Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 204
Filtrar
2.
Adv Parasitol ; 103: 151-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30878057

RESUMO

The accurate, rapid, and cost-effective diagnosis of malaria and neglected tropical diseases (NTDs) in low-resource settings may benefit by significant technological advances in handheld and mobile phone microscopy. We systematically review the available literature in this field and discuss the future directions in which these technologies may be applied. English-language studies from the PubMed, Embase, and Web of Sciences were searched through April 2018 for observational and interventional studies reporting diagnostic characteristics of handheld and mobile phone microscopy devices as compared to field-established gold standard reference tests. Seventeen studies were included in the analysis. Findings included the high performance of the Newton Nm1 microscope in the diagnosis of Plasmodium species, Schistosoma mansoni, and soil-transmitted helminths (STHs), exhibiting sensitivity and specificity values often greater than 90%. Similarly, the CellScope was shown to have excellent diagnostic characteristics in the detection of Loa loa and Schistosoma species. Fluorescent microscopy was found to have high specificity and sensitivity in the diagnosis of Plasmodium species. Mobile phone technologies and handheld microscopes hold significant promise in the rapid and effective diagnosis of malaria and NTDs in areas where accurate diagnosis is vital. Although many of these technologies have yet to be securely embedded within the health system and studied directly in this context, the foundations for significant healthcare advances and impact have already been laid by several studies conducted within the last decade.


Assuntos
Telefone Celular , Malária/diagnóstico , Microscopia , Doenças Negligenciadas/diagnóstico , Medicina Tropical/métodos , História do Século XX , História do Século XXI , Humanos , Medicina Tropical/história , Medicina Tropical/tendências
3.
Infect Dis Clin North Am ; 33(1): 169-195, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30712760

RESUMO

Ultrasound for diagnosis and staging of schistosomiasis and echinococcosis have paved the way over the past several decades for the application of ultrasound in tropical diseases. Until recently, the size and cost of ultrasound systems limited the application in low-resource settings. The increase in portable ultrasound systems has given more clinicians access to ultrasound, and clinically based protocols for the care of patients have emerged, such as focused assessment with sonography for HIV/TB and tropical cardiac ultrasound. This article explores the history and current use of ultrasound in these diseases and highlights their application in the care of patients.


Assuntos
Doenças Parasitárias/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Medicina Tropical/instrumentação , Medicina Tropical/métodos , Ultrassonografia , Doenças Transmissíveis/diagnóstico por imagem , Equinococose/diagnóstico por imagem , Humanos , Esquistossomose/diagnóstico por imagem
4.
PLoS Negl Trop Dis ; 12(11): e0006791, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30383809

RESUMO

Mobile applications (apps) can bring health research and its potential downstream benefits closer to underserved populations. Drawing on experience developing an app for detecting and referring cases of cutaneous leishmaniasis in Colombia, called Guaral/app, we review key steps in creating such mobile health (mHealth) tools. These require consideration of the sociotechnical context using methods such as systems analysis and human-centered design (HCD), predicated on engagement and iteration with all stakeholders. We emphasize usability and technical concerns and describe the interdependency of technical and human considerations for mHealth systems in rural communities.


Assuntos
Pesquisa Biomédica/métodos , Telefone Celular/estatística & dados numéricos , Doenças Negligenciadas/diagnóstico , Medicina Tropical/métodos , Pesquisa Biomédica/instrumentação , Humanos , Aplicativos Móveis , Doenças Negligenciadas/epidemiologia , Software , Medicina Tropical/instrumentação
5.
PLoS Negl Trop Dis ; 12(11): e0006929, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30462639

RESUMO

BACKGROUND: Neglected tropical diseases (NTDs) are communicable diseases that impact approximately 1 billion people, but receive relatively little research, funding, and attention. Many NTDs have similar treatments, epidemiology, and geographic distribution, and as a result, the integration of control efforts can improve accountability, efficiency, and cost-effectiveness of programs. Here, we examine the landscape of efforts towards NTD integration across countries with the highest burden of disease, and review the administrative management of integration in order to identify approaches and pathways for integration. METHODOLOGY AND PRINCIPAL FINDINGS: We utilized a standardized system to score countries for NTD endemnicity to create a list of 25 countries with the highest overall burden of NTDs. We then conducted a literature review to characterize the NTD control programs in the focus countries. Six countries were selected for key informant interviews to validate literature review results and gather additional data on opportunities and obstacles to NTD integration, from an administrative perspective. The majority of countries included in the study were located in Africa, with the remainder from Asia, North America, and South America. Multiple models and pathways were observed for the integration of NTD programs, in combination with other NTD programs, other diseases, or other health programs. Substantial heterogeneity existed with respect to the NTD control programs, and no country had integrated all of their NTD control efforts into a single program. NTDs that can be treated with preventative chemotherapy were frequently integrated into a single program. Leprosy control was also frequently integrated with those of other communicable diseases, and notably tuberculosis. Barriers to NTD integration may result from internal administrative obstacles or external obstacles. CONCLUSIONS: Although many countries have begun to integrate NTD control efforts, additional work will be required to realize the full benefits of integration in most of the countries examined here. Moving forward, NTD integration efforts must ensure that administrative structures are designed to maximize the potential success of integrated programs and account for existing administrative processes.


