Echinococcosis Research Articles

Perioperative outcomes and hospitalization costs of radical vs. conservative surgery for hepatic cystic echinococcosis: A retrospective study

Background Surgical intervention is a crucial treatment for hepatic cystic echinococcosis. However, the choice between radical and conservative surgery remains controversial. This study aimed to compare the perioperative outcomes and hospitalization costs between radical and conservative surgery for hepatic cystic echinococcosis. Method A retrospective cohort study was conducted on patients undergoing surgical treatment at the First People’s Hospital of Kashi Prefecture from July 1, 2012, to October 1, 2023. Propensity score-matching analysis was utilized to mitigate patient selection bias between the two surgical groups. Result Of the 434 patients included, 324 underwent conservative surgery and 110 underwent radical surgery. After propensity score-matching, 182 conservative surgery and 102 radical surgery patients were compared. Radical surgery patients experienced longer operative time, higher intraoperative blood loss, increased blood transfusion, and higher costs compared to conservative surgery patients. However, no differences were observed in short-term outcomes, including overall morbidity, death, bile leak, effusion, pulmonary infection, incision infection, intestinal obstruction, ICU stay, abdominal drainage time, and postoperative hospital stays. Conclusion This study suggests that radical surgery is associated with greater surgical complexity and higher hospitalization costs, while it doesn’t offer a significant short-term advantage. Conservative surgery may be a viable option in resource-limited settings or for patients unsuitable for complex procedures. Further research with long-term follow-up is needed to determine the optimal approach.

Isolated hydatid cyst in the medial rectus muscle: unveiling a rare orbital occurrence

Abstract Background Orbital hydatid disease, while rare, should be included in the differential diagnosis of unilateral proptosis, particularly in endemic areas. Accurate diagnosis and comprehensive management are essential for effective treatment and favorable long-term outcomes. Case Presentation A 12-year-old boy presented with a one-month history of diplopia and left-sided proptosis. A CT scan revealed a cystic mass within the left medial rectus muscle. Surgical intervention confirmed the presence of a hydatid cyst following cyst rupture and irrigation with hypertonic saline. The patient underwent a two-month course of albendazole therapy. Initially, the patient experienced persistent exotropia and diplopia, but at the three-year follow-up, he exhibited no diplopia or proptosis and only mild residual exotropia. Conclusion This case underscores the importance of considering orbital hydatid cysts in the differential diagnosis of unilateral proptosis in endemic regions. Heightened awareness, accurate diagnosis, and a tailored therapeutic approach, including surgical removal and antiparasitic treatment, are crucial for successful management and improved long-term outcomes.

Human Cystic Echinococcosis Treated with Individualised Homoeopathy—A Case Report

AbstractCystic echinococcosis is a chronic, complex and neglected disease caused by the larval form of cestode Echinococcus granulosus. The liver is the most frequently parasitised organ in humans. Percutaneous drainage, systemic chemotherapy and surgery are the therapies available for hydatid cyst treatment where the risks associated with invasive procedures may be particularly high. Therefore, homoeopathic individualised treatment can be a better approach to treating cases of hydatid cysts without any side effects and risks. In the presented case, the patient received homoeopathic medicine Magnesium muriaticum based on individualisation and Medorrhinum as an intercurrent medicine. The homoeopathic treatment resulted in an overall improvement in the health of the patient. Serial ultrasounds also showed a reduction in the cyst size. This case highlights the fact that homoeopathy can be a plausible alternative to conventional treatment like surgery in cases of hydatid cysts along with improvement in the quality of life of patients as represented by EQ-5D-5L. The Modified Naranjo Criteria explicitly depict the potential causal relationship between the treatment and observed changes.

