Development of an Efficient, Non-Invasive Method for Cardiovascular Disease Risk Stratification in a Resource-Limited Setting

2019 ◽  
Vol 12 (2) ◽  
pp. 91-99
Author(s):  
Biswarup Pramanik ◽  
Amit Ghosh
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Tertiary Care ◽  
Care Hospital ◽  
Resource Limited Settings ◽  
Non Invasive ◽  
Resource Limited ◽  
Increasing Risk ◽  
Risk Categories

Background: Augmentation Index (AIx) is considered as an important predictor of cardiovascular disease. So, quantification of AIx may provide a rapid cost-effective and non-invasive means of cardiovascular risk stratification. At present, WHO/ISH risk prediction charts are used to predict 10-year risk of a fatal or nonfatal major cardiovascular event, an assessment which requires laboratory support for blood chemistry and thus making it ill-suited for resource-limited settings. Objectives: In this study, we examined the association of AIx with cardiovascular risk as determined by the WHO/ISH chart and identified AIx cut-offs to stratify patients into different risk categories. Methods: A case-control study with 162 cases and 61 controls was conducted in a tertiary care hospital in eastern India. Data were obtained for demographic, anthropometric, cardiovascular, and biochemical parameters. Cardiovascular risk assessment was carried out by WHO/ISH risk model in R. Statistical analysis was done for examining the association of AIx with WHO/ISH cardiovascular risk and for identifying AIx cut-offs to stratify patients into different risk categories. Results: Box and whisker plots for assessing the correlation between AIx and WHO/ISH cardiovascular risk showed an increase in the median value of AIx with increasing risk in both cases and controls. Heart rate corrected AIx showed a steady increase with increasing risk in males. AIx cutoffs showed good sensitivity and specificity for each risk category. Conclusions: AIx is remarkably associated with cardiovascular risk as assessed by the WHO/ISH chart and the AIx cut-offs obtained in the study can be used as an efficient, non-invasive surrogate biomarker of cardiovascular risk even in resource-limited settings.

scholarly journals Feasibility of the home isolation programme for adults and children with COVID-19

2020 ◽  
Vol 7 (11) ◽  
pp. 1647
Author(s):  
Purwa Doke ◽  
Jitendra S. Oswal ◽  
Disha A. Padalkar ◽  
Mohit P. Jain
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Morbid Condition ◽  
Resource Limited Settings ◽  
Once Daily ◽  
Use Of Resources ◽  
Resource Limited ◽  
Hospital Beds ◽  
Adults And Children

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused an upsurge of cases in many countries leading to inadequate quarantine facilities and hospital beds. Studies on the feasibility of home isolation for COVID-19 patients are the need of the hour. This is the first study from India on the feasibility of home isolation to the best of the author's knowledge.Methods: This methodical study was conducted at a designated COVID-19 tertiary care hospital in India, which included all patients enrolled for the home isolation programme from the 4 July to 3 August 2020. Laboratory confirmed COVID-19 patients were assessed during the enrolment for their eligibility for home isolation. The enrolled patients were followed up once daily over a telephonic call with objective parameters like temperature, pulse and oxygen saturation.Results: There were a total of 447 adults and 67 children. Amongst adults, hypertension was the most common co-morbid condition seen in 23 (5.15%) followed by diabetes in 18 (4.03%) patients. Only 24 (5.37%) patients were hospitalised during the duration of home isolation due to reasons like persistent fever, decreased SpO2, and non-medical ones like anxiety regarding the disease. Age and the presence of co-morbidities were directly related to the requirement of hospitalisation. No children required hospitalisation. There were no deaths.Conclusions: Home isolation is effective for COVID-19 patients in resource limited settings. We provide strong evidence for adapting it for asymptomatic and mild symptomatic cases with judicious use of resources and without compromising the risk to patients.

MEASURING FOOT LENGTH TO IDENTIFY VULNERABLE NEWBORNS IN NEED OF EXTRA CARE: A CROSS SECTIONAL HOSPITAL BASED STUDY IN SOUTH INDIA

2021 ◽  
pp. 78-80
Author(s):  
Anu Varshni ◽  
Sujitha Sujitha ◽  
Sujatha Sridharan
Keyword(s):  
Birth Weight ◽  
Health Workers ◽  
Tertiary Care ◽  
Care Hospital ◽  
Resource Limited Settings ◽  
Cross Sectional ◽  
Predictive Values ◽  
Targeted Interventions ◽  
Foot Length ◽  
Resource Limited

