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Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.
Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.
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Las malformaciones linfáticas y su manejo no han sido bien descritas en República Dominicana. Es por ello, que el objetivo de este artículo es la presentación de tres casos, con diferentes patrones y necesidades de tratamiento, de modo que sirva como referencia para trabajadores de la salud en países en vías de desarrollo.
Lymphatic malformations and its management are not well described in the Dominican Republic. That is why this article's objective is to present 3 cases, with different patterns and treatment needs, so it will work as a reference for healthcare workers in developing countries.
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Humans , Male , Female , Child , Lymphangioma, Cystic , Sclerotherapy , SirolimusABSTRACT
eHealth is promoted as a means to strengthen health systems and facilitate universal health coverage. Sub-components (e.g. telehealth, telemedicine, mhealth) are seen as mitigators of healthcare provider shortages and poor rural and remote access. Teleradiology (including mobile teleradiology), widespread in developed nations, is uncommon in developing nations. Decision- and policy-makers require evidence to inform their decisions regarding implementation of mobile teleradiology in Nigeria and other subSaharan countries. To gather evidence, Scopus and PubMed were searched using defined search strings (September 2020). Duplicates were removed, and titles and abstracts reviewed using specified selection criteria. Full-text papers of selected resources were retrieved and reviewed against the criteria. Insight from included studies was charted for eight a priori categories of information: needs assessment, implementation, connectivity, evaluation, costing, image display, image capture and concordance. Fifty-seven articles were identified, duplicates removed and titles and abstracts of remaining articles reviewed against study criteria. Twenty-six papers remained. After review of full-texts, ten met the study criteria. These were summarised, and key insights for the eight categories were charted. Few papers have been published on teleradiology in sub-Saharan Africa. Teleradiology, including mobile teleradiology, is feasible in sub-Saharan Africa for routine X-ray support of patients and healthcare providers in rural and remote locations. Former technical issues (image quality, transmission speed, image compression) have been largely obviated through the high-speed, high-resolution digital imaging and network transmission capabilities of contemporary smartphones and mobile networks, where accessible. Comprehensive studies within the region are needed to guide the widespread introduction of mobile teleradiology.
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Telemedicine , Teleradiology , Cell Phone , Technology, RadiologicABSTRACT
Abstract Introduction: To date, many studies have validated the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) scoring system in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but studies from developing countries remain scarce. Objective: The aim of this study was to evaluate and categorize Mexican patients using the HCT-CI at a referral center. Methods: One hundred and nineteen consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition in Mexico City were included. Patients were classified according to the HCT-CI scores. Results: The median age was 31 years and most were males (56%). Most patients had hematological malignancies (73%) and a low HCT-CI score (72%). The non-relapse mortality and survival were predicted according to the score. Conclusions: This is one of the few studies to evaluate the HCT-CI in adults with HLA-matched donors in a developing country and our findings suggest that the high percentage of patients with a low HCT-CI scores, contrary to international reports, could be explained by different comorbidities and demographics, but mainly due to stricter filters applied to HSCT candidates and consequently, a potential selection bias caused by limited resources.
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Hematopoietic Stem Cell Transplantation , Comorbidity , Developing Countries , MexicoABSTRACT
ABSTRACT Background: The classical BCR-ABL1-negative myeloproliferative neoplasms (MPNs) are Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF). In developing countries, there are few reports that truly reveal the clinical setting of these patients. Therefore, we aimed to characterize a single center MPN population with a special focus on the correct diagnosis based on the recent review of the WHO criteria for the diagnosis of myeloid neoplasms. Methods: This retrospective study analyzed data from medical records of patients with classical BCR-ABL1-negative MPNs diagnosed from January 1997 to October 2017 and followed at the University Hospital of Ribeirão Preto Medical School. Results: A total of 162 patients were assessed, 61 with PV, 50 with ET, and 51 with PMF. The mutational status analysis revealed that 113 (69.3%) harbored the JAK2V617F mutation, 23 (14.1%), the CALR mutation, and 12 (7.4%) had a triple-negative status. None of the patients were found to have mutations on the thrombopoietin receptor gene (MPL), including some ET and PMF patients who were not tested. Among the PV patients, 57 (93.5%) were positive for the JAK2V617F mutation, one (1.6%) presented an in-frame deletion JAK2 exon 12 mutation and one (1.6%) presented a missense JAK2 exon 9 mutation, not previously described. The overall survival was lower in the triple-negative patients with PMF, when compared to the JAK2V617F or CALR-mutated (p= 0.002). Conclusion: The frequency of somatic mutations and survival in our cohort, stratified according to the respective disease, was consistent with the literature data, despite some limitations. Further prospective epidemiological studies of MPN cohorts are encouraged in developing countries.
