Delayed death after hyena bite in a 3-year-old Tanzanian boy: the unique reality of neurosurgery in a resource-limited setting

A 3-year-old boy presented after a hyena bite to the skull in Tanzania. A large degloving wound with herniating cerebrum was seen in the right parietotemporal region. A CT scan confirmed a large 8-cm skull defect. The patient was taken for irrigation and debridement, but due to significant tissue loss, the skin could not be closed. CSF leaked from the wound, and two additional operations for attempted closure were undertaken but failed. The plastic surgery team was consulted, but no closure was done because of the procedure’s complexity, lack of resources, and cost. CSF diversion could not be performed due to no available lumbar catheter or external ventricular drain. Meningitis developed, leading to severe hyponatremia and death. The current case highlights both the unique mechanism of a hyena bite requiring neurosurgical intervention and the realities of practicing neurosurgery in a low-resource setting.

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Carcinoma of the Breast in Low Resource Setting: A Surgical Case Series from Rural India

Christian Journal for Global Health ◽

10.15566/cjgh.v8i1.539 ◽

2021 ◽

Vol 8 (1) ◽

pp. 78-86

Author(s):

Royson Dsouza ◽

Anish Jacob Cherian ◽

Mrudula Rao ◽

Nandakumar Menon

Keyword(s):

Rural Women ◽

Tertiary Care ◽

Case Series ◽

Standard Of Care ◽

Comprehensive Management ◽

Common Cancer ◽

Resource Limited ◽

Resource Setting ◽

Low Resource Setting ◽

Tertiary Care Centers

The burden of breast cancer has been on the rise world over and has become the most common cancer among women in urban India and the second most common cancer in rural women after carcinoma cervix. There is a considerable delay in presentation associated with a lack of access to adequate and timely surgical intervention. Consequently, most patients present to tertiary care centers in advanced or inoperable stages. Many subsets of these patients can be managed adequately in resource-limited rural surgical centers. In this series of patients diagnosed with carcinoma breast, we have outlined comprehensive management that is possible in resource-constrained settings. The challenges in adhering to the standard of care and strategies to overcome these limitations have been discussed with a relevant review of the literature.

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Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182320 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2202

Author(s):

Ekta Sahu ◽

Jyoti Nath Modi

Keyword(s):

Diagnostic Laparoscopy ◽

Significant Proportion ◽

Secondary Infertility ◽

Primary Infertility ◽

Resource Limited ◽

Resource Setting ◽

Pelvic Ultrasonography ◽

Low Resource Setting ◽

Operative Findings ◽

Work Up

Background: Diagnostic laparoscopy and hysteroscopy are considered the gold standard for diagnosing pelvic pathology in women among couples with infertility or subfertility. Knowledge of common pathologies in these patients would help plan investigations and deliver better care especially in resource limited settings. The current study was carried out to analyse the clinical-demographic profile and operative findings among women with subfertility undergoing diagnostic laparoscopy-hysteroscopy over a 4 years period.Methods: A retrospective record-based study conducted in the Department of Obstetrics and Gynaecology of People’s Hospital, PCMS and RC, Bhopal from 1st January 2013 to 31st December 2016 (4 years).Results: Sixty-two records of women with primary/ secondary infertility who underwent diagnostic laparoscopy-hysteroscopy during the study period satisfied the inclusion and exclusion criteria and were analyzed. Among these, 54 (87.09%) couples had primary infertility and 8 (12.9%) had secondary infertility. The mean age of women was 27.1 years (range 20-38 years; SD4.43). One third of women had more than 5 years duration of infertility. Eight (13%) had menstrual abnormalities. One or more tubal abnormality was found on diagnostic laparoscopy in 33.8% of all cases (31.4% of women with primary infertility and 50 % of women with secondary infertility). Pelvic adhesions (25.8%), endometriosis (24.2%) and evidence of acute or chronic pelvic inflammatory disease (19.3%) were the other leading abnormalities.Conclusions: While it is possible to suspect many abnormalities by a detailed history, a good examination and preliminary investigations such as the pelvic ultrasonography, a significant proportion of abnormalities such as the tubal abnormalities, endometriosis and pelvic adhesions can only be detected with certainty on laparoscopy. Hence it is recommended that diagnostic laparoscopy should be an early part of infertility work up.

