Free Flaps in a Resource Constrained Environment: A Five-Year Experience—Outcomes and Lessons Learned

Introduction. Free flap surgery is a routine procedure in many developed countries with good surgical outcomes. In many developing countries, however, these services are not available. In this paper, we audit free flaps done in a resource constrained hospital in Kenya. Objective. This is a five-year audit of free flaps done in a tertiary hospital in Kenya, between 2009 and 2014. Materials and Methods. This was a prospective study of patients operated on with free flaps between 2009 and 2014. Results. A total of one hundred and thirty-two free flaps in one hundred and twenty patients were performed during the five-year duration. The age range was eight to seventy-two years with a mean of 47.2. All the flaps were done under loupe magnification. The overall flap success rate was eighty-nine percent. Conclusion. Despite the many limitations, free flaps in our setup were successful in the majority of patients operated on. Flap salvage was noted to be low due to infrequent flap monitoring as well as unavailability of theatre space. One therefore has to be meticulous during surgery to reduce any possibilities of reexploration.

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A two-year study on postmenopausal bleeding at a tertiary institute

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210008 ◽

2021 ◽

Author(s):

Sowmyanarayanan Lavanya ◽

Swetha Munivenkatappa ◽

Anthata Jyothsna Sravanthi

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

Age Distribution ◽

Developed Countries ◽

Tertiary Hospital ◽

Care Hospital ◽

Postmenopausal Bleeding ◽

Medical Problems ◽

Set Up ◽

A Prospective Study

Background: The life expectancy of women shows an increase as a result of which women experience a long postmenopausal phase. Postmenopausal bleeding is a worrisome symptom occurring in 10 % of the women, making them seek a gynaecology opinion at the earliest. Women in developed countries have a predilection for developing endometrial cancer whereas cancer cervix still dominates in the developing countries. This prospective study was carried out on 75 women presenting with postmenopausal bleeding to the gynaecology clinic at a tertiary hospital set up. The study aimed to find the incidence of postmenopausal bleeding, age distribution, causes and different evaluation methods to confirm the diagnosis.Methods: The present study is a prospective study conducted on 75 postmenopausal women reporting with postmenopausal bleeding at the gynaecology clinic at a tertiary care hospital. Results: Menopause was noted above 45 years in 84% of the patients and 16% were in 40-45 years age. Postmenopausal bleeding was observed in 50-60 years in 56% of women and 30% above 60 years. The medical problems associated were hypertension (20%), diabetes (11%), obesity (22%), hypothyroidism (4%). 53 women had benign causes while 22 had malignancy.Conclusions: Benign lesions of the genital tract are common causes of postmenopausal bleeding. Carcinoma cervix and endometrium classically present with postmenopausal bleed. Strong suspicion, thorough evaluation and early diagnosis improve the quality of life and reduce the morbidity and mortality.

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Giant Euthyroid Goitre: Clinical Profile as Seen in Otorhinolaryngology Department of a Tertiary Health Institution, in Northwestern Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i430184 ◽

2019 ◽

pp. 1-9

Author(s):

Daniel Aliyu ◽

Kufre Robert Iseh ◽

Yikawe Stephen Semen ◽

Stanley Baba Amutta ◽

Joseph Hassan Solomon ◽

...

Keyword(s):

Early Stage ◽

Adult Population ◽

Geographical Location ◽

Tertiary Hospital ◽

Recurrent Laryngeal Nerve Injury ◽

Clinical Profile ◽

Thyroid Function Tests ◽

High Prevalence ◽

A Prospective Study ◽

Age Range

Background: Goiter refers to a diffuse enlargement of thyroid gland. It has a high prevalence in adult population in endemic areas where iodized salt is not part of the regular diet. Aim: We report the clinical profile of giant goiters seen in a tertiary hospital in Northwestern Nigeria. Methods: A prospective study of all surgically operated cases of goiter carried out in a tertiary health hospital in Northwestern Nigeria, over a period of 6 years between January 2011 and December 2016. Bio data, duration of goiter, symptoms, geographical location, thyroid function tests, radiological reports and treatment were recorded and analyzed. Results: Ninety-Seven patients were operated for goitre during the study period. Out of these 19 (19.6%) were giant goitres weighing between 900g-3200g. There were 13 (68.4%) females and 6 (31.6%) males with M: F ratio of 1:2.2. Age range was between 39 – 71 years with a mean age of 53.2 years. Prevalence was high in the 41-60 year age group. Duration of goiter in 13 (68.4%) of patients was between 11-20years. Retrosternal extension was observed in 7 (36.8%) patients. Tracheal deviation was the most common risk factor for respiratory complication in all the patients followed by tracheomalacia in 8(42.1%). Postoperative temporary Tracheostomy was carried out in 4(21.1%) of patients. Recurrent laryngeal nerve injury occurred in 2(10.5%). No mortality was recorded. Conclusion: Respiratory complications are commonly associated with giant goiters, a pathology that is entirely preventive if diagnosed and managed at an early stage.

