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Background: Cholera continues to be a major public health threat, especially in regions with poor sanitation and limited access to clean water. Accurate prediction and management of cholera outbreaks are essential to reduce mortality and morbidity. This review focuses on the potential of polymerase chain reaction (PCR) cycle threshold (Ct) values as an innovative tool for early detection and control of cholera outbreaks, specifically highlighting its utility in predicting outbreaks and guiding public health responses. PCR Ct values offer a significant advantage in the early detection of Vibrio cholerae, the pathogen responsible for cholera, in both clinical and environmental samples. By providing quantitative data on bacterial load, lower Ct values indicate a higher concentration of the pathogen, signaling the potential for increased disease transmission. These values allow for more precise, real-time monitoring of cholera outbreaks and aid in targeting intervention strategies such as water sanitation improvements, vaccination campaigns, and antibiotic treatments. Moreover, the application of Ct values in environmental surveillance, particularly in monitoring water sources, offers a proactive approach to prevent the spread of cholera by identifying contamination risks before human cases arise. However, the implementation of PCR in low-resource settings faces significant challenges, including high costs, the need for advanced laboratory infrastructure, and a lack of technical expertise. Addressing these barriers through cost-effective innovations and capacity building initiatives is crucial for optimizing the use of PCR Ct values in cholera management. Conclusion: PCR Ct values hold great promise for improving cholera outbreak prediction and control. Despite challenges in adopting this technology in resource-limited settings, the integration of Ct value monitoring into public health frameworks can enhance early detection efforts and contribute to more effective cholera management strategies. [ABSTRACT FROM AUTHOR]

Purpose: To underline the feasibility of achieving early weight bearing in patients with distal end-segment femur fractures (AO/OTA 33) treated with retrograde intramedullary nailing and supplemental plate or lag screws in the absence of C-arm. Methods: 41 distal end-segment femur fractures (DFFs) included in the study were treated with SIGN nails with or without a side plate in a center that lacked intraoperative fluoroscopy and fracture table. A medial or lateral para-patellar incision was used for fracture reduction, nail insertion and side plate placement. Follow-ups were done at six weeks, 12 weeks, and six months post-operatively. Results: Distal end-segment fractures constituted 13.2% of all femur fractures treated. The patients' mean age and range were 49.6 and 23–83 years respectively. They were mostly injured in road traffic accidents. 27 were daily-income earners. By the 12th week post-operatively, 82.1% of them could flex their knee beyond 90°, all of them could bear weight fully, and 71.8% could squat & smile. Conclusion: The study highlighted the procedure for retrograde nailing of DFFs in a setting without the requisite facilities for minimally-invasive surgeries. The findings demonstrated the feasibility of achieving an expedited weight bearing for the predominantly daily-income-earning victims to ensure early return to work and poverty reduction. While the small sample size is a limitation, the study does provide information that could serve as a basis for future randomized controlled trials in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. Methods: Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. Results: A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. Conclusions: These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population. [ABSTRACT FROM AUTHOR]

Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa. [ABSTRACT FROM AUTHOR]

Purpose: It is estimated that someone dies by suicide every 40 s globally and that 3000 people end their lives daily. Of these deaths, 79% occur in low-resource settings. The very nature of the low-resource settings often serves as a barrier to the adoption and implementation of evidence-based suicide prevention models that have demonstrated success in high-resource countries. As such rates of suicide continue to increase, the workforce of trained mental health providers equipped to effectively engage, assess, and treat individuals struggling with suicidal thoughts and behaviors remains relatively stagnant. This paper aims to illustrate the implementation of the Engaged Community Action for Preventing Suicide (ECAPS) model as a means of developing a culturally relevant and responsive model of suicide prevention that is acceptable and sustainable in low-resource settings. Methods: University faculty and staff (n=34) and psychology students (n=25), and community-based mental health providers (n=41) providing mental health services to at-risk individuals in highly vulnerable communities in Lima, Peru participated in the implementation of ECAPS process. Results: The resulting program, ¡PEDIR!, demonstrates the acceptability, feasibility, and effectiveness of the ECAPS model. Conclusion: The ECAPS model is a feasible and effective framework for use in low-resource settings to guide the development of a culturally relevant community-level intervention to address the systemic, societal, and individual level factors that serve as barriers to suicide prevention. [ABSTRACT FROM AUTHOR]

