scholarly journals A four-step process for building sustainable access to diagnosis and treatment of Chagas disease

2019 ◽  
Vol 43 ◽  
pp. 1 ◽  
Author(s):  
Batista Carolina ◽  
Colin J Forsyth ◽  
Rafael Herazo ◽  
Marina Pereira Certo ◽  
Andrea Marchiol

The vast majority of people with Chagas disease (CD) are undiagnosed and untreated. Improving access to diagnosis and treatment for CD involves confronting a wide range of barriers. This report discusses a collaborative approach to eliminate barriers and increase the availability of CD testing and treatment. Potential areas for intervention are selected based on burden of disease, support of local champions, and commitment from national and local authorities. A 4D approach (diagnose, design, deliver, and demonstrate impact) is then implemented. The diagnose step involves gathering key stakeholders at a seminar to collaboratively identify important barriers and propose solutions. The design step creates a specific plan to act upon the seminar’s conclusions with consensus on core indicators. The deliver step entails implementing the plan at pilot locations, while simultaneously strengthening health system capacity for CD testing and treatment. Lastly, the demonstrate impact step compares baseline data with annual post-implementation data to measure progress. In Colombia, this approach has helped simplify testing procedures and increase CD testing and treatment access in pilot communities, though challenges remain. The 4D approach represents one of several pathways toward ensuring that the best therapeutic and diagnostic products reach people affected by neglected tropical diseases.

2019 ◽  
Vol 26 (23) ◽  
pp. 4403-4434 ◽  
Author(s):  
Susimaire Pedersoli Mantoani ◽  
Peterson de Andrade ◽  
Talita Perez Cantuaria Chierrito ◽  
Andreza Silva Figueredo ◽  
Ivone Carvalho

Neglected Diseases (NDs) affect million of people, especially the poorest population around the world. Several efforts to an effective treatment have proved insufficient at the moment. In this context, triazole derivatives have shown great relevance in medicinal chemistry due to a wide range of biological activities. This review aims to describe some of the most relevant and recent research focused on 1,2,3- and 1,2,4-triazolebased molecules targeting four expressive NDs: Chagas disease, Malaria, Tuberculosis and Leishmaniasis.


2020 ◽  
Vol 21 ◽  
Author(s):  
Boniface Pone ◽  
Ferreira Igne Elizabeth

: Neglected tropical diseases (NTDs) are responsible for over 500,000 deaths annually and are characterized by multiple disabilities. Leishmaniasis and Chagas disease are among the most severe NTDs, and are caused by the Leishmania sp, and Trypanosoma cruzi, respectively. Glucantime, pentamidine and miltefosine are commonly used to treat leishmaniasis, whereas nifurtimox, benznidazole are current treatments for Chagas disease. However, these treatments are associated with drug resistance, and severe side effects. Hence, the development of synthetic products, especially those containing N02, F, or Cl, which chemical groups are known to improve the biological activity. The present work summarizes the information on the antileishmanial and antitrypanosomal activity of nitro-, chloro-, and fluoro-synthetic derivatives. Scientific publications referring to halogenated derivatives in relation to antileishmanial and antitrypanosomal activities were hand searched in databases such as SciFinder, Wiley, Science Direct, PubMed, ACS, Springer, Scielo, and so on. According to the literature information, more than 90 compounds were predicted as lead molecules with reference to their IC50/EC50 values in in vitro studies. It is worth to mention that only active compounds with known cytotoxic effects against mammalian cells were considered in the present study. The observed activity was attributed to the presence of nitro-, fluoro- and chloro-groups in the compound backbone. All in all, nitro and h0alogenated derivatives are active antileishmanial and antitrypanosomal compounds and can serve as baseline for the development of new drugs against leishmaniasis and Chagas disease. However, efforts on in vitro and in vivo toxicity studies of the active synthetic compounds is still needed. Pharmacokinetic studies, and the mechanism of action of the promising compounds need to be explored. The use of new catalysts and chemical transformation can afford unexplored halogenated compounds with improved antileishmanial and antitrypanosomal activity.


2020 ◽  
Vol 12 ◽  
Author(s):  
Francisco Basílio ◽  
Ricardo Jorge Dinis-Oliveira

Background: Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations. Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment and other relevant clinical and forensic features of pharmacobezoars. Results: patients of a wide range of ages and in both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but is likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy and surgery through laparotomy of the lower tract are useful for diagnosis and treatment. Conclusion: Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.


