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Uranw S, Bhattarai NR, Cloots K, Roy L, Rai K, Kiran U, Pyakurel UR, Lal BK, Burza S, Rijal S, Karki P, Khanal B, Hasker E. Visceral leishmaniasis in the hills of western Nepal: A transmission assessment. PLoS One 2024; 19:e0289578. [PMID: 38630746 PMCID: PMC11023194 DOI: 10.1371/journal.pone.0289578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/12/2024] [Indexed: 04/19/2024] Open
Abstract
In Nepal, visceral leishmaniasis (VL) has been targeted for elimination as a public health problem by 2026. Recently, increasing numbers of VL cases have been reported from districts of doubtful endemicity including hills and mountains, threatening the ongoing VL elimination program in Nepal. We conducted a multi-disciplinary, descriptive cross-sectional survey to assess the local transmission of Leishmania donovani in seven such districts situated at altitudes of up to 1,764 meters in western Nepal from March to December 2019. House-to-house surveys were performed for socio-demographic data and data on past and current VL cases. Venous blood was collected from all consenting individuals aged ≥2 years and tested with the rK39 RDT. Blood samples were also tested with direct agglutination test, and a titer of ≥1:1600 was taken as a marker of infection. A Leishmania donovani species-specific PCR (SSU-rDNA) was performed for parasite species confirmation. We also captured sand flies using CDC light traps and mouth aspirators. The house-to-house surveys documented 28 past and six new VL cases of which 82% (28/34) were without travel exposure. Overall, 4.1% (54/1320) of healthy participants tested positive for L. donovani on at least one serological or molecular test. Among asymptomatic individuals, 17% (9/54) were household contacts of past VL cases, compared to 0.5% (6/1266) among non-infected individuals. Phlebotomus argentipes, the vector of L. donovani, was found in all districts except in Bajura. L. donovani was confirmed in two asymptomatic individuals and one pool of sand flies of Phlebotomus (Adlerius) sp. We found epidemiological and entomological evidence for local transmission of L. donovani in areas previously considered as non-endemic for VL. The national VL elimination program should revise the endemicity status of these districts and extend surveillance and control activities to curb further transmission of the disease.
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Affiliation(s)
- Surendra Uranw
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lalita Roy
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Tropical & Infectious Diseases Center, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Usha Kiran
- World Health Organization, Country Office for Nepal, Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal, Kathmandu, Nepal
| | - Sakib Burza
- Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suman Rijal
- Drugs for Neglected Diseases Initiative, India Office, New Delhi, India
| | - Prahlad Karki
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Sihombing B, Bhatia R, Srivastava R, Aditama TY, Laxminarayan R, Rijal S. Response to antimicrobial resistance in South-East Asia Region. Lancet Reg Health Southeast Asia 2023; 18:100306. [PMID: 38028162 PMCID: PMC10667315 DOI: 10.1016/j.lansea.2023.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Antimicrobial resistance (AMR) inflicts significant mortality, morbidity and economic loss in the 11 countries in the WHO South-East Asia Region (SEAR). With technical assistance and advocacy from WHO, all countries have developed their respective National Action Plans on AMR that are aligned with the Global Action Plan. Historically, the WHO Regional Office has been proactive in advocacy at the highest political level. The past decade has seen an enhancement of the country's capacity to combat AMR through national efforts catalyzed and supported through several WHO initiatives at all levels-global, regional and country levels. Several countries including Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand have observed a worrying trend of increasing drug resistance, despite heightened awareness and actions. Recent AMR data generated by the countries are indicative of fragmented progress. Lack of technical capacity, financial resources, weak regulatory apparatus, slow behavioural changes at all levels of the antimicrobial stewardship landscape and the COVID-19 pandemic have prevented the effective application of several interventions to minimize the impact of AMR.
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Affiliation(s)
- Benyamin Sihombing
- Antimicrobial Resistance Unit, Department of Communicable Diseases, WHO South-East Asia Region, New Delhi, India
| | - Rajesh Bhatia
- Former Director Communicable Diseases, WHO SEARO, New Delhi, India
| | - Rahul Srivastava
- Regional Director Office, WHO South-East Asia Region, New Delhi, India
| | | | | | - Suman Rijal
- Department of Communicable Diseases, WHO South-East Asia Region, New Delhi, India
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Yajima A, Lin Z, Mohamed AJ, Dash A, Rijal S. Finishing the task of eliminating neglected tropical diseases (NTDs) in WHO South-East Asia Region: promises kept, challenges, and the way forward. Lancet Reg Health Southeast Asia 2023; 18:100302. [PMID: 38028173 PMCID: PMC10667292 DOI: 10.1016/j.lansea.2023.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
Globally 20 Neglected tropical diseases (NTDs) are prioritized by World Health Organization (WHO), of which 15 are present in the South-East Asia Region (SEAR) with all 11 countries being affected. As the region bears 54% of the global burden, "Finishing the task of eliminating neglected tropical diseases and other diseases on the verge of elimination" was identified as a regional flagship priority in 2014 with focus on lymphatic filariasis (LF), kala-azar, yaws, trachoma, and leprosy. Intensified efforts have been made to raise and sustain political commitment and momentum among partners innovate tools, interventions and strategies to accelerate elimination, and establish the process and support countries to accelerate and validate achievement of elimination targets. Seven countries have verified or validated for having eliminated at least one NTD since 2016, including yaws, LF and trachoma. Between 2010 and 2020, the number of people requiring interventions against NTDs in the South-East Asia Region reduced by 20%. The priorities in the next decade are to strengthen last-mile efforts to eliminate identified NTDs, sustain it and to use the lessons learnt to eliminate other NTDs. Funding None.
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Affiliation(s)
- Aya Yajima
- Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia, Delhi, India
| | - Zaw Lin
- Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia, Delhi, India
| | - Ahmed Jamsheed Mohamed
- World Health Organization Representative to the Democratic People’s Republic of Korea, Democratic People’s Republic of Korea
| | - A.P. Dash
- Asian Institute of Public Health University, Odisha, India
| | - Suman Rijal
- Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia, Delhi, India
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Bhatia V, Rijal S, Sharma M, Islam A, Vassall A, Bhargava A, Thida A, Basri C, Onozaki I, Pai M, Rezwan MK, Arinaminpathy N, Chandrashekhar P, Sarin R, Mandal S, Raviglione M. Ending TB in South-East Asia: flagship priority and response transformation. Lancet Reg Health Southeast Asia 2023; 18:100301. [PMID: 38028166 PMCID: PMC10667305 DOI: 10.1016/j.lansea.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
Over the decades, the global tuberculosis (TB) response has evolved from sanatoria-based treatment to DOTS (Directly Observed Therapy Shortcourse) strategy and the more recent End TB Strategy. The WHO South-East Asia Region, which accounted for 45% of new TB patients and 50% of deaths globally in 2021, is pivotal to the global fight against TB. "Accelerate Efforts to End TB" by 2030 was adopted as a South-East Asia Regional Flagship Priority (RFP) in 2017. This article illustrates intensified and transformed approaches to address the disease burden following the adoption of RFP and new challenges that emerged during the COVID-19 pandemic. TB case notifications improved by 25% and treatment success rates improved by 6% between 2016 and 2019 due to interventions ranging from galvanising political commitments to empowering and engaging communities. Cumulative TB programme budget allocations in 2022 reached US$ 1.4 billion, about two and a half times the budget in 2016. An ambitious Regional Strategic Plan towards ending TB, 2021-2025, identifies priority interventions that will need investments of up to US$ 3 billion a year to fully implement them. Moving forward, countries in the Region need to leverage RFP and take up intensified, people-centred, holistic interventions for prevention, diagnosis, treatment and care of TB with commensurate investments and cross-ministerial and multi-sectoral coordination.
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Affiliation(s)
- Vineet Bhatia
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | - Suman Rijal
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | - Mukta Sharma
- Department of Communicable Diseases, WHO Country Office, Indonesia
| | | | | | | | - Aye Thida
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | | | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Md Kamar Rezwan
- Department of Communicable Diseases, WHO South-East Asia Regional Office, India
| | | | | | - Rohit Sarin
- Independent Consultant for Tuberculosis, India
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Bhatia V, Sharma M, Rijal S. Urgent need for increased investments to end tuberculosis in the South-East Asia region. Indian J Med Res 2023; 157:127-130. [PMID: 37202931 PMCID: PMC10319382 DOI: 10.4103/ijmr.ijmr_324_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Vineet Bhatia
- Department of Communicable Diseases, WHO South-East Asia Regional Office, New Delhi 110 002, India
| | - Mukta Sharma
- Anti Microbial Resistance, WHO Country Office, Jakarta, Indonesia
| | - Suman Rijal
- Department of Communicable Diseases, WHO South-East Asia Regional Office, New Delhi 110 002, India
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Bishokarma S, Shrestha S, Rijal S, Karki A, Shrestha S, Thulung S. Predictors of Outcome of Aneurysmal Subarachnoid hemorrhage. Nep J Neurosci 2022. [DOI: 10.3126/njn.v19i3.45031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is a devastating condition with high mortality and morbidity. Significant factors influencing the prognosis of aneurysmal subarachnoid hemorrhage (SAH) include the severity at presentation of the disease and delayed cerebral ischemia (DCI).
Methods: This is a prospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of aneurysm for subarachnoid hemorrhage. Various clinical and radiological prognostic factors were registered on admission and during the intensive care stay. Outcome was recorded. GOS>3 was considered good outcome and GOS ≤3 was considered poor outcome.
Results: Seventy-two patients with ruptured aneurysm were surgically clipped. Good outcome was observed in 51 (70.83%) patients while poor outcome was seen among 21 (29.17%) patients including death among 16 (22.2%) patients. In univariate analysis, WFNS>2, Fisher grade >2, EVD placement for hydrocephalus and delayed cerebral ischemia (DCI) were found to have statistically significant in poor outcome. On Multivariate logistic regression model showed delayed cerebral ischemia was statistically significant predictor of poor outcome at p= 0.032 (OR= 7.34; 95% CI=1.280 to 17.702).
Conclusion: WFNS >2, Fisher grade>2, EVD placement and DCI were found to have statistical significance in poor outcome while only DCI was an independent predictor of poor outcome following aneurysmal Subarachnoid Hemorrhage (aSAH).
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Bottieau E, Van Duffel L, El Safi S, Koirala KD, Khanal B, Rijal S, Bhattarai NR, Phe T, Lim K, Mukendi D, Kalo JRL, Lutumba P, Barbé B, Jacobs J, Van Esbroeck M, Foqué N, Tsoumanis A, Parola P, Yansouni CP, Boelaert M, Verdonck K, Chappuis F. Etiological spectrum of persistent fever in the tropics and predictors of ubiquitous infections: a prospective four-country study with pooled analysis. BMC Med 2022; 20:144. [PMID: 35491421 PMCID: PMC9059373 DOI: 10.1186/s12916-022-02347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent fever, defined as fever lasting for 7 days or more at first medical evaluation, has been hardly investigated as a separate clinical entity in the tropics. This study aimed at exploring the frequencies and diagnostic predictors of the ubiquitous priority (i.e., severe and treatable) infections causing persistent fever in the tropics. METHODS In six different health settings across four countries in Africa and Asia (Sudan, Democratic Republic of Congo [DRC], Nepal, and Cambodia), consecutive patients aged 5 years or older with persistent fever were prospectively recruited from January 2013 to October 2014. Participants underwent a reference diagnostic workup targeting a pre-established list of 12 epidemiologically relevant priority infections (i.e., malaria, tuberculosis, HIV, enteric fever, leptospirosis, rickettsiosis, brucellosis, melioidosis, relapsing fever, visceral leishmaniasis, human African trypanosomiasis, amebic liver abscess). The likelihood ratios (LRs) of clinical and basic laboratory features were determined by pooling all cases of each identified ubiquitous infection (i.e., found in all countries). In addition, we assessed the diagnostic accuracy of five antibody-based rapid diagnostic tests (RDTs): Typhidot Rapid IgM, Test-itTM Typhoid IgM Lateral Flow Assay, and SD Bioline Salmonella typhi IgG/IgM for Salmonella Typhi infection, and Test-itTM Leptospira IgM Lateral Flow Assay and SD Bioline Leptospira IgG/IgM for leptospirosis. RESULTS A total of 1922 patients (median age: 35 years; female: 51%) were enrolled (Sudan, n = 667; DRC, n = 300; Nepal, n = 577; Cambodia, n = 378). Ubiquitous priority infections were diagnosed in 452 (23.5%) participants and included malaria 8.0% (n = 154), tuberculosis 6.7% (n = 129), leptospirosis 4.0% (n = 77), rickettsiosis 2.3% (n = 44), enteric fever 1.8% (n = 34), and new HIV diagnosis 0.7% (n = 14). The other priority infections were limited to one or two countries. The only features with a positive LR ≥ 3 were diarrhea for enteric fever and elevated alanine aminotransferase level for enteric fever and rickettsiosis. Sensitivities ranged from 29 to 67% for the three RDTs targeting S. Typhi and were 9% and 16% for the two RDTs targeting leptospirosis. Specificities ranged from 86 to 99% for S. Typhi detecting RDTs and were 96% and 97% for leptospirosis RDTs. CONCLUSIONS Leptospirosis, rickettsiosis, and enteric fever accounted each for a substantial proportion of the persistent fever caseload across all tropical areas, in addition to malaria, tuberculosis, and HIV. Very few discriminative features were however identified, and RDTs for leptospirosis and Salmonella Typhi infection performed poorly. Improved field diagnostics are urgently needed for these challenging infections. TRIAL REGISTRATION NCT01766830 at ClinicalTrials.gov.
