Resource Countries Research Articles

Truenat® for Plasmodium sub-microscopic infections: Miles to go….

Truenat® for Plasmodium sub-microscopic infections: Miles to go….

Role of maintenance paclitaxel in epithelial ovarian cancer: An affordable option for poor resources countries (a Regional Cancer Institute study).

The purpose of the study is to assess the benefits of maintenance chemotherapy (CT) in epithelial ovarian cancer with CT and surgery. The primary and secondary endpoints of the study were progression-free survival (PFS) and overall survival (OS), respectively. Three hundred patients with ovarian cancer (registered between January 2012 and December 2013) received 6 cycles of 3 weekly CT (injection paclitaxel 175 mg/m2 + injection carboplatin 6 AUC) and surgery. After 4 weeks of completion of the above treatment, patients were assessed for response with radiological imaging and serum CA125. Then, these patients were randomly allotted in two arms; 150 patients in Arm A received 6 cycles of single agent, 3 weekly injection paclitaxel 175 mg/m2 as maintenance therapy while 150 patients in Arm B, were on observation. The follow-up was done at 1 month, then 3 monthly in the 1st year and 6 monthly in the 2nd year to evaluate PFS and annually up to 5 years for OS. The PFS at 1 and 2 years was 91% and 80% in study arm and 65% and 50% in control arm; the differences were statistically significant (P = 0.010). The 5-year overall survival was 43% versus 38% in study and control arms, respectively (P = 0.410) and 5-year PFS was 28% versus 18% (P = 0.039) in maintenance and observation arm, respectively. Except for peripheral neuropathy, there was no statistically significant difference in toxicities between the two arms. The study suggests that 6 cycles of single-agent paclitaxel maintenance therapy significantly prolongs the duration of PFS and better trends toward OS, though a large study is needed to come to a conclusion.

Addressing the human costs and consequences of the Pakistan flood disaster

Addressing the human costs and consequences of the Pakistan flood disaster

Vaginal misoprostol versus combined intracervical foley’s catheter and oxytocin infusion for second trimester pregnancy termination in women with previous caesarean sections: a randomised control trial

Second trimester pregnancy termination has been reported to be associated with 3–5 times higher maternal morbidity and mortality risks more than first trimester termination. Medical methods had been thoroughly assessed and it is considered the anchor of the safe abortion care. Howevere, there is no global agreement regarding the ideal method for induction of the second trimester abortion in a scarred uterus. The aim of this study was to achieve vaginal expulsion in an expeditious manner with less maternal complications. A total of 158 women having, a history of previous caesarean section undergoing second trimester pregnancy termination, were randomly allocated into group (1) vaginal misoprostol group (n = 79) or group (2) combined intracervical foley’s catheter plus intravenous oxytocin infusion group (n = 79). The primary endpoint was complete fetal expulsion. Meanwhile, secondary outcomes were the rates of maternal complications, in terms of the need for surgical evacuation of retained product of conception (ERPOC), severe haemorrhage, uterine rupture, blood transfusion, cervical laceration, diarrhoea, vomiting and fever. The registration number of this trial https://clinicaltrials.gov/ct2/show/NCT04501809. This study showed that the combined use of intracervical foley’s catheter and oxytocin is an effective, and safe alternative to vaginal misoprostol for termination of the second trimester pregnancy in women having a previous caesarean delivery. Impact statement Why was this study conducted? The purpose of this study is to achieve an expeditious delivery for second trimester pregnancy termination in a scarred uterus by combined mechanical and pharmacological methods without significant morbidity. Physicians should balance the benefit of achieving vaginal exlpusion in an expeditious manner versus the risk of uterine rupture or any other maternal complications. What does this add to what is known? This study showed that a combined mechanical and pharmacolohical approach for second trimester termination of pregnancy has comparable efficacy and safety to vaginal misoprostol which is more affordable to the low resources countries where termination of pregnancy in a scarred uterus still has an increased maternal morbidity. What is the implication of this study on clinical practice? The combined use of intracervical foley’s catheter with intravenous oxytocin infusion is a safer option than vaginal misoprostol with less serious maternal complications.

Evaluating chemical hazard on a global scale

Approaches to address the growing burden of chemical related diseases globally has not kept pace with this increasing human health threat. Policy and regulatory structures for addressing chemical exposures vary globally, but all incorporate elements of scientific evidence collection and evaluation. More transparent, consistent methods for hazard identification including systematic reviews have been implemented and adopted by various countries and global agencies. This talk will discuss opportunities to standardize and improve hazard identification that can be shared between high resource and low resource countries. More consistent approaches that incorporate contemporary scientific principles for robust data evaluation will improve the basis for health-related decision making.

