Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea

Delivery of health care services to rural and remote populations in Papua New Guinea (PNG) is problematic. This is mainly due to difficulties with transportation and communication. Hence, the children in this region of PNG are likely to be at risk of malnutrition compounded by inadequate vaccination that may predispose them to preventable diseases. This study was conducted to determine the vaccination and nutritional status of children less than 5 years old in the remote and rural Karawari area of PNG. 105 children were included in the study, of whom 55% were male and 45% female. The mean age of children included in the study was 32.6 months. Their age, height, and weight by gender was not significantly different. Overall, 85% of children had incomplete vaccination. However, children above the median age of 32 months (34%) were more likely to be fully vaccinated for their age, χ2 (1) = 23.294, p < 0.005. In addition, 25% of children were below the -1 SD (Z-scores) for weight-for—height, 33% below the -1 SD for weight-for-age, and 25.5% below the -1 SD for height-for-age compared to WHO standards. A large proportion of children had poor nutrition status and lack protection from vaccine preventable diseases. This study recommends that the government should introduce a surveillance system for detecting issues of importance to the rural majority. We also recommend that the PNG government reopen the nearby health centre, and/ or establish new facilities within the region, with adequately trained and compensated staff

Management of eclampsia in an unbooked primigravida: a case report showing the impact of cultural and socio-economic factors on health outcomes

Eclampsia is characterised by the occurrence of one or more generalised tonic-clonic seizures in patients with severe preeclampsia in the absence of other neurologic conditions. The clinical features of eclampsia can present at any time during pregnancy, but are more common from the second trimester to the puerperium. This report presents the challenges encountered in the management of eclampsia in a remote setting of a developing country and the influence of cultural and socio-economic factors on health outcomes associated with this condition

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

Adverse birth outcomes due to exposure to household air pollution from unclean cooking fuel among women of reproductive age in Nigeria

Exposure to household air pollution (HAP) from cooking with unclean fuels and indoor smoking has become a significant contributor to global mortality and morbidity, especially in low- and middle-income countries such as Nigeria. Growing evidence suggests that exposure to HAP disproportionately affects mothers and children and can increase risks of adverse birth outcomes. We aimed to quantify the association between HAP and adverse birth outcomes of stillbirth, preterm births, and low birth weight while controlling for geographic variability. This study is based on a cross-sectional survey of 127,545 birth records from 41,821 individual women collected as part of the 2018 Nigeria Demographic and Health Survey (NDHS) covering 2013–2018. We developed Bayesian structured additive regression models based on Bayesian splines for adverse birth outcomes. Our model includes the mother’s level and household characteristics while correcting for spatial effects and multiple births per mother. Model parameters and inferences were based on a fully Bayesian approach via Markov Chain Monte Carlo (MCMC) simulations. We observe that unclean fuel is the primary source of cooking for 89.3% of the 41,821 surveyed women in the 2018 NDHS. Of all pregnancies, 14.9% resulted in at least one adverse birth outcome; 14.3% resulted in stillbirth, 7.3% resulted in an underweight birth, and 1% resulted in premature birth. We found that the risk of stillbirth is significantly higher for mothers using unclean cooking fuel. However, exposure to unclean fuel was not significantly associated with low birth weight and preterm birth. Mothers who attained at least primary education had reduced risk of stillbirth, while the risk of stillbirth increased with the increasing age of the mother. Mothers living in the Northern states had a significantly higher risk of adverse births outcomes in 2018. Our results show that decreasing national levels of adverse birth outcomes depends on working toward addressing the disparities between states

Prevalence of hepatitis B virus amongst refugees, asylum seekers and internally displaced persons in low- and middle-income countries: A systematic review

Hepatitis B, caused by the hepatitis B virus (HBV), is a global public health issue that affects 290 million people worldwide. Most people with hepatitis B are in low- and middle-income countries (LMIC), where health systems and resources are often constrained. Refugees, asylum seekers and internally displaced persons (IDPs) often face barriers in seeking health care and are a priority population at risk of hepatitis B. No systematic review to date has evaluated the prevalence of hepatitis B amongst refugees in in LMIC. We undertook a systematic review of the literature identifying 28 studies addressing this topic. Though few studies on this topic exist, the available evidence suggests a high prevalence amongst refugees in LMIC, with wide variation between and within countries. Possible risk factors contributing to hepatitis B include unsafe injections, low immunization coverage, low awareness, mother-to-child transmission, and limited health services. Further study is needed to better understand the prevalence and risk factors for hepatitis B amongst refugees in LMIC, to inform public health responses. Vulnerable populations such as refugees are an important group to consider in national and global efforts to eliminate hepatitis B

