83 research outputs found
Hypoxaemia in Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models
OBJECTIVE: To determine the prevalence of hypoxaemia among
under-five children admitted to hospital with clinical severe
pneumonia, and to assess the performance to diagnose hypoxaemia
of models based on clinical signs. METHODS: We conducted a
hospital-based survey in a district hospital from Southern
Mozambique. RESULTS: A total of 825 children were recruited
after obtaining an informed consent. The prevalence of
hypoxaemia on admission was 27.9%, and 19.8% of these children
died (OR compared to non-hypoxaemic children 3.22, 95%CI 1.98 -
5.21, p<0.001). The model with larger area under the ROC
curve (AUC-ROC) to predict hypoxaemia included cyanosis or
thoracoabdominal breathing or respiratory rate >/= 70 breaths
per minute. None of the models performed well when tested in
different case scenarios of oxygen availability through
mathematical modelling, with over 50% of hypoxaemic children not
receiving oxygen even in favourable case scenarios. CONCLUSIONS:
Clinical signs alone or in combination are not suitable to
diagnose hypoxaemia. The use of pulse oximeters should be
strongly encouraged. This article is protected by copyright. All
rights reserved
CKD of Unknown Cause: A Global Epidemic?
World Kidney Day is an appropriate time to reflect on the epidemics(s) of chronic kidney disease (CKD) of undetermined cause (CKDu) that are affecting agricultural communities in Central America, South Asia, and possibly other parts of the world.1, 2, 3, 4 The cause(s) of CKDu remain to be established, with heat, pesticides, water (including heavy metals), infections, or other factors being suggested as the primary cause(s). However, we still do not know, at least on a global level, who gets this disease, or even if the disease is the same in different parts of the world. This lack of basic epidemiological information also has important implications for health care. World Kidney Day 2019 has a theme of “health care access for all,” but health care access cannot be provided for a disease that is unrecognized, undiagnosed, and (even when diagnosed) often untreated. CKDu is clinically silent in the early stages and, in many of the affected areas, carries a poor prognosis. It is usually diagnosed late, and no data are available on factors predicting progression. Renal replacement therapy is unavailable in many low- and middle-income countries,5 and even if present, it is often inaccessible to most of the population, meaning that end-stage renal disease is usually fatal. In addition to the young lives lost, CKDu has a substantial negative impact on social and economic development of affected countries, through jeopardizing the economic development of the affected communities, and straining the poorly resourced health systems of the affected countries
High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia
We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa, and
to investigate PCP-associated risk factors. During 2006-2007 we
used molecular methods to test children younger than 5 years old
admitted with severe pneumonia to a hospital in Southern
Mozambique for Pneumocystis infection. We recruited 834
children. PCP prevalence was 6.8% and HIV prevalence was 25.7%.
The in-hospital and delayed mortality were significantly higher
among children with PCP (20.8% vs. 10.2 %, p=0.021, and 11.5%
vs. 3.6%, p=0.044, respectively). Clinical features were mostly
overlapping between the two groups. Independent risk factors for
PCP were age less than a year (OR 6.34, 95%CI 1.86-21.65), HIV
infection (OR 2.99, 95%CI 1.16-7.70), grunting (OR 2.64, 95%CI
1.04-6.73), and digital clubbing (OR 10.75, 95%CI 1.21-95.56).
