Resource-limited Settings Research Articles

Background: Percutaneous Coronary Intervention (PCI) is essential for coronary artery disease management. Coronary Artery Perforation (CAP), though rare (0.4% incidence), is a critical complication with high morbidity and mortality. As PCI techniques advance, understanding CAP outcomes becomes vital – particularly in resource-limited settings like Pakistan. This study at a major Pakistani tertiary center addresses local knowledge gaps and provides insights for managing this complication. Research Question: What are the angiographic and clinical characteristics of patients experiencing CAP during PCI, and what are the outcomes of different management strategies in-hospital and over long-term follow-up? Methodology: This single-center, retrospective observational study was conducted at Army Cardiac Center, Lahore. It included all CAP cases encountered during PCI over six years (January 2018 to December 2024). Patient and procedural data were collected from hospital records. Outcomes were categorized as in-hospital mortality and long-term endpoints: functional status (NYHA, CCS), repeat angiography, rehospitalization, and survival. Structured interviews and follow-up visits provided long-term data, which was analyzed using SPSS v28. Results: Thirty patients with CAP were identified (mean age 60.2 ± 1.57 years; 70% male). Common comorbidities were hypertension (73.3%) and diabetes (53.3%). The LAD was the most frequently involved vessel (63.3%). Most perforations resulted from non-compliant balloons and hydrophilic guidewires. Covered stents were used in 76.6%(n=23) of cases; balloon tamponade in 20%(n=6). Only two cases of significant pericardial effusion leading to cardiac tamponade were encountered. In-hospital mortality was 6.7%(n=2), with overall survival at follow-up of 86.7%(n=26). Functional outcomes were favorable (NYHA I: 56.7%, CCS I: 66.7%). Repeat angiography was needed in 10% of cases(n=3). Most patients (86.7%) were managed medically post-discharge, and 76.7% avoided rehospitalization. Conclusion: Our CAP mortality of 6.7% dramatically undercuts the 20% reported for Ellis III perforations. This outcome stems from our institutional protocol: leaving the balloon inside the stent with immediate safety testing (2 mL contrast injection) ,which enables instant inflation and tamponade during perforations. These results prove that systematic vigilance and rapid intervention optimize CAP outcomes—even in resource-limited settings

Acute pancreatitis (AP) requires early risk stratification, particularly in resource-limited settings. This study evaluates the Neutrophil× C-Reactive Protein Index (NCI) as a biomarker for predicting severe acute pancreatitis (SAP) and in-hospital mortality. In this prospective cohort study, adult AP patients were enrolled consecutively at a tertiary hospital in Vietnam. Complete blood count and C-reactive protein (CRP) levels were measured within 24hours of admission. NCI was compared against other neutrophil-lymphocyte-CRP combinations and the Bedside Index for Severity in Acute Pancreatitis (BISAP). Prognostic performance was assessed using the area under the receiver operating characteristic curves (AUCs), and a Restricted Cubic Splines analysis explored the linear relationship between NCI and SAP risk. Internal and external validations were performed. The study included 257, 83, and 121 patients in the training, internal, and external cohorts, respectively. Optimal NCI cut-off values were ≥1877 for SAP and ≥3180 for mortality. NCI showed a linear relationship with SAP risk (p-values for non-linearity: 0.420-0.773). NCI predicted SAP with AUCs of 0.853, 0.897, and 0.844 across cohorts. It outperformed CLR (AUCs 0.653-0.856) and NLR (AUCs 0.719-0.844), with performance similar to NCLR (AUCs 0.832-0.898). For in-hospital mortality, NCI achieved AUCs of 0.824-0.902, comparable to BISAP (0.735-0.943), and outperformed other combinations. Good calibration and clinically relevant post-test probabilities were observed. NCI is a simple, accessible, and effective biomarker for early risk stratification in SAP and in-hospital mortality, particularly in resource-limited settings. Its reliance on routine blood tests supports its practical use for timely triage and management of AP.