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Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Lukas Van Duffel
- Infectious Diseases Operative Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Sayda El Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Basudha Khanal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Kruy Lim
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Deby Mukendi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.,Service de neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Roger Lilo Kalo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foqué
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Philippe Parola
- IHU-Méditerranée Infection & Aix-Marseille University, Marseille, France
| | - Cedric P Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Burza S, Mahajan R, Kazmi S, Alexander N, Kumar D, Kumar V, Lasry E, Harshana A, de Lima Pereira A, Das P, Verma N, Das VNR, Lal CS, Rewari B, Goyal V, Rijal S, Alves F, Gill N, Pandey K. AmBisome monotherapy and combination AmBisome - miltefosine therapy for the treatment of visceral leishmaniasis in patients co-infected with HIV in India: a randomised open label, parallel arm, phase 3 trial. Clin Infect Dis 2022; 75:1423-1432. [PMID: 35147680 PMCID: PMC9555838 DOI: 10.1093/cid/ciac127] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background Visceral leishmaniasis (VL) in patients with human immunodeficiency virus (HIV) presents an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian subcontinent. Methods This is a randomized, open-label, parallel-arm, phase 3 trial conducted within a single hospital in Patna, India. One hundred and fifty patients aged ≥18 years with serologically confirmed HIV and parasitologically confirmed VL were randomly allocated to 1 of 2 treatment arms, either a total 40 mg/kg intravenous liposomal amphotericin B (AmBisome; Gilead Pharmaceuticals) administered in 8 equal doses over 24 days or a total 30 mg/kg intravenous AmBisome administered in 6 equal doses given concomitantly with a total 1.4 g oral miltefosine administered through 2 daily doses of 50 mg over 14 days. The primary outcome was intention-to-treat relapse-free survival at day 210, defined as absence of signs and symptoms of VL or, if symptomatic, negative parasitological investigations. Results Among 243 patients assessed for eligibility, 150 were recruited between 2 January 2017 and 5 April 2018, with no loss to follow-up. Relapse-free survival at day 210 was 85% (64/75; 95% CI, 77–100%) in the monotherapy arm, and 96%, (72/75; 90–100%) in the combination arm. Nineteen percent (28/150) were infected with concurrent tuberculosis, divided equally between arms. Excluding those with concurrent tuberculosis, relapse-free survival at day 210 was 90% (55/61; 82–100%) in the monotherapy and 97% (59/61; 91–100%) in the combination therapy arm. Serious adverse events were uncommon and similar in each arm. Conclusions Combination therapy appears to be safe, well tolerated, and effective, and halves treatment duration of current recommendations. Clinical Trials Registration Clinical Trial Registry India (CTRI/2015/05/005807; the protocol is available online at https://osf.io/avz7r).
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Affiliation(s)
- Sakib Burza
- Médecins Sans Frontières, New Delhi, India.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Neal Alexander
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Neena Verma
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | | | - Bharat Rewari
- National Aids Control Organisation, New Delhi, India
| | - Vishal Goyal
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Naresh Gill
- National Vector Borne Disease Control Programme, New Delhi, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Sapkota S, Rijal S, Karn M. Neurosurgery in Nepal: Past, Present, and Future. World Neurosurg 2021; 158:100-105. [PMID: 34728395 DOI: 10.1016/j.wneu.2021.10.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Neurosurgery in Nepal is now more than half a century old. Though Nepalese neurosurgical roots can be traced back to ancient times, modern services began in Nepal only after 1990 following the arrival of Dr. Upendra Devkota-the father of Nepalese neurosurgery. Contributions from many reputable global advisors as well as local leaders have yielded many changes to the field ever since. Despite these advancements, neurosurgical care in Nepal is mostly limited to the capital city of Kathmandu, and there remains a deficit of qualified neurosurgeons. Geographical dissemination of neurosurgical care, reappraisal of residency training programs, and initiation of subspecialty-based neurosurgical practices are the next steps to further improve the field in Nepal.
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Affiliation(s)
- Shabal Sapkota
- National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Suman Rijal
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Mitesh Karn
- School of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal.
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Bista SS, Li DB, Awni RA, Song Z, Subedi KK, Shrestha N, Rijal S, Neupane S, Grice CR, Phillips AB, Ellingson RJ, Heben M, Li JV, Yan Y. Effects of Cu Precursor on the Performance of Efficient CdTe Solar Cells. ACS Appl Mater Interfaces 2021; 13:38432-38440. [PMID: 34347421 DOI: 10.1021/acsami.1c11784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Copper (Cu) incorporation is a key process for fabricating efficient CdTe-based thin-film solar cells and has been used in CdTe-based solar cell module manufacturing. Here, we investigate the effects of different Cu precursors on the performance of CdTe-based thin-film solar cells by incorporating Cu using a metallic Cu source (evaporated Cu) and ionic Cu sources (solution-processed cuprous chloride (CuCl) and copper chloride (CuCl2)). We find that ionic Cu precursors offer much better control in Cu diffusion than the metallic Cu precursor, producing better front junction quality, lower back-barrier heights, and better bulk defect property. Finally, outperforming power conversion efficiencies of 17.2 and 17.5% are obtained for devices with cadmium sulfide and zinc magnesium oxide as the front window layers, respectively, which are among the highest reported CdTe solar cells efficiencies. Our results suggest that an ionic Cu precursor is preferred as the dopant to fabricate efficient CdTe thin-film solar cells and modules.
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Affiliation(s)
- Sandip S Bista
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Deng-Bing Li
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Rasha A Awni
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Zhaoning Song
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Kamala K Subedi
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Niraj Shrestha
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Suman Rijal
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Sabin Neupane
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Corey R Grice
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Adam B Phillips
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Randy J Ellingson
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Michael Heben
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
| | - Jian V Li
- Department of Aeronautics and Astronautics, National Cheng Kung University, 70101 Tainan, Taiwan
| | - Yanfa Yan
- Department of Physics and Astronomy, and Wright Center for Photovoltaics Innovation and Commercialization (PVIC), University of Toledo, Toledo, Ohio 43606, United States
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11
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Pande K, Sinha AK, Pradhan A, Rijal S, Bhatta NK. Role of Bone Marrow Trephine Biopsies in the Diagnosis of Hematological and Non-Hematological Disorders. Nep Med J 2020. [DOI: 10.3126/nmj.v3i2.31042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Bone marrow aspirates along with their peripheral smears and bone marrow trephine biopsies are considered to be complementary.Materials and Methods: This hospital-based, cross-sectional study was carried out in the Department of Pathology for one year (March 2011 to March 2012) at BPKIHS, Dharan. Fortyeight adequate bone marrow aspirates along with peripheral blood smears and trephine biopsies were selected and examined. Bone marrow trephine biopsies performed simultaneously with aspirate were correlated with the other two fi ndings to arrive at a conclusive diagnosis.Results: Bone marrow aspiration and trephine biopsy were found as complementary tests in 51.8% of cases. Bone marrow trephine biopsy provided a conclusive diagnosis in 25.9% of cases where bone marrow aspiration was inconclusive. Bone marrow aspiration alone was diagnostic in 22.2% of cases. In 43.7% of cases both aspiration and trephine biopsy were unable to provide a specificdiagnosis. Bone marrow biopsy was the diagnostic investigation in cases like aplastic anemia, myelofi brosis, and hypoplastic marrow.Conclusions: This study concludes that bone marrow aspiration smear along with peripheral smear findings and marrow trephine biopsy is required to arrive at a conclusive result.
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Zijlstra EE, Kumar A, Sharma A, Rijal S, Mondal D, Routray S. Report of the Fifth Post-Kala-Azar Dermal Leishmaniasis Consortium Meeting, Colombo, Sri Lanka, 14-16 May 2018. Parasit Vectors 2020; 13:159. [PMID: 32228668 PMCID: PMC7106569 DOI: 10.1186/s13071-020-04011-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
The 5th Post-Kala-Azar Dermal Leishmaniasis (PKDL) Consortium meeting brought together PKDL experts from all endemic areas to review and discuss existing and new data on PKDL. This report summarizes the presentations and discussions and provides the overall conclusions and recommendations.
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Affiliation(s)
- Eduard E Zijlstra
- Drugs for Neglected Diseases Initiative, 15 Chemin Louis Dunant, 1202, Geneva, Switzerland.
| | - Amresh Kumar
- PATH, 15th Floor, Dr. Gopaldas Building, 28 Barakhamba Road, Connaught Place, New Delhi, 110001, India
| | - Abhijit Sharma
- PATH, 15th Floor, Dr. Gopaldas Building, 28 Barakhamba Road, Connaught Place, New Delhi, 110001, India
| | - Suman Rijal
- Drugs for Neglected Diseases Initiative, PHD House, 3rd Floor, 4/2 Siri Institutional Area, New Delhi, 110016, India
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, International Center For Diarrheal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Satyabrata Routray
- PATH, 15th Floor, Dr. Gopaldas Building, 28 Barakhamba Road, Connaught Place, New Delhi, 110001, India
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Cloots K, Uranw S, Ostyn B, Bhattarai NR, Le Rutte E, Khanal B, Picado A, Chappuis F, Hasker E, Karki P, Rijal S, Boelaert M. Impact of the visceral leishmaniasis elimination initiative on Leishmania donovani transmission in Nepal: a 10-year repeat survey. The Lancet Global Health 2020; 8:e237-e243. [DOI: 10.1016/s2214-109x(19)30536-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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14
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Cloots K, Burza S, Malaviya P, Hasker E, Kansal S, Mollett G, Chakravarty J, Roy N, Lal BK, Rijal S, Sundar S, Boelaert M. Male predominance in reported Visceral Leishmaniasis cases: Nature or nurture? A comparison of population-based with health facility-reported data. PLoS Negl Trop Dis 2020; 14:e0007995. [PMID: 31995564 PMCID: PMC7010295 DOI: 10.1371/journal.pntd.0007995] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 02/10/2020] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background Bangladesh, India, and Nepal aim for the elimination of Visceral Leishmaniasis (VL), a systemic parasitic infectious disease, as a public health problem by 2020. For decades, male patients have comprised the majority of reported VL cases in this region. By comparing this reported VL sex ratio to the one observed in population-based studies conducted in the Indian subcontinent, we tested the working hypothesis that mainly socio-cultural gender differences in healthcare-seeking behavior explain this gender imbalance. Methodology/Principal findings We compared the observed sex ratio of male versus female among all VL cases reported by the health system in Nepal and in the two most endemic states in India with that observed in population-based cohort studies in India and Nepal. Also, we assessed male sex as a potential risk factor for seroprevalence at baseline, seroconversion, and VL incidence in the same population-based data. The male/female ratio among VL cases reported by the health systems was 1.40 (95% CI 1.37–1.43). In the population cohort data, the age- and study site-adjusted male to female risk ratio was 1.27 (95% CI 1.08–1.51). Also, males had a 19% higher chance of being seropositive at baseline in the population surveys (RR 1.19; 95% CI 1.11–1.27), while we observed no significant difference in seroconversion rate between both sexes at the DAT cut-off titer defined as the primary endpoint. Conclusions/Significance Our population-based data show that male sex is a risk factor for VL, and not only as a socio-cultural determinant. Biological sex-related differences likely play an important role in the pathogenesis of this disease. Visceral Leishmaniasis (VL) is a parasitic disease that is lethal if not treated timely and mainly affects impoverished populations. Bangladesh, India, and Nepal have targeted the elimination of this disease as a public health problem by 2020. The majority of VL patients attending the health services are male, and this is usually attributed to unequal access to health care for men and women in this sociocultural context. We analyzed two large datasets obtained in population surveillance projects, including regular door-to-door screening for VL, in India and Nepal. Thereby we minimized any potential differences in access to health care between both sexes, as every suspect VL case occurring in the community received a full diagnostic work-up, and the research project facilitated transport to treatment centers if needed. By comparing the observed sex ratio in the health services records with those of the population surveillance records, we aimed to reach meaningful conclusions about the pathway through which male gender exerts its leverage for increasing VL risk: socio-cultural determinants blocking women from accessing care (nurture) or biological factors (nature) making men more vulnerable to VL. Because in the population-based age adjusted-data, male VL cases were significantly more frequent than female, our findings strongly suggest that in the Indian subcontinent, biological differences between men and women play a more critical role in the pathogenesis of VL than previously assumed, and the observed male predominance in VL cases in health services cannot be explained by socio-cultural factors only. Moreover, data show that above the age of 14 years, males are seropositive more often than females and are at higher risk to develop VL disease.
