Plasmodium vivax cerebral malaria complicated with venous sinus thrombosis in Colombia

Complicated malaria is usually due to Plasmodium falciparum.Nevertheless,Plasmodium vivax is infrequently related with life-threatening complications.Few cases have been reported of severe Plasmodium vivax infection,and most of them from Southeast Asia and India.We report the first case of cerebral malaria due to Plasmodium vivax in Latin America,complicated with sagittal sinus thrombosis and confirmed by a molecular method.

Acute kidney injury in severely injured patients admitted to the Intensive Care Unit

Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care Unit(ICU)for whom creatine kinase(CK)levels were available.Methods:For this retrospective observational study,we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili(FVL)University Hospital.Our primary outcome was the incidence of AKI.Multivariate regression analysis was used to assess risk factors for this outcome.Results:A total of 315 patients were included.The trauma mechanisms were blunt(n=130),penetrating(n=66)and blast(n=44)trauma.The median[interquartile range,(IQR)of injury severity score(ISS)was 21(16–29).AKI developed in 75 patients(23.8%).Multivariate regression analysis revealed that the thoracic abbreviated injury scale(AIS)value(median(IQR)in the AKI group:3(0–4)],Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score[median(IQR)in the AKI group:18(10–27)],CK greater than 5000 U/L,lactic acid concentration at admission,and dobutamine administration were independently associated with AKI.Conclusions:We found that age,APACHE Ⅱ score,thoracic trauma,lactic acidosis,and dobutamine administration were independently associated with AKI.Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

Universities as catalysts of social innovation in health systems in low-and middle-income countries: a multi-country case study

Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-income countries.An evidence gap exits on SI in healthcare delivery in the context of low-and middle-income countries(LMICs)as well as on the engagement of universities from these contexts.There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities.The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa,Asia and Latin America.The objectives were to describe the model,components and implementation process of the hubs;identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI.Methods A case study design was adopted to study the implementation process of a network of university hubs.Data from documentation,team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework.Results/discussion SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms,established to catalyse SI within the local health system through four core activities:research,community-building,storytelling and institutional embedding,and adhering to values of inclusion,assets,co-creation and hope.Hubs were implemented as informal structures,managed by a small core team,in existing department.Enablers of hub implementation and functioning were the availability of strong in-country social networks,legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages.Barriers encountered were internal institutional resistance,administrative challenges associated with university bureaucracy and annual funding cycles.Conclusions This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC.

Documentary research on social innovation in health in Latin America

Background:Identifying social innovation in health initiatives,promoting quality of life through them,and transforming current health conditions demand the knowledge,comprehension and appropriation of the theoretical and methodological developments of this concept Academic developments in social innovation have mainly occurred in and been documented for English-speaking countries,although relevant experiences have been implemented in Latin America.In this article,we describe and analyze how social innovation in health is being approached and understood in this region.Main text:To identify the theoretical and methodological developments of social innovation in health between 2013 and 2018,a scoping review with a mixed approach was carried out.Eighty texts in English,Spanish and Portuguese were selected for a process of reflexive analysis of intra and intertextual reading.The approaches identified in the studied initiatives were complementary.The most applied approaches were innovation in health,technological innovation in health and social innovation,each with twelve publications,and social innovation in health and ecohealth with ten and seven publications respectively.The approaches showed a general interest in reaching the goals of the Sustainable Development Goals(SDGs),the Alma Ata Declaration and the Ottawa Letter.Conclusions:The social innovation in health approach in Latin America adopts educational strategies,identifies risk factors,optimizes resources,promotes interculturality,participation,community empowerment,and enhances intersectorality and interdisciplinarity.As an approach,process,program or solution,social innovation in health is a conceptual category under construction.This research provides a baseline for other systematic reviews on the subject.