Could Myocardial 99mTc-MIBI Washout rate be the savior in patients with Ischemic Cardiomyopathy in limited resources countries?!

Background: proper assessment of patients with ischemic cardiomyopathy is a key determinant for management with other investigations, improving the patient’s quality of life and reducing future cardiac events. This study was conducted to evaluate the value of myocardial MIBI washout rate using delayed resting myocardial perfusion imaging in patients with ischemic cardiomyopathy in limited resources countries. Patients and Methods: this prospective study included 86 patients (64 males (74.4%) & 22 females (25.6%) with ejection fraction less than 35%. The mean age was 56.7 ± 9.4 years, all patients underwent ECG-gated single-photon emission computed tomography (SPECT) technetium-99m MIBI myocardial perfusion imaging (99mTc MIBI).

Bedside lung ultrasonography: comparison with chest radiography (BLUR), a diagnostic study in a developing country

BackgroundThis study determines the diagnostic utility of lung ultrasonography (LUS) in a medical ward in a developing country. In a low resource country like India, we hope that use of...

Peritoneal dialysis for acute kidney injury: back on the front-line.

Peritoneal dialysis (PD) for acute kidney injury (AKI) has been available for nearly 80 years and has been through periods of use and disuse largely determined by availability of other modalities of kidney replacement therapy and the relative enthusiasm of clinicians. In the past 10 years there has been a resurgence in the use of acute PD globally, facilitated by promotion of PD for AKI in lower resource countries by nephrology organizations effected through the Saving Young Lives program and collaborations with the World Health Organisation, the development of guidelines standardizing prescribing practices and finally the COVID-19 pandemic. This review highlights the history of PD for AKI and looks at misconceptions about efficacy as well as the available evidence demonstrating that acute PD is a safe and lifesaving therapy with comparable outcomes to other modalities of treatment.

Lower back musculoskeletal hydatid cyst: a rare presentation in a South Sudanese patient

Echinococcosis (hydatidosis) remains a crucial public health concern in areas of endemicity including South Sudan. It affects mostly liver and lungs but rarely musculoskeletal system. A female, aged 75 years, presented to Kapoeta State Hospital, with a three years’ history of a painless mass on her back, gradual onset. There was no history of trauma, pain or fever. On examination there was a mass of 8cm x 5cm, soft, non-tender and lobulated on the right lower back above the gluteal region with intact skin. Imaging investigations (ultrasound, X-ray, CT scan) were not available. A provisional diagnosis of a lipoma was made. Surgery was done successfully and a hydatid cyst was found and removed. There were no post-operative complications. She was discharged on the next day with oral albendazole (400mg), twice a day for 28 days. Six months later, the patient was seen with no complains or recurrence. In endemic areas hydatid cysts should be considered in the differential diagnosis of any cystic swelling or lump. In low resource countries, incorporation of health education to school curriculum will play a key role in reducing incidence or prevalence of the disease.

National Culture and Human Resources Management of Transnational Companies

The national culture of each country is certainly different. It certainly contains a cultural direction that influences the character of the citizens of that country. The character of each country's human resources is clearly shaped by the national culture adopted. In the business world, it is possible for a country to open a business unit in a country that they perceive as having an accommodative investment climate. No wonder an automotive manufacturer from Japan, for example, will set up its industry in Thailand, Vietnam, Latin America, to the European region. This study will look at the extent to which the role of national culture influences work culture in the company. Likewise, a country's company in transferring the management of Human Resources (HR) to its subsidiaries in various countries. This research is a qualitative literature review with descriptive method, corporate culture differs in one country and another where the company is located. Then the conclusion that can be drawn is that the management of manpower will depend on the national culture of the country.

Quality standards for managing children and adolescents with bronchiectasis: an international consensus.

The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients' survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.

Breathing new life into an old approach: The looking-east policy of the post-war Iraq

After many years of devastating military conflicts and sweeping international sanction, the Middle Eastern country was devoid of sufficient financial and technological resources to rebuild in the post-war era. And since the West did not commit itself to a thorough programme of nation-building and reconstruction as widely expected, the Iraqis had to turn to eastern nations. By embarking upon a looking-east approach, therefore, Iraq aimed to particularly persuade a number of rich and resourceful Asian countries into close cooperation with Baghdad. Many Asian nations were equally interested in rekindling their connections to the post-Saddam Iraq at a critical time when the doubts and reluctance of western businesses could provide them with a potentially unique opportunity to invest especially in the sectors more conducive to their long-term vested interests in the Mideast country.

Economic impacts of overweight and obesity: current and future estimates for 161 countries

IntroductionThe scope of the challenge of overweight and obesity (OAO) has not been fully realised globally, in part because much of what is known about the economic impacts of OAO...

