Mid-income Countries Research Articles

Overcoming challenges to reduce time to antibiotic therapy in febrile neutropenic children: insights from a Mexican center

BackgroundProviding quality supportive therapy for children with cancer is essential to reduce the high mortality rates in low- and middle-income countries. Febrile neutropenia is the most common life-threatening complication of cancer in children. The objective of this study was to evaluate the long-term effectiveness of the ‘Golden Hour’ intervention in reducing the time to administer antibiotics and its impact on clinical outcomes in a Mexican hospital. MethodsA comparative study of children with febrile neutropenia who attended the emergency department at the Hospital Universitario “Dr. José Eleuterio González” was performed between January 2017 and December 2022. In May 2019, this center joined the collaborative ‘Mexico in Alliance with St. Jude’ project. An adapted improvement program was developed based on the implementation of an algorithm comprising institutional guidance, supplies kit, standardization of sample processing, training of healthcare providers, and patient education. The time to antibiotic administration was compared with clinical outcomes between the historical control and post-intervention groups. ResultsA total of 291 patients were included, 122 in the pre-intervention period and 169 in the intervention period. Only 5.7% of the pre-intervention group received the first dose of antibiotics within 60 minutes of presenting to the emergency department compared to 84.6% in the intervention group (p-value <0.000). The median times to antibiotic administration in the pre-intervention and post-intervention periods were 269.4 and 50.54 minutes, respectively (p-value <0.000). Clinical deterioration and admission to the pediatric intensive care unit decreased significantly from 6.6% to 2.3% (p-value = 0.03). ConclusionsSustainability of the quality improvement project ‘Golden Hour’ in low- to mid-income countries demonstrated high effectiveness in reducing time to antibiotic administration among children with febrile neutropenia and improved clinical outcomes over three years of implementation.

Clinical outcome of patients with rheumatic tricuspid valve disease: matched cohort study.

Rheumatic heart disease (RHD) is still a major health problem, especially in low- to mid-income countries, leading premature deaths owing to valvular disease. Although left-sided valvular involvement is most commonly seen in RHD, the tricuspid valve can also be affected. However, there is a lack of information about the prognostic value of primary tricuspid valve (TV) disease in RHD. This study aimed to determine the impact of TV disease on clinical outcome in RHD. This prospective study enrolled patients with rheumatic mitral valve disease (MVD) referred to a tertiary center for management of heart valve disease. Primary rheumatic TV disease was defined by echocardiographic features including thickening of leaflets associated with some degree of restricted mobility. Patients with rheumatic TV disease were matched to patients with MVD using 1:1 genetic matching algorithm that maximized balance of baseline covariates prior to exploring outcome differences. The main outcome was either need for MV replacement or death. Among 694 patients eligible for the study, age of 47 ± 13 years, 84% female, 39 patients (5.6%) had rheumatic TV disease. After excluding patients with incomplete data, 33 patients with TV disease were matched to 33 controls based on age, right-sided heart failure, atrial fibrillation, and MV area. During a mean follow-up of 42 months (median 28, IQR 8 to 71 months), 32 patients (48.5%) experienced adverse events, including 6 cardiovascular deaths and 26 patients who underwent surgery for mitral valve replacement. The adjusted analysis demonstrated a significant association between TV disease and the outcome, with a hazard ratio (HR) of 3.386 (95% CI 1.559-7.353; P = 0.002) in the genetic matched cohort with balance on baseline covariates of interest. The model exhibited good discriminative ability, as indicated by a C-statistic of 0.837. In patients with rheumatic mitral valve disease, rheumatic TV disease significantly increased risk of adverse events compared with matched controls. The involvement of TV may express overall disease severity that adversely affects clinical outcome.

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Mental Disorders – A Serious Global Concern that Needs to Address

A major global health concern that affects millions of individuals globally is mental illness. Recent estimates place the number of people with mental or behavioral disorders at 450 million worldwide, making up over 12% of all diseases (Friedrich, 2017). These issues include substance use disorders, bipolar disorder, schizophrenia, depression, and concern disorders, among many other conditions. It is projected that 322 million people worldwide, or 4.4% of the total population, suffer from depression alone. These figures were featured in the report “Depression and Other Common Mental Disorders: Global Health Estimates,” released by the World Health Organization (WHO) in 2017. The prevalence of anxiety disorders, which currently affect 260 million individuals worldwide, or 3.6% of the total population, is another topic covered in the report. The consequences of mental diseases are prevalent in low and mid-income countries as well; they are not exclusive to high-income ones. According to the report, mental health issues are rising in these countries

A microRNA Profile Regulates Inflammation-Related Signaling Pathways in Young Women with Locally Advanced Cervical Cancer.