Cardiac resynchronization therapy (CRT) improves outcomes in patients with reduced left ventricular ejection fraction, but device cost limits access. In patients without atrial pacing needs, the atrial port of a dual-chamber pacemaker or ICD can be repurposed for conduction system pacing to deliver CRT. We retrospectively analyzed 18 patients who underwent left bundle branch area pacing using a dual-chamber generator. The left bundle branch lead was connected to the atrial port. Over 12 months, LVEF remained stable in patients with pacemakers, with modest QRS narrowing, and limited ICD data suggested LVEF improvement. No intra-procedural complications occurred, and one patient developed a self-resolving pericardial effusion. No inappropriate ICD therapies were observed. Cost analysis demonstrated savings of $3,922 per CRT-D and $2,963 per CRT-P device avoided. Delivering CRT via dual-chamber generators in patients without atrial pacing needs is feasible, safe, and cost-effective, potentially broadening access to CRT, particularly in resource-limited settings. Larger studies are needed to confirm these findings.

Background: Cardiovascular disease (CVD) and chronic kidney disease (CKD) are leading global causes of morbidity and mortality, often exacerbated by late diagnosis and limited access to early detection methods. Conventional diagnostic tools are frequently invasive or inaccessible in resource-limited settings. Retinal imaging presents a non-invasive alternative, capturing microvascular features that reflect systemic health. However, most validation studies have focused on Asian and Western populations, leaving a gap in South American representation. Hypothesis: We hypothesized that deep learning models trained to predict systemic biomarkers from retinal images in a Korean population could generalize to a Brazilian cohort. Specifically, we examined whether retinal models estimating albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) for CKD, and coronary artery calcium for CVD, could effectively identify affected individuals using data from the Brazilian Multilabel Ophthalmological Dataset (BRSET). Methods: We applied three retinal image-based models to 16,266 fundus images from 8,524 patients in BRSET. These models infer systemic biomarker values by analyzing retinal vascular and structural features. Ground truth labels were based on disease comorbidity annotations. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. Thresholds were optimized using the Youden index. Class imbalance (10 CKD cases and 89 CVD cases) in BRSET was preserved to reflect real-world disease prevalence. Results: For CKD detection, the ACR model achieved an AUROC of 0.84 (95%CI=0.66-0.97), sensitivity of 0.70, and specificity of 0.89. The eGFR model achieved an AUROC of 0.76 (95%CI=0.65-0.89), sensitivity of 0.70, and specificity of 0.76. For CVD, the coronary artery calcium model showed an AUROC of 0.71(95%CI=0.66-0.75), with high sensitivity (0.91) but lower specificity (0.47). Conclusion: Deep learning-derived retinal biomarkers demonstrated generalizability from an Asian to a South American cohort, supporting their potential as scalable, non-invasive tools for early systemic disease detection. The ACR model performed best for CKD prediction, while other models showed fair discriminatory ability. Future work should focus on addressing class imbalance, increasing positive case representation, and conducting prospective validation.

Red cell distribution width (RDW) is recognised as a prognostic biomarker for predicting mortality in neonatal sepsis. However, its utility in forecasting 28-day mortality amongst very low birth weight (VLBW) neonates remains uncertain. We conducted a retrospective, observational, single-centre study involving neonates with a birth weight of less than 1500 g. The primary endpoint was 28-day mortality. RDW and the Score for Neonatal Acute Physiology-Perinatal Extension II (SNAPPE-II) were measured on Days 1 and 3 following admission to evaluate their predictive value for mortality. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were used to assess the association between RDW and 28-day mortality, and to compare the predictive performance of RDW with SNAPPE-II. RDW levels were significantly higher in the non-survivor group (n = 35) compared to the survivor group (n = 70) on both Day 1 and 3 post-admission (p < 0.01 for both). Additionally, RDW was positively correlated with SNAPPE-II scores (r = 0.63 and 0.61, p < 0.01). ROC analysis revealed that RDW measured on Day 3 had a strong predictive value for 28-day mortality (AUC = 0.89, p < 0.01), which was significantly greater than the AUC for RDW on Day 1 (AUC = 0.73). These findings suggest that dynamic RDW changes (on post-admission Day 1-3) are a reliable prognostic biomarker for 28-day mortality in VLBW neonates, with predictive performance comparable to SNAPPE-II. It can serve as a low-cost, easily accessible tool for risk stratification in resource-limited settings. China Clinical Trial Registration Center Registration No.: ChiCTR2100043217.