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Affiliation(s)
- Kristien Cloots
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | | | | | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sangeeta Kansal
- Department of Medicine, Banaras Hindu University, Varanasi, India
| | - Guy Mollett
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jaya Chakravarty
- Department of Medicine, Banaras Hindu University, Varanasi, India
| | - Nurpur Roy
- National Vector Borne Disease Control Program, Ministry of Health & Family Welfare, New Delhi, India
| | - Bibek Kumar Lal
- Epidemiology and Disease Control Division, Ministry of Health, Kathmandu, Nepal
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, New Delhi, India
| | - Shyam Sundar
- Department of Medicine, Banaras Hindu University, Varanasi, India
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Domagalska MA, Imamura H, Sanders M, Van den Broeck F, Bhattarai NR, Vanaerschot M, Maes I, D’Haenens E, Rai K, Rijal S, Berriman M, Cotton JA, Dujardin JC. Genomes of Leishmania parasites directly sequenced from patients with visceral leishmaniasis in the Indian subcontinent. PLoS Negl Trop Dis 2019; 13:e0007900. [PMID: 31830038 PMCID: PMC6932831 DOI: 10.1371/journal.pntd.0007900] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/26/2019] [Accepted: 11/01/2019] [Indexed: 12/02/2022] Open
Abstract
Whole genome sequencing (WGS) is increasingly used for molecular diagnosis and epidemiology of infectious diseases. Current Leishmania genomic studies rely on DNA extracted from cultured parasites, which might introduce sampling and biological biases into the subsequent analyses. Up to now, direct analysis of Leishmania genome in clinical samples is hampered by high levels of human DNA and large variation in parasite load in clinical samples. Here, we present a method, based on target enrichment of Leishmania donovani DNA with Agilent SureSelect technology, that allows the analysis of Leishmania genomes directly in clinical samples. We validated our protocol with a set of artificially mixed samples, followed by the analysis of 63 clinical samples (bone marrow or spleen aspirates) from visceral leishmaniasis patients in Nepal. We were able to identify genotypes using a set of diagnostic SNPs in almost all of these samples (97%) and access comprehensive genome-wide information in most (83%). This allowed us to perform phylogenomic analysis, assess chromosome copy number and identify large copy number variants (CNVs). Pairwise comparisons between the parasite genomes in clinical samples and derived in vitro cultured promastigotes showed a lower aneuploidy in amastigotes as well as genomic differences, suggesting polyclonal infections in patients. Altogether our results underline the need for sequencing parasite genomes directly in the host samples Visceral leishmaniasis (VL) is caused by parasitic protozoa of the Leishmania donovani complex and is lethal in the absence of treatment. Whole Genome Sequencing (WGS) of L. donovani clinical isolates revealed hitherto cryptic population structure in the Indian Sub-Continent and provided insights into the epidemiology and potential mechanisms of drug resistance. However, several biases are likely introduced during the culture step. We report here the development of a method that allows determination of parasite genomes directly in clinical samples, and validate it on bone marrow and splenic aspirates of VL patients in Nepal. Our study sheds a new light on the biology of Leishmania in the human host: we found that intracellular parasites of the patients had very low levels of aneuploidy, in sharp contrast to the situation in cultivated isolates. Moreover, the observed differences in genomes between intracellular amastigotes of the patient and the derived cultured parasites suggests polyclonality of infections, with different clones dominating in clinical samples and in culture, likely due to fitness differences. We believe this method is most suitable for clinical studies and for molecular tracking in the context of elimination programs.
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Affiliation(s)
- Malgorzata A. Domagalska
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
- * E-mail: (MAD); (JAC); (JC-D)
| | - Hideo Imamura
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
| | | | | | | | - Manu Vanaerschot
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
| | - Ilse Maes
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
| | - Erika D’Haenens
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
| | - Keshav Rai
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - James A. Cotton
- Wellcome Sanger Institute, Hinxton, United Kingdom
- * E-mail: (MAD); (JAC); (JC-D)
| | - Jean-Claude Dujardin
- Institute of Tropical Medicine Antwerp, Molecular Parasitology Unit, Antwerp, Belgium
- University of Antwerp, Department of Biomedical Sciences, Antwerp, Belgium
- * E-mail: (MAD); (JAC); (JC-D)
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16
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Seblova V, Dujardin JC, Rijal S, Domagalska MA, Volf P. ISC1, a new Leishmania donovani population emerging in the Indian sub-continent: Vector competence of Phlebotomus argentipes. Infect Genet Evol 2019; 76:104073. [PMID: 31629887 DOI: 10.1016/j.meegid.2019.104073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 02/06/2023]
Abstract
Visceral leishmaniasis (VL), the most severe form of the disease, is caused by Leishmania donovani in the Indian sub-continent (ISC). Whole genome sequencing studies revealed that two parasite populations exist in the ISC: a main population named the Core Group (CG) found mostly in the lowlands, and a new, genetically different subpopulation called ISC1. Parasites belonging to the CG were shown to be responsible for the recent epidemics, while the ISC1 variant was originally identified in hilly districts of Nepal and was later on increasingly found in the lowlands. Importantly, the ISC1 and CG isolates differ in their drug susceptibility and virulence signatures, suggesting that ISC1 constitutes an emerging and functionally different variant of L. donovani. In present study we aimed to address the potential of ISC1 transmission by the natural vector of L. donovani in the lowlands, Phlebotomus argentipes. By experimental infection of sand flies with parasites of the different genotypes, we demonstrate that ISC1 and CG strains are developing similarly in P. argentipes, suggesting that P. argentipes is a fully competent vector for ISC1 parasites. Integration of previous and current findings shows thus that ISC1 is a new and different variant of L. donovani, fully adapted to spread in the ISC through the main vector. This information is directly useful for managers of the elimination program. Furthermore, integration of our successive studies (genotyping, phenotyping and vector competence) demonstrates the relevance of molecular surveillance and should be of interest for scientists working on vector borne diseases and control managers.
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Affiliation(s)
- Veronika Seblova
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Petr Volf
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czech Republic.
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Goyal V, Burza S, Pandey K, Singh SN, Singh RS, Strub-Wourgaft N, Das VNR, Bern C, Hightower A, Rijal S, Sunyoto T, Alves F, Lima N, Das P, Alvar J. Field effectiveness of new visceral leishmaniasis regimens after 1 year following treatment within public health facilities in Bihar, India. PLoS Negl Trop Dis 2019; 13:e0007726. [PMID: 31557162 PMCID: PMC6782108 DOI: 10.1371/journal.pntd.0007726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/08/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND An earlier open label, prospective, non-randomized, non-comparative, multi-centric study conducted within public health facilities in Bihar, India (CTRI/2012/08/002891) measured the field effectiveness of three new treatment regimens for visceral leishmaniasis (VL): single dose AmBisome (SDA), and combination therapies of AmBisome and miltefosine (AmB+Milt) and miltefosine and paromomycin (Milt+PM) up to 6 months follow-up. The National Vector Borne Disease Control Program (NVBDCP) recommended an extended follow up at 12 months post-treatment of the original study cohort to quantify late relapses. METHODS The 1,761 patients enrolled in the original study with the three new regimens were contacted and traced between 10 and 36 months following completion of treatment to determine their health status and any occurrence of VL relapse. RESULTS Of 1,761 patients enrolled in the original study, 1,368 were traced at the extended follow-up visit: 711 (80.5%), 295 (83.2%) and 362 (71.5%) patients treated with SDA, AmB+Milt and Milt+PM respectively. Of those traced, a total of 75 patients were reported to have relapsed by the extended follow-up; 45 (6.3%) in the SDA, 25 (8.5%) in the AmB+Milt and 5 (1.4%) in the Milt+PM arms. Of the 75 relapse cases, 55 had already been identified in the 6-months follow-up and 20 were identified as new cases of relapse at extended follow-up; 7 in the SDA, 10 in the AmB+Milt and 3 in the Milt+PM arms. CONCLUSION Extending follow-up beyond the standard 6 months identified additional relapses, suggesting that 12-month sentinel follow-up may be useful as a programmatic tool to better identify and quantify relapses. With limited drug options, there remains an urgent need to develop effective new chemical entities (NCEs) for VL.
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Affiliation(s)
- Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), New York, United States of America
- * E-mail:
| | - Sakib Burza
- Médecins Sans Frontières (MSF), New Delhi, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | | | | | | | - Vidya Nand Rabi Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
| | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Abstract
Background & objectives Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute febrile illnesses (AFIs). In contrast, there are limited data on the causes of persistent febrile illnesses (PFIs) in LMIC. Lack of clarity on the differential diagnosis of PFIs in the rural tropics leads to the absence of diagnostic guidance tools. Methods In this study, a review of the potential causes of persistent fever defined as fever of more than seven days was done in Nepal, with a focus on nine pathogen-specific conditions. The current knowledge on their burden, distribution and diagnosis was summarized. Results Limited data were found on the incidence and public health burden of leptospirosis, murine typhus and brucellosis due to the absence of diagnostic tools outside reference laboratories and the overlap of signs and symptoms with other febrile conditions. The incidence of malaria and visceral leishmaniasis (VL) was found to be decreasing in Nepal, with some changes of the geographical areas at risk. Interpretation & conclusions This review indicates a need for more research on the causes of PFIs in Nepal and in the region and for the development of clinical guidance tailored to current local epidemiology. Guidance tools should include specific clinical features (e.g. eschar), results of rapid diagnostic tests (e.g. malaria, VL), appropriate indications for more sophisticated tests (e.g. abdominal ultrasound, polymerase chain reaction) and recommendations for adequate use of empirical treatment.
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Affiliation(s)
- Kanika Deshpande Koirala
- Department of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal; Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - François Chappuis
- Institute of Global Health, University of Geneva; Division of Tropical & Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kristien Verdonck
- Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Suman Rijal
- Department of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - Marleen Boelaert
- Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Rijal S, Nepal PR, Raut M, Gongal DN. Clinical Experience of Fluroscopy Guided Percutaneous Transpedicular Biopsy of Spinal Lesion. JNMA J Nepal Med Assoc 2019. [PMID: 31080241 PMCID: PMC8827565 DOI: 10.31729/jnma.3950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction: The diagnosis of the spinal lesions often puts the clinician in dilemma. The definite diagnosis is obviously needed for the proper management of the disease. The wrong diagnosis not only imposes the adverse effects, but sometimes may lead to the disabling conditions and even prove to be life threatening. This study is aimed at evaluating the need of fluoroscopy guided percutaneous transpedicular biopsy for establishing the proper diagnosis and find the diagnostic yield.Methods: This is the descriptive cross-sectional study conducted over the period of 10 years in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences among the patients who underwent transpedicular biopsy for various spinal lesions.Results: Among the 77 cases, 38 (49%) of the lesions on MRI were single level whereas 39 (51%) of the lesions were multiple. Most of the lesions were diagnosed as the non-tubercular infection 30 (42%), followed by the osteoporotic fractures and malignancy in 18 (25%) and 15 (21%) respectively. The sensitivity and specificity of the radiology with the background of clinical scenario was 79.5% and 90.9% respectively. The diagnostic yield of the biopsy was 93.5%.Conclusions: The transpedicular biopsy of the spinal lesion is the must for the proper diagnosis and treatment plan of such cases. The change in the diagnosis after biopsy is often possible which will drastically alter the treatment plan.