Rapid diagnosis of culture-negative Klebsiella pneumoniae liver abscesses by next-generation sequencing: A case series

Diagnosis of Klebsiella pneumoniae (Kp) pyogenic liver abscesses is usually achieved by imaging and isolation of the bacterium. However, when blood and other cultures were negative, laboratory diagnosis of Kp liver abscess may be challenging. Herein we report two patients with culture-negative Kp liver abscess with atypical presentations diagnosed by metagenomic next-generation sequencing (mNGS). For the first non-diabetic patient, computed tomography examination of the abdomen showed multiple round low-density foci with untidy margin in the liver, which mimicked hydatid cysts; while the second patient presented with acute cholecystitis/cholangitis. mNGS analysis of the blood sample from the first patient revealed 144 sequence reads of Kp; and that of the second revealed 153 sequence reads of Kp as well as other latent or non-pathogenic microorganisms. Both patients responded promptly to antibiotics treatment. mNGS is a useful tool for laboratory diagnosis of culture-negative Kp liver abscess.

Primary Cervical Hydatid Cyst: An Unusual Presentation of Hydatid Disease: A Case Report

Primary Cervical Hydatid Cyst: An Unusual Presentation of Hydatid Disease: A Case Report

The burden and distribution of cystic echinococcosis in Bhutan: a retrospective study.

Cystic echinococcosis (CE), caused by Echinococcus granulosus s.l. is a neglected zoonosis posing a significant public health challenge. Little is known about human CE in Bhutan. This study was conducted to gain an understanding of the burden, distribution, and potential risk factors of CE in Bhutan. From January 2015 to December 2019 data from Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) and 6 other district-level hospitals were reviewed. Descriptive statistics were used to summarize the data. DALYs and Poisson regression models were used to estimate the burden and explore the relationship between cases and possible risk factors. A total of 159 cases were recorded. Most cases (145) were admitted to the surgical ward and 14 cases were referred to India. The average annual incidence was 4.4 cases per 100 000 population. The burden of disease was estimated to be approximately 39 DALYs per year for treatment-seeking cases, or possibly 80 DALYs per year including non-treatment seeking cases. This translates to approximately to 5.2 DALYs and 10.2 per 100 000 per year respectively. The commonest sites of infection were the liver (78%) and lungs (13%). Most cases were treated with surgery (>82%), and more than 47% were admitted to the hospital for >4 days. Policy interventions targeting community engagement, awareness, education, high risk occupational groups, females, and those living in the endemic districts of the central and western regions may yield larger gains. More studies and the institution of a surveillance system can help better guide policy interventions.

Global burden of zoonotic infectious diseases of poverty, 1990–2021

BackgroundThe zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs—schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)—to support policy making and resource allocation for their control and elimination.MethodsData of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI).ResultsIn 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden—woven predominantly through low and lower-middle SDI regions—stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = − 0.610, − 0.622 and − 0.610), cystic echinococcosis (− 0.676 of ASMR, − 0.550 of age-standardized DALYs), cysticercosis (− 0.420, − 0.797 and − 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively.ConclusionThe burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.Graphical

Ultrasonography (USG) Evaluation among Patients with Biliary Obstruction in a Tertiary Care Center

Background: Biliary obstruction is a blockage in the bile ducts that prevents bile from flowing from the liver to the small intestine. Objectives: This study aimed to assess the efficacy of ultrasonography (USG) among patients with a blockage in the bile ducts as known as biliary obstruction. Methods: This was a prospective observational study conducted at the Department of Radiology and Imaging at Sir Salimulliah Medical College Hospital, Dhaka, Bangladesh. This study included patients with clinical suspicion of biliary obstruction who underwent USG. Characteristics of the obstruction were evaluated for both benign and malignant lesions through USG. The findings were then correlated with ERCP, histopathology, or surgery to calculate the diagnostic performance of the former two modalities. Results: Out of 145 patients, 63 were in the malignant group and 82 were in the benign group. The sensitivity, specificity, and accuracy of detecting the nature of obstruction by USG were 33%, 84%, and 48.9%, respectively. The overall diagnostic accuracy of USG in predicting the site of obstruction was 64.3%. Hydatid Cyst and the Main Pancreatic Duct Stricture were the most accurate findings of USG. Conclusions: USG should be the initial screening modality of choice for predicting the level and nature of obstruction in patients with a clinical suspicion of obstructive jaundice.

