Clinical Progress in the Management of Tetralogy of Fallot in the Dominican Republic: A Case Series

2017 ◽  
Vol 8 (5) ◽  
pp. 584-589
Author(s):  
María T. Perez ◽  
Marietta Vázquez ◽  
Michael F. Canarie ◽  
Janet Toribio ◽  
Juan León-Wyss
Keyword(s):  
Dominican Republic ◽  
Tetralogy Of Fallot ◽  
Congenital Heart ◽  
Care Setting ◽  
Case Series ◽  
Middle Income ◽  
Surgical Interventions ◽  
Time Of Surgery ◽  
Middle Income Countries ◽  
Complex Forms

Background: Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. Methods: We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. Results: According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. Conclusions: Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional “mission model” to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.

scholarly journals Mental health of children with neurodevelopmental disorders during COVID-19: A brief report of family experiences from a low and middle income country

2021 ◽  
pp. 135910452110260
Author(s):  
Sowmyashree M Kaku
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Neurodevelopmental Disorder ◽  
Case Series ◽  
Ground Level ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Difficulties ◽  
Similar Report ◽  
Low And Middle Income

COVID-19 has grossly impacted lives of people across the globe. In particular, children have also been affected due to closure of schools, therapy, and day care centers. Families have been challenged with new circumstances, and mental health professionals are coming up with novel ways to help these families who have children with mental health issues. This article describes experiences of families who have children with a diagnosed neurodevelopmental disorder with comorbid mental health difficulties and their ways of coping with the pandemic challenges. The series will throw light on ground level experiences of families during the pandemic, give insights into their ways of adapting, and brings out problem areas which healthcare professionals must work on, to design novel ways of care. The case series is novel and a similar report has probably not been presented from India or other low and middle income countries.

scholarly journals Considerations for Newborn Screening for Critical Congenital Heart Disease in Low- and Middle-Income Countries

2020 ◽  
Vol 6 (2) ◽  
pp. 49
Author(s):  
Bistra Zheleva ◽  
Sreehari M. Nair ◽  
Adriana Dobrzycka ◽  
Annamarie Saarinen
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Staff Training ◽  
Congenital Heart ◽  
Training Needs ◽  
Screening Service ◽  
Critical Congenital Heart Disease ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

We propose several considerations for implementation of critical congenital heart disease (CCHD) screening for low- and middle-income countries to assess health system readiness for countries that may not have all the downstream capacity needed for treatment of CCHD. The recommendations include: (1) assessment of secondary and tertiary level CHD health services, (2) assessment of birth delivery center processes and staff training needs, (3) data collection on implementation and quality surgical outcomes, (4) budgetary consideration, and (5) consideration of the CCHD screening service as part of the overall patient care continuum.

scholarly journals Penetrating Orbital-Cranial Injuries Management in a Limited Resource Hospital in Latin America

2015 ◽  
Vol 8 (4) ◽  
pp. 356-362 ◽  
Author(s):  
Glyn Estebanez ◽  
Diana Garavito ◽  
Laura López ◽  
JuanCarlos Ortiz ◽  
Andrés M. Rubiano
Keyword(s):  
Ct Angiography ◽  
Case Series ◽  
Limited Resource ◽  
University Hospital ◽  
Retrospective Case ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Occipital Lobes ◽  
Difficult Cases

Penetrating orbital-cranial injuries (POCIs) are difficult cases especially in hospitals in low-middle-income countries (LMIC) where resources are limited. We present a case series of POCI managed in a university hospital in such scenario. A retrospective case series was conducted including patients with POCI in 2011. Mechanism of injury, Glasgow Coma Scale score, imaging, medical and surgical management, complications, and Glasgow Outcome Scale (GOS) score were analyzed. A total of 30 patients with penetrating orbital injuries were admitted from March 2011 to December 2011. Of this group, only four patients were diagnosed with cranial penetration. Computed tomography (CT) angiography revealed orbital fractures and injury to frontal, temporal, or occipital lobes. Urgent craniotomy with isolation of ipsilateral carotid artery was performed. GOS score at discharge was 5 in three patients and 4 in one patient. POCIs are not uncommon in hospitals of LMIC. In such scenarios, a standard approach with CT angiography and early neurosurgical intervention results in good outcome.