PCP is a common and life-threatening cause of severe pneumonia
in Mozambican children. Mother-to-child HIV transmission
prevention should be strengthened. Better diagnostic tools are
needed
Incidence Of Endemic Burkitt Lymphoma In Three Regions Of Mozambique
Data on the burden and incidence of endemic Burkitt lymphoma (eBL) across Mozambique are scarce. We retrospectively retrieved information on eBL cases from reports of the three main hospitals of Mozambique: Maputo Central Hospital (MCH), Beira Central Hospital (BCH), and Nampula Central Hospital (NCH) between 2004 and 2014. For 2015, we prospectively collected information of new eBL cases attending these hospitals. A total of 512 eBL cases were reported between 2004 and 2015: 153 eBL cases were reported in MCH, 195 in BCH, and 164 in NCH. Mean age of cases was 6.9 years (standard deviation = 2.8); 63% (319/504) of cases were males. For 2015, the estimated incidence rate of eBL was 2.0, 1.7, and 3.9 per 10(6) person-year at risk in MCH, BCH, and NCH, respectively. Incidence was higher in NCH (northern Mozambique), where intensity of malaria transmission is higher. Data presented show that eBL is a common pediatric malignancy in Mozambique, as observed in neighboring countries
Cognitive stimulation has potential for brain activation in individuals with Rett syndrome
Background: Knowledge regarding neuropsychological training in Rett syndrome (RS) is scarce. The aim of this study was to assess the outcome and the duration of the effect of cognitive stimulation on topographic EEG data in RS. Method: Twenty female children diagnosed with RS were included in the analysis. Girls with RS conducted a cognitive task using an eye-tracker designed to evaluate access and choice skills. EEG data was acquired during the experimental procedure including two 10-minutes baseline stages before and after the task. Topographical changes of several EEG spectral markers including absolute and relative powers, brain symmetry index and entropy were assessed. Results: Topographic significance probability maps suggested statistical decreases on delta activity and increases on beta rhythm associated with the cognitive task. Entropy increased during and after the task, likely related to more complex brain activity. A significant positive interaction was obtained between brain symmetry index (BSI) and age showing that the improvement of interhemispheric symmetry was higher in younger girls (5-10 years). Conclusions: According to our findings, significant alterations of brain rhythms were observed during and after cognitive stimulation, suggesting that cognitive stimulation may have effects on brain activity beyond the stimulation period. Finally, our promising results also showed an increased brain symmetry that was especially relevant for the younger group. This could suggest an interaction of the eye-tracking cognitive task, however, further studies in this field are needed to assess the relation between brain asymmetries and age.We would like to acknowledge specific funding support from the Spanish Patient Associations Mi Princesa Rett and Rettando al Síndrome de Rett. This project has also received funding from Torrons Vicens and the Ministry of Science and Innovation (MICINN), Spain, under
contract PID2020-117751RB-I00. CIBER-BBN is an initiative of the Instituto de Salud Carlos III, Spain. A. Bachiller is a Serra Húnter Fellow. A.García-Cazorla is supported by FIS P118/00111 “Instituto de Salud Carlos III (ISCIII)” and “Fondo Europeo de desarrollo regional (FEDER)”.
A. Tost has received the predoctoral scholarship FI-AGAUR from the Generalitat de Catalunya.Peer ReviewedPostprint (author's final draft
Procalcitonin and C-Reactive Protein for Invasive Bacterial Pneumonia Diagnosis among Children in Mozambique, a Malaria-Endemic Area
Background: Pneumonia is the major cause of mortality and morbidity in children worldwide. Procalcitonin (PCT) and C-reactive protein (CRP) are used in developed countries to differentiate between viral and bacterial causes of pneumonia. Validity of these markers needs to be further explored in Africa. Methodology and Principal Findings: We assessed the utility of PCT and CRP to differentiate viral from invasive bacterial pneumonia in children <5 years hospitalized with clinical severe pneumonia (CSP) in rural Mozambique, a malaria-endemic area with high HIV prevalence. Prognostic capacity of these markers was also evaluated. Out of 835 children with CSP, 87 fulfilled definition of viral pneumonia and 89 of invasive bacterial pneumonia. In absence of malaria parasites, levels of PCT and CRP were lower in the viral group when compared to the invasive bacterial one (PCT: median = 0.21 versus 8.31 ng/ml, p<0.001; CRP: 18.3 vs. 185.35 mg/l, p<0.001). However, in presence of malaria parasites distribution between clinical groups overlapped (PCT: median = 23.1 vs. 21.75 ng/ml, p = 0.825; CRP: median = 96.8 vs. 217.4 mg/l, p = 0.052). None of the two markers could predict mortality. Conclusions: Presence of malaria parasites should be taken into consideration, either for clinical or epidemiological purposes, if using PCT or CRP to differentiate viral from invasive bacterial pneumonia in malaria-endemic areas