Comparison of the Diagnostic Performance of Antigen B Purified from Sheep Hydatid Cyst Fluid (HCF) with Commercial ELISA Kit.

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the metacestode of Echinococcus granulosus. CE is a health problem in Middle Eastern countries, such as Iran. The purpose of this study was to purify subunit 8 KDa antigen B from crude sheep hydatid cyst fluid (HCF) and compare its sensitivity and specificity with a commercial human ELISA kit (PT-Hydatid-96). 28 sera samples were collected from hydatid cyst patients who had surgery for a hydatid cyst and had their disease confirmed by pathology after the surgery. Furthermore, 35 samples of healthy individuals with no history of hydatid cysts were collected, as were nine serum samples from parasite-infected non-CE patients. HCF was obtained from sheep fertile cysts at a Sari slaughterhouse and used as an antigen. In an indirect ELISA test, the B antigen was employed, and the results were compared to those from a commercial ELISA kit. The results of this study were analyzed using the Kappa test. The commercial ELISA kit showed 17 cases (23.6%) positive, 44 cases (61.1%) negative, and 11 cases (15.3%) borderline. B antigen showed that 18 (25%), 43 (59.7 %), and 11 (15.3%) were positive, negative, and borderline, respectively. One sample (1.4% of 72 total samples) of 35 serum samples from healthy individuals was positive using B antigen-based ELISA. In addition, all nine serum samples from parasite-infected non-CE patients were negative for both tests. The sensitivity and specificity of the commercial ELISA kit have been evaluated at 60.7% and 100%, respectively. For B antigenbased ELISA, these values are 64.3 and 97.7%, respectively. Antigen B produced from hydatid cyst fluid is a promising option for serological identification of hydatid cysts in both infected and healthy individuals. In an indirect ELISA test, hydatid fluid antigen could be used as a precise source of detection.

Comparative analysis of Roux-en-Y cystojejunostomy versus conservative surgical strategies for giant hepatic hydatid cysts: A retrospective study

BackgroundThis retrospective study addressed the challenge of postoperative biliary fistula, a common complication observed after surgical management of giant hepatic hydatid cysts. The primary objective was to compare the efficacy and safety of conservative surgical techniques versus prophylactic Roux-en-Y cystojejunostomy (R-en-Y CJ) in addressing residual cavity. MethodsRetrospective analysis was conducted on patients who underwent surgical intervention for giant hepatic hydatid cysts with cysto-biliary communication from July 2021 to Jan 2024. Preoperative laboratory tests, imaging studies, surgical procedures, and postoperative outcomes were reviewed from medical records. Results32 patients who underwent surgery for giant hepatic hydatid cysts were included. There were 19 (59.38%) female patients, with a mean age of cohort was 39.13 years. The patients were divided into two groups with respect to the treatment modality: Group A (n = 14), treated with conservative surgical techniques and R-en-Y CJ, and Group B (n = 18), treated with conservative surgical methods. The overall cavity-related complications occurred in 9/18 (50%) in Group B, whereas 2/14 patients (14.29%) in Group A during the follow-up period (p < 0.05). ConclusionR-en-Y CJ is an effective and safe surgical procedure for tackling residual cavities in giant hepatic hydatid cysts with cysto-biliary communication.

CASE REPORT: GIANT HYDATID CYST OF THE LIVER IN A YOUNG PATIENT: SURGICAL MANAGEMENT AND LONG-TERM FOLLOW-UP

Hydatid disease, caused by the parasite Echinococcus granulosus, remains a significant public health issue in endemic areas, especially in rural settings. This report presents the case of an 18-year-old female patient residing in a rural area, with no significant medical history, who developed a symptomatic hepatic hydatid cyst. The patient was treated surgically without preoperative antiparasitic therapy and was placed on postoperative albendazole. The case highlights the importance of timely surgical intervention and long-term follow-up to prevent recurrence.

Surgical treatment of pulmonary hydatid disease: a nine-year single-center experience.

