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Tools for measuring medical internship experience: a scoping review

@Oxford KWTRP

Posted 26/01/2021. Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. Yingxi Zhao and colleagues identified and described a large number of tools designed for measuring medical internship experience, to help medical educators and human resource managers make an evidence-based decision on designing surveys to understand interns’ experience of training.

Plasma inflammatory biomarkers predict CD4+ T-cell recovery and viral rebound in HIV-1 infected Africans on suppressive antiretroviral therapy

EOCRU OUCRU

Posted 22/01/2021. Raph Hamers and colleagues conducted a multi-country prospective study of Africans with HIV-1 on suppressive antiretroviral therapy. Plasma concentrations of sCD14 and CRP predicted subsequent poor CD4+ T-cell recovery, and CXCL10 and sCD163 predicted viral rebound. Further research is needed to increase our understanding of and to explore the potential for adjunctive therapeutic interventions targeting these pathways.

Viral metagenomic analysis of cerebrospinal fluid from patients with acute central nervous system infections of unknown origin, Vietnam

OUCRU

Posted 19/01/2021. Tan Le Van and colleagues show that metagenomics could detect enteroviruses (n=23), hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1) and germycircularvirus (1) in 14.7% of 204 cerebrospinal fluid from Vietnamese patients presenting with central nervous system infections of unknown origin. It remains a challenge to identify a plausible cause in patients with brain infections.

Immunogenicity and safety of fractional doses of yellow fever vaccines

KWTRP

Posted 15/01/2021. Yellow Fever is a re-emerging disease whose incidence has increased globally in the last three decades. Although very successful, the stocks of the YF vaccine are often insufficient. Derick Kimathi, George Warimwe and colleagues assessed the immunogenicity and safety of fractional (1/5th) doses. Our results support fractional dosing of all four WHO-prequalified YF vaccines in general adult population as a dose-sparing strategy.

The emergence of azithromycin-resistant Salmonella Typhi in Nepal

OUCRU OUCRU-Nepal

Posted 12/01/2021. Azithromycin is effectively the last remaining oral antimicrobial to treat typhoid fever and is widely used for empirical therapy in South Asia. Although azithromycin resistance in Salmonella Typhi has rarely been reported, Abhilasha Karkey and colleagues show that an increasing reliance on this drug has led to the emergence of azithromycin resistant S. Typhi in the region.

First do no harm: practitioners’ ability to ‘diagnose’ system weaknesses and improve safety is a critical initial step in improving care quality

@Oxford KWTRP

Posted 08/01/2021. Patient safety is much less well studied in low-resource settings than in higher income settings. Mike English and colleagues suggest how concepts being employed to advance patient safety thinking in higher income settings could be usefully applied by practitioners in low-resource settings. The ability to diagnose system weaknesses should become a core skill for those leading teams, wards, departments or facilities in low-resource settings

Serological evidence indicates widespread distribution of rickettsioses in Myanmar

LOMWRU MORU

Posted 05/01/2021. Diagnosing rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study the distribution of rickettsioses in Myanmar was not known. This report of a serosurvey by Philip Elders, Elizabeth Ashley and colleagues shows rickettsioses are widespread in Myanmar, with high scrub typhus prevalence in central and northern regions.

Old age is associated with decreased wealth in rural villages in Mtwara, Tanzania

MORU

Posted 18/12/2020. Lorenz Von Seidlein and colleagues observed that poorest people in rural Tanzania were the oldest people and especially old people without children. This observation came as a surprise because generation, the baby boomers has accumulated wealth throughout life and ended up wealthier by the time they reached retirement. There is a need to provide more financial and housing security for older people in rural Africa. Currently for many older people in rural Africa the only security are their children.

Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

COMRU MORU

Posted 15/12/2020. A recent study co-led by Paul Turner and colleagues at COMRU identified extremely high prevalence of antimicrobial resistant (AMR) bacterial carriage in households from Siem Reap, Cambodia. Extended-spectrum beta-lactamase producing Escherichia coli were detected in stool samples from >90% of participants. The results highlight the challenges to AMR control in locations where antibiotic overuse is common.

Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

MORU

Posted 11/12/2020. COVID-19 has hit informal urban settlements particularly hard. The control and prevention of COVID-19 in slums starts with organizing community infrastructure, provision of basic needs and protection of people at highest risk. Slums are a source for persistent transmission. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, Lorenz Von Seidlein and colleagues provide suggestions.

