RESUMO
Fetal neck masses are uncommon but challenging to manage, particularly in limited-resource settings. We prenatally diagnosed a large fetal neck mass after consultative referral for polyhydramnios at 30 weeks' gestation. The pregnant patient was counseled on the findings, differential diagnoses, and the prenatal and postnatal management options. She delivered at 38 weeks' gestation through emergent cesarean delivery after presenting in labor owing to concern for labor dystocia with the large mass. The diagnosis of lymphangioma was made postnatally through imaging. Good prognosis has been reported in several cases with surgery and/or sclerotherapy, even in low-resource settings. Despite the availability of a pediatric surgeon to perform a resection, the family declined treatment because of a belief that the mass was of supernatural etiology. Patient-centered, multidisciplinary services focusing on maternal and fetal complications should assess and account for cultural beliefs to better understand and counsel families who have a fetus or neonate with a congenital anomaly.
RESUMO
Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.
RESUMO
Sexually transmitted infections (STIs) pose a serious public health threat with more than 1 million curable infections diagnosed every day. While these infections are prevalent globally, the approach to evaluation and treatment varies greatly based on the capacity to make an accurate diagnosis. In low-resource settings, a syndromic approach is often used over an etiologic-based evaluation and management. Syndromic treatment of STIs recognizes groups of symptoms and recommends a multidrug empiric treatment that will cover the most likely causative organisms. By definition, syndromic treatment cannot be used as a screening tool, leaving a large portion of asymptomatic infections untreated. This will lead to the persistence of infection and associated sequelae including pelvic inflammatory disease and infertility. Syndromic treatment also leads to the overtreatment of many infections, which contributes to antimicrobial resistance. The rising threat of Neisseria gonorrhoeae resistance to last-line antibiotics is of global concern. Rapid, accurate, affordable, and easy-to-use point-of-care testing needs to be made readily available to all corners of the world to provide better care to patients and address the growing threat of multidrug resistant organisms. An urgent and collaborative global effort is needed to address the looming threat of a dangerous STI that is resistant to last-line antibiotics.
