Burden of pediatric neurosurgical disease in a rural developing country: perspectives from southwest Nigeria

2021 ◽  
pp. 1-6
Author(s):  
Toyin A. Oyemolade ◽  
Amos O. Adeleye ◽  
Ayodele J. Olusola ◽  
Busayo A. Ehinola ◽  
Ebosetale P. Aikhomu ◽  
...  
Keyword(s):  
Developing Country ◽  
Age Distribution ◽  
Significant Proportion ◽  
Hospital Treatment ◽  
Middle Income ◽  
Female Ratio ◽  
Common Presentation ◽  
Neurosurgical Patients ◽  
Specialized Care ◽  
Southwest Nigeria

OBJECTIVE The proportion of the global burden of neurosurgical disease represented by pediatric neurosurgical pathology is unknown, especially in lower-middle income countries (LMICs) where there exists no known data-driven literature on the subject. In this study, the authors aimed to quantify the pediatric neurosurgical disease profile in a rural area of a developing country. METHODS This was a prospective observational study of all pediatric neurosurgical patients managed at a single center over a 30-month period. RESULTS Overall, 226 pediatric patients were included in the study (150 males and 76 females, male/female ratio 2:1), accounting for 20.4% of the total patient population during the study period. The modal age distribution was the 0- to 4-year-old group (32.3%), and head injury was the most common presentation, occurring alone in 157 patients (69.5%). Hydrocephalus alone was seen in 21 patients (9.3%) and in combination with myelomeningocele in 4 patients (1.8%). Brain tumors were found in 6 patients (2.7%), infective lesions in 6 patients (2.7%), and encephaloceles in 2 patients (0.9%). The treatment outcome was good in 170 patients (75.2%). Fourteen patients (6.2%) were referred to more advanced health facilities for specialized care; 29 patients (12.8%) were discharged against medical advice, mostly because of financial constraints; and 8 patients (3.5%) died. Several surgical cases could not be performed because of sundry logistical constraints. CONCLUSIONS Pediatric neurosurgical disease accounted for one-fifth of the neurosurgical workload at a tertiary health facility in southwest Nigeria. Trauma was the most common presentation, and optimal in-hospital treatment, including surgery, was hampered by severe logistical constraints in a significant proportion of the cases.

Cancer as a Scottish Problem

1968 ◽  
Vol 13 (10) ◽  
pp. 338-348
Author(s):  
A. J. Haddow
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cause Of Death ◽  
Cancer Mortality ◽  
Time Lag ◽  
Age Distribution ◽  
Lung Cancer Mortality ◽  
Cervix Uteri ◽  
Hospital Treatment ◽  
Cancer Of The Lung

Cancer, responsible for about 1 death in 5 in Scotland, cost over £1 per head of population in 1965 and led to bed occupation of almost 2,000 bed years. Time lag (symptoms-doctor-hospital-treatment) is usuallv small. Age distribution is as in other European countries. Excluding accidents, cancer is the second most important cause of death in children. In relation to other countries Scotland's position is very poor and the lung cancer mortality in both sexes is the highest known. Lung cancer is the most important in males, breast cancer in females. Alimentary cancers come second in both sexes. In this century alimentary cancers increased till the thirties or forties and then declined. Cancers of pancreas, cervix uteri, ovary, prostate, kidney and bladder, together with leukaemia, have all increased. Cancer of the lung has increased elevenfold in women and fiftyfold in men. It now accounts for 9 to 12 per cent of all male deaths in cities and large towns

scholarly journals Predictions of FluSurge 2.0 methodology on hospital utilization during the Covid-19 outbreaks in several countries

2021 ◽  
Vol 13 ◽  
pp. 184797902110205
Author(s):  
Francisco Reyes-Santias ◽  
Isabel Barrachina-Martinez ◽  
David Vivas-Consuelo
Keyword(s):  
Total Population ◽  
Age Distribution ◽  
Scenario Planning ◽  
Hospital Utilization ◽  
Hospital Treatment ◽  
Health Security ◽  
Support Resources ◽  
Hospital Beds ◽  
The Usa ◽  
America South