Impact of low blood culture usage on rates of antimicrobial resistance

MORU

Posted 08/12/2020. “No bacterial culture, no drug-resistant infections.” Cherry Lim, Direk Limmathurotsakul and colleagues show that the impact of low blood culture utilization on the observed proportions and incidences of drug-resistant infections could be high. This is likely happening in most of LMICs. A set of recommendations are proposed.

MALDI-TOF mass spectrometry for sub-typing of Streptococcus pneumoniae

COMRU MORU

Posted 04/12/2020. Paul Turner and COMRU researchers, working with Cambodia’s University of Health Sciences and Fondation Merieux, evaluated recently the potential of MALDI-TOF-based serotyping of Streptococcus pneumoniae for vaccine impact surveillance. Despite early promise, the team found that MALDI-TOF performed poorly and should not replace existing serotyping methodologies.

Research ethics in context: understanding the vulnerabilities, agency and resourcefulness of research participants living along the Thai–Myanmar border

MORU SMRU

Posted 01/12/2020. This paper confirms that research is important to inform evidence-based medical care in LMICs settings. Napat Khirikoekkong, Phaik Yeong Cheah and colleagues found that migrants living along the Thai-Myanmar border, who were traditionally deemed vulnerable, exercise their agency and resourcefulness when navigating through their daily challenges, and participating in important health research

TB outcomes and mortality risk factors in adult migrants at the Thailand-Myanmar border

MORU SMRU

Posted 27/11/2020. The migrant-friendly residential TB program of SMRU on the Thailand-Myanmar border has achieved high treatment success rate. However, many TB patients admitted to the centers are in advanced stage of disease. Win Pa Pa Htun and colleagues show that early TB death (in the first month of treatment) is highest among pulmonary TB cases and in particular in HIV co-infected patients and in those with co-morbidity. Early detection and treatment for both TB and HIV are crucial for migrants, if the case fatality rate is to be reduced in this marginalized population.

Malaria Screener: a smartphone application for automated malaria screening

MORU

Posted 24/11/2020. Malaria Screener is a smartphone application developed by the National Library of Medicine, in partnership with Richard Maude and colleagues at MORU Epidemiology, aiming to improve the availability of high quality malaria diagnosis. It is cheap, fast and easy-to-use with a standard smartphone and microscope and detects malaria parasites by machine learning.

Towards a fair and transparent research participant compensation and reimbursement framework in Vietnam

OUCRU

Posted 20/11/2020. Providing compensation for participants in clinical research is well established but defining compensation in low-resource settings is challenging due to ethical concerns and the lack of appropriate frameworks. Evelyne Kestelyn and colleagues at OUCRU Vietnam developed a compensation and reimbursement framework, providing a consistent, fair and transparent decision-making process that will be implemented across all future clinical research.

Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam

OUCRU

Posted 17/11/20. Rogier van Doorn and colleagues show that antibiotics were prescribed to almost all 500 children with mild respiratory infection presenting to an outpatient clinic. They assessed prior antibiotic use by questionnaire and urine testing (HPLC), and reported overuse and overprescription of antibiotics when most respiratory infections are caused by viruses, and selection of resistant Enterobacteriaceae in gutflora with transmission potential.

Antimicrobial use in food animals and human health: time to implement ‘One Health’ approach

@Oxford MORU

Posted 13/11/2020. Use of antimicrobials in animals and the environment has been established to contribute to the global antimicrobial resistance (AMR), and yet there have been inadequate collaborative efforts to tackle this problem. Sunil Pokharel, Bipin Adhikari and colleagues discuss how and why ‘One health’ approach is important to tackle antimicrobial resistance.

Transmission of artemisinin-resistant malaria parasites to mosquitoes under antimalarial drug pressure

MORU

Posted 10/11/20. Artemisinin-based combination therapies are not only effectively curing malaria, they also impact male malaria parasites in their capacity for onward transmission to the mosquito. Here, Andrea Ruecker and colleagues provide clear evidence that artemisinin resistant parasites overcome this sterilising effect to successfully infect mosquitoes under drug pressure, facilitating the spread of artemisinin resistance.

Impact of outdoor residual spraying on the biting rate of malaria vectors in Myanmar

MORU SMRU

Posted 06/11/20. Victor Chaumeau and colleagues assessed the impact of outdoor residual spraying on the biting rate of malaria mosquitoes in four villages in Kayin state, Myanmar. They reported a 10-fold decrease in mosquito biting rate immediately after the intervention and concluded that outdoor residual spraying can be used to control malaria mosquitoes in this area.

Prediction modelling of inpatient neonatal mortality in high-mortality settings

KWTRP

Posted 31/10/2020. Existing neonatal prognostic models are suited for advanced care settings; however, they use parameters that are not available in low-resource settings. Jalemba Aluvaala and colleagues demonstrate that two novel models - NETS and SENSS - using basic routine data can accurately predict in-hospital mortality which may allow us to better understand neonatal mortality.

How many human pathogens are there in Laos? An estimate of national human pathogen diversity and analysis of historical trends

@Oxford LOMWRU MORU

Posted 27/10/2020. Madeleine Clarkson, Paul Newton and colleagues reviewed when individual species of human pathogens were described in Laos, and estimated the in-country diversity and how many more pathogens there may be. Combining modelling with historical assessment improved understanding of the factors affecting pathogen description. During the last decade there has been a 33-fold increase in the description rate, coinciding with the strengthening of medical research in Laos.

Trimethoprim-sulfamethoxazole (SXT) versus azithromycin for the treatment of undifferentiated febrile illness in Nepal

OUCRU OUCRU-Nepal

Posted 20/10/2020. Buddha Basnyat and colleagues describe findings from NUFIT, the Nepal Undifferentiated Febrile Illness Trial, a randomized, double blind, placebo controlled trial. The trial revealed that 7 days of sulphamethoxazole-trimethoprim (Bactrim) is inferior to azithromycin in the treatment of undifferentiated febrile illness (fever without a focus) and enteric fever in Nepal and the wider region in South Asia.

Preparing for a pandemic: highlighting themes for research funding and practice

@Oxford

Posted 16/10/2020. In December 2019, The Global Research Collaboration for Infectious Disease Preparedness (GloPID-R) convened a Frontiers meeting to identify how to enable a coordinated research response in the event of an epidemic or pandemic. Alice Norton, Louise Sigfrid, Gail Carson and colleagues here highlight findings to strengthen the ongoing response for COVID-19.

The efficacy of PPE for COVID-19-type respiratory illnesses in primary and community care staff

MORU

Posted 13/10/2020. Xin Hui Chan and colleagues summarise their rapid reviews on the efficacy of personal protective equipment for preventing COVID-19 in primary and community care. They highlight how PPE is designed for use as an ensemble, is a complex intervention which should include appropriate training and support, and is the least effective of the hierarchy of controls.

How severe anaemia might influence the risk of invasive bacterial infections in African children

KWTRP

Posted 09/10/2020. Children with severe anaemia are more likely to get bacterial infections. Kelvin Mokaya, Sarah Atkinson and colleagues discuss how severe anaemia interferes with iron regulation, and how this promotes bacterial growth in blood and dampens immune responses to these bacteria. The authors also suggest possible studies that can be used to explore their hypothesis.

Implementing parasite genotyping into national surveillance frameworks

MORU

Posted 07/10/2020. The Asia-Pacific region is the epicentre of the emergence of resistance against frontline antimalarials, and also faces a high proportion of non-falciparum malaria. Sarah Auburn and colleagues review novel approaches for molecular surveillance that can help track drug resistant parasites and the spread of parasites across the region, discussed at a recent APMEN workshop in Jakarta, and how these approaches can provide important information for policy makers in malaria-endemic regions.

Red blood cell tension protects against severe malaria in the Dantu blood group

KWTRP

Posted 29/09/2020. In a collaborative effort to investigate the mechanism of protection conferred by the rare Dantu blood group variant, found at highest frequency in East Africa, Silvia Kariuki and colleagues found a strong correlation between red blood cell membrane tension and parasite invasion ability. Increased membrane tension led to resistance to parasite invasion, and Dantu red blood cells had higher average membrane tension, meaning that a greater proportion resisted invasion. The findings from this study could inform the design of drugs that imitate this increased membrane tension to prevent or treat malaria.

Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation

MORU SMRU

Posted 25/09/2020. Prevention of mother to child transmission of hepatitis B with maternal tenofovir DF is one option to reach elimination of this infection. However, implementing this in a resource limited setting is challenging. Marieke Bierhoff and colleagues describe the most common challenges and possible solutions like transport assistance and local agreements to facilitate access.