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Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Polycythemia Vera , Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative , Primary Myelofibrosis , Thrombocythemia, Essential , Myeloproliferative DisordersABSTRACT
Aims: The morbidities and mortalities associated with diabetes are disproportionately high in low and middle income countries. This study aimed to explore important barriers and facilitators to diabetes care in Nigeria from the perspectives of diabetes healthcare providers (DHPs).Study Design:A nationwide descriptive survey Place and Duration:Onsite (Calabar, Nigeria) and online surveys conducted between September 2016 and March 2017. Methodology:A validated self-administered questionnaire was used to assess barriers to diabetes care and strategies to improve care among DHPs in Nigeria.Results:A total of 129 subjects with mean ± SD age and mean ± SD duration of practice of 42.4 ± 7.6 years and 8.5 ± 5.4 years respectively were surveyed. About 84.5% of the respondents perceived diabetes care in Nigeria as being remarkably challenging. The most common barriers identified include: poverty, low diabetes awareness, shortage of trained diabetes care specialists, poor diabetes care knowledge among primary care doctors, and poor knowledge of diabetes self care among patients and other institutional, cultural and religious barriers. To improve care, respondents recommended, among other strategies, increasing healthcare funding, expansion of national health insurance coverage, introduction of government subsidy on diabetes medications, encouraging local production of diabetes medicines and supplies, increasing public diabetes awareness, periodic training of general practitioners and strict regulation of alternative medicine practitioners and faith healing centers.Conclusion:This survey identified several barriers to diabetes care in Nigeria and proffered some useful and implementable strategies to improve care. In order to reduce the burden of diabetes in Nigeria and perhaps other countries in SSA, these expert opinions should form the basis for a blue print by major diabetes stakeholders and health policy makers
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ABSTRACT While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.
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Humans , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/blood , Hyperparathyroidism, Primary/epidemiology , Severity of Illness Index , Developing CountriesABSTRACT
Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level <250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level >650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P <0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin.
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Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study.
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RESUMO Objetivo: Determinar a incidência, os fatores de risco e os desfechos da extubação não planejada em pacientes adultos. Métodos: Conduzimos estudo prospectivo de coorte de pacientes adultos intubados admitidos em ala de atendimento gratuito em um hospital governamental terciário de ensino nas Filipinas. Incluíram-se tanto pacientes em cuidados de terapia intensiva quanto fora dela. Os pacientes foram seguidos até a alta ou até o sétimo dia após a extubação. Resultados: Os desfechos dos 191 pacientes incluídos foram: extubação planejada (35%), extubação não planejada (19%), óbito (39%) e alta a pedido (7%). A regressão de riscos competitivos demonstrou que o sexo masculino (OR bruta de 2,25; IC95% 1,10 - 4,63) e a idade (OR bruta: 0,976; IC95%: 0,957 - 0,996) foram fatores basais significantes. O turno da noite (OR bruta: 24,6; IC95%: 2,87 - 211) também teve associação consistente com maior ocorrência de extubação não planejada. Dentre os desfechos após a extubação, ocorreram significantemente mais, entre os pacientes com extubação não planejada, reintubação (extubação não planejada, com 61,1%, versus extubação planejada, com 25,4%), insuficiência respiratória aguda (extubação não planejada, com 38,9%, versus extubação planejada, com 17,5%) e eventos cardiovasculares (extubação não planejada, com 8,33%, versus extubação planejada, com 1,49%). A admissão à unidade de terapia intensiva não se associou com risco menor de extubação não planejada (OR bruta de 1,15; IC95% 0,594 - 2,21). Conclusão: Muitos pacientes intubados tiveram extubação não planejada. Os pacientes admitidos em outras unidades, que não a de terapia intensiva, não tiveram tendências mais elevadas de extubação não planejada.