Assuntos
Erradicação de Doenças/métodos , Doenças Negligenciadas/prevenção & controle , Medicina Tropical/métodos , África , Ásia , Erradicação de Doenças/organização & administração , Saúde Global , Humanos , Medicina Tropical/organização & administração
6.
J Bioenerg Biomembr ; 50(4): 307-313, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29882206

RESUMO

Purinergic receptors are widespread in the human organism and are involved in several physiological functions like neurotransmission, nociception, platelet aggregation, etc. In the immune system, they may regulate the expression and release of pro-inflammatory factors as well as the activation and death of several cell types. It is already described the participation of some purinergic receptors in the inflammation and pathological processes, such as a few neglected tropical diseases (NTDs) which affect more than 1 billion people in the world. Although the high social influence those diseases represent endemic countries, most of them do not have an efficient, safe or affordable drug treatment. In that way, this review aims to discuss the current literature involving purinergic receptor and immune response to NTDs pathogens, which may contribute in the search for new therapeutic possibilities.


Assuntos
Doenças Negligenciadas/tratamento farmacológico , Receptores Purinérgicos/metabolismo , Medicina Tropical/métodos , Animais , Humanos , Imunidade , Inflamação , Terapia de Alvo Molecular/métodos , Doenças Negligenciadas/imunologia , Doenças Negligenciadas/patologia , Transdução de Sinais/efeitos dos fármacos
7.
J Crit Care ; 46: 119-126, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29625787

RESUMO

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.


Assuntos
Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/terapia , Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva , Medicina Tropical/métodos , Artesunato/uso terapêutico , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Criança , Dengue/diagnóstico , Dengue/terapia , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Exantema , Feminino , Febre/diagnóstico , Febre/terapia , Geografia , Humanos , Leptospirose/diagnóstico , Leptospirose/terapia , Malária/diagnóstico , Malária/terapia , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Gravidez , Choque Hemorrágico , Síndrome , Viagem , Febre Tifoide
8.
Ned Tijdschr Geneeskd ; 162: D2286, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-29676709

RESUMO

Consult Online is a Dutch telemedicine system for physicians who work in international healthcare and tropical medicine (formerly known as 'tropical doctors'). It provides specialist advice for complicated cases where local specialist services are lacking. Eighty-nine experts from 25 different specialties are available for advice via www.troie.nl/consult-online. Most of these experts have worked in low resource settings for years before becoming specialists in other disciplines. Since its inception in 2008, Consult Online has received 639 consultations from 41 different countries. On average, a consultation resulted in 2.3 reactions. Consult Online is not the only telemedicine service for low resource settings, but it offers Dutch physicians the unique opportunity to liaise with specialists from their home country, who understand their background, training and limitations. A decade later, it continues to be available to anyone in need of tailor-made specialist advice for patients in low resource settings.


Assuntos
Consulta Remota/métodos , Telemedicina/métodos , Medicina Tropical , Humanos , Cooperação Internacional , Especialização , Medicina Tropical/métodos , Medicina Tropical/organização & administração
9.
Virchows Arch ; 472(1): 135-147, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28589386

RESUMO

International travels and global human migration have had the unforeseen consequence of increasing the exposure of histopathologists in developed countries to the pathology of tropical infectious disease. The gastrointestinal tract (GIT) is often the primary site of infection due to the faecal-oral route of transmission and the high risk of exposure to contaminated water, food or soil when travelling to these regions. Whilst current microbiologic techniques are far more sensitive than histology in detecting infectious pathogens, the histopathologist nonetheless retains a pivotal role in diagnosing tropical GIT disease. This role entails evaluating endoscopic biopsies for any characteristic inflammatory pattern, identifying pathogens which may be present and excluding other look-alike pathologies. Recent advances in commercially available diagnostic modalities, including molecular techniques, have further broadened the scope of the histopathologist's armamentarium. This review outlines a practical pattern-based approach to diagnosing tropical GIT infections in endoscopic material, so as to assist pathologists less familiar with this spectrum of pathology.


Assuntos
Doenças Transmissíveis/diagnóstico , Gastroenteropatias/diagnóstico , Gastroenteropatias/parasitologia , Medicina Tropical/métodos , Biópsia , Doenças Transmissíveis/parasitologia , Doenças Transmissíveis/patologia , Citodiagnóstico/métodos , Endoscopia do Sistema Digestório , Gastroenteropatias/patologia , Humanos
11.
F1000Res ; 7: 1464, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31119028

RESUMO

Background. Limited laboratory capacity is a significant bottleneck in meeting global targets for the control and elimination of neglected tropical diseases (NTD). Laboratories are essential for providing clinical data and monitoring data about the status and changes in NTD prevalence, and for detecting early drug resistance. Currently NTD laboratory networks are informal and specialist laboratory expertise is not well publicised, making it difficult to share global expertise and provide training, supervision, and quality assurance for NTD diagnosis and research. This study aimed to identify laboratories within five World Health Organisation regions (South-East Asia, Eastern Mediterranean, Americas, Western Pacific and Europe) that provide NTD services and could be regarded as national or regional reference laboratories, and to conduct a survey to document their networks and capacity to support NTD programmes. Methods. Potential NTD reference laboratories were identified through systematic searches, snowball sampling and key informants. Results. Thirty-two laboratories responded to the survey. The laboratories covered 25 different NTDs and their main regional and national roles were to provide technical support and training, research, test validation and standard setting. Two thirds of the laboratories were based in academic institutions and almost half had less than 11 staff. Although greater than 90 per cent of the laboratories had adequate technical skills to function as an NTD reference laboratory, almost all laboratories lacked systems for external verification that their results met international standards. Conclusions. This study highlights that although  many laboratories believed they could act as a reference laboratory, only a few had all the characteristics required to fulfil this role as they fell short in the standard and quality assurance of laboratory processes. Networks of high quality laboratories are essential for the control and elimination of disease and this study presents a critical first step in the development of such networks for NTDs.


Assuntos
Redes Comunitárias/organização & administração , Laboratórios/organização & administração , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/epidemiologia , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Demografia , Saúde Global , Recursos em Saúde , Mão de Obra em Saúde , Humanos , Laboratórios/normas , Garantia da Qualidade dos Cuidados de Saúde , Medicina Tropical/métodos , Medicina Tropical/organização & administração , Medicina Tropical/normas , Medicina Tropical/estatística & dados numéricos , Organização Mundial da Saúde
13.
Gac. sanit. (Barc., Ed. impr.) ; 31(6): 531-534, nov.-dic. 2017. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168545

RESUMO

La actual epidemia por virus Zika ha generado gran alarma social, favorecida en parte por la falta de información de la población general. Para proporcionar información veraz y contrastada, la Unidad de Medicina Tropical y del Viajero del Hospital Carlos III-La Paz (Madrid) puso en marcha una línea de atención telefónica sobre la infección por el virus Zika. En este artículo se presentan los datos relativos a los primeros 6 meses de su funcionamiento. El perfil predominante de llamadas corresponde a mujeres solicitando información previa a la realización del viaje. Los destinos sobre los que más información se ha demandado han sido Brasil, Méjico y Colombia. La mayoría de las llamadas se resolvieron ofreciendo información exclusivamente. La implementación de dispositivos de atención telefónica que ofrezcan información contrastada y fiable en el contexto de enfermedades asociadas a gran alarma social es de gran interés sanitario, reduce el número de consultas innecesarias y ahorra costes (AU)


The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs (AU)


Assuntos
Humanos , Infecção por Zika virus/epidemiologia , Telefone , Saúde do Viajante , Saúde Global/normas , Epidemias , Medicina Tropical/métodos , Brasil/epidemiologia , México/epidemiologia , Colômbia/epidemiologia , Análise Estatística
14.
Infect Dis Poverty ; 6(1): 130, 2017 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-28965490

