Medical Care Development International

To evaluate the clinical, functional and prognostic outcomes, including left ventricular (LV) reverse remodeling, of combining percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) in patients with ischemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF). ICM with significantly reduced LVEF remains one of the severe forms of chronic heart failure (CHF), associated with a high risk of adverse outcomes. The choice of the optimal treatment strategy, coronary revascularization in addition to intensive medical therapy, is a subject of active discussion and requires further study, especially regarding its effect on LV reverse remodeling and long-term prognosis. This retrospective cohort study included 561 patients with ICM and LVEF <40%. The follow-up lasted from 2014 through 2024. 74% of the patients were men aged 61.4±8.7 years. Patients were divided into a revascularization group (PCI+OMT, n=281) and an OMT group (n=280). The structural and functional state of the heart was assessed using transthoracic echocardiography (ECHO) with standard protocols. The OMT group had a significantly higher EuroSCORE II surgical risk (4.0±1.9% vs. 3.0±1.5% in the PCI+OMT group; p<0.05), a greater prevalence of stage III or higher chronic kidney disease (35.7% vs. 17.8%; p<0.05), and more severe LV dilatation (LV end-diastolic volume 265±54 ml vs. 245±45 ml; p<0.05). The PCI+OMT group presented with significantly higher anatomical lesion complexity compared to the OMT group (SYNTAX Score 33.5±8.8 vs. 28.9±9.7, p<0.05). At the 24-month follow-up, the PCI+OMT group demonstrated a superior improvement in LVEF (+10.7±6.8% vs. +2.1±4.5%, p<0.001). The proportion of patients with severe mitral regurgitation (III+) was lower in the PCI+OMT group (5.3% vs. 16.1%, p<0.001), and overall mortality was 10.7% vs. 23.2% in the OMT group (p<0.001). The CHF-related hospitalization rate was also significantly lower in the PCI+OMT group than in the OMT group (17.8% vs. 33.9%; p<0.001). The combination of PCI and OMT is associated with a pronounced recovery of myocardial contractility, reverse LV remodeling, and regression of functional mitral regurgitation. The structural changes in the myocardium achieved through the integrative approach translate into a significant reduction in overall mortality and hospitalizations rates due to decompensated CHF during mid-term follow-up.

Pregnant women are particularly vulnerable to many health conditions, including infectious diseases, which place them at elevated risk of severe outcomes. In particular, malaria poses a significant burden during pregnancy, and as such there has long been a strong focus on delivering malaria prevention interventions to pregnant women during antenatal care (ANC), including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp). However, outreach to drive uptake of these interventions presents some distinct challenges. For example, pregnant women may not attend ANC or may not do it in public health facilities, where these interventions are freely available, precluding access. In this study, an implementation of routine annual indoor residual spraying (IRS) on Bioko Island, Equatorial Guinea was leveraged to identify pregnant women and conduct follow-up visits focused on awareness and uptake of LLINs and IPTp. IRS campaign data was used to generate lists of households with pregnant women for follow-up visits, during which communication agents conducted an interview based on relevant sections of a malaria indicator survey to assess knowledge about malaria, LLINs and IPTp, and uptake of these interventions. Uptake was defined on an ordinal, three-category scale, and ordinal regression modeling was performed to assess the relationship between uptake and knowledge indicators. In total, 1,567 households were visited, and 589 pregnant women identified. There was a high awareness about LLINs (76.9% cited LLINs as a malaria prevention method), but low awareness of IPTp (34.5% could cite any benefit and 37.1% were aware of availability in public health facilities). In line with awareness levels, regular use of LLINs (54.8% reported using every night) was higher than IPTp uptake (35.2% on track for three doses). Ordinal regression modelling confirmed that LLIN use on some or all nights was associated with awareness that LLINs prevent malaria, and IPTp uptake was associated with awareness of the number of doses required. This work demonstrated that complementary malaria control interventions can be leveraged to identify pregnant women for further outreach. The information collected provides a baseline to evaluate the impact of future activities on Bioko Island and suggests that increasing awareness of IPTp could improve coverage, while further increasing LLIN use will likely require identifying specific barriers to use.

Background Mass drug administration (MDA) is a WHO-recommended strategy for the elimination of Plasmodium falciparum malaria in low-transmission settings close to elimination. After achieving zero autochthonous cases between 2013 and 2015, Costa Rica experienced a resurgence, primarily of P. falciparum, prompting an MDA intervention in 2023 in the Los Chiles focus. We evaluate its impact on the incidence of autochthonous malaria. Methods An MDA with two cycles of chloroquine (25 mg/kg per cycle, spaced seven weeks apart) was implemented between April—June 2023 in three localities (Medio Queso, Coquital, and San Gerardo) within the Los Chiles focus. We use a cluster-target trial emulation to estimate the overall average treatment effect on the treated (ATT) under an intention-to-treat approach. We use generalized synthetic control methods (GSCM) to construct a counterfactual for the intervened localities, using malaria surveillance data from January 2021 to April 2024. Our primary outcome was the autochthonous malaria case count at 1, 3, 6, and 12 months post-intervention. Results We found that the MDA achieved 93.3% coverage across the two cycles (4,316/4,624 people received at least one dose). The first cycle had 77.3% coverage and the second 51.2%, achieving 68.1% adherence (full treatment in at least one cycle) and 20.4% in both cycles. Following the intervention, autochthonous malaria cases in the treated localities decreased to zero in the first month and remained at zero throughout the 12-month follow-up period. Overall, we estimated that in the absence of MDA, cases would have persisted (approximately 3-4 cases/month). The strategy was associated with a significant reduction in cases, with an overall post-intervention Rate Ratio (RR) of 0.23 (95% CI: 0.13, 0.49) and an average reduction of 3.72 cases per period (95% CI: -7.2, -0.94) compared to the synthetic control. Conclusion We found that the chloroquine-based MDA strategy implemented in the Los Chiles focus was highly effective in interrupting autochthonous malaria transmission in the short and medium term. Our results suggest that MDA, when well-planned and implemented in a low transmission setting with a strengthened health system, can be a powerful tool to accelerate malaria elimination.

The present study was carried out with the aim of comparing antiseptics containing povidone-iodine and hypochlorous acid active substances in preventing central catheter-related bloodstream infection in intensive care units. This study was conducted in the tertiary care intensive care units of Erzurum Regional Training and Research Hospital between October 2022 and January 2023. The study was performed using a randomized controlled experimental research design with a control group. Sixty patients (30 in the intervention group and 30 in the control group) were included in the study. During the catheter dressings, a dressing with an antiseptic containing a hypochlorous acid active substance was applied to the patients in the intervention group. A dressing with an antiseptic containing povidone-iodine active substance, which is routinely used in the clinic, was applied to the patients in the control group. The Descriptive Characteristics Form and the Central Venous Catheter-Related Bloodstream Infection Follow-up Form were used in data collection. Number, percentage, χ2, and Fisher exact probability test, arithmetic mean, SD, and independent-samples t test were used to evaluate the data. No significant difference was found between the groups in terms of descriptive and clinical characteristics (P > .05). It was determined that the percentage of patients in the intervention group who were diagnosed with central venous catheter-related bloodstream infection was lower than the control group, and the difference was statistically significant (P < .05). The infection signs at the catheter exit site of the patients in the intervention group were found to be significantly lower than those of the patients in the control group (P < .05). In the study findings, central venous catheter-related bloodstream infection was observed to be less in catheter dressings applied with an antiseptic containing hypochlorous acid active substance than in catheter dressings applied with povidone-iodine. Hence, it is recommended to expand the use of an antiseptic containing hypochlorous acid active substance in catheter dressings.

BackgroundEffective malaria control requires accurate identification of Plasmodium infections to tailor interventions appropriately. Rapid diagnostic tests (RDTs) are crucial tools for this purpose due to their small size and ease-of-use functionality. These tests typically target the Plasmodium falciparum histidine-rich protein 2 (HRP2) antigen. However, some strains of P. falciparum have deletions in the hrp2 and hrp3 genes, which may result in a false negative diagnosis using HRP2-based RDTs. Additionally, RDTs have a detection limit of 100 parasites per microlitre, insufficient for identifying low-density infections that sustain malaria transmission. This study explores integrating molecular monitoring using a novel cartridge-based PCR test, PlasmoPod, using samples from a malaria indicator survey (MIS) on Bioko Island, Equatorial Guinea to enhance detection of low-density infections and inform targeted malaria control strategies.MethodsThe study utilized a combination of RDTs and the DiaxxoPCR device for molecular monitoring. The device DiaxxoPCR uses a prefilled cartridge system, termed PlasmoPod for a malaria-based assay that employs a qPCR assay targeting 18S rDNA/rRNA. Samples from the 2023 MIS were extracted from dried blood spots (DBS), qPCR run in duplicate on the PlasmoPod. Epidemiological data from the MIS were merged with molecular data and the association between MIS variables to malaria infection by qPCR, and low-density infections were measured.ResultsThe integration of molecular monitoring revealed a proportion of low-density infections that circumvented RDTs diagnosis. Notably, individuals in urban communities and those reporting recent fever were more likely to harbour low-density, asymptomatic malaria infections. Findings suggest that urban residents, although less associated to malaria infection than rural residents by both RDT and qPCR, may be serving as a transmission reservoir. The relationship between low-density infections and individuals who recently reported fever may reflect recent anti-malarial treatment or natural clearance, and thus have lingering parasites in their blood.ConclusionThe study highlights the limitations of HRP2-based RDTs in detecting low density infections and underscores the potential of molecular tools like PlasmoPod in malaria surveillance. By identifying elusive transmission reservoirs and tracking parasite importation, molecular monitoring can play a crucial role in achieving malaria elimination. The findings advocate for the broader implementation of molecular diagnostics in malaria programs, especially in areas with low transmission, to enhance the detection and targeting of hidden reservoirs of infection.

ABSTRACT.A malaria control program established in 2004 on Bioko Island, Equatorial Guinea, achieved significant reductions in malaria prevalence; however, progress subsequently stalled, leading to a proposal to develop and implement a highly effective malaria vaccine to increase impact. After conducting clinical trials of Sanaria® (Rockville, MD) Plasmodium falciparum (P. falciparum) sporozite vaccines against P. falciparum malaria, which demonstrated safety and efficacy, a larger phase 3 trial was planned to support vaccine licensure for specific target populations and eventual island-wide malaria elimination. The Equatorial Guinea Pilot Study for Recruitment, Screening and Participant Registry (EGRESPAR) assessed the health status of the target population and generated a registry of eligible children and adults. Households in areas with malaria prevalence ≥15% were randomly selected, aiming to register 2,100 healthy Equatoguineans divided equally into age groups of 1.5–9, 10–17, and 18–50 years. A total of 6,493 individuals from 1,807 households, who considered themselves or their children to be healthy, completed questionnaires; 2,021 were screened using phase 3 enrollment criteria, 643 were excluded, and 1,378 were entered into the registry. Among those screened, 13.6% had Plasmodium, 1.8% had Loa loa, 4.8% had hepatitis B, 0.5% had hepatitis C, and 2.1% had HIV. Adults were twice as likely to have clinically relevant medical conditions, such as obesity, hypertension, or diabetes, meeting exclusion criteria compared to children. In conclusion, there was a significant prevalence of infections and chronic medical conditions among Bioko Island residents who considered themselves or their children to be healthy and interested in clinical research participation, particularly in adults. The EGRESPAR successfully generated a registry to support the initiation of a large-scale phase 3 vaccine trial.