ABSTRACT Objective: We aimed to determine the incidence, risk factors, and outcomes of unplanned extubation among adult patients. Methods: We conducted a prospective cohort study of adult intubated patients admitted to the charity wards of a government tertiary teaching hospital in the Philippines. Patients managed in both intensive care and nonintensive care settings were included. Patients were followed-up until discharge or until seven days postextubation. Results: The outcomes of the 191 included patients were planned extubation (35%), unplanned extubation (19%), death (39%), and discharge against advice (7%). Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10 - 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was also consistently associated with more unplanned extubations. Among postextubation outcomes, reintubation (unplanned extubation: 61.1% versus planned extubation: 25.4%), acute respiratory failure (unplanned extubation: 38.9% versus planned extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33% versus planned extubation: 1.49%) occurred significantly more often among the unplanned extubation patients. Admission in an intensive care unit was not associated with a lower risk of unplanned extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21). Conclusion: Many intubated patients had unplanned extubation. Patients admitted in nonintensive care unit settings did not have significantly higher odds of unplanned extubation.
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Humans , Male , Female , Adult , Aged , Respiration, Artificial/statistics & numerical data , Airway Extubation/statistics & numerical data , Intensive Care Units/statistics & numerical data , Intubation, Intratracheal/statistics & numerical data , Philippines , Incidence , Prospective Studies , Risk Factors , Cohort Studies , Follow-Up Studies , Tertiary Care Centers , Hospitals, Teaching , Middle AgedABSTRACT
INTRODUCCIÓN La laparoscopía es actualmente el estándar en el manejo de la endometriosis profunda. Sin embargo, requiere de un entrenamiento específico e involucra la realización de procedimientos complejos y asociados a una alta tasa de complicaciones. Por lo anterior en Chile y Latinoamérica, la endometriosis profunda es frecuentemente manejada de manera inadecuada. OBJETIVO Describir nuestra experiencia en el enfrentamiento clínico y manejo quirúrgico laparoscópico de la endometriosis profunda, durante los últimos siete años. MÉTODOS Estudio de cohorte retrospectivo de 137 pacientes consecutivas operadas y con confirmación histológica de endometriosis profunda. Se recolectaron los datos demográficos, datos quirúrgicos, complicaciones, resultados reproductivos y seguimiento. RESULTADOS Todas las cirugías fueron completadas por laparoscopía, sin conversión. La dismenorrea y la dispareunia fueron los síntomas más frecuentes en 85,4 y 56,9%, respectivamente. La localización más frecuente de endometriosis profunda fueron los ligamentos úterosacros, coexistiendo un endometrioma en 48,9% de los casos. La mediana de tiempo operatorio fue de 140 minutos, siendo significativamente más prolongado en casos con compromiso intestinal (p < 0,0001). Quince pacientes (10,9%) presentaron complicaciones. El seguimiento medio fue de 24,5 meses. La tasa de embarazo fue de 58,1% y 90% de las pacientes reportó una mejoría significativa de su sintomatología. CONCLUSIONES El manejo laparoscópico de la endometriosis profunda es efectivo y seguro, pero debe reservarse a centros especializados y con disponibilidad de equipo multidisciplinario.
BACKGROUND Laparoscopy has become the standard of care in the surgical management of deep infiltrating endometriosis (DIE). However, it is a challenging procedure with a high complication rate. Despite the benefits of the minimally invasive approach, DIE resection is often performed by surgeons without adequate training, especially in developing countries like Chile. OBJECTIVE To asses our experience in the diagnosis and laparoscopic management of DIE during seven years. METHODS A retrospective cohort study of data including 137 patients with pathology-proven DIE. Surgical and fertility outcomes were evaluated. RESULTS All procedures were performed laparoscopically without conversion. Dysmenorrhea and dyspareunia were the most common symptoms in 85.4% and 56.9%, respectively. Uterosacral ligaments were the most common DIE location. Endometrioma was present in 48.9% of cases. Median operative time was 140 minutes; however, it was longer in cases requiring bowel surgery (p < 0.0001). The complication rate was 10.9%. Median follow-up was 24.5 months. The pregnancy rate was 58.1% and 90% of patients reported significant symptom relief after surgery. CONCLUSION Laparoscopic surgical management of DIE is effective and safe but it must be performed in tertiary centers with the availability of multidisciplinary teams.