Keywords: fluoroscopy guided; metastasis; spinal lesions; transpedicular biopsy; tuberculosis.
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Affiliation(s)
- Suman Rijal
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
- Correspondence: Dr. Suman Rijal, Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Science, Bansbari, Kathmandu, Nepal. , Phone: +977-9841315945
| | - Pankaj Raj Nepal
- Department of Neurosurgery, B and C Medical College and Teaching Hospital, Birtamod, Jhapa, Nepal
| | - Manita Raut
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - Dinesh Nath Gongal
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
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Abstract
Suman Rijal and colleagues highlight lessons from a regional collaboration to eliminate visceral leishmaniasis and identify priorities for the post-elimination plan
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Affiliation(s)
- Suman Rijal
- Drugs for Neglected Diseases Initiative, New Delhi, India
| | | | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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21
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Affiliation(s)
- Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Balram Bhargava
- Department of Health Research, Government of India and Director General, Indian Council of Medical Research, New Delhi, India
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Affiliation(s)
- Ravikar Ralph
- Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - Isabela Ribeiro
- Dynamic Portfolio, Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ulrich Kuch
- Department of Tropical Medicine and Public Health, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
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Rijal S, Nepal PR, Bishokarma S, Ranabhat K, Gongal DN. Morphometric Relationship of the Transverse Sinus with Sigmoid Sinus Groove and Jugular Foramen. Nep J Neurosci 2018. [DOI: 10.3126/njn.v15i3.23281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cranial venous sinus anatomy is fundamental in neurosurgery and radiology, especially in surgical planning and treatment of neurological diseases. In this study, we aimed to study the morphometric relationship of the transverse sinus with sigmoid sinus groove and jugular foramen and imply if this relationship could aid in diagnosing the transverse sinus thrombosis. This is a retrospective analytical study conducted in our center among 30 patients who underwent Computed Tomography (CT) venogram during a period of 1 year. Diameter of transverse sinus and sigmoid groove at midpoint, and diameter of jugular foramen as it enters the skull base were collected. Relation of transverse sinus with sigmoid sinus groove and jugular foramen was analyzed. There were 60 transverse sinuses in the study with left and right being 50% (30 each). Mean age of patients collected was 53.20 years. There were 43.3% male and 56.7% female patients. Diameter of the Transverse sinus has statistically significantly linear relationship with the diameter of the sigmoid sinus groove and jugular foramen (p<0.001) and was positively correlated (r= 0.651 and 0.624 respectively). Diameter of the transverse sinus has significant positive linear correlation with the sigmoid sinus groove and jugular foramen.
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Marlais T, Bhattacharyya T, Singh OP, Mertens P, Gilleman Q, Thunissen C, Hinckel BCB, Pearson C, Gardner BL, Airs S, de la Roche M, Hayes K, Hafezi H, Falconar AK, Eisa O, Saad A, Khanal B, Bhattarai NR, Rijal S, Boelaert M, El-Safi S, Sundar S, Miles MA. Visceral Leishmaniasis IgG1 Rapid Monitoring of Cure vs. Relapse, and Potential for Diagnosis of Post Kala-Azar Dermal Leishmaniasis. Front Cell Infect Microbiol 2018; 8:427. [PMID: 30619774 PMCID: PMC6300496 DOI: 10.3389/fcimb.2018.00427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background: There is a recognized need for an improved diagnostic test to assess post-chemotherapeutic treatment outcome in visceral leishmaniasis (VL) and to diagnose post kala-azar dermal leishmaniasis (PKDL). We previously demonstrated by ELISA and a prototype novel rapid diagnostic test (RDT), that high anti-Leishmania IgG1 is associated with post-treatment relapse versus cure in VL. Methodology: Here, we further evaluate this novel, low-cost RDT, named VL Sero K-SeT, and ELISA for monitoring IgG1 levels in VL patients after treatment. IgG1 levels against L. donovani lysate were determined. We applied these assays to Indian sera from cured VL at 6 months post treatment as well as to relapse and PKDL patients. Sudanese sera from pre- and post-treatment and relapse were also tested. Results: Of 104 paired Indian sera taken before and after treatment for VL, when deemed clinically cured, 81 (77.9%) were positive by VL Sero K-SeT before treatment; by 6 months, 68 of these 81 (84.0%) had a negative or reduced RDT test line intensity. ELISAs differed in positivity rate between pre- and post-treatment (p = 0.0162). Twenty eight of 33 (84.8%) Indian samples taken at diagnosis of relapse were RDT positive. A comparison of Indian VL Sero K-SeT data from patients deemed cured and relapsed confirmed that there was a significant difference (p < 0.0001) in positivity rate for the two groups using this RDT. Ten of 17 (58.8%) Sudanese sera went from positive to negative or decreased VL Sero K-SeT at the end of 11–30 days of treatment. Forty nine of 63 (77.8%) PKDL samples from India were positive by VL Sero K-SeT. Conclusion: We have further shown the relevance of IgG1 in determining clinical status in VL patients. A positive VL Sero K-SeT may also be helpful in supporting diagnosis of PKDL. With further refinement, such as the use of specific antigens, the VL Sero K-SeT and/or IgG1 ELISA may be adjuncts to current VL control programmes.
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Affiliation(s)
- Tegwen Marlais
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Tapan Bhattacharyya
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Om Prakash Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, India
| | | | | | | | - Bruno C Bremer Hinckel
- Coris BioConcept Gembloux, Belgium.,Department of Biomedical Sciences, University of Antwerp Antwerp, Belgium
| | - Callum Pearson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Bathsheba L Gardner
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Stephanie Airs
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Marianne de la Roche
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Kiera Hayes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Hannah Hafezi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Andrew K Falconar
- Departamento de Medicina, Universidad del Norte Barranquilla, Colombia
| | - Osama Eisa
- Faculty of Medicine, University of Khartoum Khartoum, Sudan
| | | | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences Dharan, Nepal
| | | | - Suman Rijal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences Dharan, Nepal
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium
| | - Sayda El-Safi
- Faculty of Medicine, University of Khartoum Khartoum, Sudan
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, India
| | - Michael A Miles
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
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Goyal V, Mahajan R, Pandey K, Singh SN, Singh RS, Strub-Wourgaft N, Alves F, Rabi Das VN, Topno RK, Sharma B, Balasegaram M, Bern C, Hightower A, Rijal S, Ellis S, Sunyoto T, Burza S, Lima N, Das P, Alvar J. Field safety and effectiveness of new visceral leishmaniasis treatment regimens within public health facilities in Bihar, India. PLoS Negl Trop Dis 2018; 12:e0006830. [PMID: 30346949 PMCID: PMC6197645 DOI: 10.1371/journal.pntd.0006830] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2010, WHO recommended the use of new short-course treatment regimens in kala-azar elimination efforts for the Indian subcontinent. Although phase 3 studies have shown excellent results, there remains a lack of evidence on a wider treatment population and the safety and effectiveness of these regimens under field conditions. METHODS This was an open label, prospective, non-randomized, non-comparative, multi-centric trial conducted within public health facilities in two highly endemic districts and a specialist referral centre in Bihar, India. Three treatment regimens were tested: single dose AmBisome (SDA), concomitant miltefosine and paromomycin (Milt+PM), and concomitant AmBisome and miltefosine (AmB+Milt). Patients with complicated disease or significant co-morbidities were treated in the SDA arm. Sample sizes were set at a minimum of 300 per arm, taking into account inter-site variation and an estimated failure risk of 5% with 5% precision. Outcomes of drug effectiveness and safety were measured at 6 months. The trial was prospectively registered with the Clinical Trials Registry India: CTRI/2012/08/002891. RESULTS Out of 1,761 patients recruited, 50.6% (n = 891) received SDA, 20.3% (n = 358) AmB+Milt and 29.1% (n = 512) Milt+PM. In the ITT analysis, the final cure rates were SDA 91.4% (95% CI 89.3-93.1), AmB+Milt 88.8% (95% CI 85.1-91.9) and Milt+PM 96.9% (95% CI 95.0-98.2). In the complete case analysis, cure rates were SDA 95.5% (95% CI 93.9-96.8), AmB+Milt 95.5% (95% CI 92.7-97.5) and Milt+PM 99.6% (95% CI 98.6-99.9). All three regimens were safe, with 5 severe adverse events in the SDA arm, two of which were considered to be drug related. CONCLUSION All regimens showed acceptable outcomes and safety profiles in a range of patients under field conditions. Phase IV field-based studies, although extremely rare for neglected tropical diseases, are good practice and an important step in validating the results of more restrictive hospital-based studies before widespread implementation, and in this case contributed to national level policy change in India. TRIAL REGISTRATION Clinical trial is registered at Clinical trial registry of India (CTRI/2012/08/002891, Registered on 16/08/2012, Trial Registered Prospectively).
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Affiliation(s)
- Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Krishna Pandey
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | | | | | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Vidya Nand Rabi Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Roshan Kamal Topno
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Bhawna Sharma
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Caryn Bern
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco CA, United States of America
| | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | - Sally Ellis
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Sakib Burza
- Médecins Sans Frontières (MSF), New Delhi, India
| | - Nines Lima
- Médecins Sans Frontières (MSF), Barcelona, Spain
| | - Pradeep Das
- Division of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (RMRI), New Delhi, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Rijal S, Nepal PR, Bishokarma S, Devkota UP. Outcome of cranioplasty after decompressive craniectomy: Algorithm based study. Nep J Neurosci 2018. [DOI: 10.3126/njn.v15i2.20991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cranioplasty is the next major surgical procedure that the patient undergoes following the decompressive craniotomy for severe traumatic brain injury (TBI). This study was designed with the objective to evaluate the outcome of our institutional algorithm-based protocol in the management of cranioplasty. This is aretrospective analytical study conducted in National Institute of Neurological and Allied sciences, Bansbari Kathmandu among 40 patients who underwent cranioplasty during a period of 5 years. Variables viz. postoperative CT changes, cranioplasty site infection and change in the modified Rankin scale following the cranioplasty were analyzed. Among 40 patients who underwent the cranioplasty, 82.5% were male and 17.5% were female. The age of the patients ranged from 4 to 72 years with mean of 29.5±13.13. Interval between primary decompression and cranioplasty ranged from 3 to 78 weeks. Algorithm based preoperative planning was done before cranioplasty. Previous abdominal bone fl ap preservation site infection was significantly associated (p value 0.048) with cranioplasty site infection. There was no deterioration in the MRS score. The proper evaluation of the preoperative CT scan and the combined adjunctive procedure with cranioplasty in the selected patients helps to decrease the post cranioplasty related complications.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 36-40
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Cuypers B, Berg M, Imamura H, Dumetz F, De Muylder G, Domagalska MA, Rijal S, Bhattarai NR, Maes I, Sanders M, Cotton JA, Meysman P, Laukens K, Dujardin JC. Integrated genomic and metabolomic profiling of ISC1, an emerging Leishmania donovani population in the Indian subcontinent. Infect Genet Evol 2018; 62:170-178. [PMID: 29679745 PMCID: PMC6261844 DOI: 10.1016/j.meegid.2018.04.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 01/06/2023]
Abstract
Leishmania donovani is the responsible agent for visceral leishmaniasis (VL) in the Indian subcontinent (ISC). The disease is lethal without treatment and causes 0.2 to 0.4 million cases each year. Recently, reports of VL in Nepalese hilly districts have increased as well as VL cases caused by L. donovani from the ISC1 genetic group, a new and emerging genotype. In this study, we perform for the first time an integrated, untargeted genomics and metabolomics approach to characterize ISC1, in comparison with the Core Group (CG), main population that drove the most recent outbreak of VL in the ISC. We show that the ISC1 population is very different from the CG, both at genome and metabolome levels. The genomic differences include SNPs, CNV and small indels in genes coding for known virulence factors, immunogens and surface proteins. Both genomic and metabolic approaches highlighted dissimilarities related to membrane lipids, the nucleotide salvage pathway and the urea cycle in ISC1 versus CG. Many of these pathways and molecules are important for the interaction with the host/extracellular environment. Altogether, our data predict major functional differences in ISC1 versus CG parasites, including virulence. Therefore, particular attention is required to monitor the fate of this emerging ISC1 population in the ISC, especially in a post-VL elimination context.
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Affiliation(s)
- Bart Cuypers
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - Maya Berg
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hideo Imamura
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Franck Dumetz
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Géraldine De Muylder
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Ilse Maes
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mandy Sanders
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - James A Cotton
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Pieter Meysman
- Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - Kris Laukens
- Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
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Kariyawasam UL, Selvapandiyan A, Rai K, Wani TH, Ahuja K, Beg MA, Premathilake HU, Bhattarai NR, Siriwardena YD, Zhong D, Zhou G, Rijal S, Nakhasi H, Karunaweera ND. Genetic diversity of Leishmania donovani that causes cutaneous leishmaniasis in Sri Lanka: a cross sectional study with regional comparisons. BMC Infect Dis 2017; 17:791. [PMID: 29273010 PMCID: PMC5741890 DOI: 10.1186/s12879-017-2883-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leishmania donovani is the etiological agent of visceral leishmaniasis (VL) in the Indian subcontinent. However, it is also known to cause cutaneous leishmaniasis (CL) in Sri Lanka. Sri Lankan L. donovani differs from other L. donovani strains, both at the molecular and biochemical level. To investigate the different species or strain-specific differences of L. donovani in Sri Lanka we evaluated sequence variation of the kinetoplastid DNA (kDNA). METHODS Parasites isolated from skin lesions of 34 CL patients and bone marrow aspirates from 4 VL patients were genotyped using the kDNA minicircle PCR analysis. A total of 301 minicircle sequences that included sequences from Sri Lanka, India, Nepal and six reference species of Leishmania were analyzed. RESULTS Haplotype diversity of Sri Lankan isolates were high (H d = 0.757) with strong inter-geographical genetic differentiation (F ST > 0.25). In this study, L. donovani isolates clustered according to their geographic origin, while Sri Lankan isolates formed a separate cluster and were clearly distinct from other Leishmania species. Within the Sri Lankan group, there were three distinct sub-clusters formed, from CL patients who responded to standard antimony therapy, CL patients who responded poorly to antimony therapy and from VL patients. There was no specific clustering of sequences based on geographical origin within Sri Lanka. CONCLUSION This study reveals high levels of haplotype diversity of L. donovani in Sri Lanka with a distinct genetic association with clinically relevant phenotypic characteristics. The use of genetic tools to identify clinically relevant features of Leishmania parasites has important therapeutic implications for leishmaniasis.
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Affiliation(s)
- Udeshika Lakmini Kariyawasam
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
| | | | - Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Kavita Ahuja
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | - Mizra Adil Beg
- JH-Institute of Molecular Medicine, Jamia Hamdard, New Delhi, India
| | | | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yamuna Deepani Siriwardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
| | - Daibin Zhong
- University of California Irvine, College of Health Sciences, Irvine, CA USA
| | - Guofa Zhou
- University of California Irvine, College of Health Sciences, Irvine, CA USA
| | - Suman Rijal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Hira Nakhasi
- Division of Emerging and Transfusion Transmitted Diseases, Food and Drug Administration, Bethesda, USA
| | - Nadira D. Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 8 Sri Lanka
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Zijlstra EE, Alves F, Rijal S, Arana B, Alvar J. Post-kala-azar dermal leishmaniasis in the Indian subcontinent: A threat to the South-East Asia Region Kala-azar Elimination Programme. PLoS Negl Trop Dis 2017; 11:e0005877. [PMID: 29145397 PMCID: PMC5689828 DOI: 10.1371/journal.pntd.0005877] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The South-East Asia Region Kala-azar Elimination Programme (KAEP) is expected to enter the consolidation phase in 2017, which focuses on case detection, vector control, and identifying potential sources of infection. Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP. Methodology and principal finding We reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations. There is a considerable knowledge gap regarding the pathophysiology of VL and PKDL, especially the underlying immune responses. Risk factors (of which previous VL treatments may be most important) are poorly understood and need to be better defined. The role of PKDL patients in transmission is largely unknown, and there is insufficient information about the importance of duration, distribution and severity of the rash, time of onset, and self-healing. Current intervention methods focus on active case detection and treatment of all PKDL cases with miltefosine while there is increasing drug resistance. The prevention of PKDL by improved VL treatment currently receives insufficient attention. Conclusion and significance PKDL is a heterogeneous and dynamic condition, and patients differ with regard to time of onset after VL, chronicity, and distribution and appearance of the rash, as well as immune responses (including tendency to self-heal), all of which may vary over time. It is essential to fully describe the pathophysiology in order to make informed decisions on the most cost-effective approach. Emphasis should be on early detection of those who contribute to transmission and those who are in need of treatment, for whom short-course, effective, and safe drug regimens should be available. The prevention of PKDL should be emphasised by innovative and improved treatment for VL, which may include immunomodulation.
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Affiliation(s)
- Eduard E. Zijlstra
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
- Rotterdam Centre for Tropical Medicine, Rotterdam, the Netherlands
- * E-mail:
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases initiative, India Office, New Delhi, India
| | - Byron Arana
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
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Rahman R, Goyal V, Haque R, Jamil K, Faiz A, Samad R, Ellis S, Balasegaram M, den Boer M, Rijal S, Strub-Wourgaft N, Alves F, Alvar J, Sharma B. Safety and efficacy of short course combination regimens with AmBisome, miltefosine and paromomycin for the treatment of visceral leishmaniasis (VL) in Bangladesh. PLoS Negl Trop Dis 2017; 11:e0005635. [PMID: 28558062 PMCID: PMC5466346 DOI: 10.1371/journal.pntd.0005635] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 06/09/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023] Open
Abstract
Background AmBisome therapy for VL has an excellent efficacy and safety profile and has been adopted as a first-line regimen in Bangladesh. Second-line treatment options are limited and should preferably be given in short course combinations in order to prevent the development of resistant strains. Combination regimens including AmBisome, paromomycin and miltefosine have proved to be safe and effective in the treatment of VL in India. In the present study, the safety and efficacy of these same combinations were assessed in field conditions in Bangladesh. Methods The safety and efficacy of three combination regimens: a 5 mg/kg single dose of AmBisome + 7 subsequent days of miltefosine (2.5 mg/kg/day), a 5 mg/kg single dose of AmBisome + 10 subsequent days of paromomycin (15 mg/kg/day) and 10 days of paromomycin (15 mg/kg/day) + miltefosine (2.5 mg/kg/day), were compared with a standard regimen of AmBisome 15 mg/kg given in 5 mg/kg doses on days 1, 3 and 5. This was a phase III open label, individually randomized clinical trial. Patients from 5 to 60 years with uncomplicated primary VL were recruited from the Community Based Medical College Bangladesh (CBMC,B) and the Upazila Health Complexes of Trishal, Bhaluka and Fulbaria (all located in Mymensingh district), and randomly assigned to one of the treatments. The objective was to assess safety and definitive cure at 6 months after treatment. Results 601 patients recruited between July 2010 and September 2013 received either AmBisome monotherapy (n = 158), AmBisome + paromomycin (n = 159), AmBisome + miltefosine (n = 142) or paromomycin + miltefosine (n = 142). At 6 months post- treatment, final cure rates for the intention-to-treat population were 98.1% (95%CI 96.0–100) for AmBisome monotherapy, 99.4% (95%CI 98.2–100) for the AmBisome + paromomycin arm, 94.4% (95%CI 90.6–98.2) for the AmBisome + miltefosine arm, and 97.9% (95%CI 95.5–100) for paromomycin + miltefosine arm. There were 12 serious adverse events in the study in 11 patients that included 3 non-study drug related deaths. There were no relapses or PKDL up to 6 months follow-up. All treatments were well tolerated with no unexpected side effects. Adverse events were most frequent during treatment with miltefosine + paromomycin, three serious adverse events related to the treatment occurred in this arm, all of which resolved. Conclusion None of the combinations were inferior to AmBisome in both the intention-to-treat and per-protocol populations. All the combinations demonstrated excellent overall efficacy, were well tolerated and safe, and could be deployed under field conditions in Bangladesh. The trial was conducted by the International Centre for Diarrhoeal Disease Research (ICDDR,B) and the Shaheed Suhrawardy Medical College (ShSMC), Dhaka, in collaboration with the trial sites and sponsored by the Drugs for Neglected Diseases initiative (DNDi). Trial registration ClinicalTrials.gov NCT01122771 Treatment is one of the key strategies for visceral leishmaniasis control and elimination. Historically a number of monotherapy drugs for VL treatment were used in Bangladesh, including pentavalent antimonials, amphotericin B deoxycholate (AmB), and miltefosine (MF). With the limited number of drugs available, it was necessary to preserve existing drugs and also to develop shorter and safer treatment regimens. At the time the study was initiated, miltefosine monotherapy was a recommended first-line treatment in Bangladesh. The present study aimed to provide safety and efficacy data for three short-course combination regimens including AmBisome, miltefosine and paromomycin when rolled out in field conditions in Bangladesh, and to compare these to AmBisome monotherapy. All combinations proved non-inferior to AmBisome monotherapy and were safe and well tolerated. This study was implemented in field conditions at Upazila level with treatment provided by government doctors, providing further evidence for scaling up new regimens in national program contexts within the public health sector.
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Affiliation(s)
- Ridwanur Rahman
- Shaheed Suhrawardy Medical College (ShSMC), University of Dhaka, Dhaka, Bangladesh
| | - Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
- * E-mail:
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Kazi Jamil
- Kuwait institute for Scientific Research, Environment and Life Sciences Research centre, Food and Nutrition Program formerly ICDDR,B, Dhaka, Bangladesh
| | - Abul Faiz
- Dev Care Foundation, Dhaka, Bangladesh and Retired Ministry of Health, Government official Dhaka, Bangladesh
| | | | - Sally Ellis
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Bhawna Sharma
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Ionita G, Malviya A, Rajbhandari R, Schluter WW, Sharma G, Kakchapati S, Rijal S, Dixit S. Seroprevalence of hepatitis B virus and hepatitis C virus co-infection among people living with HIV/AIDS visiting antiretroviral therapy centres in Nepal: a first nationally representative study. Int J Infect Dis 2017; 60:64-69. [PMID: 28483724 DOI: 10.1016/j.ijid.2017.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To assess the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) co-infections among people living with HIV (PLHIV) in Nepal. METHODS A sample of 677 PLHIV representing key affected populations (KAP) in Nepal, who were undergoing antiretroviral (ART) therapy in ART clinics around the country, were voluntarily enrolled in the study. Rapid kit-based testing followed by ELISA for validation was performed, focusing on HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV). A multivariate logistic regression model was used to identify factors associated with HBV and HCV co-infection. RESULTS HCV and HBV co-infection among the 677 PLHIV was found to be 19% (95% confidence interval (CI) 16.6-22.7%) and 4.4% (95% CI 3.1-6.6%), respectively. The Eastern Region had the highest percentage of HCV infection (48%). The age group with the highest rates of co-infection was 30-39 years (58% and 70%, respectively, for HCV and HBV co-infection). After adjusting for confounding, males were more likely to have HBV co-infection than females (adjusted odds ratio (AOR) 4.61, 95% CI 1.42-14.98). Similarly, PLHIV who were male (AOR 5.7, 95% CI 2.06-15.98), had a secondary level of education (AOR 3.04, 95% CI 1.06-8.70), or who were drug users (AOR 28.7, 95% CI 14.9-55.22) were significantly more likely to have HCV co-infection. CONCLUSION This first ever national assessment of HIV, HBV, and HCV co-infection performed among PLHIV in Nepal demonstrates that HCV and HBV infections are a health threat to this population and that interventions are required to mitigate the effects of co-infection and to prevent further morbidity and mortality.
