scholarly journals Collaboration between Paediatrician and Orthopaedician in Management of Congenitial Talipes Equino Varus by Ponseti Method

2020 ◽  
Author(s):  
JB Santhosha ◽  
SP Akshatha
Keyword(s):  
Low Income ◽  
Ponseti Method ◽  
Lower Limbs ◽  
Low Income Countries ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Medical Sciences ◽  
Orthopaedic Department ◽  
Pregnancy And Delivery ◽  
One Year

Introduction: Congenital Talipes Equino Varus (CTEV) or Clubfoot is one of the commonest orthopaedic problems observed in infants. Deformity involving in utero malalignment of calcaneo-talar-navicular complex of the foot is known as CTEV. Due to lack of treatment capacity and less knowledge about “Appearance, Pulse, Grimace, Activity, and Respiration.” (APGAR) Score in low income countries, CTEV end up with neglected clubfoot deformity (untreated children >2 years). About 1-2/1000 live births is the estimated incidence of idiopathic clubfoot. Aim: To assess the clinical profile and efficacy of Ponseti technique in the management and treatment of CTEV by Paediatrician and Orthopaedician collaboration. Materials and Methods: The observational study was conducted at AdiChunchanagiri Institute of Medical Sciences (AIMS). The data was recorded in a standard predesigned proforma which contained all details of patients like name, age, sex, parent details, address, family history, pregnancy and delivery details of mother, any prior treatment taken for clubfoot and examination details of spine, hips, upper and lower limbs with both feet and also other systems for associated clinical problems. The parents of the patients visiting Paediatric Out Patient’s Department (OPD) with CTEV were informed regarding the deformity and were sent to Orthopaedic Department. In Orthopaedic Department, after counselling of the parents regarding the ponseti method, all patients were treated and managed. All patients were followed over a two year period and assessed for any deformities which were subsequently managed surgically. All the data was documented, statistically analysed using suitable statistical methods. Results: Total 53 patients had 81 idiopathic CTEV or Clubfoot between the period of three years from 2015 to 2018. The age of patients varied upto one year after birth. Among 53 patients, 38 (72%) were males and 15 (28%) were females. Out of 53 infants, 35 had one clubfoot and 23 had bilateral clubfoot (total 81 clubfoot in 53 infants). The mean age of initial presentation to treatment was 3.5 weeks, 11 out of 53 infants came in 1st week of life. Out of 53 infants, 21,14,6,5,4,2 were followed-up for 7-12 months, 13-18 months, 0-6 months, 25-30 months, 19-24 months and 31-36 months, respectively. Out of 81 clubfoot; 76 (93.83%) had achieved near normal correction, five clubfoot (6.17%) required posteromedial soft tissue release, 67 foot (82.71%) had undergone percuteneoustenotomy and nine foot (11.11%) got corrected without tenotomy. Conclusion: CTEV or clubfoot is treated very safely and effectively by using ponseti method. It is rapidly decreasing the necessity of extensive surgery. This method should be encouraged to be set as the gold standard treatment of congenital clubfoot or CTEV by national efforts.

scholarly journals Challenges of Virtual Medical Sciences Education during the COVID-19 Pandemic: A Systematic Review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Farhad Salari ◽  
Vida Sepahi
Keyword(s):  
Systematic Review ◽  
Medical Education ◽  
Low Income ◽  
Virtual Education ◽  
Low Income Countries ◽  
Medical Sciences ◽  
Study Selection ◽  
E Learning ◽  
Multiple Challenges ◽  
Sudden Transition

Context: Since the onset of the COVID-19 pandemic, there have been numerous higher education challenges. Medical universities have been urged to dispel students from educational and clinical settings and led them toward virtual education. This sudden transition has been accompanied by multiple challenges. Objectives: The present study aimed to evaluate the challenges of virtual medical education in the COVID-19 pandemic. Study Selection: This systematic review was performed by reviewing the current literature on the research subject and the studies conducted in this regard during March 2019 to April 2021 by searching via five key search engines and databases, including Google Scholar, ScienceDirect, PubMed, Scopus, and ERIC. Results: In total, 23 studies were assessed, and different virtual education challenges in medical universities were classified into three categories of structural challenges, student-related challenges, and teacher-related challenges. In addition, strategies were proposed for overcoming the identified challenges. Conclusions: Since medical education was not properly pursued before the COVID-19 pandemic and the necessary infrastructures are lacking in this area, designing and implementing such programs could bring about fundamental challenges in several countries (especially developing and low-income countries), thereby decreasing their success rate. On the other hand, the coronavirus crisis could be an opportunity to identify the weaknesses, shortcomings, and infrastructural deficiencies in e-learning and address these issues effectively.

