Pregnancy and early post-natal outcomes of fetuses with functionally univentricular heart in a low-and-middle-income country

2020 ◽  
Vol 30 (12) ◽  
pp. 1844-1850
Author(s):  
Balu Vaidyanathan ◽  
Aparna Vijayaraghavan ◽  
Stephy Thomas ◽  
Abish Sudhakar
Keyword(s):  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Middle Income Country ◽  
Age At Diagnosis ◽  
Middle Income ◽  
Comfort Care ◽  
Live Births ◽  
Survival Status ◽  
Intention To Treat

AbstractBackground:Care of children with functionally univentricular hearts is resource-intensive.Objectives:To analyse pregnancy and early post-natal outcomes of fetuses with functionally univentricular hearts in the setting of a low–middle-income country.Methods:A retrospective study was conducted during the period of January 2008–October 2019. Study variables analysed included gestational age at diagnosis, maternal and fetal comorbidities and cardiac diagnosis including morphologic type of single ventricle. Outcomes analysed included pregnancy outcomes, type of post-natal care and survival status on the last follow-up.Results:A total of 504 fetuses were included. Mean maternal age was 27.5 ± 4.8 years and mean gestational age at diagnosis was 25.6 ± 5.7 weeks. Pregnancy outcomes included non-continued pregnancies (54%), live births (42.7%) and loss to follow-up (3.3%). Gestational age at diagnosis was the only factor that impacted pregnancy outcomes (non-continued pregnancies 22.5 ± 3.5 vs. live births 29.7 ± 5.7 weeks; p < 0.001). Of the 215 live births, intention-to-treat was reported in 119 (55.3%) cases; of these 103 (86.6%) underwent cardiac procedures. Seventy-nine patients (36.7%) opted for comfort care. On follow-up (median 10 (1–120) months), 106 patients (21%) were alive. Parental choice of intention-to-.treat or comfort care was the only factor that impacted survival on follow-up.Conclusions:Prenatal diagnosis of functionally univentricular hearts was associated with overall low survival status on follow-up due to parental decisions on not to continue pregnancy or non-intention-to-treat after birth. Early detection of these complex defects by improved prenatal screening can enhance parental options and reduce resource impact in low-and-middle-income countries.

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 (&gt;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 A novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
K. Sorsdahl ◽  
D. J. Stein ◽  
S. Pasche ◽  
Y. Jacobs ◽  
R. Kader ◽  
...  
Keyword(s):  
South Africa ◽  
Controlled Trial ◽  
Adverse Outcomes ◽  
Feasibility Trial ◽  
Control Group ◽  
Brief Treatment ◽  
Middle Income ◽  
Methamphetamine Use ◽  
Intention To Treat

Abstract Background Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD. Methods We enrolled 60 adults with a MAUD and randomly assigned them 1:1 to the IDMI intervention delivered by clinical psychologists and a control group who we referred to usual care. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, were calculated. Follow-up interviews were conducted at 6 weeks and 3 months post-enrollment. Results Over 9 months, 278 potential particiants initiated contact. Following initial screening 78 (28%) met inclusion criteria, and 60 (77%) were randomised. Thirteen of the 30 participants assigned to the treatment group completed the intervention. Both psychologists were highly adherent to the intervention, obtaining a fidelity rating of 91%. In total, 39 (65%) participants completed the 6-week follow-up and 40 (67%) completed the 3-month follow-up. The intervention shows potential effectiveness in the intention-to-treat analysis where frequency of methamphetamine use was significantly lower in the treatment than in the control group at both the 6 week and 3-month endpoints. No adverse outcomes were reported. Conclusions This feasibility trial suggests that the locally adapted IDMI intervention is an acceptable and safe intervention as a brief treatment for MAUD in South Africa. Modifications to the study design should be considered in a fully powered, definitive controlled trial to assess this potentially effective intervention. Trial registration The trial is registered with the Pan African Clinical Trials Registry (Trial ID: PACTR201310000589295)

Fetal abdominal cysts: antenatal course and postnatal outcomes

2019 ◽  
Vol 47 (4) ◽  
pp. 418-421
Author(s):  
Elisabetta Sanna ◽  
Stavros Loukogeorgakis ◽  
Thomas Prior ◽  
Iris Derwig ◽  
Gowrishankar Paramasivam ◽  
...  
Keyword(s):  
Gestational Age ◽  
Surgical Intervention ◽  
Antenatal Diagnosis ◽  
Age At Diagnosis ◽  
Single Centre ◽  
Intestinal Origin ◽  
Abdominal Cyst

Abstract Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0–38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery.

Leukemia during Pregnancy: 32 Cases from a Single Institution.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3153-3153
Author(s):  
Ayman Alhejazi ◽  
Mahmoud Aljurf ◽  
Entezam Sahovic ◽  
Fahed Almhareb ◽  
Irfan Maghfoor ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Gestational Age ◽  
Disease Free Survival ◽  
First Trimester ◽  
Underlying Disease ◽  
Salvage Chemotherapy ◽  
Cell Transplant ◽  
Single Institution ◽  
Live Births

Abstract In an attempt to evaluate the outcome of leukemia during pregnancy we performed a study of all such cases identified in our institution leukemia database. Thirty two cases were identified as cases of leukemia during pregnancy among the cohort of patients treated between January 1991 and July 2003. The cases were AML (15), ALL (6) and CML (11). At diagnosis the median age was 24.5 years and the median gestational age was 16 weeks. Twenty patients were treated for their leukemia during pregnancy at a median gestational age of 20 weeks (4 in the first trimester, 8 in the second trimester and 8 patients in the third trimester). Among the acute leukemia patients (n=21), 10 patients (47.6 %) received chemotherapy during pregnancy, 9 (90%) of them achieved CR and one patient needed salvage chemotherapy. Of these 10 patients, 7 had normal live births, one spontaneously aborted at 15 weeks of gestation and 2 had therapeutic abortion at 16 and 19 weeks of gestation. The remaining 11 (52.4%) were not given chemotherapy while pregnant as 3 patients (27.3%) presented late in their pregnancy after 34 weeks of gestation ending in normal live births and then received induction chemotherapy and 8 patients (72.7%) presented early in their pregnancy and they either spontaneously aborted or had a therapeutic termination of their pregnancy before starting chemotherapy. Among the CML patients (n=11), 9 patients received Hydroxyurea (HU) treatment during pregnancy, one patient received α-Interferon and one patient was treated with leukapheresis. Eight of the 11 patients (63.6%) had normal live births. Three patients (18.1%) aborted, 2 at 11 weeks of gestation while on HU treatment and one shortly after diagnosis before treatment. Of the total 32 patients 13 (40.6%) subsequently underwent allogeneic stem cell transplant, 8 for AML, 2 for ALL and 3 for CML. At a median follow up of 19.1 months, the disease free survival (DFS) and overall survival (OS) were 19% and 33.3% respectively for the acute leukemia patients. For CML patients, the OS was 90.9% at a median follow up of 38 months. The above data suggest that a high CR rate and satisfactory OS can be achieved in leukemia during pregnancy. Furthermore, chemotherapy did not lead to any teratogenic effects among live births. All spontaneous and therapeutic abortions were for disease related complications and not chemotherapy induced. This series of cases, which is the largest from a single institution, clearly supports early treatment of leukemia during pregnancy based on the underlying disease rather than concomitant pregnancy.

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.

Sign in / Sign up

Export Citation Format

Share Document