Case histories of infectious disease management in developing countries: Phnom Penh and Kabul

Abstract

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections). Key-words:Developing countries. Infectious diseases. Collaboration. Cambodia. Afghanistan. RESUMOA assistência à saúde em países em desenvolvimento é afetada pela pobreza extrema, instabilidade política e doenças que podem ter menor importância em países industrializados. O objetivo deste trabalho foi apresentar dois casos e histórias de médicos que trabalham em hospitais de países em desenvolvimento e discutir as oportunidades de investigação clínica e cooperação. São discutidos casos de pacientes em Phnom Penh, no Camboja, com histoplasmose, meningite criptocócica, sarna, lesões cerebrais e vírus da imunodeficiência humana, e de pacientes em Kabul, no Afeganistão, com cirrose hepática, síndrome nefrótica e úlcera facial. Maior apoio ao desenvolvimento por parte dos países desenvolvidos é essencial, e uma cooperação mutuamente benéfica é possível, visto que problemas clínicos similares existem em ambos os lados (p. ex. infecções cardiovasculares oportunistas). Exemplos para possível apoio à medicina hospitalar incluem intercâmbio de médicos para visitas com objetivos definidos (p. ex. controle de infecção ou treinamento em ecocardiografia) e colaboração com investigações clínicas e projetos desenvolvidos localmente (p. ex. epidemiologia de doenças cardiovasculares ou infecções hospitalares causadas por via sanguínea). Palavras-chaves:Países em desenvolvimento. Doenças infecciosas. Colaboração. Camboja. Afeganistão.

Frequency of Vitamin a Deficiency in Children Hospitalized for Pneumonia: An Integrative Review

“…The age group of evaluation of the studies presented differed, ranging from 2 months to 18 years, indicating a great heterogeneity of the population evaluated; however, this fact did not prejudice the evaluation data, since the classification values of serum retinol levels is equal for the various age groups. In relation to the place of study, all were carried out in developing countries that historically present higher prevalence of deficiency and infectious diseases corroborating with data presented by organs as WHO [ 40 ] and Ministry of Health of Brazil [ 41 ], in addition to others [ 42 , 43 ].…”

“…Vitamin A deficiency is a deficit disease that occurs mainly between the low socioeconomic groups that feed poorly and live in unsatisfactory health conditions [38]. The VAD is disseminated in Southeast Asia, in the Middle East, Africa and Central and South America, especially in children, and is associated with general malnutrition, although there is a trend of decline in the World Prevalence of VAD, significant reductions in 1991-2013 in East and Southeast Oceania, from 42% to 6%, and in Latin America and Caribbean of 21%-11% [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. The highest rates of vitamin A deficiency are in sub-Saharan Africa and South Asia, at 48% and 44%, respectively [53].…”

Malaria, a difficult diagnosis in a febrile patient with sub-microscopic parasitaemia and polyclonal lymphocyte activation outside the endemic region, in Brazil

“…Autochthonous malaria in the Atlantic Forest (1,300,000 km 2 distributed over 17 states) are reported mainly in the states of São Paulo [ 7 - 10 ] and Espírito Santo [ 11 ], in the Ribeira Valley and Atlantic Coast, and are most often due to Plasmodium vivax [ 7 - 11 ]. In the state of Rio de Janeiro, the rare cases of malaria transmission was restricted, until 2010, to a localized area, named Lumiar [ 3 , 12 , 13 ], a district of Nova Friburgo [ 14 ] and a mountainous tourist region, of 700 metres altitude with temperatures between 18°C and 24°C, and 170 km far from Rio de Janeiro [ 13 ]. While the state of Sao Paulo registered 229 autochthonous malaria cases in the period of 2003 to 2010 [ 15 ], the state of Rio de Janeiro reported 29 cases, most of them from Lumiar [ 14 , 16 ].…”