Neglected diseases and mortality

There are concern about the way the medical diseases are perceived and the attention is given to them in terms of detection tests, treatments and  research spending in the recent past. Biomedical progress on neglected diseases seems to be very slow and limited. The neglected diseases account for 2.6 million deaths a year. 756 new drugs are approved for use in Europe and USA and only 3.8.% of them are going to be useful for the neglected diseases. That means these diseases are truly neglected as their name says.

The neglected group of diseases includes malaria, tuberculosis, lethal childhood diarrhoea, and other diseases that kill impoverished people around the world, who tend to lack clean water, secure housing, sanitary waste disposal, and access to healthcare. People who live on less than $2 per day cannot afford high-priced drugs, and therefore drug companies have little incentive to spend millions to develop the drugs and bring them to market.

This is going to be an important issue for many countries to address in the coming years. Prioritisation of the research funding and health care expenditure allocation in the health budgets needs to appropriate to the needs of the society.  Although drugs and vaccines are an essential step in saving the millions who die each year of neglected diseases, public health experts point out that they can only help if they reach the most vulnerable populations. Almost 2 million children under five years old die each year worldwide from diseases which existing vaccines could prevent.
    

Trauma induced left upper llimb DVT and hiccups due to suspected phrenic nerve injury

Hiccups - physiology

Young man (25 years)  tried to avoid hitting a buffalo while riding a two wheeler and fell on the outstretched hand. Initially he did not find any problem. He got up and went home. After one week he noticed a swelling of the arm and forearm. He went to the local doctor (general surgeon) and he suspected deep vein thrombosis and confirmed it on colour doppler scan. In the scan left internal jugular vein thrombosis, subclavian vein, axillary vein and upper brachial vein thrombosis was noted. He gave antibiotics and analgesics and referred him to the vascular surgery clinic for further management. Based on the clinical and colour doppler scan findings the patient was given Injection Heparin 1000 units per hour and APTT was monitored. There was no prolongation of the APTT after 2 days of anticoagulation. Then the dose was increased to 1250 units per hour. The dull aching pain and swelling was persisting in the arm and forearm. So, to relieve the pain and inflammation (traumatic) he was put on Deflazacort 4 mg x daily. The pain, swelling significantly reduced and APTT was prolonged to therapeutic levels.
He developed hiccups which bothered him throughout the day. We were not able to associate hiccups with any known medical condition and physical examination was normal, there were no neurological deficits in him. We suspected it could be due to partial injury to the phrenic nerve on the left side. We considered various pharmacological therapies for the hiccups such as chlorpromazine, haloperidol, valproic acid, gabapentin, and pregabalin. He was given Tab Pregabalin and reassured that hiccups are generally temporary and subside in couple of weeks.

Reference: 
Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc. 2002;94:480–3. [PMC free article] [PubMed]