Genetic characterization of human coxsackievirus A6 variants associated with atypical hand, foot and mouth disease: a potential role of recombination in emergence and pathogenicity

Human coxsackievirus A6 (CVA6) is an enterically transmitted enterovirus. Until recently, CVA6 infections were considered as being of minor clinical significance, and only rarely aetiologically linked with hand, foot and mouth disease (HFMD) associated with other species A enteroviruses (particularly EV71 and CVA16). From 2008 onwards, however, CVA6 infections have been associated with several outbreaks worldwide of atypical HFMD (aHFMD) accompanied by a varicelliform rash. We recently reported CVA6-associated eczema herpeticum occurring predominantly in children and young adults in Edinburgh in January and February 2014. To investigate genetic determinants of novel clinical phenotypes of CVA6, we genetically characterized and analysed CVA6 variants associated with eczema herpeticum in Edinburgh in 2014 and those with aHFMD in CAV isolates collected from 2008. A total of eight recombinant forms (RFs) have circulated worldwide over the past 10 years, with the particularly recent appearance of RF-H associated with eczema herpeticum cases in Edinburgh in 2014. Comparison of phylogenies and divergence of complete genome sequences of CVA6 identified recombination breakpoints in 2A-2C, within VP3, and between 5' untranslated region and VP1. A Bayesian temporal reconstruction of CVA6 evolution since 2004 provided estimates of dates and the actual recombination events that generated more recently appearing recombination groups (RF-E, -F, -G and -H). Associations were observed between recombination groups and clinical presentations of herpangina, aHFMD and eczema herpeticum, but not with VP1 or other structural genes. These observations provided evidence that NS gene regions may potentially contribute to clinical phenotypes and outcomes of CVA6 infection

Isolated entrapment of the brachialis branch of the musculocutaneous nerve: a case report

Non peer reviewe

RANDOMISED DOUBLE BLIND STUDY TO COMPARE EFFECTIVENESS OF HONEY, SALBUTAMOL AND PLACEBO IN TREATMENT OF COUGH IN CHILDREN WITH COMMON COLD

Background: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies. Objective: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough. Design: Randomised control trial Setting: Aga Khan University Hospital Paediatric Casualty Subjects: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled. Outcome measures: Frequency, severity and extent to which cough bothered and disturbed child and parental sleep were assessed at baseline and over the subsequent five days through telephone interview using a validated scoring tool. Results: One hundred and forty five children were enrolled in the study (45- placebo, 57 –honey, 43 –salbutamol). Of the 145 children 51% were male. Honey significantly reduced the total mean symptom score by day three (p\u3c 0.001). Total mean difference in scores between day zero to five demonstrated a significant difference of honey’s efficacy over placebo (p\u3c 0.002) however no difference was noted when compared to salbutamol (p\u3c0.478). Significant differences in both total as well as each individual symptom score was detected with honey consistently scoring the best whilst placebo and salbutamol scored the worst. In paired comparisons honey was superior to placebo but not salbutamol, whilst salbutamol was not superior to placebo. Conclusion: Honey was most effective in symptomatic relief of symptoms associated with the common cold whilst salbutamol or placebo offered no benefit

Global competencies in family medicine

Introduction:This project was devised to provide a global snapshot of required national competencies in Family Medicine, and is the result of an international collaboration of the International Fellowship of Primary Care Research Networks (IFPCRN). The Research team, which devised the questionnaire and original list of competencies, was drawn from around 30 countries and 15 countries responded to the questionnaire and contributed national data. These countries however represented close to two thirds of our global population and included Low, Middle and High Income countries (based on World Bank Purchasing price Parity (PPP) 2005) as well Parity (PPP) 2005) as well as representing a good cross section of climatological, socio economic and geographical situations. Aims and Objectives: To compile a list of competencies required of global family doctors, via global consultation, and use them in the form of a questionnaire to survey national family medicine representatives to ascertain if family doctors are required to be competent in these disciplines. The Objective is to provide a ‘global snapshot’ of competencies and trends in family medicine Materials and Methods: A representative list of family medicine competencies was compiled by an International Fellowship of Primary Care Research Networks (IFPCRN) group, from 30 countries over a 3-month period, commencing June 2009. A list of 57 expanded items, and 44 core items was then compiled and formed the basis of a questionnaire, with provision for adding additional competencies that did not appear in the list of 57. This was broadcast by list server to the IFPCRN email group. Results: 15 Family medicine/ primary care representatives completed the survey on behalf of their nation (or region in the case of West Africa). Results showed a trend toward a globally standard curriculum but still much variation in competencies taught