Efficiency and its influencing factors of urban water sector in China and major OECD countries

Improving the efficiency and productivity of the water supply sector is related to the mitigation of a country's water resources crisis and the governance of the water ecological environment. This paper employs a sequential data envelopment analysis (DEA) approach to examine the comparative efficiency of China's urban water industry by using the country-level data from 1998 to 2017, and then attempts to make a cross-country comparison of the technology gap in the urban water industry between China and major OECD countries. The results show that China's urban water sector performance is improving despite falling short of urban water development in the major OECD. The gap between the performance of China's urban water sector and that of major OECD countries is narrowing. Efficiency improvement has become the main driver of productivity growth of urban water sector in both China and the major OECD countries. Besides, the reduction of capital deepening in the water industry and the easing of water stress could improve the water industry's performance in efficiency. While increased foreign direct investment instead reduces the water industry's efficiency, increased R&D expenditure can improve efficiency, but both are not statistically significant. These findings indicate that compared to major OECD countries, China's urban water industry should strengthen the reform change as soon as possible from asset-heavy to asset-light operation and service, and then improve the water conservation system.

A Novel Energy Planning Scheme Based on PGA Algorithm and Its Application.

In order to actively respond to the “14th Five-Year Plan,” the PGA algorithm is used to develop a new energy planning strategy in this paper. The project can make full use of my country's abundant renewable energy resources, encourage energy conservation and reduction of emissions, improve the energy structure's low-carbon level, support the development of smart green energy, and achieve ecological civilization construction. This solution can show users how much greenhouse gas emissions can be reduced through some environmental changes, as well as the basic issues of meeting the future energy needs. It can display the benefits, costs, and emissions data under different scenarios in the future and use the scenario demonstration method to show energy planning to make energy data more vivid. It allows people, technicians, and decision makers to understand what will happen to China's carbon emissions over time in the next 15 years. This paper innovatively combines a particle swarm optimization algorithm with a genetic algorithm and designs a PGA algorithm for path optimization. In terms of carbon emission reduction, comparative trials demonstrate that the PGA algorithm's path optimization is 58.06 percent greater than the genetic algorithm; In terms of cost, the PGA algorithm's path optimization is 15.72% less expensive than the genetic algorithm's. This article provides a reference path for selecting the best results for future energy planning schemes and provides a new strategy for the “14th Five-Year” energy plan.

Recommendations for the prevention, screening, diagnosis, staging, and management of cervical cancer in areas with limited resources: Report from the International Gynecological Cancer Society consensus meeting.

Nearly 85% of cervical cancer new cases are diagnosed in limited resources countries. Although several strategies have been proposed to reduce the disease burden, challenges remain to provide the best possible care. We report recommendations from an expert consensus meeting convened to address from prevention to management of cervical cancer in limited resources countries. The expert panel, composed by invited specialists from 38 developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East, convened in Rio de Janeiro in September 2019, during the Global Meeting of the International Gynecological Cancer Society (IGCS). Panel members considered the published scientific evidence and their practical experience on the topics, as well as the perceived cost-effectiveness of, and access to, the available interventions. The focus of the recommendations was on geographic regions rather than entire countries because medical practice varies considerably in the countries represented. Resource limitation was qualified as limited access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or overall funding for provision of state-of-the-art care. Consensus was defined as at least 75% of the voting members selecting a particular answer of the multiple-choice questionnaire, whereas the majority vote was considered as 50% to 74.9%. Consensus was reached for 25 of the 121 (20.7%) questions, whereas for 54 (44.6%) questions there was one option garnering between 50% to 74.9% of votes (majority votes). For the remaining questions, considerable heterogeneity in responses was observed. The implementation of international guidelines is challenging in countries with resource limitations or unique health-care landscapes. The development of guidelines by the health care providers in those regions is more reflective of the reality on the ground and may improve medical practice and patient care. However, challenges remain toward achieving that goal at political, economic, social, and medical levels.

Improving Youth Unemployment Issues and Further Development of Youth Policies in the European Union member states

Young people are the most important part of the country's labour resources and a strategic resource for socio-economic development. Employment of young people requires special assistance and support. They are distinguished from other socio-demographic groups of the population by their health, level of education, vocational training, mobility, high demands on work, etc. It is necessary to establish mechanisms and set goals through ministries, local governments, youth organizations, the private sector, civil society and international organizations to improve the various problems or challenges facing young people. Solving the employment problems of young people requires a special approach because it is the youth who are the most active part of society, which reacts strongly to social injustice. This chapter will summarize all the issues mentioned in the previous chapter and offer possible solutions for improving the youth unemployment problem.