Background: Congenital heart diseases (CHD) are among the most common congenital malformations, with sepsis and lower respiratory tract infections significantly contributing to morbidity and mortality in this population. Factors such as chronic catabolic states, pulmonary over-circulation, chronic hypoxia, genetic predispositions, and the use of invasive devices heighten the risk of sepsis in children with CHD. In low- and middle-income countries (LMICs) like India, resource limitations, such as delayed diagnosis, restricted access to pediatric cardiac surgery, overburdened ICUs, and limited availability of antimicrobials and critical care support, exacerbate these risks. Despite this, data from LMIC settings remain sparse. This study aims to fill that gap by evaluating the burden and outcomes of sepsis in children with CHD admitted to a tertiary center in India. Objectives: This study aimed to assess the prevalence of sepsis and pneumonia and evaluate in-hospital outcomes related to sepsis in pediatric patients with congenital heart disease. Methods: In this single-center retrospective study, we reviewed the records of children aged 0 to 5 years with CHD admitted with sepsis. We analyzed the prevalence of sepsis and in-hospital outcome parameters, comparing these outcomes to those of children in the same age group admitted without sepsis. Multivariate logistic regression identified predictors of mortality. Results: A total of 913 children (median age 3 months, IQR 11) were analyzed. Sepsis was identified in 304 (33.3%) cases, with hospital-acquired sepsis in 25 (8.22%). Mortality during hospitalization was 12.4% overall, with 24.7% in infected patients compared to 6.2% in non-infected patients (p=0.001). Septic shock was associated with mortality exceeding 70%. Multivariate regression revealed that higher sepsis grade (adjusted OR 6.24, p=0.001), haemoglobin &lt;11 gm/dL (adjusted OR 3.16, p=0.05), and renal failure (adjusted OR 14.24, p=0.001) predicted mortality. Conclusions: Infections and sepsis account for one-third of hospitalizations among children under five with CHD. In resource-limited settings, early recognition, aggressive supportive management, and targeted interventions are urgently needed to improve outcomes in this high-risk population, including prompt antibiotic initiation, ventilatory support, and anemia management.

Background: Electrocardiography (ECG) is a cornerstone of cardiovascular disease (CVD) diagnosis, but it faces limitations in spatial resolution and susceptibility to artifacts. Recent advances in vision-language foundation models, such as CLIP, offer potential for enhancing ECG interpretation by aligning multimodal data. This study introduces ECGCLIP, a novel model enabling the diagnosis of a broad spectrum of CVD by integrating ECG waveforms with clinical annotations. Methods: ECGCLIP was trained on 5 million ECG-image/report pairs from multicenter datasets, annotated by experienced physicians. Using a self-supervised contrastive learning framework, the model aligned ECG signals with textual interpretations. Performance was evaluated on 45 ECG tasks (e.g., arrhythmias, conduction disorders) and 29 echocardiography tasks (e.g., valvular diseases, heart failure) across internal and external validation cohorts, by comparing precision-recall AUC (PRAUC) under varying data regimes. Results: ECGCLIP achieved PRAUC improvements up to 0.5873 (e.g., AAI pacing: 0.0511 → 0.6384) and 0.5253 for rare conditions (e.g., Wolff-Parkinson-White syndrome at 1% data). Critical conditions like ST-elevation myocardial infarction (STEMI) showed gains of 0.2170 (0.1156 → 0.3326), addressing traditional ECG limitations in ischemia detection. The model enhanced detection of valvular diseases (e.g., mitral stenosis: Δ+0.211) and heart failure (LVEF &lt; 40%: Δ+0.139), with 79% generalizability retention for tricuspid regurgitation in external validation. With only 1% training data, ECGCLIP matched or exceeded full-data baselines (e.g., sinus rhythm PRAUC: 0.9747 vs. 0.9877). Gains in low-incidence diseases (e.g., hyperkalemia: Δ+0.0169) highlighted efficacy in sparse-data scenarios. External validation showed an overall PRAUC improvement of 0.1565, with consistent gains in ventricular pre-excitation (Δ+0.5253) but gaps in structural anomalies (e.g., mitral stenosis external Δ+0.100 vs. internal Δ+0.211), reflecting ECG's dependence on functional sequelae. Conclusion: ECGCLIP establishes a new paradigm for ECG interpretation by leveraging vision-language foundation models. It demonstrates exceptional data efficiency, enabling accurate diagnosis of diverse cardiac conditions—including rare and critical diseases—with minimal labeled data. The model's robustness across diseases supports its potential for deployment in resource-limited settings, enhancing accessibility and precision in CVD care.

