Pediatric mortality in low- and middle-income countries (LMICs) remains largely attributable to time-sensitive and treatable conditions. Structured triage systems are essential to prioritize care and reduce preventable deaths, yet implementation evidence in LMIC referral hospitals is limited. This study aimed to describe the implementation of a newly developed national triage tool in the Pediatric Emergency Department (PED) in a referral hospital in Beira, Mozambique, and evaluate its early operational integration using implementation outcomes over the first year of practice. We conducted a multi-component implementation of the triage tool between October 2023 and January 2026. A retrospective observational analysis evaluated implementation outcomes between April 2024 and March 2025. Of 28,469 pediatric visits, 76.3
BACKGROUND:Accurate determination of gestational age (GA) has an important role in clinical practice, especially prevention/anticipation of prematurity-related complications. In low- and middle-income countries, the availability and accuracy of the gold standard for GA determination is very limited. In fact, prenatal ultrasonography in the first trimester is strongly affected by high costs, lack of skills and poor maternal access to health service. Furthermore, the determination by Last Menstrual Period has a very low accuracy, as well as postnatal clinical tools such as the Ballard Score. Recent studies in high-income countries tested TCD measurement by cranial ultrasound for GA determination with reported acceptable accuracy. The development of technology over the years is leading to a progressive spread of cranial ultrasound also in LMICs. OBJECTIVE:To assess the performance of a published equation in estimating GA using fetal TCD measurements from low-income settings. METHODS:Data were simulated using available information from relevant studies conducted in LMICs. Estimated GA was calculated as GA in weeks = 0.470 × TCD in mm + 13.162. The performance was assessed using modified calibration plots and Bland-Altman plots. Pooled bias and 95% limits of agreement (LoA) were also calculated. RESULTS:Four datasets (n = 400, 257, 450, 500) were generated based on data from relevant studies. For GA 23-32 weeks, the equation was prone to overestimate and pooled bias was 6.0 days (95% LoA -6.7 to 18.7 days). For GA 33-36 weeks, the equation was prone to underestimate in one dataset and pooled bias was -1.5 days (95% LoA -16.8 to 13.8 days). For GA 37-40 weeks, the equation showed bad calibration and pooled bias was -5.0 days (95% LoA -25.8 to 15.8 days). When extending the original interval to GA 23-40 weeks, pooled bias was 2.8 days (95% LoA -13.0 to 18.6 days). CONCLUSIONS:Within the limitations of a simulation study, our findings suggest that the TCD-based equation may provide some benefits in postnatal estimation of GA between 23-32 weeks in low-resource settings. Lower precision, yet acceptable for clinical use, may be expected beyond 32 weeks' gestation. Future studies may validate the equation in real newborns in low-resource settings where precise GA dating is available.
Chimeric antigen receptor T (CAR-T) cell therapies have revolutionized the treatment of hematological malignancies, achieving high response rates in patients with relapsed or refractory disease. Despite these benefits, CAR-T cell therapies are associated with unique toxicities, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), immune cell-associated hematotoxicity (ICAHT), and immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS), which is characterized by a rare and life-threatening hyperinflammatory response. This paper presents a case of a 56-year-old woman with relapsed mantle cell lymphoma (MCL) treated with the CAR-T cell therapy, brexucabtagene autoleucel, who had subsequently developed CRS and later IEC-HS. Initial management included tocilizumab, corticosteroids, and anakinra, followed by the compassionate use of emapalumab, an interferon-γ blocker. To provide broader context, we conducted a literature review of CAR-T cell-related toxicities, focusing on IEC-HS and its management with emapalumab. Clinical and laboratory manifestations, such as elevated ferritin levels, cytopenias, and organ dysfunction, underpin the diagnostic criteria for IEC-HS. Vigilant monitoring and tailored therapeutic approaches are required to effectively manage toxicities associated with CAR-T cell therapy, to maximize its benefits and minimize adverse effects. In more severe IEC-HS cases, emapalumab may be used as an effective targeted therapy.
BackgroundHousing conditions play a fundamental role in infectious diseases transmission, particularly in endemic regions. Structural modifications to homes-such as screened windows and doors, sealed eaves, elevated flooring, and insecticide-treated barriers-are increasingly recognized as key strategies for reducing mosquito entry and, consequently, malaria risk. Similarly, improved latrine, proper waste disposal, and the possibility to hand wash can help to reduce the spread of waterborne diseases such as cholera. However, their effectiveness and feasibility vary across geographical and socio-economic settings. This study examines the impact of housing-based interventions on malaria and cholera prevention through two case studies conducted in Uganda and Mozambique.MethodsA literature review was conducted alongside case studies from Uganda and Mozambique, where housing interventions for endemic infectious diseases prevention have been implemented. Data were collected from scientific literature, local health reports, and field observations.ResultsThe combination of multiple preventive measures at the community level, including both structural modifications to housing and changes in domestic behavior, holds great potential in combating various endemic diseases in low-income countries, such as malaria and cholera. These integrated strategies are generally low-cost, community-acceptable, and easily implementable, and can complement existing large-scale control programs.ConclusionHouse-based interventions represent a sustainable and complementary strategy for malaria and cholera control in endemic regions. However, their successful implementation depends on affordability, cultural adaptation, and integration with existing control programs. Future research should focus on scaling up these interventions and evaluating their long-term impact on vector- and water-borne diseases transmission in endemic and low-resource settings.
Background: Migrant agricultural workers in Italy often experience social and health vulnerabilities, including unstable housing and limited access to primary care. In Southern Italy, many live in informal settlements and seek care through outreach services. This study describes patterns of pharmacological treatment in this population and examines how they relate to the clinical conditions managed in mobile clinics. Methods: We analyzed routinely collected data from 2928 unique patients (8547 clinical encounters; 8965 treatment occurrences) managed by Doctors with Africa CUAMM mobile clinics in 12 informal settlements in Apulia, Italy, between 2017 and 2026. Diagnoses were grouped into clinical categories, and pharmacological treatments were classified by therapeutic class. We conducted a descriptive analysis of the distribution of diagnostic categories and associated treatments. Results: The population was predominantly male (96.5%), young (81% <45 years), and largely excluded from regular primary care (93.5% without a General Practitioner). Musculoskeletal disorders and fatigue were the leading diagnostic category (34.0%), followed by gastrointestinal (13.5%) and respiratory conditions (13.0%). Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics were the most frequently recorded treatments (32.6% of treatment occurrences). Among musculoskeletal presentations, NSAIDs were used in 76% of cases. Gastroprotective agents were documented in 52% of encounters with gastrointestinal symptoms. Among cardiovascular presentations, 87.7% of treatment occurrences involved chronic management with antihypertensives or beta-blockers. Conclusions: In this outreach setting, medication use provides a descriptive picture of common health problems and treatment responses among migrant agricultural workers living in informal settlements. The prominent use of symptomatic pharmacological relief, particularly NSAIDs in musculoskeletal conditions, suggests that care is often focused on managing pain and acute complaints in a population facing barriers to continuous primary care. These findings support the need for stronger inclusion of migrant workers in the National Health Service and for policies that address underlying social and structural determinants of health.