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Affiliation(s)
- G Ionita
- United Nations Development Programme, Project Management Unit, Guinea-Bissau
| | | | - R Rajbhandari
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - W William Schluter
- World Health Organization - Western Pacific Regional Office (WPRO), Manila, Philippines
| | | | - S Kakchapati
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - S Rijal
- United Nations Children's Fund, Kathmandu, Nepal
| | - S Dixit
- Centre for Molecular Dynamics Nepal, Kathmandu, Nepal
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Rai K, Bhattarai NR, Vanaerschot M, Imamura H, Gebru G, Khanal B, Rijal S, Boelaert M, Pal C, Karki P, Dujardin JC, Van der Auwera G. Single locus genotyping to track Leishmania donovani in the Indian subcontinent: Application in Nepal. PLoS Negl Trop Dis 2017; 11:e0005420. [PMID: 28249021 PMCID: PMC5348045 DOI: 10.1371/journal.pntd.0005420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/13/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background We designed a straightforward method for discriminating circulating Leishmania populations in the Indian subcontinent (ISC). Research on transmission dynamics of visceral leishmaniasis (VL, or Kala-azar) was recently identified as one of the key research priorities for elimination of the disease in the ISC. VL in Bangladesh, India, and Nepal is caused by genetically homogeneous populations of Leishmania donovani parasites, transmitted by female sandflies. Classical methods to study diversity of these protozoa in other regions of the world, such as microsatellite typing, have proven of little use in the area, as they are not able to discriminate most genotypes. Recently, whole genome sequencing (WGS) so far identified 10 different populations termed ISC001-ISC010. Methodology / Principle findings As an alternative to WGS for epidemiological or clinical studies, we designed assays based on PCR amplification followed by dideoxynucleotide sequencing for identification of the non-recombinant genotypes ISC001 up to ISC007. These assays were applied on 106 parasite isolates collected in Nepal between 2011 and 2014. Combined with data from WGS on strains collected in the period 2002–2011, we provide a proof-of-principle for the application of genotyping to study treatment outcome, and differential geographic distribution. Conclusions / Significance Our method can aid in epidemiological follow-up of visceral leishmaniasis in the Indian subcontinent, a necessity in the frame of the Kala-azar elimination initiative in the region. Visceral Leishmaniasis (VL) or Kala-azar is a life-threatening neglected tropical disease that annually affects half a million people worldwide. In the Indian subcontinent (India, Nepal, Bangladesh), the disease is caused by infection with the protozoan parasite Leishmania donovani, which is transmitted by female sand flies. Currently, the Kala-azar elimination program aims at reducing the number of VL cases in the region to less than 1 in 10.000 at upazila, sub-district and district level in Bangladesh, India, and Nepal respectively. In support of this program, tools for tracking L. donovani populations are essential, because these allow monitoring geographic spread over time. However, the parasite populations in the region are highly homogeneous, requiring sequencing of the entire genome to gather sufficient information for discriminating them. Because whole genome sequencing (WGS) is impractical for large-scale use, we designed a simple alternative to identify the WGS-genotypes. Our method is based on PCR amplification followed by sequencing of one particular locus, diagnostic of each population. We provide proof-of-principle that our method can be used to track parasite populations over time, and to correlate them with clinical parameters. We believe that our assay can support the Kala-azar control efforts in the Indian subcontinent.
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Affiliation(s)
- Keshav Rai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Department of Zoology, West Bengal State University, Barasat, West Bengal, India
| | - Narayan Raj Bhattarai
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Manu Vanaerschot
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Hideo Imamura
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gebreyohans Gebru
- Department of Animal Science, College of Agriculture, Aksum University, Aksum, Ethiopia
| | - Basudha Khanal
- Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chiranjib Pal
- Department of Zoology, West Bengal State University, Barasat, West Bengal, India
| | - Prahlad Karki
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Belgium
- * E-mail: (JCD); (GVdA)
| | - Gert Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail: (JCD); (GVdA)
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Ravinetto R, Tinto H, Diro E, Okebe J, Mahendradhata Y, Rijal S, Gotuzzo E, Lutumba P, Nahum A, Nys KD, Casteels M, Boelaert M. THE INTERNATIONAL GOOD CLINICAL PRACTICES GUIDELINES: TIME FOR A REVISION? BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ravinetto R, Tinto H, Diro E, Mahendrahata Y, Okebe J, Rijal S, Garcia C, Sundar S, Ndayisaba G, Sopheak T, Ngoduc T, Loen HV, Jacobs J, D'Alessandro U, Boelaert M, Buvé A. THE ADDED VALUE OF A MULTICOUNTRY NETWORK FOR PROMOTING ETHICAL AND REGULATORY STANDARDS IN CLINICAL TRIALS IN LOW- AND MIDDLE-INCOME COUNTRIES: THE EXPERIENCE OF THE ‘SWITCHING THE POLES NETWORK’. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Olliaro PL, Shamsuzzaman TAKM, Marasini B, Dhariwal AC, Be-Nazir A, Mondal D, Banjara MR, Das P, Sundar S, Rijal S, Arana B, Alvar J, Argaw D, Peeling RW, Kroeger A, Matlashewski G. Investments in Research and Surveillance Are Needed to Go Beyond Elimination and Stop Transmission of Leishmania in the Indian Subcontinent. PLoS Negl Trop Dis 2017; 11:e0005190. [PMID: 28125596 PMCID: PMC5268387 DOI: 10.1371/journal.pntd.0005190] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Piero L. Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | | | - Baburam Marasini
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - A. C. Dhariwal
- National Vector Borne Disease Control Programme (NVBDCP), Directorate General of Health Services, Ministry of Health, New Delhi, India
| | - Ahmed Be-Nazir
- National Institute of Preventive and Social Medicine (NIPSOM), Ministry of Health, Dhaka, Bangladesh
| | - Dinesh Mondal
- International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Pradeep Das
- Rajendra Memorial Research Institute (RMRI)–ICMR, Patna, India
| | - Shyam Sundar
- Department of Medicine, Banaras Hindu University, Varanasi, India
| | - Suman Rijal
- Drugs for neglected Diseases initiative (DNDi) Regional Office, New Delhi, India
| | - Byron Arana
- Drugs for neglected Diseases initiative DNDi, Geneva, Switzerland
| | - Jorge Alvar
- Drugs for neglected Diseases initiative DNDi, Geneva, Switzerland
| | - Daniel Argaw
- Neglected Tropical Diseases (NTD) Department, World Health Organization, Geneva, Switzerland
| | | | - Axel Kroeger
- UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
- Centre for Medicine and Society, Department of Anthropology, University of Freiburg, Freiburg, Germany
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
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Koschutnik M, Ionin VA, Boeckstaens S, Zakhama L, Hinojar R, Chiu DYY, Kovacs A, Kochmareva EA, Saliba E, Stanojevic D, Aalen J, Chen XH, Zito C, Demerouti E, Smarz K, Krljanac G, Christensen NL, Cavalcante JL, Pal M, Magne J, Giannakopoulos G, Liu D, Chien CY, Moustafa TAMER, Schwaiger M, Zotter-Tufaro C, Aschauer S, Duca F, Kammerlander A, Bonderman D, Mascherbauer J, Zaslavskaya EL, Soboleva AV, Listopad OV, Malikov KN, Baranova EI, Shlyakhto EV, Van Der Hoogstraete M, Coltel N, De Laet N, Beernaerts C, Desmet K, Gillis K, Droogmans S, Cosyns B, Antit S, Herbegue B, Slama I, Belaouer A, Chenik S, Boussabah E, Thameur M, Masmoudi M, Benyoussef S, Fernandez-Golfin C, Gonzalez-Gomez A, Casas E, Garcia Martin A, Pardo A, Del Val D, Ruiz S, Moya JL, Barrios V, Jimenez Nacher JJ, Zamorano JL, Kalra PA, Green D, Hughes J, Sinha S, Abidin N, Muraru D, Lakatos BK, Surkova E, Peluso D, Toser Z, Tokodi M, Merkely B, Badano LP, Volkova AL, Rusina VA, Kokorin VA, Gordeev IG, Baudet M, Chartrand Lefebvre C, Chen-Tournoux A, Hodzic A, Tournoux F, Apostolovic S, Jankovic-Tomasevic R, Djordjevic-Radojkovic D, Salinger-Martinovic S, Kostic T, Tahirovic E, Dungen HD, Andersen OS, Gude E, Andreassen A, Aalen OO, Larsen CK, Remme EW, Smiseth OA, Xu HG, Liu FC, Zha DG, Cui K, Zhang AD, Trio O, Soraci E, Cusma Piccione M, D'amico G, Ioppolo A, Alibani L, Falanga G, Todaro MC, Oreto L, Nucifora G, Vizzari G, Pizzino F, Di Bella G, Carerj S, Boutsikou M, Perreas K, Katselis CH, Samanidis G, Antoniou TH, Karatasakis G, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Bartoszewicz Z, Budaj A, Trifunovic D, Asanin M, Savic L, Matovic D, Petrovic M, Zlatic N, Mrdovic I, Dahl JS, Carter-Storch R, Bakkestroem R, Soendergaard E, Videbaek L, Moeller JE, Rijal S, Abdelkarim I, Althouse AD, Sharbaugh MS, Fridman Y, Han W, Soman P, Forman DE, Schindler JT, Gleason TG, Lee JE, Schelbert EB, Dekany G, Mandzak A, Chaurasia AK, Gyovai J, Hegedus N, Piroth ZS, Szabo GY, Fontos G, Andreka P, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai M, Kearney L, Marwick T, Sato K, Takeuchi M, Zito C, Mohty D, Lancellotti P, Habib G, Noble S, Frei A, Mueller H, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G, Voelker W, Gorski A, Leyh R, Stoerk S, Nordbeck P, Tsai WC, Moustafa TAMER, Aldydamony MOHAMD, Aldydamony MOHAMD. Poster Session 5The imaging examination and quality assessmentP1064The natural course of heart failure with preserved ejection fraction (HFpEF) - insights from an exploratory echocardiographic registryP1065Epicardial fat and effectiveness of catheter radiofrequency ablation in patients with atrial fibrillation and metabolic syndromeP1066Systematic disinfection of echocardiographic probe after each examination to reduce the persistence of pathogens as a potential source of nosocomial infectionsP1067Left atrial mechanical function assessed by two-dimensional echocardiography in hypertensive patientsP1068Real live applications of three-dimensional echocardiographic quantification of the left ventricular volumes and function using an automated adaptive analytics algorithmP10693D echocardiographic left ventricular dyssynchrony indices in end stage kidney disease: associations and outcomesP1070Relative contribution of right ventricular longitudinal shortening and radial displacement to global pump function in healthy volunteersP1071ECHO-parameters, associated with short-term mortality and long-term complications in patients with pulmonary embolism of high and intermediate riskP1072Increased epicardial fat is an independent marker of heart failure with preserved ejection fraction.P1073Influence of optimized beta-blocker therapy on diastolic dysfunction determined echocardiographically in heart failure patientsP1074Early diastolic mitral flow velocity/ annular velocity ratio is a sensitive marker of elevated filling pressure in left ventricular dyssynchronyP1075Left ventricular diastolic function in STEMI patients receiving early and late reperfusion by percutaneous coronary intervention P1076Could anatomical and functional features predict cerebrovascular events in patients with patent foramen ovale?P1077Efficacy of endarterectomy of the left anterior descending artery: evaluation by adenosine echocardiography?P1078Left ventricular diastolic dysfunction after acute myocardial infarction with preserved ejection fraction is related to lower exercise capacityP1079Potentially predictors of ventricular arrhythmia during six months follow up in STEMI patientsP1080Association between left atrial dilatation and invasive haemodynamics at rest and during exercise in asymptimatic aortic stenosisP1081Cardiac amyloidosis and aortic stenosis - the convergence of two aging processes and its association with outcomesP1082Prognostic impact of initial left ventricular dysfunction and mean gradient after transcatheter aortic valve implantationP1083Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysisP1084Discrepancies between echocardiographic and invasive assessment of aortic stenosis in multimorbid elderly patientsP1085Echocardiographic determinants and outcome of patients with low-gradient moderate and severe aortic valve stenosis: implications for aortic valve replacementP1086Atrial deformation correlated with functional capacity in mitral stenosisP1087Net atrioventricular compliance can predict reduction of pulmonary artery pressure after percutaneous mitral balloon commissurotomy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ravinetto R, Tinto H, Diro E, Okebe J, Mahendradhata Y, Rijal S, Gotuzzo E, Lutumba P, Nahum A, De Nys K, Casteels M, Boelaert M. It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North-South collaborative trials. BMJ Glob Health 2016; 1:e000122. [PMID: 28588969 PMCID: PMC5321366 DOI: 10.1136/bmjgh-2016-000122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/04/2022] Open
Abstract
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global', 'context centred' and 'patient centred'.
