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  • 1
    Language: English
    In: Environmental health perspectives, October 2010, Vol.118(10), pp.A424; author reply A424-5
    Description: We appreciate the comments by Rylance et al. stimulated by our analysis of the global burden of disease due to outdoor air pollution (Anenberg et al. 2010). We acknowledge that indoor air pollution is—and has long been recognized as—a significant burden on public health, particularly in developing countries where solid fuels are used extensively for cooking and heating (e.g., Smith 1987; Smith et al. 2004), but these comments on indoor air pollution do not affect our conclusions about the impacts of outdoor air pollution on global mortality.
    Keywords: Air Pollution ; Air Pollution, Indoor ; Biomass ; Environmental Exposure ; Mortality
    ISSN: 00916765
    E-ISSN: 1552-9924
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  • 2
    Language: English
    In: JAMA, 20 November 2018, Vol.320(19), pp.2038-2039
    Keywords: Hospital Mortality ; Organ Dysfunction Scores
    ISSN: 00987484
    E-ISSN: 1538-3598
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  • 3
    In: Clinical Infectious Diseases, 2018, Vol. 66(2), pp.274-281
    Description: There is a substantial burden of chronic lung disease among treated children with human immunodeficiency virus infection in this study from Zimbabwe. The radiological findings, coupled with functional test results, indicate that the key pathological lesion is constrictive obliterative bronchiolitis.
    Keywords: Sub - Saharan Africa ; Hiv ; Chronic Lung Disease ; Hrct ; Chest X - Ray
    ISSN: 1058-4838
    E-ISSN: 1537-6591
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  • 4
    In: PLoS ONE, 2013, Vol.8(3)
    Description: Aim Early warning scores (EWS) are widely used in well-resourced healthcare settings to identify patients at risk of mortality. The Modified Early Warning Score (MEWS) is a well-known EWS used comprehensively in the United Kingdom. The HOTEL score (Hypotension, Oxygen saturation, Temperature, ECG abnormality, Loss of independence) was developed and tested in a European cohort; however, its validity is unknown in resource limited settings. This study compared the performance of both scores and suggested modifications to enhance accuracy. Methods A prospective cohort study of adults (≥18 yrs) admitted to medical wards at a Malawian hospital. Primary outcome was mortality within three days. Performance of MEWS and HOTEL were assessed using ROC analysis. Logistic regression analysis identified important predictors of mortality and from this a new score was defined. Results Three-hundred-and-two patients were included. Fifty-one (16.9%) died within three days of admission. With a cut-point ≥2, the HOTEL score had sensitivity 70.6% (95% CI: 56.2 to 82.5) and specificity 59.4% (95% CI: 53.0 to 65.5), and was superior to MEWS (cut-point ≥5); sensitivity: 58.8% (95% CI: 44.2 to 72.4), specificity: 56.2% (95% CI: 49.8 to 62.4). The new score, dubbed TOTAL (Tachypnoea, Oxygen saturation, Temperature, Alert, Loss of independence), showed slight improvement with a cut-point ≥2; sensitivity 76.5% (95% CI: 62.5 to 87.2) and specificity 67.3% (95% CI: 61.1 to 73.1). Conclusion Using an EWS generated in developed healthcare systems in resource limited settings results in loss of sensitivity and specificity. A score based on predictors of mortality specific to the Malawian population showed enhanced accuracy but not enough to warrant clinical use. Despite an assumption of common physiological responses, disease and population differences seem to strongly determine the performance of EWS. Local validation and impact assessment of these scores should precede their adoption in resource limited settings.
    Keywords: Research Article ; Biology ; Medicine
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: The Lancet Infectious Diseases, December 2010, Vol.10(12), pp.886-892
    Description: Reliable and relevant research can help to improve tuberculosis control worldwide. In recent years, various organisations have assessed research needs and proposed priorities for tuberculosis. We summarise existing priority statements and assess the rigour of the methods used to generate them. We found 33 documents that specifically outline priorities in tuberculosis research. The top priority areas were drug development (28 articles), diagnosis and diagnostic tests (27), epidemiology (20), health services research (16), basic research (13), and vaccine development and use (13). The most focused questions were on the treatment and prevention of multidrug-resistant tuberculosis in people co-infected with HIV. Methods used to identify these priorities were varied. Improvements can be made to ensure the process is more rigorous and transparent, and to use existing research or systematic reviews more often. WHO, Stop TB Partnership, and other organisations could adopt an incremental process of priority development, building on the existing knowledge base.
    Keywords: Medicine ; Public Health
    ISSN: 1473-3099
    E-ISSN: 1474-4457
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  • 6
    Language: English
    In: Seminars in Respiratory and Critical Care Medicine, 2016, Vol.37(06), pp.855-867
    Description: Community-acquired pneumonia (CAP) in sub-Saharan Africa is a common cause of adult hospitalization and is associated with significant mortality. Human immunodeficiency virus (HIV) prevalence in the region leads to differences in CAP epidemiology compared with most high-income settings: patients are younger, and coinfection with tuberculosis and opportunistic infections is common and difficult to diagnose. Resource limitations affect the availability of medical expertise as well as radiological and laboratory diagnostic services. These factors impact on key aspects of health care, including pathways of investigation, severity assessment, and the selection of empirical antimicrobial therapy. This review summarizes recent data from sub-Saharan Africa describing the burden, etiology, risk factors, and outcome of CAP. We describe the rational and context-appropriate approach to CAP diagnosis and management, including supportive therapy. Priorities for future research to inform strategies for CAP prevention and initial management are suggested.
    Keywords: Community-acquired pneumonia ; Sub-saharan africa ; Tuberculosis ; Hiv
    ISSN: 1069-3424
    E-ISSN: 1098-9048
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  • 7
    In: Pneumonia, 2014, Vol.5(Suppl 1), p.30-37
    Description: Clinical prognostc scores are increasingly used to streamline care in well-resourced setngs. The potental benefts of identfying patents at risk of clinical deterioraton and poor outcome, delivering appropriate higher level clinical care, and increasing efciency are clear. In this focused review, we...
    Keywords: Review ; Pneumonia ; Severity Of Illness Index ; Developing Countries ; Health Resources ; Operatons Research
    E-ISSN: 2200-6133
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  • 8
    Language: English
    In: Malawi medical journal : the journal of Medical Association of Malawi, June 2011, Vol.23(2), pp.58-9
    Description: A 29 years old male presented to our hospital with a three week history of left foot and left knee swelling. This was followed a week later by lower back, hip and bilateral lower chest pains. In the third week of illness, his walking became impaired due to his limb pain, and due to increasing difficulty in fully extending his neck. These symptoms were worse in the early morning, and initially eased over a few hours. This deteriorated, and by the time he presented to hospital he was confined to bed for most of the day. There was no preceding history of rash, dyspnoea, cough or gastrointestinal disturbance. Vision was subjectively normal, and he reported no ocular problems. Constitutionally, he was well with no weight loss or night sweats.
    Keywords: Back Pain -- Etiology ; Pain -- Etiology ; Spondylitis, Ankylosing -- Complications
    ISSN: 1995-7262
    E-ISSN: 19957270
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  • 9
    In: AIDS, 2016, Vol.30(18), pp.2795-2803
    Description: OBJECTIVE:: Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function and exercise capacity among older children established on ART and an age-matched HIV-uninfected group. DESIGN:: A cross-sectional study in Zimbabwe of HIV-infected children aged 6–16 years receiving ART for over 6 months and HIV-uninfected children attending primary health clinics from the same area. METHODS:: Standardized questionnaire, spirometry, incremental shuttle walk testing, CD4 cell count, HIV viral load and sputum culture for tuberculosis were performed. RESULTS:: A total of 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (interquartile range 2.8–7.5) and 6.1 (interquartile range 3.6–8.4) years, respectively. Median CD4 cell count was 726 cells/μl, and 79% had HIV viral load less than 400 copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children [n = 1 (0.7%)], but common in HIV-infected participants [51 (25%)], especially cough [30 (15%)] and dyspnoea [30 (15%)]. HIV-infected participants were more commonly previously treated for tuberculosis [76 (38%) vs 1 (0.7%), P 〈 0.001], had lower exercise capacity (mean incremental shuttle walk testing distance 771 vs 889 m, respectively, P 〈 0.001) and more frequently abnormal spirometry [43 (24.3%) vs 15 (11.5%), P = 0.003] compared with HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (P = 0.025). No participant tested positive for Mycobacterium tuberculosis. CONCLUSION:: In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required.
    ISSN: 0269-9370
    Source: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.〈img src=http://exlibris-pub.s3.amazonaws.com/LWW%20logo.png style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(9), p.e0138762
    Description: BACKGROUND:Household air pollution in low income countries is an important cause of mortality from respiratory infection. We hypothesised that chronic smoke exposure is detrimental to alveolar macrophage function, causing failure of innate immunity. We report the relationship between macrophage...
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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