Author(s):  
Damian Clarke ◽  
Joseph P. Romano ◽  
Michael Wolf

When considering multiple-hypothesis tests simultaneously, standard statistical techniques will lead to overrejection of null hypotheses unless the multiplicity of the testing framework is explicitly considered. In this article, we discuss the Romano–Wolf multiple-hypothesis correction and document its implementation in Stata. The Romano–Wolf correction (asymptotically) controls the familywise error rate, that is, the probability of rejecting at least one true null hypothesis among a family of hypotheses under test. This correction is considerably more powerful than earlier multiple-testing procedures, such as the Bonferroni and Holm corrections, given that it takes into account the dependence structure of the test statistics by resampling from the original data. We describe a command, rwolf, that implements this correction and provide several examples based on a wide range of models. We document and discuss the performance gains from using rwolf over other multiple-testing procedures that control the familywise error rate.


2018 ◽  
Vol 3 (5) ◽  
pp. e001069 ◽  
Author(s):  
Albert Picado ◽  
Israel Cruz ◽  
Maël Redard-Jacot ◽  
Alejandro G Schijman ◽  
Faustino Torrico ◽  
...  

It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.


2021 ◽  
Vol 15 (10) ◽  
pp. e0009819
Author(s):  
Danya A. Dean ◽  
Gautham Gautham ◽  
Jair L. Siqueira-Neto ◽  
James H. McKerrow ◽  
Pieter C. Dorrestein ◽  
...  

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is one of nineteen neglected tropical diseases. CD is a vector-borne disease transmitted by triatomines, but CD can also be transmitted through blood transfusions, organ transplants, T. cruzi-contaminated food and drinks, and congenital transmission. While endemic to the Americas, T. cruzi infects 7–8 million people worldwide and can induce severe cardiac symptoms including apical aneurysms, thromboembolisms and arrhythmias during the chronic stage of CD. However, these cardiac clinical manifestations and CD pathogenesis are not fully understood. Using spatial metabolomics (chemical cartography), we sought to understand the localized impact of chronic CD on the cardiac metabolome of mice infected with two divergent T. cruzi strains. Our data showed chemical differences in localized cardiac regions upon chronic T. cruzi infection, indicating that parasite infection changes the host metabolome at specific sites in chronic CD. These sites were distinct from the sites of highest parasite burden. In addition, we identified acylcarnitines and glycerophosphocholines as discriminatory chemical families within each heart region, comparing infected and uninfected samples. Overall, our study indicated global and positional metabolic differences common to infection with different T. cruzi strains and identified select infection-modulated pathways. These results provide further insight into CD pathogenesis and demonstrate the advantage of a systematic spatial perspective to understand infectious disease tropism.