Case-control study of use of personal protective measures and risk for severe acute respiratory syndrome coronavirus 2 infection, Thailand

MORU

Posted 22/09/2020. This case-control study, conducted by Direk Limmathurotsakul and colleagues in Thailand, shows that wearing masks all the time, maintaining >1 m distance, having close contact for <15 minutes, and frequent handwashing are independently associated with lower risk for SARS-CoV-2 infection (COVID-19)

Estimating the proportion of Plasmodium vivax recurrences caused by relapse

MORU

Posted 18/09/2020. New findings by Ric Price and colleagues highlight that a remarkably high number of P. vivax infections arise from relapses (reactivation of dormant liver stages). This has important implications since almost 85% of recurrent infections could be prevented if more patients were treated with primaquine. The study emphasises the important of work done by the VxWG (Vivax Working Group for the Asia Pacific Malaria Eliminiation Network) in promoting wider access to safe and effective radical cure.

Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 – 2018

OUCRU

Posted 11/09/2020. Nineteen different enterovirus serotypes were detected in 1196 Vietnamese children presenting with hand foot and mouth disease during 2015-2018. Le Van Tan and colleagues show that EV-A71 was the major cause, especially in those with severe disease, followed by CV-A6, CV-A10 and CV-A16. Multivalent vaccines are urgently needed to control hand foot and mouth disease.

Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya

@Oxford KWTRP

Posted 03/09/2020. Cian Wade, Mike English and colleagues brought together a large body of evidence to inform recommendations for Kenya on neonatal analgesic guidelines for routine procedures. They describe the process by which a group of local experts translated systematic review and meta-analysis findings into context-specific clinical guidelines. The work emphasises the value of breastfeeding or breast milk as an important and feasible therapeutic strategy for alleviating neonatal pain.

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

@Oxford LOMWRU MORU

Posted 01/09/2020. This paper provides an overview of FIEBRE’s activities. The study aims to identify infections that are treatable and/or preventable, to assess antimicrobial susceptibility of bacterial pathogens and to collect qualitative data on care-seeking and treatment behaviours. Paul Newton and colleagues detail clinical and laboratory assessments, data analysis plan, and outline the study’s strengths and limitations.

G6PD deficiency in malaria endemic areas of Nepal

MORU SMRU

Posted 27/08/2020. Germana Bancone and colleagues from EDCD (Nepal) and SMRU conducted this study in malaria endemic districts of Nepal, showing that G6PD deficiency is prevalent among most ethnic groups across the region. G6PD testing will be necessary for safe deployment of 8-aminoquinolines in order to eliminate Plasmodium vivax malaria in Nepal.

No evidence that chloroquine or hydroxychloroquine induce hemolysis in G6PD deficiency

MORU

Posted 25/08/2020. With renewed interest in chloroquine and hydroxychloroquine, much has recently been written and published about the risk of haemolysis in G6PD deficient individuals. William Schilling and colleagues believe many have overlooked the wealth of data which already exists about this very issue. Here presented is an overview of the long-accrued evidence (as well as that from recent COVID-19 publications) that chloroquine and hydroxychloroquine do not induce haemolysis in G6PD deficiency.

Integration of HIV services with primary care in Yangon, Myanmar

MOCRU MORU

Posted 21/08/2020. Frank Smithuis and colleagues did a retrospective cohort analysis looking at integration of HIV care with general health care clinics in Yangon, Myanmar. HIV patient survival was high at 0.95 at 1 year and 0.90 at 5 years. Integration is effective to attain early linkage to care but attention should be given to disengagement from care, in particular for pregnant women.

Initiating a network to support engagement between health researchers and schools: recommendations from an international meeting of schools engagement practitioners held in Kilifi, Kenya

KWTRP

Posted 18/08/2020. In November 2018 twenty-nine participants, representing 21 institutions from 11 countries, participated in a first international “school engagement” workshop hosted by the KEMRI-Wellcome Research Programme in Kilifi, Kenya. Alun Davies and colleagues report on the broad range of goals and approaches for engagement between health researchers and school students.

Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off (ECOFF) values

LOMWRU MORU

Posted 14/08/2020. David Dance and colleagues describe a multi-centre study, co-ordinated by EUCAST, to establish interpretative criteria for Burkholderia pseudomallei disc diffusion tests. Three MORU network sites (Laos, Thailand and Cambodia) participated. The results, based on 361 isolates, will enable laboratories around the world to conduct quality-assured testing of B. pseudomallei susceptibility.

Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion

MORU

Posted 11/08/2020. This very large molecular epidemiology study done over 12 years describes the evolution and spread of antimalarial drug resistance across the entire Greater Mekong subregion (GMS). Mallika Imwong and colleagues show no evidence of spread of artemisinin resistant parasite lineages from the eastern to the western GMS. There is also no evidence for piperaquine resistance in the western GMS.

Dengue virus induces PCSK9 expression to alter antiviral responses and disease outcomes

OUCRU

Posted 06/08/2020. Cholesterol is required for efficient dengue virus (DENV) replication, however statin treatment did not show efficacy against dengue in clinical trials, and underscored the need for a more detailed understanding of the interaction between DENV and cellular cholesterol. In this paper, in collaboration with DUKE-NUS, Sophie Yacoub and colleagues demonstrate the pivotal role of PCSK9 in DENV infections.

Addressing challenges for clinical research responses to emerging epidemics and pandemics

@Oxford

Posted 04/08/2020. Major infectious disease outbreaks are a constant threat to human health; clinical research responses generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses to emergency epidemics. Louise Sigfrid and colleagues review those challenges and identify solutions to address them.

Evaluation of the forum theatre approach for public engagement around antibiotic use in Myanmar

MOCRU MORU

Posted 31/07/2020. Myo Maung Maung Swe and colleagues describe evaluation and experience of using the forum theatre technique, a novel form of public engagement. Our experience was fun, informative and encouraged widespread participation around the subject of antibiotic use. We believe that this technique will be of great interest to scientists who engage in activities using participatory techniques.

Screening of ectoparasites from domesticated dogs for bacterial pathogens in Vientiane, Lao PDR

LOMWRU MORU

Posted 28/07/2020. Ticks, fleas and lice from dogs in Vientiane (Lao PDR) were shown to carry a variety of zoonotic pathogens including R. felis (cat-flea typhus). Matthew Robinson and colleagues highlight the risk of these pathogens transmitted between dogs and humans within the city, as well as the role of pets in human diseases, and important public health considerations

Value of lipocalin 2 as a potential biomarker for bacterial meningitis

OUCRU

Posted 24/07/2020. A team from OUCRU led by Le Van Tan, Hospital for Tropical Diseases, Vietnam, and the Target Discovery Institute at the University of Oxford showed that lipocalin 2 is a sensitive and specific biomarker for discriminating bacterial meningitis from a broad spectrum of other brain infections, and outperforms routine CSF markers such as leukocytes, glucose, protein and lactate.

Respiratory support in COVID-19 patients, with a focus on resource-limited settings

MORU

Posted 21/07/2020. This article by Arjen Dondorp and colleagues provides guidance on respiratory support for patients with severe COVID-19 focusing on low- and middle-income countries, based on current evidence and experience. Rather than the usual focus on mechanical ventilation, it emphasizes the importance of having the right modalities for non-invasive oxygen therapy in place

Enhancing science preparedness for health emergencies in Africa through research capacity building

KWTRP

Posted 17/07/2020. In this editorial, Sam Kinyanjui and colleagues argue that establishing science preparedness, which is an integral component of emergency preparedness, should be embedded within long-term investment in research capacity. They illustrate how African-led research capacity building consortia including IDeAL have contributed to Africa’s preparedness for the COVID-19 pandemic.

Non-adherence in non-inferiority trials: pitfalls and recommendations

MORU

Posted 14/07/2020. Non-adherence in non-inferiority trials typically dilutes observed treatment effects, leading to a higher probability of claiming non-inferiority. Mo Yin and colleagues describe different patterns of non-adherence and the influence of the confounders on treatment effects. Causal inference methods that account for these confounders can minimise bias and risk of false non-inferiority claims.

The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

@Oxford KWTRP

Posted 07/07/2020. In a country with 25 million newborns, children and adolescents, how many paediatricians are there and where are they? This paper by Mike English and colleagues seeks to start a debate on how to deliver paediatric services in LMIC in the future.

Malaria infection, disease and mortality among children and adults on the coast of Kenya

KWTRP

Posted 03/07/2020. Under declining malaria transmission on the Kenyan coast Kilifi, Alice Kamau, Bob Snow and colleagues show that children continue to bear the brunt of mild and severe disease. There was no significant malaria disease or mortality burden in adults. This is contrary to current modelled approaches to malaria disease burden among African adults.

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