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Humans , Female , Adult , Postoperative Complications/epidemiology , Laparoscopy/methods , Endometriosis/surgery , Patient Care Team/organization & administration , Chile , Retrospective Studies , Cohort Studies , Follow-Up Studies , Treatment Outcome , Dysmenorrhea/etiology , Dysmenorrhea/epidemiology , Dyspareunia/etiology , Dyspareunia/epidemiology , Endometriosis/diagnosis , Endometriosis/pathologyABSTRACT
@#The study was conducted to evaluate compliance of antibiotics prescribing in three selected outpatients healthcare facilities in Papua New Guinea(PNG), to the country specific Standard Treatment Guidelines(STG)and to identify factors influencing prescribing pattern. The study was carried out in the Losuia Health Centre (LHC), Alotau Provincial Hospital and Port Moresby General Hospital (PMGH) outpatient departments. The study sample involved300participants at each setting. Oral amoxicillin products, chloramphenicol and co-trimoxazole made up approximately 70% of the antibiotics prescribed to 637/1090 of patients. Almost one-quarter (24.4%) of prescriptions for antibiotics were non-compliant selections. At the LHC approximately 20% of both dosage and duration errors occurred. Overall non-compliant prescribing for children was approximately 50% but significantly more compliant at PMGH (P= 0.0058) contrasting with the other settings. At the LHC only 30.6% of antibiotic prescriptions for children were compliant with STG requirements and fulfilled PNG regulatory requirements. With respect to the STGs, Community Health Workers (68.0%) and Nurse Officers made more non-compliant antibiotic selections. High levels of antibiotic prescribing combined with high levels of non-compliant antibiotic prescribing as compared to PNG-STGs, were identified in this study. This is a disturbing finding as it raises many questions related to quality assurance of health care interventions in PNG. The data also raises a clinical concern for the high level of oral chloramphenicol prescribed in out-patient settings.
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Introduction Electronic health information systems (HISs) are believed to improve access to health information. The District Health Information System Version 2 (DHIS2) is used widely in developing countries. While numerous successful cases highlighting the introduction of DHIS in facility-based settings have been reported, it remains unclear how similarly effective results can be obtained in developing countries. Methods We conducted a literature review to clarify the achievements and challenges regarding the use of DHIS2, and extracted 62 papers from PubMed and Google Scholar using the search term ‘District Health Information Software System’. Eleven papers that described the process of introducing DHIS2 were selected for analysis.Results We categorized the achievements into two groups: ‘Improvement of the reporting system’ and ‘Human resources development’. The challenges were categorized into eight groups, of which most commonly reported were human resources-related issues, followed by system complexity and data collection inadequacy. Conclusions The introduction of DHIS2 contributed to the improvement of the timeliness and completeness of data reporting, as well as human resources development, while utilization of data should be further strengthened. The most common challenges reported consisted of human resources-related issues. The HISs should be simple and easy to understand, even for individuals with low computer literacy.
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Purpose: To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants. Methods: Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated. Results: Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59–67.53) and negative predictive value was 83.3% (95% CI: 57.73–95.59). Conclusion: This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists.
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INTRODUCCIÓN: La leucemia linfoblástica aguda es la neoplasia más común en pediatría. Hasta la fecha no se estudiaron los aspectos clínicos y resultados del tratamiento de este trastorno en Bolivia. OBJETIVO: Describir los resultados de la inducción a la remisión en un grupo de niños con leucemia linfoblástica aguda. MÉTODOS: Estudio descriptivo de una serie de casos tratados en el Hospital del Niño "Ovidio Aliaga Uría", durante el periodo 2013-2015. RESULTADOS: Se incluyeron en el análisis 25 casos, con una edad promedio de 5,8 años, el 60% correspondía al sexo femenino. Las manifestaciones clínicas frecuentes al diagnóstico fueron la palidez, fiebre y la anorexia con 68%, 64% y 60% respectivamente. El 100% de los casos correspondía al fenotipo B, con un 96% para subtipo B común. Al finalizar la inducción con el protocolo institucional (Total Therapy XV modificado) el 92% alcanzó remisión completa, la mortalidad durante la inducción fue del 4%. La complicación más frecuente durante la inducción fue la toxicidad hematológica, seguida de la morbilidad infecciosa. El 92% requirió apoyo transfusional durante el tratamiento. La SG y la SLE estimada a los 2 años fue del 95% y 56% respectivamente. CONCLUSIÓN: La respuesta terapéutica a la inducción a la remisión con el protocolo institucional es comparable a estudios previos. La SLE es menor a datos reportados previamente, siendo el abandono de tratamiento un factor clave asociado a este hallazgo.