2021 ◽  
Author(s):  
◽  
Edward Johnson

<p><b>The gold mining industry in Ghana is characterised by complexity in terms of its extended/sequential operations, its system-wide reach, its multiple stakeholders, and the variety of formal and informal organisations that constitute the industry. Perceptions of the industry differ considerably amongst stakeholders, depending on their stakes and interests, knowledge, understanding, involvement and agency within or without the sector. Studies of the industry to date have overlooked these diverse viewpoints and used limited-scope, single-frame analyses. However, they have highlighted wide-ranging industry issues that impact the diversity of stakeholders, which could benefit from a fuller and more comprehensive analysis.</b></p> <p>This study addresses this need by adopting a multi-framing systems-based approach. Data was examined and analysed through a variety of systems-based lenses and frames, including a stakeholder analysis (SA) frame, a causal loop modelling (CLM) frame, supply chain analysis (SCA) frame and the Theory of Constraints (TOC) Thinking Processes analytical frames lenses. First the Current Reality Tree (CRT) tool of the Theory of Constraints (TOC) was used to synthesise information from the literature examined, providing an initial provisional CRT model. Interview data was collected by sharing and seeking feedback to the CRT model at multiple levels of the industry, giving voice to stakeholders throughout the sector. Subsequent analysis used all the modelling frameworks mentioned above in a multi-framing analysis.</p> <p>In particular, the evaporating cloud (EC) tool from TOC was used to structure and develop potential solutions to conflict highlighted by the literature review, the SA, SCA and CLM. Building on this, a final CRT was developed, and a goal tree (GT) used to design the desired future whilst employing the future reality tree (FRT) to test the plausibility of solutions from the EC to deliver the desired future. The prerequisite tree (PRT) was then used to identify obstacles and intermediate objectives that must be overcome for successful transition to the desired future.</p> <p>Insights from the research shows a desire by multi-national large scale-gold mining companies and government alike to minimise adverse impacts and maximise the sector’s outcomes for key stakeholders, including those at the community level. However, the research has documented many instances of actions taken to address issues and improve outcomes that have instead resulted in unresolved dilemmas and paradoxes, failing to achieve desired outcomes.</p> <p>A number of factors have been identified as being responsible for these situations. Key amongst them is a limited understanding to deliver desired outcome for stakeholders without compromises, a focus on short-term goals, no collective effort, and arms-length/win-lose relationships amongst the Ghanaian stakeholders of the industry.</p> <p>The study’s concluding findings and results allow decision makers to benefit significantly from the study through its recommendations and showcasing of tools that may allow them to make sound decisions and address endogenous and exogenous cause-effect relationships limiting desirable outcomes from actions taken.</p> <p>Theoretical and knowledge-based contributions are made by conceptualising and offering evidence for three key factors or dimensions that can explain a significant number of issues limiting desirable outcomes for stakeholders of the gold mining industry. These include difficulty to transition from theory (espoused aims) to practice, a relative focus on local optima (silo thinking), poor monitoring (lack of evaluation), and a control culture. Methodological contributions are made by demonstrating the application of a multi-framing approach in a more organic and iterative manner as opposed to its use in a designed sequence, working down through layers of various systemic levels of an industry (in this case, the gold mining industry in Ghana). By so doing, the study builds on and extends the practicality of the multi-framing approach and stimulates further research in the field.</p> <p>In terms of its contribution to practice, the study provides Government, political and mining sector policy decision makers, and other interested actors, with a platform for understanding the sector in order to support their decision making about the industry to ultimately improve outcomes for key stakeholders. In particular, the study allows mining sector policy decision makers and other stakeholders to recognise complexity, uncertainty and conflicts that are embedded in the mining system and in their everyday decision-making activities about the industry. It also allows these stakeholders to become more aware that such issues can be addressed and improved by identifying and focusing on one or few underlying causes.</p> <p>This thesis draws on systems-based frameworks drawn both from functional management, for example, the supply chain and value chain frameworks of operations management and the stakeholder framework of strategic management, and from the broad domain of systems thinking (ST) and systems-based methodologies; and then focuses on the intersection of these frameworks in relation to the gold mining sector in Ghana. Due to the wide range of techniques applied, none are over-explored, creating potential for further research. On the other hand, with regard to explanations, depending on background, practitioners, and researchers familiar with some techniques may consider those sections over-explained. The researcher has sought a balance for the purpose of this study. Whilst limiting the scope of this work has been necessary in the context of doctoral study, topics ripe for future research are set out in the conclusion.</p>


2017 ◽  
Vol 50 (3) ◽  
pp. 296-300 ◽  
Author(s):  
Eloan Pinheiro ◽  
Lucia Brum-Soares ◽  
Renata Reis ◽  
Juan-Carlos Cubides

2020 ◽  
Vol 1 (54) ◽  
pp. 23-29
Author(s):  
Łukasz Mazurek ◽  
Agnieszka Kotalczyk ◽  
Michał Mazurek ◽  
Ewa Jędrzejczyk-Patej

We currently have a wide range of different imaging tests that are constantly improving and developing. Each test has its sensitivity and specificity and is used in various fields of medicine. Knowledge of the possibilities of using imaging tests in electrotherapy is an important element of the diagnostic and therapeutic process. This article presents selected issues regarding the use of imaging methods in the diagnosis and treatment of patients with cardiac implantable electronic devices.


2021 ◽  
Author(s):  
Rachel Eliza Guetta ◽  
Clair Cassiello-Robbins ◽  
Deepika Anand ◽  
Mark Zachary Rosenthal

Misophonia is a newly described disorder associated with significant emotional distress, functional impairment, and a wide range of mental health problems (e.g., mood, anxiety, and personality disorders). Although recent studies have begun to validate self-report measures of misophonia, no psychometrically validated interviews have been developed. To advance a scientific understanding of misophonia, rigorously developed structured interviews are needed as a complimentary measurement approach to self-report inventories. Accordingly, the aim of this study was to develop and begin preliminarily validating a semi-structured clinical interview for misophonia. We took an iterative, grassroots approach to item generation and interview development involving key stakeholders (i.e., misophonia sufferers, experts in the field). Initial psychometric analyses from the current sample (n = 30) evidenced excellent preliminary estimates for internal consistency, convergent, discriminant, and predictive validity. Results from this study provide preliminary support for the Duke Misophonia Interview, and we recommend that this interviewer-rated measure be iteratively developed and refined using larger and more diverse samples.


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