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Affiliation(s)
- Raffaella Ravinetto
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Joseph Okebe
- Medical Research Council Unit, The Gambia, Fajara, Gambia
| | - Yodi Mahendradhata
- Faculty of Medicine, Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Suman Rijal
- B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - Eduardo Gotuzzo
- Department of Medicine, Alexander von Humboldt Institute of Tropical Medicine and Infectious Diseases, Lima, Peru
| | - Pascal Lutumba
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alain Nahum
- Centre des Recherches Entomologiques de Cotonou, Cotonou, Benin
| | - Katelijne De Nys
- Clinical Trial Center, Leuven University Hospital, KU Leuven, Leuven, Belgium
| | - Minne Casteels
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marleen Boelaert
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
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Becker SL, Yap P, Horié NS, Alirol E, Barbé B, Bhatta NK, Bhattarai NR, Bottieau E, Chatigre JK, Coulibaly JT, Fofana HKM, Jacobs J, Karki P, Khanal B, Knopp S, Koirala K, Mahendradhata Y, Mertens P, Meyanti F, Murhandarwati EH, N’Goran EK, Peeling RW, Pradhan B, Ravinetto R, Rijal S, Sacko M, Saye R, Schneeberger PHH, Schurmans C, Silué KD, Steinmann P, van Loen H, Verdonck K, van Lieshout L, von Müller L, Yao JA, Boelaert M, Chappuis F, Polman K, Utzinger J. Experiences and Lessons from a Multicountry NIDIAG Study on Persistent Digestive Disorders in the Tropics. PLoS Negl Trop Dis 2016; 10:e0004818. [PMID: 27812101 PMCID: PMC5094778 DOI: 10.1371/journal.pntd.0004818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sören L. Becker
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Peiling Yap
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ninon S. Horié
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Emilie Alirol
- Clinical Research Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nisha K. Bhatta
- Department of Paediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan R. Bhattarai
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Jean T. Coulibaly
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | | | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Prahlad Karki
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, London, United Kingdom
| | - Kanika Koirala
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yodi Mahendradhata
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Fransiska Meyanti
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Elsa H. Murhandarwati
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Eliézer K. N’Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | | | - Bickram Pradhan
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Raffaella Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Suman Rijal
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Moussa Sacko
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Rénion Saye
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Pierre H. H. Schneeberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Molecular Diagnostics, Agroscope Changins Wädenswil, Wädenswil, Switzerland
- Department of Virology, Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | - Céline Schurmans
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kigbafori D. Silué
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Harry van Loen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lutz von Müller
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Joel A. Yao
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Alirol E, Horie NS, Barbé B, Lejon V, Verdonck K, Gillet P, Jacobs J, Büscher P, Kanal B, Bhattarai NR, El Safi S, Phe T, Lim K, Leng L, Lutumba P, Mukendi D, Bottieau E, Boelaert M, Rijal S, Chappuis F. Diagnosis of Persistent Fever in the Tropics: Set of Standard Operating Procedures Used in the NIDIAG Febrile Syndrome Study. PLoS Negl Trop Dis 2016; 10:e0004749. [PMID: 27812090 PMCID: PMC5094701 DOI: 10.1371/journal.pntd.0004749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In resource-limited settings, the scarcity of skilled personnel and adequate laboratory facilities makes the differential diagnosis of fevers complex [1–5]. Febrile illnesses are diagnosed clinically in most rural centers, and both Rapid Diagnostic Tests (RDTs) and clinical algorithms can be valuable aids to health workers and facilitate therapeutic decisions [6,7]. The persistent fever syndrome targeted by NIDIAG is defined as presence of fever for at least one week. The NIDIAG clinical research consortium focused on potentially severe and treatable infections and therefore targeted the following conditions as differential diagnosis of persistent fever: visceral leishmaniasis (VL), human African trypanosomiasis (HAT), enteric (typhoid and paratyphoid) fever, brucellosis, melioidosis, leptospirosis, malaria, tuberculosis, amoebic liver abscess, relapsing fever, HIV/AIDS, rickettsiosis, and other infectious diseases (e.g., pneumonia). From January 2013 to October 2014, a prospective clinical phase III diagnostic accuracy study was conducted in one site in Cambodia, two sites in Nepal, two sites in Democratic Republic of the Congo (DRC), and one site in Sudan (clinicaltrials.gov no. NCT01766830). The study objectives were to (1) determine the prevalence of the target diseases in patients presenting with persistent fever, (2) assess the predictive value of clinical and first-line laboratory features, and (3) assess the diagnostic accuracy of several RDTs for the diagnosis of the different target conditions.
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Affiliation(s)
- Emilie Alirol
- Clinical Research Centre, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Ninon Seiko Horie
- Clinical Research Centre, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva Switzerland
| | | | - Veerle Lejon
- Institut de Recherche pour le Développement (IRD), Unité Mixte de Recherche IRD-CIRAD 177, Montpellier, France
| | | | | | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | | | - Basudha Kanal
- B.P. Koirala Institute of Health Science, Dharan, Nepal
| | | | - Sayda El Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Kruy Lim
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Long Leng
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Deby Mukendi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Suman Rijal
- B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva Switzerland
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Ravinetto R, Becker SL, Sacko M, El-Safi S, Mahendradhata Y, Lutumba P, Rijal S, Lim K, Sundar S, N'Goran EK, Verdonck K, Utzinger J, Chappuis F, Boelaert M. Governance and Standards in International Clinical Research: The Role of Transnational Consortia. Am J Bioeth 2016; 16:59-61. [PMID: 27653405 DOI: 10.1080/15265161.2016.1214317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Sören L Becker
- b Swiss Tropical and Public Health Institute, University of Basel, and Saarland University
| | - Moussa Sacko
- c Institut National de Recherche en Santé Publique
| | | | | | - Pascal Lutumba
- f Institut National de Recherche Biomédicale and University of Kinshasa
| | | | - Kruy Lim
- h Sihanouk Hospital Center of HOPE
| | - Shyam Sundar
- i Kala-Azar Medical Research Centre and Banaras Hindu University
| | - Eliézer K N'Goran
- j Université Félix Houphouët-Boigny and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire
| | | | - Jürg Utzinger
- l Swiss Tropical and Public Health Institute and University of Basel
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Abstract
This longitudinal study was conducted in BP Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal, between May 2001 and December 2001. The main objective of the study was to identify the role of adenosine deaminase (ADA) activity in patients with visceral leishmaniasis (VL) for management. There was a significant increase in mean ADA activity in sera of 49 patients with VL (323.71±184.51 IU/L) compared with 50 samples of control groups (47.11±24.94 IU/L) from the same endemic area ( P<0.001). ADA activities were found to be significantly decreased (50.35±41.35 IU/L) in follow-up cases ( n = 19) after 30 days with sodium stibogluconate treatment at a dose of 20 mg/kg/day intramuscularly. The fall in the level of ADA (after treatment) in follow-up cases correlated with the cure of disease, as evident from improvement of vital signs and symptoms and the absence of Leishmania donavani bodies in the sera. The study therefore suggests the possibility of using human serum ADA as a convenient marker to evaluate the diagnosis of VL to support the clinical findings, especially in those settings where there is a lack of highly qualified personnel and diagnostic facilities.
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Affiliation(s)
- N Baral
- Department of Biochemistry, BP Koirala Institute of Health Sciences, Ghopa, BPKIHS, Dharan, Nepal.
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42
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Goyal V, Mahajan R, Sharma B, Strub-Wourgaft N, Balasegaram M, Rijal S, Ellis S, Alves F, Burza S, Sunyoto T, Lima N, Pandey K, Rabi Das V, Das P, Alvar J. Twelve months outcome in kala-azar patients treated with 3 novel regimens, at public health care facilities in Bihar. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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43
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Imamura H, Downing T, Van den Broeck F, Sanders MJ, Rijal S, Sundar S, Mannaert A, Vanaerschot M, Berg M, De Muylder G, Dumetz F, Cuypers B, Maes I, Domagalska M, Decuypere S, Rai K, Uranw S, Bhattarai NR, Khanal B, Prajapati VK, Sharma S, Stark O, Schönian G, De Koning HP, Settimo L, Vanhollebeke B, Roy S, Ostyn B, Boelaert M, Maes L, Berriman M, Dujardin JC, Cotton JA. Evolutionary genomics of epidemic visceral leishmaniasis in the Indian subcontinent. eLife 2016; 5. [PMID: 27003289 PMCID: PMC4811772 DOI: 10.7554/elife.12613] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/15/2016] [Indexed: 12/25/2022] Open
Abstract
Leishmania donovani causes visceral leishmaniasis (VL), the second most deadly vector-borne parasitic disease. A recent epidemic in the Indian subcontinent (ISC) caused up to 80% of global VL and over 30,000 deaths per year. Resistance against antimonial drugs has probably been a contributing factor in the persistence of this epidemic. Here we use whole genome sequences from 204 clinical isolates to track the evolution and epidemiology of L. donovani from the ISC. We identify independent radiations that have emerged since a bottleneck coincident with 1960s DDT spraying campaigns. A genetically distinct population frequently resistant to antimonials has a two base-pair insertion in the aquaglyceroporin gene LdAQP1 that prevents the transport of trivalent antimonials. We find evidence of genetic exchange between ISC populations, and show that the mutation in LdAQP1 has spread by recombination. Our results reveal the complexity of L. donovani evolution in the ISC in response to drug treatment. DOI:http://dx.doi.org/10.7554/eLife.12613.001 The parasite Leishmania donovani causes a disease called visceral leishmaniasis that affects many of the world's poorest people. Around half a million new cases develop every year, but health authorities lack safe and effective drugs to treat them. Up to 80% of these cases occur in the Indian subcontinent, where devastating epidemics have occurred in the last decades. One reason these epidemics continue to occur is that the parasites develop genetic mutations allowing them to adapt to and resist the drugs used to kill them. As there are few existing drugs that can kill L. donovani, it is crucial to understand how drug resistance emerges and spreads among parasite populations. Imamura, Downing, Van den Broeck et al. have now investigated the history of visceral leishmaniasis epidemics by characterising the complete genetic sequence – or genome – of 204 L. donovani parasite samples. This revealed that the majority of parasites in the Indian subcontinent first appeared in the nineteenth century, matching the first historical records of visceral leishmaniasis epidemics. The genomes show that most of the parasites are genetically similar and can be clustered into several closely related groups. These groups first appeared in the 1960s following the end of a regional campaign to eradicate malaria. The most common parasite group is particularly resistant to drugs called antimonials, which were the main treatment for leishmaniasis until recently. These parasites have a small genetic change that scrambles most of a protein known to be involved in the uptake of antimonials. Parasites may also be able to develop resistance to drugs through additional mechanisms that allow them to produce many copies of the same gene. These mechanisms could allow the parasites to rapidly adapt to new drugs or changes in the populations it infects. The work of Imamura et al. looks only at parasites isolated from patients then grown in the laboratory, so further research is now needed to explore how variable the Leishmania genome is in both of the parasite’s hosts: humans and sandflies. Imamura et al.’s study reveals how L. donovani has spread throughout the Indian subcontinent in fine detail. The genome data can be used to create simple molecular tools that could form an "early warning system" to track the success of disease control programs and to determine how well the current drugs are working. DOI:http://dx.doi.org/10.7554/eLife.12613.002
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Affiliation(s)
- Hideo Imamura
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tim Downing
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom.,School of Maths, Applied Maths and Statistics, National University of Ireland Galway, Galway, Ireland
| | | | | | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - An Mannaert
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manu Vanaerschot
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maya Berg
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Géraldine De Muylder
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Franck Dumetz
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Cuypers
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ilse Maes
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Saskia Decuypere
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Keshav Rai
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | | | | | - Vijay Kumar Prajapati
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Smriti Sharma
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Olivia Stark
- Institut für Mikrobiologie und Hygiene, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele Schönian
- Institut für Mikrobiologie und Hygiene, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Harry P De Koning
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Luca Settimo
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Chemistry and Chemical Biology, Northeastern University, Boston, United States
| | - Benoit Vanhollebeke
- Laboratory of Molecular Parasitology, Université Libre de Bruxelles, Gosselies, Belgium
| | - Syamal Roy
- Department of Infectious Diseases and Immunology, Council of Scientific and Industrial Research, Indian Institute of Chemical Biology, Kolkata, India
| | - Bart Ostyn
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Louis Maes
- Department of Biomedical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - James A Cotton
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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Hotez PJ, Pecoul B, Rijal S, Boehme C, Aksoy S, Malecela M, Tapia-Conyer R, Reeder JC. Eliminating the Neglected Tropical Diseases: Translational Science and New Technologies. PLoS Negl Trop Dis 2016; 10:e0003895. [PMID: 26934395 PMCID: PMC4774924 DOI: 10.1371/journal.pntd.0003895] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Today, the World Health Organization recognizes 17 major parasitic and related infections as the neglected tropical diseases (NTDs). Despite recent gains in the understanding of the nature and prevalence of NTDs, as well as successes in recent scaled-up preventive chemotherapy strategies and other health interventions, the NTDs continue to rank among the world’s greatest global health problems. For virtually all of the NTDs (including those slated for elimination under the auspices of a 2012 London Declaration for NTDs and a 2013 World Health Assembly resolution [WHA 66.12]), additional control mechanisms and tools are needed, including new NTD drugs, vaccines, diagnostics, and vector control agents and strategies. Elimination will not be possible without these new tools. Here we summarize some of the key challenges in translational science to develop and introduce these new technologies in order to ensure success in global NTD elimination efforts.
