New initiative to tackle leading killer
that hadn’t changed vastly since Louis Pasteur’s time. By
applying modern tools with standardised methods, we will be able to provide new, precise information to guide
The Johns Hopkins Bloomberg School of Public Health the development of new vaccines and treatments.’
has received three grants from the Bill & Melinda Gates
Two additional Johns Hopkins studies will strengthen
Foundation totalling more than US$43 million to be used the initiative’s ﬁght against pneumonia and related
to help understand the causes of pneumonia, which go diseases. Dr Hope Johnson will project the burden
unidentiﬁed in up to one-third of patients. Pneumonia of disease in adolescents and adults attributable to
kills more children than any other illness. Scaling up two dangerous bacteria – the pneumococcus and the
proven and available interventions, like pneumococcal meningococcus – that together cause many cases of
vaccines and antibiotic treatments, could prevent many pneumonia and other life-threatening illnesses such as
pneumonia deaths and research to fully understand the meningitis. Dr Jennifer Moïsi will undertake an evalua-causes of pneumonia in the remaining cases could help tion of diagnostic methods for pneumococcal disease, a develop the tools to prevent even more.
major cause of childhood pneumonia, particularly in the
The core initiative at Johns Hopkins, called PERCH developing world. Together these projects will inﬂuence
(Pneumonia Etiology Research for Child Health), aims the development and deployment of life-saving vaccines to build a new, rigorous evidence base by studying the throughout the world.
causes of paediatric pneumonia in ﬁve to ten countries
The pneumonia initiative, based at Johns Hopkins’
across the developing world using state-of-the-art Department of International Health, follows on the heels diagnostics.
of the successful PneumoADIP project at JHSPH, which
‘Our current information on pneumonia etiology is accelerated access to childhood pneumococcal vaccines
about to become obsolete,’ said Dr Orin Levine, principal for the developing world by nearly 10 years. Through the investigator of the project. ‘Most existing information was new initiative, the JHSPH group continues to advance generated 10 to 20 years ago with laboratory techniques protection for all children against pneumonia.
High-dose inhaled ﬂuticasone for virus-
and meta-analyses have given inconclusive results. Now
induced wheezing in young children
a new meta-analysis has provided evidence in favour of
A study at ﬁve centres in Quebec, Canada has led to the prophylactic steroid.
conclusion that high-dose inhaled ﬂuticasone should not
The analysis included six trials (1923 patients). Com-
be used for the treatment of young children with virus- pared with placebo, steroids given before extubation induced wheezing.
reduced the risk of laryngeal oedema signiﬁcantly by
A total of 129 children aged 1–6 years with virus in-
62% and of reintubation by 71%. A multidose steroid
duced wheezing were randomised to inhaled ﬂuticasone regimen reduced the risk of laryngeal oedema by 86% propionate 750 µg or placebo twice daily for a maximum and of reintubation by 81%. A single dose of steroid did of 10 days, at the onset of an upper respiratory infection not have a signiﬁcant effect. The number-needed-to-treat over a period of 12 months. Treatment was started by was 10 for the prevention of a case of laryngeal oedema the parents using an age-appropriate spacer with a mask and 50 to prevent one reintubation. Steroid administra-or mouthpiece. Over an average of 40 weeks rescue tion was safe.
systemic steroid treatment was given for 8% of URTIs
Scientists concluded that steroids in multiple doses are
in the ﬂuticasone group and 18% in the placebo group, safe and effective in reducing postextubation laryngeal oe-a signiﬁcant 51% reduction. Children in the ﬂuticasone dema and reintubation rates. BMJ e
ditorialists advise using group gained signiﬁcantly less height and weight. There steroids only for patients at high risk of reintubation.
were no differences between the group in basal cortisol level, bone mineral density, or adverse events.
Tissue engineered tracheo-bronchus
Prophylactive treatment with high-dose ﬂuticasone re-
Surgeons in Spain have used tissue bioengineering to
duced the need for rescue oral steroid but also interfered replace the distal trachea and left main bronchus of a
with growth. The researchers publishing in the New Eng-
30-year-old woman with severe post-tuberculous bron-
land Journal of Medicine
recommend that this treatment chomalacia.
should not be used in clinical practice until more is known
Cells and MHC antigens were removed from a hu-
man donor trachea which was then colonised with the
recipient’s cultured epithelial cells and mesenchymal
Steroids to facilitate extubation:
stem-cell-derived chondrocytes. The trachea was then
transplanted into the recipient. Four months after the
Steroids are often used to reduce complications after re-
operation the patient was well with a functional airway
moval of an endotracheal tube but the evidence is unclear and not taking immunosuppressives.
2 Mera: African Journal of Respiratory Medicine
“Enseñar a pensar. Por qué y cómo hacerlo, y su aplicación a las Ciencias Exactas.” Autor: Cnl (R) OIM D Héctor Tomás GONZALEZ – Dpto Planto Acad – Secr Acad – CMN. El trabajo trata de reflejar y justificar la importancia que en el presente adquiere el objetivo de “enseñar a pensar” ya que somos ricos en discursos pedagógicos, pero en la práctica seguimos exigiendo
Analysis of patient data from the Global Health Partnership mobile clinic at Kipsongo, Kitale, Kenya on 27 July 2011 Myer Glickman MFPH FHRIM FBMIS Consultant Statistician Development and Health Informatics Ltd Introduction This report is a brief analysis of patient data collected at the Global Health Partnership mobile clinic held in Kipsongo, Kitale, Kenya on 27 July 2011.