Is vaccination the only option for possible global malaria eradication?

In the last century, vaccines, together with the discovery of antibiotics have been powerful tools in the management of infectious diseases. Both were of particular importance in reducing the morbidity and mortality associated with infections prevailing in the early 20th century. Whereas antibiotics were useful in treating the infection, vaccines worked by priming the uninfected individual against future infections. The success of vaccination can be seen through numerous examples. The World Health Organisation (WHO) was able to certify that smallpox had been eradicated in 1980 whereas the European Regional Commission for the Certification of the Eradication of Poliomyelitis declared the European Region polio-free on 21 June 2002.2 On the other hand, measles has been reduced to very low levels in many regions of the world. This led to the speculation that such a good result could be extended to other diseases. Tuberculosis, human immunodeficiency virus (HIV) and malaria are currently three infectious diseases requiring urgent attention due to their serious consequences especially in less developed countries.peer-reviewe

Malaria and the traveller

Malaria has reached epidemic proportions. About 40% of the world’s population live in malarious areas. It is estimated that 400 million people are infected by malaria each year and of these, 1-3 million die, mostly children under five years of age. In the year 2000, malaria was estimated to be the cause for the loss of nearly 45 million Disability Adjusted Life Years (DALYs) and this accounts for 13% of all DALYs associated with infectious diseases. Malaria has gained importance in Western Europe, including Malta, mainly due to the increasing tourism to malaria endemic countries. There have been 21 reported cases of malaria in Malta between the years 2000-2003.peer-reviewe

The complexity of treatment with warfarin

Maintaining a patient within a therapeutic international normalized ratio (INR) is the main aim of treatment with warfarin. Anticoagulation above or below the therapeutic window may result in bleeding or thrombosis respectively. This is made more complex by the numerous factors that may affect warfarin management including other drugs, diet and disease. This review aims to highlight factors that may affect therapy with oral anticoagulants (Figure 1). A sound knowledge of such factors ensures safe administration of warfarin.peer-reviewe

A focus on the newer antibiotics targeting Gram-positive bacteria

The incidence of antimicrobial resistance has continued to rise with a threat to return to the “pre-antibiotic” era. This has included a sharp increase in multi-drug resistant organisms, which may cause life-threatening infections. Efforts have been made to develop new antibiotics with novel modes of action, aimed at acting against these multi-drug resistant strains. This review aims to focus on newly available and investigational antibiotics targeting Grampositive organisms. It is likely that these antibiotics will be used mainly in a secondary care setting; however primary care health care professionals also need to have an understanding of these antibiotics, since patients may be discharged home on them.peer-reviewe

Does quality of care differ when HIV patients are treated by non-specialist and specialist HIV healthcare providers in developed countries? A Systematic narrative review

Copyright © 2015 by authors and Scientific Research Publishing Inc.Peer reviewedPublisher PD

Management of infection in primary care : a case-based approach

Resistance is a recognised problem that is affecting management of infection worldwide. It is a very complex problem that is potentially caused by numerous factors including use of inappropriate strengths and routes of antimicrobials, needless use of antimicrobials when managing viral infections, inappropriate use of broad-spectrum antimicrobials, use of poor generics and lack of development of newer antimicrobials with novel modes of actions. Antimicrobials are probably the only drug class where misuse can have a community effect.peer-reviewe

Time taken to reach undetectable viral loads in therapy-naïve HIV patients commencing ART

Peer reviewedPublisher PD

Experience with dalbavancin use in various gram-positive infections within Aberdeen Royal Infirmary OPAT service

Open Access via the Springer/JISC agreementPeer reviewe

Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer

Objectives: This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics. Setting: Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland. Participants: Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6). Outcomes: Key behavioural determinants that influenced patients’ behaviours relating to self-administration of intravenous antibiotics. Design: Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework. Results: The key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications. Conclusion: Though patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques

Outbreak of Neisseria meningitidis capsular group W among scouts returning from the World Scout Jamboree, Japan, 2015

The 23rd World Scout Jamboree was held in Japan from 28 July to 8 August 2015 and was attended by over 33,000 scouts from 162 countries. An outbreak of invasive meningococcal disease capsular group W was investigated among participants, with four confirmed cases identified in Scotland, who were all associated with one particular scout unit, and two confirmed cases in Sweden; molecular testing showed the same strain to be responsible for illness in both countries. The report describes the public health action taken to prevent further cases and the different decisions reached with respect to how wide to extend the offer of chemoprophylaxis in the two countries; in Scotland, chemoprophylaxis was offered to the unit of 40 participants to which the four cases belonged and to other close contacts of cases, while in Sweden chemoprophylaxis was offered to all those returning from the Jamboree. The report also describes the international collaboration and communication required to investigate and manage such multinational outbreaks in a timely manner