Low Mid-income Countries Research Articles

Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study.

This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.

Determining transfusion risk factors in digestive major oncologic surgeries: the only way to address blood shortage in developing countries

Background: Blood shortage is a chronic problem particularly in low-mid income countries, with a huge impact on surgical activity, many protocols are deployed to prevent delayed surgeries due to blood inavailability like protocols of shared blood surgery reserve, the iron supplementation of high risk patients of anemia. Our study aims to take part in this strategy by identifying the patients with risk factors of peroperative transfusions whose blood is required for the procedure.

Audit of laparoscopic surgery for colon cancer in Morocco: A report of the results of a prospective multicentre cohort study

BackgroundLittle data is available about colon laparoscopic surgery in low mid-income countries. The aim of this study was to audit the status and results of laparoscopic colon cancer surgery in Morocco. Patients and methodsThis was a prospective study performed at 4 academic departments in Morocco between January 1, 2018, and March 31, 2020. All adult patients who underwent elective right or left colonic resection for colon adenocarcinoma were included. The main outcomes were the rate of laparoscopic surgery (LS) and the comparison of its short-term outcomes with open surgery (OS). ResultsAmong 121 patients included, 52 (43%) underwent laparoscopic resection (0–49.3%). Five surgeons (29%) performed at least one laparoscopic resection. There were more left colectomies in the laparoscopic group (71.2% vs. 39.1%. p = 0.0004), and more extended resections (23.1% vs. 40.6%. p = 0.043) and T4 stage (19% vs. 37.5%. p = 0.037) in the open group. There were no differences in 90-days overall and serious complications. OS patients had significantly more harvested lymph nodes (14 vs. 18. P = 0.007) and higher median surgical margins (6 cm vs. 9 cm. P = 0.003) than LS patients. ConclusionsLS for colon cancer in Morocco is performed by few surgeons, who apply strict patient selection for laparoscopic cases. It was associated with lower quality resections compared to open surgery. There are still many challenges requiring more focus on training, certification, centralization and standardisation of care across the nation.

Evaluation of the implementation of a quality improvement program through morbidity and mortality reviews in a developing country

BackgroundMorbidity and mortality reviews represent an opportunity to discuss adverse events and healthcare issues. Aim: Report the first experience of implementing a procedure of MMR, and assess its impact on quality improvement. MethodsFrom July 2019 to December 2019, members of the surgical and ICU departments designed and implemented a regular procedure of MMR. Cases of severe postoperative complications after curative resection for digestive cancer were selected to be presented by a surgical resident and discussed in an interdisciplinary conference following a standardized presentation based on an analysis tool adapted from the ALARM framework. Process was assessed by the number of MMRs held, number and type of recommendations issued and implemented. ResultsAmong 13 serious complications during the study period, 10 were discussed. The “Tasks” category was activated in 90% of the cases where lack or misuse of protocols was identified in 90% of the events discussed. Test results availability or accuracy were incarnated in 30% of cases. Poor communication was a contributing factor in 60% of the cases. Written medical records were defective in 40% of the cases. From 16 recommendations for improvement emitted, 87.5% (14/16) were translated into projects and successfully implemented. Conclusionsa standardized and regular procedure of morbidity and mortality reviews in a tertiary care facility in a developing country allowed a significant improvement in patient care through quality initiatives implementation. MMRs might be a strong tool for the improvement of surgical care particularly for low-mid income countries.

Prevalent yet preventable causes of traumatic brain injury in low-mid income countries & the role of law enforcement

Prevalent yet preventable causes of traumatic brain injury in low-mid income countries & the role of law enforcement

Prevalence and correlations of hepatorenal functions in diabetes and cardiovascular disease among stratified adults.