Risk of breast cancer and residential proximity to industrial installations: New findings from a multicase-control study (MCC-Spain)
Breast cancer is the most frequent tumor in women worldwide, although well-established risk factors account for 53%-55% of cases. Therefore, other risk factors, including environmental exposures, may explain the remaining variation. Our objective was to assess the relationship between risk of breast cancer and residential proximity to industries, according to categories of industrial groups and specific pollutants released, in the context of a population-based multicase-control study of incident cancer carried out in Spain (MCC-Spain). Using the current residence of cases and controls, this study was restricted to small administrative divisions, including both breast cancer cases (452) and controls (1511) in the 10 geographical areas recruiting breast cancer cases. Distances were calculated from the respective woman's residences to the 116 industries located in the study area. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (between 1 km and 3 km) to industrial plants, adjusting for matching variables and other confounders. Excess risk (OR; 95%CI) of breast cancer was found near industries overall (1.30; 1.00-1.69 at 3 km), particularly organic chemical industry (2.12; 1.20-3.76 at 2.5 km), food/beverage sector (1.87; 1.26-2.78 at 3 km), ceramic (4.71; 1.62-13.66 at 1.5 km), surface treatment with organic solvents (2.00; 1.23-3.24 at 3 km), and surface treatment of plastic and metals (1.51; 1.06-2.14 at 3 km). By pollutants, the excess risk (OR; 95%CI) was detected near industries releasing pesticides (2.09; 1.14-3.82 at 2 km), and dichloromethane (2.09; 1.28-3.40 at 3 km). Our results suggest a possible increased risk of breast cancer in women living near specific industrial plants and support the need for more detailed exposure assessment of certain agents released by these plants.The authors thank all those who took part in this study providing questionnaire data. The study was partially funded by the “Acción Transversal del Cáncer", approved on the Spanish Ministry Council on the 11th October 2007, by the Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) – EVP-1178/14), by the Spain's Health Research Fund (Fondo de Investigación Sanitaria - FIS 12/01416), by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359 PS09/01286-León, PS09/00773-Cantabria, PS09/02078-Huelva, PS09/01903-Valencia, PS09/01662-Granada, PI11/01403, PI11/01889-FEDER, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/00613, PI15/00069, PI15/00914, PI15/01032), by the ICGC International Cancer Genome Consortium CLL (The ICGC CLL-Genome Project is funded by Spanish Ministerio de Economía y Competitividad (MINECO) through the Instituto de Salud Carlos III (ISCIII) and Red Temática de Investigación del Cáncer (RTICC) del ISCIII (RD12/0036/0036)), by the Fundación Marqués de Valdecilla (API 10/09), by the Consejería de Salud of the Junta de Andalucía (PI-0571-2009, PI-0306-2011, salud201200057018tra), by the Junta de Castilla y León (LE22A10-2), by the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), by the Regional Government of the Basque Country, by the Recercaixa (2010ACUP 00310), by the European Commission grants FOOD-CT-2006-036224-HIWATE, by the Spanish Association Against Cancer (AECC) Scientific Foundation, by the Catalan Government DURSI grant 2017SGR723, by the University of Oviedo, and by the Fundación Caja de Ahorros de Asturias. ISGlobal is a member of the CERCA Program, Generalitat de Catalunya.S
Responding to the need of postgraduate education for Planetary Health : Development of an online Master's Degree
Unidad de excelencia María de Maeztu CEX2019-000940-MAltres ajuts: CERCA Programme/Generalitat de CatalunyaPlanetary Health has emerged as a new approach to respond to the existential risks that the clime and global environmental crises pose to human societies. As stated by various stakeholders, the challenges involved in Planetary Health are of such magnitude that education must be at the forefront to obtain a meaningful response. Universities and higher education institutions have been specifically called to embed the concept of planetary stewardship in all curricula and train the next generation of researchers and change makers as a matter of urgency. As a response to this call, the Universitat Oberta de Catalunya (UOC), the Universitat Pompeu Fabra (UPF), and the Barcelona Institute for Global Health (ISGlobal) developed the first online and asynchronous Master in Science (MSc) in Planetary Health. The aim of the programme is to train a new generation of academics and professionals who understand the challenges of Planetary Health and have tools to tackle them. This article describes the