The introduction of health products to low- and middle-income countries (LMICs) is hindered by several barriers. Even when these barriers are overcome, improper use of health products can have a negative effect on health outcomes. Health products may go unused due to a mismatch of product needs as well as a lack of public infrastructure, spare parts and consumables, or trained technicians. This study presents a comprehensive framework of the essential steps for effectively delivering quality health products to people in need based on our document reviews and case studies. We divide the value chain of health products into seven steps: 1) situation analysis, 2) research and development, 3) regulatory authorization, 4) selection and prioritization, 5) public procurement, 6) distribution and storage, and 7) health service delivery. We find that the practice of undertaking one step at a time leads to enormous costs in terms of time and resources, often with little success. Failed attempts sometimes necessitate starting over from the beginning. Therefore, it is important to attempt each step while looking ahead to the end through the entire chain of seven steps. More in-depth analysis and lessons from best practices for each of the seven steps may need to be investigated further to consider possible interventions.
Adipose tissue (AT) acts as a highly active endocrine organ, which secretes a wide range of adipokine hormones. In the past few years, several adipokines (leptin, adiponectin, resistin etc.) have been discovered showing metabolic consequences in relation to insulin resistance (IR), obesity and diabetes. These adipokines are considered to be an important component playing an important role in the regulation of energy metabolism. They have been shown to be involved in the pathogenesis of metabolic syndrome (MetS) and cardiac diseases. The current article provides a holistic summary of recent knowledge on adipokines and emphasizes their importance in association with IR, obesity, diabetes and MetS. Adipokines such as leptin, adiponectin, resistin and tumor necrosis factor-alpha (TNF-α) have been involved in the regulation of an array of metabolic functions and disease associated with it, e.g. appetite and energy balance of the body, suppression of atherosclerosis and liver fibrosis, obesity with type 2 diabetes (T2D) and IR. An important adipokine, Interleukin-6 (IL-6), also correlates positively with human obesity and IR and also the elevated level of IL-6 predicts development of T2D. All of these hormones have important correlation with energy homeostasis, glucose and lipid metabolism, cardiovascular function and immunity. All the possible connections have extended the biological emphasis of AT secreted adipokines as an investigator in the development of MetS, and are now no longer considered as only an energy storage site.
The environment surrounding clinical trials is evolving rapidly with the advancement of digital transformation (DX). Especially during the COVID-19 pandemic, digital methods are effective in promoting multiregional clinical trials (MRCT). eConsent is an electronic tool for obtaining informed consent that is expected as a key solution to improve patient understanding. According to the report by Pietrzykowski et al., patient understanding in clinical trials is surprisingly low, and this is a significant ethical problem. Despite the current situation, the use of eConsent has not significantly progressed at least in Japan. This study aimed to identify the current issues for eConsent and consider measures to solve them. In January 2022, an online questionnaire survey was sent to 69 member companies of the Japan Pharmaceutical Manufacturers Association (JPMA), and 52 companies (75.4%) responded. Thirteen companies (25.0%) conducted a trial using eConsent. Among the 13 companies, 17 trials were conducted by 8 companies after the COVID-19 pandemic (summer 2020), compared to 8 trials by 5 companies before the pandemic. We found that the biggest obstacles to the spread of eConsent are the lack of awareness of eConsent use and the development of provisions for treating electronic files as source records in medical institutions. In conclusion, we need to encourage medical institutions to update provisions for handling electronic source documents and to notify them of the importance of eConsent. Thus, further promotion of eConsent is needed to increase patient understanding and enable more efficient clinical trials.
Some mutated strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presumably have high infectivity and pathogenicity. Using Japanese medical claims data, we assessed the pathogenicity of Alpha and Delta variants and vaccine effectiveness by severity. Inpatient records from the Medical Information Analysis Databank for the National Hospital Organization were used. Severity was defined as the proportion of inpatients using respiratory ventilators among inpatients with oxygen administration. We regressed severity and fatality on the proportion of patients with Alpha or Delta variant and on vaccination coverage, while allowing for some lag to reflect development from infection to hospitalization. We also examined results obtained when using data for all new inpatients, instead of inpatients with oxygen administration, as the denominator for severity. Estimation results were better when using severity defined by inpatients with oxygen administration as the denominator than when using all new inpatients. Especially for severity measures for inpatients 65 years old or older with oxygen administration, we confirmed an association of vaccination with lower severity and an association of Delta variant infection with high severity. Vaccines were most effective for people 65 years old or older. The age distributions of inpatients and confirmed patients were greater than for people younger than 65 years old. Vaccination reduced severity and fatality and Alpha and Delta variants might increase severity and fatality among inpatients 65 years old or older receiving oxygen therapy.
