Search

Gross inequities in disease burden between developed and developing countries are now the subject of intense global attention. Public and private donors have marshaled resources and created organizational structures to accelerate the development of new health products and to procure and distribute drugs and vaccines for the poor. Despite these encouraging efforts directed primarily from and funded by industrialized countries, sufficiency and sustainability remain enormous challenges because of the sheer magnitude of the problem. Here we highlight a complementary and increasingly important means to improve health equity: the growing ability of some developing countries to undertake health innovation., Improving the health of the poorest people in the developing world depends on the development and deployment of many varieties of health innovations, including new drugs, vaccines, devices, and diagnostics, [...]

Since the discovery of HIV 20 years ago and the demonstration that HIV is the cause of AIDS, the world has awaited the development of an effective preventive vaccine. Recent [...]

The epidemiology of rheumatic fever and rheumatic heart disease in a rural community (total population 114 610) in northern India was studied by setting up a registry based on primary health care centres. Health workers and schoolteachers were trained to identify suspected patients in school and village surveys (121 villages). Medical specialists screened 5-15-year-olds (n = 31 200). The population was followed up for 3 years (from March 1988 to March 1991). All suspected and registered cases were investigated by serial echocardiography and Doppler ultrasonography at a tertiary care centre. A total of 102 cases were confirmed to have rheumatic fever/rheumatic heart disease (prevalence, 0.09%); 66 were aged 5-15 years (prevalence, 0.21%). A total of 48 patients (24 males, 24 females; mean age, 12.11 +/- 3.7 years) were diagnosed to have a possible first attack of rheumatic fever (incidence, 0.54 per 1000 per year). Arthritis was observed in 36 (75%) and carditis in 18 (37.5%) of cases. Prolapse of the anterior mitral leaflet into the left atrium occurred in 5 (22%) cases with carditis. Mitral regurgitation was observed in all 18 cases of carditis; over the period of observation it disappeared in three cases and progressed to mitral stenosis in a further three. A total of 22 patients (11 males, 11 females; mean age, 19.41 +/- 8.1 years) were registered as rheumatic fever recurrences, and 32 patients (1 8 females, 14 males; mean age, 22. 1 +/- 10.1 years) had chronic rheumatic heart disease. Of those with recurrences, 9 (41%) had carditis and 11 (50%) had arthritis. No recurrences were observed among patients who complied with secondary prophylaxis with benzathine penicillin at 4-week intervals. Four patients with chronic rheumatic heart disease required mitral valvotomy and three required valve replacements. Eight patients (5 males, 3 females; mean age, 21.8 +/- 8.8 years) died over the duration of the study period (3 with acute rheumatic fever, 3 from progressive heart failure, 1 from an adverse penicillin reaction, and 1 from a non-cardiac cause)., Introduction In developed countries acute rheumatic fever and rheumatic heart disease were considered to be of decreasing significance until reports of recent outbreaks.[1-8] In developing countries most studies of these [...]

Examines the cellular reaction to group A beta-hemolytic streptococcal membrane antigen to patients with chronic rheumatic heart disease (RHD). Evidences on the relation of RHD with streptococcal infections; Reduction of B-cells; Differences between patients with chronic RHD and those with evidence of acute rheumatic activity.