scholarly journals An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource-Limited Setting

2022 ◽  
Author(s):  
Somy Charuvila ◽  
Tasmiah Tahera Aziz ◽  
Sarah E. Davidson ◽  
Ummay Naznin ◽  
Shiuly Sinha ◽  
...  
Keyword(s):  
Observational Study ◽  
Management Strategies ◽  
Transfusion Practice ◽  
Major Surgery ◽  
Blood Testing ◽  
Optimal Care ◽  
Middle Income ◽  
Resource Limited ◽  
Low Middle Income Countries ◽  
Preoperative Anaemia

Abstract Background Paediatric anaemia is highly prevalent in low–middle-income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource-limited settings: balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices. To address this, a joint UK–Bangladesh team conducted an observational study at a paediatric surgical centre in Bangladesh. Methods A total of 464 patients ≤16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes. Results Median age was 4 years and 73% were male. 32.5% (151/464) patients had preoperative blood testing for anaemia. 17.5% (81/464) children were transfused preoperatively. Of those children transfused, 40.7% (33/81) underwent transfusion solely based on visible signs of anaemia on clinical examination. Seventy-five percentage (36/48) of children who underwent transfusion after blood testing had haemoglobin ≥80 g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia. Conclusion A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and reduction in laboratory costs incurred by families when clinical suspicion of anaemia was high. Further research is needed to analyse the potential of using bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.

scholarly journals Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

2021 ◽  
pp. bmjinnov-2021-000837
Author(s):  
Hariharan Subbiah Ponniah ◽  
Viraj Shah ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
George Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Case Reports ◽  
Surgical Care ◽  
Cochrane Collaboration ◽  
Optimal Care ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ObjectiveThis systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).DesignA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.Data sourcesEMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.Eligibility criteria for selecting studiesAll original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.ResultsThere were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.ConclusionThe presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

scholarly journals LINC-10. SIOP PODC ADAPTED TREATMENT GUIDELINES FOR CRANIOPHARYNGIOMA IN LOW- AND MIDDLE-INCOME SETTINGS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii379-iii380
Author(s):  
Nisreen amayiri ◽  
Ariane Spitaels ◽  
Mohamed Zaghloul ◽  
Anthony Figaji ◽  
Sergio Cavalheiro ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Pediatric Oncology ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Care Providers ◽  
Middle Income ◽  
Service Levels ◽  
Resource Limited ◽  
Low Middle Income Countries ◽  
Available Resources

Abstract Pediatric craniopharyngioma is a rare tumor with excellent survival but significant long-term morbidities due to the loco-regional tumor growth or secondary to its treatment. Visual impairment, panhypopituitarism, hypothalamic damage and behavioral changes are amongst the main challenges. This tumor should be managed under the care of a multidisciplinary team to determine the optimum treatment within the available resources. This is particularly important for low middle-income countries (LMICs) where resources are variable. We provide a risk-stratified management guideline for children diagnosed with craniopharyngioma in a resource limited setting based on the service levels describing the facilities and personnel required for management as previously specified by the Pediatric Oncology in Developing Countries (PODC) committee of The International Society of Pediatric Oncology (SIOP). A multi-disciplinary group of neurosurgeons, radiation and pediatric oncologists, radiologists, pediatric endocrinologists and an ophthalmologist with experience in managing children with craniopharyngioma in LMIC setting was formed and carried online meetings to form a consensus guideline. The clinical characteristics (including the visual and endocrine presentations), suggestive radiological features as well as potential treatment options including surgery, radiotherapy and intra-cystic therapies were discussed in depth and in relation to available resources. In addition, hormonal management, pre- and post-operative PICU care and expected future complications related to craniopharyngioma and to follow up these children were discussed and documented in the guideline. We believe this guideline is a useful reference for health care providers in LMIC.

scholarly journals Nucleic Acid–Based Rapid Detection of Tuberculosis and Rifampicin Resistance in a Resource-Limited Setting

2021 ◽  
Author(s):  
Michael Abel Alao
Keyword(s):  
Nucleic Acid ◽  
Urban Communities ◽  
Molecular Beacon ◽  
Paediatric Population ◽  
Early Morning ◽  
Global Village ◽  
Middle Income ◽  
Resource Limited ◽  
Low Middle Income Countries ◽  
Sensitivity Specificity

