Infectious diseases are constantly in transition. New diseases develop, known dis-eases become widespread or reemerge, and occasionally a disease is eradicated.Infectious diseases such as HIV, tuberculosis, and cholera are significant causes ofillness and death in many parts of the world. Health car...e personnel are on thefront lines, helping to protect their clients from infectious diseases and treatingthem when infections occur. During the course of their work, health care person-nel perform clinical procedures or other activities that can expose both them andtheir clients to potentially infectious microorganisms. Many of their clients aresick and thus may be more susceptible to infections or may have infections thatcan be transmitted to others. Fortunately, all staff working at health care facilities can perform simple proce-dures to minimize risk—to themselves and clients—and reduce the spread ofinfections. These practices can be integrated at minimal cost into the routineworkday at clinics and hospitals around the world. This reference booklet isspecifically designed for use at all levels of the health care system, from thelargest hospitals to the smallest dispensaries or health posts, in settings whereresources are scarce. This booklet, which was first published in 1999, has now been updated. Whilemost practices remain the same, there have been a few important changes—forexample, in recommendations related to hand hygiene and standard precautions.Nonetheless, this booklet continues to present practical recommendations forsimple and relatively low-cost procedures that can be implemented anywhere,with basic supplies and little to no high-technology equipment.
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Mientras los países se esfuerzan por avanzar hacia los Objetivos de Desarrollo Sostenible (ODS) y lograr la cobertura sanitaria universal, las desigualdades sanitarias provocadas por la discriminación racial y los factores interrelacionados siguen estando omnipresentes. Las desigualdades que sufre...n los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas son preocupantes a nivel mundial; son injustas, prevenibles y remediables
Los propios sistemas de salud son determinantes importantes de la salud y la equidad sanitaria. Pueden perpetuar las desigualdades sanitarias al reflejar el racismo estructural y las prácticas discriminatorias de la sociedad en general. En este sentido, el racismo sistémico (por ejemplo, relacionado con la ubicación de los servicios o los requisitos para acceder a ellos), los prejuicios implícitos, la práctica clínica mal informada o la discriminación por parte de los profesionales de la salud contribuyen a las desigualdades sanitarias. Ahora bien, los sistemas de salud también pueden convertirse en una de las principales fuerzas para combatir las desigualdades a las que se enfrentan las poblaciones que sufren discriminación racial.
La atención primaria de salud (APS) representa la estrategia esencial que permite reorientar los sistemas de salud y las sociedades para que sean más saludables, equitativos, eficaces y sostenibles. En 2018, al cumplirse el 40.º aniversario de la Declaración de Alma-Ata, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF) renovaron el énfasis en la atención primaria de salud con su estrategia sobre la atención primaria de salud en el siglo XXI.
La OMS ha señalado 14 mecanismos estratégicos y operacionales con los que los responsables políticos pueden reforzar la atención primaria de salud. Cada mecanismo dispone de múltiples puntos de partida posibles para emprender acciones específicas dirigidas a combatir la discriminación racial, fomentar la atención de salud intercultural y reducir las desigualdades sanitarias que sufren los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas
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Revista Médica del Hospital General de México, Vol. 81. Issue 3.Pages 154-164 (July - September 2018)
Chagas disease is a parasitic zoonosis caused by Trypanosoma cruzi, a protozoan whose transmission to humans is primarily vector-borne. It is estimated that 6–8 million people worldwide are inf...ected and that 65–100 million people are at risk of becoming infected. Its clinical spectrum is very broad. During the acute phase, non-specific manifestations develop that may go unnoticed. During the chronic phase, specific manifestations develop that are diagnosed late and increase the morbidity and mortality of those suffering from it.
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The protozoan parasite Trypanosoma cruzi causes Chagas disease, an important public health problem throughout Latin America. Current therapeutic options are characterised by limited efficacy, long treatment regimens and frequent toxic side-effects. Advances in this area have been compromised by gaps... in our knowledge of disease pathogenesis, parasite biology and drug activity. Nevertheless, several factors have come together to create a more optimistic scenario. Drug-based research has become more systematic, with increased collaborations between the academic and commercial sectors, often within the framework of not-for-profit consortia. High-throughput screening of compound libraries is being widely applied, and new technical advances are helping to streamline the drug development pipeline. In addition, drug repurposing and optimisation of current treatment regimens, informed by laboratory research, are providing a basis for new clinical trials. Here, we will provide an overview of the current status of Chagas disease drug development, highlight those areas where progress can be expected, and describe how fundamental research is helping to underpin the process.
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HIV-1 infection disproportionately affects women in sub-Saharan Africa, where areas of high HIV-1 prevalence and Schistosoma haematobium endemicity largely overlap. Female genital schistosomiasis (FGS), caused most frequently by S. haematobium egg deposition in the genital tract, has been associated... with prevalent HIV-1 infection in cross-sectional studies. The presence of S. haematobium eggs in genital tissue is also associated with vascularization and the accumulation of CD4+ lymphocytes and macrophages, making the granuloma-associated environment a potential contributor to HIV-1 vulnerability. In addition to modulation of the local cervicovaginal environment, FGS has also been associated with a higher frequency of systemic CD4 T-cells expressing the chemokine receptor CCR5. Tissue-entrapped eggs are also associated with clinically visible FGS-associated manifestations in the cervicovaginal mucosa. FGS lesions may breach the intact cervicovaginal immune barrier and are hypothesized to provide an entry point for HIV-1 infection. However, the underlying mechanism for potential HIV-1 vulnerability in FGS has not been fully characterized and requires further investigation.
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Dengue is a significant public health problem. There are four dengue virus serotypes identified; however, its diagnosis is difficult due to the existence of many viruses, bacteria, and parasites producing the same clinical presentation, being present in the same geographical area and even producing ...coinfections. Therefore, determining whether a person has, had, or is infected with dengue virus is of great importance. In order to do so, direct and indirect laboratory tests have been developed to identify the virus or part of its structure that generally detects the antibody response. These techniques are used for diagnosis, epidemiological studies, monitoring, assessment and production of vaccines and antivirals, etc. They range from the use of cell cultures, animal models, inoculation by insects, and serology tests to the use of detection molecular tests and quantification of genetic material that are described in this chapter herein, a brief explanation of this methodology, its strengths and weaknesses, and its application in the dengue research.
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After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery, pre-clinical development, and operational challenge...s of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
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Breast cancer is the most common cancer worldwide and the leading cause of cancer deaths among women, disproportionately affecting low- and middle-income countries. The Global Breast Cancer Initiative strives to reduce breast cancer mortality by 2.5 percent per year, which over a 20-year period can ...save 2.5 million lives. The purpose of this core technical package is to outline a pathway for incremental, sustainable improvements tailored to country-specific needs based on three key strategies and objectives: health promotion for early detection; timely diagnosis; and comprehensive breast cancer management. This document provides a common framework linking policy makers, stakeholders, the clinical community, program managers and civil society to evidence-based systematic approaches that can facilitate health systems strengthening and reduce inequities in women’s health throughout their life cycles
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El objetivo de este conjunto de herramientas técnicas básicas es delinear una trayectoria para lograr mejoras acumulativas y sostenibles adaptadas a las necesidades específicas de cada país a partir de tres estrategias y objetivos clave: la promoción de la salud para una detección precoz; el d...iagnóstico oportuno; y la gestión integral del cáncer de mama. En este documento se ofrece un marco común que vincula a los responsables de formular políticas, las partes interesadas, la comunidad de atención clínica, los gestores de programas y la sociedad civil con enfoques sistemáticos basados en la evidencia que pueden facilitar el fortalecimiento de los sistemas de salud y reducir las inequidades en la salud de las mujeres a lo largo de su ciclo vital.
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Treatment of second-stage gambiense human African trypanosomiasis relied on toxicarsenic-based derivatives for over 50 years. The availability and subsequent use of eflornithine,initially in monotherapy and more recently in combination with nifurtimox (NECT), has drasticallyimproved the pro...gnosis of treated patients. However, NECT logistic and nursing requirementsremain obstacles to its deployment and use in peripheral health structures in rural sub-SaharanAfrica. Two oral compounds, fexinidazole and SCYX-7158, are currently in clinical development.The main scope of this article is to discuss the potential impact of new oral therapies to improvediagnosis-treatment algorithms and patients’access to treatment, and to contribute to reach theobjectives of the recently launched gambiense humanAfrican trypanosomiasis elimination program
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Sleeping sickness is a neglected tropical disease affecting rural communities in sub-Saharan Africa. The reduction in the number of reported cases in recent years indicates that disease transmission is under control. However, many aspects of patient management still need to be improved. Undiagnosed ...patients or inappropriate treatment due to an incorrect determination of the disease stage could in fact lead to its re-emergence. There is thus a strong need for new diagnostic and staging tools to keep the disease under control and to improve the clinical care of patients. This review describes the most promising biomarkers proposed so far for the diagnosis and stage determination of patients suffering from sleeping sickness, with a particular emphasis on their translation into diagnostic tools for field applications.
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Lateral-flow rapid diagnostic tests (RDTs) continue to play a vital role in global health in the management and diagnosis of infectious diseases, including malaria, HIV and COVID-19. Visually interpreted RDTs, more than any other class of diagnostics, fulfil WHO’s ASSURED criteria,1 enabling their... use at the lowest levels of health care and in self-testing.2 Their utility is, however, compromised every time a test is incorrectly performed or interpreted or its result is not available in a timely manner for clinical decisionmaking and surveillance.
