Post-operative endophthalmitis after immediate sequential bilateral cataract Surgery: a retrospective study from Pakistan.

2021 ◽  
Author(s):  
Muhammad Abdul Rehman Siddiqui ◽  
Syed Zohaib Maroof Hussain ◽  
Irfan Jeeva
Keyword(s):  
Retrospective Study ◽  
Cataract Surgery ◽  
Middle Income Country ◽  
Income Country ◽  
University Hospital ◽  
P Value ◽  
Safe Procedure ◽  
Coding System ◽  
Middle Income ◽  
Bilateral Cataract

Objective: The aim of this study was to assess the frequency of post-operative complications after immediate sequential bilateral cataract surgery (ISBSC) in Pakistan, a low-middle income country. Methods: This is a 10-year retrospective study including all consecutive patients who underwent ISBCS between 1st January 2009 and 31st December 2018 at Aga Khan University Hospital (AKUH), Karachi, Pakistan. We identified potential patients through the procedure coding system of the hospital. A structured proforma was used to collect information. The inclusion criterion was bilateral cataract extraction without any additional secondary procedures. Patients who underwent a planned additional procedure on the operated eye on the same day, such as phaco combined with vitrectomy, corneal graft, or glaucoma surgery, were excluded. The primary outcome measure was the incidence of endophthalmitis. The data were analyzed with Statistical Package for the Social Sciences (SPSS) version 23.0, IBM Corporation, Armonk, New York, United States. A p-value of < 0.05 was considered significant. Results: We identified 352 patients through the coding system of our hospital who underwent ISBCS from January 2009 to December 2018. A total of 298 patients (596 eyes) met the inclusion criteria. The mean age was 33.14±25.83 years. Participants were divided into two  age groups:  <16 (39.26 %) years and  >16 (60.73)  years of age. Best-corrected visual acuity improved from -0.5650±8.2027 to -0.0043+4.05. Among 596 eyes, we found no case of post-operative endophthalmitis after ISBCS. Conclusions: ISBCS is a safe procedure in selected patients undergoing cataract surgery in a low-middle income country. Continuous...

scholarly journals A retrospective study of physiological observation-reporting practices and the recognition, response, and outcomes following cardiopulmonary arrest in a low-to-middle-income country

2017 ◽  
Vol 21 (6) ◽  
pp. 343-345 ◽  
Author(s):  
Ambepitiyawaduge Pubudu De Silva ◽  
Jayasingha Arachchilage Sujeewa ◽  
Nirodha De Silva ◽  
Rathnayake Mudiyanselage Danapala Rathnayake ◽  
Lakmal Vithanage ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cardiopulmonary Arrest ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Reporting Practices ◽  
Recognition Response

scholarly journals Preconception air pollution exposure and glucose tolerance in healthy pregnant women in a middle income country

2020 ◽  
Author(s):  
Mehdi Zareie ◽  
Ali Gohari ◽  
Leyla Haghighi ◽  
Hafez Heydari ◽  
Mohammad miri
Keyword(s):  
Air Pollution ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Middle Income Country ◽  
Income Country ◽  
P Value ◽  
Oral Glucose ◽  
Middle Income

Abstract Background: The effect of preconception exposure to air pollution on glucose tolerance during pregnancy in developing and middle-income countries is under debate yet. Therefore, this study aimed to assess the relationship between exposure to ambient particulate matter (PM) and traffic indicators with glucose tolerance in healthy pregnant women in Sabzevar, Iran (2019). Methods: Accordingly, 250 healthy pregnant women with singleton pregnancies of 24-26 weeks of gestations were participated in our study. Land use regression (LUR) models were applied to estimate the annual mean of PM1, PM2.5 and PM10 at residential address. Traffic indicators, including distance from home to the nearest major road (DHMR) as well as total streets length in 100, 300 and 500m buffers around the home (TSL-100, 300 and 500) were calculated using the street map of Sabzevar. Oral glucose tolerance test (OGTT) was used to assess glucose tolerance during pregnancy. Multiple linear regression adjusted for relevant covariates was used to estimate the association of fasting blood glucose (FBG), 1-h and 2-h post-load glucose with PMs and traffic indicators. Results: Exposure to PM1, PM2.5 and PM10 was significantly associated with higher FBG concentration. Higher TSL-100 was associated with higher FBG and 1-h glucose concentrations. Each one interquartile range (IQR) increase in DHMR the levels of FBG and 1-h post-load glucose were decreased -3.42 mg/dL (95% confidence interval (CI): -4.47, -2.37, P-value < 0.01) and -4.65 mg/dL (95% CI: -8.03, -1.26, P-value < 0.01), respectively. Conclusion: We found higher preconception exposure to air pollution and exposure to air pollution during pregnancy were negatively associated with glucose tolerance during pregnancy in a middle income country.

scholarly journals Trauma Team Conformation in a War-influenced Middle-income Country in South America: Is It Possible?