Introduction: Visceral adipose tissue (VAT) is a key contributor to adverse cardiometabolic outcomes. However, its direct measurement via imaging techniques is costly and impractical in primary care settings, particularly in low- and middle-income countries. The Metabolic Score for Visceral Fat (METS-VF), a previously validated index based on simple clinical and biochemical parameters, provides an accessible estimate of VAT (eVAT) in grams. Nevertheless, its association with incident fatal and non-fatal cardiovascular events remains understudied in Latin America. Research Question: Is higher eVAT associated with an increased risk of incident fatal and non-fatal cardiovascular events in Latin American adults? Methods: We analyzed data from adults without type 2 diabetes participating in the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). eVAT was estimated using the following equation: METS-VF = 4.466 + 0.011(Ln(METS-IR))^3 + 3.239(Ln(WHtr))^3 + 0.319*(Sex) + 0.594*(Ln(Age))**, where METS-IR = (Ln((2*G0) + TG0) * BMI) / (Ln(HDL-C)). We applied Cox proportional hazards regression models to estimate adjusted hazard ratios (aHR) for fatal and non-fatal cardiovascular events per 100 g increase and by eVAT quartiles. Models were adjusted for age, sex, residence, smoking status, non-HDL cholesterol, systolic blood pressure, and prior diabetes diagnosis. Results: Among 23,097 adults (median age: 52) followed for a total of 113,622 person-years, 436 participants (1.9%) experienced an incident cardiovascular event (262 [1.1%] non-fatal; 174 [0.75%] fatal). Each 100 g increase in eVAT was associated with a 4% higher risk of any cardiovascular event (95% CI: 1.03–1.05). Compared to the lowest quartile (&lt;726 g), participants in the third (1,058–1,426 g) and fourth (&gt;1,426 g) quartiles had 68% (95% CI: 1.23–2.29) and 85% (95% CI: 1.37–2.50) higher risk, respectively. Stratified analyses showed consistent associations across subgroups, with a stronger effect observed among overweight individuals (p-for-interaction &lt; 0.001). Conclusion: In this large, prospective cohort of Latin American adults without diabetes, higher eVAT was significantly associated with increased risk of cardiovascular events. These findings underscore the role of visceral adiposity in cardiovascular disease development and the need to incorporate its assessment in primary care risk stratification. METS-VF may serve as a practical tool to support this objective in resource-limited settings

Background: Hypertrophic cardiomyopathy (HCM) is a common genetic cardiac disorder with heterogeneous clinical expression. While global data on HCM phenotypes are available, there is a paucity of region-specific data from India. Objectives: To characterize the clinical and imaging profile of Indian patients with HCM and assess the correlation between STE-derived GLS, CMR-derived LGE, electrocardiographic abnormalities, indexed LV mass, and left atrial (LA) size. Methods: In this cross-sectional study, 150 adult HCM patients were prospectively enrolled at a tertiary care center in North India. All patients underwent clinical evaluation, 12-lead ECG, 24-hour Holter monitoring, transthoracic echocardiography including STE-derived GLS, and tissue Doppler imaging. CMR was performed in 74 patients. GLS and LGE were quantified using vendor-specific software. Indexed LV mass and LA diameter were recorded. Correlations were assessed using Spearman’s rank coefficient (ρ). Results: The mean age was 46.7 ± 13.8 years; 80% were male. Asymmetric septal hypertrophy was the most common phenotype (76%), with obstructive HCM in 53%. Mean indexed LV mass on CMR was 109.5 ± 22.6 g/m 2 . Mean LA diameter was 38.4 ± 4.2 mm, significantly larger in patients with atrial fibrillation (41.2 ± 4.7 mm vs. 38.1 ± 4.0 mm; p = 0.02). STE-derived GLS was reduced (&lt;–20%) in 89% of patients (mean GLS: –12.1% ± 4.1%). CMR revealed LGE in 92% of patients, with extensive fibrosis (LGE ≥15%) in 40.5%. Peak GLS showed a strong positive correlation with percent LGE (ρ = 0.739, p &lt; 0.001), and was significantly lower in those with perfusion deficits (–9.8% vs. –12.2%, p = 0.04). Patients with extensive LGE had significantly higher indexed LV mass (116.4 ± 18.9 g/m 2 vs. 104.6 ± 22.4 g/m 2 , p = 0.02). Modest inverse correlations were observed between GLS and tissue Doppler velocities (medial e′: ρ = –0.55; lateral e′: ρ = –0.60), and between LA diameter and medial e′ (ρ = –0.41, p &lt; 0.001). GLS was not significantly associated with non-sustained ventricular tachycardia (NSVT, p = 0.18). Conclusions: Indian patients with HCM exhibit a high burden of myocardial fibrosis, enlarged left atria, and increased LV mass. STE-derived GLS correlates strongly with CMR-derived fibrosis, indexed LV mass, and diastolic dysfunction, suggesting its potential as a pragmatic surrogate for risk stratification in resource-limited settings. Larger multicenter studies are needed to validate these findings.