INTRODUCTION: Acute lymphoblastic leukemia is the most common neoplasm in pediatrics. To date, the clinical aspects and results of the treatment of this disorder in Bolivia have not been studied. OBJECTIVE: To describe the results of induction to remission in a group of children with acute lymphoblastic leukemia. METHODS: Descriptive, cross-sectional and analytical study of a case series treated at Hospital del Niño "Ovidio Aliaga Uría" during the period 2013-2015. RESULTS: Twenty-five cases, with an average age of 5.8 years, were included in the analysis, 60% of which were female. The common clinical manifestations at the diagnosis were pallor, fever and anorexia with 68%, 64% and 60% respectively. 100% of the cases corresponded to phenotype B, with 96% for common B subtype. At the end of the induction with the institutional protocol (Total Therapy XV modified), 92% achieved complete remission, the mortality during induction was 4%. The most frequent complication during induction was haematological toxicity, followed by infectious morbidity. 92% required transfusion support during treatment. The OS and EFS estimated at 2 years was 95% and 56%, respectively. CONCLUSION: Therapeutic response to induction of remission with the institutional protocol is comparable to previous studies. SLE is lower than previously reported data, with treatment abandonment being a key factor associated with this finding.
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Humans , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , LeukemiaABSTRACT
@#Introduction: Secure attachment to parents prevents adolescents from externalizingbehaviours especially in developing countries. The aim of this study was to identify thecontributors to parental attachment in a developing society. Methodology: This crosssectional study was performed on urban secondary students (aged between 13 and 17 years)based on multistage sampling in Pasir Gudang District, Johor, Malaysia. The depression,anxiety and stress (DASS-21) and Inventory of parent and peer attachment (IPPA)questionnaires were used along with a questionnaire for demographic information. Analysisof covariance (ANCOVA) was used to identify the main effect of study parameters on IPPAscores for father and mother. Results: A total of 2980 students (46.9% male and 53.1%female) participated in this study. Mean and SD for age was 14.39±1.28. Depression scoreand school form had a significant main effect on both paternal and maternal attachment(p<0.05). Age (p=0.003), ethnicity (p=0.01), history of intimate relationship (p=0.03),paternal education level (p=0.006) and maternal education level (p=0.04) had a main effecton paternal attachment, while gender (p=0.02) and stress (p=0.001) were shown to havesignificant main effect on maternal attachment. Discussion: The findings of this studyrevealed different contributors for adolescent attachment with father and mother. Local,cultural and economic structure of the community should be taken into account in order toplan for an intervention strategy to secure adolescent’s relationship with parents.
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bjective: Differences in health status between socioeconomic groups continue to challenge epidemiological research. To evaluate health inequalities in tooth loss, using indicators of socioeconomic position (education level, occupation and subjective economic situation), in a large representative sample of elderly Costa Ricans, can contribute to conceive better adapted public health interventions. Methods: Data are from the Costa Rican Longevity and Healthy Aging Study (CRELES Pre-1945), a longitudinal study of a nationally representative sample of elders. 2827 participants were included in the study using data from the first wave conducted in 2005, and analyzed cross-sectionally. The sample was imputed for missing data using a multiple imputation model. Tooth loss was self-reported and informed about the quantity of missing teeth. Information on participant's socioeconomic factors was collected via a questionnaire, including three measures approaching socioeconomic position: education level, occupation and subjective economic situation. Additional variables were included in the multivariate analyses as potential confounders. Results: Tooth loss was found to be strongly socially patterned, using variables characterizing socioeconomic position, mainly education level, occupational status and subjective economic situation. Conclusions: To highlight how socioeconomic position relates to tooth loss, can allow a better understanding of the origins of the social gradient in oral health, to tackle the most common chronic diseases across the world.