scholarly journals RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY

2020 ◽  
Vol 73 (12) ◽  
pp. 2640-2643
Author(s):  
Oleksii O. Holubenko ◽  
Anatolii F. Levytskyi ◽  
Oleksandr V. Karabenyuk
Keyword(s):  
Soft Tissue ◽  
Recurrence Rate ◽  
Primary Treatment ◽  
Nonparametric Tests ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Results Of Treatment ◽  
Pirani Score ◽  
Serial Casting

The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children’s Specialized Hospital “Okhmatdet”. Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-tests). Statistical data processing was performed in SPSS 17.0 program. Results: The results of Pirani score reveal satisfactory outcomes for both groups. But Ponseti method has the more conservative approach and lower complication rate (11,29±5,27% and 24,24±11,74%, p=0,52). Conclusions: Ponseti method is a safe, effective method for treatment of congenital idiopathic clubfoot in children from first days after birth. Open surgery should be reserved for deformity that cannot be completely corrected or for treatment of recurrences.

scholarly journals Designing A Model of Medical Equipment Purchase Management in Hospitals of Tehran University of Medical Sciences

2021 ◽  
Vol 16 (2) ◽  
pp. 137-147
Author(s):  
Azam Lari ◽  
Ali Komeili ◽  
Kamran Hajinabi ◽  
Leila Riahi
Keyword(s):  
Low Income ◽  
Content Validity ◽  
Medical Equipment ◽  
Health Resources ◽  
Vital Role ◽  
Low Income Countries ◽  
Path Coefficient ◽  
Medical Sciences ◽  
Statistical Population ◽  
Purchase Management

Objective: Medical equipment plays an effective and vital role in the diagnosis and treatment of diseases. Each society dedicates a plethora of health resources to these facilities. Since prioritizing and resource allocation are crucial in low-income countries with limited health resources, understanding and improving the purchase management of medical equipment in hospitals is a primary key for preparing high-quality health services. The aim of this study was to design a model for medical equipment purchase management at hospitals affiliated with the Tehran University of Medical Sciences. Methods: The statistical population for the present applied study, consisted of 623 people and the research sample was comprised of 420 people, which was selected using the stratified random sampling method. Data was collected using a researcher-made questionnaire whose variables were extracted from comparative studies and whose validity was measured by the relative content validity coefficient, content validity index and Cronbach's alpha coefficient. The SPSS 18 and AMOS were employed for analyses. Results: The most and the least effective aspects of medical equipment purchase management in the studied hospitals were found to be decision-making (path coefficient of 1.244) and organization respectively (path coefficient of 0. 845). Conclusion: It is crucial to take factors into consideration when using the facilities and capacities available in health and treatment centres. The proposed model can best guide buyer institutions to move towards efficient purchase mentioned in upstream policy documents.

scholarly journals Ponseti technique: efficacy in idiopathic clubfoot in Indian population

2018 ◽  
Vol 4 (4) ◽  
pp. 614
Author(s):  
Neetin Mahajan ◽  
Ujwal Ramteke ◽  
Sandeep Gavhale ◽  
Nikhil Palange ◽  
Akash Mane ◽  
...  
Keyword(s):  
Low Cost ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Acceptable Result ◽  
Short Period ◽  
Strict Compliance ◽  
Analysis Of Results ◽  
One Year ◽  
Non Surgical Treatment

<p class="abstract"><strong>Background:</strong> The number of operations for clubfoot is many, but the results are not encouraging and more complications are encountered after operative treatment. Most surgeons believe manipulation to be easy; however they rarely complete the treatment and abandon it and go on to surgery. In the confusing scenario Ponseti Method evolved and proved across the world to be one of the most promising ways to correct club foot with low cost minimum surgery and good result in short period of time.</p><p class="abstract"><strong>Methods:</strong> 50 cases of idiopathic clubfeet (76 feet) were enrolled from a period of May 2006 to May 2008 in the department of Orthopaedic. Out of 50, 42 patients were followed-up for two years. Post tenotomy follow-up done every monthly for 3 months. At every visit babies were checked for any relapse and parents were counselled for the strict compliance with Foot Abduction Brace. The results of correction in 42 patients (64 feets) evaluated and compared with Ponseti's observation and other form of conservative management.<strong></strong></p><p class="abstract"><strong>Results:</strong> The analysis of results of correction of clubfeet deformity by Ponseti's method reveals around 95.30% of good to acceptable result as compared with Ponseti’s observation of around 99% which is comparable. We have observed 4.69% of poor result as compared with 1% observed by Ponseti.</p><p class="abstract"><strong>Conclusions:</strong> It is safe, efficient, Economical and most effective treatment for clubfoot which decreases the need for extensive corrective surgery. This technique can be used in children up to one year of age even after previous unsuccessful non-surgical treatment.</p>

