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Rural Anaesthesia

Sharnie Wu, Kong Chan Tang
PURPOSE: Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position...
September 2018: Asia-Pacific Journal of Ophthalmology
F Oehme, L Fourie, F J-P Beeres, S Ogbaji, P Nussbaumer
PURPOSE: Surgical teaching missions are known to contribute significantly in reducing the local burden of disease. However, the value of short-term medical service trips (MSTs) remains under debate. Humanitarian surgery is highly dependent on funding, and consequently, data evaluation is needed to secure funding for future projects. The aim of this trial is to evaluate the results of 6-year MSTs to rural Nigeria with a specific emphasis on hernia repairs. METHODS: Retrospective series of consecutive operations performed between 2011 and 2016 in rural Nigeria during 13 MSTs...
June 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Sreeparna Chattopadhyay, Arima Mishra, Suraj Jacob
The majority of maternal health interventions in India focus on increasing institutional deliveries to reduce maternal mortality, typically by incentivising village health workers to register births and making conditional cash transfers to mothers for hospital births. Based on over 15 months of ethnographically informed fieldwork conducted between 2015 and 2017 in rural Assam, the Indian state with the highest recorded rate of maternal deaths, we find that while there has been an expansion in institutional deliveries, the experience of childbirth in government facilities is characterised by obstetric violence...
July 2018: Culture, Health & Sexuality
Vikram Singh Chauhan, P L Kariholu, Sabyasachi Saha, Himanshu Singh, Jasmine Ray
Premise and Objective: Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting...
July 2018: Journal of Minimal Access Surgery
Duangporn Duangthip, Kitty Jieyi Chen, Sherry Shiqian Gao, Edward Chin Man Lo, Chun Hung Chu
Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child's growth, development and general health. Fundamental caries management is based on the conventional restorative approach...
October 10, 2017: International Journal of Environmental Research and Public Health
E De Plecker, R Zachariah, A M V Kumar, M Trelles, S Caluwaerts, W van den Boogaard, J Manirampa, K Tayler-Smith, M Manzi, K Nanan-N'zeth, B Duchenne, B Ndelema, W Etienne, P Alders, R Veerman, R Van den Bergh
OBJECTIVES: In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. METHODS: A retrospective analysis of EmOC data (2011 and 2012). RESULTS: A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure)...
2017: PloS One
Rafael Gaszynski, Gratian Punch, Kurt Verschuer
BACKGROUND: This study evaluated the safety, efficacy and compliance of an emerging technique for managing complex subcutaneous abscesses in an adult population (≥16 years). METHODS: A retrospective review of prospectively collected data between April and October 2015 at a rural hospital comparing conventional incision drainage (CID) and repetitive packing to the minimal incision, irrigation, loop and drain technique (LDT). LDT method was consistent with previous publications, being ≤5 mm incisions at abscess edges, irrigation and passage of a VessiLoop through the cavity and then secured above the skin...
January 2018: ANZ Journal of Surgery
Laura Macpherson, Maggie Collins
BACKGROUND: Urgent investment in human resources for surgical and anaesthesia care is needed globally. Responsible training and education is required to ensure healthcare providers are confident and skilled in the delivery of this care in both the rural and the urban setting. The Tropical Health and Education Trust (THET), a UK-based specialist global health organisation, is working with health training institutions, health professionals, Ministries of Health and Health Partnerships or 'links' between healthcare institutions in the UK and low- or middle-income country (LMIC) counterparts...
January 2017: Tropical Doctor
A Nyamtema, N Mwakatundu, S Dominico, H Mohamed, A Shayo, R Rumanyika, C Kairuki, C Nzabuhakwa, O Issa, C Lyimo, I Kasiga, J van Roosmalen
OBJECTIVE: To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. DESIGN: Before-after intervention study design. SETTINGS: Rural Tanzania. METHODS: Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems...
September 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Dawie Du Plessis, Paul Alfred Kapp, Louis S Jenkins, Laurel Giddy
BACKGROUND: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital...
June 30, 2016: African Journal of Primary Health Care & Family Medicine
Soha Sobhy, Javier Zamora, Kuhan Dharmarajah, David Arroyo-Manzano, Matthew Wilson, Ramesan Navaratnarajah, Arri Coomarasamy, Khalid S Khan, Shakila Thangaratinam
BACKGROUND: The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries. METHODS: In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries...
May 2016: Lancet Global Health
S Thilakavathi, P Manickam, S M Mehendale
Stigma, isoIation and discrimination are typically associated with diagnosis of leprosy and its disclosure. Health care providers (HCPs) find it challenging to disclose the diagnosis of leprosy to patients and their family members. A qualitative study was done in a rural community near Chennai in Tamil Nadu, from August 2011 to March 2012, covering 155 out of 648 (23.9%) purposively selected leprosy patients from 53 out of 148 panchayats, representing 264 villages in the study area; Out of these 155 patients, 59% were males; 30% were illiterates; 70% were married; 56% were living in nuclear families; half the leprosy patients were either agricultural labourers or skilled workers (50%)...