Background: Neonatal mortality remains high in many developing country settings mainly because of low birth weight (LBW) or preterm births (PTB). Easy-to-use anthropometric parameters like foot length which are appropriate for resource-limited settings are necessary, to guarantee these neonates are distinguished and alluded as required for extra care. This research aimed to estimate the sensitivity and specicity, and the positive and negative predictive values of newborn foot length to identify babies who are LBWand PTB. Materials and Methods: A cross-sectional study of newborn babies in a tertiary care hospital was carried out between July to September 2018. Foot length, birth weight and gestational age were estimated on the rst day of life. Receiver Operating Characteristic (ROC) curves were plotted to determine the operational cut-offs. Results: In hospital 150 babies were recruited and measured within 24 hours of birth. Of the 150 babies, 21 (14.00%) were born LBW (<2500 grams) and 77 (51.33%) were PTB. Mean foot length on the rst day was 7.62 ± 0.47 cm. Day one average foot length 7.32 cm at birth was 84.5% (77.70 – 89.89) sensitive and 90.5% (84.64 – 94.68) specic to identify birth weight ≥2500 grams; foot length 7.47 cm had sensitivity and specicity of 76.70% (69.11 – 83.21) and 49.4% (41.15 – 57.68) to identify those having term births. Conclusion: Measurement of newborn foot length for home births in resource-limited settings has the potential to be used by birth attendants, community health workers so that vulnerable newborns can be identied and receive targeted interventions for improved survival.

scholarly journals Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Richard Kwizera ◽  
Andrew Katende ◽  
Felix Bongomin ◽  
Lydia Nakiyingi ◽  
Bruce J. Kirenga
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Diagnostic Criteria ◽  
Tertiary Care ◽  
Chest Imaging ◽  
Resource Limited Settings ◽  
Pulmonary Aspergillosis ◽  
Resource Limited ◽  
Chronic Pulmonary Aspergillosis ◽  
Hiv Negative

Abstract Background Diagnosis of chronic pulmonary aspergillosis (CPA) is based on a combination of clinical symptomatology, compatible chest imaging findings, evidence of Aspergillus infection and exclusion of alternative diagnosis, all occurring for more than 3 months. Recently, a rapid, highly sensitive and specific point-of-care lateral flow device (LFD) has been introduced for the detection of Aspergillus-specific immunoglobulin (Ig)G, especially in resource-limited settings where CPA is underdiagnosed and often misdiagnosed as smear-negative pulmonary tuberculosis (PTB). Therefore, in our setting, where tuberculosis (TB) is endemic, exclusion of PTB is an important first step to the diagnosis of CPA. We used the recently published CPA diagnostic criteria for resource-limited settings to identify patients with CPA in our center. Case presentation Three Ugandan women (45/human immunodeficiency virus (HIV) negative, 53/HIV infected and 18/HIV negative), with a longstanding history of cough, chest pain, weight loss and constitutional symptoms, were clinically and radiologically diagnosed with PTB and empirically treated with an anti-tuberculous regimen despite negative microbiological tests. Repeat sputum Mycobacteria GeneXpert assays were negative for all three patients. On further evaluation, all three patients met the CPA diagnostic criteria with demonstrable thick-walled cavities and fungal balls (aspergilomas) on chest imaging and positive Aspergillus-specific IgG/IgM antibody tests. After CPA diagnosis, anti-TB drugs were safely discontinued for all patients, and they were initiated on capsules of itraconazole 200 mg twice daily with good treatment outcomes. Conclusions The availability of simple clinical diagnostic criteria for CPA and a LFD have the potential to reduce misdiagnosis of CPA and in turn improve treatment outcomes in resource-limited settings.

Sa104 PERFORMANCE OF LOWER GI BLEED RISK STRATIFICATION TOOLS IN A LARGE TERTIARY CARE HOSPITAL

2021 ◽  
Vol 160 (6) ◽  
pp. S-422-S-423
Author(s):  
Randy Cheung ◽  
Yousef Fazel ◽  
Gina Sparacino ◽  
Sarah Sadek ◽  
Muhammad Tahir ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Large Tertiary Care ◽  
Gi Bleed

scholarly journals Lessons from the frontlines: a junior doctor’s experience of the first wave of the COVID-19 pandemic in a resource-limited setting

2021 ◽  
pp. medhum-2020-012109
Author(s):  
Brabaharan Subhani ◽  
Dilushi Wijayaratne ◽  
Saroj Jayasinghe
Keyword(s):  
Structural Changes ◽  
Tertiary Care ◽  
Medical Officer ◽  
Healthcare Services ◽  
Care Hospital ◽  
Generic Skills ◽  
Quality Healthcare ◽  
Resource Limited ◽  
Uncertain Future ◽  
Second Wave

COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.

ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 43-47
Author(s):  
Veenit Kumar Prasad ◽  
Bapilal Bala ◽  
Biswadev Basumazumder ◽  
Achintya Narayan Ray
Keyword(s):  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Transient Elastography ◽  
Wide Spectrum ◽  
Tertiary Care ◽  
Disease Patient ◽  
Liver Stiffness ◽  
Care Hospital ◽  
Non Invasive ◽  
Number Of Patients

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

scholarly journals Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

2021 ◽  
Vol 9 ◽  
Author(s):  
Audrey Marilyn Smith ◽  
Hendry R. Sawe ◽  
Michael A. Matthay ◽  
Brittany Lee Murray ◽  
Teri Reynolds ◽  
...  
Keyword(s):  
Parental Education ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Transportation Systems ◽  
Care Hospital ◽  
Delayed Presentation ◽  
Suspected Infection ◽  
Logistic Regression Models ◽  
Resource Limited ◽  
Pediatric Sepsis

Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (&gt;48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.

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