The document "Management of Type 2 Diabetes Mellitus" provides comprehensive guidelines for the diagnosis, prevention, and treatment of type 2 diabetes in adults. It emphasizes the importance of individualized glycemic targets, lifestyle interventions like diet and exercise, and the use of medicatio...ns such as metformin, SGLT2 inhibitors, and GLP1 receptor agonists to manage blood sugar levels and reduce long-term complications. The document also discusses the screening and management of comorbidities such as hypertension, hyperlipidemia, and diabetic complications like retinopathy, neuropathy, and nephropathy. It highlights the role of diabetes self-management education and support in improving adherence to treatment and patient outcomes. The guidelines are evidence-based and aim to reduce morbidity and mortality associated with type 2 diabetes.
more
WHO Package of Essential NCD interventions will help to improve the coverage of appropriate services for people with NCDs services in primary care settings. The HEARTS technical package provides a strategic approach to improving cardiovascular health in countries in primary care settings.
Diabetes mellitus is a major cause of morbidity and mortality in Scotland and worldwide, with an increasing prevalence. In 2009 there were around 228,000 people registered as having diabetes in Scotland, an increase of 3.6% from the preceding year. This increase relates, in part, to the increasing a...ge of the population, an increase in obesity and also perhaps to increasing survival of those with diabetes.
more
Diabetes is a major public health problem. The rising incidence of Diabetes Type 2 is related to the effects of urbanization and unhealthy lifestyles. Research studies show that healthy eating and regular physical activity can prevent or delay the onset of Diabetes Type 2, even in high-risk individu...als.
more
The document outlines the 2019 update to the South African guideline for managing chronic obstructive pulmonary disease (COPD). It emphasizes the importance of early diagnosis, prevention through smoking cessation, use of bronchodilators as primary pharmacotherapy, and a comprehensive approach to pa...tient care including pulmonary rehabilitation and the management of comorbidities. The guideline also covers recommendations for handling acute exacerbations, surgical interventions, and long-term treatment options.
more
With the growing prevalence of type 2 diabetes, particularly in emerging countries, its management in the context of available resources should be considered. International guidelines, while comprehensive and scientifically valid, may not be appropriate for regions such as Asia, Latin America or Afr...ica, where epidemiology, patient phenotypes, cultural conditions and socioeconomic status are different from America and Europe. Although glycaemic control and reduction of micro- and macrovascular outcomes remain essential aspects of treatment, access and cost are major limiting factors; therefore, a pragmatic approach is required in restricted-resource settings. Newer agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in particular, are relatively expensive, with limited availability despite potentially being valuable for patients with insulin resistance and cardiovascular complications. This review makes a case for the role of more accessible second-line treatments with long-established efficacy and affordability, such as sulfonylureas, in the management of type 2 diabetes, particularly in developing or restricted-resource countries.
more
Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (...SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
more
Non-communicable diseases (NCDs) are of increasing concern for society and national governments, as well as globally due to their high mortality rate. The main risk factors of NCDs can be classified into the categories of self-management, genetic factors, environmental factors, factors of medical co...nditions, and socio-demographic factors.
more
Cholera is a transmissible diarrhoeal infection caused by Vibrio cholerae. Endemic and/or epidemic in over 40 countries (mainly in Africa and Asia), cholera continues to be a major global public health issue.
The World Health Organization (WHO) estimates that the number of cases reported worldwid...e represents in reality only 5 to 10% of actual cases.
This guide is intended for medical and non-medical staff responding to a cholera outbreak. It attempts to provide concrete answers to the questions and problems faced by staff, based on the recommendations of reference organisations, such as WHO and UNICEF, as well as Médecins Sans Frontières’ experience in the field.
It is divided into 8 chapters. Chapter 1, Cholera overview, outlines the epidemiological and clinical features of cholera. Chapter 2, Outbreak investigation, explains the method and stages of a field investigation, from the alert to implementation of initial activities. Chapter 3, Cholera control measures, details measures and tools to prevent and/or control cholera transmission and mortality in populations affected, or at risk of being affected, by an epidemic (curative care, prevention means and health promotion activities). Chapter 4, Strategies for epidemic response, addresses the roll-out strategies of the measures described in Chapter 3 which depend on context (e.g. urban, rural, endemic, non-endemic setting, etc.), resources and particular constraints. Chapter 5, Cholera case management, details the different stages of cholera treatment, from diagnosis through to cure.
Chapter 6, Setting up cholera treatment facilities, focuses on the installation of treatment facilities that vary in size and complexity according to operational requirements (treatment centres and units and oral rehydration points). Chapter 7, Organisation of cholera treatment facilities, describes the organisation of these specialized facilities in terms of human resources, supply, water, hygiene and sanitation, etc. Chapter 8, Monitoring and evaluation, presents the key data to be collected and analysed during an epidemic to facilitate a tailored response and evaluate its quality and effectiveness.
The guide includes various practical tools in the appendices to facilitate activities (e.g. water quality tests, job descriptions, documents, etc.). Moreover, the toolbox also contains additional tools in editable formats (individual patient file, cholera case register, pictograms).
Despite all efforts, it is possible that certain errors may have been overlooked in this guide. Please inform the authors of any errors detected.
To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions.
more
Technical Update
Areas of Africa endemic for Buruli ulcer (BU), caused by Mycobacterium ulcerans, also have a high prevalence of human immunodeficiency virus (HIV), with adult prevalence rates between 1% and 5% (Maps). However, there is limited information on the prevalence of BU–HIV coinfection.... Preliminary
evidence suggests that HIV infection may increase the risk of BU disease (1–3). In the Médecins Sans Frontières project in Akonolinga, Cameroon, HIV prevalence was approximately 3–6 times higher among BU patients than the regional estimated HIV prevalence (2). Similarly in Benin and Ghana, BU
patients were 8 times and 3 times respectively more likely to have HIV infection than those without BU (1, 3). Further study is needed to clarify this association and enhance knowledge about the prevalence ofBU–HIV coinfection in endemic areas.
more
Practical guide for doctors, nurses,laboratory technicians, medical auxiliaries,water and sanitation specialists and logisticians
Practical guide for doctors, nurses, laboratory technicians, medical auxiliaries and logisticians
Second edition. This revised edition incorporates experience gained in recent catastrophes, such as the 2013 Typhoon Haiyan in the Philippines, the 2014/15 Ebola epidemic in West Africa and the 2015 earthquake in Nepal. It also contains a number of annexes, which cover such topics as handling the bo...dies of people who died from an infectious disease, burial planning and using DNA analysis in mass fatality events
more
Proper and dignified management of the dead in disasters is one of the three key pillars of humanitarian response and a fundamental factor in facilitating identification of the deceased and helping families discover the fate of their loved ones. This second and updated edition of this hugely success...ful manual provides practical and easy-to-follow guidelines on the recovery, documentation and storage of the remains of individuals who have died in disasters, helping first responders ensure that the dead are treated with respect and that information crucial for their subsequent identification is recorded. This revised edition incorporates experience gained in recent catastrophes, such as the 2013 Typhoon Haiyan in the Philippines, the 2014/15 Ebola epidemic in West Africa and the 2015 earthquake in Nepal.
more
In the mid-1980s, recognizing the limitations of traditional training and that the knowledge and skills acquired are not necessarily applied back in the workplace, MSH developed the Monitoring‐Training-Planning (MTP) approach to assist the Ecuadorian Ministry of Health to implement its Child Survi...val Program. Using the MTP approach, staff me
mbers learn to mobilize their own resources and to improve, incrementally, the management of medicines and other pharmaceuticals at their own facility.
more
Practical guide for doctors, nurses,laboratory technicians, medical auxiliaries,water and sanitation specialists and logisticians. Online version
For patients on HFNO with persistent hypoxaemia or respiratory distress:
• Check the equipment: inspect the exterior of the machine, the tubing (circuit), the prong for any sign of mechanical damage, confirm it fits and the filters are in place. Ensure the settings are appropriate and flow is max...imized.
• Check the oxygen source: there is sufficient oxygen available and flowing through the device. If FiO2 > 50% of oxygen is needed, the device must have a blender.
• Check there is no obstruction with secretions: patients with COVID-19 may have very thick secretions which may block small and large airways and cause sudden respiratory deterioration.
more
WHO recommends prompt recognition of progressive acute hypoxaemic respiratory failure when a patient with respiratory distress is failing to respond to standard oxygen therapy and adequate preparation to provide advanced oxygen/ventilatory support.
Hypoxaemic respiratory failure in ARDS commonly re...sults from intrapulmonary ventilation-perfusion mismatch or shunt and usually requires mechanical ventilation.
At any time, if there are urgent or emergent indications for intubation, do not delay.
WHO suggests that hospitalized patients with severe or critical COVID-19 with acute hypoxaemic respiratory failure that do not require emergent intubation be treated with HFNO, or CPAP or NIV (BiPAP) rather than standard oxygen therapy.
more
WHO recommends prompt recognition of progressive acute hypoxaemic respiratory failure when a patient with respiratory distress is failing to respond to standard oxygen therapy and adequate preparation to provide advanced oxygen/ventilatory support.
Hypoxaemic respiratory failure in ARDS commonly ...results from intrapulmonary ventilation-perfusion mismatch or shunt and usually requires mechanical ventilation.
At any time, if there are urgent or emergent indications for intubation, do not delay.
We recommend prompt recognition of progressive acute hypoxaemic respiratory failure when a patient with respiratory distress is failing to respond to standard oxygen therapy and adequate preparation to provide advanced oxygen/ventilatory support.
WHO suggests that patients with severe or critical COVID-19 with acute hypoxaemic respiratory failure that do not require emergent intubation be treated with HFNO, or CPAP or NIV (BiPAP) over standard oxygen therapy.
more