RESUMO

BACKGROUND: Interventions are currently being used against 'infectious diseases of poverty', which remain highly debilitating and deadly in most endemic countries, especially malaria, schistosomiasis, echinococcosis and African sleeping sickness. However, major limitations of current 'traditional' methods for diagnosis are neither simple nor convenient for population surveillance, and showed low sensitivity and specificity. Access to novel technologies for the development of adequate and reliable tools are expressly needed. A collaborative project between African Network for Drugs and Diagnostics Innovation and partner institutions in Africa and China aims to screen suitable serological biomarkers for diagnostic pipelines against these 'diseases of the poor'. METHODS: Parasite-specific exposed versus unexposed individuals were screened and sera or urine/stools were collected through case-control studies in China and African countries. Target genes/open reading frames were selected, then will be cloned and cell-free expressed, quantified and immuno-detected. Target antigens/epitopes will be probed and screened with sera from exposed or unexposed individuals using a high-throughput antigen screening platform as the study progresses. The specificity and sensitivity of highly immunoreactive biomarkers will be evaluated as well, using enzyme-linked immunosorbent assays or dipsticks. DISCUSSION: This roadmap explicitly unfolds the integrated operating procedures with focus on malaria and schistosomiasis, for the identification of suitable biomarkers that will aid the prioritization of diagnostics for population use. However, there is need to further validate any new diagnostic through comparison with standard methods in field deployable tests for each region. Our expectations for the future are to seek regulatory approval and promote the use of diagnostics in endemic areas.


Assuntos
Biomarcadores/análise , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Malária/diagnóstico , Esquistossomose/diagnóstico , Medicina Tropical/métodos , África , China , Cooperação Internacional
15.
Mil Med ; 182(9): e1796-e1801, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28885939

RESUMO

BACKGROUND: Since 2006, the Division of Tropical Public Health at the Uniformed Services University (USU) has sponsored the Tropical Medicine Training Program (TMTP). Despite practice guidelines stating that global health education should include the collection and evaluation of data on the impact of the training experiences, no quantitative evaluation of program outcomes had previously occurred. The objective of this report was to evaluate TMTP outcomes to guide program improvement. METHODS: We developed an anonymous, web-based survey to assess program outcomes as part of routine program evaluation. The survey addressed four main areas of potential TMTP impact: (1) career engagement, (2) military service contributions, (3) scholarly activity, and (4) acquisition of knowledge and skills. In February 2016, we sent the survey electronically to 222 program participants between Fiscal Years 2006 and 2015 who had e-mails available in DoD administrative systems. FINDINGS: Ninety-eight (44%) of these responded to the survey. TMTP demonstrated impact in several areas. Increased knowledge and skills were reported by 81% of trainees, and 70% reported increased interest in serving at military overseas medical research laboratories. Subsequent career engagement by trainees included seven assignments to overseas research laboratories, 71 military deployments, and 193 short-term military missions. The ability to achieve many of the desired outcomes was associated with time elapsed since completion of formal medical education, including 24% who were still enrolled in graduate medical education. DISCUSSION/IMPACT/RECOMMENDATIONS: The TMTP has improved the U.S. military's ability to perform surveillance for emerging tropical and infectious diseases and has contributed to force health protection and readiness. Although many of the outcomes, such as service in the overseas research laboratories and military deployments, are dependent on military service requirements, these results remain perhaps the most relevant ways that the TMTP meets global health requirements of the US military and the nation. Additional outcomes from this training are expected to accrue as these participants complete their medical postgraduate training programs.


Assuntos
Saúde Global , Militares/educação , Medicina Tropical/normas , Currículo/normas , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/normas , Humanos , Internato e Residência/normas , Militares/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Inquéritos e Questionários , Medicina Tropical/métodos , Estados Unidos , Recursos Humanos
16.
Infect Dis Poverty ; 6(1): 147, 2017 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-28950893

RESUMO

BACKGROUND: Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered. MAIN BODY: The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process. Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps. Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process. CONCLUSION: The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.


Assuntos
Assistência à Saúde/organização & administração , Erradicação de Doenças/métodos , Monitoramento Epidemiológico , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/prevenção & controle , Humanos , Medicina Tropical/métodos , Medicina Tropical/organização & administração
19.
Health Policy ; 121(7): 745-754, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28579276

RESUMO

Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available preventive and curative interventions for NTDs mostly rely on old technologies and products that are often not adequate. Moreover, NTDs mostly affect populations living in remote rural areas and conflict zones, thereby hampering access to healthcare. The challenges posed by NTDs have led to the proliferation of a variety of public-private partnerships (PPPs) in the last decades. We conducted a systematic review to assess the functioning and impact of these partnerships on the development of and access to better technologies for NTDs. Our systematic review revealed a clear lack of empirical assessment of PPPs: we could not find any impact evaluation analyses, while these are crucial to realize the full potential of PPPs and to progress further towards NTDs elimination.


Assuntos
Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/prevenção & controle , Parcerias Público-Privadas/organização & administração , Medicina Tropical/métodos , Controle de Doenças Transmissíveis/organização & administração , Doenças Transmissíveis/tratamento farmacológico , Humanos , Patentes como Assunto , Parcerias Público-Privadas/economia , Parcerias Público-Privadas/normas , Pesquisa/economia , Pesquisa/organização & administração , Medicina Tropical/organização & administração , Vacinas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA