Journal Article > ResearchFull Text
J Clin Med. 2 June 2024; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, et al.
J Clin Med. 2 June 2024; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
BACKGROUND
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
Conference Material > Abstract
Amevoin Y, Ale F
Epicentre Scientific Day 2024. 23 May 2024
BACKGROUND
Diphtheria is an infection of the upper respiratory tract characterized by the production of an extracellular toxin. Individuals with incomplete immunization or low levels of antitoxin antibodies are particularly susceptible to infection. Specific treatment relies on Diphtheria Anti-Toxin (DAT) and the disease is preventable by active immunization. Since 2019, large outbreaks have been reported in WHO African Region, but 2023 has seen an unprecedented surge in diphtheria cases in West Africa, mainly Kano State, Nigeria.
METHODS
Médecins Sans Frontières (MSF) and Epicentre have been involved in response efforts but have faced several challenges due to limited hospital capacity and a global shortage of DAT. This led to the implementation of new solutions such as home-based care, adaptation of DAT dosage and strategic allocation of DAT stocks. Preliminary descriptive analysis shows the key figures from the 2023 diphtheria outbreak and summarizes critical insights from one year of MSF intervention in Kano.
RESULTS
MSF treated around 23 thousand individuals across 14 sites in five countries. Nearly half of these patients required hospitalization, with an overall case fatality rate (CFR) of 6%. The majority of patients were under 15 years of age, and most were female.
In Kano State, Nigeria, specifically, three main centres were established at the peak of the outbreak. MSF used adaptive strategies to deal with the constraints of the response, which were phased according to the number of cases and the availability of drugs. Centralised case management was used for severe cases, while a decentralised care model, including home-based care, was used for mild and close contacts. The primary centre, which remains operational, has received approximately 9 thousand patients.
Data indicate that the prompt administration of diphtheria antitoxin (DAT) may influence patient outcomes. Furthermore, an early immunization campaign could have potentially reduced the overall mortality rate associated with the epidemic.
CONCLUSION
The surge of diphtheria in West Africa highlighted numerous challenges in combating the disease in low-resource settings, particularly concerning the availability of diphtheria antitoxin (DAT). Further analyses are required to accurately assess the impact of home-based care and DAT dosage strategies. Scaling up global DAT production and enhancing routine vaccination programs could be crucial in preventing future outbreaks.
Diphtheria is an infection of the upper respiratory tract characterized by the production of an extracellular toxin. Individuals with incomplete immunization or low levels of antitoxin antibodies are particularly susceptible to infection. Specific treatment relies on Diphtheria Anti-Toxin (DAT) and the disease is preventable by active immunization. Since 2019, large outbreaks have been reported in WHO African Region, but 2023 has seen an unprecedented surge in diphtheria cases in West Africa, mainly Kano State, Nigeria.
METHODS
Médecins Sans Frontières (MSF) and Epicentre have been involved in response efforts but have faced several challenges due to limited hospital capacity and a global shortage of DAT. This led to the implementation of new solutions such as home-based care, adaptation of DAT dosage and strategic allocation of DAT stocks. Preliminary descriptive analysis shows the key figures from the 2023 diphtheria outbreak and summarizes critical insights from one year of MSF intervention in Kano.
RESULTS
MSF treated around 23 thousand individuals across 14 sites in five countries. Nearly half of these patients required hospitalization, with an overall case fatality rate (CFR) of 6%. The majority of patients were under 15 years of age, and most were female.
In Kano State, Nigeria, specifically, three main centres were established at the peak of the outbreak. MSF used adaptive strategies to deal with the constraints of the response, which were phased according to the number of cases and the availability of drugs. Centralised case management was used for severe cases, while a decentralised care model, including home-based care, was used for mild and close contacts. The primary centre, which remains operational, has received approximately 9 thousand patients.
Data indicate that the prompt administration of diphtheria antitoxin (DAT) may influence patient outcomes. Furthermore, an early immunization campaign could have potentially reduced the overall mortality rate associated with the epidemic.
CONCLUSION
The surge of diphtheria in West Africa highlighted numerous challenges in combating the disease in low-resource settings, particularly concerning the availability of diphtheria antitoxin (DAT). Further analyses are required to accurately assess the impact of home-based care and DAT dosage strategies. Scaling up global DAT production and enhancing routine vaccination programs could be crucial in preventing future outbreaks.
Conference Material > Abstract
Haj-Hassan TA, Amer M, Al-Jubori K, Salim H, Hameed A, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/f0Fo0R
BACKGROUND AND OBJECTIVES
Continuous Positive Airway Pressure (CPAP) is recommended for neonates with respiratory distress. CPAP is widely used in high-income countries, but less so in low- and middle-income settings. Here we assess key aspects of implementing CPAP in a humanitarian setting and describe the initial cohort of neonates treated, along with their clinical outcomes.
METHODS
MSF implemented CPAP in a basic neonatal unit in Mosul following the request of the local medical team. Implementation of two bubble CPAP machines included initial training and refresher training one year later. Clinical data was recorded over 16 months (13 April 2021- 21 July 2022). Descriptive statistics were used to assess the feasibility and outcomes of using CPAP in this setting.
RESULTS
CPAP was well accepted by most healthcare workers and parents. 93 neonates were placed on CPAP. 98% of patients had a birthweight >1.5Kg. The main indications were respiratory distress syndrome, pneumonia, transient tachypnoea, and meconium aspiration (46%, 22%, 16%, and 14% respectively). Average duration on CPAP was 53 hours. 63% of patients recovered, 8% were discharged against medical advice, 9% were referred, and 15% died. Among the 15 patients who died at our facility or at the referral facility, 7 had a contraindication to CPAP, and the initiation of CPAP was delayed in 9 patients. Complications included minor nasal lesions (17%), irritability (8%), and pneumothoraces (5%).
DISCUSSION
Most patients improved with CPAP and were discharged home. 5% of patients developed pneumothoraces, which is in keeping with other reports. However, among patients who did not improve, a significant proportion had contraindications to CPAP initiation and/or were placed on CPAP in extremis, highlighting the importance of clear indication criteria and training. Using CPAP in a humanitarian setting may be feasible but is associated with high human resource needs for both training and practice.
Continuous Positive Airway Pressure (CPAP) is recommended for neonates with respiratory distress. CPAP is widely used in high-income countries, but less so in low- and middle-income settings. Here we assess key aspects of implementing CPAP in a humanitarian setting and describe the initial cohort of neonates treated, along with their clinical outcomes.
METHODS
MSF implemented CPAP in a basic neonatal unit in Mosul following the request of the local medical team. Implementation of two bubble CPAP machines included initial training and refresher training one year later. Clinical data was recorded over 16 months (13 April 2021- 21 July 2022). Descriptive statistics were used to assess the feasibility and outcomes of using CPAP in this setting.
RESULTS
CPAP was well accepted by most healthcare workers and parents. 93 neonates were placed on CPAP. 98% of patients had a birthweight >1.5Kg. The main indications were respiratory distress syndrome, pneumonia, transient tachypnoea, and meconium aspiration (46%, 22%, 16%, and 14% respectively). Average duration on CPAP was 53 hours. 63% of patients recovered, 8% were discharged against medical advice, 9% were referred, and 15% died. Among the 15 patients who died at our facility or at the referral facility, 7 had a contraindication to CPAP, and the initiation of CPAP was delayed in 9 patients. Complications included minor nasal lesions (17%), irritability (8%), and pneumothoraces (5%).
DISCUSSION
Most patients improved with CPAP and were discharged home. 5% of patients developed pneumothoraces, which is in keeping with other reports. However, among patients who did not improve, a significant proportion had contraindications to CPAP initiation and/or were placed on CPAP in extremis, highlighting the importance of clear indication criteria and training. Using CPAP in a humanitarian setting may be feasible but is associated with high human resource needs for both training and practice.
Conference Material > Slide Presentation
Haj-Hassan TA, Amer M, Al-Jubori K, Salim H, Jakubcova M, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/Wsnjd3LLZr
Journal Article > ReviewFull Text
Eur J Pediatr. 1 January 2024; Volume 183 (Issue 1); 9-50.; DOI:10.1007/s00431-023-05238-z
Tochie JN, Sibetcheu AT, Arrey-Ebot PE, Choukem SP
Eur J Pediatr. 1 January 2024; Volume 183 (Issue 1); 9-50.; DOI:10.1007/s00431-023-05238-z
Neonatal respiratory failure (NRF) is an emergency which has not been examined extensively. We critically synthesized the contemporary in-hospital prevalence, mortality rate, predictors, aetiologies, diagnosis and management of NRF to better formulate measures to curb its burden. We searched MEDLINE and Google Scholar from 01/01/1992 to 31/12/2022 for relevant publications. We identified 237 papers from 58 high-income and low-and middle-income countries (LMICs). NRF prevalence ranged from 0.64 to 88.4% with some heterogeneity. The prevalence was highest in Africa, the Middle East and Asia. Globally as well as in Asia and the Americas, respiratory distress syndrome (RDS) was the leading aetiology of NRF. Neonatal sepsis was first aetiology in Africa, whereas in both Europe and the Middle East it was transient tachypnoea of the newborn. Independent predictors of NRF were prematurity, male gender, ethnicity, low/high birth weight, young/advanced maternal age, primiparity/multiparity, maternal smoking, pregestational/gestational diabetes mellitus, infectious anamneses, antepartum haemorrhage, gestational hypertensive disorders, multiple pregnancy, caesarean delivery, antenatal drugs, foetal distress, APGAR score, meconium-stained amniotic fluid and poor pregnancy follow-up. The NRF-related in-hospital mortality rate was 0.21-57.3%, highest in Africa, Asia and the Middle East. This death toll was primarily due to RDS globally and in all regions. Clinical evaluation using the Silverman-Anderson score was widely used and reliable. Initial resuscitation followed by specific management was the common clinical practice.
Journal Article > ResearchFull Text
Euro Surveill. 1 November 2023; Volume 28 (Issue 44); 2300130.; DOI:10.2807/1560-7917.ES.2023.28.44.2300130
Jacquinet S, Martini H, Mangion JP, Neusy S, Detollenaere A, et al.
Euro Surveill. 1 November 2023; Volume 28 (Issue 44); 2300130.; DOI:10.2807/1560-7917.ES.2023.28.44.2300130
Since 2022, European countries have been facing an outbreak of mainly cutaneous diphtheria caused by toxigenic Corynebacterium diphtheriae among asylum seekers. In Belgium, between 1 March and 31 December 2022, 25 cases of toxigenic C. diphtheriae infection were confirmed among asylum seekers, mostly among young males from Afghanistan. Multi-locus sequence typing showed that most isolates belonged to sequence types 574 or 377, similar to the majority of cases in other European countries. The investigation and management of the outbreak, with many asylum seekers without shelter, required adjustments to case finding, contact tracing and treatment procedures. A test-and-treat centre was organised by non-governmental organisations, the duration of the antimicrobial treatment was shortened to increase compliance, and isolation and contact tracing of cases was not possible. A vaccination centre was opened, and mobile vaccination campaigns were organised to vaccinate a maximum of asylum seekers. No more cases were detected between end December 2022 and May 2023. Unfortunately, though, three cases of respiratory diphtheria, including one death, were reported at the end of June 2023. To prevent future outbreaks, specific attention and sufficient resources should be allocated to this vulnerable population, in Belgium and at international level.
Conference Material > Poster
Post N, Boobier L, Vyncke J, Tremblay LL
MSF Scientific Day International 2023. 7 June 2023
Journal Article > CommentaryFull Text
ATS Sch. 15 November 2022; Volume 3 (Issue 4); 625-630.; DOI:10.34197/ats-scholar.2022-0071CM
Haj-Hassan TA, Mtaweh H, Martinez D, Mema B
ATS Sch. 15 November 2022; Volume 3 (Issue 4); 625-630.; DOI:10.34197/ats-scholar.2022-0071CM
Journal Article > ResearchFull Text
Int J Environ Res Public Health. 1 September 2022; Volume 19 (Issue 17); 10927.; DOI:10.3390/ijerph191710927
Osei MM, Dayie NTKD, Azaglo GSK, Tettey EY, Nartey ET, et al.
Int J Environ Res Public Health. 1 September 2022; Volume 19 (Issue 17); 10927.; DOI:10.3390/ijerph191710927
Nasopharyngeal carriage of aerobic Gram-negative bacilli (GNB) may precede the development of invasive respiratory infections. We assessed the prevalence of nasopharyngeal carriage of aerobic GNB and their antimicrobial resistance patterns among healthy under-five children attending seven selected day-care centres in the Accra metropolis of the Greater Accra region of Ghana from September to December 2016. This cross-sectional study analysed a total of 410 frozen nasopharyngeal samples for GNB and antimicrobial drug resistance. The GNB prevalence was 13.9% (95% CI: 10.8–17.6%). The most common GNB were Escherichia coli (26.3%), Klebsiella pneumoniae (24.6%), and Enterobacter cloacae (17.5%). Resistance was most frequent for cefuroxime (73.7%), ampicillin (64.9%), and amoxicillin/clavulanic acid (59.6%). The organisms were least resistant to gentamicin (7.0%), amikacin (8.8%), and meropenem (8.8%). Multidrug resistance (MDR, being resistant to ≥3 classes of antibiotics) was observed in 66.7% (95% CI: 53.3–77.8%). Extended-spectrum beta-lactamase (ESBL)-producing bacteria constituted 17.5% (95% CI: 9.5–29.9%), AmpC-producing bacteria constituted 42.1% (95% CI: 29.8–55.5%), and carbapenemase-producing bacteria constituted 10.5% (95% CI: 4.7–21.8%) of isolates. The high levels of MDR are of great concern. These findings are useful in informing the choice of antibiotics in empiric treatment of GNB infections and call for improved infection control in day-care centres to prevent further transmission.
Journal Article > ResearchFull Text
Confl Health. 21 November 2019; Volume 13 (Issue 1); DOI:10.1186/s13031-019-0232-y
Robinson E, Crispino V, Ouabo A, Iballa F, Kremer R, et al.
Confl Health. 21 November 2019; Volume 13 (Issue 1); DOI:10.1186/s13031-019-0232-y
BACKGROUND
During humanitarian crises, health information systems are often lacking and surveys are a valuable tool to assess the health needs of affected populations. In 2013, a mortality and health survey undertaken by Médecins Sans Frontières (MSF) in the conflict affected Walikale territory of North Kivu, Democratic Republic of the Congo (DRC), indicated mortality rates exceeding humanitarian crisis thresholds and a high burden of mortality and morbidity due to malaria. In late 2017, after a period of relative stability, MSF reassessed the health status of the population through a second survey to guide ongoing operations.
METHODS
A two-stage cluster survey, selecting villages using probability proportional to size and households using random walk procedures, was conducted. Household members were interviewed on morbidity and mortality, healthcare use, vaccination status, and bednet availability.
RESULTS
The sample included 5711 persons in 794 households. The crude mortality rate (CMR) and under-five mortality rate (U5MR) were 0.98 per 10,000 persons/day (95% confidence interval (CI) 0.78–1.2) and 1.3 per 10,000 persons/day (95% CI): 0.82–2.0), respectively. The most frequently reported causes of death were fever/malaria (31%), diarrhoea (15%) and respiratory infections (8%). In 89% of households at least one person was reported as falling ill in the previous 2 weeks, and 58% sought healthcare. Cost was the main barrier amongst 58% of those who did not seek healthcare. Coverage of measles-containing-vaccine was 62% in under-fives. Sufficient bednet coverage (1 bednet/2 people) was reported from 17% of households.
CONCLUSION
The second survey illustrates that although mortality is now just below crisis thresholds, the area still experiences excess mortality and has substantial health needs. The study results have supported the further expansion of integrated community case management to improve access to care for malaria, diarrhoea and respiratory infections. Such surveys are important to orient operations to the health needs of the population being served and also highlight the ongoing vulnerability of populations after humanitarian crises.
During humanitarian crises, health information systems are often lacking and surveys are a valuable tool to assess the health needs of affected populations. In 2013, a mortality and health survey undertaken by Médecins Sans Frontières (MSF) in the conflict affected Walikale territory of North Kivu, Democratic Republic of the Congo (DRC), indicated mortality rates exceeding humanitarian crisis thresholds and a high burden of mortality and morbidity due to malaria. In late 2017, after a period of relative stability, MSF reassessed the health status of the population through a second survey to guide ongoing operations.
METHODS
A two-stage cluster survey, selecting villages using probability proportional to size and households using random walk procedures, was conducted. Household members were interviewed on morbidity and mortality, healthcare use, vaccination status, and bednet availability.
RESULTS
The sample included 5711 persons in 794 households. The crude mortality rate (CMR) and under-five mortality rate (U5MR) were 0.98 per 10,000 persons/day (95% confidence interval (CI) 0.78–1.2) and 1.3 per 10,000 persons/day (95% CI): 0.82–2.0), respectively. The most frequently reported causes of death were fever/malaria (31%), diarrhoea (15%) and respiratory infections (8%). In 89% of households at least one person was reported as falling ill in the previous 2 weeks, and 58% sought healthcare. Cost was the main barrier amongst 58% of those who did not seek healthcare. Coverage of measles-containing-vaccine was 62% in under-fives. Sufficient bednet coverage (1 bednet/2 people) was reported from 17% of households.
CONCLUSION
The second survey illustrates that although mortality is now just below crisis thresholds, the area still experiences excess mortality and has substantial health needs. The study results have supported the further expansion of integrated community case management to improve access to care for malaria, diarrhoea and respiratory infections. Such surveys are important to orient operations to the health needs of the population being served and also highlight the ongoing vulnerability of populations after humanitarian crises.