Application of the Flusurge 2.0 methodology to predict the needs of conventional hospital treatment, intensive care, and respiratory support resources as a consequence of coronavirus disease (COVID-19) in several countries. Different countries of the following continents have been selected: Europe, Asia, Africa, North America, South America, and Oceania. Variables: Total population and age distribution; Number of COVID19 infections; Number of deaths from COVID19; Number of non-ICU hospital beds; Number of ICU beds; Number of ventilators. Method: The proposed possible scenario planning is based on the application of FluSurge 2.0 Software, developed by The Johns Hopkins Center for Health Security (CHS/CDC). Saturation of conventional hospitalization is expected in India, Uganda, Nepal, and Haiti; there is a forecast of saturation for ICU beds in all sample countries except Turkey. Ventilator saturation is expected in all countries of the sample except Argentina, Austria, Brazil, France, United Kingdom, Japan, South Korea, Norway, Poland, Turkey and the USA. The model shows, for a percentage greater than 50% of the countries, difficulties related to the saturation of their ICU units, and the use of ventilators.

scholarly journals LINC-28. EPIDEMIOLOGICAL CHARACTERISTICS AND SURVIVAL OUTCOMES OF CHILDREN WITH MEDULLOBLASTOMA TREATED AT THE NATIONAL CANCER INSTITUTE (INCA) IN RIO DE JANEIRO, BRAZIL

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii383-iii384
Author(s):  
Gabriela Oigman ◽  
Diana Osorio ◽  
Joseph Stanek ◽  
Jonathan Finlay ◽  
Denizar Vianna ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Education ◽  
Survival Outcomes ◽  
Middle Income ◽  
Female Ratio ◽  
High Risk Patients ◽  
Presenting Symptoms ◽  
Risk Patients ◽  
Epidemiological Characteristics ◽  
Standard Risk

Abstract BACKGROUND Medulloblastoma (MB), the most malignant brain tumor of childhood has survival outcomes exceeding 80% for standard risk and 60% for high risk patients in high-income countries (HIC). These results have not been replicated in low-to-middle income countries (LMIC), where 80% of children with cancer live. Brazil is an upper-middle income country according to World Bank, with features of LMIC and HIC. METHODS We conducted a retrospective review of 126 children (0–18 years) diagnosed with MB from 1997 to 2016 at INCA. Data on patients, disease characteristics and treatment information were retrieved from the charts and summarized descriptively; overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier Method. RESULTS The male/female ratio was 1.42 and the median age at diagnosis was 7.9 years. Headache (79%) and nausea/vomiting (75%) were the most common presenting symptoms. The median time from onset of symptoms to surgery was 50 days. The OS for standard-risk patients was 69% and 53% for high-risk patients. Patients initiating radiation therapy within 42 days after surgery (70.6% versus 59.6% p=0.016) experienced better OS. Forty-five patients (35%) had metastatic disease at admission. Lower maternal education correlated with lower OS (71.3% versus 49% p=0.025). Patients who lived >40km from INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20% of families lived below the Brazilian minimum wage. CONCLUSIONS These findings suggest that socioeconomic factors, education, early diagnosis and continuous data collection, besides oncological treatment must be adressed to improve the survival of children with MB.

scholarly journals P129 The utility of routine operative swab culture in uncomplicated peri-anal abscesses

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Apoorva Khajuria ◽  
Tuba Rahim ◽  
Mariam Baig ◽  
Kai Leong ◽  
Apoorva Khajuria
Keyword(s):  
Inflammatory Bowel Disease ◽  
Perianal Abscess ◽  
Female Ratio ◽  
Incision And Drainage ◽  
Common Presentation ◽  
History Of ◽  
Inflammatory Bowel ◽  
Operative Findings ◽  
The Cost ◽  
Male To Female

Abstract Introduction Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures. Methods A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken. Results Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually. Conclusion Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.

scholarly journals Attributes of childhood Cancer among the patients attending specialized hospitals in Bangladesh

2015 ◽  
Vol 14 (2) ◽  
pp. 173-178
Author(s):  
Syeda Musleha Ahmed ◽  
Md Ziaul Islam
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Childhood Cancer ◽  
Urban Communities ◽  
Lymphoblastic Leukaemia ◽  
Child Death ◽  
Income Group ◽  
Middle Income ◽  
Female Ratio ◽  
Middle Income Group ◽  
Structured Questionnaire