Introduction/Background - Research Questions/Hypothesis: There is a notable lack of robust evidence regarding imaging follow-up in Fontan patients from resource-limited settings, where access to advanced imaging modalities remains scarce. This study aims to describe the prevalence of cardiac magnetic resonance (CMR) use, key findings, and associated clinical outcomes in a Latin American cohort of Fontan patients. Methods/Approach: A retrospective, observational, single-center study included patients who underwent Fontan procedure completion and had an available postoperative cardiac magnetic resonance scan performed between 2006 and 2024. Data were analyzed descriptively using means ± SD, and frequencies (%). Results: Of 174 Fontan surgeries performed in our center, we included 27 (12.7%) with a follow-up CMR, spanning all age groups. The cohort comprised 15 males (55.6%), with a mean age at the time of CMR of 23.4 years. The most prevalent congenital defect was tricuspid atresia (55.6%), and in 88.8% of patients, the left ventricle was the systemic ventricle. For the Fontan pathway the extracardiac conduit was the preferred surgical technique (92.5%) and fenestration was present in 48.1% of patients. CMR was performed 19 ± 7.4 years after Fontan completion, revealing a mean indexed systemic ventricular end-diastolic volume of 101.7 ± 44.9 mL/m2 and a mean indexed end-systolic volume of 52.8 ± 30.8 mL/m2. The mean ventricular ejection fraction was 49.7% ± 7.2%, and the mean cardiac index was 4.25 ± 1.78 L/min/m2. Among those with a documented fenestration, 7.4% remained patent at time of CMR. Venovenous collaterals were present in 55.5% of the cohort. With 29.6% having more than moderate atrioventricular valve regurgitation. Venovenous collaterals were identified in 55.5% of patients, and 29.6% had more than moderate atrioventricular valve regurgitation. Findings consistent with Fontan-associated liver disease were present in 55.6% of patients, and 7.4% were diagnosed with hepatocellular carcinoma all of whom died, yielding an overall mortality rate of 7.4%. Conclusion(s): Despite limitations, our findings highlight that few Fontan patients undergo routine CMR follow-up. The high prevalence of complications suggests that CMR surveillance may be occurring too late to enable timely interventions. These results underscore the need for guideline-adherent imaging protocols to improve outcomes in this high-risk population.

Early detection of Trypanosoma cruzi infection is essential for timely treatment of acute Chagas disease, reducing severe complications and chronic disease progression. Traditional diagnostic methods have limitations, particularly in sensitivity and accessibility. Molecular techniques such as loop-mediated isothermal amplification (LAMP) offer high sensitivity and are well suited for resource-limited settings due to their simplicity. LAMP enables specific and efficient DNA amplification without requiring complex equipment, making it ideal for basic laboratories and field applications. This chapter presents standardized procedures for ultra-rapid DNA extraction combined with LAMP (Tc-LAMP), validated for the early diagnosis of congenital Chagas disease.

