The Use of ICT for Teaching in a Poor Resource Setting

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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Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting

World Journal of Surgery ◽

10.1007/s00268-021-06001-x ◽

2021 ◽

Author(s):

Víctor Lopez-Lopez ◽

Ana Morales ◽

Elisa García-Vazquez ◽

Miguel González ◽

Quiteria Hernandez ◽

...

Keyword(s):

Sub Saharan Africa ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Sub Saharan

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Delivering Essential Surgical Care for Lower-limb Musculoskeletal disorders in the Low-Resource Setting

World Journal of Surgery ◽

10.1007/s00268-021-06211-3 ◽

2021 ◽

Author(s):

Deeptiman James ◽

Faye M. Evans ◽

Ekta Rai ◽

Nobhojit Roy

Keyword(s):

Musculoskeletal Disorders ◽

Lower Limb ◽

Surgical Care ◽

Central India ◽

Orthopedic Procedures ◽

Nerve Blocks ◽

Low Resource ◽

Resource Setting ◽

Retrospective Audit ◽

Essential Surgical Care

Abstract Background Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia. Methods A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients. Conclusion Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.

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Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

Global Spine Journal ◽

10.1177/2192568220980703 ◽

2021 ◽

pp. 219256822098070

Author(s):

Gyanendra Shah ◽

Gaurav Raj Dhakal ◽

Anil Gupta ◽

Pawan Kumar Hamal ◽

Siddhartha Dhungana ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cervical Spine ◽

Cervical Spinal Cord ◽

Limited Resource ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Resource Setting ◽

Cord Injury ◽

Huge Impact

Study Design: Retrospective study. Objectives: Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). Methods: All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. Results: Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. Conclusions: Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.

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Vulvar cancer: surgical management and survival trends in a low resource setting

Journal of the Egyptian National Cancer Institute ◽

10.1186/s43046-019-0015-y ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Navin Kumar ◽

Mukur Dipi Ray ◽

D. N. Sharma ◽

Rambha Pandey ◽

Kanak Lata ◽

...

Keyword(s):

Surgical Management ◽

Vulvar Cancer ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Uptake of next‐generation sequencing in children with end‐stage renal disease secondary to focal segmental glomerulosclerosis and parental decision for kidney transplantation—Experience from a low resource setting: A Retrospective Cohort Study

Pediatric Transplantation ◽

10.1111/petr.13960 ◽

2020 ◽

Author(s):

Rajiv Sinha ◽

Subhankar Sarkar ◽

Kausik Mandal ◽

Yincent Tse

Keyword(s):

Cohort Study ◽

Kidney Transplantation ◽

Next Generation Sequencing ◽

End Stage Renal Disease ◽

Retrospective Cohort ◽

Resource Setting ◽

Low Resource Setting ◽

Stage Renal Disease ◽

End Stage ◽

Generation Sequencing

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Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial

International Journal of Epidemiology ◽

10.1093/ije/dyab072 ◽

2021 ◽

Author(s):

Cecilia B Rosales ◽

Catalina A Denman ◽

Melanie L Bell ◽

Elsa Cornejo ◽

Maia Ingram ◽

...

Keyword(s):

Cardiovascular Disease ◽

Clinical Trial ◽

Support Groups ◽

Diabetes Distress ◽

Primary Study ◽

Positive Trend ◽

Cvd Risk ◽

Low Resource ◽

Resource Setting ◽

Cluster Randomized

Abstract Background Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk. Methods We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months. Results CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): −5.60, −0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: −4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8. Conclusions MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.

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