A Low-Tech Analytical Method for Diethylcarbamazine Citrate in Medicated Salt

The World Health Organization has called for an effort to eliminate Lymphatic Filariasis (LF) around the world. In regions where the disease is endemic, local production and distribution of medicated salt dosed with diethylcarbamazine (DEC) has been an effective method for eradicating LF. A partner of the Notre Dame Haiti program, Group SPES in Port-au-Prince, Haiti, produces a medicated salt called Bon Sel. Coarse salt is pre-washed and sprayed with a solution of DEC citrate and potassium iodate. Iodine levels are routinely monitored on site by a titrimetric method. However, the factory had no method for monitoring DEC. Critical analytical issues include 1) determining whether the amount of DEC in each lot of Bon Sel is within safe and therapeutically useful limits, 2) monitoring variability within and between production runs, and 3) determining the effect of a common local practice (washing salt before use) on the availability of DEC. This paper describes a novel titrimetric method for analysis of DEC citrate in medicated salt. The analysis needs no electrical power and requires only a balance, volumetric glassware, and burets that most salt production programs have on hand for monitoring iodine levels. The staff of the factory used this analysis method on site to detect underloading of DEC on the salt by their sprayer and to test a process change that fixed the problem

Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti

Background: In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. Methods: In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Results: Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program’s success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Conclusion: Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings

COVID‐19 vaccine controversy: A cross‐sectional analysis of factors associated with COVID‐19 vaccine acceptance amongst emergency department patients in New York City

Abstract Objective Understanding variables associated with coronavirus disease 2019 (COVID‐19) vaccine confidence and hesitancy may inform strategies to improve vaccine uptake in clinical settings such as the emergency department (ED). We aim to identify factors contributing to COVID‐19 vaccine acceptance and to assess patient attitudes surrounding offering COVID‐19 vaccines in the ED. Methods We conducted a survey of a convenience sample of patients and patient visitors over the age 18 years, who were native English or Spanish speakers. The survey was conducted from March through August 2021 at 3 EDs in New York City. The survey was administered via an electronic format, and participants provided verbal consent. Results Our sample size was 377. Individuals with post‐graduate degrees viewed vaccines positively (Prevalence Ratio [PR], 1.63; 95% Confidence Interval [CI], 1.07–2.47).  Of the various high‐risk medical conditions associated with adverse COVID‐19 infection outcomes, diabetes was the only condition associated with more positive views of vaccines (PR, 1.37; CI, 1.17–1.59). Of all participants, 71.21% stated that they believed offering a COVID‐19 vaccine in the ED was a good idea. Of unvaccinated participants, 21.80% stated they would get vaccinated if it were offered to them in the ED. Conclusion EDs can serve as a safety net for vulnerable populations and can act as an access point for vaccination

DEC citrate.

<p>DEC citrate.</p

Comparison of titration and HPLC analysis of Bon Sel samples.

<p>Comparison of titration and HPLC analysis of Bon Sel samples.</p

Comparison of back-titration and HPLC concentration determinations.

<p>Error bars show standard deviation of triplicate measurements. For low concentration samples, error bars in HPLC measurement are very small.</p

Within-lot and between-lot DEC citrate concentrations^* in Bon Sel samples determined by titration method.

<p>*Different samples were taken from different bags of Bon Sel (see text for discussion of sample heterogeneity). The lots are approximately 500 kg in weight. Errors for each sample are the standard deviations for triplicate titration of the sample, except for X1, which was titrated 6 times. Lots 16–22 were analyzed by the titration method at Notre Dame, the other samples were analyzed in Haiti.</p

DEC citrate standard curve for back titration.

<p>DEC concentration (g/100 g salt) versus endpoint volume of back-titration are plotted for triplicate standards.</p