Background: Aortic stenosis remains a significant cause of morbidity and mortality worldwide. Transcatheter aortic valve replacement (TAVR) has become a transformative therapy for patients with severe aortic stenosis who are not suitable candidates for traditional surgical valve replacement in developed countries. However, access to TAVR therapy is highly variable, particularly in developing countries where resources and infrastructure may be limited. Objective: This study aims to elucidate the existing disparities in access to TAVR therapy in developing nations and propose sustainable strategies. We report over a decade of experience and outcomes from performing TAVR during humanitarian missions in a resource-limited setting of a developing country. Methods: This is a case series conducted on patients who underwent TAVR in Santo Domingo, Dominican Republic, between June 2010 and May 2024. Eligibility criteria included symptomatic severe aortic stenosis deemed high-risk or inoperable for surgical valve replacement in patients of limited economic resources. Baseline clinical characteristics and main outcomes, such as intra- and post-procedural complications, as well as the 30-day mortality rate, were obtained. Results: A total of 18 patients were included, with a mean age of 76 years (SD ± 5), predominantly female (56%). High rates of hypertension (88.9%), diabetes mellitus (44.4%), and heart failure (16.7%) were observed. Balloon-expandable valves were implanted in 56% of cases, while the remaining 44% received self-expandable valves. Two patients had complications during the procedure, including left ventricular perforation leading to cardiac tamponade and aortic annular rupture in another patient. Both patients expired intra-op or within 24 hours post-op. One patient developed complete heart block requiring permanent pacemaker placement. Self-resolving groin hematoma was seen on one occasion. None of the patients required re-intervention. There were no significant paravalvular leaks post valve implantation. The mortality rate at 30-day follow-up was 11%. Conclusion: Disparities in access to TAVR persist in developing countries, disproportionately affecting individuals of lower socioeconomic status. Strategies targeting the equitable distribution of healthcare resources and financial assistance programs are warranted. This humanitarian experience demonstrates the viability of performing TAVR as part of humanitarian medical missions to developing countries.

SummaryThe diagnosis of autoimmune gastritis poses significant challenges, particularly in resource-limited settings where access to serological tests is restricted. This study aimed to evaluate the histological, endoscopic, and serological features of patients diagnosed with autoimmune gastritis in our population.MethodsWe retrospectively reviewed cases diagnosed with autoimmune gastritis at two medical centers in Peru. Clinical data, serological and endoscopic reports were collected for each case, and gastric mucosal tissue samples from the antrum and corpus were histologically examined. Immunohistochemistry was also performed to evaluate neuroendocrine hyperplasia.ResultsHistologically, all 44 cases exhibited atrophy in the corpus, with the majority presenting at advanced stages of the disease (84%). However, endoscopic findings did not correlate with histology, as only 59.09% of cases showed corpus atrophy on endoscopy. Immunohistochemical analysis revealed neuroendocrine hyperplasia in all cases (100%). Anti-intrinsic factor antibody was positive in only 25% of cases, whereas 84.1% showed positivity for anti-parietal cell antibodies.ConclusionHistological evaluation of autoimmune gastritis cases demonstrates significant diagnostic potential, offering an effective alternative to costly and less accessible serological tests, particularly in resource-limited settings like ours.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12876-025-04363-3.

High quality DNA extraction is fundamental for molecular diagnostics, biomedical research, and forensic sciences. Among biological sources, blood provides high yields, whereas saliva offers a non-invasive alternative. Classical methods such as phenol-chloroform and salting-out remain widely used, but their comparative performance requires further evaluation. This comparative laboratory study analyzed 60 human samples (blood and saliva) using phenol-chloroform and salting-out extraction protocols. DNA yield and purity were assessed with Nanodrop spectrophotometry, and results were compared across sample types and methods. Phenol-chloroform yielded significantly higher DNA concentrations and superior purity than salting-out. From blood, the mean yield was ~308 ng/µL with A260/A280 ~1.89 using phenol-chloroform, compared with ~18 ng/µL (A260/A280 ~1.82) using salting-out. From saliva, phenol-chloroform produced ~64 ng/µL (A260/A280 ~1.87) versus ~38 ng/µL (A260/A280 ~1.75) with salting-out. Blood was the most reliable DNA source, but saliva provided adequate DNA quality for PCR-based and genotyping applications. Phenol-chloroform extraction remains the superior method for obtaining high-yield, high-purity DNA, particularly from blood. However, due to biosafety risks associated with organic solvents, the salting-out method offers a safer and low-cost alternative suitable for routine diagnostics and use in resource-limited settings.

This study presents the development and evaluation of MedOne, an AI-powered mobile healthcare application designed to improve healthcare accessibility in Rwanda. MedOne integrates AI-driven diagnostic tools with teleconsultation services, aiming to address critical healthcare challenges in resource-limited settings. The research employs a mixed-methods approach involving 247 participants, including healthcare professionals, end users, and administrators. The system incorporates machine learning algorithms for symptom assessment, natural language processing for multi-language support, and cloud-based architecture for scalability. Findings suggest the system could significantly reduce consultation times by 34%, increase rural healthcare consultations by 67%, and achieve a diagnostic accuracy of 78.5%. The system's design incorporates offline functionality, multi-language support, and cultural adaptation for the Rwandan context.

