Establishment of a cohort of HC of CL patients in <i>L. braziliensis</i> endemic area.

<p>Establishment of a cohort of HC of CL patients in <i>L. braziliensis</i> endemic area.</p

Demographic and epidemiologic features of patients with cutaneous leishmaniasis and household contacts with and without evidence of immune response to leishmania antigen.

<p>Values with identical superscripts are significantly different. Statistical tests and p-values are below.</p><p>P-values for pair-wise Bonferroni post-hoc tests:</p>a<p> = 0.002,</p>b<p> = 0.004,</p>c<p> = 0.005,</p>d<p> = 0.003,</p>e<p> = 0.009,</p>f<p><0.001.</p>*<p>one-way ANOVA test.</p>**<p>Pearson's chi-square test.</p>***<p>before 4:00 pm.</p

Correlation between IFN-γ and CXCL10 production to soluble <i>Leishmania</i> antigen.

<p>The data was obtained from 54 household contacts (HC) with evidence of immune response and 51 household contacts without evidence of immune response which were selected among individuals living in the same households as HC with evidence of immune response. Values of IFN-γ (pg/ml) and CXCL10 (pg/ml) from 105 HC were plotted in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001947#pntd-0001947-g003" target="_blank">Figure 3</a> and these data were analyzed by the Spearman correlation test. P<0.0001, r = 0,74.</p

Production of CXCL9 and CXCL10 in cultures with or without stimulation with soluble <i>Leishmania</i> antigen.

<p>Aliquots of 1 ml of heparinized peripheral blood were cultured in the absence (medium) or stimulated with SLA for 72 hours. Chemokines production was determined by ELISA and results are expressed as pg/ml. Figure A shows the data obtained for CXCL9 and Figure B CXCL10. Values statistically different are indicated as: *** p<0.0001; *p<0.05; Wilcoxon test; GraphPad Prism 4. Medium; SLA.</p

Spontaneous and SLA induced IFN-γ and chemokines production by cells of household contacts of cutaneous leishmaniasis patients with and without evidence of immune response to leishmania antigen.

<p>Values with identical super-scripts are significantly different. Statistical tests and p-values are below:</p><p>P-values for Kruskal Wallis Dunn's post test:</p>a<p><0.05,</p>b<p><0.001,</p>c<p><0.001,</p>d<p><0.001,</p>e<p><0.001,</p>f<p><0.001,</p>g<p><0.001,</p>h<p><0.001,</p>i<p> = <0.001,</p>j<p> = 0.01,</p>k<p><0.001,</p>l<p><0.001,</p>m<p><0.001,</p>n<p><0.001.</p>*<p>one-way ANOVA test;</p>**<p>Kruskal Wallis test;</p>***<p><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001947#s3" target="_blank">Results</a> expressed as Median value (inter-quartile range).</p

White Paper on Early Critical Care Services in Limited Resource Settings

This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources