Objective:To evaluate the clinical efficacy of albendazole in pediatric toxocariasis.Methods:This interventional study was conducted over a 6-month period,enrolling 117 children aged 3-15 years between 2023 and 2024 i...Objective:To evaluate the clinical efficacy of albendazole in pediatric toxocariasis.Methods:This interventional study was conducted over a 6-month period,enrolling 117 children aged 3-15 years between 2023 and 2024 in Ho Chi Minh City,Vietnam.All patients received oral albendazole at a dosage of 15 mg/kg/day,divided into two daily doses,for five consecutive days.Treatment efficacy was assessed at 6 months based on the following criteria:(1)resolution or marked improvement of clinical symptoms;(2)negative ELISA serology;(3)normalization or significant reduction of eosinophil(EOS)counts to within the normal range;and(4)normalization or significant reduction of total IgE levels.Results:After six months,significant reductions were observed in white blood cell(WBC)count,neutrophil(NEU)count,mean corpuscular hemoglobin(MCH),mean corpuscular volume(MCV),mean corpuscular hemoglobin concentration(MCHC),platelet(PLT)count,EOS count,ELISA optical density(OD),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and creatinine levels(all P<0.05).Age-stratified analysis revealed that children aged 3-11 years showed statistically significant improvements in OD levels and EOS counts compared to baseline(P<0.05).The overall treatment recovery rate was 28%.Conclusions:The cure rate for pediatric toxocariasis following a five-day albendazole regimen remains modest.Further research is required to optimize treatment durations and regimens to improve clinical outcomes in children.展开更多
Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of vi...Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of visceral leishmaniasis in children.Methods:The efficacy and safety of visceral leishmaniasis treatments in children were systematically reviewed using literature from PubMed,Cochrane,clinicaltrials.gov,and Google Scholar,focusing on randomised trials with separate pediatric data(published from 2000-2024).The risk of bias of selected trials was assessed using the revised Cochrane risk-of-bias tool for randomised trials(RoB 2).Reporting was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.Results:Of 1186 records,only 7 were eligible for qualitative synthesis.Three trials exclusively included children.The treatment regimens studied showed high heterogeneity and lacked sufficient data for a meta-analysis.Most trial arms reported efficacies over 94%for children across different regimens.Miltefosine monotherapy showed the highest rate of late treatment failures,highlighting that allometric dosing is crucial to ensure proper drug exposure in children.Safety data for children were available in only three studies with varied reporting systems of adverse events.Although regimens in this review were generally considered to be safe in children,antimonial-related cardiac toxicity remains a threat.Conclusions:This review highlights the need for pediatric-specific trials,clear presentation of pediatric data,and systematic documentation of adverse events to enhance evidence for policy-making and pediatric guideline development.展开更多
Background Access to primary healthcare remains a major challenge in sub-Saharan Africa.In 2016,Burkina Faso introduced the free healthcare policy,eliminating financial barriers by offering free healthcare services fo...Background Access to primary healthcare remains a major challenge in sub-Saharan Africa.In 2016,Burkina Faso introduced the free healthcare policy,eliminating financial barriers by offering free healthcare services for children under five and pregnant women.While previous studies have reported increased healthcare utilization under the policy,its effects on health outcomes remains unassessed.Here,we evaluate the free healthcare policy's effects on three key indicators:frequency of clinical visits,malaria prevalence,and severe malaria.Methods Routine health and demographic data for children under five were collected from health facilities using the government's Electronic Medical Record(EMR)platform.Generalized Linear Mixed Effects Models(GLMM)with a Differences-in-Differences design assessed changes in the three indicators between baseline(2015)and 2018 while Bayesian hierarchical models were used to forecast trends through 2020.Results Analysis of 344,935 clinical visits from 199,664 children across 192 villages showed an increase in healthcare utilization,with clinical visits rising from 1.1 to 2 per child between 2015 and 2018(p<0.001)resulting in a percentage increase of 82%.However,disparities persisted,as children living within 5 km of a health facility accessed more care than those in remote areas(2.2 vs.1.7 visits,p<0.001).Malaria prevalence decreased from 98 to 80%(p<0.001),and severe malaria declined from 6%to 2.2%(p<0.001)during the same period.Bayesian forecasts indicated continued increases in clinical visits(from 2.36 in 2019 to 2.75 in 2020)and further declines in malaria prevalence(to 64%)and severe malaria(to 1.02%)by 2020.Conclusions Our study highlights the transformative effects of the free healthcare policy in improving healthcare access and outcomes for children under five in Burkina Faso.However,inequities in access remain a challenge.Strengthening community health worker programs and expanding community health activities are critical to addressing these gaps.The findings offer valuable insights for policymakers in Burkina Faso and contribute to global efforts to leverage health reforms to improve malaria control and progress toward universal health coverage.展开更多
A substantial proportion of those affected by visceral leishmaniasis(VL)in endemic regions are children-a vulnerable group at higher risk of severe outcomes,morbidity,and mortality.It is estimated that children accoun...A substantial proportion of those affected by visceral leishmaniasis(VL)in endemic regions are children-a vulnerable group at higher risk of severe outcomes,morbidity,and mortality.It is estimated that children account for around 50%of all VL cases[1],with a similar proportion seen in high-burden areas like Eastern Africa,where half of the cases occur in those under 15 years[2],highlighting the disproportionate impact on children and economically disadvantaged populations.Afflicted children are vulnerable to malnutrition,stunting,impaired cognitive development,school absenteeism and premature death.展开更多
Rationale:Myiasis is more commonly found in ulcerated tissues and tropical climates,although it can also occur in non-tropical climates and in healthy individuals.Patient concerns:The patient was a 4-year-old girl who...Rationale:Myiasis is more commonly found in ulcerated tissues and tropical climates,although it can also occur in non-tropical climates and in healthy individuals.Patient concerns:The patient was a 4-year-old girl who presented to the emergency department with three nodular lesions on the skull,associated with edema,tenderness,pain,and purulent drainage.Diagnosis:Furuncular myiasis caused by Wohlfahrtia magnifica.Interventions:Antibiotic therapy was initiated,and the patient was taken to the operating room for larval removal.Mupirocin ointment and petroleum jelly were applied daily.Three days later,a second operation was performed to remove the remaining live larvae from the tissue.Outcomes:After 14 days of treatment,the patient was cured and discharged.Lessons:Although furuncular myiasis is more commonly observed in ulcerated and necrotic tissues,it can also occur in healthy individuals,particularly in the absence of proper hygiene,even in non-tropical regions.展开更多
摘要Objective:To evaluate the clinical efficacy of albendazole in pediatric toxocariasis.Methods:This interventional study was conducted over a 6-month period,enrolling 117 children aged 3-15 years between 2023 and 2024 in Ho Chi Minh City,Vietnam.All patients received oral albendazole at a dosage of 15 mg/kg/day,divided into two daily doses,for five consecutive days.Treatment efficacy was assessed at 6 months based on the following criteria:(1)resolution or marked improvement of clinical symptoms;(2)negative ELISA serology;(3)normalization or significant reduction of eosinophil(EOS)counts to within the normal range;and(4)normalization or significant reduction of total IgE levels.Results:After six months,significant reductions were observed in white blood cell(WBC)count,neutrophil(NEU)count,mean corpuscular hemoglobin(MCH),mean corpuscular volume(MCV),mean corpuscular hemoglobin concentration(MCHC),platelet(PLT)count,EOS count,ELISA optical density(OD),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and creatinine levels(all P<0.05).Age-stratified analysis revealed that children aged 3-11 years showed statistically significant improvements in OD levels and EOS counts compared to baseline(P<0.05).The overall treatment recovery rate was 28%.Conclusions:The cure rate for pediatric toxocariasis following a five-day albendazole regimen remains modest.Further research is required to optimize treatment durations and regimens to improve clinical outcomes in children.
摘要Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of visceral leishmaniasis in children.Methods:The efficacy and safety of visceral leishmaniasis treatments in children were systematically reviewed using literature from PubMed,Cochrane,clinicaltrials.gov,and Google Scholar,focusing on randomised trials with separate pediatric data(published from 2000-2024).The risk of bias of selected trials was assessed using the revised Cochrane risk-of-bias tool for randomised trials(RoB 2).Reporting was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.Results:Of 1186 records,only 7 were eligible for qualitative synthesis.Three trials exclusively included children.The treatment regimens studied showed high heterogeneity and lacked sufficient data for a meta-analysis.Most trial arms reported efficacies over 94%for children across different regimens.Miltefosine monotherapy showed the highest rate of late treatment failures,highlighting that allometric dosing is crucial to ensure proper drug exposure in children.Safety data for children were available in only three studies with varied reporting systems of adverse events.Although regimens in this review were generally considered to be safe in children,antimonial-related cardiac toxicity remains a threat.Conclusions:This review highlights the need for pediatric-specific trials,clear presentation of pediatric data,and systematic documentation of adverse events to enhance evidence for policy-making and pediatric guideline development.
基金based on programs funded by the Government of Burkina Fasosupported by the Bill&Melinda Gates Foundation through Thinkwell.
摘要Background Access to primary healthcare remains a major challenge in sub-Saharan Africa.In 2016,Burkina Faso introduced the free healthcare policy,eliminating financial barriers by offering free healthcare services for children under five and pregnant women.While previous studies have reported increased healthcare utilization under the policy,its effects on health outcomes remains unassessed.Here,we evaluate the free healthcare policy's effects on three key indicators:frequency of clinical visits,malaria prevalence,and severe malaria.Methods Routine health and demographic data for children under five were collected from health facilities using the government's Electronic Medical Record(EMR)platform.Generalized Linear Mixed Effects Models(GLMM)with a Differences-in-Differences design assessed changes in the three indicators between baseline(2015)and 2018 while Bayesian hierarchical models were used to forecast trends through 2020.Results Analysis of 344,935 clinical visits from 199,664 children across 192 villages showed an increase in healthcare utilization,with clinical visits rising from 1.1 to 2 per child between 2015 and 2018(p<0.001)resulting in a percentage increase of 82%.However,disparities persisted,as children living within 5 km of a health facility accessed more care than those in remote areas(2.2 vs.1.7 visits,p<0.001).Malaria prevalence decreased from 98 to 80%(p<0.001),and severe malaria declined from 6%to 2.2%(p<0.001)during the same period.Bayesian forecasts indicated continued increases in clinical visits(from 2.36 in 2019 to 2.75 in 2020)and further declines in malaria prevalence(to 64%)and severe malaria(to 1.02%)by 2020.Conclusions Our study highlights the transformative effects of the free healthcare policy in improving healthcare access and outcomes for children under five in Burkina Faso.However,inequities in access remain a challenge.Strengthening community health worker programs and expanding community health activities are critical to addressing these gaps.The findings offer valuable insights for policymakers in Burkina Faso and contribute to global efforts to leverage health reforms to improve malaria control and progress toward universal health coverage.
摘要A substantial proportion of those affected by visceral leishmaniasis(VL)in endemic regions are children-a vulnerable group at higher risk of severe outcomes,morbidity,and mortality.It is estimated that children account for around 50%of all VL cases[1],with a similar proportion seen in high-burden areas like Eastern Africa,where half of the cases occur in those under 15 years[2],highlighting the disproportionate impact on children and economically disadvantaged populations.Afflicted children are vulnerable to malnutrition,stunting,impaired cognitive development,school absenteeism and premature death.
摘要Rationale:Myiasis is more commonly found in ulcerated tissues and tropical climates,although it can also occur in non-tropical climates and in healthy individuals.Patient concerns:The patient was a 4-year-old girl who presented to the emergency department with three nodular lesions on the skull,associated with edema,tenderness,pain,and purulent drainage.Diagnosis:Furuncular myiasis caused by Wohlfahrtia magnifica.Interventions:Antibiotic therapy was initiated,and the patient was taken to the operating room for larval removal.Mupirocin ointment and petroleum jelly were applied daily.Three days later,a second operation was performed to remove the remaining live larvae from the tissue.Outcomes:After 14 days of treatment,the patient was cured and discharged.Lessons:Although furuncular myiasis is more commonly observed in ulcerated and necrotic tissues,it can also occur in healthy individuals,particularly in the absence of proper hygiene,even in non-tropical regions.