Background Stereotactic systems and various robot-assisted navigation platforms in neurosurgery have enabled high-precision localization. However, these systems, while highly accurate, are expensive, technically demanding, and procedurally complex, making them less practical for routine use. This study introduced and evaluated the Navigation and Projection Guide (NP-Guide), a projection-based augmented reality (AR) system designed to provide a portable and accessible solution for surgical navigation. Methods NP-Guide, a mobile application, projects patient imaging data and three-dimensional (3D) reconstructions onto the patient’s head surface to assist with localization. This proof-of-concept study prospectively enrolled 52 neurosurgical patients, randomized to the NP-Guide group ( n = 27) or the freehand localization group ( n = 25). Two physicians with different training backgrounds performed the procedures. Localization error and operating time were measured using a commercial optical navigation system (ONS). Bland–Altman analysis was applied to assess inter-operator agreement, and learning curves were generated to evaluate proficiency. Results Baseline characteristics were comparable (all p &amp;gt; 0.05). In the NP-Guide group, mean localization error was 4.1 ± 2.1 mm for Physician A and 3.4 ± 1.8 mm for Physician B, with mean times of 1.2 ± 0.5 min and 1.1 ± 0.4 min, respectively. Compared with freehand localization, NP-Guide significantly improved the accuracy and efficiency (all p &amp;lt; 0.001). Bland–Altman analysis demonstrated good inter-operator agreement; no significant difference was observed ( p = 0.25). Learning curves showed that operating times plateaued at approximately 1 min after about 15 cases. Conclusion The NP-Guide demonstrated accurate, efficient, and reproducible projection-based localization in this proof-of-concept study. Its portability, low cost, and ease of use suggest potential value, particularly in resource-limited settings. However, these findings should be interpreted as preliminary, and further phantom experiments and multicenter clinical studies are required before widespread adoption in routine practice.

BackgroundHip dislocation in children with cerebral palsy (CP) presents significant challenges, including pain, and severe contractures, which impair positioning, sitting, standing, and walking. This study investigated the prevalence and factors associated with hip displacement in a cohort of children with CP in a resource-limited setting lacking a dedicated hip surveillance program.MethodsA cross-sectional study was conducted from August 1, 2023, to January 30, 2024, at Tikur Anbesa Hospital, Ethiopia’s largest tertiary hospital. The study included 141 children with CP who met the inclusion criteria and underwent hip radiography. The hip migration percentage was assessed, with hip subluxation defined as a migration percentage between 30% and 80% and hip dislocation defined as a percentage greater than 80%. The migration percentages were analyzed in relation to sociodemographic and clinical data via statistical tests.ResultsThe study cohort predominantly consisted of children with spastic tetraplegic CP (56.7%), and 52.6% had GMFCS levels IV and V. A high comorbidity rate was observed, with 98% of the children having additional conditions, the most common being epilepsy (59%). The prevalence of hip displacement was 28%, with 88% of these cases classified as hip subluxation and nearly 11% as dislocation. Displacement was more common in the left hip (56.4%) than in the right hip or both hips. Osteopenia was present in 3.5% of the children. Factors associated with hip displacement included home rehabilitation, frequency of carrying by caregivers, GMFCS levels, and being aged 5–10 years.ConclusionsThis study highlights the significant prevalence of hip displacement among children with CP in a resource-limited setting, despite being managed at a tertiary hospital. The findings underscore the need for the implementation of hip surveillance programs and timely interventions to prevent or mitigate hip displacement, thereby enhancing the quality of life and functional outcomes of these children.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06276-2.

Viral zoonoses or viral pathogens transmitted from animals to humans—constitute a rapidly intensifying global health and economic challenge. They are responsible for an estimated 2.5 billion illnesses and 2.7 million deaths annually, representing nearly 60% of all infectious diseases and 75% of newly emerging infections. Recent outbreaks, including Coronavirus disease 2019 (COVID-19), Ebola, Nipah, and avian influenza, underscore their capacity to overwhelm health systems, with COVID-19 alone projected to reduce global Gross Domestic Product by USD 22 trillion by 2025 and impose annual healthcare costs of USD 2–3 trillion. Beyond mortality and morbidity, zoonotic events disrupt trade, depress rural livelihoods, and inflict agricultural losses exceeding USD 100 billion per outbreak, with impacts disproportionately borne by low- and middle-income countries. Hotspot regions across tropical North and South America, Asia, and Central Africa remain especially vulnerable due to accelerating land use change, climate variability, and intensified wildlife–human interfaces. While the Global One Health Index highlights high regional heterogeneity, with sub-Saharan Africa scoring lowest, a critical gap persists between the conceptual strength of One Health and its operationalization in resource-limited settings. This review synthesizes evidence on drivers, clinical manifestations, and socioeconomic burdens of viral zoonoses, while highlighting novel perspectives on equity gaps, co-infection dynamics, and limitations of global preparedness initiatives. We argue that current strategies remain over-reliant on donor-driven agendas and insufficiently integrated across sectors. Addressing future zoonotic threats requires prioritizing surveillance in high-risk geographies, integrating epidemiological and economic data for preparedness planning, and supporting context sensitive One Health approaches that confront political, financial, and structural barriers to implementation.