Hydatidosis is one of the most critical parasitic zoonotic diseases worldwide. Lungs are the second most common site of the disease.

Coinfection of pulmonary lophomoniasis, tuberculosis, and hydatid cyst in a pediatric autism patient: a case report and literature review

IntroductionAutism Spectrum Disorder (ASD) is a neurodevelopmental condition marked by difficulties in social interaction, communication, and repetitive behaviors or restricted interests. Although research on the link between ASD and parasitic diseases is limited, immune deficiency and inflammation may contribute to the development of parasitic infections.Case reportWe admitted a 14-year-old boy to the hospital who had a known history of ASD because he was presenting with respiratory symptoms, including cough and hemoptysis. During his time in the hospital, after conducting a series of tests and evaluations, we made a critical diagnosis of co-infection of lophomonas, tuberculosis, and hydatid cyst. In response to this diagnosis, we initiated a treatment plan that involved administering appropriate antibiotics as well as preparing for surgical intervention.ConclusionThis case report highlights the complexities and challenges of managing such a rare combination of co-infections with TB, pulmonary hydatid disease and lophomonas in a pediatric patient with underlying developmental considerations such as ASD.

The prevalence of hydatid cyst in raw meat products: a global systematic review, meta-analysis, and meta-regression

Hydatid cyst contamination in food presents a persistent and pervasive threat to public health. Hence, several studies have been published on hydatid cysts in raw meat products. The current study aimed to meta-analyze the prevalence of hydatid cysts in meat. The search was performed in international databases, including PubMed, Web of Science, Scopus, and Google Scholar, from January 1, 2000, to February 10, 2024. A meta-analysis of prevalence was conducted using the metaprop command in the subgroups of countries, animals, and WHO regions. Meta-regression of the prevalence of hydatid cysts in meat over time and sanitation services ranking was conducted using a random effects model (restricted maximum–-likelihood). Fifty-seven published references with 130 data reports were included in the study. The lowest and highest prevalence of hydatid cysts in raw meat was observed in Sudan at 0.01%, 95%CI (0.01–0.02) and Italy at 69.86%, 95%CI (68.14–71.55), respectively. The highest prevalence of hydatid cysts was observed in Sheep (12.32%), Cattle (11.85%), and Buffalo (10.65%). The lowest and highest prevalence of hydatid cysts was South-East Asian Reg (2.77%) and European Region (33.21%), respectively. Meta-regression showed that the prevalence of hydatid cysts has significantly decreased over time (p-value = 0.021) and insignificantly decreased with sanitation services ranking (p-value = 0.679). Therefore, in order to maintain the existing conditions and even reduce the burden of hydatidosis, public health education, promotion of hygienic practices, and investment need to be carried out continuously.

Evaluation of TNF-α Concentration Level in Al-Najaf Hospitals Patients Infected with Hydatid Cysts

Human echinococcosis is a zoonotic disease caused by a species of medical importance, the Echinococcus granulosus , an etiological agent of cystic echinococcosis (CE). A radiological examination will be performed for these patients to diagnose Echinococcus granulosus parasite by find echinococcal cysts. All of these patients were involved in this study and during the period starting from October 2023 to the end of January 2024, from all ages of patient from both sex (Males and Females At Al-Sader Medical City, AL-Hakeem General Hospital, AL-Haidarya general Hospital and Al-Hayat Hospital. The mean level of TNF-α in patients is 163.27 pg/ml, which is significantly higher than the mean level of 38.58 pg/ml in controls (p-value &lt; 0.001). The prevalence of hydatid disease in Al-Najaf Al-Ashraf in this study was 33%. Levels of the cytokines IL-6, TNF-α, IL-1ß, and IL-4 are more important in patients with Echinococcus granulosus under 40 years of age than in those over 40 years of age.

