxyprogesterone acetate (DMPA) using a randomized controlled trial. In the urban sample (n = 355), 88 percent of FWW DMPA clients were appropriately screened versus 77 percent of LHW clients (noninferiority test p = 0.88). In rural facilities (n = 105), over 90 percent of both providers’ clients were screened appropriately. Appropriate counseling was low overall, but LHWs were significantly noninferior to FWWs (p = 0.003). Notably, LHWs demonstrated better injection technique than FWWs. We could not conclude that LHWs screened new DMPA users as well as FWWs from an urban sample of providers but results from the rural sample suggests that service delivery context played an important role.     

Haemophilus influenzae type b disease in HIV-infected children: A review of the disease epidemiology and effectiveness of Hib conjugate vaccines

The paper reviews the literature on the epidemiology of Hib disease and the effectiveness of Hib conjugate vaccine (HibCV) in HIV-infected children. The current three-dose primary Hib conjugate vaccine schedule in low-income settings has had a striking impact on the incidence of Hib disease. However, HIV-infected children have an almost 6-fold higher risk of Haemophilus influenzae type b (Hib) invasive disease than HIV-uninfected children and HibCV effectiveness is lower in this population. HIV-related HibCV failures are difficult to detect without well functioning surveillance systems and HIV testing of cases. Breakthrough Hib cases have been noted in vaccinated HIV-infected children in South Africa. A HibCV booster dose in addition to the three-dose primary schedule is routine in many, but not all, high-income countries. In order to determine whether a booster dose should be given to HIV-infected children in developing countries, well-designed studies need to be conducted to better determine the persistence of protective antibody concentrations, response to booster doses of vaccine as well as timing of and risk factors for vaccine failure in HIV-infected children both treated and naive to antiretroviral drug therapy (ART). Meanwhile, physicians and public health personnel should be especially vigilant at ensuring that HIV-infected infants receive their primary doses of HibCV, ART and co-trimoxazole prophylaxis. Until more definitive evidence is available, physicians may also need to consider a booster dose for such children irrespective of ART status. In any updating of vaccine schedules, HIV-infected children need particular consideration.     

The integral role of the clinical pharmacist in drug-assisted intubation at a newly established children’s major trauma center

International Journal of Clinical Pharmacy - This commentary outlines how the clinical pharmacist can support the safe administration of emergency medications in trauma anesthesia for seriously...     

Contrary to Expectations: Off-Label Transcatheter Aortic Valve Replacement in the Case of Left Ventricular Outflow Tract Obstruction

We present the case of a 71-year-old woman who showed recurrent signs of congestive heart failure with the need of rehospitalization after double valve (mitral and aortic) replacement. Extensive diagnostic workup revealed a moderate aortic stenosis and additionally a significant left ventricular outflow tract obstruction. The tissue overgrowth might be attributed to an inflammatory reaction with extensive pannus deposit after aortic valve surgery. With no-option for re-do surgery we performed the first-in-man off-label valve-in-left ventricular outflow tract procedure with an Edwards Sapien III 23 mm in deep orientation.     

Effects of feeding urea and copper sulphate in different combinations on live body weight,carcass weight,percent weight to body weight of different organs and histopathological tissue changes in broilers

The study was carried out on a total of 100 broiler chicks divided into six equal groups at day 7 of age. Birds were fed copper sulphate and urea in different combinations for up to 37 days and then the birds of all the groups were fed plan feed for one week. The general signs were an increased water intake, ruffled feathering, watery droppings along with salivation in treatment groups. These signs were mild in groups fed low level of urea, while were severe in fed higher levels of these compounds together. Mild to moderate gross changes were observed in the birds of group B, C and D, while more pronounced changes were seen in birds of group E and F. In the latter groups, the liver was pale to yellowish and fragile. Kidneys were enlarged, swollen, congested and sometimes hemorrhagic. Histologically, mild cytoplasmic vacuolation and condensation/pyknosis or disappearance of the nucleus in the cells of the liver and kidney were the salient changes observed in the treatment groups, those were severe in birds fed higher levels of the two compounds. Changes in lungs were congestion and edema. Changes in the bursa of Fabricius were mild cytoplasmic vacuolation, cell depletion and chromatolysis. The live and carcass weights were lower in broilers fed higher levels of both copper and urea than the control group. The weights of kidney and heart were higher in birds fed higher levels of both of the compounds than the control group. It can be concluded from the present study that urea above 2% and copper sulphate above 1 gm in combination cause tissue damage, especially the liver and kidneys.     

Long-term immunogenicity and efficacy of a 9-valent conjugate pneumococcal vaccine in human immunodeficient virus infected and non-infected children in the absence of a booster dose of vaccine

The long-term immunogenicity and vaccine efficacy (VE) of a 9-valent conjugate pneumococcal vaccine was studied in HIV infected and HIV non-infected children. VE against vaccine-serotype invasive pneumococcal disease following 6.16 years of follow-up persisted in HIV non-infected children (77.8%; 95% CI 34.4-92.5 compared to 83% after 2.3 years of follow-up), and declined from 65% to 38.8% (95% CI -7.8 to 65.2) in HIV infected children. HIV non-infected vaccinees had equal (serotypes 4, 6B, 14, 19F) or greater (serotypes 9V, 18C, 23F) proportions of serotype-specific antibody concentrations of > or =0.2microg/ml to vaccine-serotypes analyzed compared to HIV infected vaccinees at 5.3 years of age.