2020 ◽  
Author(s):  
Sandra Carvajal ◽  
Francisco Uribe-Buritica ◽  
Ana Maria Angel ◽  
Maria Camila Lopez ◽  
Andres Gonzalez ◽  
...  
Keyword(s):  
Trauma Team ◽  
Middle Income Country ◽  
Income Country ◽  
University Hospital ◽  
Categorical Variables ◽  
Time Interval ◽  
Continuous Variables ◽  
Middle Income ◽  
Tertiary Center ◽  
The Impact

Abstract Introduction: Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary Level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. Objective: To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle income country war influenced country. Material & Methods: Retrospective analytical study. Patients older than 17 years, admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. 464 patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using Chi2 or Fisher's test and continuous variables using Student's T-test or Wilcoxon-Mann-Withney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission. Results: The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p<0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p<0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215 - 0.789) P = 0.006 Conclusions: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in polytrauma patients.

scholarly journals Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000–2017

2021 ◽  
Vol 6 (8) ◽  
pp. e005798
Author(s):  
Matthew T Schneider ◽  
Angela Y Chang ◽  
Sawyer W Crosby ◽  
Stephen Gloyd ◽  
Anton C Harle ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Health Expenditures ◽  
Middle Income Country ◽  
Income Country ◽  
P Value ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita

IntroductionAs the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are unknown. We estimate PHC expenditure for each low-income and middle-income country between 2000 and 2017 and test which health outputs and outcomes were associated with PHC expenditure.MethodsWe used three data sources to estimate PHC expenditures: recently published health expenditure estimates for each low-income and middle-income country, which were constructed using 1662 country-reported National Health Accounts; proprietary data from IQVIA to estimate expenditure of prescribed pharmaceuticals for PHC; and household surveys and costing estimates to estimate inpatient vaginal delivery expenditures. We employed regression analyses to measure the association between PHC expenditures and 15 health outcomes and intermediate health outputs.ResultsPHC expenditures in low-income and middle-income countries increased between 2000 and 2017, from $41 per capita (95% uncertainty interval $33–$49) to $90 ($73–$105). Expenditures for low-income countries plateaued since 2014 at $17 per capita ($15–$19). As national income increased, the proportion of health expenditures on PHC generally decrease; however, the fraction of PHC expenditures spent via ambulatory care providers grew. Increases in the fraction of health expenditures on PHC was associated with lower maternal mortality rate (p value≤0.001), improved coverage of antenatal care visits (p value≤0.001), measles vaccination (p value≤0.001) and an increase in the Health Access and Quality index (p value≤0.05). PHC expenditure was not systematically associated with all-age mortality, communicable and non-communicable disease (NCD) burden.ConclusionPHC expenditures were associated with maternal and child health but were not associated with reduction in health burden for other key causes of disability, such as NCDs. To combat changing disease burdens, policy-makers and health professionals need to adapt primary healthcare to ensure continued impact on emerging health challenges.

scholarly journals Subspecialized radiology reporting: productivity and impact on the turnaround times for radiology reports in a middle-income country

2020 ◽  
Vol 53 (4) ◽  
pp. 236-240
Author(s):  
Nupur Verma ◽  
Gabriel Sartori Pacini ◽  
Juliana Pastorino Torrada ◽  
Diogo Martins de Oliveira ◽  
Matheus Zanon ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Reporting System ◽  
Middle Income Country ◽  
Income Country ◽  
Radiology Department ◽  
Radiology Reporting ◽  
Imaging Studies ◽  
Middle Income ◽  
Productivity Data ◽  
Radiology Reports

Abstract Objective: To evaluate the effect that transitioning from a model of general radiology reporting to one of subspecialized radiology reporting has on report turnaround times (TATs) and on productivity in the radiology department of a hospital in a middle-income country. Materials and Methods: The reporting workflow in our radiology department was changed from general reporting (any radiologist reporting imaging studies for any specialty) to subspecialized reporting (radiologists exclusively reporting imaging studies that fall within their subspecialty-abdominal, musculoskeletal, cardiothoracic, emergency, or neurological imaging). This was a retrospective study in which we compared general reporting with subspecialized reporting in terms of the following variables: the TAT; the proportions of reports completed within 2 h and within 24 h (TAT-2h and TAT- 24 h, respectively); and productivity. Data were collected over two 24-month periods (2015-2016 for general reporting and 2017-2018 for subspecialized reporting). Results: A total of 208,516 reports were generated. The median report TAT decreased from 49.1 h and 52.9 h in 2015 and 2016, respectively, to 16.1 h and 15.2 h in 2017 and 2018, respectively (p < 0.001). The TAT-2h also improved, increasing from 8.7% and 7.9% in 2015 and 2016, respectively, to 52.0% and 61.3% in 2017 and 2018, respectively (p < 0.001), as did the TAT- 24 h, which increased from 12.1% and 14.1% in 2015 and 2016, respectively, to 74.3% and 78.7% in 2017 and 2018, respectively (p < 0.001). Between the two periods, the total number of scans performed increased by 33% (p = 0.001). Conclusion: The implementation of a subspecialized reporting system significantly improved the median TAT for radiology reports, as well as increasing the TAT-2h and TAT- 24 h, during a time of increased productivity.

scholarly journals Trauma team conformation in a war-influenced middle-income country in South America: is it possible?

2020 ◽  
Author(s):  
Sandra Carvajal ◽  
FRANCISCO URIBE ◽  
Ana Maria Angel ◽  
Maria Camila Lopez ◽  
Andres Gonzalez ◽  
...  
Keyword(s):  
Trauma Team ◽  
Middle Income Country ◽  
Income Country ◽  
University Hospital ◽  
Categorical Variables ◽  
Time Interval ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Middle Income ◽  
The Impact

Abstract Introduction: Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary Level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. Objective: To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle income country war influenced country. Material & Methods: Retrospective analytical study. Patients older than 17 years, admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. 464 patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using Chi2 or Fisher's test and continuous variables using Student's T-test or Wilcoxon-Mann-Withney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission.Results: The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p<0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p<0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215 - 0.789) P = 0.006Conclusions: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in trauma patients.

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