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Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America

Journal of Medical Internet Research ◽

10.2196/16513 ◽

2019 ◽

Vol 21 (12) ◽

pp. e16513 ◽

Cited By ~ 8

Author(s):

Walter H Curioso

Keyword(s):

Latin America ◽

Rural Areas ◽

Training Programs ◽

Digital Health ◽

Unmet Need ◽

Developed Countries ◽

Lessons Learned ◽

Resource Constrained ◽

Challenges And Opportunities ◽

And Training

Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.

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Chronic lymphocytic leukaemia trends and features at a tertiary hospital in South Africa (2011–2016)

South African Journal of Oncology ◽

10.4102/sajo.v5i0.168 ◽

2021 ◽

Vol 5 ◽

Author(s):

Fungai Musaigwa ◽

Ravnit Grewal ◽

Akin Abayomi ◽

Carmen C. Swanepoel

Keyword(s):

Chronic Lymphocytic Leukaemia ◽

Lymphocytic Leukaemia ◽

Developed Countries ◽

Tertiary Hospital ◽

Men And Women ◽

Laboratory Service ◽

Younger Age ◽

Trisomy 12 ◽

Chromosome 13Q14 ◽

Age Range

Background: Chronic lymphocytic leukaemia (CLL) is a common lymphoproliferative disorder in developed countries. However, this condition is rare in Africa and there is a paucity of information on CLL, specifically on the continent.Aim: This study described, retrospectively, the frequency, demographics and laboratory features of CLL cases diagnosed from 2011 to 2016.Setting: Department of Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town.Methods: A retrospective analysis was performed for all CLL diagnoses made between 01 January 2011 and 31 December 2016.Results: Eighty CLL cases were diagnosed between 2011 and 2016. Men and women presented with the disease equally (48.8% vs. 51.2%, p 0.05). The mean age at diagnosis was 66.79 years (range of 37–95 years) and the modal age range (36.3%) was 60–69 years. Men presented with the disease at a significantly younger age than women (mean = 64 years vs. mean = 69.5 years, p 0.05). There were three (3.75%) human immunodeficiency virus (HIV)-positive patients (age range 43–50 years). Chromosome 13q14 deletion was found in 6 out of 19 patients (31.6%). Trisomy 12 and deletion 11q22 were found in 5 out of 21 (24%) and 7 out of 21 (33.3%) patients, respectively. Deletions 13q34 and 17p were negative for 6 and 20 patients, respectively.Conclusion: Chronic lymphocytic leukaemia at our facility presented equally in men and women. Men presented with the disease at a younger age than women. Additionally, our findings suggested that HIV is uncommon amongst CLL patients tested for HIV.

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Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America (Preprint)

10.2196/preprints.16513 ◽

2019 ◽

Author(s):

Walter H Curioso

Keyword(s):

Latin America ◽

Rural Areas ◽

Training Programs ◽

Digital Health ◽

Unmet Need ◽

Developed Countries ◽

Lessons Learned ◽

Resource Constrained ◽

Challenges And Opportunities ◽

And Training

UNSTRUCTURED Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.

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Prevalence and geographic distribution of haemophilia in Costa Rica

Hämostaseologie ◽

10.1055/s-0037-1619065 ◽

2010 ◽

Vol 30 (S 01) ◽

pp. S28-S31 ◽

Cited By ~ 1

Author(s):

J. Arroyo ◽

L. Salazar-Sánchez ◽

G. Jiménez-Cruz ◽

P. Chaverri ◽

E. Arrieta-Bolaños ◽

...

Keyword(s):