Background: The vulnerability of older adults to diabetes and cardiovascular complications is a global concern. Hepatorenal pathophysiology is implicated in these complications, but has yet to be clearly established, especially from rural low-mid income countries. This study investigates differences in prevalence of diabetes in aging groups and correlations of age with hepatorenal variables. Methods: 203 participants of both sexes above the age of 18 years underwent anthropometric measurements at Catholic Hospital, Abbi, Nigeria. Questionnaires collected demographic information and medical history. Urinalysis as well as routine liver and renal function tests were performed. Data analysis included determination of levels of hepatorenal abnormalities and prevalence of diseases in age groups. Percentage of disease subpopulations made up by each age-group was also determined as well as Pearson’s correlation coefficient between age and hepatorenal variables, and comparison of average age and hepatorenal variables in disease subgroups. Results: Percentage hepatorenal abnormalities are not significantly different between age-groups. There is no significant difference in percentage level of disease between groups, but in age-groups constituting disease sub-populations (p<0.00001). The apparently healthy subpopulation comprises of younger adults compared to older adults constituting diabetes and hypertension (p < 0...). Age shows moderate correlation with renal function parameters, especially urea and chloride (r = 0.42), but relatively insignificant with liver function variables. Conclusion: This report affirms that diabetes cardiovascular co-morbidity comes with aging. It also indicates that renal pathophysiology may be more associated, than liver, functions in the vulnerability of adults. (www.actabiomedica.it)

Comparison of immunohistochemistry with in situ hybridization methods: discrepancy resolution and implications for low-mid income countries

Some pathology tests that involve immunohistochemistry (IHC) staining now have in situ hybridization (ISH – including chromogenic ISH [CISH] and fluorescence ISH [FISH])) technology being used either as alternative or confirmatory methods. This technical note, based on a critical appraisal, shares opinion on ISH and IHC discrepancy resolution as well as adoptability of the ISH methods by pathology services in low-mid income countries. The report that is appraised involved 174 cases of human epidermal growth factor receptor 2 (HER2) from pathology archives. The CISH, FISH, and IHC slides were reviewed by two pathologists and consensus scores assigned if a discrepancy occurred. The report indicated absolute concordance between the CISH and FISH results, with 82% between IHC and ISH. No equivocal case was reported. The report was assessed to resolve the 18% discrepancy between the IHC and ISH results that were otherwise unequivocal. Recent guidelines for Her2 testing, jointly issued by the American Society of Clinical Oncology and the College of American Pathologists, is still being debated – for example, the associated workload implications and challenges for support in most health care systems. What is being contributed to the discourse is that using ISH to confirm positive IHC is not recommended and could create discrepancies that are, as yet, difficult to resolve. The cost of performing ISH is something to consider, especially in low-mid income countries where affordability and availability of tests are abysmal. CISH, which speculated to be a less expensive alternative to FISH, should be given serious consideration.

Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies

ObjectiveGlobally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs.This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. MethodsA manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. ResultsQuestionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. ConclusionThe mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data.

Screening of cardiovascular disease risk in diabetes: questions concerning prediabetes and low-mid income countries.

Background:The prevalence of prediabetes is increasing world-wide and this condition predisposes to substantially increased risk of cardiovascular disease in addition to developing diabetes mellitus (DM). This article debates screening for early identification and intervention of cardiovascular risk in prediabetes.Discussion:Screening methods exist for cardiovascular disease, but the models have diabetes and smoking status as dichotomous variables. A [Yes or No] response in regards to diabetes then ignores dysglycemia in prediabetes individuals who may nevertheless have hyperglycemia-induced oxidative stress. Therefore, the sufferers are treated like healthy persons in such screening models. The problem is worse especially in the low - mid income countries where diagnostic services are either inaccessible or unaffordable for comprehensive testing.Conclusion:To improve early intervention of cardiovascular risk in subclinical diabetes, a model that employs a combination of blood glucose level and an index of oxidative damage is imperative to cater for prediabetes.

Vulnerability of riders and passengers to injuries in multi-occupant motorcycle crashes

BackgroundMotorcycles in Low-Mid Income Countries (LMIC) are rarely ridden for recreational purposes; rather they form an essential part of daily commuting. Consequently, most motorcycles on the roads have more than...