Abstract BackgroundThe GeneXpert MTB/RIF assay for the diagnosis of tuberculosis (TB) and its uptake has been limited in most developing countries. This may lead to under-diagnosis, ineffective treatment and high mortality. We determine the prevalence of Mycobacterium tuberculosis (MTB) and Rifampicin-resistant TB using a nucleic acid–based test and AFB-smear in a Nigerian population.MethodsWe analyzed a single early morning sputum and extrapulmonary specimen from suspected cases of TB. Smear microscopic and real-time PCR for the detection of MTB and mutation on the rpoB gene using a molecular beacon was performed. ResultsThe median age of the participants was 40 years (range: 6 weeks to 120 years). The incidence of MTB and RR-TB determined using GeneXpert were 620 (16.6%) and 59(1.6%), respectively. Acid-fast bacilli (AFB) smear identified AFB only in 2 out of 59(3.4%) cases with RR-TB. The agreement between the paired test of GeneXpert and AFB smear was poor (Kappa = 0.009, p = 0.01; McNemar’s p < 0.0001). AFB sensitivity, specificity positive and negative predictive value were 2.4%, 98.2%, 1.9 and 98.1 respectively. The distribution of the RR-TB are more prominent among new TB-AFB-negative cases, those residing in densely populated semi urban communities and migrants at border towns. Conclusion The GeneXpert test shows a high detection for MTB in the paediatric population but a lower RR-TB than the national average. There is a need for aggressive escalation of the nuclei acid based test in low middle-income-countries in order to achieve the end TB strategy in a global village.

scholarly journals Antidoping Concept of Play Clean to Win Clean: Implication of Herbal Supplements uses for Athletes in Competitive Sports

2021 ◽  
pp. 39-58
Author(s):  
John Dobgima Fonmboh ◽  
Estella Achick Tembe Fokunang ◽  
Ngono Mballa Rose ◽  
Tama Wango ◽  
Richard Abah Ejoh ◽  
...  
Keyword(s):  
Critical Issue ◽  
Competitive Sports ◽  
Herbal Supplement ◽  
Herbal Supplements ◽  
Herbal Products ◽  
Middle Income ◽  
As Doping ◽  
Supplement Use ◽  
Resource Limited ◽  
Low Middle Income Countries

The popularity of doping in competitive sports is relevant for all those involved in sports, particularly for evaluating anti-doping policy measures. However, there is a gap of information that addresses this subject so far. As a consequence, the prevalence of doping in competitive sports in resource limited countries is unknown. Even though it is challenging to uncover the exact prevalence of herbal products with prohibited activity such as doping, various methods put in place by world antidoping agency (WADA) have now been adopted to uncover parts of this particular problem, and enables the circumvention to some extend the issues of honesty, definition problems and the limits of pharmacological evidence. It is evident that current doping control test results can show a distinct underestimation of true doping prevalence in low middle income countries (LMIC). Nowadays, doping is a critical issue at international levels of sporting competitions. Athletes’ use of herbal supplements has seen a significant increase in the past two decades. At the top of the list of popular herbs used in sports are echinacea and ginseng, whereas garlic, St. John’s wort, soybean, ephedra and others are also gaining popularity or have been historically prevalent. Despite the increasing popularity of herbal supplements, recent events have illustrated possible concerns regarding efficacy and safety of herbal supplements usage. Remarkable sports performances at the end of the 20th century raised suspicions about herbal supplement use by athletes, prompting the formation of WADA. With WADA creation it was not long when the deaths of two professional athletes raised concerns that the herbal supplement ephedra, may have contributed to their deaths. These events and others have prompted clinicians and scientists to reexamine and evaluate the role of herbal supplements in competitive sports. This review attempts to give an insight into the use of herbal supplement in doping within the concept of play clean to win clean. An attempt has been made to provide guidance on the efficacy and side effect of most used herbal supplements found in sporting activities, especially in international competitive sports.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

2020 ◽  
Author(s):  
Larrey Kamabu ◽  
Hervé Monka Lekuya ◽  
Bienvenu Muhindo Kasusula ◽  
Nicole Kavugho Mutimani ◽  
Louange Maha Kathaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

scholarly journals Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045005
Author(s):  
Fadia Gamieldien ◽  
Roshan Galvaan ◽  
Bronwyn Myers ◽  
Zarina Syed ◽  
Katherine Sorsdahl
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Scoping Review ◽  
Data Extraction ◽  
Flow Diagram ◽  
Personal Recovery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Perspectives ◽  
Low Middle Income Countries

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

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