Cervical cancer (CC) remains among the most frequent cancers worldwide despite advances in screening and the development of vaccines against human papillomavirus (HPV), involved in virtually all cases of CC. In mid-income countries, a substantial proportion of the cases are diagnosed in advanced stages, and around 40% of them are diagnosed in women under 49 years, just below the global median age. This suggests that members of this age group share common risk factors, such as chronic inflammation. In this work, we studied samples from 46 patients below 45 years old, searching for a miRNA profile regulating cancer pathways. We found 615 differentially expressed miRNAs between tumor samples and healthy tissues. Through bioinformatic analysis, we found that several of them targeted elements of the JAK/STAT pathway and other inflammation-related pathways. We validated the interactions of miR-30a and miR-34c with JAK1 and STAT3, respectively, through dual-luciferase and expression assays in cervical carcinoma-derived cell lines. Finally, through knockdown experiments, we observed that these miRNAs decreased viability and promoted proliferation in HeLa cells. This work contributes to understanding the mechanisms through which HPV regulates inflammation, in addition to its canonical oncogenic function, and brings attention to the JAK/STAT signaling pathway as a possible diagnostic marker for CC patients younger than 45 years. To our knowledge to date, there has been no previous description of a panel of miRNAs or even ncRNAs in young women with locally advanced cervical cancer.

IKZF1plus is a frequent biomarker of adverse prognosis in Mexican pediatric patients with B-acute lymphoblastic leukemia.

Recurrent genetic alterations contributing to leukemogenesis have been identified in pediatric B-cell Acute Lymphoblastic Leukemia (B-ALL), and some are useful for refining classification, prognosis, and treatment selection. IKZF1plus is a complex biomarker associated with a poor prognosis. It is characterized by IKZF1 deletion coexisting with PAX5, CDKN2A/2B, or PAR1 region deletions. The mutational spectrum and clinical impact of these alterations have scarcely been explored in Mexican pediatric patients with B-ALL. Here, we report the frequency of the IKZF1plus profile and the mutational spectrum of IKZF1, PAX5, CDKN2A/2B, and ERG genes and evaluate their impact on overall survival (OS) in a group of patients with B-ALL. A total of 206 pediatric patients with de novo B-ALL were included. DNA was obtained from bone marrow samples at diagnosis before treatment initiation. A custom-designed next-generation sequencing panel was used for mutational analysis. Kaplan-Meier analysis was used for OS estimation. We identified the IKZF1plus profile in 21.8% of patients, which was higher than that previously reported in other studies. A significantly older age (p=0.04), a trend toward high-risk stratification (p=0.06), and a decrease in 5-year Overall Survival (OS) (p=0.009) were observed, although heterogeneous treatment protocols in our cohort would have impacted OS. A mutation frequency higher than that reported was found for IKZF1 (35.9%) and CDKN2A/2B (35.9%) but lower for PAX5 (26.6%). IKZF1MUT group was older at diagnosis (p=0.0002), and most of them were classified as high-risk (73.8%, p=0.02), while patients with CDKN2A/2BMUT had a higher leukocyte count (p=0.01) and a tendency toward a higher percentage of blasts (98.6%, >50% blasts, p=0.05) than the non-mutated patients. A decrease in OS was found in IKZF1MUT and CDKN2A/2BMUT patients, but the significance was lost after IKZF1plus was removed. Our findings demonstrated that Mexican patients with B-ALL have a higher prevalence of genetic markers associated with poor outcomes. Incorporating genomic methodologies into the diagnostic process, a significant unmet need in low- and mid-income countries, will allow a comprehensive identification of relevant alterations, improving disease classification, treatment selection, and the general outcome.