development of the curriculum of this MSc, presents the main characteristics of the programme and discusses some of the challenges encountered in the development of the programme and its implementation. The design of this MSc was based on: the alignment of the programme with the principles for Planetary Health education with a focus on human health; a multi-, inter-, and trans-disciplinary approach; the urgency to respond to the Anthropocene challenges; and the commitment to the 2030 Agenda. The MSc was recognized as an official degree by the Agency for Quality of the Catalan University System, included in the European Quality Assurance Register for Higher Education, and the Spanish National Academic Coordination body in April 2021 and launched in October 2021. There are currently more than 50 students enrolled in the program coming from a broad range of disciplines and geographic locations. The information presented in this article and the discussion on challenges encountered in developing and implementing the programme can be useful for those working in the development of similar programs
High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia
We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa and to investigate PCP-associated risk factors. During 2006–2007 we used molecular methods to test children younger than 5 years old admitted with severe pneumonia to a hospital in southern Mozambique for Pneumocystis infection. We recruited 834 children. PCP prevalence was 6.8% and HIV prevalence was 25.7%. The in-hospital and delayed mortality were significantly higher among children with PCP (20.8% vs. 10.2%, p 0.021, and 11.5% vs. 3.6%, p 0.044, respectively). Clinical features were mostly overlapping between the two groups. Independent risk factors for PCP were age less than a year (odds ratio (OR) 6.34, 95% confidence interval (CI) 1.86–21.65), HIV infection (OR 2.99, 95% CI 1.16–7.70), grunting (OR 2.64, 95% CI 1.04–6.73) and digital clubbing (OR 10.75, 95% CI 1.21–95.56). PCP is a common and life-threatening cause of severe pneumonia in Mozambican children. Mother-to-child HIV transmission prevention should be strengthened. Better diagnostic tools are needed.This work was supported by the World Health Organization (WHO-C6-181-489). QB has a fellowship from the program Miguel Servet of the ISCIII (Plan Nacional de I+D+I 2008–2011, grant CP11/00269). LM has a fellowship from the program Río Hortega of the ISCIII (CM13/00260).Peer reviewe
Assessment of the Combined Effect of Epstein-Barr Virus and Plasmodium falciparum Infections on Endemic Burkitt Lymphoma Using a Multiplex Serological Approach
Epstein–Barr virus (EBV) is a necessary cause of endemic Burkitt lymphoma (eBL), while the role of Plasmodium falciparum in eBL remains uncertain. This study aimed to generate new hypotheses on the interplay between both infections in the development of eBL by investigating the IgG and IgM profiles against several EBV and P. falciparum antigens. Serum samples collected in a childhood study in Malawi (2005–2006) from 442 HIV-seronegative children (271 eBL cases and 171 controls) between 1.4 and 15 years old were tested by quantitative suspension array technology against a newly developed multiplex panel combining 4 EBV antigens [Z Epstein–Barr replication activator protein (ZEBRA), early antigen-diffuse component (EA-D), EBV nuclear antigen 1, and viral capsid antigen p18 subunit (VCA-p18)] and 15 P. falciparum antigens selected for their immunogenicity, role in malaria pathogenesis, and presence in different parasite stages. Principal component analyses, multivariate logistic models, and elastic-net regressions were used. As expected, elevated levels of EBV IgG (especially against the lytic antigens ZEBRA, EA-D, and VCA-p18) were strongly associated with eBL [high vs low tertile odds ratio (OR) = 8.67, 95% confidence interval (CI) = 4.81–15.64]. Higher IgG responses to the merozoite surface protein 3 were observed in children with eBL compared with controls (OR = 1.29, 95% CI = 1.02–1.64), showing an additive interaction with EBV IgGs (OR = 10.6, 95% CI = 5.1–22.2, P = 0.05). Using elastic-net regression models, eBL serological profile was further characterized by lower IgM levels against P. falciparum preerythrocytic-stage antigen CelTOS and EBV lytic antigen VCA-p18 compared with controls. In a secondary analysis, abdominal Burkitt lymphoma had lower IgM to EBV and higher IgG to EA-D levels than cases with head involvement. Overall, this exploratory study confirmed the strong role of EBV in eBL and identified differential IgG and IgM patterns to erythrocytic vs preerythrocytic P. falciparum antigens that suggest a more persistent/chronic malaria exposure and a weaker IgM immune response in children with eBL compared with controls. Future studies should continue exploring how the malaria infection status and the immune response to P. falciparum interact with EBV infection in the development of eBL
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