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Social Stigma and Other Consequences of COVID-19 Pandemic in Low Resource Setting, in Eastern Africa: The Need to Increase Preventive Efforts and Addressing the Consequences, 2020

10.47363/jmcn/2020(1)107 ◽

2020 ◽

pp. 1-4

Author(s):

Shewangizaw Haile Mariam ◽

◽

Mengistu Abayneh ◽

Keyword(s):

Social Stigma ◽

Health Impact ◽

Social Consequences ◽

Eastern Africa ◽

Care Services ◽

Resource Limited ◽

Resource Setting ◽

Low Resource Setting ◽

Health Related ◽

And Control

Since the emergency of COVID-19 pandemics, many countries have been encountered a multitude of challenges. People have been facing health related and other social consequences throughout the world. It is too early to know the aggravated impact of COVID-19 on people living in resource-limited setting, like east Africa countries. In these countries, besides direct public health impact, the COVID-19 pandemic has provoked social stigma and discriminatory behaviors against people of certain ethnic backgrounds as well as anyone perceived to have been in contact with the virus. Social stigma can negatively affect those with the disease, as well as their caregivers, family, friends and communities. COVID-19 pandemics have also been provoked great impacts on daily social consumptions such as food and other food supplements. In addition, COVID-19 pandemic were overshadowed endemics diseases such as malaria, TB and HIV related care and antenatal care services as well as other non-communicable diseases prevention and control. Social stigma coupled with other consequences could result in more severe health problems, can undermine social cohesion and prompt possible social isolation of groups, which might contribute to a situation where the virus is more, not less, likely to spread and difficulties controlling a disease outbreak. Therefore, how we communicate about COVID-19 is critical in supporting people to take effective action to help combat the disease and to avoid fuelling fear and stigma. An environment needs to be created in which the disease and its impact can be discussed and addressed openly, honestly and effectively. This is a message for government, media and local organizations working on the COVID-19 infections.

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Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v4i1.176 ◽

2015 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Julia Driessen ◽

Henry Limula ◽

Oliver J. Gadabu ◽

Gervase Gamadzi ◽

Edwin Chitandale ◽

...

Keyword(s):

Formal Analysis ◽

Laboratory Data ◽

Quality Audit ◽

Laboratory Service ◽

Low Resource ◽

Resource Limited ◽

Laboratory Services ◽

Resource Setting ◽

Low Resource Setting ◽

Resource Laboratory

Background: There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure.Objectives: This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and proposes ways in which informatics can bolster the efficiency and role of low-resource laboratory systems.Methods: We evaluated previously-collected data on three different aspects of laboratory use. A four-week quality audit of laboratory test orders quantified challenges associated with collecting viable specimens for testing. Data on tests run by the laboratory over a one yearperiod described the magnitude of the demand for laboratory services. Descriptive information about the laboratory workflow identified informational process breakdowns in the pre-analytical and post-analytical phases and was paired with a 24-hour sample of laboratory data on results reporting.Results: The laboratory conducted 242 242 tests over a 12-month period. The four-week quality audit identified 54% of samples as untestable. Prohibitive paperwork errors were identified in 16% of samples. Laboratory service workflows indicated a potential process breakdown in sample transport and results reporting resulting from the lack of assignment of these tasks to any specific employee cadre. The study of result reporting time showed a mean of almost six hours, with significant variation.Conclusions: This analysis identified challenges in each phase of laboratory testing. Informatics could improve the management of this information by streamlining test ordering and the communication of test orders to the laboratory and results back to the ordering physician.

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Challenges to Bringing Personalized Medicine to a Low-Resource Setting in Peru

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041470 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1470

Author(s):

Nelly Solis ◽

Elizabeth Zavaleta ◽

Patrik Wernhoff ◽

Constantino Dominguez-Barrera ◽

Mev Dominguez-Valentin

Keyword(s):

Low Income ◽

Age Of Onset ◽

Genomic Research ◽

Mortality And Morbidity ◽

Screening Programs ◽

Low Resource ◽

Effective Interventions ◽

Resource Limited ◽

Resource Setting ◽

Low Resource Setting

We provide an overview of the challenges that low-resource setting cities are facing, including a lack of global implementation of cancer screening programs, accurate data and statistics that may aid the health authorities and guide future public health activities, as well as reorient strategies, interventions and budgets to promote lifestyles that help prevent disease. Current cancer care does not fully reflect ethnic, cultural, environmental and resource differences. Herein, we described a snapshot of the cancer mortality and morbidity from a hospital that cares a rural and low-income population from Peru, called Chimbote (316,966 inhabitants) and showed the limitation of access to oncological care and genetic services. The city is located in the region of Ancash, which is a department of Northern Peru. Of note, we identified a greater proportion of cancer cases than previously described, with a young age of onset and differential profile of the most frequent cancers. With the emergence of increasingly effective interventions, it becomes paramount that populations living in resource-limited settings have access to cancer services and participate in genetics and genomic research.

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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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