Adults with Spastic Diplegic Cerebral Palsy living in a Low-To-Middle Income Country: A Six-Year Follow-up Study on Pain, Functional Mobility, Activity and Participation

2021 ◽  
pp. 101130
Author(s):  
Jacques du Toit ◽  
Maaike M. Eken ◽  
Robert P. Lamberts ◽  
Nelleke G. Langerak
Keyword(s):  
Cerebral Palsy ◽  
Middle Income Country ◽  
Functional Mobility ◽  
Income Country ◽  
Middle Income ◽  
Follow Up Study

scholarly journals Adherence and persistence of optimal medical therapy after myocardial infarction in a low to middle income country

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Villalobos-Pedroza ◽  
AP Flores-Batres ◽  
E Rivera-Pedrote ◽  
AA Brindis-Aranda ◽  
A Jara-Nevarez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Therapy ◽  
Middle Income Country ◽  
Income Country ◽  
Survey Study ◽  
Middle Income ◽  
Common Mean ◽  
Coronary Syndrome ◽  
Adherence To Medication

Abstract Funding Acknowledgements Type of funding sources: None. Background Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce. Purpose To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country. Methods We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables. Study population The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published. Results A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (>95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2). Conclusions In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.

scholarly journals Lessons learnt from enrolment and follow up of pregnant women and their infants in clinical trials in South Africa, a low-middle income country

Vaccine ◽  
2015 ◽  
Vol 33 (47) ◽  
pp. 6406-6412 ◽  
Author(s):  
Clare L. Cutland ◽  
Marianne Cunnington ◽  
Morounfolu Olugbosi ◽  
Stephanie A. Jones ◽  
Andrea Hugo ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Trials ◽  
Pregnant Women ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Lessons Learnt

Fifteen-Year Follow-Up of Stapedotomy Patients: Audiological Outcomes and Associated Factors in a Middle Income Country

2020 ◽  
pp. 1-8
Author(s):  
Daniel Peñaranda ◽  
Sergio Moreno ◽  
Felipe Montes ◽  
Juan Manuel Garcia ◽  
Zulehima Rico ◽  
...  
Keyword(s):  
Associated Factors ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income

scholarly journals Psychiatric sequelae in women who experience life-threatening complications during pregnancy in a low-and-middle income country (LMIC)

2020 ◽  
Author(s):  
Nadira Khamker ◽  
Johannes Lodewikus Roos
Keyword(s):  
Sleep Disturbances ◽  
Middle Income Country ◽  
Income Country ◽  
Psychotic Symptoms ◽  
University Hospitals ◽  
Middle Income ◽  
Life Threatening ◽  
Psychiatric Sequelae ◽  
Low And Middle Income

Abstract Purpose: Researchers compared psychiatric sequelae in women with life threatening complications during pregnancy (LT), and uncomplicated pregnancies (UP) in a low- and middle-income country (LMIC) over a 6-month follow-up period.Method: The study design was a mixed method and quantitative data was collected in a parallel convergent manner at two university hospitals in Gauteng, South Africa. Women from two groups, namely those with uncomplicated pregnancies and those with life threatening complications were followed up over a six-month period postnatally. Results: Eighty-nine women participated in the study of whom 46 experienced a life-threatening pregnancy complication. At six-week follow-up, 65.5% (n=19) of women in the LT-group and 29.2% (n=7) of the UP-group experienced symptoms of depression (p=0.08). In the LT-group, 30.4% (n=14) had anxiety symptoms compared to 7% (n=3) of UP-group (p=0.011). Compared to the UP-group, more women in the LT-group experienced somatic symptoms (28.3%, n=13, p=0.003) and sleep disturbances (28.3%, n=13, p=0.0009). More women in the LT-group reported memory disturbance 15.2% (n=7, p=0.034) compared to women in the UP-group. Psychotic symptoms were not prominent in either group.Conclusions: Women who experienced life-threatening complications at birth experienced significant distress including depression, anxiety, somatic complaints, sleep disturbances and memory deficits compared to women with uncomplicated pregnancies and deliveries. Maternal services for women with complicated deliveries should include a comprehensive package of obstetric, paediatric and psychiatric care that involves a multi-professional team.

scholarly journals Use of Idarucizumab in Ischemic Stroke: A National Experience in a Middle Income Country and a Concise Review.

2021 ◽  
Author(s):  
Julián Alejandro Rivillas ◽  
Arango Akemi ◽  
Bayona Hernán ◽  
Jaramillo Eugenia ◽  
Amaya Pablo
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Combined Therapy ◽  
Oral Anticoagulants ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Stroke Treatment

Abstract Background Despite receiving anticoagulation for primary or secondary prevention for atrial fibrillation, new embolic events may occur. Current stroke guidelines contraindicate the use of thrombolysis if oral anticoagulants are used within 48 hours of symptom onset. Idarucizumab may be an alternative for patients receiving dabigatran with an acute stroke when alteplase is indicated. We present a series of four cases of patients who received idarucizumab in neurological emergencies in a middle-income country in Latin America. Methods Using the national pharmacologic surveillance data, we retrospectively collected the cases of idarucizumab used in acute stroke, including retinal thrombosis in Colombia between 2018 and 2020. Results Four male patients with atrial fibrillation received thrombolysis for acute stroke, and two of them received mechanical thrombectomy. No major complications during hospitalization were present. One of the patients that received combined therapy presented with hematuria; the other patient that received thrombolysis presented with groin hematoma, but none required transfusion. All had favorable mRS at discharge and 90-day follow-up. Conclusion The use of thrombolysis after reversal with idarucizumab in patients with ischemic stroke is safe. Our patients presented favorable mRS at discharge and 90-day follow-up. The low number of cases is related to the poor availability of idarucizumab. Only 11 hospitals in 5 cities have storage of the medication. Stronger public policies are needed to guarantee optimal stroke treatment in patients with atrial fibrillation receiving anticoagulation, including access to reversal and reperfusion therapies to reduce further disability, especially in a middle-income country such as Colombia.

scholarly journals Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e050958
Author(s):  
Emmanuel Segnon Sogbossi ◽  
Solange Sotindjo Adon ◽  
Leontine Adjagodo ◽  
Solange Dossou ◽  
Hyppolite Dakè ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Young Children ◽  
Motor Function ◽  
Intensive Therapy ◽  
Lower Extremities ◽  
Middle Income Country ◽  
Income Country ◽  
Gross Motor ◽  
Middle Income ◽  
Randomised Controlled

IntroductionCerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children’s access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa.Methods and analysisForty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions.Ethics and disseminationThis study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01–2019/MS/CNHU-HKM/CEI/CUMPR). All participants’ parents/caregivers will provide their written informed consent. Data will be managed with confidentiality.Trial registration numberPACTR201911894444879.

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