scholarly journals Mycetoma in Timor-Leste and first report of nocardiosis

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Nicola Townell ◽  
Thomas Locke ◽  
Margaret Gibbons ◽  
Dan Murphy ◽  
Joshua Francis ◽  
...  
Keyword(s):  
Causative Organism ◽  
Molecular Testing ◽  
High Morbidity ◽  
Middle Income ◽  
Diagnosis And Management ◽  
Middle Income Countries ◽  
First Case ◽  
Soft Tissue Involvement ◽  
Timor Leste ◽  
Resource Issue

Mycetoma is a neglected tropical disease with an unknown global burden. Although considered endemic to South-east Asia, it has not previously been reported from Timor-Lest. We describe two cases in Timor-Leste, highlighting the challenges surrounding microbiological diagnosis and management shared by many low to middle-income countries. As characteristically described, both patients lived rurally and presented late with marked soft tissue involvement and multiple draining sinuses following a prolonged period of high morbidity. Nocardia brasiliensis, a beadedbranched, modified acid-fast, gram-positive bacilli, was isolated and confirmed by molecular testing in the first case. The causative organism in the second case could not be confirmed due to limited microbiological capabilities. Due to limited local laboratory capabilities, Nocardia spp. infection cannot be routinely confirmed in Timor- Leste. However, the microbiology laboratory is essential for the successful diagnosis and management of Mycetoma. In both cases, medical therapy alone resulted in cure and favorable outcomes, although supply of antibiotic remains an ongoing resource issue.

scholarly journals Improving the global diagnosis and management of asthma in children

Thorax ◽  
2018 ◽  
Vol 73 (7) ◽  
pp. 662-669 ◽  
Author(s):  
Warren Lenney ◽  
Andrew Bush ◽  
Dominic A Fitzgerald ◽  
Monica Fletcher ◽  
Anders Ostrem ◽  
...  
Keyword(s):  
School Attendance ◽  
Substantial Improvement ◽  
Optimal Care ◽  
Middle Income ◽  
Diagnosis And Management ◽  
Middle Income Countries ◽  
New Thinking ◽  
Specific Barriers ◽  
Selection Of

Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.

scholarly journals Estimates of Antibacterial Consumption in Timor-Leste Using Distribution Data and Variation in Municipality Usage Patterns

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1468
Author(s):  
Lisa Harris ◽  
Alexander Bongers ◽  
Jennifer Yan ◽  
Joshua R Francis ◽  
Ian Marr ◽  
...  
Keyword(s):  
National Level ◽  
The Body ◽  
Essential Medicines ◽  
Small Island ◽  
Distribution Data ◽  
Defined Daily Dose ◽  
Middle Income ◽  
Middle Income Countries ◽  
Antimicrobial Usage ◽  
Timor Leste

The association between antimicrobial resistance and antimicrobial usage has become a growing global concern. Many lower-middle income countries including Timor-Leste (TL) have limited information on antimicrobial usage, although recent research suggests increasing resistance rates among human pathogens there. The aim of this study was to use distribution data to estimate antibiotic consumption at both the national and sub-national level in Timor-Leste, stratifying into resistance class and adherence to the national essential medicines list (EML) and WHO AWaRe guidelines. A retrospective review of distribution data from Timor-Leste central medical store (SAMES) was undertaken to give a defined daily dose (DDD)/1000 inhabitants/day using WHO methodology. National antibiotic distribution in the TL EML in 2019 was estimated at 11.1 DDD/1000 inhabitants/day, comparable to consumption rates observed in other lower-middle-income countries using similar methodology. Differences in distribution quantities were noted between municipalities, with 4 of the 13 municipalities notably above the national average and around 32% of listed restricted antimicrobials distributed incongruent with the EML. This study provides insights into estimated antimicrobial consumption in Timor-Leste that has previously been poorly defined. Estimates of consumption can be used to understand emerging resistance in this small island nation, add to the body of knowledge on antimicrobial use to advise policy and guideline development, and help with stewardship activities.