Over-the-counter hearing aids: implementations and opportunities

After decades of effort by shareholders, including government agencies, patient advocacy groups, and professional organizations, the U.S. Food and Drug Administration (FDA) established a new medical device category for over-the-counter (OTC) hearing aids on October 17, 2022. This FDA regulation allows adults aged 18 years or older with perceived mild-to-moderate hearing loss to purchase OTC hearing aids without a prescription or even a hearing test. The goal is to increase hearing aid accessibility, potentially leading to improved hearing and a better quality of life. In our analysis of the FDA Establishment Registration &amp;amp; Device Listing database, we found that the current OTC hearing aid market is still dominated by traditional hearing aid manufacturers, with limited disruptor from major consumer electronics and startup companies. Our technological analyses showed that the relatively high-level output specification without gain limitation allows sufficient amplification even for people with severe-to-profound hearing loss. Additionally, borrowing from the cochlear implant mapping strategy, we propose novel amplification algorithms for fitting OTC hearing aids without an audiogram. We argue that smartphones and true-wireless-stereo earbuds can functionally serve as OTC hearing aids, further increasing accessibility and affordability while reducing the stigma associated with hearing aids, especially in low- and mid-income countries. By treating more people at a younger age with less hearing loss than traditional prescription hearing aids, OTC hearing aids can potentially have a significant impact beyond hearing care, such as delaying or preventing cognitive decline in the elderly.

Evaluating physical activities in clinical diabetes: lifestyle scores hypothesis.

The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices. This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18-90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age. Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities. This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.

CHALLENGES AND OPPORTUNITIES OF THE 2022 G20 SUMMIT IN STRENGTHENING PREVENTION, PREPAREDNESS, AND RESPONSE (PPR) FINANCING AS A PART OF GLOBAL HEALTH ARCHITECTURE RESTRUCTURATION

Restructuring and strengthening the framework of Global Health Architecture (GHA) is one of the significant agendas raised at the 2022 G20 Summit held in Bali, Indonesia. One of the identified motivations behind this initiative concerns the gap in the prevention, preparedness, and response (PPR) financing policy and its sustainability. This problem generates inequity in the global health system–especially experienced by the low- and mid-income countries (LMICs)–and hinders the effort to comprehensively mitigate the impacts the threats have caused, such as from the current COVID-19 outbreak. Consequently, these countries are struggling due to their inability to acquire healthcare resources such as health infrastructures, vaccine access, and human resources. To understand how the 2022 G20 forum could contribute to restructuring and strengthening the architecture, this paper investigates the upcoming summit's potential challenges and opportunities in restructuring the GHA framework to close the gap in financing PPR and creating an equal global health system. In doing so, this article will apply desk study by collecting information from secondary data sources. One of the potential opportunities is to strengthen global health multilateralism through the G20 members' active engagement in the financial intermediary fund (FIF) platform. However, there is also a significant challenge regarding the current global solidarity and political tension. Therefore, the forum must consider these notions to create a more robust and sustained financial policy to strengthen the architecture.

Asia-Pacific Leukemia Consortium: An innovative and collaborative initiative to improve care of leukemia and related diseases in the Asia-Pacific region.

The burden of leukemia and related diseases is rapidly growing in Asia. Currently, there is a paucity of regional collaborative groups/initiatives that focus exclusively on the management of leukemia in the Asia-Pacific (APAC) region. The Asia-Pacific Leukemia Consortium (APLC) was established on the 8 September 2021 to understand the status quo, unmet needs, and ways to improve the management of leukemia and related diseases in the APAC region. The APLC working group set up a group of experts from various countries (Singapore, Malaysia, Thailand, Hong Kong, Japan, South Korea, Taiwan, China, and Australia) to discuss on the status of: (i) clinical trials; (ii) disease registry database; (iii) genetic and tissue repository; (iv) patient advocacy and care; and (v) disease prevention and education in the APAC region. Low levels of awareness about leukemia amongst the public, lack of financial support, and limited access to newly approved therapies were identified as barriers to the implementation of effective leukemia management in low- or mid-income Asian countries. Patients often enroll in clinical trials to gain access to novel/approved therapies. The APLC group aims to address the growing threat of leukemia through a collaborative approach to advance disease prevention, research, clinical trials, and education.