Time taken by individuals with respiratory symptoms to present to primary care: a descriptive study of assessments at Australian General Practitioner-led respiratory clinics

Effective control of coronavirus disease 2019 (COVID-19) has been challenging, in part due to significant asymptomatic and pre-symptomatic transmission of disease. Reducing the time between symptom onset and COVID-19 testing and isolation allows enhanced outbreak control. The purpose of this study is to describe the time taken by participants to present to general practitioner-led (GP) respiratory clinics for assessment following the development of symptoms, and to explore associations between demographic and geographic characteristics and the time to presentation. A total of 314,148 participants, who were assessed in GP respiratory clinics between 1 February and 31 August 2021, were included in the analysis. The median age of participants at presentation was 33 years (interquartile range, IQR: 15–49). The median time from development of symptoms to presentation for assessment at GP respiratory clinics was 2 days (IQR: 1–3). Participants were more likely to present within one day of symptom onset if they were aged between 15 and 64 years (43.4%), lived in urban areas (40.9%) or were non-Indigenous (40.2%). Participants in New South Wales and Victoria had twice the odds (OR 2.01; 95% confidence interval (CI): 1.95, 2.08) of presenting at a GP respiratory clinic within one day of symptom onset in August 2021, when there was a COVID-19 outbreak in those states, than they did in March 2021, when there was no COVID-19 outbreak in Australia. The number of days from symptom onset to presentation at a GP respiratory clinic was strongly associated with the presence of a COVID-19 outbreak. Participant age, location of the clinic, and Indigenous status of participants were also associated with the time to presentation. This study highlights the importance of recognising COVID-19 as a potential cause of symptoms, as well as the importance of providing easily accessible, and culturally appropriate, testing facilities for the population

Emerging role of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer: a systematic review

Background/Aims: Pancreatic cancer is the fourth most common cause of cancer associated death worldwide with a five year survival rate less than 5%. The poor prognosis is mainly due to late presentation in 80% of patients and its drug resistant nature. Most diagnoses are made using contrast-enhanced computed-tomography (CT) or magnetic-resonance-imaging (MRI) which have a limited sensitivity between 76-86%. Iron oxide nanoparticles are increasingly used in the diagnostic imaging of pancreatic cancer, due their ability to selectively target tumour cells thereby increasing image resolution. The aim of this study is to identify studies investigating the use of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer. Methods: A systematic review was performed using PubMed for records up to 2015. Search terms used included "iron oxide nanoparticles", "pancreatic cancer" and "imaging". Results: A total of 16 studies were identified evaluating the use of iron oxide nanoparticles in the imaging of pancreatic cancer in-vitro and in in-vivo animal models. Eight of the studies evaluated the use of superparamagnetic-iron-oxide-nanoparticles (SPION), they showed SPION significantly decrease the T2 and T2* relaxation times of tumour tissue, providing a high sensitivity for MRI. Similar results were seen in eight studies that investigated the use of iron oxide nanoparticles conjugated to other molecules including gelatin, survivin, chemokine-receptor-4, silica-gold, endothelial-growth-factor-receptor, urokinase-receptor activator, Clostridium and a sonic-hedgehog target. Conclusion: Iron oxide nanoparticles in the form of SPION or conjugates are biocompatible and effective at targeting tumour cells and significantly attenuate MRI signals in T2-weighted images of pancreatic cancers from a range of cell lines

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures

Raising the D-dimer threshold for ruling out pulmonary embolism: A single-site, observational study with a historical comparison

Objective: The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D-dimer threshold. Methods: This is a single-site, observational, cohort study with a historical comparison. The new guideline raised the D-dimer threshold to 1000 ng/mL for most patients with a Wells' score of 4 or less. Patients investigated for PE with a D-dimer level and/or definitive imaging in 6-month periods before and after the introduction of the guideline were eligible. Patients with D-dimers of 500–1000 ng/mL were prospectively followed up at 3 months for missed PE. Results: During the pre-intervention period, 688 patients were investigated for PE, 366 (53.2%) received definitive imaging and 39 PE were diagnosed (5.7% overall, 10.7% of those imaged). For the 121 patients with D-dimers ≥500 and <1000 ng/mL, 87 (71.9%) were imaged with 7 (5.8%) having a PE diagnosed. Post intervention there were 930 patients, of which 426 (45.8%) received definitive chest imaging and there were 50 patients with PE diagnosed (5.4% overall, 11.7% of those imaged). For the 185 patients with D-dimers ≥500 and <1000 ng/mL, 60 (32.4%) were imaged with 5 (2.7%) having PE diagnosed. No cases of missed PE were identified at 3 months. Conclusion: The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended