Accurate blood pressure(BP)monitoring is essential for preventing and managing cardiovascular disease.Advancements in materials science,medicine,flexible electronic,and artificial intelligence(AI)have enabled cuffless...Accurate blood pressure(BP)monitoring is essential for preventing and managing cardiovascular disease.Advancements in materials science,medicine,flexible electronic,and artificial intelligence(AI)have enabled cuffless,unobtrusive BP monitoring systems,offering an alternative to traditional sphygmomanometers.However,extending these advances to real-world cardiovascular care particularly in resource-limited settings remains challenging due to constraints in computational resources,power efficiency,and deployment scalability.This review presents a comprehensive synthesis of AI-enhanced wearable BP monitoring,emphasizing its potential for personalized,scalable,and accessible healthcare.We systematically analyze the end-to-end system architecture,from mechano-electric sensing principles and AI-based estimation models to edge-aware deployment strategies tailored for low-resource environments.We further discuss clinical validation metrics and implementation barriers and prospective strategies.To bridge lab-to-field translation,we propose an innovative"sensor-model-deployment-assessment"co-design framework.This roadmap highlights how AI-enhanced BP technologies can support proactive hypertension control and promote cardiovascular health equity on a global scale.展开更多
The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high al...The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes.Based on a retrospective analysis of 48 patients from Yunnan Province,China,the authors identified four independent predictors of mortality:Age;Elevated uric acid levels;Interleukin-6 and decreased hemoglobin.Integrating these factors into a nomogram demonstrated high predictive accuracy(area under the curve=0.939).This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas.This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.展开更多
Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-y...Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.展开更多
Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge w...Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge worldwide[1].According to data from the Institute for Health Metrics and Evaluation(IHME)and the World Health Organization(WHO),the gap in access to healthcare services between high-and low-income countries contributes to delayed detection,increased incidence of advanced-stage disease,and,consequently,higher mortality rates(up to 50%higher compared to high-income countries)[1,2].This translates into inequalities in access to screening and early diagnosis methods,which exacerbate the burden of this disease in low-resource settings where infrastructure,funding,and access to trained professionals are limited[3].展开更多
Most existing domain adaptation(DA) methods aim to explore favorable performance under complicated environments by sampling.However,there are three unsolved problems that limit their efficiencies:ⅰ) they adopt global...Most existing domain adaptation(DA) methods aim to explore favorable performance under complicated environments by sampling.However,there are three unsolved problems that limit their efficiencies:ⅰ) they adopt global sampling but neglect to exploit global and local sampling simultaneously;ⅱ)they either transfer knowledge from a global perspective or a local perspective,while overlooking transmission of confident knowledge from both perspectives;and ⅲ) they apply repeated sampling during iteration,which takes a lot of time.To address these problems,knowledge transfer learning via dual density sampling(KTL-DDS) is proposed in this study,which consists of three parts:ⅰ) Dual density sampling(DDS) that jointly leverages two sampling methods associated with different views,i.e.,global density sampling that extracts representative samples with the most common features and local density sampling that selects representative samples with critical boundary information;ⅱ)Consistent maximum mean discrepancy(CMMD) that reduces intra-and cross-domain risks and guarantees high consistency of knowledge by shortening the distances of every two subsets among the four subsets collected by DDS;and ⅲ) Knowledge dissemination(KD) that transmits confident and consistent knowledge from the representative target samples with global and local properties to the whole target domain by preserving the neighboring relationships of the target domain.Mathematical analyses show that DDS avoids repeated sampling during the iteration.With the above three actions,confident knowledge with both global and local properties is transferred,and the memory and running time are greatly reduced.In addition,a general framework named dual density sampling approximation(DDSA) is extended,which can be easily applied to other DA algorithms.Extensive experiments on five datasets in clean,label corruption(LC),feature missing(FM),and LC&FM environments demonstrate the encouraging performance of KTL-DDS.展开更多
AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessi...AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised work-shops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Preand post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at thesymposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited.展开更多
The global burden of hepatitis B virus(HBV)and hepatitis C virus(HCV)infections and coinfection represents a major public health concern,particularly in resource-limited settings.Elimination of HCV by 2030 has become ...The global burden of hepatitis B virus(HBV)and hepatitis C virus(HCV)infections and coinfection represents a major public health concern,particularly in resource-limited settings.Elimination of HCV by 2030 has become foreseeable,with effective direct-acting antiviral oral therapies and the availability of affordable generics in low-and-middle-income countries(LMICs).However,access to oral nucleos(t)ide therapy for HBV remains critical and is limited outside the existing global HIV program platforms despite affordable prices.Prevention of mother-to-child transmission of HBV through scaling up of birth dose implementation in LMICs is essential to achieve the 2030 elimination goal.Most individuals living with HBV and/or HCV in resource-limited settings are unaware of their infection,and with improved access to medications,the most significant barrier remains access to affordable diagnostics and preventive strategies.The coronavirus disease 2019 pandemic interrupted hepatitis elimination programs,albeit offered opportunities for improved diagnostic capacities and raised political awareness of the critical need for strengthening health care services and universal health coverage.This review underpins the HBV and HCV management challenges in resource-limited settings,highlighting the current status and suggested future elimination strategies in some of these countries.Global efforts should continue to improve awareness and political commitment.Financial resources should be secured to access and implement comprehensive strategies for diagnosis and linkage to care in resource-constrained settings to fulfill the 2030 elimination goal.展开更多
Background:Wolff-Parkinson-White(WPW)syndrome,a rare but lifethreatening arrhythmia,is underdiagnosed in sub-Saharan Africa due to limited healthcare resources.This case highlights the regional uniqueness of managing ...Background:Wolff-Parkinson-White(WPW)syndrome,a rare but lifethreatening arrhythmia,is underdiagnosed in sub-Saharan Africa due to limited healthcare resources.This case highlights the regional uniqueness of managing WPW in Kisangani,DRC,where diagnostic and therapeutic gaps exacerbate patient outcomes.Catheter ablation,the gold standard,remains inaccessible here,necessitating reliance on pharmacotherapy.Case Presentation:A 43-year-old woman presented with three days of sudden-onset palpitations.Electrocardiography(ECG)revealed a PR interval of 90 ms,QRS duration of 130 ms,and delta waves with positive polarity in leads II,III,aVF,and V4-V6.Echocardiography confirmed normal cardiac structure(left ventricular ejection fraction:65%,left atrial diameter:34 mm).She was treated with sustained-release flecainide(150 mg/day)and bisoprolol(5 mg/day),achieving symptom resolution within one week.Conclusion:Strengthening arrhythmia care in resource-limited settings requires training,technology transfer,and national registries.Long-term strategies must balance pharmacotherapy with advocacy for ablation access.展开更多
Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleed...Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.展开更多
BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of tr...BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure.Most gastroenterologists in Ethiopia work in major cities,leaving the 80%rural population with limited access to endoscopy due to economic and logistical challenges.Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence.To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable.Findings were documented electronically and stored safely.AIM To evaluate the findings,success,and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.METHODS In partnership with Jimma Awetu Hospital,a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019,training local nursing staff as coordinators.Physicians selected and referred patients for colonoscopy,and informed consent was obtained before the procedure.A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system,and findings were documented electronically.Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.RESULTS From 2019 to 20241612 colonoscopy procedures were performed,achieving an 83.0%diagnostic yield.The cohort was predominantly male(70.6%)with a mean age of 44 years;61%were under 50.Ninety-one percent of patients were referred by 21 hospitals across three regions.Primary indications included abdominal pain(26.8%)and lower gastrointestinal bleeding(25.3%).Abnormal findings included inflammation(39.5%),colorectal masses(13.2%),and hemorrhoid(11.8%).Histology confirmed inflammatory bowel disease in 11.5%,cancers in 11.0%,and polyps in 10.0%.In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8%in females and 10.8%in males,challenging the global trend that shows this disease predominantly affects older individuals and males.CONCLUSION This weekend outreach colonoscopy service implemented standard diagnostics,improved the existing service,and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a poorly understood complication in hepatosplenic schistosomiasis(HSS),a neglected cause of non-cirrhotic portal hypertension.Although portosystemic shunts(PSS)are commonly obse...BACKGROUND Hepatic encephalopathy(HE)is a poorly understood complication in hepatosplenic schistosomiasis(HSS),a neglected cause of non-cirrhotic portal hypertension.Although portosystemic shunts(PSS)are commonly observed in HSS patients,the prevalence and clinical impact of overt HE(OHE)and minimal HE(MHE)remain understudied,particularly in resource-limited settings.AIM To determine OHE/MHE prevalence in HSS and its associations with PSS,clinical,and laboratory characteristics.METHODS This cross-sectional study included 200 HSS patients undergoing treatment at the Hospital of Universidade Federal de Pernambuco in Brazil between 2021 and 2023.Cognitive function was assessed using the animal naming test(ANT)and Mini-Mental State Examination(MMSE),while psychological status was evaluated with the Hospital Anxiety and Depression Scale.PSS was identified via ultrasound,and fibrosis severity was quantified using the Coutinho index(CI).Analyses were adjusted for education level and the presence of comorbidities.Statistical analyses were performed using R software.RESULTS The prevalence of OHE was 0.5%,while MHE,diagnosed via ANT,affected 24%of patients.ANT positivity was significantly associated with the presence of PSS(35.1%vs 15.1%;P=0.0018)and higher CI scores(1.79±0.26 vs 1.30±0.84;P=0.045).Patients with MHE demonstrated notably lower MMSE scores(24.06±1.17 vs 26.04±0.63;P=0.0003),independent of education level.The ANT showed high diagnostic robustness,even among patients with limited formal education.CONCLUSION MHE is prevalent in HSS,especially with PSS,and is associated with portal hypertension severity.The ANT enables practical screening,underscoring the need for routine assessment to improve outcomes.展开更多
Surgical site infections remain a significant challenge in gastrointestinal surgery,despite advances in surgical techniques and antimicrobial therapy.Wang et al’s retrospective analysis highlights the transformative ...Surgical site infections remain a significant challenge in gastrointestinal surgery,despite advances in surgical techniques and antimicrobial therapy.Wang et al’s retrospective analysis highlights the transformative potential of comprehensive perioperative disinfection and isolation protocols in gastrointestinal surgery,demonstrating a 55%reduction in postoperative infection rates and attenuation of systemic inflammation.Their findings underscore the critical role of multidisciplinary strategies—such as preoperative povidone-iodine decolonization,intraoperative laminar airflow systems,and strict postoperative wound care—in mitigating infection risk and preserving organ function.However,the study revealed persistent gaps in protocol standardization and compliance monitoring,particularly in resource-limited settings.Although these measures reduce reliance on antibiotics and align with global antimicrobial resistance containment efforts,challenges such as the high cost of technology and issues with contextual adaptability warrant urgent attention.This study conclusively demonstrated that structured perioperative disinfection protocols significantly transform surgical outcomes by creating comprehensive infection barriers that extend beyond traditional antibiotic prophylaxis.Future priorities include prospective multicenter trials to validate efficacy,cost-benefit analyses for equitable implementation,and integration of artificial intelligence-driven innovations to optimize infection prevention.This study redefines infection control as a cornerstone of surgical quality,urging collaborative action to bridge the gap between clinical evidence and real-world practice.展开更多
BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virologic...BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.展开更多
Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general informatio...Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (x2=16.44, P<0.001), symptom duration (x2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age ( 37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.展开更多
Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in...Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in the management of sepsis in a resource limited setting and make appropriate recommendations. Methodology: The data was collected through an online literature search for cases of sepsis managed in resource limited settings from 1990 to 2015. Search terms used included: “sepsis”, “septicaemia”, “incidence”, “prevalence”, “morbidity”, “mortality” and “management challenges” using the English and American spellings. Studies from peer reviewed journals or those presented in professional conferences were selected. Finally, studies with proper definition of sepsis and positive blood cultures were selected. Result: Twenty one studies from eleven resource limited settings were found. A total of 14,862 cases of sepsis were studied with 9260 (62.3%) of neonatal sepsis and 5602 (37.7%) of post neonatal sepsis. Challenges in the management of sepsis that were identified at the community level included: false cultural beliefs and practices, ignorance and poverty, poor health seeking behavior, late presentation, lack of access to skilled care and patronage of unskilled medical practitioners. While challenges identified at the hospital level include: poor knowledge skills of the health workers, delay in making a diagnosis and initiating treatment, poorly equipped laboratory materials and personnel, no protocol for management of sepsis, limited supply of bedside monitoring equipment, poor staffing, repeated industrial actions, use of fake drugs and high cost of care and drugs. Conclusion and recommendation: Management of sepsis in resource limited settings is an uphill task and requires health education and re-orientation of the people. To significantly reduce the mortality associated with sepsis, there is a need to bring health care services to the communities where the people are, improve the management skills of health professionals and translate major components of sepsis management to resource limited settings.展开更多
Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intract...Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcinoma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilutions. She was treated with chemotherapy involving Adriamycin, Cyclophosphamide, Methotrexate and Folinic acid. Conclusion: The diagnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring.展开更多
Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic e...Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of Fran?ois’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated Fran?ois’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2;category 2, score between -6 and 2;category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1;19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies.展开更多
Background: Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents ar...Background: Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. Methods: The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. Results: A total of 624 acute burn cases were treated during the period;among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons. Conclusion: There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.展开更多
基金the Chinese University of Hong Kong for providing research resources and institutional support
文摘Accurate blood pressure(BP)monitoring is essential for preventing and managing cardiovascular disease.Advancements in materials science,medicine,flexible electronic,and artificial intelligence(AI)have enabled cuffless,unobtrusive BP monitoring systems,offering an alternative to traditional sphygmomanometers.However,extending these advances to real-world cardiovascular care particularly in resource-limited settings remains challenging due to constraints in computational resources,power efficiency,and deployment scalability.This review presents a comprehensive synthesis of AI-enhanced wearable BP monitoring,emphasizing its potential for personalized,scalable,and accessible healthcare.We systematically analyze the end-to-end system architecture,from mechano-electric sensing principles and AI-based estimation models to edge-aware deployment strategies tailored for low-resource environments.We further discuss clinical validation metrics and implementation barriers and prospective strategies.To bridge lab-to-field translation,we propose an innovative"sensor-model-deployment-assessment"co-design framework.This roadmap highlights how AI-enhanced BP technologies can support proactive hypertension control and promote cardiovascular health equity on a global scale.
文摘The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes.Based on a retrospective analysis of 48 patients from Yunnan Province,China,the authors identified four independent predictors of mortality:Age;Elevated uric acid levels;Interleukin-6 and decreased hemoglobin.Integrating these factors into a nomogram demonstrated high predictive accuracy(area under the curve=0.939).This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas.This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.
文摘Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.
文摘Breast cancer is the leading cause of cancer-related mortality in women globally,with its incidence continuing to rise,particularly in low-and middle-income countries,presenting a significant public health challenge worldwide[1].According to data from the Institute for Health Metrics and Evaluation(IHME)and the World Health Organization(WHO),the gap in access to healthcare services between high-and low-income countries contributes to delayed detection,increased incidence of advanced-stage disease,and,consequently,higher mortality rates(up to 50%higher compared to high-income countries)[1,2].This translates into inequalities in access to screening and early diagnosis methods,which exacerbate the burden of this disease in low-resource settings where infrastructure,funding,and access to trained professionals are limited[3].
基金supported in part by the Key-Area Research and Development Program of Guangdong Province (2020B010166006)the National Natural Science Foundation of China (61972102)+1 种基金the Guangzhou Science and Technology Plan Project (023A04J1729)the Science and Technology development fund (FDCT),Macao SAR (015/2020/AMJ)。
文摘Most existing domain adaptation(DA) methods aim to explore favorable performance under complicated environments by sampling.However,there are three unsolved problems that limit their efficiencies:ⅰ) they adopt global sampling but neglect to exploit global and local sampling simultaneously;ⅱ)they either transfer knowledge from a global perspective or a local perspective,while overlooking transmission of confident knowledge from both perspectives;and ⅲ) they apply repeated sampling during iteration,which takes a lot of time.To address these problems,knowledge transfer learning via dual density sampling(KTL-DDS) is proposed in this study,which consists of three parts:ⅰ) Dual density sampling(DDS) that jointly leverages two sampling methods associated with different views,i.e.,global density sampling that extracts representative samples with the most common features and local density sampling that selects representative samples with critical boundary information;ⅱ)Consistent maximum mean discrepancy(CMMD) that reduces intra-and cross-domain risks and guarantees high consistency of knowledge by shortening the distances of every two subsets among the four subsets collected by DDS;and ⅲ) Knowledge dissemination(KD) that transmits confident and consistent knowledge from the representative target samples with global and local properties to the whole target domain by preserving the neighboring relationships of the target domain.Mathematical analyses show that DDS avoids repeated sampling during the iteration.With the above three actions,confident knowledge with both global and local properties is transferred,and the memory and running time are greatly reduced.In addition,a general framework named dual density sampling approximation(DDSA) is extended,which can be easily applied to other DA algorithms.Extensive experiments on five datasets in clean,label corruption(LC),feature missing(FM),and LC&FM environments demonstrate the encouraging performance of KTL-DDS.
文摘AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised work-shops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Preand post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at thesymposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited.
文摘The global burden of hepatitis B virus(HBV)and hepatitis C virus(HCV)infections and coinfection represents a major public health concern,particularly in resource-limited settings.Elimination of HCV by 2030 has become foreseeable,with effective direct-acting antiviral oral therapies and the availability of affordable generics in low-and-middle-income countries(LMICs).However,access to oral nucleos(t)ide therapy for HBV remains critical and is limited outside the existing global HIV program platforms despite affordable prices.Prevention of mother-to-child transmission of HBV through scaling up of birth dose implementation in LMICs is essential to achieve the 2030 elimination goal.Most individuals living with HBV and/or HCV in resource-limited settings are unaware of their infection,and with improved access to medications,the most significant barrier remains access to affordable diagnostics and preventive strategies.The coronavirus disease 2019 pandemic interrupted hepatitis elimination programs,albeit offered opportunities for improved diagnostic capacities and raised political awareness of the critical need for strengthening health care services and universal health coverage.This review underpins the HBV and HCV management challenges in resource-limited settings,highlighting the current status and suggested future elimination strategies in some of these countries.Global efforts should continue to improve awareness and political commitment.Financial resources should be secured to access and implement comprehensive strategies for diagnosis and linkage to care in resource-constrained settings to fulfill the 2030 elimination goal.
文摘Background:Wolff-Parkinson-White(WPW)syndrome,a rare but lifethreatening arrhythmia,is underdiagnosed in sub-Saharan Africa due to limited healthcare resources.This case highlights the regional uniqueness of managing WPW in Kisangani,DRC,where diagnostic and therapeutic gaps exacerbate patient outcomes.Catheter ablation,the gold standard,remains inaccessible here,necessitating reliance on pharmacotherapy.Case Presentation:A 43-year-old woman presented with three days of sudden-onset palpitations.Electrocardiography(ECG)revealed a PR interval of 90 ms,QRS duration of 130 ms,and delta waves with positive polarity in leads II,III,aVF,and V4-V6.Echocardiography confirmed normal cardiac structure(left ventricular ejection fraction:65%,left atrial diameter:34 mm).She was treated with sustained-release flecainide(150 mg/day)and bisoprolol(5 mg/day),achieving symptom resolution within one week.Conclusion:Strengthening arrhythmia care in resource-limited settings requires training,technology transfer,and national registries.Long-term strategies must balance pharmacotherapy with advocacy for ablation access.
文摘Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.
文摘BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure.Most gastroenterologists in Ethiopia work in major cities,leaving the 80%rural population with limited access to endoscopy due to economic and logistical challenges.Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence.To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable.Findings were documented electronically and stored safely.AIM To evaluate the findings,success,and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.METHODS In partnership with Jimma Awetu Hospital,a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019,training local nursing staff as coordinators.Physicians selected and referred patients for colonoscopy,and informed consent was obtained before the procedure.A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system,and findings were documented electronically.Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.RESULTS From 2019 to 20241612 colonoscopy procedures were performed,achieving an 83.0%diagnostic yield.The cohort was predominantly male(70.6%)with a mean age of 44 years;61%were under 50.Ninety-one percent of patients were referred by 21 hospitals across three regions.Primary indications included abdominal pain(26.8%)and lower gastrointestinal bleeding(25.3%).Abnormal findings included inflammation(39.5%),colorectal masses(13.2%),and hemorrhoid(11.8%).Histology confirmed inflammatory bowel disease in 11.5%,cancers in 11.0%,and polyps in 10.0%.In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8%in females and 10.8%in males,challenging the global trend that shows this disease predominantly affects older individuals and males.CONCLUSION This weekend outreach colonoscopy service implemented standard diagnostics,improved the existing service,and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.
文摘BACKGROUND Hepatic encephalopathy(HE)is a poorly understood complication in hepatosplenic schistosomiasis(HSS),a neglected cause of non-cirrhotic portal hypertension.Although portosystemic shunts(PSS)are commonly observed in HSS patients,the prevalence and clinical impact of overt HE(OHE)and minimal HE(MHE)remain understudied,particularly in resource-limited settings.AIM To determine OHE/MHE prevalence in HSS and its associations with PSS,clinical,and laboratory characteristics.METHODS This cross-sectional study included 200 HSS patients undergoing treatment at the Hospital of Universidade Federal de Pernambuco in Brazil between 2021 and 2023.Cognitive function was assessed using the animal naming test(ANT)and Mini-Mental State Examination(MMSE),while psychological status was evaluated with the Hospital Anxiety and Depression Scale.PSS was identified via ultrasound,and fibrosis severity was quantified using the Coutinho index(CI).Analyses were adjusted for education level and the presence of comorbidities.Statistical analyses were performed using R software.RESULTS The prevalence of OHE was 0.5%,while MHE,diagnosed via ANT,affected 24%of patients.ANT positivity was significantly associated with the presence of PSS(35.1%vs 15.1%;P=0.0018)and higher CI scores(1.79±0.26 vs 1.30±0.84;P=0.045).Patients with MHE demonstrated notably lower MMSE scores(24.06±1.17 vs 26.04±0.63;P=0.0003),independent of education level.The ANT showed high diagnostic robustness,even among patients with limited formal education.CONCLUSION MHE is prevalent in HSS,especially with PSS,and is associated with portal hypertension severity.The ANT enables practical screening,underscoring the need for routine assessment to improve outcomes.