Tracheal intubation is an essential procedure in the induction of general anesthesia; however, it is also a main source of infectious aerosols such as severe acute respiratory virus 2 (SARS-CoV-2). For protection from infectious aerosols, an air conditioning system which provides continuous laminar air flow from the ceiling and a local isolating device are widely used in typical operating rooms. However, how aerosols spread in an actual operating room has not been visualized, especially during tracheal intubation. In this study, we observed the spread of aerosols under several circumstances. To recreate the scenario of general anesthesia induction, we substituted aerosol spray with smoke from a smoke tester device in the mouth of a human body model placed on the operating table. Then we measured the maximum height of aerosol spread every second for 9 seconds. To verify the contribution of air conditioning and an isolating device, we compared four situations based on their presence or absence. The maximum height of aerosol spread was significantly lower in the presence of laminar air flow from the ceiling. An isolating device contributed to initially enclosing the aerosol; however, some aerosol leaked and diffused depending on the air flow outside the device. During tracheal intubation in typical operating room, air-conditioned laminar air flow can contribute to prevent infectious aerosol spread, and an isolating device can provide supplementary protection.
The clinical features of newly diagnosed cervical cancer in Cambodia are poorly documented. We aimed to describe the histologic type and stage distributions of newly diagnosed cervical cancer patients at the Khmer Soviet Friendship Hospital in Phnom Penh, which is one of the two national cancer centers in Cambodia. A descriptive cross-sectional study was conducted using the Gynecologic Test Registry of the gynecology department between January and December 2019. In 2019, 351 women were histologically diagnosed with cervical cancer, representing approximately one-third of the estimated total cases occurring in the country. The mean age at presentation was 54.7 years. The histologic type distribution was largely consistent with other Asian countries, with squamous cell carcinoma accounting for 83.8%, followed by adenocarcinoma (15.4%). Among 309 patients with recorded staging information, 57.6% were advanced-stage cancers (i.e. stage IIB or higher). Raising awareness of early symptoms of cervical cancer, increasing access to cancer diagnosis, and better recording of patients’ clinical information are important to improve cervical cancer management in Cambodia.
Child abuse and neurodevelopmental disorders are serious social issues in Japan. Abused children may present with symptoms similar to attention deficit/hyperactivity disorder (ADHD), such as increased impulsivity and difficulty concentrating. It is also known that children with ADHD are more likely to suffer from maltreatment, which can lead to psychiatric symptoms such as low self-esteem, depression, and defiant, challenging attitudes. Child psychiatric treatment needs to take both perspectives, childhood adversity and neurodevelopmental disorders, into account. In this case (A), there was a history of impulsive challenging behavior; in addition to the ADHD symptoms, the abusive upbringing from an early age had resulted in increased aggression, psychological damage, and low self-esteem. The abusive mother was also a competitor to her and was vulnerable and unable to present a healthy femininity to her. She entered adolescence without sufficient support from her mother before puberty. The ambivalence of dependence and rebellion extremely increased, and the problem manifested as withdrawal. In the treatment, while setting limits, positive evaluations of the positive aspects were actively communicated. Her therapist was particularly aware of becoming a part of her ego function different from her mother. A's challenging behavior was gradually reduced, and she was able to develop the right self-image. This is a case in which the structure of the hospitalization enabled the work of limiting the patient while protecting and accepting her. Clinical serious issues such as withdrawal, defiant challenging behavior, and symptoms of hyperactive impulsive inattention in adolescents require consideration and response to background adversity experiences and child abuse factors.
Pulmonary sclerosing pneumocytoma (PSP), a rare benign lung tumor of primordial epithelial origin, commonly effects middle-aged Asian females. Diagnosis of this entity is challenging because of the non-specific radiological characteristics that resemble malignancies and its histological heterogeneity. Main differential diagnoses considered are adenocarcinoma lung and carcinoid tumor. In this case report, we discuss our experience of diagnosing a case of pulmonary sclerosing pneumocytoma, which showed increased SUV uptake in PET-CT indicating towards a malignancy and was also misdiagnosed as adenocarcinoma in CT-guided FNAC. The histology showed variable morphological features and there was a differential staining pattern of TTF1 and napsin A in the cells. We have highlighted the differential diagnosis and the challenges faced for diagnosing this benign, rare entity.
The “Hiroshima Vision”, unveiled at the G7 Hiroshima Summit in 2023, leaves room for enhancement in the specific content of equitable global vaccine distribution plans. Despite the efforts of COVID-19 Vaccines Global Access (COVAX), vaccine supply faces severe disparities, with high-income countries receiving a disproportionately larger share. To mitigate future public health crises, mechanisms proven by past instances, such as establishing regional vaccine hubs, promoting technology transfers, and considering early patent rights relinquishment, need to be implemented. Correcting vaccine inequity necessitates learning from the COVID-19 pandemic and demands global cooperation and consensus from the G7.