Use of Ivermectin to Treat an Institutional Outbreak of Scabies in a Low-Resource Setting

In a limited-resource hospital in Lima, Peru, 23 (63.9%) of 36 healthcare workers developed pruritus and/or skin lesions after contact with a patient with classic scabies. Of these 23, a total of 5 healthcare workers had scabies confirmed by microscopy. Oral ivermectin was used to control the outbreak effectively.

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The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study

Wellcome Open Research ◽

10.12688/wellcomeopenres.10352.2 ◽

2018 ◽

Vol 1 ◽

pp. 32 ◽

Cited By ~ 3

Author(s):

Rose McGready ◽

Moo Kho Paw ◽

Jacher Wiladphaingern ◽

Aung Myat Min ◽

Verena I. Carrara ◽

...

Keyword(s):

Preterm Birth ◽

Scale Up ◽

Limited Resource ◽

Gestational Trophoblastic Disease ◽

Exclusion Criteria ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Record Review

Background: Countries vary on the demarcation gestational age that distinguishes miscarriage and extreme preterm birth (PTB). This study provides a synopsis of the outcome of pregnancy between 22 to <28 weeks’ gestation from a low resource setting. Methods: A retrospective record review of a refugee and migrant population on the Thailand-Myanmar border with outcome between 22 to <28 weeks’ gestation, was conducted. Outcomes were classified as miscarriage: non-viability prior to 22 week’s gestation with expulsion of products between 22 to < 28 weeks’ gestation; or extreme PTB when the fetus was viable at ≥22 weeks and delivered between 22 to < 28 weeks’ gestation. Termination of pregnancy and gestational trophoblastic disease were excluded. Results: From 1995-2015, outcomes occurred between 22 to <28 weeks’ gestation in 0.9% (472/49,931) of pregnancies and 3.8% (18/472) met the exclusion criteria. Most included pregnancies (n=454) had ultrasound done 72.5% (n=329). Overall 43.6% (n=197) were miscarriage and 56.4% (n=257) extreme PTB. Miscarriage (late expulsion) between 22 to <28 weeks was observed with non-viability occurring at an estimated median gestation of 16 weeks. For cases with available data (n=252, 5 missing) the proportion of stillborn was 47.6% (n=120), liveborn 52.4% (n=132); and congenital abnormality 10.5% (24/228, 29 missing). Neonatal death was high 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as birth rather than miscarriage. Conclusion: In this low resource setting <1% of pregnancy outcomes occur in the 22 to <28 weeks’ gestation window; nearly half were miscarriage; and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.

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MANAGING PLACENTA ACCRETA SPECTRUM IN LOW RESOURCE SETTING USING A NOVEL DISSECTION-FREE AORTA CLAMP: OPERATIVE TECHNIQUE

10.22541/au.163256932.25508238/v1 ◽

2021 ◽

Author(s):

Vakkanal Paily ◽

Afshana Sidhik ◽

Raji Raj ◽

Ajithakumari Sudhamma ◽

Joshy Joseph ◽

...

Keyword(s):

Placenta Accreta ◽

Limited Resource ◽

Balloon Occlusion ◽

Low Resource ◽

Resource Setting ◽

Aortic Balloon Occlusion ◽

Low Resource Setting ◽

Placenta Accreta Spectrum ◽

Low Incidence ◽

Urological Injuries

A novel over-the-peritoneum aorta clamp enabled a senior obstetrician, backed by a urologist, to manage 33 women with histopathology-confirmed Placenta Accreta spectrum, with no maternal mortality, relatively low incidence of blood transfusion and urological injuries in a limited resource setting. Easily applied by the obstetricians themselves, this clamp can be an effective and relatively safer alternative to intra-aortic balloon occlusion and aortic-cross clamping. We anticipate, obstetricians in low-resource settings can easily adapt our methods and contribute further prospective evidence.