scholarly journals Phenotypic Similarities Within The Morphologic Spectrum Of DICER1-Associated Sarcomas and Pleuropulmonary Blastoma -- Histopathologic Features Suggesting Genetic Testing and Counselling

2021 ◽  
Author(s):  
Paromita Roy ◽  
Anirban Das ◽  
Angad Singh ◽  
Joyshree Panda ◽  
Arpita Bhattacharya ◽  
...  
Keyword(s):  
Broad Ligament ◽  
Female Genital Tract ◽  
Chromosome 8 ◽  
Pleuropulmonary Blastoma ◽  
Molecular Testing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pathogenic Variation ◽  
Pediatric Sarcomas ◽  
Low Middle Income Countries

Context - DICER1-associated sarcomas are rare. These are currently described under a wide variety of appellations; morphologic characterizations in reported cases and sites of occurrence have also been disparate. Design – We aimed to review pediatric sarcomas associated with DICER1-mutation reported at our center, along with literature review, to identify histologic hallmarks for diagnosis. Results - A 12 year old girl with intracranial sarcoma mimicking mesenchymal chondrosarcoma, a 16 year old girl with broad ligament sarcoma mimicking fibrosarcoma and a 5 month old girl with vaginal sarcoma mimicking embryonal rhabdomyosarcoma showed DICER1-mutation. All three tumors though seemingly diverse, had an uncanny resemblance, comprising of a primitive mesenchyme-like spindle cell component with rhabdomyoblastic differentiation on immunohistochemistry. Primitive blastema, chondroid differentiation and foci of anaplasia mimicking pleuropulmonary blastoma histology were variably present. One case showed primitive neuroblastic differentiation. Though the constellation of features reported in literature is quite varied, rhabdomyoblastic differentiation has been ubiquitously reported in tumours across sites. Molecular testing showed gain of chromosome 8 in 2 cases. All 3 cases responded to alternating Vincristine, doxorubicin and cyclophosphamide / Cisplatin, etoposide and ifosfamide (VDC/PEI) backbone followed by maintenance chemotherapy. Conclusion - We highlight this morphologic hallmark of rhabdomyoblastic differentiation with or without chondroid differentiation, in primitive appearing pediatric sarcomas, especially of female genital tract and brain, which should raise a flag to test for DICER1 pathogenic variation. This is crucial in low / middle income countries where sequencing is not done routinely. Timely diagnosis can ensure appropriate treatment and implementation of surveillance protocols for those with germline mutation.

scholarly journals Presentation, diagnosis and management of locally advanced breast cancer: Is it different in low/middle income countries?

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Shahneela Manzoor ◽  
Mariyah Anwer ◽  
Salim Soomro ◽  
Dileep Kumar
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Advanced Breast ◽  
Middle Income ◽  
Diagnosis And Management ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Background and Objective: Breast cancer incidence is increasing and it is highest in low income countries. The main challenge is regarding awareness, screening, late presentation and its management in a third-world country. Our objective was to share the experience faced in various presentations, diagnosis and management of locally advanced breast cancer (LABC) in a third world country and discuss if they are different with respect to developed countries. Methods: It is a retrospective case series study performed at Jinnah Postgraduate Medical Centre Karachi, from January 2015 to December 2017, over period of three years. Data was collected from the record maintained by authors about patients presenting in breast clinic. Patients of breast cancer were managed in breast clinic over 3 years. Our study included patients who presented with LABC based on their clinical presentation confirmed by histopathological diagnosis and followed by surgical management. Statistical analysis for students t-test was performed using SPSS (version 20.0). A p-value less than 0.05 was considered statistically significant. Results: One hundred twelve patients presented with LABC over period of 3 years. All but two were female. Mean age was 52 years (range 26-78 years), SD 18.96. On presentation size of tumor was 5cm & more in 103 (91.9%) patients. Involvement of axilla was in 86 (76.7%). Chest wall was involved in 22 (19.6%). Total T3 and T4 were 71 (63.3%) and 41 (36.6%) respectively Diagnosis of all patients was confirmed by histopathology. Neoadjuvant was given to all patients to downstage the tumor. ER/PR was positive in 46(41.1%), HER-2/neu positive in 31 (27.6%). On staging breast carcinoma was metastatic in 13(11.6%) with liver, lung and bone in 4 (3.5%), 3 (2.7%) and 6 (5.3%) respectively. Breast conservation was done in 6 (6.1%) patients, Modified Radical Mastectomy was done in 86 (86.9%), Radical Mastectomy in 3 (3.03%), Toilet Mastectomy in 4 (4.045) and 13 (11.6%) patients were not operated. Conclusion: In our series 65% of all breast cancers are LABC at presentation. In low/middle income countries high percentage of LABC at presentation result in high metastatic disease, poor prognosis and limits conservation of breast. Awareness and education can improve outcomes. doi: https://doi.org/10.12669/pjms.35.6.165 How to cite this:Manzoor S, Anwer M, Soomro S, Kumar D. Presentation, diagnosis and management of locally advanced breast cancer: Is it different in low/middle income countries (LMICs)?. Pak J Med Sci. 2019;35(6):1554-1557. doi: https://doi.org/10.12669/pjms.35.6.165 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 327 ◽  
Author(s):  
Thokozani Khubone ◽  
Boikhutso Tlou ◽  
Tivani Phosa Mashamba-Thompson
Keyword(s):  
Health Care ◽  
Health Information ◽  
Point Of Care ◽  
Disease Diagnosis ◽  
Middle Income ◽  
Diagnosis And Management ◽  
Middle Income Countries ◽  
Electronic Health ◽  
Electronic Health Information ◽  
Low And Middle Income

The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS’s with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders’ roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.

scholarly journals Early response to COVID-19 in the Philippines

2021 ◽  
Vol 12 (1) ◽  
pp. 56-60
Author(s):  
Arianna Maever Amit ◽  
Veincent Christian Pepito ◽  
Manuel Dayrit
Keyword(s):  
Public Health ◽  
Risk Communication ◽  
Early Response ◽  
The Philippines ◽  
Community Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
First Case ◽  
Travel Restrictions ◽  
Philippine Government

Low- and middle-income countries (LMICs) with weak health systems are especially vulnerable during the COVID-19 pandemic. In this paper, we describe the challenges and early response of the Philippine Government, focusing on travel restrictions, community interventions, risk communication and testing, from 30 January 2020 when the first case was reported, to 21 March 2020. Our narrative provides a better understanding of the specific limitations of the Philippines and other LMICs, which could serve as basis for future action to improve national strategies for current and future public health outbreaks and emergencies.

scholarly journals Characteristics of Adult Sepsis Patients in the Intensive Care Units in a Tertiary Hospital in Jordan: An Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Anas H. A. Abu-Humaidan ◽  
Fatima M. Ahmad ◽  
Maysaa’ A. Al-Binni ◽  
Amjad Bani Hani ◽  
Mahmoud Abu Abeeleh
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Causative Organism ◽  
High Morbidity ◽  
Icu Patients ◽  
Middle Income ◽  
Tertiary Teaching