Tahapan Eliminasi Malaria Di Kabupaten Kepulauan Aru Provinsi Maluku, Tahun 2014

Malaria cases in Aru Islands district is remain high in 2013, shown by high number of clinical malaria patients (1.617 person), 620 person were laboratory confirmed, 14 of them was pregnant women. This study was aimed to assess the condition of the public health center (Puskesmas) in order to eliminate malaria in Indonesia by 2030. Study was a documents observation and in-depth interviews in charge of malaria and other relevant officials in the District Health Office (DHO) in October 2014. Study was designed by cross sectional. Information on human resources (HR), facilities and budgets and territorial obtained by questionnaire tool prepared for mentoring troubled areas of health (PDBK) 2014. The results shown that both morbidity and suspected malaria evenly in each Puskesmas. Malaria control program in the form of distribution of mosquito nets and RDTs examination in Puskesmas were already done. Theworkers who handle malaria were not distributed well, even for health analysts were still lacking. Facilities were concentrated in Dobo Puskesmas and public hospitals. This study recommends the need of microscopic health analyst as well as research to improve the report system and evaluation of the effectiveness of the mosquito net USAge

Genotyping of clinically relevant human adenoviruses by array-in-well hybridization assay

AbstractA robust oligonucleotide array-in-well hybridization assay using novel up-converting phosphor reporter technology was applied for genotyping clinically relevant human adenovirus types. A total of 231 adenovirus-positive respiratory, ocular swab, stool and other specimens from 219 patients collected between April 2010 and April 2011 were included in the study. After a real-time PCR amplification targeting the adenovirus hexon gene, the array-in-well assay identified the presence of B03 (n = 122; 57.5% of patients), E04 (29; 13.7%), C02 (21; 9.9%), D37 (14; 6.6%), C01 (12; 5.7%), C05 (5; 2.4%), D19 (4; 1.9%), C06 (2; 0.9%), D08 (1; 0.5%), A31 (1; 0.5%) and F41 (1; 0.5%) genotypes among the clinical sample panel. The typing result was obtained for all specimens that could be amplified (n = 223; 97%), and specificity of the typing was confirmed by sequencing specimens representing each of the different genotypes. No hybridization signal was obtained in adenovirus-negative specimens or specimens with other viruses (n = 30). The array-in-well hybridization assay has great potential as a rapid and multiplex platform for the typing of clinically relevant human adenovirus genotypes in different specimen types

The right to health of non-nationals and displaced persons in the sustainable development goals era: challenges for equity in universal health care

Introduction: Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States’ borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in MDG-reporting frameworks. Conclusion: We have identified four ways to promote the protection of vulnerable non-nationals’ health and well being in States’ application of the post-2015 SDG framework: In setting their own post-2015 indicators the UN Member States should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalized groups in the content of such indicators. Our second recommendation is that statisticians from different agencies, including the World Health Organization’s Gender, Equity and Human Rights programme should be actively involved in the formulation of SDG indicators at both the global and country level. In addition, communities, civil society and health justice advocates should also vigorously engage in country’s formulation of post-2015 indicators. Finally, we advocate that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for progress.publishedVersio

Duration of shedding of respiratory syncytial virus in a community study of Kenyan children

Background: Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Methods: In a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods. Results: From 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age. Conclusion: We provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community

No Correlation Between Nasopharyngeal Human Bocavirus 1 Genome Load and mRNA Detection or Serology in Adeno-/Tonsillectomy Patients

Human bocavirus 1 (HBoV1) can persist in nasopharynx and tonsils. Using HBoV1 serology, reverse-transcription polymerase chain reaction (PCR) for detecting messenger RNA (mRNA) and quantitative PCR for HBoV1 genome load count, we studied to what extent the HBoV1 DNA loads in nasopharynx correlate with acute infection markers. Tonsillar tissue, nasopharyngeal aspirate, and serum were obtained from 188 elective adeno-/tonsillectomy patients. Relatively high loads of HBoV1 DNA were detected in the nasopharynx of 14 (7%) primarily asymptomatic subjects with negative mRNA and/or serodiagnostic results. Quantitative HBoV1 DNA PCR may have lower specificity than HBoV1 mRNA detection for diagnosing symptomatic infection.Peer reviewe