Today April 25 is World Malaria Day. We would like to highlight a malaria photography project by photographer Pearl Gan, in collaboration with OUCRU in Vietnam and EOCRU in Indonesia. Pearl's malaria project aims to bring visibility to the people and their malaria burden through her photographs of them and their environment. She hopes to humanise the faces of malaria and the malaria problem in the Asia-Pacific to audiences unfamiliar with it.
Posted 21/05/2021. Based on the analysis of a large volume of observational data on disease (diarrhea, nervous and respiratory signs, legs lesions) and antimicrobial usage (from 13 classes), Marc Choisy and colleagues highlight the absence or negative effects from prophylactic antimicrobial use in small-scale chicken farms in the Mekong Delta of Vietnam.
Posted 04/05/2021. This survey in Jakarta, Indonesia, led by Licia Limato & Raph Hamers, evaluated patterns and quality indicators of antibiotic prescribing in six public and private hospitals. The study reported a high rate of empirical use of broad-spectrum antibiotics, coupled with poor documentation and guideline adherence, suggesting important areas for antimicrobial stewardship interventions.
Posted 09/04/2021. Survivorship after an intensive care unit (ICU) stay is associated with long-term disability throughout the world. Nguyen Thi Kim Anh, Louise Thwaites and colleagues designed, implemented and evaluated the feasibility of a sustainable ICU rehabilitation programme in a resource-limited setting with the aim of improving the long-term outcome of critically ill patients.
Posted 23/03/2021. In tuberculous meningitis, raised intracranial pressure often results in irreversible neurological injury. In this study of 107 participants with tuberculous meningitis, Joseph Donovan and colleagues show how optic nerve sheath diameter ultrasound may provide a low-cost point-of-care option for the identification of individuals with raised intracranial pressure in tuberculous meningitis
Posted 12/03/2021. Henry Surendra, Raph Hamers and colleagues report a large retrospective study of patients hospitalised with COVID-19 in Jakarta, Indonesia. In-hospital mortality was lower than reported in high-income countries, likely explained by the younger population, fewer comorbidities and less severe disease. Nonetheless, this study affirmed the vulnerability of elderly and comorbid patients as well as children under 5 years in LMICs
Posted 02/02/2021. Indiscriminate antimicrobial use (AMU) in animal production is a driver of antimicrobial resistance globally. In this trial, Juan Carrique-Mas and colleague provided regular veterinary advice to chicken farmers in Vietnam aiming to reducing AMU. AMU was quantitatively reduced by 66% and flock mortality by 40%. This study demonstrates that reductions in AMU without compromising health and productivity can be achieved in LMICs.
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.
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.
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.
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.
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.
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.
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.
Posted 19/06/2018. Many people with pre-existing heart problems (including heart attack, pacemaker implantation, arrhythmia), high blood pressure and even past history of a stroke seek advice regarding high altitude travel ( > 2500m) for recreation, meetings or pilgrimages. Dr Buddha Basnyat and colleagues succinctly try to address these conditions at altitude and make reasonable recommendations in the face of limited data.
Posted 17/12/2019. Typhoid fever is rampant in South Asia. This new typhoid vaccine (studied in Kathmandu, Nepal, by Buddha Basnyat and colleagues) appears to be very effective in the prevention of typhoid. Administration of the new vaccine, especially in children, will revolutionize the prevention of this disease. And, crucially, help fight typhoid treatment resistance, a burgeoning problem.
Posted 18/05/2020. The etiology of high altitude pulmonary edema (HAPE), a disease sometimes seen in sojourners to high altitude, is lack of adequate oxygen and not an inflammation provoked by an infectious agent like the novel coronavirus. Except for supplemental oxygen, Buddha Basnyat and colleagues strongly caution against managing COVID-19 lung injury with treatments that are used for HAPE.
Posted 02/04/2019: Underdiagnosed in South Asia, melioidosis is caused by a bacterium called Burkholderia pseudomallei which is often referred to as a remarkable imitator. Pulmonary involvement including infections mimicking tuberculosis is a common form of presentation. In this case report, Buddha Basnyat and colleagues show that if a South Asian patient does not respond to anti tuberculosis treatment, melioidosis should be considered.
Posted 02/10/2018. Rising prevalence of HIV drug resistance in low and middle-income countries poses a growing threat to the HIV response. To curb resistance, enhanced strategies are needed that improve quality of ART care and treatment. Raph Hamers reviews contemporary data and highlights the potential impact and resistance risks of novel ART strategies and knowledge gaps.
Posted 07/04/2017. Collaboration between photographer Pearl Gan and Professor Kevin Baird from our EOCRU unit in Jakarta, Indonesia, this photographic project aims to raise public awareness of malaria as a serious health problem for the region by telling the human story of Asia’s invisible malaria burden.
Posted 28/05/2019. Kevin Baird calls attention to the importance of local expertise in anopheline mosquito ecology as an essential weapon in striving to eliminate malaria. Slight but very specific modifications to environments that disfavour those mosquitoes achieved very significant gains before the advent of DDT insecticide and synthetic antimalarial commodities in the middle of the 20th century. Loss of those commodities, and a lack of alternative strategies, led to the great malaria resurgence of the latter 20th century.
A trial in infants and toddlers in Burkina Faso showed that experimental malaria vaccine R21/MM confers 77% protection, an unprecedented level and the first malaria vaccine to exceed WHO’s goal of 75% efficacy. While a larger trial is needed to assess its safety and efficacy, R21/MM may substantially reduce child mortality in Sub-Saharan Africa. But this vaccine may be less relevant to Asia Pacific where malaria causes severe morbidity and mortality in all age groups, asymptomatic malaria infections are frequent, and the vaccine may not be effective against P. vivax.
COVID-19 in Nepal is out of hand and slowly, but surely tracking the infection in India. Although many healthcare workers have been vaccinated throughout the country, the actual vaccination rate is likely very low for the entire country. Buddha Basynat discusses Nepal’s COVID response so far, and why vaccines are an urgent priority.
Director for the Oxford University Clinical Research Unit Nepal, Professor Buddha Basnyat is a medical doctor based in Kathmandu, Nepal. His research interests are infectious diseases and high altitude medicine, and he has almost 300 publications in peer-reviewed medical journals. One of his primary interests is to encourage young people to do clinical research.
Live and on-line from Bangkok! Be ready for Thursday 13th May, when Pint of Science Thailand will stream live from Bangkok. Join us via Facebook, YouTube or right here from the Pint of Science Thailand website as we journey from bacterial infections to viruses, discover how clinical trials work, and how scientific development is seen in the eyes of the law!
Nepal is seeing a COVID surge that is proportionately similar to India. While we try to treat the sick by increasing hospital space and ensuring oxygen supply, we must also plan for an exit strategy. Over-preparation rather than under-preparedness needs to be our mantra, with widespread vaccination the key to get us out of this pandemic, by Professor Buddha Basnyat
The International Girl’s in ICT day is commemorated to create awareness on the critical need for more girls and women in the ICT sector, encourage and inspire young girls to actively pursue careers in STEM as well as engage the community to promote collaboration through partnerships. Kathreen Wafula, an ICT Support Technician in Kilifi, joins a strong team of techies and is one of the 4 women in the department.