Background: Childhood cancer is an emerging health problem worldwide. It is the second common cause of child death. Epidemiological and clinical attributes of childhood cancer are not properly documented in Bangladesh. This study was designed to reveal the attributes of childhood cancer among the patients attended specialized hospitals in Dhaka city.Objective: To determine the epidemiological and clinical attributes of childhood cancer.Materials and Methods: The cross-sectional study was conducted among 99 under 18 years old children suffering from cancer, who were included considering specific selection criteria. Data were collected by face to face interview using a semi-structured questionnaire with the help of a semi-structured questionnaire and checklist. Data were analyzed by using SPSS software.Results: Of all the children, majority (40.4%) was in age group of 6-10 years and their mean (±SD) age was 7.48 (±3.70) years. Male to female ratio was 1.9:1.6 and majority (48.5%) was in middle income group. Major part (42.4%) of the children was from sub-urban followed by 30.3% rural and 27.2% from urban communities. Major types of childhood cancer comprised acute lymphoblastic leukaemia (37.4%), retinoblastoma (14.1%), neuroblastoma (10.1%), and Wilm’stumour (10.1%). Less common cancers included non-Hodgekin’s lymphoma (7.1%), Hodgekin’s lymphoma (5.1%), osteosercoma (5.1%), nasopharyngeal carcinoma (4.0%), germ cell tumour (3.0%), acute myeloid leukaemia (3.0%) and Ewing’s tumour (1.0%). Majority (35.1%) of acute lymphoblastic leukaemia patients were from urban while most (85.7%) of retinoblastoma patients from sub-urban, 50.0% of neuroblastoma cases from rural, and 40.0% of Wilm’s tumour from sub-urban communities, this geographical variation of childhood cancer was statistically significant [?2(33)=56.46, p=0.01]. In poor and middle income group, most of the children (91.8%) were detected in stage II while among the higher income group, most (88.9%) of the cancer were detected in stage-I and this variation was statistically significant [?2(9)=16.77, p=0.05]. Family history was strongly related with childhood cancer [?2(20)=32.81, p=0.04].Conclusion: Cancer was more prevalent among male children with poor socio-economic condition residing in sub-urban communities. The study recommends specific measures to detect childhood cancer and related risk factors at early stage to prevention and control.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.173-178

scholarly journals Paediatric brought-in-dead at a tertiary health facility in South western Nigeria: Patterns and drivers

2021 ◽  
Vol 48 (2) ◽  
pp. 66-73
Author(s):  
Oladele S. Olatunya ◽  
Adefunke O. Babatola ◽  
Adewuyi T. Adeniyi ◽  
Adebukola B. Ajite ◽  
Isaac O. Oluwayemi ◽  
...  
Keyword(s):  
Health Facility ◽  
Causes Of Death ◽  
Severe Anaemia ◽  
Hospital Treatment ◽  
Cross Sectional ◽  
Over The Counter ◽  
Pediatric Health Care ◽  
Duration Of Illness ◽  
Common Causes ◽  
Southwest Nigeria

Background: ‘Brought- in-dead’ (BID) refers to the demise of an individual before presentation to a health facility. This study assessed the pattern of paediatric BID cases seen at a tertiary health facility in southwest Nigeria. Method: A cross-sectional, descriptive study was done at the Children Emergency Ward (CEW) of the hospital between January 2014 and December 2018. The patterns of BID cases and presumed causes of death were determined using a standardized checklist adapted from the WHO verbal autopsy instrument. Results: Ninety-eight BID cases were seen during the study, constituting 2.5% of total patients seen during the period. The median (IQR) age of cases was 24.0 (8.75 – 63.0) months and 72.4% were under-fives. Most had symptoms related to the haematologic (36.7%), respiratory (24.5%) or digestive (20.4%) systems. Severe anaemia 31(31.6%), gastroenteritis 19 (19.4) and aspiration 17 (17.3%) were the most common causes of death. The median (IQR) duration of illness before presentation was 3.0 (1.0 – 7.0) days but most presented from 4 – 7 days of illness. A significant relationship was found between the duration of illness and whether or not pre-hospital treatment was received (p < 0.0001). Unprescribed drugs purchased over the counter were the most commonly used treatment in 79.1% of cases (p < 0.0001). Conclusion: This study has highlighted the prevalence and pattern of paediatric BID in a tertiary health facility in southwest Nigeria and the factors that were associated with it. More efforts need to be geared towards community sensitization and pediatric health care to prevent factors drivingits menace.

scholarly journals Age and gender distribution among the patients with Gilbert’s syndrome

2021 ◽  
Vol 6 (2) ◽  
pp. 75-81
Author(s):  
A. N. Volkov ◽  
E. V. Tsurkan
Keyword(s):  
Age Distribution ◽  
Significant Proportion ◽  
Age And Gender ◽  
Gender Distribution ◽  
Gilbert’S Syndrome ◽  
Ugt1a1 Gene ◽  
Screening Programs ◽  
Gilbert's Syndrome ◽  
Syndrome Diagnosis ◽  
And Gender

Aim. To analyze age and gender distribution in patients with Gilbert's syndrome.Materials and Methods. We consecutively recruited 115 patients with Gilbert's syndrome. All patients underwent genotyping of the rs8175347 polymorphism within the UGT1A1 gene using allele-specific polymerase chain reaction to confirm the diagnosis.Results. The age of initial diagnosis ranged from 3 years to 71 years, with the majority (44.3%) of cases detected ≤ 20 years of age. Mean ± standard error and median age of the diagnosis were 30.03 ± 1.72 years and 23 years. Despite the proportion of females and males among patients was similar, age distribution at primary diagnosis was significantly different across the genders. In women, Gilbert's syndrome was most frequently detected between 11 and 20 years (23.1%) and between 51 and 60 years (19.2%). In contrast, male adolescents were more prone to the development of Gilbert's syndrome, as 47.6% of male patients belonged to this age category.Conclusions. Variable age of Gilbert's syndrome diagnosis is probably determined by an individual combination of genetic causes (e.g., mutation of the UGT1A1 gene) and additional risk factors. Adolescents compose a significant proportion of patients. Because of relatively mild disease in many patients and unpredictability of the provoking factors, primary detection of Gilbert's syndrome can be delayed. Differences in age of Gilbert's syndrome diagnosis across the genders can be partially explained by organizational reasons associated with the current screening programs. 

scholarly journals Economic Analysis of Severe TBI Treatment in Uganda

2016 ◽  
Vol 11 (28) ◽  
pp. 1637-1650
Author(s):  
Michael Haglund ◽  
Lauren Simpsom ◽  
Jonathan Chang ◽  
Anthony Fuller
Keyword(s):  
Human Capital ◽  
Economic Benefit ◽  
Significant Proportion ◽  
Health Benefit ◽  
Human Capital Approach ◽  
Mulago Hospital ◽  
Middle Income ◽  
Severe Tbi ◽  
Data Surveillance ◽  
Long Term Impact

Introduction: Although the majority of the global burden of disease occurs in low- and middle-income countries, there is a paucity of data surveillance and analysis on the incidence of, morbidity and mortality associated with, and economic costs attributable to traumatic brain injury (TBI).Methods: A prognostic model was used to estimate outcomes of conservative and neurosurgical treatment for severe TBI based on data from a cohort of patients at the national referral hospital, Mulago Hospital, in Uganda during a 13-month study period. To evaluate the long-term impact of treatment for severe TBI, averted DALYs were calculated and converted to dollars using the human capital and the value of a statistical life (VSL) approaches. This cohort was then used as a representative sample for assessing the benefit of treating severe TBI for all of Uganda.Results: During the study period, 127 cases of severe TBI were treated averting 1,448 DALYs [0,0,0], 1,075 DALYs [3,1,0.04], or 974 DALYs [3,1,0.03]. Using the human capital approach, the economic benefit of intervention ranged from $1.3 million to $1.7 million. The VSL approach estimated an economic benefit of $282,902 to over $11 million. The health benefit of treating severe TBI for all Ugandans was estimated at between about 11,000 and 17,000 averted DALYs per year with an annual potential economic benefit of $15 to $20 million as determined with the human capital approach and $3.3 to $130 million with the VSL approach.Discussion: Treatment of severe TBI in Uganda has the potential to reduce a significant proportion of morbidity, mortality, and economic burden, which indicates the importance of treating severe TBI in developing countries. 

Asthma in the Critically Ill Patient

2019 ◽  
pp. 150-156
Author(s):  
Jonathan J. Danaraj ◽  
Augustine S. Lee
Keyword(s):  
United States ◽  
Risk Factors ◽  
Immunoglobulin E ◽  
Age Distribution ◽  
The United States ◽  
Critically Ill Patient ◽  
Common Condition ◽  
Female Ratio ◽  
Genetic And Environmental Factors ◽  
Male To Female

Asthma is a common condition that affects an estimated 24 million children and adults in the United States (prevalence, 8%-10%). Globally, over 300 million people are affected and the number is expected to increase. The age distribution is bimodal, but in most patients, asthma is diagnosed before age 18 years (male to female ratio, 2:1 in children; 1:1 in adults). Susceptibility to asthma is multifactorial with both genetic and environmental factors. The strongest risk factor is atopy, a sensitivity to the development of immunoglobulin E (IgE) to specific allergens. A person with atopy is 3- to 4-fold more likely to have asthma than a person without atopy. Other risk factors include birth weight, prematurity, tobacco use (including secondary exposure), and obesity.

Sign in / Sign up

Export Citation Format

Share Document