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El objetivo de esta guía es brindar recomendaciones prácticas al personal de salud que se hace cargo de las actividades de preparación y respuesta a las enfermedades contagiosas para asegurar que se mantenga el acceso a servicios de aborto seguro (SAS) cuando surja un brote de enfermedades contag...iosas. Es una guía operativa que puede servir para apoyar a los actores de la salud para que los SAS se mantengan durante los brotes y asegurar que las consideraciones necesarias de SAS se integren dentro de la respuesta al brote; no es una guía clínica. El enfoque centrado en la ubicación de este documento se dirige a los asentamientos frágiles y de ayuda humanitaria; sin embargo, las recomendaciones pueden aplicarse a brotes de enfermedades contagiosas a cualquier población con escasez de recursos. Esta guía busca complementar el trabajo llamado La salud sexual y reproductiva y los derechos durante los brotes de enfermedades contagiosas: Guía operativa para escenarios frágiles y de ayuda humanitaria.
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The objectives of the meeting were:
1. To update the current status of the disease transmission, country capacities and plans for tackling the disease.
2. To understand the epidemiology including disease distribution and risk, the models
for estimating under-detection, the geographical variati...ons of in clinical presentation,
the roles of domestic and wild animal reservoirs and the subsequent different
transmission patterns and control approaches, including vector control.
3. To update current research and development efforts for improving diagnostic and
treatment tools.
4. To define the goals for achieving the control of r-HAT, the need for a multisectoral
approach and to discuss the strategy for controlling r-HAT and the coordination
mechanisms.
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In the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients living with HIV (PLHIV) is higher. It is important t...o investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.
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Cutaneous Leishmaniasis (CL) is a painful disease that exerts a serious toll on societies around the world that are afflicted by it. Although not life-threatening, the skin ulcers and scars it causes can lead to isolation and psychosocial pathologies due to social stigma, and its occurrence is often... associated with regional conflicts. The Cutaneous Leishmaniasis Research Meeting was held on December 7, 2020, with participation by basic researchers, clinical researchers, and drug discovery experts involved in research and development related to CL under the auspices of the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine. In addition, the CL Webinar was held on March 5, 2021, hosted by the Graduate School of Tropical Medicine and Global Health, co-hosted by the Institute of Tropical Medicine, and supported by Médecins Sans Frontières and DNDi.
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Cutaneous Leishmaniasis (CL) is a painful disease that exerts a serious toll on societies around the world that are afflicted by it. Although not life-threatening, the skin ulcers and scars it causes can lead to isolation and psychosocial pathologies due to social stigma, and its occurrence is often... associated with regional conflicts. The Cutaneous Leishmaniasis Research Meeting was held on December 7, 2020, with participation by basic researchers, clinical researchers, and drug discovery experts involved in research and development related to CL under the auspices of the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine. In addition, the CL Webinar was held on March 5, 2021, hosted by the Graduate School of Tropical Medicine and Global Health, co-hosted by the Institute of Tropical Medicine, and supported by Médecins Sans Frontières and DNDi.
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Cutaneous Leishmaniasis (CL) is a painful disease that exerts a serious toll on societies around the world that are afflicted by it. Although not life-threatening, the skin ulcers and scars it causes can lead to isolation and psychosocial pathologies due to social stigma, and its occurrence is often... associated with regional conflicts. The Cutaneous Leishmaniasis Research Meeting was held on December 7, 2020, with participation by basic researchers, clinical researchers, and drug discovery experts involved in research and development related to CL under the auspices of the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine. In addition, the CL Webinar was held on March 5, 2021, hosted by the Graduate School of Tropical Medicine and Global Health, co-hosted by the Institute of Tropical Medicine, and supported by Médecins Sans Frontières and DNDi.
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Cutaneous Leishmaniasis (CL) is a painful disease that exerts a serious toll on societies around the world that are afflicted by it. Although not life-threatening, the skin ulcers and scars it causes can lead to isolation and psychosocial pathologies due to social stigma, and its occurrence is often... associated with regional conflicts. The Cutaneous Leishmaniasis Research Meeting was held on December 7, 2020, with participation by basic researchers, clinical researchers, and drug discovery experts involved in research and development related to CL under the auspices of the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine. In addition, the CL Webinar was held on March 5, 2021, hosted by the Graduate School of Tropical Medicine and Global Health, co-hosted by the Institute of Tropical Medicine, and supported by Médecins Sans Frontières and DNDi.
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Violence against women and girls is widespread in the Region of the Americas, resulting in enormous consequences for the health and wellbeing of women and girls, their families and communities. These costs are unacceptable and they can be prevented through evidence-based action, including the health... sector through its policies and protocols, as well as in collaboration with other sectors. This report remains the first of its kind and is a major milestone for the Region. It is specifically informed by the commitments of Member States in the regional Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women. The report provides an analysis of efforts to advance the prevention of violence against women through health policies, clinical protocols, multisectoral plans and related approaches across the Americas. Attention to this topic is timely, as the COVID-19 pandemic has created new visibility for this area of work. This report offers critical information on efforts in the Region that can be learned from and used to build upon in the future to prevent and respond to violence against all women and girls everywhere.
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