文摘Surgical site infections remain a significant challenge in gastrointestinal surgery,despite advances in surgical techniques and antimicrobial therapy.Wang et al’s retrospective analysis highlights the transformative potential of comprehensive perioperative disinfection and isolation protocols in gastrointestinal surgery,demonstrating a 55%reduction in postoperative infection rates and attenuation of systemic inflammation.Their findings underscore the critical role of multidisciplinary strategies—such as preoperative povidone-iodine decolonization,intraoperative laminar airflow systems,and strict postoperative wound care—in mitigating infection risk and preserving organ function.However,the study revealed persistent gaps in protocol standardization and compliance monitoring,particularly in resource-limited settings.Although these measures reduce reliance on antibiotics and align with global antimicrobial resistance containment efforts,challenges such as the high cost of technology and issues with contextual adaptability warrant urgent attention.This study conclusively demonstrated that structured perioperative disinfection protocols significantly transform surgical outcomes by creating comprehensive infection barriers that extend beyond traditional antibiotic prophylaxis.Future priorities include prospective multicenter trials to validate efficacy,cost-benefit analyses for equitable implementation,and integration of artificial intelligence-driven innovations to optimize infection prevention.This study redefines infection control as a cornerstone of surgical quality,urging collaborative action to bridge the gap between clinical evidence and real-world practice.
基金Supported by the Norwegian Research Council,220622/H10.
文摘BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.
文摘Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (x2=16.44, P<0.001), symptom duration (x2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age ( 37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.
文摘Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in the management of sepsis in a resource limited setting and make appropriate recommendations. Methodology: The data was collected through an online literature search for cases of sepsis managed in resource limited settings from 1990 to 2015. Search terms used included: “sepsis”, “septicaemia”, “incidence”, “prevalence”, “morbidity”, “mortality” and “management challenges” using the English and American spellings. Studies from peer reviewed journals or those presented in professional conferences were selected. Finally, studies with proper definition of sepsis and positive blood cultures were selected. Result: Twenty one studies from eleven resource limited settings were found. A total of 14,862 cases of sepsis were studied with 9260 (62.3%) of neonatal sepsis and 5602 (37.7%) of post neonatal sepsis. Challenges in the management of sepsis that were identified at the community level included: false cultural beliefs and practices, ignorance and poverty, poor health seeking behavior, late presentation, lack of access to skilled care and patronage of unskilled medical practitioners. While challenges identified at the hospital level include: poor knowledge skills of the health workers, delay in making a diagnosis and initiating treatment, poorly equipped laboratory materials and personnel, no protocol for management of sepsis, limited supply of bedside monitoring equipment, poor staffing, repeated industrial actions, use of fake drugs and high cost of care and drugs. Conclusion and recommendation: Management of sepsis in resource limited settings is an uphill task and requires health education and re-orientation of the people. To significantly reduce the mortality associated with sepsis, there is a need to bring health care services to the communities where the people are, improve the management skills of health professionals and translate major components of sepsis management to resource limited settings.
文摘Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcinoma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilutions. She was treated with chemotherapy involving Adriamycin, Cyclophosphamide, Methotrexate and Folinic acid. Conclusion: The diagnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring.
文摘Introduction: Diagnostic wanderings of acute appendicitis are responsible for serious complications or abusive appendectomies. Existing Clinico-biological scores are efficient. Objective: To determine the diagnostic efficiency of Fran?ois’ score in acute appendicitis. Methodology: over 10 months, all the patients admitted in the CHUD-Parakou Emergency Department for pain in the right iliac fossa had been examined by resident students who calculated Fran?ois’ score. After verification by the surgeon, patients were put into three categories: category 1 score ≥ 2;category 2, score between -6 and 2;category 3, score below -6. Sensitivity and specificity were calculated. Results: out of 54 patients selected (29 men and 25 women), 29 were classified as group 1;19 as group 2 and 6 as group 3. An ultrasound was performed in all patients in group 2, and signs in favor of appendicitis were found in 12 patients. Of the 41 appendicectomies performed, the histologic analysis of 33 operative specimens found a pathological appendix. Sensitivity, specificity and negative predictive value per group were 100%. It has prevented almost in one every four patients (24.07%) an abusive appendectomy. Conclusion: This score would reduce diagnostic wanderings and target patient groups for imaging studies.
文摘Background: Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. Methods: The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. Results: A total of 624 acute burn cases were treated during the period;among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons. Conclusion: There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.