Purpose of reviews: There are many places in the world where comprehensive echocardiography is not available, including remote or rural regions of high-income countries and outside urban centers of low- to middle-income countries. In this review, we discuss the use case for focused cardiac ultrasound (FoCUS) in remote and low-resource settings including its use by non-expert providers as well as its accuracy and limitations in the assessment of the most common heart valve lesions. Recent findings: FoCUS requires a different workflow compared to comprehensive echocardiography including a system for remote review and reporting by experts who are usually not on site. Multiple approaches used to train novice users to acquire limited FoCUS views, including protocols placing high importance on the parasternal long-axis view, have demonstrated success. Many approaches focus on rheumatic heart disease (RHD) screening and evaluation given its high worldwide prevalence. Models of task-shifting, cloud-based storage, and telemedicine will make diagnosis of heart valve disease more accessible in resource-limited settings. Summary: FoCUS has been increasingly studied as a useful tool to screen for RHD and assess for valve disease in low-resource settings. However, FoCUS is limited in the full evaluation of valvular lesions and requires remote or local expert support, and patient transfer may be necessary for comprehensive echocardiography when appropriate. [ABSTRACT FROM AUTHOR]

Although it is well-documented that families of children with autism in developed nations report hardships, few researchers have focused on families who live in less-developed, low-resource settings. Using five focus groups with 30 parents of children with autism in Mongolia, a low- resource setting, the purpose of this study was to provide detailed accounts of their experiences, challenges, and needs. Participants reported severe challenges related to raising their children with autism in their country. Parents shared barriers related to the limited availability of services and support, exacerbated financial burdens, and a lack of enforcement of relevant laws. Parents also shared their perceived needs including more services for their children, more sustainable training and coaching programs for parents, and parents' collective advocacy. [ABSTRACT FROM AUTHOR]

Background: An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30–65 years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21–29, 30–65 and > 65 years. Study Design: A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010–2019) was conducted. Three age bands were defined: 21–29 years, 30–65 years and > 65 years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available. Results: Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21–29 years, while 4.5% presented in > 65 years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65 years were high-grade squamous abnormalities. Among the total 512 significant high-grade and malignant (squamous and glandular) lesions, 5.6% presented in women 21–29 years, while 10.1% were seen in > 65 years of age. Conclusion: Majority of the significant cervical lesions would be detected if the screening focuses on the 30–65 years age group. However, about 19% of high-grade squamous preneoplastic lesions (ASC-H/ HSIL) and 13% of preneoplastic glandular lesions (AGC-N) are likely to be missed if women 21–29 years and > 65 years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group. [ABSTRACT FROM AUTHOR]

White blood cell (WBC) and neutrophil counts are important laboratory tests used by clinicians to assess a variety of conditions. However, current methods to measure WBC and neutrophil counts are difficult to perform at the point of care, being either cost or labor prohibitive. To meet this need, we developed the LeukoScope: a portable, imaging-based system to measure WBC and neutrophil counts from a drop of blood. Here, we present the performance of the LeukoScope in 136 pediatric and 164 neonatal subjects at a central hospital in Malawi. For pediatric patients, 95.4, 66.7, and 80.0% of samples with normal, low, and high WBC counts, respectively, were correctly identified, and 88.6, 100.0, and 89.3% of samples with normal, low, and high neutrophil counts, respectively, were correctly identified. Accuracy was lower overall for neonatal samples; 92.1, 64.3, and 26.7% of samples with normal, low, and high WBC counts, respectively, were correctly identified, and 73.2 and 78.6% of samples with normal and high neutrophil counts, respectively, were correctly identified. Results of this study show that the LeukoScope can help meet need for point-of-care measurement of WBC counts in pediatric patients and highlight the challenges of point-of-care assessment of WBC counts in neonatal patients. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods: One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results: Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion: Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy of two types of condom uterine balloon tamponade systems, namely Chhattisgarh condom balloon device "CG balloon (CGB)" having a central drainage channel as well as indigenous tying system to fasten condom to the catheter and conventional condom uterine balloon device (C-UBT) as a second-line intervention in post-partum haemorrhage (PPH). Materials and Methods: The present non-randomised prospective case series was carried out from December 2014 to September 2016 and included 60 women having PPH which was refractory to first-line management and who were treated with either of the two condom balloon tamponade devices prepared on spot. Women with allergy to latex, retained placenta, uterine rupture, anomaly, genital infection and/or malignancy were excluded. Case report forms were filled for all participants and analysed. Primary outcome was arrest of haemorrhage, and one of the secondary outcomes was cost and consistency of the devices. Results: CGB was used in 46 and C-UBT in 14 women. The overall success rate was 98.33%. The mean blood loss was 1417 mL. Women of C-UBT group had greater blood loss, higher inflation volume and delays due to technical issues (OR 7.6). CGB was cheaper and more consistent than C-UBT by omitting the use of suture material. Conclusion: CGB and conventional condom balloon tamponade both are easy to use, feasible and efficacious for control of PPH, but CGB condom balloon device has the advantage of a central drainage lumen for real-time assessment of blood loss and therefore early corrective action. [ABSTRACT FROM AUTHOR]

Molecular diagnostic tools in the field of food and water quality analysis are becoming increasingly widespread. Usually, based on DNA amplification techniques such as polymerase chain reaction (PCR), these methods are highly sensitive and versatile but require well-equipped laboratories and trained personnel. To reduce analysis time and avoid expensive equipment, isothermal DNA amplification methods for detecting various target organisms have been developed. However, to make molecular diagnostics suitable for low-resource settings and in-field applications, it is crucial to continuously adapt the working steps associated with DNA amplification, namely sample preparation, DNA extraction, and visualization of the results. Many novel approaches have been evaluated in recent years to tackle these challenges, e.g., the use of ionic liquids for the rapid isolation of nucleic acids from organisms relevant for food and water analysis or the integration of entire analytical workflows on microfluidic chips. In any event, the future of applications in the field of isothermal amplification will probably lie in ready-to-use cartridges combined with affordable handheld devices for on-site analysis. This trend article aims to make prospective users more familiar with this technology and its potential for moving molecular diagnostics from the laboratory to the field. Graphical abstract ᅟ [ABSTRACT FROM AUTHOR]

Purpose: Food insecurity has been linked with maternal depression in low-income settings. Few studies have looked at factors associated with both food insecurity and maternal depression as outcomes. This study aimed to assess factors associated with food insecurity and depression in a sample of pregnant South African women.Methods: We conducted a cross-sectional study at a Midwife Obstetric Unit in a low-income suburb in Cape Town. Pregnant women attending the clinic for their first antenatal visit were invited to participate. The shortened form of the US Household Food Security Survey Module was used to measure food insecurity. The Expanded Mini-International Neuropsychiatric Interview was used to diagnose depression, anxiety, alcohol and drug dependence, and assess for suicidal ideation and behaviour. Logistic regression modelling was conducted to explore factors associated with food insecurity and depression in separate models.Results: We found that 42% of households were food insecure and that 21% of participants were depressed (N = 376). The odds of being food insecure were increased in women with suicidal behaviour (OR = 5.34; 95% CI 1.26-22.57), with depression (4.27; 1.43-12.70) and in those with three or more children (3.79; 1.25-11.55). The odds of depression was greater in women who were food insecure (5.30; 1.63-17.30), substance dependent (15.83; 1.31-191.48) or diagnosed with an anxiety disorder (5.04; 1.71-14.82).Conclusions: Food insecurity and depression are strongly associated in pregnant women. The relationship between food insecurity and depression is complex and requires further investigation. Interventions that improve both food security and mental health during the perinatal period are likely to benefit the physical and mental well-being of mothers and children. [ABSTRACT FROM AUTHOR]

