From diagnosis to treatment: a holistic approach to intraepithelial cervical disease

Cervical cancer remains a significant cause of mortality among women worldwide. Screening methods play a crucial role in identifying individuals with cervical pre-cancerous lesions, allowing for timely intervention to prevent progression to invasive disease. Treatment modalities for cervical intraepithelial neoplasia (CIN) are effective, straightforward, and safe. The choice between ablative techniques (such as cryotherapy or thermal ablation) and excisional techniques (like large loop excision or cold knife conization) depends on lesion characteristics and transformation zone type. Ablative techniques are particularly suitable for low-resource settings due to their simplicity, low complication rates, and cost-effectiveness. In areas where access to colposcopy and histopathology services is limited, strategies such as visual inspection with acetic acid (VIA) followed by immediate ablative treatment for VIA-positive individuals are recommended by the World Health Organization. This approach not only prevents the progression of high-grade CIN but also ensures high compliance among screen-positive individuals. Overall, effective screening and treatment strategies are essential in reducing the burden of cervical preinvasive lesions and preventing the development of cervical cancer.

Feasibility of tele-rehabilitation in low resource setting: perceived barriers and facilitators among physiotherapy professionals

Background: Robust evidence illustrates the significance and efficacy of telerehabilitation to optimize the participation in rehabilitation program taking into account organisational, geographical and transportation aspects. Despite knowing the remarkable benefits, there exist an array of challenges to implement telerehabilitation services in a setting with meagre resources. In order to augment the uptake of telerehabilitation services, our study aims to explore the perceived barriers and facilitators to telerehabilitation among Physiotherapy professional in a resource limited setting. Methods: A cross-sectional survey was conducted among physiotherapy professionals in Maharashtra using a questionnaire with a content validation index of 0.95. The survey sought to ascertain the awareness, barriers, facilitators and strategies to improve practice of telerehabilitation. Results: A total of 450 Physiotherapists were invited, of which, 201 participated in the study. The major barriers to telerehabilitation were inaccuracy in obtaining adequate information (n=149, 74%), lack of face-to-face monitoring (n=131, 65%) and physical limitation in older adults (n=114, 57%); on the other hand, the facilitators were reduced transportation time to hospital/clinic (n=132, 67%) and improved accessibility to healthcare services (n=125, 62%). The factors that enabled the patients to participate were flexible appointment schedule (n=139, 69%) and minimal transportation costs (n=129, 64%). Furthermore, the participants majorly considered encouraging patients’ appropriate environment, insurance coverage, training and upskilling of clinicians as the strategies to improve practice. Conclusions: The implementation of telerehabilitation program has been limited due to perceived constraints associated with various organizational, geographical and patient factors. However, physiotherapists reported strategies to improve practices could be implemented to accelerate the utilization of telerehabilitation services.

Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program

Purpose: Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low?resource clinical care at home and abroad. Low?resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small?incision cataract surgery (MSICS) curriculum was started in the University of Colorado’s residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States–based residency program. Methods: This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low?resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results: Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that “MSICS is a valuable skill to have”. Eighty percent of respondents agreed or strongly agreed that “exposure to MSICS has increased my likelihood of doing any type of outreach work in the future” and 86.67% agreed or strongly agreed that “exposure to MSICS increased my understanding about sustainable outreach work”. The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4–12). Conclusion: A formal MSICS curriculum for US?based ophthalmology residents was well?received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program’s curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed

Public health challenges of restorative dental practice in low resource settings during the Covid-19 pandemic

Background: COVID-19 remains a major public health threat globally, and has challenged healthcare systems and services including oral health Objective: This study examines the key public health challenges posed by the COVID-19 pandemic in low resource settings. While healthcare services are learning to cope with the COVID-19 pandemic, dental care services, in particular restorative dental practice have been adversely impacted because of the closeness of caregivers to the patient's mouth as well as the generation of aerosols during most restorative procedures. This presents a challenge for low-and-middle-income countries (LMICs) such as Nigeria where weak and poor governance structures characterize healthcare systems in addition to paucity of economic resources. Another challenge in the form of COVID-19 conspiracy theories has threatened to undermine public health efforts designed to control the pandemic. Conclusion: The implementation of optimal guidelines and safety protocols for effective COVID -19 infection prevention and control is a major challenge for restorative dental care practice in low resource settings owing to paucity of key material resources and inappropriate behaviour associated with lingering doubts about COVID-19 reality among the majority of the populace. The Safer Aerosol-Free Emergent Dentistry concept offers a viable practical approach for restorative dental practice in LMICs during and in the post COVID-19 pandemic era. There is a need to deploy all resources, human and material, in the education and enlightenment of the populace regarding the reality of COVID-19.

A retrospective clinicopathological study of 131 cases with endometrial cancers - Is it possible to define the role of retroperitoneal lymphadenectomy in low-resource settings.

AIM: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor grades, and their implications on lymph node metastasis. MATERIALS AND METHODS: We conducted a retrospective descriptive study of 131 cases of endometrial cancer examined and treated at a tertiary regional cancer institute between the years 2003 and 2009. We reviewed the oncology database as well as the clinical records and surgico‑pathological registry of all these patients. STATISTICAL METHODS USED: All the summary measure computation and Chi‑square test for comparing more than one proportion was done in spreadsheet (Excel). RESULTS: The multiparity association with endometrial cancer was commonly seen 113/131 (86.2%). Twelve (9.7%) patients preoperatively diagnosed as Grade 1 tumors upgraded to Grade 3 changes in postoperative specimens and six of these 12 patients (50%) had lymph node metastasis. A total of 14/131 (10.6%) cases had lymph nodes metastasis. CONCLUSIONS: There is a poor correlation between the preoperative and the postoperative tumor grades. Routine pelvic lymphadenectomy may be a valuable method in low‑risk cases and para‑aortic lymphadenectomy may be limited to high‑risk endometrial cancers.