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    • Cepheid s GeneXpert system achieved

    2019-05-31

    Cepheid\'s GeneXpert system achieved recognition as a rapid molecular test to identify active tuberculosis and rifampicin resistance, a marker for multidrug-resistant tuberculosis. So far, more than 13 million Xpert /rifampicin (MTB/RIF) tests have been done worldwide. However, the primary criticism has been that implementation of rapid GeneXpert testing in reference laboratories has had little effect on reaching the 3 million individuals with infection who remain undiagnosed each year. What had been lacking, until now, was an accurate, portable device to allow health-care workers to actively identify infected patients in the community, thereby breaking the cycle of tuberculosis transmission. GeneXpert was designed to identify several infectious organisms and genetic biomarkers, and the machines are operating in laboratories around the world. The system can already identify eight hospital-associated infections, 12 additional infectious diseases, and genetic markers for cancer () and thrombosis risk (Factors II and V), with several more tests in development. By using the same platform, the portable Omni gives health-care workers the ability to do all the same cartridge-based tests in the community. Although the ability to do advanced nucleic Dig-11-utp testing in remote, resource-limited settings could change the approach to global health delivery, discussion of the potential challenges is needed before widespread implementation. First, an agreement must be reached about regulatory assurances and quality control measures to ensure oversight for maintenance of the integrity and accuracy of diagnostic testing. Although GeneXpert Omni has wireless connectivity for remote result monitoring, who will be responsible for such a task is unclear. Second, in view of the existing global shortage of laboratory expertise, there is little understanding of whether community-based testing might place an additional strain on laboratory systems by requiring more staff resources and logistical support, or whether effective point-of-care testing could help to offload some of the burden on laboratory workers. Third, no clear guidance exists to help stakeholders to decide on the adoption of novel point-of-care tests. Should each new device or test be required to show greater accessibility to testing or better patient outcomes than existing ones? If so, then each device or test might need to be assessed in clinical implementation trials and analysed for its cost-effectiveness, which will be time consuming and costly. These are just some of the topics that will need an open discussion between public health officials, hospital and clinic administrators, laboratory managers, clinicians, and outreach workers. GeneXpert Omni has set a new bar for true point-of-care molecular assays and opened the door for a range of applications, from improved contact tracing for infectious diseases to community-based screening for certain cancers. The global research and market for diagnostic point-of-care tests will continue to grow rapidly over the coming years (). However, for these tests to have a positive effect, dialogue among the various stakeholders should begin now.
    On April 25, 2015, a powerful 7·8-magnitude earthquake struck Nepal. The Nepalese Government declared 14 of the country\'s 75 districts as severely affected (ie, 5·6 million people). As of July 25, 2015, the confirmed number of casualties was 8897 with a further 22 310 people injured, and 887 356 houses fully damaged. Immediately after the earthquake, the Government of Nepal declared a state of emergency and requested the UN to activate the humanitarian clusters. The Nutrition Cluster, led by the Ministry of Health and Population and including 28 national and international partners, devised a 3-month (May–July, 2015) Emergency Nutrition Response aiming to: (1) protect, promote, and support breastfeeding for children aged 0–23 months and avoid the distribution or use of unsolicited donations of breastmilk substitutes; (2) improve complementary feeding for children aged 6–23 months through information, counselling, and the distribution of multiple micronutrient powders (MNPs) for home fortification of child foods; (3) identify and treat children aged 6–59 months with severe acute malnutrition through community management of acute malnutrition; (4) improve the micronutrient intake of children aged 6–59 months through MNPs and vitamin A supplementation; and (5) improve the micronutrient intake of women during pregnancy and the early post-partum period through iron-folic acid supplementation.