Sepsis is a global health issue that is commonly encountered in the intensive care unit (ICU) and is associated with high morbidity and mortality. Available data regarding sepsis in low- and middle-income countries (LMIC) is lacking compared to higher income countries, especially using updated sepsis definitions. The lack of recent data on sepsis in Jordan prompted us to investigate the burden of sepsis among Jordanian ICU patients. We conducted a prospective cohort study at Jordan University Hospital, a tertiary teaching hospital in the capital, Amman. All adult patients admitted to the adult ICUs between June 2020 and January 2021 were included in the study. Patients’ clinical and demographic data, comorbidities, ICU length of stay (LOS), medical interventions, microbiological findings, and mortality rate were studied. Descriptive and inferential statistics were used to analyse data from patients with and without sepsis. We observed 194 ICU patients during the study period; 45 patients (23.3%) were diagnosed with sepsis using the Sepsis-3 criteria. Mortality rate and median ICU LOS in patients who had sepsis were significantly higher than those in other ICU patients (mortality rate, 57.8% vs. 6.0%, p value < 0.001, resp., and LOS 7 days vs. 4 days, p value < 0.001, resp.). Additionally, sepsis patients had a higher combined number of comorbidities (2.27 ± 1.51 vs. 1.27 ± 1.09, p value < 0.001). The use of mechanical ventilation, endotracheal intubation, and blood transfusions were all significantly more common among sepsis patients. A causative organism was isolated in 68.4% of sepsis patients with a prevalence of Gram-negative bacteria in 77.1% of cases. While the occurrence of sepsis in the ICU in Jordan is comparable to other regions in the world, the mortality rate of sepsis patients in the ICU remains high. Further studies from LMIC are required to reveal the true burden of sepsis globally.

Gynecologic pathology services in low- and middle-income countries

2021 ◽  
pp. ijgc-2021-003103
Author(s):  
Ekaternia Olkhov-Mitsel ◽  
Fang-I Lu ◽  
Anna Gagliardi ◽  
Anna Plotkin
Keyword(s):  
Online Education ◽  
Central America ◽  
Gynecologic Cancer ◽  
Molecular Testing ◽  
Subspecialty Training ◽  
Middle Income ◽  
Middle Income Countries ◽  
Tumor Boards ◽  
The Caribbean ◽  
Low And Middle Income

ObjectiveThe International Gynecologic Cancer Society (IGCS) offers multidisciplinary conferences to underserved communities. Mentor pathologists have become an integral part of these tumor boards, as pathology services in low-to-middle-income countries are often inadequate and disjointed. The IGCS Pathology Working Group conducted a survey to assess barriers to quality pathology services in low-to-middle-income countries and identified potential solutions.MethodsA 69-question cross-sectional survey assessing different aspects of pathology services was sent to 15 IGCS Extension for Community Healthcare Outcomes (ECHO) training sites in Africa, Asia, Central America, and the Caribbean. Local gynecologic oncologists distributed the survey to their pathology departments for review. The responses were tabulated in Microsoft Excel.ResultsResponses were received from nine training sites: five sites in Africa, two in Asia, one in Central America, and one in the Caribbean. There were no pathologists with subspecialty training in gynecologic pathology. Most (7/9, 78%) surveyed sites indicated that they have limited access to online education and knowledge transfer resources. Of the eight sites that responded to the questions, 50% had an electronic medical system and 75% had a cancer registry. Synoptic reporting was used in 75% of the sites and paper-based reporting was predominant (75%). Most (6/7, 86%) laboratories performed limited immunohistochemical stains on site. None of the sites had access to molecular testing.ConclusionsInitial goals for collaboration with local pathologists to improve diagnostic pathology in low- and middle-income countries could be defining minimal gross, microscopic, and reporting pathology requirements, as well as wisely designed educational programs intended to mentor local leaders in pathology. Larger studies are warranted to confirm these observations.

scholarly journals Weak surveillance and policy attention to cancer in global health: the example of Mozambique

2018 ◽  
Vol 3 (2) ◽  
pp. e000654 ◽  
Author(s):  
Cesaltina Lorenzoni ◽  
Laura Oliveras ◽  
Alba Vilajeliu ◽  
Carla Carrilho ◽  
Mamudo R Ismail ◽  
...  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Public Health Problem ◽  
Cancer Surveillance ◽  
Sub Saharan Africa ◽  
High Morbidity ◽  
Middle Income ◽  
Cancer Burden ◽  
Middle Income Countries ◽  
Policy Attention

Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention.

Sign in / Sign up

Export Citation Format

Share Document