Introduction The HIV epidemic is often primarily associated with key populations at higher risk of transmission, which has led to an underestimation of its impact on the pediatric population. In children, the disease may go unnoticed due to the delayed onset of symptoms, and diagnosis is often made at advanced stages, once opportunistic infections have already appeared such as cryptococcal meningitis, which carries high morbidity and mortality rates. Case report A 13-year-old adolescent, newly diagnosed with WHO clinical stage IV HIV infection (unknown transmission route), was admitted with a central nervous system opportunistic infection caused by Cryptococcus neoformans . The patient presented with fever and seizures; the diagnosis was confirmed by positive India ink staining. Management, led by the Pediatric Infectious Diseases and Neurology services, focused on controlling intracranial hypertension (ICH) through 12 successive lumbar punctures for cerebrospinal fluid (CSF) drainage. Despite this aggressive multidisciplinary approach, the patient developed bilateral blindness secondary to chronic papilledema. This case highlights the challenges of advanced HIV in adolescence and the crucial need for effective ICH management in cryptococcal meningitis. Discussion Cryptococcosis is one of the most severe opportunistic infections in immunocompromised patients, and its management in children and adolescents lacks standardized guidelines, which further complicates treatment. In this case, the absence of an external CSF drainage system and the need for multiple lumbar punctures highlight the therapeutic limitations in managing intracranial hypertension in resource-limited settings. This patient’s history shows that with appropriate care and a committed interdisciplinary team, it is possible to improve the quality of life for pediatric HIV patients, even in complex clinical scenarios. Conclusion Early detection of HIV in children and adolescents must be strengthened, along with optimizing access to timely treatment to reduce the impact of opportunistic infections. Ongoing training should be promoted for healthcare professionals managing immunodeficient patients, as adherence to updated protocols and an interdisciplinary approach can make a significant difference in the prognosis and quality of life of these patients.

Background: Bloodstream infections (BSIs) leading to sepsis remain major causes of morbidity and mortality in hospitalized patients worldwide. Conventional blood culture methods, though regarded as the diagnostic gold standard, require prolonged incubation and manual monitoring, which delay the detection of microbial growth and the initiation of targeted therapy. The BACTEC Automated Blood Culture System (Becton Dickinson, USA) has been developed to address these limitations through continuous monitoring of carbon dioxide (CO₂) production using a fluorescent sensor, allowing rapid and reliable detection of microbial growth. This study aimed to evaluate the clinical impact of switching from the Conventional Blood Culture Method to the BACTEC System in a tertiary care hospital setting in Nepal. Methods: A total of 150 blood samples were analyzed—75 using the Conventional Method and 75 using the BACTEC System—to compare time to detection, positivity rate, contamination rate, turnaround time, and early clinical response. Results: The BACTEC system significantly reduced mean time to detection from 48.3 ± 8.7 hours to 18.6 ± 4.2 hours (p &lt; 0.001), increased culture positivity from 34.7% to 50.7% (p = 0.03), and decreased contamination from 8.0% to 2.7% (p = 0.04). Antibiotic therapy was changed based on BACTEC results in 46.6% of patients, compared to 25.3% in the conventional group (p = 0.01). Conclusion: The findings indicate that the BACTEC Blood Culture System enhances diagnostic efficiency, accelerates clinical decision-making, reduces unnecessary empirical therapy, and supports antimicrobial stewardship. It represents a reliable, cost-effective solution for improving patient outcomes in resource-limited hospital settings. Novelty: Introducing automated blood culture testing strengthens diagnostic turnaround and supports earlier targeted therapy in a tertiary hospital with limited resources.