Congenital Heart Disease in Low- and Lower-Middle–Income Countries: Current Status and New Opportunities

2019 ◽  
Vol 21 (12) ◽  
Author(s):  
Liesl Zühlke ◽  
John Lawrenson ◽  
George Comitis ◽  
Rik De Decker ◽  
Andre Brooks ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Current Status ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

2018 ◽  
Vol 7 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Chau Huynh ◽  
Minh NQ Huynh
Keyword(s):  
Global Health ◽  
Financial Burden ◽  
Surgical Care ◽  
Anaesthetic Management ◽  
Global Burden ◽  
Political Climate ◽  
Middle Income ◽  
Surgical Interventions ◽  
Middle Income Countries ◽  
Low And Middle Income

Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed “the neglected child of global health,” a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low- and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the current resolutions, such as humanitarian aid missions.

scholarly journals COVID-19 Mortality and Case-Fatality Rates in Sergipe State, Northeast Brazil, From April to June 2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Paulo R. Martins-Filho ◽  
Adriano A. S. Araújo ◽  
Marco A. O. Góes ◽  
Mércia S. F. de Souza ◽  
Lucindo J. Quintans-Júnior ◽  
...  
Keyword(s):  
Time Lag ◽  
Case Series ◽  
Case Fatality ◽  
Population Data ◽  
Population Based ◽  
Population Characteristics ◽  
Northeast Brazil ◽  
Middle Income ◽  
Middle Income Countries ◽  
Case Series Study

Information on how coronavirus disease 2019 (COVID-19) mortality is related to population characteristics in low- and middle-income countries is still limited. We described the deaths from COVID-19 in Sergipe state, Northeast Brazil, from April 2 to June 27, 2020. For this purpose, we conducted a study composed of (i) a case series study of all deaths due to COVID-19 and (ii) a population-based study to verify the behavior of the mortality and case-fatality rates (CFR) related to COVID-19. Data from 605 deaths due to COVID-19 were used to describe the characteristics of individuals with the disease, as well as the differences in gender, age, and comorbidities. Additionally, population data were extracted to estimate the mortality and CFR by population stratum. We also performed an adjusted CFR analysis including a time lag of 14 days between the onset of symptoms and reporting deaths. Of the 605 patients included in this study, 321 (53.1%) were males and the median age was 67.0 years. Most patients (n = 447, 73.9%) who died from COVID-19 had at least one pre-existing clinical condition. The mortality rate was 29.3 deaths per 100,000 inhabitants and the crude CRF was 2.6% (95% CI 2.4–2.8). CFR was higher in males (3.1%, 95% CI 2.8–3.4; p < 0.001) and people aged ≥60 years (14.2%, 95% CI 13.0–15.6; p = 0.042). About 25% of patients died during the first 24-h post-hospital admission. The adjusted CFR for a 14-day time lag was ~2-fold higher than the crude CFR over the study period.

scholarly journals Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028307 ◽  
Author(s):  
Sarah Rahman ◽  
Bistra Zheleva ◽  
K M Cherian ◽  
Jan T Christenson ◽  
Kaitlin E Doherty ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Low Income ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Middle Income Countries ◽  
Standardised Mortality Ratios ◽  
Per Capita

ObjectiveMany low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.DesignRetrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated.Setting and participantsThe International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included.Outcome measuresIn-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission.ResultsThe IQIC registry includes 24 917 congenital heart surgeries performed in children<18 years of age. The overall in-hospital mortality rate was 5.0%. Country-level congenital heart surgery standardised mortality ratios were negatively correlated with gross domestic product (GDP) per capita (r=−0.34, p=0.18), and health expenditure per capita (r=−0.23, p=0.37) and positively correlated with under-five mortality (r=0.60, p=0.01) and undernourishment (r=0.39, p=0.17). Countries with lower development had wider variation in mortality. GDP per capita is a driver of the association between some other measures and mortality.ConclusionsResults display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings.

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