July 2015: Indian Journal of Leprosy
Angelo S Nyamtema, Nguke Mwakatundu, Sunday Dominico, Hamed Mohamed, Senga Pemba, Richard Rumanyika, Clementina Kairuki, Irene Kassiga, Allan Shayo, Omary Issa, Calist Nzabuhakwa, Chagi Lyimo, Jos van Roosmalen
BACKGROUND: In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. METHODS: Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems...
2016: PloS One
David R Ellard, Aloisia Shemdoe, Festo Mazuguni, Godfrey Mbaruku, David Davies, Paul Kihaile, Senga Pemba, Staffan Bergström, Angelo Nyamtema, Hamed-Mahfoudh Mohamed, Joseph Paul O'Hare
OBJECTIVES: The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way...
February 12, 2016: BMJ Open
Priyanka Gupta, Geeta Kamal, Mayank Gupta
Malignant hyperpyrexia syndrome (MHS) is a rare entity and may not be encountered by the anaesthesiologists throughout their professional career. Whenever it manifests can be a challenging task to manage and prove to be fatal when a timely diagnosis and required therapeutic measures are not taken. Althoughthe dantrolene should be available wherever anaesthesia is practiced, considering the rarity of the syndrome this may not be the scenario always. We are reporting a case of MHS in a pediatric patient to highlight the facts that prompt clinical diagnosis, ongoing supportive treatment, discontinuation of all the anaesthetic agents and and stringent perioperative monitoring along with postoperative oral dantrolene may provide an answer to the MHS crisis in the face of an unavailability of the IV dantrolene; as may be the case in many rural and developing set-ups...
October 2015: Journal of Pharmacology & Pharmacotherapeutics
Janet Martin, Goa Tau, Meena Nathan Cherian, Jennifer Vergel de Dios, David Mills, Jane Fitzpatrick, William Adu-Krow, Davy Cheng
OBJECTIVE: To assess capacity to provide essential surgical services including emergency, obstetric and anaesthesia care in Papua New Guinea (PNG) in order to support planning for relevant post-2015 sustainable development goals for PNG. DESIGN: Cross-sectional survey. SETTING: Hospitals and health facilities in PNG. PARTICIPANTS: 21 facilities including 3 national/provincial hospitals, 11 district/rural hospitals, and 7 health centres...
December 16, 2015: BMJ Open
Benjamin Bowsher
A man in his 50s presented to a rural Australian emergency department with complete unilateral hearing loss following transurethral resection of the prostate. His hearing impairment progressed from 'muffled hearing' with tinnitus on emergence from anaesthesia, to total sensorineural deafness by day three. His surgery and anaesthesia were uncomplicated and he had remained normotensive throughout. He had no pre-existing auditory disease. He had received 240 mg of intravenous gentamicin intraoperatively for surgical prophylaxis...
November 12, 2015: BMJ Case Reports
Joshua S Ng-Kamstra, Anna J Dare, Jayadeep Patra, Sze Hang Fu, Peter S Rodriguez, Marvin Hsiao, Raju M Jotkar, J S Thakur, Jay K Sheth, Prabhat Jha
BACKGROUND: Acute abdominal conditions have high case-fatality rates in the absence of timely surgical care. In India, and many other low-income and middle-income countries, few population-based studies have quantified mortality from surgical conditions and related mortality to access to surgical care. We aimed to describe the spatial and socioeconomic distributions of deaths from acute abdomen (DAA) in India and to quantify potential access to surgical facilities in relation to such deaths...
April 27, 2015: Lancet
Anna J Dare, Joshua S Ng-Kamstra, Jayadeep Patra, Sze Hang Fu, Peter S Rodriguez, Marvin Hsiao, Raju M Jotkar, J S Thakur, Jay Sheth, Prabhat Jha
BACKGROUND: Few population-based studies quantify mortality from surgical conditions and relate mortality to access to surgical care in low-income and middle-income countries. METHODS: We linked deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million households in India to nationally representative facility data. We calculated total and age-standardised death rates for acute abdominal conditions...
October 2015: Lancet Global Health
Bhamar Lal, Jai Pal Paryani, Shafique-ur-Rehman Memon
BACKGROUND: Bladder calculi are one of the commonest health problems in young children especially in rural and underprivileged areas. METHODS: All children of bladder stones operated at District Headquarter Hospital Mithi from July 2009 to June 2012 were included in this cross-sectional study. Data was collected regarding age, sex, address (rural or urban), body weight, duration of breast feeding, weaning, detailed dietary history regarding milk type, volume, amount of water intake, recurrent diarrhoea, urinary tract infection (UTI), family history, and socioeconomic history...
January 2015: Journal of Ayub Medical College, Abbottabad: JAMC
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