Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

Primary Sjogren's syndrome presenting as hypokalemic paralysis: A case series

Primary Sjögren's syndrome (pSS) primarily involves exocrine glands, and renal tubular acidosis (RTA) is seen in one-third of the cases. RTA with hypokalemic paralysis as a presenting feature of pSS is described in few case reports in literature. We report 13 cases who presented as hypokalemic paralysis, and on evaluation were diagnosed to be pSS, as per the diagnostic criteria laid by the Sjögren's International Collaborative Clinical Alliance (2012). All patients were female, with a mean age at presentation being 33.1 ± 8.22 years (range, 25–48 years). Eleven patients had a complete distal RTA and two patients had incomplete distal RTA at the time of presentation. 62% (8/13) of patients had no signs and symptoms of exocrine gland involvement. All the cases were managed with oral alkali therapy, and six patients received additional immunomodulating agents. No improvement in renal tubular dysfunction (in the form of a reduction in the alkali dose) after immunomodulating therapy was observed over a mean follow-up of 2.8 years. Renal tubular dysfunction can be the presenting manifestation of pSS. It is important to consider the possible presence of this disorder in adults with otherwise unexplained distal RTA or hypokalemia

Hemolytic uremic syndrome associated with Plasmodium vivax malaria successfully treated with plasma exchange

We report a case of hemolytic uremic syndrome (HUS) in an adult patient with Plasmodium vivax malaria. The patient presented with worsening anemia, persistent thrombocytopenia and acute kidney injury. HUS was diagnosed based on the high serum lactate dehydrogenase, elevated reticulocyte count and presence of schistocytes on peripheral blood smear. Kidney biopsy showed features of thrombotic microangiopathy. Complete hematological remission was achieved after five sessions of therapeutic plasma exchange. Renal function partially recovered and stabilized at discharge. Vivax malaria, generally considered benign, may be rarely associated with HUS

Epidemic of Chemical Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Report from Western India

While non-infectious etiologies like chemical irritants are rare causes of epidemics of peritonitis, this possibility should be considered when one encounters an unusual clustering of peritonitis cases. We describe here an epidemic of chemical peritonitis at our center

Lymphorrhea: An unusual complication of jugular venous catheterization for hemodialysis

A considerable number of end-stage renal disease patients undergo tunneled cuffed catheter insertion for hemodialysis under ultrasonographic guidance while awaiting arteriovenous fistula creation. We report a case of a 62-year-old female who underwent tunneled catheter insertion in the left internal jugular vein under ultrasound and fluoroscopic guidance, which was followed by pericatheter serous discharge. Fluid examination confirmed the diagnosis of lymphorrhea, and lymphoscintigraphy facilitated its localization. This case is reported for its rarity and with a discussion on literature review, complications of lymphorrhea, and their management

Ecofriendly synthesis and biological evaluation of 4-(4-nitro-phenyl)-2-phenyl-1,4-dihydro-benzo[4,5]imidazo[1,2-a]pyrimidine-3-carboxylic acid ethyl ester derivatives as an antitubercular agents

<p>An ecofriendly route has been investigated for the synthesis of 4-(4-nitro-phenyl)-2-phenyl-1,4-dihydro-benzo[4,5]imidazo[1,2-a]pyrimidine-3-carboxylic acid ethyl ester derivatives by one-pot, three-component condensation of ethyl benzoylacetate, aromatic aldehydes, and 2-amino benzimidazole using 260 mol% of citric acid as reaction mediator. Citric acid is an inexpensive, nontoxic, and green medium with smoothly activates the rate of reaction. The synthesized compounds were assessed for in vitro antimycobacterial activity against <i>Mycobacterium tuberculosis</i> H₃₇RV strain using the microplate alamar blue assay (MABA). The results indicate that among all the synthesized compound series, P-4 and P-9 compounds illustrate effective activity with a minimum inhibitory concentration of 25 µg/ml.</p

Uncatalyzed four-component synthesis of pyrazolopyranopyrimidine derivatives and their antituberculosis activities

<p>Fused pyrazolopyranopyrimidines containing both biologically active pyranopyrazole and pyranopyrimidine compounds were synthesized using a one-pot, four-component reaction of ethyl aceto acetate, hydrazine hydrate, benzaldehydes, and thiobarbituric acid without catalyst in ethanol. All target compounds obtained in very good to excellent yields over short reaction times by adapting a simple workup procedure. All the synthesized compounds exhibited good to excellent antituberculosis activities. The results shown that 4-(1<i>H</i>-imidazol-2-yl)-3-methyl-7-thioxo-4,6,7,8-tetrahydropyrazolo[4’,3′:5,6]pyrano[2,3-<i>d</i>] pyrimidin-5(1<i>H</i>)-one (<b>5a</b>) is a good antitubercular agent, as good as the standard streptomycin drug, based on minimum inhibitory concentration (MIC).</p