Introduction: The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean section must be performed within 30 min of the decision. The present study was conducted with an objective to assess DDI in a busy obstetric unit in India and its impact on obstetric outcome. Material and Method: A total of 480 women with indications of category I (emergency): Immediate threat to life of woman or foetus ( n = 66), and category II (urgent): Maternal or foetal compromise but not immediately life-threatening ( n = 414), were studied in the context of DDI and composite adverse perinatal outcomes including fresh stillbirth, 5-min Apgar score <7 and NICU admission. Result: Recommended DDI of <30 min could be achieved in 30% cases of emergency CS only. Sixty-three per cent with prolapsed cord could be delivered within 30 min. The composite neonatal outcomes were not significantly increased up to DDI of 60 min for category I (emergency) (except in prolapsed cord) and up to 90 min in category II (urgent) caesarean sections. Conclusion: Authors propose reconsideration of the present recommendations of DDI in categories I and II, while Crash CS (cord prolapse or catastrophic antepartum haemorrhage) should be a separate group with recommended DDI of 30 min. For the remaining cases in the present emergency CS group, the suggested DDI of 60 and, for urgent group, 90 min may be made following further studies to prevent this DDI yardstick from becoming a rod at our back. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions.Methods: A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed.Results: A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training.Conclusions: LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether an intervention from the Triple P Positive Parenting Program system was effective in reducing parental reports of child behavioral difficulties in urban low-income settings in Panama City. A pilot parallel-group randomized controlled trial was carried out. A total of 108 parents of children 3 to 12 years old with some level of parent-rated behavioral difficulties were randomly assigned to a discussion group on 'dealing with disobedience' or to a no intervention control. Blinded assessments were carried out prior to the intervention, 2 weeks, 3 months, and 6 months later. Results indicated that parental reports of child behavioral difficulties changed over time and decreased more steeply in the intervention than in the control group. The effects of the intervention on parental reports of behavioral difficulties were moderate at post-intervention and 3-month follow-up, and large at 6-month follow-up. Parents who participated in the discussion group reported fewer behavioral difficulties in their children after the intervention than those in the control condition. They also reported reduced parental stress and less use of dysfunctional parenting practices. There is a limited amount of evidence on the efficacy of parenting interventions in low-resource settings. This pilot trial was carried out using a small convenience sample living in low-income urban communities in Panama City, and therefore, the findings are of reduced generalizability to other settings. However, the methodology employed in this trial represents an example for future work in other low-resource settings. [ABSTRACT FROM AUTHOR]

Noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes, have emerged as an underappreciated health threat with enormous economic and public health implications for populations in low-resource settings. In order to address these diseases, devices that are to be used in low-resource settings have to conform to requirements that are generally more challenging than those developed for traditional markets. Characteristics and issues that must be considered when working in low- and middle-income countries (LMICs) include challenging environmental conditions, a complex supply chain, sometimes inadequate operator training, and cost. Somewhat counterintuitively, devices for low-resource setting (LRS) markets need to be of at least as high quality and reliability as those for developed countries to be setting-appropriate and achieve impact. Finally, the devices need to be designed and tested for the populations in which they are to be used in order to achieve the performance that is needed. In this review, we focus on technologies for primary and secondary health-care settings and group them according to the continuum of care from prevention to treatment. [ABSTRACT FROM AUTHOR]