Zero subsidy strategies for accelerating access to rural water and sanitation services

2011 ◽  
Vol 63 (5) ◽  
pp. 1037-1043 ◽  
Author(s):  
Peter A. Harvey
Keyword(s):  
Low Income ◽  
Service Provision ◽  
Low Income Countries ◽  
Water And Sanitation ◽  
Sanitation Services ◽  
The Past ◽  
Self Sufficiency ◽  
Rural Water ◽  
Sustainable Services ◽  
One Year

Community-Led Total Sanitation (CLTS) and Household-Led Water Supply (HLWS) are zero subsidy approaches to water and sanitation service provision that have been recently piloted in Zambia. The increases in access to sanitation and toilet usage levels achieved in one year under CLTS were far greater than any achieved in subsidised programmes of the past. Similarly, HLWS has shown that rural households are willing to invest in their own infrastructure and that they can increase coverage of safe water without external hardware subsidy. The promotion of self-sufficiency rather than dependency is a key component of both approaches, as is the focus on the development of sustainable services rather than the external provision of infrastructure. Zero subsidy strategies have the potential to deliver far more rapid increases in service coverage and higher levels of sustainability than the conventional subsidised approaches that predominate in low-income countries.

scholarly journals Ponseti Casting vs. Soft Tissue Release for the Initial Treatment of Non-idiopathic Clubfoot

2021 ◽  
Vol 8 ◽  
Author(s):  
Jonathan Abraham ◽  
Jon Cooper Wall ◽  
Michel Diab ◽  
Cody Beaver
Keyword(s):  
Soft Tissue ◽  
Initial Treatment ◽  
Operating Time ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Continuous Variables ◽  
Time Data ◽  
Retrospective Case ◽  
Level Of Evidence

Purpose: Ponseti casting has universally been accepted as the gold standard for treatment of idiopathic clubfoot. Conversely, primary treatment for non-idiopathic clubfoot has not been established. The purpose of this study is to compare treatment outcomes following primary soft tissue release (STR) and Ponseti casting of non-idiopathic clubfoot.Methods: An IRB-approved retrospective study of patients treated for non-idiopathic clubfoot between 2005 and 2020 was conducted. Patients were included if they began treatment before the age of 2 and had at least 1 year of follow up. Patients were placed into either the STR group or Ponseti group and variables of interest were documented including reoccurrence of deformity, number of surgeries performed, type of surgeries performed, anesthesia time, and surgery time. Data was analyzed using Mann-Whitney U test for continuous variables.Results: A total of 33 children with 57 neuromuscular/syndromic clubfoot were identified of which 9 (15 feet) were treated with STR and 24 (42 feet) were treated with Ponseti casting. Average anesthesia and surgery time were found to be 291 and 179 min, respectively, for the STR group, and 113 and 67 min for the Ponseti group. The difference in operating time was determined to be significant (p = 0.02, p = 0.01). Patients treated with STR were found to have significantly more surgeries performed over the course of treatment than those treated with Ponseti casting (p = 0.001) with an average of 4.2 surgeries in the STR group and 1.5 surgeries in the Ponseti group. Extracapsular procedures were performed in 100% of the STR group and 97.6% of the Ponseti group (p = 0.55). Intracapsular procedures were performed in 100% of the STR group and 50% of the Ponseti group (p = 0.001).Conclusion: The Ponseti method should serve as the primary approach in the initial treatment of non-idiopathic clubfoot as it can reduce the risk of future invasive intracapsular surgery and shorten anesthesia and surgery times when surgical treatment is necessary.Level of Evidence: Level III retrospective case control study.

scholarly journals Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Edward I. Broughton ◽  
Sergio R. López ◽  
María Nela Aguilar ◽  
María Mercedes Somarriba ◽  
Magaly Pérez ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Low Income ◽  
Cost Savings ◽  
Pediatric Intensive Care ◽  
Low Income Countries ◽  
Ventilator Associated Pneumonia ◽  
Intervention Cost ◽  
One Year ◽  
Intervention Costs ◽  
The Cost

We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.

scholarly journals Assessment of a Cattle Manure Vermicomposting System Using Material Flow Analysis: A Case Study from Uganda

2019 ◽  
Vol 11 (19) ◽  
pp. 5173 ◽  
Author(s):  
Jjagwe ◽  
Komakech ◽  
Karungi ◽  
Amann ◽  
Wanyama ◽  
...  
Keyword(s):  
Low Income ◽  
Material Flow ◽  
Flow Analysis ◽  
Material Flow Analysis ◽  
Cattle Manure ◽  
Low Income Countries ◽  
Manure Management ◽  
Total Solids ◽  
One Year

