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Neuroepidemiology, 2014
Background: The majority of people with epilepsy (PWE) live in low-and middle-income countries (LMICs). However, they remain largely untreated and the bulk of resources are used to treat patients in the developed world. This disparity constitutes a challenge for neuroepidemiological studies on a global scale. In the past, several studies have focused on diverse populations in disparate countries at various periods of time and for particular purposes. The specificity of different contexts and circumstances makes it difficult to analyse PWE as a group either qualitatively or quantitatively. Such methodological limitations are further complicated by a lack of logistical support. There is a lack of interest in conducting studies, which results in inadequate funding and, in addition, there is the considerable challenge of publishing research reports from LMICs in peer-reviewed international journals. Methods: This paper focuses on methodological problems
Epidemiological profile of epilepsy in low income populations
Seizure, 2018
Epilepsy is a global disease with an unequal distribution. About 80% of the affected individuals reside in low and middle income countries. The incidence and prevalence of epilepsy in low income populations is higher than in the rest of the world, this is partly explained by some risk factors such as head trauma, perinatal injury and CNS infections, which are more common in poor regions, especially in rural areas. Epilepsy is considered a treatable condition with high rates of therapeutic response. About three fourths of patients achieve control of the disease with the use of antiepileptic drugs, however, despite this benign prognosis, over 75% of patients from low income populations do not receive treatment at all. The cultural beliefs, the inequity in the distribution of public health services, the inadequate supply of antiepileptic drugs, the low number of neurologists involved in the attention of epilepsy, and the social stigma, are the main reasons that increase the treatment g...
Epilepsy in poor regions of the world
The Lancet, 2012
Epilepsy is a common disorder, particularly in poor areas of the world, and can have a devastating eff ect on people with the disorder and their families. The burden of epilepsy in low-income countries is more than twice that found in high-income countries, probably because the incidence of risk factors is higher. Many of these risk factors can be prevented with inexpensive interventions, but there are only a few studies that have assessed the eff ect of reducing risk factors on the burden of epilepsy. The mortality associated with epilepsy in low-income countries is substantially higher than in less impoverished countries and most deaths seem to be related to untreated epilepsy (eg, as a result of falls or status epilepticus), but the risk factors for death have not been adequately examined. Epilepsy is associated with substantial stigma in low-income countries, which acts as a barrier to patients accessing biomedical treatment and becoming integrated within society. Seizures can be controlled by inexpensive antiepileptic drugs, but the supply and quality of these drugs can be erratic in poor areas. The treatment gap for epilepsy is high (>60%) in deprived areas, but this could be reduced with low-cost interventions. The substantial burden of epilepsy in poor regions of the world can be reduced by preventing the risk factors, reducing stigma, improving access to biomedical diagnosis and treatment, and ensuring that there is a continuous supply of good quality antiepileptic drugs.
Epilepsia, 2015
From July to August 2014, Epilepsia conducted an online survey seeking opinions that explained the discrepancy between the incidence and prevalence of epilepsy in lower income countries. Data on cumulative incidence suggest a higher rate of active epilepsy than reported in lifetime prevalence surveys. This study reports the findings of that poll addressing the proposal in our Controversy in Epilepsy series that it could be from increased death rates. The survey consisted of a question addressing possible reasons to explain the discrepancy between the incidence and prevalence of epilepsy. Another four questions addressed demographic information. There were 34 responders who completed the survey. Half (50%) of the responders felt that the discrepancy between cumulative incidence and lifetime prevalence was due to lack of uniform definitions and misclassification of patients in study design, 23.5% said the discrepancy was due to a higher mortality from diseases and conditions such as t...
The Lancet Neurology, 2019
Background Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. Methods We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings In 2016, there were 45•9 million (95% UI 39•9-54•6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621•5 per 100 000 population; 540•1-737•0). Of these patients, 24•0 million (20•4-27•7) had active idiopathic epilepsy (prevalence 326•7 per 100 000 population; 278•4-378•1). Prevalence of active epilepsy increased with age, with peaks at 5-9 years (374•8 [280•1-490•0]) and at older than 80 years of age (545•1 [444•2-652•0]). Age-standardised prevalence of active idiopathic epilepsy was 329•3 per 100 000 population (280•3-381•2) in men and 318•9 per 100 000 population (271•1-369•4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1•74 per 100 000 population (1•64-1•87; 1•40 per 100 000 population [1•23-1•54] for women and 2•09 per 100 000 population [1•96-2•25] for men). Age-standardised DALYs were 182•6 per 100 000 population (149•0-223•5; 163•6 per 100 000 population [130•6-204•3] for women and 201•2 per 100 000 population [166•9-241•4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6•0% (-4•0 to 16•7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24•5% [10•8 to 31•8]) and age-standardised DALY rates (19•4% [9•0 to 27•6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. Interpretation Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. Funding Bill & Melinda Gates Foundation.
Clinical and socio-economic factors among epileptic patients in Nepal: A big challenge
cmsnepal.edu.np
Epilepsy is commonly found neurological disorder in developing countries where huge treatment gap exists. Amongst many etiologies, neuroinfection is found to be prevalent in developing countries. We designed a self-structured goal directed questionnaire and interviewed 20 consecutive patients with epilepsy. We also collected their clinical symptoms and neuroimaging reports. 70 % were males. Majority (30%) had neuroinfection (20% neurocysticercosis and 10% meningitis). Eighty percent of patients had a belief on traditional healer. Epilepsy in Nepal still remains a big challenge. Public awareness to reduce infections may help in reducing seizure incidence and prevalence in developing countries like ours.
International League Against Epilepsy, and the World Health Organization
2015
Summary: In North America, overall epilepsy incidence is ap-proximately 50/100,000 per year, highest for children below five years of age, and the elderly. The best data suggest prevalence of 5–10/1000. Potential effects of gender, ethnicity, access to care and socioeconomic variables need further study. Studies of epilepsy etiology and classification mainly were performed without modern imaging tools. The best study found an overall standardized mortality ratio (SMR) for epilepsy relative to the general population of 2.3. There is evidence to suggest a greater increase in patients with symptomatic epilepsy, particularly chil-dren. People with epilepsy are more likely to report reduced Health-related Quality of Life than controls. They have reduced income, and are less likely to have full-time employment. They suffer from persistent stigma throughout the region, in developed as well as developing countries. Poor treatment access and health
Challenges in the management of epilepsy in resource-poor countries
Nature reviews. Neurology, 2009
Of the 50 million people with epilepsy worldwide, around 80% reside in resource-poor countries, which are ill-equipped to tackle the enormous medical, social and economic challenges posed by epilepsy. The capability to identify people with epilepsy and provide cost-effective care is compromised by widespread poverty, illiteracy, inefficient and unevenly distributed health-care systems, and social stigma and misconceptions surrounding the disease. Several studies have reported that a large proportion of patients with epilepsy in resource-poor countries never receive appropriate treatment for their condition, and many, although diagnosed and initiated on treatment, soon discontinue treatment. The high cost of treatment, a lack of availability of antiepileptic drugs, and superstitious and cultural beliefs contribute to a large epilepsy treatment gap. A substantial proportion of the current burden of epilepsy in resource-poor countries could be minimized by educating the public about po...