Costa Rica ◽

Survival Rates ◽

Coagulation Factors ◽

Developed Countries ◽

Health Centers ◽

Distribution Analysis ◽

Distribution Maps ◽

Immunodeficiency Virus ◽

The Many ◽

Low Prevalence

SummaryHaemophilia is the most frequent hereditary haemorrhagic illness and it is due to the deficiency of coagulation factors VIII (haemophilia A, HA) or IX (haemophilia B, HB).The prevalence of this disease varies according to the country, those having better survival rates having also higher prevalences. Specifically in Costa Rica, there are around 130 HA and 30 HB families. This study reports the prevalence and a spatial distribution analysis of both types of the disease in this country. The prevalence of haemophilia in this country is 7 cases per 100 000 men, for HA it is 6 cases per 100 000 and for HB it is 1 case per 100 000 male inhabitants. The prevalence of this disease is low when compared with other populations. This low prevalence could be due to the many patients that have died because of infection with human immunodeficiency virus during the 1980s. The prevalence of haemophilia in Costa Rica is almost one half of that present in developed countries. Nevertheless, the ratio between HA and HB follows world tendency: 5 : 1. In this study, nationwide geographical distribution maps were drawn in order to visualize the origin of severe cases and how this influences the pattern of distribution for both types of haemophilia. By means of these maps, it was possible to state that there is no association between the sites of maximum prevalence of mutated alleles and ethnicity. With this study, haemophilia prevalence distribution maps can be used to improve efforts for the establishment of hemophilia clinics or specialized health centers in those areas which hold the highest prevalences in this country. Also, this knowledge can be applied to improve treatment skills and offer the possibility of developing focused genetic counseling for these populations.

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Surveying adherence of dental clinic patients to preventive measures in oral cavity

Periodontology ◽

10.33925/1683-3759-2019-24-2-167-172 ◽

2019 ◽

Vol 24 (2) ◽

pp. 167-172 ◽

Cited By ~ 1

Author(s):

T. V. Kudryavtseva ◽

V. V. Tachalov ◽

E. S. Loboda ◽

L. Yu. Orekhova ◽

E. Yu. Nechai ◽

...

Keyword(s):

Oral Cavity ◽

Working Conditions ◽

Oral Hygiene ◽

Preventive Measures ◽

Periodontal Diseases ◽

Dental Health ◽

Developed Countries ◽

Dental Clinic ◽

The Many ◽

The Impact

Relevance. Periodontal diseases are a medical and social problem due to the wide spread among the population of developed countries and the impact on the quality of life. Among the many factors that are important in the development of inﬂammatory periodontal diseases, an important role is played by adherence to the recommendations of the dentist in respecting oral hygiene. Aim of the work was to study the adherence of patients of the dental clinic to compliance with preventive measures in the oral cavity.Materials and methods. A total of 98 patients of dental clinic, 62 female (medial age 38,6 ± 14,0 years) and 36 male (medial age 37,2±13,1 years) participated in survey. The study participants flled in the profle and answered questions about age, gender, harmful working conditions and bad habits, frequency of visits to the dental clinic, attitudes to the prevention of dental diseases, knowledge about the means and methods of oral hygiene.Results. As a result of the study, it was found that in the vast majority of cases, respondents are employed in production that does not adversely aﬀect their health (91%), only 8% of patients indicated harmful working conditions.Conclusions. The study revealed that, despite the recommendations of the dentist, patients are not always committed to the implementation of preventive measures in the oral cavity. Dentists need to motivate patients to use not only the usual methods and means of hygiene, but also additional ones necessary for maintaining dental health.

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A prospective study on covid‐19 convalescent plasma donor (CCP) recruitment strategies in a resource constrained blood centre.

ISBT Science Series ◽

10.1111/voxs.12639 ◽

2021 ◽

Author(s):

Durba Biswas ◽

Chikam Maiti ◽

Biplabendu Talukder ◽

Md Azharuddin ◽

Sayantan Saha ◽

...

Keyword(s):

Prospective Study ◽

Recruitment Strategies ◽

Resource Constrained ◽

Plasma Donor ◽

A Prospective Study

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Preparedness and response of a tertiary hospital to the COVID-19 pandemic in Nigeria: challenges, opportunities and lessons

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trab028 ◽

2021 ◽

Author(s):

Darlington E Obaseki ◽

Iriagbonse I Osaigbovo ◽

Esohe O Ogboghodo ◽

Omokhoa Adeleye ◽

Obehi A Akoria ◽

...

Keyword(s):

Public Health ◽

Personal Protective Equipment ◽

Tertiary Hospital ◽

Lessons Learned ◽

Protective Equipment ◽

Scientific Journals ◽

Healthcare Facilities ◽

Public Health Agencies ◽

Health Agencies ◽

Individual Healthcare

Abstract Africa was the last continent to be affected by the COVID-19 pandemic. Much of the discourse on Africa's response captured in scientific journals revolves around nations, public health agencies and organizations, but little is documented about how individual healthcare facilities have fared. This article reports the challenges faced in a tertiary hospital in Nigeria, including space constraints, diagnostic challenges, shortages in personal protective equipment and health worker infections. The opportunities and strengths that aided the response are also highlighted. The lessons learned will be useful to similar facilities. More information about health facility response at various levels is needed to comprehensively assess Africa's response to the pandemic.

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