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Antibiotic resistance in conflict settings: lessons learned in the Middle East

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Antibiotic resistance in conflict settings: lessons learned in the Middle East Kanapathipillai, R; Malou, N; Hopman, J; Bowman, C; Yousef, N; Michel, J; Hussein, N; Herard, P; Ousley, J; Mills, C; Seguin, C; Saim, M Me´decins Sans Frontie`res (MSF) has designed context-adapted antibiotic resistance (ABR) responses in countries across the Middle East. There, some health systems have been severely damaged by conflict resulting in delayed access to care, crowded facilities and supply shortages. Microbiological surveillance data are rarely available, but when MSF laboratories are installed we often find MDR bacteria at alarming levels.1 In MSF’s regional hospital in Jordan, where surgical patients have often had multiple surgeries in field hospitals before reaching definitive care (often four or more), MSF microbiological data analysis reveals that, among Enterobacteriaceae isolates, third-generation cephalosporin and carbapenem resistance is 86.2% and 4.3%, respectively; MRSA prevalence among Staphylococcus aureus is 60.5%; and resistance types and rates are similar in patients originating from Yemen, Syria and Iraq.1–3 These trends compel MSF to aggressively prevent and diagnose ABR in Jordan, providing ABR lessons that inform the antibiotic choices, microbiological diagnostics and anti-ABR strategies in other Middle Eastern MSF trauma projects (such as Yemen and Gaza). As a result, MSF has created a multifaceted, context-adapted, field experience-based, approach to ABR in hospitals in Middle Eastern conflict settings. We focus on three pillars: (1) infection prevention and control (IPC); (2) microbiology and surveillance; and (3) antibiotic stewardship.

Sudan: ‘Exercise utmost restraint’ urges Guterres as thousands march in Khartoum, sparking deadly clashes

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With security forces reportedly firing tear gas at protesters and signs that there may be division between the army and security forces in Sudan’s capital, Khartoum, over how to deal with ongoing demonstrations, the UN chief on Monday called on “all actors to exercise utmost restraint and avoid violence.”

Venezuelans brave torrential border river, face exploitation, abuse – UN urges greater protection

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The Venezuela refugee crisis, which has already left some 1.1 million children, returnees and people in-transit lacking protection and basic services across Latin America and the Caribbean (LAC), has prompt the UN Children’s Fund (UNICEF) to call on regional Governments to uphold their rights and protect unaccompanied, undocumented children.

Greta Thunberg e il Venezuela

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È arrivata Greta, mentre tutto intorno a noi si sfascia. Forse perché l'aspettavamo. Aspettavamo per svegliarci il tocco semplice e diretto di chi, semplice e diretta, vede il bene e il male e non si fa confondere.

Haiti stands ‘at the crossroads’ between peacekeeping, development – Bachelet urges strengthened ‘human rights protection’ 

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With the end of the UN’s peacekeeping presence in Haiti in sight, the UN’s human rights chief told the Security Council on Wednesday that the country now stands “at the crossroads between peacekeeping and development”, urging all concerned parties to continue building on progress made, or “risk losing it” altogether. 

UN chief commends Algerians for ‘mature and calm’ demonstrations for change, leading up to presidential resignation

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In the wake of the resignation in Algeria of President Abdelaziz Bouteflika, the UN Secretary-General on Wednesday saluted “the mature and calm nature” of protests involving hundreds of thousands of citizens who took to the streets peacefully in recent weeks, to express “their desire for change.” 

The aftermath of Cyclone Idai—building bridges where we can

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The aftermath of Cyclone Idai—building bridges where we can Frieden, M Marthe Frieden is the medical team leader in MSF’s emergency response to the destruction caused by tropical Cyclone Idai. On the night of 15 March, the cyclone hit Zimbabwe’s mountainous Manicaland province, causing flooding and deadly landslides, particularly in the Chimanimani District. Before Idai hit, Marthe was working on an MSF pilot project for managing diabetes and hypertension in the nearby Chipinge District, in partnership with Zimbabwe’s health ministry. Writing from the worst hit districts of Chimanimani and Chipinge, Marthe describes the events of the first six days as an MSF team of 10 people rapidly switched from their regular activities to emergency mode.

2017 Outbreak of Ebola Virus Disease in Northern Democratic Republic of Congo

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2017 Outbreak of Ebola Virus Disease in Northern Democratic Republic of Congo Nsio, J; Kapetshi, J; Makiala, S; Raymond, F; Tshapenda, G; Boucher, N; Corbeil, J; Okitandjate, A; Mbuyi, G; Kiyele, M; Mondonge, V; Kikoo, MJ; Van Herp, M; Barboza, P; Petrucci, R; Benedetti, G; Formenty, P; Muzinga, BM; Kalenga, OI; Ahuka, S; Fausther-Bovendo, H; Ilunga, BK; Kobinger, GP; Muyembe, JJT Background In 2017, the Democratic Republic of the Congo (DRC) recorded its eighth Ebola virus disease (EVD) outbreak, approximately 3 years after the previous outbreak. Methods Suspect cases of EVD were identified on the basis of clinical and epidemiological information. Reverse transcription–polymerase chain reaction (RT-PCR) analysis or serological testing was used to confirm Ebola virus infection in suspected cases. The causative virus was later sequenced from a RT-PCR–positive individual and assessed using phylogenetic analysis. Results Three probable and 5 laboratory-confirmed cases of EVD were recorded between 27 March and 1 July 2017 in the DRC. Fifty percent of cases died from the infection. EVD cases were detected in 4 separate areas, resulting in > 270 contacts monitored. The complete genome of the causative agent, a variant from the Zaireebolavirus species, denoted Ebola virus Muyembe, was obtained using next-generation sequencing. This variant is genetically closest, with 98.73% homology, to the Ebola virus Mayinga variant isolated from the first DRC outbreaks in 1976–1977. Conclusion A single spillover event into the human population is responsible for this DRC outbreak. Human-to-human transmission resulted in limited dissemination of the causative agent, a novel Ebola virus variant closely related to the initial Mayinga variant isolated in 1976–1977 in the DRC.

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