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Affiliation(s)
- Peter J Hotez
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Bernard Pecoul
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Suman Rijal
- Drugs for Neglected Diseases Initiative (DNDi), Delhi, India
| | - Catharina Boehme
- Foundation for Innovative new Diagnostics (FIND), Geneva, Switzerland
| | - Serap Aksoy
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, Connecticut, United States of America
| | | | | | - John C Reeder
- UNICEF/UNDP/ World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
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Shaw CD, Lonchamp J, Downing T, Imamura H, Freeman TM, Cotton JA, Sanders M, Blackburn G, Dujardin JC, Rijal S, Khanal B, Illingworth CJR, Coombs GH, Carter KC. In vitro selection of miltefosine resistance in promastigotes of Leishmania donovani from Nepal: genomic and metabolomic characterization. Mol Microbiol 2016; 99:1134-48. [PMID: 26713880 PMCID: PMC4832254 DOI: 10.1111/mmi.13291] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/17/2022]
Abstract
In this study, we followed the genomic, lipidomic and metabolomic changes associated with the selection of miltefosine (MIL) resistance in two clinically derived Leishmania donovani strains with different inherent resistance to antimonial drugs (antimony sensitive strain Sb‐S; and antimony resistant Sb‐R). MIL‐R was easily induced in both strains using the promastigote‐stage, but a significant increase in MIL‐R in the intracellular amastigote compared to the corresponding wild‐type did not occur until promastigotes had adapted to 12.2 μM MIL. A variety of common and strain‐specific genetic changes were discovered in MIL‐adapted parasites, including deletions at the LdMT transporter gene, single‐base mutations and changes in somy. The most obvious lipid changes in MIL‐R promastigotes occurred to phosphatidylcholines and lysophosphatidylcholines and results indicate that the Kennedy pathway is involved in MIL resistance. The inherent Sb resistance of the parasite had an impact on the changes that occurred in MIL‐R parasites, with more genetic changes occurring in Sb‐R compared with Sb‐S parasites. Initial interpretation of the changes identified in this study does not support synergies with Sb‐R in the mechanisms of MIL resistance, though this requires an enhanced understanding of the parasite's biochemical pathways and how they are genetically regulated to be verified fully.
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Affiliation(s)
- C D Shaw
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - J Lonchamp
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - T Downing
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK.,College of Science, NUI Galway, Galway, Ireland
| | - H Imamura
- Department of Biomedical Sciences, Instituut voor Tropische Geneeskunde Nationalestraat, Antwerpen, Belgium
| | - T M Freeman
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - J A Cotton
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - M Sanders
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - G Blackburn
- Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium.,Glasgow Polyomics, University of Glasgow, Glasgow
| | - J C Dujardin
- Department of Biomedical Sciences, Instituut voor Tropische Geneeskunde Nationalestraat, Antwerpen, Belgium.,Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium
| | - S Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Khanal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - G H Coombs
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - K C Carter
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
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Van Horn KS, Zhu X, Pandharkar T, Yang S, Vesely B, Vanaerschot M, Dujardin JC, Rijal S, Kyle DE, Wang MZ, Werbovetz KA, Manetsch R. Correction to Antileishmanial Activity of a Series of N2, N4-Disubstituted Quinazoline-2,4-diamines. J Med Chem 2016; 59:775. [DOI: 10.1021/acs.jmedchem.5b00981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Banskota B, Shrestha S, Chaudhary RK, Rajbhandari T, Rijal S, Shrestha BK, Banskota AK. Patterns of Orthopaedic Injuries among Motorbike Accident Admissions Presenting to a Tertiary Care Hospital in Kathmandu. J Nepal Health Res Counc 2016; 14:51-57. [PMID: 27426712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The anecdotal burden of morbidity secondary to motorbike accidents is thought to enormous by personnel involved in trauma care. The objective of the present study is to ascertain patterns and association of injuries and causes of mortality in a cohort of motorbike accident victims. METHODS A retrospective chart review of 1337 motorbike accident admissions B and B Hospital in Kathmandu between January 2009 and December 2010 was undertaken. RESULTS Majority of victims were between 20 to 50 years [1230 (92%) males]. Lower extremity injuries comprised on 816 (61% of total admissions). Tibia fractures were the most common injury in isolation, multiple injury, as well as polytrauma, and a vast majority of these were open fractures. Multiple injuries were seen in 82 (6.1%) patients and 33 (2.5% of Total) patients were polytraumatized. An amputation was necessary in 16 (1.2%) patients and emergent fasciotomy for compartment syndrome was necessary in 23 (1.7%) cases of tibia fractures and 39 (2.2%) of foot and ankle injuries. A floating joint injury was present in 24 (1.8%) patients.. A fat embolism syndrome (FES) was diagnosed in 8 (0.6%) patients. The overall mortality was 0.45% (6 patients). CONCLUSIONS Motorbike accident is an important cause of morbidity and mortality in Kathmandu, and often involves a very productive age group. There is an imminent need to address this public health problem.
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Affiliation(s)
| | | | | | | | - S Rijal
- B & B Hospital, Gwarko, Lalitpur, Nepal
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48
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, De La Rosa Riestra A, Alonso Bello J, Perez Gonzalez F, Wan S, Sun JP, Lee AP, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Cimino S, Salatino T, Silvetti E, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Yesin M, Gunduz S, Gursoy MO, Astarcioglu MA, Karakoyun S, Bayam E, Cersit S, Ozkan M, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Quintana Razcka O, Romero Pereiro A, Zugazabeitia Irazabal G, Braga M, Flores L, Ribeiro V, Melao F, Dias P, Maciel MJ, Bettencourt P, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Vaturi M, Weisenberg D, Monakier D, Valdman A, Vaknin- Assa H, Assali A, Kornowski R, Sagie A, Shapira Y, Ribeiras R, Abecasis J, Teles R, Castro M, Tralhao A, Horta E, Brito J, Andrade M, Mendes M, Avegliano G, Ronderos R, Matta MG, Camporrotondo M, Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Polman K, Becker SL, Alirol E, Bhatta NK, Bhattarai NR, Bottieau E, Bratschi MW, Burza S, Coulibaly JT, Doumbia MN, Horié NS, Jacobs J, Khanal B, Landouré A, Mahendradhata Y, Meheus F, Mertens P, Meyanti F, Murhandarwati EH, N'Goran EK, Peeling RW, Ravinetto R, Rijal S, Sacko M, Saye R, Schneeberger PHH, Schurmans C, Silué KD, Thobari JA, Traoré MS, van Lieshout L, van Loen H, Verdonck K, von Müller L, Yansouni CP, Yao JA, Yao PK, Yap P, Boelaert M, Chappuis F, Utzinger J. Erratum to: Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain ≥14 days): a multi-country, prospective, non-experimental case-control study. BMC Infect Dis 2015; 15:499. [PMID: 26537896 PMCID: PMC4634142 DOI: 10.1186/s12879-015-1160-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Sören L Becker
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.,Institute of Medical Microbiology and Hygiene, Saarland University, Saar, Germany
| | - Emilie Alirol
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nisha K Bhatta
- Department of Paediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan R Bhattarai
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Martin W Bratschi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sakib Burza
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jean T Coulibaly
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Mama N Doumbia
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Ninon S Horié
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jan Jacobs
- Department of Paediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Aly Landouré
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Yodi Mahendradhata
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Filip Meheus
- University of Cape Town, Cape Town, South Africa
| | | | - Fransiska Meyanti
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Elsa H Murhandarwati
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Raffaella Ravinetto
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Suman Rijal
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Moussa Sacko
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Rénion Saye
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Pierre H H Schneeberger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Department of Epidemiology and Molecular Diagnostics, Agroscope Changins-Wädenswil ACW, Wädenswil, Switzerland.,Department of Virology, Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | - Céline Schurmans
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kigbafori D Silué
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jarir A Thobari
- Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harry van Loen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lutz von Müller
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.,Institute of Medical Microbiology and Hygiene, Saarland University, Saar, Germany
| | - Cédric P Yansouni
- Divisions of Infectious Diseases and Medical Microbiology, J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Joel A Yao
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Patrick K Yao
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Peiling Yap
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Hendrickx S, Leemans A, Mondelaers A, Rijal S, Khanal B, Dujardin JC, Delputte P, Cos P, Maes L. Comparative Fitness of a Parent Leishmania donovani Clinical Isolate and Its Experimentally Derived Paromomycin-Resistant Strain. PLoS One 2015; 10:e0140139. [PMID: 26469696 PMCID: PMC4607421 DOI: 10.1371/journal.pone.0140139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Paromomycin has recently been introduced for the treatment of visceral leishmaniasis and emergence of drug resistance can only be appropriately judged upon its long term routine use in the field. Understanding alterations in parasite behavior linked to paromomycin-resistance may be essential to assess the propensity for emergence and spread of resistant strains. A standardized and integrated laboratory approach was adopted to define and assess parasite fitness of both promastigotes and amastigotes using an experimentally induced paromomycin-resistant Leishmania donovani strain and its paromomycin-susceptible parent wild-type clinical isolate. Primary focus was placed on parasite growth and virulence, two major components of parasite fitness. The combination of in vitro and in vivo approaches enabled detailed comparison of wild-type and resistant strains for which no differences could be demonstrated with regard to promastigote growth, metacyclogenesis, in vitro infectivity, multiplication in primary peritoneal mouse macrophages and infectivity for Balb/c mice upon infection with 2 x 107 metacyclic promastigotes. Monitoring of in vitro intracellular amastigote multiplication revealed a consistent decrease in parasite burden over time for both wild-type and resistant parasites, an observation that was subsequently also confirmed in a larger set of L. donovani clinical isolates. Though the impact of these findings should be further explored, the study results suggest that the epidemiological implications of acquired paromomycin-resistance may remain minimal other than the loss of one of the last remaining drugs effective against visceral leishmaniasis.
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Affiliation(s)
- Sarah Hendrickx
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Annelies Leemans
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Annelies Mondelaers
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Jean-Claude Dujardin
- Molecular Parasitology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Louis Maes
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
- * E-mail:
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