Hydatid disease contributes to spinal cord compression: a case report and literature review

BackgroundHydatid disease is an infectious disease caused by echinococcus that causes liver and lung damage in humans. Bone involvement is rare and accounts for only 0.5%-4% of hydatid diseases; the spine is more prone to be infected with a proportion of 50% in musculoskeletal tissue. Missed hydatid cysts may lead to serious consequence, it is necessary to diagnosis and treatment of hydatid cysts at early stage.Case presentationWe present a case of a 47-year-old Han Chinese male diagnosed with spinal hydatidosis. The patient lived in pasturing areas accompanied by symptoms of low back pain radiating to the legs, progressive weakness, and hypoesthesia in the lower limbs accompanied by difficulty walking. Computed tomography (CT) images showed a spinal hydatid cyst in the lumbar vertebra2 (L2) that caused bone destruction in the vertebral body and lamina. Magnetic resonance imaging (MRI) images showed hyperintense cystic components on L2 with the appearance of a lobulated, multiocular, septate cystic mass and compression of the spinal cord at the segments of L2. The patient underwent subtotal vertebral resection to completely remove the damaged vertebral and paravertebral cysts, and histopathological examination revealed the characteristic features of hydatid cysts. The patient received a postoperative antiparasitic drug treatment and finally achieved a successful treatment.ConclusionsSpinal hydatidosis is a rare infectious disease. It should be considered as an important differential diagnosis for patients accompanying by spinal bone destruction with animal contact history. Surgical removal combined with antiviral drugs is an effective way to treat spinal hydatidosis. In addition, long term follow-up is mandatory for avoiding its recurrence.

Chest Wall Hydatid Disease: Surgical management and risk Factors for Recurrence and Mortality

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

Hydatid cyst in the tail of the pancreas: a rare case report

Hydatid cysts, caused by Echinococcus granulosus, are rare but significant when found in the pancreas, particularly in endemic regions. This case report discusses a 32-year-old female with a pancreatic tail cyst presenting with epigastric pain and intermittent fever. Diagnostic imaging, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP), and serological tests were inconclusive, making preoperative diagnosis challenging. Differential diagnoses included pancreatic pseudocysts, benign neoplasms, abscesses, and other cystic lesions. The patient underwent surgical exploration, where a hydatid cyst was identified and treated with cyst removal, partial pericystectomy, and marsupialization. Postoperative management included albendazole therapy. Pancreatic hydatid cysts, though rare, should be considered in differential diagnoses for pancreatic cystic lesions, especially in endemic areas. Accurate diagnosis typically requires a combination of imaging, serology, and histopathological examination, with surgery often necessary for definitive diagnosis and treatment.

Working on new topics: Estimation of the burden of zoonotic diseases

Abstract Zoonoses, diseases naturally transmitted between vertebrates and humans, represent significant global health threats. These diseases not only affect human health but also impose a considerable burden on animal populations, emphasizing the need for a One Health approach that integrates strategies across human, animal, and environmental health sectors. The socioeconomic impacts of zoonoses are profound in low- and middle-income countries, disrupting production systems, impacting livelihoods, and compromising food security. Populations in these regions are excessively affected, highlighting the urgent need for a comprehensive approach. The disability-adjusted life year (DALY) quantifies disease burden in terms of morbidity and mortality. The zoonotic DALY (zDALY) expands this metric by incorporating the burden on animals through the ‘animal loss equivalents’, accounting for both fatal and non-fatal outcomes in livestock. However, zDALYs do not encompass broader economic impacts associated with prevention and treatment. Cost of illness (COI) studies further quantify the financial costs due to health issues; ad hoc approaches can be used to quantify other costs related to animal disease control and eradication, trade and movement Implications, or loss of consumer confidence. While few zoonoses, such as cystic echinococcosis and brucellosis, have comprehensive data across these metrics, most do not. While these metrics provide complementary insights, no holistic metric currently encompasses all necessary aspects to fully assess the burden of zoonoses within a One Health framework. This presentation aims to offer state-of-the-art estimates of the disease burdens of zoonoses, employing DALY, zDALY, and COI studies. It will explore how to integrate these metrics from a One Health perspective. Indeed, only by integrating health and economic metrics that consider the well-being of humans and animals, can the One Health approach effectively be developed for zoonotic diseases.

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.