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Evaluating sensitivity and specificity of handheld point-of-care ultrasound testing for gynecologic pathology: a pilot study for use in low resource settings

BMC Medical Imaging ◽

10.1186/s12880-020-00518-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Marika Toscano ◽

Kam Szlachetka ◽

Natalie Whaley ◽

Loralei L. Thornburg

Keyword(s):

Sensitivity And Specificity ◽

Point Of Care ◽

Limited Resource ◽

Future Application ◽

Point Of Care Ultrasound ◽

Low Resource ◽

Quantitative Measurements ◽

Resource Setting ◽

Low Resource Setting ◽

Significant Difference

Abstract Background Point-of-care ultrasound (POC-US) is a diagnostic test conducted at the site of patient care with direct interpretation by the clinician, providing immediate results. POC-US for gynecologic application is not well characterized by current literature yet has the potential to increase access in limited resource settings. We compared the diagnostics of three POC-US devices for gynecologic (GYN) pathology and then performed evaluation of sensitivity and specificity of a single best POC-US device for intended use in a low resource setting. Methods This is prospective, pilot descriptive study of 60 subjects. In part 1, comparison of three POC-US devices was performed. Twenty subjects underwent POC-US with three test units [GE Vscan (Vscan), Sonosite Iviz (Iviz), Philips Lumify (Lumify)] followed by diagnostic ultrasound (Dx-US) for reference imaging. Image quality and correlation for devices was scored by blinded reviewers and quantitative measurements of GYN pathology were compared. In part 2, forty subjects underwent POC-US validation with the highest scoring device (Lumify) and Dx-US for reference imaging. Concordance of POC-US operator-interpreted diagnosis with reference imaging interpretation were assessed by Cohen’s unweighted kappa coefficient. Accuracy and agreement of POC-US were assessed by linear regression and Bland–Altman plot analysis. Sensitivity and specificity of POC-US for gynecologic pathologies were calculated. Results In aggregate qualitative measurements, Lumify and Iviz units performed superiorly to Vscan. There was no statistically significant difference in quantitative measurements between devices, but a trend towards lower mean error was seen for Lumify and Iviz as compared to Vscan. Lumify device had highest overall scoring and was selected for further testing. In validation comparison of Lumify to Dx-US, no statistically significant differences were found for measurements of endometrium, uterus, ovaries, adnexal pathology, or leiomyomata, (P < 0.02) with excellent agreement in operator-interpreted diagnosis (Kappa > 0.7). Sensitivity and specificity of detecting pathology was 80–100% with PPV and NPV 76–100%. Conclusion Among three POC-US devices, Lumify and Iviz devices show highest potential for successful application to clinical gynecologic ultrasound. Clinician-performed POC-US has high diagnostic accuracy, sensitivity, and specificity for basic GYN anatomy and pathology. POC-US is an acceptable and feasible diagnostic tool with potential for future application in a low resource setting to increase access to ultrasound.

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G273 Feasibility of triage training for non-healthcare workers in a low-resource setting

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310863.265 ◽

2016 ◽

Vol 101 (Suppl 1) ◽

pp. A154.2-A155

Author(s):

MCC Lee

Keyword(s):

Healthcare Workers ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study

Wellcome Open Research ◽

10.12688/wellcomeopenres.10352.3 ◽

2018 ◽

Vol 1 ◽

pp. 32

Author(s):

Rose McGready ◽

Moo Kho Paw ◽

Jacher Wiladphaingern ◽

Aung Myat Min ◽

Verena I. Carrara ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Scale Up ◽

Limited Resource ◽

Heart Beat ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Individual Record ◽

Record Review

Background : No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods : A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results : From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion : In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.

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Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽

10.2337/db18-93-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 93-LB

Author(s):

EDDY JEAN BAPTISTE ◽

PHILIPPE LARCO ◽

MARIE-NANCY CHARLES LARCO ◽

JULIA E. VON OETTINGEN ◽

EDDLYS DUBOIS ◽

...

Keyword(s):

Dose Adjustment ◽

Insulin Dose ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Quality indicators and post operative outcome of ERCP performed in a low resource setting ; can quality indicators from developed settings be applied?

10.26226/morressier.59a6b34bd462b80290b557f5 ◽

2017 ◽

Author(s):

Supun Kulatunge

Keyword(s):

Quality Indicators ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Operative Outcome

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Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

BMJ Case Reports ◽

10.1136/bcr-2020-239250 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239250

Author(s):

Vijay Anand Ismavel ◽

Moloti Kichu ◽

David Paul Hechhula ◽

Rebecca Yanadi

Keyword(s):

Plastic Material ◽

Successful Outcome ◽

Paraduodenal Hernia ◽

Transparent Plastic ◽

Low Resource ◽

Entire Small Bowel ◽

Resource Setting ◽

Low Resource Setting ◽

Right Paraduodenal Hernia ◽

Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

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