Multitemporal relative landslide exposure and risk analysis for the sustainable development of rapidly growing cities

In recent decades, developing countries have experienced an increase in the impact of natural disasters due to ongoing climate change and the sustained expansion of urban areas. The intrinsic vulnerability of settlements, due to poverty and poor governance, as well as the lack of tools for urban occupation planning and mitigation protocols, has made such impacts particularly severe. Cuenca (Ecuador) is a significant example of a city that in recent decades has experienced considerable population growth (i.e. exposure) and an associated increase in loss due to landslide occurrence. Despite such effects, updated urban planning tools are absent, so an evaluation of multitemporal exposure to landslides and related risks is required. In this perspective, a potential urban planning tool is presented based on updated data depicting the spatial distribution of landslides and their predisposing factors, as well as population change between 2010 and 2020. In addition, a multitemporal analysis accounting for changes in exposure between 2010 and 2020 and an estimation of relative landside risk was carried out. Due to the absence of spatially distributed population data, energy supply contract data have been used as a proxy of the population. The results show that the current higher exposure and related relative risk are estimated for parishes (parroquias) located in the southern sector of the study area (i.e. Turi, Santa Ana, Tarqui, Nulti, Baños and Paccha). Moreover, the exposure multitemporal analysis indicates that most parishes located in the hilly areas bounding the city centre (i.e. Sayausi, San Joaquin, Tarqui, Sidcay, Baños, Ricaurte, Paccha and Chiquintad) are experiencing sustained population growth and will be potentially exposed to an increased risk with a consistently growing trend. The obtained relative risk map can be considered a valuable tool for guiding land planning, land management, occupation restriction and early warning strategy adoption in the area. The methodological approach used, which accounts for landslide susceptibility and population variation through proxy data analysis, has the potential to be applied in a similar context of growing population cities in low- to mid-income countries, where data usually needed for a comprehensive landslide risk analysis are non-existing or only partially available.

Pushing the limits of low-cost ultra-low-field MRI bydual-acquisition deep learning 3D superresolution.

Recent development of ultra-low-field (ULF) MRI presents opportunities for low-power, shielding-free, and portable clinical applications at a fraction of the cost. However, its performance remains limited by poor image quality. Here, a computational approach is formulated to advance ULF MR brain imaging through deep learning of large-scale publicly available 3T brain data. A dual-acquisition 3D superresolution model is developed for ULF brain MRI at 0.055 T. It consists of deep cross-scale feature extraction, attentional fusion of two acquisitions, and reconstruction. Models for T1 -weighted and T2 -weighted imaging were trained with 3D ULF image data sets synthesized from the high-resolution 3T brain data from the Human Connectome Project. They were applied to 0.055T brain MRI with two repetitions and isotropic 3-mm acquisition resolution in healthy volunteers, young and old, as well as patients. The proposed approach significantly enhanced image spatial resolution and suppressed noise/artifacts. It yielded high 3D image quality at 0.055 T for the two most common neuroimaging protocols with isotropic 1.5-mm synthetic resolution and total scan time under 20 min. Fine anatomical details were restored with intrasubject reproducibility, intercontrast consistency, and confirmed by 3T MRI. The proposed dual-acquisition 3D superresolution approach advances ULF MRI for quality brain imaging through deep learning of high-field brain data. Such strategy can empower ULF MRI for low-cost brain imaging, especially in point-of-care scenarios or/and in low-income and mid-income countries.

Integrating the influence of untreated sewage into our understanding of the urban stream syndrome

The process of urbanization profoundly changes aquatic ecosystems. Urban streams often have flashier hydrology, increased nutrient and contaminant concentrations, and reduced biodiversity when compared with nonurban streams. Collectively, these characteristics are described as the urban stream syndrome (USS). The USS is traditionally attributed to the discharge of large volumes of stormwater into streams, thus pointing to stormwater as the primary driver of urban stream degradation. However, the USS was developed using evidence from studies in streams in high-income economies in the Global North, and the extent to which it applies to low- and mid-income countries in the Global South remains unclear. Urban expansion in the Global South is often not concomitant with the expansion of sanitation infrastructure, which can lead to large volumes of untreated sewage being discharged into urban streams. In this paper we explore the role of untreated sewage in the application of the USS concept in Latin America. First, we collected and quantified studies that consider the effect of untreated sewage on urban streams in Latin America. We then use the existing evidence to assess if untreated sewage has the potential to affect urban streams in Latin America in similar ways as stormwater affects urban streams in the Global North. Although untreated sewage pollution is widespread in Latin America, our search documented only 57 studies that consider the effects of untreated sewage in local streams. Despite the lack of empirical studies, it is likely that untreated sewage can be as important as stormwater in driving the USS in Latin America. We assert that to support effective management and conservation of urban streams in Latin America, untreated sewage pollution needs to be explicitly considered in the application of the USS concept.

Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and Functional Mobility Scale Following Surgical Intervention: A Single Centre Experience.

Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there wereany changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicatorofchange in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospitalon spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit,with the latest recordbeingtwo years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to thescore of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month toone-year post-surgery, after whicha few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Mostchildren soughtconsultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions doimprove the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvementcan be expected one year after surgery in most patients, possible of worsening from baseline scores doexist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.

A Low-Cost Calibration Method for Temperature, Relative Humidity, and Carbon Dioxide Sensors Used in Air Quality Monitoring Systems

Low-cost sensors provide an affordable alternative to monitor environmental parameters with acceptable performance. There is a substantial amount of literature where low-cost sensors are compared with high-end reference measurements. However, not all organizations have access to such reference infrastructure. We propose low-cost calibration methods for temperature, relative humidity, and CO2 to allow them to collect their own reliable data. These methods are based on simple techniques and procedures that allow temperature calibration to be achieved in the range of 0 to 50 °C, relative humidity from 0 to 90%, and CO2 between 0 and 1100 ppm. The materials used to create the calibration setups can be purchased online, at hardware stores, and in pharmacies. The reliability of the calibration methods was evaluated using several indicators, such as the airtightness of the calibration box, similarity with the factory calibration, similarity with the reference, similarity between different sensors, replicability of the calibration method, and the similarity with a golden standard. In addition, the results of the low-cost calibration methods were compared with the more advanced calibration methods. A short measurement campaign in the city of Santa Clara, Cuba, demonstrated that such calibrations transform in-house developed monitoring systems into valid low-cost scientific instruments for decision-making. This work creates opportunities for institutions and researchers hosted in low- and mid-income countries to build and validate their own equipment to reliably solve local problems.

Are Child Domestic Workers Key Ingredients In Employers’ Households? Employers’ Perception Towards Child Domestic Workers in Dar es Salaam, Tanzania

This study explored employers’ perception towards child domestic workers in Dar es Salaam, Tanzania. It involved a sample of 15 employers of child domestic workers. Data was gathered through key informant interviews and field observation, and analysed thematically between August 2021 and February, 2022. The findings indicate that child domestic workers (15–18 years old) are culturally acceptable in the name of work socialization, are often perceived and treated as fictive kin, and are a key ingredient in employers’ households. However, some employers had negative perception towards child domestic workers and described them as stubborn, witchy, and lazy; hence kept on hiring and firing these child domestic workers from time and space. It is therefore concluded that in the context of developing and mid-income countries like Tanzania where most people, including the elite, consider child domestic work as a charity, socially and culturally removing children from domestic work is not enough; and may leave them more vulnerable to other dangerous forms of work within or outside their biological homes. Hence, the study recommends that the human rights of children—like their right to light work, their best interests, and their voices and those of their employers—remain to be vital aspects of policies affecting children. Again, in line with the current International Labour Organization’s emphasis on making domestic work decent, there is a need of implementing strategies to promote positive work experiences among child domestic workers (15–18 years old), and formalize/regulate their employment across Tanzania.

China’s urban-rural expansion and natural habitat loss since the 1980s: Retrospective analysis and future suggestions

Natural habitats transformed to city or countryside with human activities of different intensities have reshaped regional and global landscapes, especially in those rapid developed low- and mid-income countries, like China. China’s rapid shift in urban and rural expansion, which are greater than and equal to, and below county-level’s artificial land expansion, and reduction in farmland and ecological land are important for determining future urban and rural development under the conservation and protection of farmland and ecosystems; however, such an understanding is still inadequate. Here, we show that both urban and rural expansions have encroached on farmland and ecological land since 1980; rural areas, with 1.33 km2 × 105 km2 in 2020, remain larger than urban areas, with 0.97 km2 × 105 km2 in 2020. However, urban areas (1857.5 km2/year) increased faster than rural areas (695.0 km2/year) during 1980–2020, rural expansion primarily occurred in the 1980s and 1990s, and urban expansion primarily occurred after 2000 especially 2000s. Farmland is the major land cover that has been occupied by urban and rural expansion for 53.7 and 39.1 thousand km2, especially in East China’s densely populated areas. And, both farmland and ecological land were primarily encroached during 2000s. Our results demonstrate imbalanced urban and rural expansion and encroachment on farmland and ecological land; thus, both forms of encroachment should be optimized at the regional scale based on the socioeconomic needs and natural conditions, and diverse policies can be designed to support local sustainable development.