bjetivo: Las diferencias en el estado de salud entre los grupos socioeconómicos continúan desafiando la investigación epidemiológica. El objetivo de este estudio es evaluar las inequidades sociales en salud con respecto a la pérdida de piezas dentales, utilizando distintos indicadores de la posición socioeconómica (nivel de educación, ocupación y situación económica subjetiva). Se utilizó un amplio estudio representativo de la población de adultos mayores costarricenses. Este trabajo podría contribuir a concebir intervenciones en salud pública más adaptadas para el país. Métodos: Los datos provienen del Estudio de Longevidad y Envejecimiento Saludable de Costa Rica (CRELES Pre-1945), un estudio longitudinal representativo de la población de personas adultas mayores. La muestra, analizada transversalmente, incluyó 2827 participantes usando datos de la primera ronda realizada en 2005. La muestra fue imputada para tomar en cuenta los datos faltantes usando un modelo de imputación múltiple. La pérdida de piezas dentales fue declarada como la cantidad de dientes perdidos en el momento de la entrevista. La información sobre los factores socioeconómicos de los participantes se recopiló a través de un cuestionario, incluyendo tres medidas que aproximaban la posición socioeconómica: nivel educativo, ocupación y situación económica subjetiva. Otras variables fueron incluídas en el modelo de regresión múltiple, como potenciales factores de confusión. Resultados: Se encontró que la pérdida de piezas dentales estaba fuertemente asociada a las todas las variables socioeconómicas analizadas, principalmente el nivel educativo, la ocupación y la situación económica subjetiva. Conclusiones: Mostrar cómo la posición socioeconómica se relaciona con la pérdida de piezas dentales podría permitir una mejor comprensión de los orígenes del gradiente social en la salud oral. Esto permitiría la concepción de mejores políticas en salud oral para hacer frente a estas enfermedades crónicas, reconocidas como las más comunes en el mundo.
ABSTRACT
Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.
Subject(s)
Humans , Female , Breast Neoplasms/epidemiology , Developing Countries/statistics & numerical data , Mass Screening/methods , Breast Neoplasms/diagnosis , Breast Neoplasms/prevention & control , Early Detection of Cancer/statistics & numerical data , Mammography/statistics & numerical data , Survival RateABSTRACT
OBJECTIVE: The aim of the study was to evaluate the impact of traumatic lumbar puncture (TLP) at diagnosis of relapse in childhood acute lymphoblastic leukemia (ALL). Risk factors associated with TLP were assessed. MATERIALS AND METHODS: A retrospective analysis was performed from the records of children with ALL who were treated from January 2010 to December 2012. RESULTS: A total of 311 patients with median age of 5 years (range: 1–13) were treated for ALL. The cerebrospinal fluid analysis obtained from first LP revealed 275: Central nervous system 1 (CNS 1) (no blasts); 8: CNS 3 (blasts positive); and 28: TLP. Twenty‑eight (9%) patients relapsed. Twelve (3.9%) had a CNS relapse. A TLP at diagnosis was not associated with an increased risk of systemic or CNS relapse (P = 0.298, 0.295). Three years event‑free survival of patients with TLP and without atraumatic LP (ATLP) at diagnosis was 56 ± 5.2% and 51.8 ± 12.4%, (P = 0.520). Three years overall survival with TLP and ATLP was 73.3 ± 3.5% and 70.4 ± 12.5%, respectively, (P = 0.963). Median platelet count in patients with TLP was significantly lower than those without TLP (10,000/μL and 28,000/μL, P < 0.001). A receiver operating characteristic curve was constructed for predicting the risk of TLP based on platelet count. Area under the curve was 0.74 ± 0.05 (95% confidence interval 0.64–0.84). Platelet count < 23.5 × 109/L at the time of LP had 75% sensitivity and 64.4% specificity in predicting a TLP. CONCLUSIONS: Low platelet counts are significantly associated with risk of TLP. Traumatic LP at diagnosis was not associated with an increased risk of relapse.
ABSTRACT
Background: The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-‑hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.