Effectiveness of Akper Student Assistance to Mothers whose Children are Stunting

Cases Stunting in children can be a predictor the low quality of a country's human resources. The state of stunting causes poor cognitive abilities, low productivity, and increased risk of disease resulting in long-term losses for the Indonesian economy. Nutrition problems, especially stunting in infants, can inhibit a child's development, with negative impacts that will last in the next life such as intellectual decline, susceptibility to non-communicable diseases, decreased productivity to cause poverty and the risk of giving birth to babies with low birth weight. Knowing the effectiveness of the assistance of Akper students to mothers who have children Stunting to Height / Length of Child Body. This research is a quasi-experimental quantitative research with a Pre and Post Test with Control Group Control Test design, where mothers who have stunting children are assisted by acper students by providing health education 6 properly taking medicine, immunization, breastfeeding Exclusive, MP-ASI, Nursing Mothers Nutrition and Benefits of Zynk and Fe. After mentoring, a re-evaluation of body length / height was then compared with the control group. Analysis of different tests using the Mann Whitney Test.The results of the statistical analysis of the treatment group accompanied by the student akper to the addition of the stunting length / height of the child obtained p = 0,000 (P0.05), the control group p = 0,000 (P0.05). Although equally significant changes occur in body length / height, if examined based on nutritional status (TB / Age) the control group only changes its status from very short to short. Adds because it is still involved in a period of growth and development but is not maximal compared to the assistance was carried out. This means that the child who is a control group is still in a stunting condition. However, the treatment group, from very short status to normal status, is free from stunting status. While Mann Whytney's different test in the treatment group and the control group results p = 0,000 (P0.05), meaning that the Akper student assistance for mothers whose children are stunting effectively increases the length / height of the child compared to the control group. The assistance of Akper students to mothers who have stunting children effectively increases the length / height of the child.

Digital cervical cancer screening: a reliable One-Stop method ?

BackgroundWorldwide, cervical cancer (CC) is considered the fourth most common cancer in women. Globocandata stated 311,365 CC related mortalities in the world in 2018, 90% of them occurred in low-income countries. In Jordan, CC ranks as the 12th most common cancer among women. The primary aim of this report is to be able to decide if digital screening (DS) is reliable and worth using in our one stop gynecology clinics. Materials and MethodsThis study was done for all women who attended one stop out-patient gynecology services for routine CC screening between 1/1/2019 and 31/12/2019. Inclusion criteria requested women to be 18 years of age or more, healthy, and had previously normal cervical smear (conventional Pap smear (CPS) or Liquid based cytology (LBC)) i.e., all previous screening tests results were normal. ResultsA total number of 94 patients agreed to have the DS method done, mean age was 43 years. 25.5% were found to have abnormal screening results on DS. When compared to the national data of 12.5% abnormal smears in Liquid‐based cytology (LBC), there was a statistically significant difference in the numbers of abnormal screening results between both methods (p value of 0.000). LBC is used in most centers for CCS in Jordan ConclusionThe digital cervical screening method saves time and offers a one stop clinic management, therefore minimizing lost to follow up rate, and where colposcopy is indicated. Additionally, DS should be considered in low resource countries.

Comparison of BIRADS lexicon to breast biopsy findings in low resource countries

Breast cancer is the most common malignancy in women worldwide and early detection is of utmost importance. In developed countries, mandatory mammographic screening programs help in early detection, whereas, in developing countries cancer is often detected at an advanced stage. The BIRADS guidelines permit a standard approach and follow up for breast lesions. Many newer imaging modalities are being available for better diagnosis. Breast lesions have a varied spectrum and the gold standard for diagnosis of breast cancer is based on histopathological examination of tissue. At times, even on trucut biopsy, it is difficult to categorize the lesion as the tissue studied is limited and some evolving lesions may have overlapping features. As there are limitations to both radiologic and pathologic approaches, the general and accepted way is to combine both modalities to arrive at a diagnosis. The aim: The aim of the study was to find out how well the BIRADS radiological findings correlate with histopathological findings on breast biopsies. Materials and methods: A MEDLINE search for articles published in English language, with key words as breast biopsy histopathology and BIRADS was done for the years between 1985 and 2021. In addition, other cross-referenced articles were also searched for relevant data. Results: There is good correlation between BIRADS category 1, 2 and 5 with the findings on core needle biopsy in breast lumps i.e., good correlation is seen at the end of spectrum of breast lesions in totally benign and unequivocally malignant lesions. But this correlation is lacking in the middle of the spectrum i.e., in borderline/intermediate category of BIRADS. Conclusion: The non-suspicious (BIRADS 1/ 2) and highly suspicious (BIRADS 4C/5) compare very well with the histopathologic findings. It is the grey zone i.e., BIRADS 3/4A which has a wide and variable predictive value for breast cancer when compared with histopathology and imaging study alone is insufficient and mandates histopathology in all such cases