Имон ва унга тегишли масалалар Қуръон ва ҳадисда содда, тушунарли тарзда баён қилиб берилган бўлиб, саҳобалар даврида у мураккаб хусусиятга эга бўлмаган. Бироқ кейинги даврларда турли оқимларнинг пайдо бўлиши, турли дин вакилларининг исломга кириши, юнон фалсафаси тарқалган ҳудудларда ислом динининг тарқалиши натижасида “имон” сўзининг истилоҳий таърифидан тортиб, унга тегишли барча масалалар мураккаблаштирилиб таҳлил қилинган. Бу, ўз навбатида, “такфир” масаласининг ўртага чиқишига замин яратган.Мақолада аҳли сунна валжамоа уламоларининг имонга берган таърифи, хорижийлик ва муътазилийлик вакилларининг талқини, аҳли ҳадислар, шофеийлар томонидан имонга берилган таърифнинг ўзига хос хусусиятлари таҳлилий тадқиқ қилинган. Шунингдек, мақолада мотуридийлик таълимот вакиллари ҳамда муржиийлар томонидан имонга берилган таърифнинг ўхшаш ва фарқли жиҳатлари ўрганилган. Аҳли ҳадисларнинг имонга берган таърифи билан шофеийлар томонидан берилган таърифидаги ўхшашлик ва фарқли ўринлари таҳлил қилинган. “Имоннинг зиёда бўлиши”, “амал имоннинг таркибий қисми ёки эмаслиги” каби масалалар мотуридийлик ва ашъарийлик таълимотлари орасида ўзаро қиёслаб ўрганилган ҳамда мазкур масалаларнинг тарихий жиҳатлари ёритилган. Умуман олиб қараганда, мақолада бугунги кунда пайдо бўлган турли оқимларнинг имон борасидаги қарашлари тарихий илдизлари билан асосли равишда очиб берилган. Шунингдек, унда мотуридийлик манбаларининг ақида мавзуларини ёритишдаги услубияти, ривожланиш босқичлари таҳлил қилинган.

Ушбу мақола XI-XII асрлардаги Мовароуннаҳрдаги ижтимоий-сиёсий муҳит ва унинг исломий илмларнинг, айниқса, Қуръон тафсири илмининг ривожига қандай таъсир кўрсатганини чуқур ўрганишга бағишланган. Мақоланинг асосий мақсади Алоуддин Самарқандий каби улуғ олимлар ва у билан бир даврда яшаб ижод этган муфассирларнинг Қуръон тафсири ва бошқа исломий илмлардаги ҳиссаларини очиб беришдир. Қорахонийлар ва Салжуқийлар даврида исломий таълимотлар, айниқса, Қуръон илмлари ва тафсир илмлари ўзининг илмий етуклигига эришган. Бу жараёнда Алоуддин Самарқандий каби муфассирлар ва олимларнинг илмий мерослари муҳим ўрин тутади. Уларнинг фиқҳ, калом, тасаввуф ва тафсир соҳаларидаги асарлари исломий фикрнинг шаклланишига катта таъсир кўрсатган.Тадқиқотда Алоуддин Самарқандийнинг асарлари чуқур таҳлил қилинган бўлиб, унинг услуби, ўзига хослиги, шарҳларининг илмий қиймати ва бу борадаги янги илмий ютуқлари ёритилган. Самарқандийнинг асарлари тафсир ва шариат илмининг ўзаро таъсирини кўрсатиб, унинг ижодий фаолияти нафақат Мовароуннаҳрда, балки бутун ислом оламида муҳим аҳамиятга эга экани кўрсатилган.Мақола муаллифининг мақсади Қуръон илмларининг Мовароуннаҳрдаги ўзига хос ривожланишини кўрсатиб бериш ҳамда Алоуддин Самарқандийнинг илмий мероси орқали мазкур давр исломий фикрининг етуклик даражасига эришганини очиб беришдан иборатдир.Калит сўзлар: Алоуддин Самарқандий, қорахонийлар даври, Мовароуннаҳр тарихи, тафсир илми, Мотуридий таълимоти, XI-XII аср фиқҳи, тасаввуф тарихидаги пирлар, Абул Муин Насафий, Абу Ҳафс Умар Насафий, Замахшарийнинг тафсири.

This final chapter summarizes key insights, offers policy and research recommendations, and reflects on immigration and geopolitical trends. It also suggests directions for future research into Nikkei and transnational entrepreneurship in Japan and Latin America.