Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Early diagnosis of tuberculosis-reported from third world country
- Prof(Dr)Jogenananda Pramanik.MD. (12 May 2004)
-
India needs to learn.
- SUDEEP KHANNA (13 May 2004)
-
One Additional Lesson...
- Rocío Sapag, Jaime Bayona (26 July 2004)
-
Re: One Additional Lesson...
- Antonio J Cunha, MD, PhD (3 March 2005)
|
|
|||
|
Prof(Dr)Jogenananda Pramanik.MD., Professor,Dept of Biochemistry College of Medicine,Internation American University,St.Lucia,West Indies.
Send response to journal:
|
A research letter from India.
Abstract: Tuberculosis is re-emerging as a dreaded killer disease in recent years. Due to delayed diagnosis, aggravation of this disease is a common feature. Slow growth rate of tubercle bacilli in vitro is a bottleneck problem. Several attempts have been made till recently to enrich the conventional L -J medium for accelerating the bacillary growth rate in vitro. Thyroid hormone induces cellular gene transcription and promotes protein synthesis. Effect of thyroid hormone in acceleration of bacterial growth rate was reported earlier. Thyroxine supplemented L-J medium was used in our study for in vitro culture of tubercle bacilli. Possibilities of contamination of bacillary seeds by rapid grower species of Mycobacteria were eliminated after related biochemical tests. Tubercle bacillary growth rate acceleration was observed in L-J medium and Sauton medium following thyroxine supplementation (4ug/ml and 8ug/ml respectively).). Use of thyroxine supplemented L-J medium for culture of tubercle bacilli may be helpful for early laboratory diagnosis of suspected tubercular patients as well as for antitubercular drug sensitivity tests. Key words: L-J medium, Thyroxine, Mycobacterium tuberculosis. Abstract from BMJ-16th Nov'2003. References: 1.Alison Rodger, Shabbar Jaffar, Stuart Paynter, Andrew Hayward, Jacqui Carless, and Helen Maguire Delay in the diagnosis of pulmonary tuberculosis, London, 1998-2000: analysis of surveillance data BMJ 2003; 326: 909-910. 2.Dr.J.Pramanik et al., Detection of tubercular antibody and antigen in sera of bone and joint tuberculosis.Ind.J.Clin.Bioch.2000,15(1),22-28. 3.Dr.S.K.Biswas, Effect of thyroxine on bacterial growth. Lancet;1975, 2,716. 4.Dr.J.Pramanik et al., Increased yield of excretory-secretory antigen with thyroxine supplementation in in vitro culture of tubercle bacilli. Ind. J. Tub.1997,44, 185-190. 5. J.Robert,A. North Angelo, Izzo: Mycobacterial virulence. Virulent strain of mycobacterium tuberculosis have faster in vivo doubling times and are better equipped to resisting growth inhibiting functions of macrophages in the presence and absence of specific immunity. J.Exp.Med: 1993, 177,1723 Competing interests: None declared |
|||
|
|
|||
|
SUDEEP KHANNA, Consultant gastroenterologist and Chief research officer Pushpawati Singhania Research Institute for Liver, Renal and Digestuve Diseases,Shiekh Sarai Phase I
Send response to journal:
|
Sir, The article by Donald M Berwick should be an eye opener for people who make health policies in a developing country like India. India is full of villages and small cities from where a patient would have to travel atleast fifty to sixty miles before he can have access to a primary care facility which would be less than equipped with basic minimum drugs and services.India is a living example of politics hindering the growth of primary health care.Health is the last priority of any government considering that less than 2percent of the budget is allocated to health.That is why more and more patients are running to private hospitals for treatment.This is a big financial burden for the patients.Also there is no interest shown by the government to improve the sanitary conditions.The slogan 'Health for all by 2010" seems a distant dream.We need to learn lessons from countries like Peru and Russsia regarding primary health care and seriously introspect our health policies and their implementation. Competing interests: None declared |
|||
|
|
|||
|
Rocío Sapag, Director of Training and Communications Socios En Salud Sucursal Peru, Lima 06, Peru, Jaime Bayona
Send response to journal:
|
In the article, "Lessons from developing nations on improving health care", Dr. Donald Berwick takes a close look at what he considers are some of the strengths and obstacles to healthcare improvement within resource- constrained settings, such as those of Peru, Russia and several Sub- Saharan countries. We worked with Dr. Berwick for the last two years on the improvement collaborative in Peru that he cites. Among the many things we learned together is that significant improvement can happen, even in resource- constrained settings. However, we think Dr. Berwick's article mistakenly abstracts health care improvement efforts from the broad and complex context of poverty and inequality in which most of the developing world is immersed. Improvement is indeed "an inborn human endeavor", as Dr. Berwick says, "and every healthy child will want to try and jump higher or run faster even without an outside incentive" (p. 1124). But an undernourished or unhealthy child, as many children of the developing world are, will probably not be able to run much faster, or run at all, unless we can find ways to meet his basic needs. It takes more than just good will to succeed, or the joy of success to sustain improvement. Aims, teamwork, cleverness to do more with less, and ability to handle the political interface, are important, yes - especially when initiating the path of improvement - but they are not sufficient. Most health organizations from developing nations face resource and structural constraints that cannot be ignored when pursuing sustainable system changes and improvement. Improvement in developing countries certainly will not be "even more feasible than it is in wealthy ones" unless resource and structural constraints are addressed. For those of us who belong to or have long worked in a developing country, the barriers to improvement mentioned by Dr. Berwick, are well known. Awareness of obstacles, rather than strengths, and the daily struggle to overcome them are deeply rooted in poor communities. It is important to look, as Dr. Berwick has, at the strengths of health sector professionals and teams in the developing world, but we should also focus on what the wealthier nations can learn from non-wealthy countries about the complexities of poverty in order to become more deeply engaged in improving healthcare for and with the poor. Doing so is essential for lasting health care improvement in the developing world. As a result, we think that some of the lessons 'from' developing countries that Dr. Berwick offers (under the heading: Lessons 'for' Developing Countries, in p.1128), should be read with caution. What may be waste for a wealthy nation or organization may not be so for an impoverished one. Two examples: "Dependency is waste": Sometimes true, but developing and developed countries relate to each other in many ways. For many organizations, dependency on donor agencies may be the only means of delivering care to the poor, or of improving care. Paternalism should be eradicated and self- sufficiency certainly be pursued, but in every field. In addition, wealthier nations and organizations providing external technical assistance need to be prepared to engage the issue of resources and help promote improvement and self-sufficiency in this arena also. "Complain is waste": Also true, at times, and at times not. If we had not complained in 1996, when multidrug-resistant tuberculosis (MDR-TB) was considered untreatable in resource poor settings because it was `too expensive' to treat, we could not have started treating our first patients in Lima. Again, if we had not complained that the drugs were too expensive, pharmaceutical companies would not have lowered their prices (by up to 90% compared to 1996 prices). If we had not demanded international and external financial support, today Peru would not be providing free treatment for all TB and MDR-TB patients, because it would be paying its external debt first. Understanding is important for collaboration among nations. But most important is the ability and the will of leaders, advisors and donors to listen and become involved in improving healthcare worldwide. Perhaps then, every child will have the chance to succeed in the intent to run farther and keep running. Rocío Sapag, MD, MPH Jaime Bayona, MD, MPH Socios En Salud Sucursal Perú Competing interests: None declared |
|||
|
|
|||
|
Antonio J Cunha, MD, PhD, Professor of Pediatrics & Director, Institute of Pediatrics, IPPMG Federal University of Rio de Janeiro, Brazil
Send response to journal:
|
Dear Editor, In relation to the topic of lessons from developing nations on improving health care, I agree with Dr. Sapag who responded to Dr. Berwick (1) that improvement in developing countries will not be "even more feasible than it is in wealthy ones" unless resource and structural constraints are addressed. It is not by chance that at the beginning of the third millennium, still some 10.8 million children die in a year in developing countries before they reach their fifth birthday. And it is well known why those children die. Most of these deaths are due to acute respiratory infections, diarrhea, measles, malaria or malnutrition or a combination of these conditions (1). With the use of the existing technology, the world would be able to decrease those deaths by at least 60%. WHO and UNICEF developed the Integrated Management of Childhood Illness (IMCI) strategy, which aims to reduce death, the frequency and severity of illness and disability, and to contribute to improved growth and development. It combines improved management of childhood illness with aspect of nutrition, immunization, and other important interventions that influence child health, including maternal health (2). Based on the evidence it is clear that the time is not for contemplation or expectation, but for action. Authorities from developed and developing nations should learn that those problems affecting children in developing countries are not acceptable in a rational world. More resources should be allocated for implementation and for research that will support the implementation of those interventions. As expressed by Dr.Sapag, "understanding is important for collaboration among nations, but most important is the ability and the will of leaders, advisors and donors to listen and become involved in improving healthcare worldwide." We from developing countries do hope that all authorities, from developing and mainly from developed nations, can learn that every child deserves a chance to succeed, to grow healthy, to be happy and to be able to contribute to a construction of a new and more equitable world. 1. Donald M Berwick. Lessons from developing nations on improving health care. BMJ 2004 328: 1124-1129. 2. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? The Lancet 2003; 361: 2226-34. 3. Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 1997; 75 Suppl 1: 7-24. Competing interests: None declared |
|||