Growth in cattle population is associated with increased manure generation whose current management in low-income countries is associated with health and environmental problems as well as low utilization rates. This trend can be reversed by promoting better manure management technologies. This study assessed vermicomposting as one of the technologies to manage organic wastes, using the case study in Uganda. A vermicomposting system using cattle manure and earthworms (Eudrilus euginea) was monitored for one year with the harvesting of products (compost, earthworm biomass) after every three months. Vermicompost samples from the beginning of the experiment and after every harvest were analyzed for the following parameters: pH, ash content, volatile and total solids, nutrients N, P, K, and C. Emissions of CO2, CH4, NH3, and N2O were also measured. Material flow analysis was used to determine the flows and retention of nutrients within the system. Results showed that total solids, ash, N, P, and K content significantly increased, while contents of volatile solids and C, as well as the pH, significantly decreased over time. Of the materials that entered the vermicomposting system, 46% went to vermicompost, 2% into earthworms, and 52% was lost to the atmosphere. Substance flow analysis showed that 30% of C went to vermicompost, 69% was emitted to the atmosphere, and 2% ended up in earthworms while 75% of N was transferred to vermicompost, 7% went to earthworms, and 18% escaped into the atmosphere. The cumulative emissions were 102 g CO2 kg−1 waste, 7.6 g CH4 kg−1 waste, and 3.943 × 10−5 g N2O kg−1 waste on a dry basis, while NH3 was not detected throughout the measurement time. Compared to other manure management methods, vermicomposting demonstrated good potential in conserving nutrients as well as reducing greenhouse gas emissions.

scholarly journals HOW WELL DO MOTHERS UNDERSTAND WHY THEIR NEWBORN IS HOSPITALIZED?

2016 ◽  
Vol 3 (2) ◽  
pp. 10-15
Author(s):  
Raju Kafle ◽  
Binod Kumar Gupta ◽  
Nikhil Agrawal
Keyword(s):  
Low Income ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Facility ◽  
Adverse Outcomes ◽  
Warning Signs ◽  
Low Income Countries ◽  
Clear Understanding ◽  
Medical Sciences ◽  
Tertiary Care Facility

INTRODUCTION: Maternal knowledge about serious infant illnesses has significant implications for care after discharge, particularly in countries with high infant mortality rates. No existing studies on this topic in low income countries were identified. The study sought to identify the level of maternal understanding about why a newborn was hospitalized and how mothers attributed blame for the illness.  MATERIAL AND METHODS: We conducted semi-structured interviews with mothers aged 18 and older who had infants hospitalized in a tertiary care facility in Universal College of Medical Sciences, Bhairahawa, Nepal and collected data on demographics, pregnancy and delivery, and beliefs about their infant's illness. Infant charts were abstracted to identify medical reasons for hospitalization for comparison with the mother's understanding, and levels of understanding were coded as 'none', 'partial' or 'full'. RESULTS: One hundred and fifty three mothers were interviewed and their average age was 28. For 27%, this was their first pregnancy. Forty per cent of mothers had no understanding of why their infant was in the hospital and 28% had only partial understanding. One-third of the women reported blaming themselves for the child's illness. In multivariable analysis, demographic factors including maternal age, education, primiparous status, and urban vs rural residence did not predict maternal understanding or self-blame. CONCLUSIONS: Sick newborns in low-income countries are at very high risk of adverse outcomes. Mothers who lack a clear understanding of why their infant is in the hospital might have difficulty communicating preferences about care, understanding the type of care that is being given, and recognizing future warning signs of illness. Such gaps in understanding could put the discharged infant at significant risk.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10  

scholarly journals Evaluating the Causes of Rising Food Prices in Low and Middle Income Countries

2012 ◽  
Vol 44 (3) ◽  
pp. 411-422 ◽  
Author(s):  
Osei Yeboah ◽  
Saleem Shaik ◽  
Obed Quaicoe
Keyword(s):  
Low Income ◽  
Food Prices ◽  
Low Income Countries ◽  
Middle Income ◽  
Vector Autoregressive ◽  
Middle Income Countries ◽  
Unrelated Regression ◽  
Food Commodities ◽  
One Year ◽  
Short Time

The effects of population, income, prices of major inputs, and exchange rate of the U.S. dollar on the prices of three key agricultural and food commodities (feed grains, oilseed, and fruits) for 13 low-income countries and seven middle-income countries were evaluated. Given the short time period, a modified seeming unrelated regression-vector autoregressive model that incorporates the lagged exogenous variables property of time series models and the system of equation estimation is employed in the analysis. The study finds no single factor that persistently explains all soaring food prices as reported in the literature. The only factor that persistently explains soaring food prices are the contemporaneous and one-year lagged exchange rates and income.

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