The role of artificial intelligence based systems for cost optimization in colorectal cancer prevention programs.

Colorectal Cancer (CRC) has seen a dramatic increase in incidence globally. In 2019, colorectal cancer accounted for 1.15 million deaths and 24.28 million disability-adjusted life-years (DALYs) worldwide. In India, the annual incidence rates (AARs) for colon cancer was 4.4 per 100,000. There has been a steady rise in the prevalence of CRC in India which may be attributed to urbanization, mass migration of population, westernization of diet and lifestyle practices and a rise of obesity and metabolic risk factors that place the population at a higher risk of CRC. Moreoever, CRC in India differs from that described in the Western countries, with a higher proportion of young patients and more patients presenting with an advanced stage. This may be due to poor access to specialized healthcare and socio-economic factors. Early identification of adenomatous colonic polyps, which are well-recognized pre-cancerous lesions, at the time of screening colonoscopy has been shown to be the most effective measure used for CRC prevention. However, colonic polyps are frequently missed during colonoscopy and moreover, these screening programs necessitate man-power, time and resources for processing resected polyps, that may hamper penetration and efficacy in mid- to low-income countries. In the last decade, there has been significant progress made in the automatic detection of colonic polyps by multiple AI-based systems. With the advent of better AI methodology, the focus has shifted from mere detection to accurate discrimination and diagnosis of colonic polyps. These systems, once validated, could usher in a new era in Colorectal Cancer (CRC) prevention programs which would center around “Leave in-situ” and “Resect and discard” strategies. These new strategies hinge around the specificity and accuracy of AI based systems in correctly identifying the pathological diagnosis of the polyps, thereby providing the endoscopist with real-time information in order to make a clinical decision of either leaving the lesion in-situ (mucosal polyps) or resecting and discarding the polyp (hyperplastic polyps). The major advantage of employing these strategies would be in cost optimization of CRC prevention programs while ensuring good clinical outcomes. The adoption of these AI-based systems in the national cancer prevention program of India in accordance with the mandate to increase technology integration could prove to be cost-effective and enable implementation of CRC prevention programs at the population level. This level of penetration could potentially reduce the incidence of CRC and improve patient survival by enabling early diagnosis and treatment. In this review, we will highlight key advancements made in the field of AI in the identification of polyps during colonoscopy and explore the role of AI based systems in cost optimization during the universal implementation of CRC prevention programs in the context of mid-income countries like India.

A GIS Vulnerability Assessment Tool to Support Strategic Planning of Cities Facing Flash Floods - Case Study of Nuweiba City - Egypt

As a part of climate change; flash floods are rapidly increasing and becoming more severe, challenging more and more cities around the world. According to the recent facts published by the UN and the WHO, their risk increases particularly in low- and mid-income countries, where it exceeds the ability of communities to cope with it. This sheds the light on the importance of the community's pre-impact conditions, which determine its vulnerability to floods. This research develops a vulnerability assessment tool and its associated methodology as an effective tool to be integrated into the strategic planning of existing cities facing flash floods. It is an indicators-based GIS tool to Assess Physical and Social vulnerability. Nuweiba city on the gulf of Aqaba-Egypt was chosen as a case study. However, it is located in an arid zone, and suffers from frequent and severe flash floods. It could be considered the effluent of Wadi Watir's main watershed (3509 km²). A GIS model has been developed to apply the Physical part of the developed assessment tool. So, Detailed data on the city's urban structure, DEM and satellite images were integrated and processed to extract the evaluated layer for each vulnerability indicator. Then, a weighted overlay of these indicators was applied to produce the final vulnerability map. The results showed a high level of applicability for the developed model, however, the vulnerability map was compared to the available strategic plan for the city. Accordingly, several changes to the plan were recommended to achieve a more sustainable future for the city.

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.