Pulse oximetry, a non-invasive method for accurate assessment of blood oxygen saturation (SPO2), is an important monitoring tool in health care facilities. However, it is often not available in many low-resource settings, due to expense, overly sophisticated design, a lack of organised procurement systems and inadequate medical device management and maintenance structures. Furthermore medical devices are often fragile and not designed to withstand the conditions of low-resource settings. In order to design a probe, better suited to the needs of health care facilities in low-resource settings this study aimed to document the site and nature of pulse oximeter probe breakages in a range of different probe designs in a low to middle income country. A retrospective review of job cards relating to the assessment and repair of damaged or faulty pulse oximeter probes was conducted at a medical device repair company based in Cape Town, South Africa, specializing in pulse oximeter probe repairs. 1,840 job cards relating to the assessment and repair of pulse oximeter probes were reviewed. 60.2 % of probes sent for assessment were finger-clip probes. For all probes, excluding the neonatal wrap probes, the most common point of failure was the probe wiring (>50 %). The neonatal wrap most commonly failed at the strap (51.5 %). The total cost for quoting on the broken pulse oximeter probes and for the subsequent repair of devices, excluding replacement components, amounted to an estimated ZAR 738,810 (USD $98,508). Improving the probe wiring would increase the life span of pulse oximeter probes. Increasing the life span of probes will make pulse oximetry more affordable and accessible. This is of high priority in low-resource settings where frequent repair or replacement of probes is unaffordable or impossible. [ABSTRACT FROM AUTHOR]

Pediatricians in Africa requested a tool to improve caregiver dosing of liquid antiretroviral medication. We developed, evaluated and disseminated a clip to control the amount of medication drawn into an oral syringe. In a laboratory, a user tested clips of different lengths, corresponding to different volumes, by drawing water into a syringe with a clip. In Texas and Malawi, 149 adults attempted to measure Pepto-Bismol™ using a syringe with a clip, a syringe without a clip, and a dosing cup, in a randomly assigned order. In the laboratory, the volume of liquid, ranging from 1 to 4.5 mL, drawn into the syringe was always within at least 5 μL of the intended dose. In Texas, 84% of doses were accurate within ±10%, vs. 63% using the syringe alone, and 21% with the dosing cup. In Malawi, 98% of doses were accurate to within ±10%, vs. 90% using the syringe alone, and 27% with the dosing cup. For target accuracy values within ±45% (±21%), a significantly higher fraction of Houston (Kamangira) participants delivered an accurate dose using the syringe with the clip than with the syringe alone ( p < 0.05). The clip enables a greater proportion of users to accurately measure liquid medication. [ABSTRACT FROM AUTHOR]

Purpose: To compare the sensitivity, specificity, positive and negative predictive values and accuracy of visual inspection with acetic acid under magnification (VIAM) and colposcopy for detecting cervical intraepithelial neoplasia (CIN) to determine if VIAM can substitute colposcopy in identifying the biopsy site in screen-positive cases. Methods: A prospective cross-sectional study was carried out on 408 symptomatic multiparous women in the reproductive age group (15-49 years) at a tertiary care teaching hospital. VIAM and colposcopy were used to screen for cervical precancerous lesions. Screen-positive women underwent guided biopsy and endocervical curettage. The site of biopsy was recorded as VIAM guided or colposcopy guided. Histopathology was taken as the gold standard. Results: The mean age was 32.3 ± 6.8 years (range 15-49), whilst the mean parity was 2.9 ± 1.2 (range 1-9). A total of 113 women screened positive. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VIAM and colposcopy were 95, 78, 19, 99 and 79%, and 86, 79, 18, 99 and 79%, respectively for high-grade lesions. Conclusions: VIAM can be a useful alternative to colposcopy when the latter is not available, as it has better sensitivity and equivalent specificity for detecting high-grade CIN. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) is a mode of non-invasive ventilation used to treat a variety of respiratory conditions in the emergency department and intensive care unit. In low-resource settings where ventilators are not available, the ability to improvise a CPAP system from locally available equipment would provide a previously unavailable means of respiratory support for patients in respiratory distress. This manuscript details the design of such a system and its performance in healthy volunteers.Methods: An improvised CPAP system was assembled from standard emergency department equipment and tested in 10 healthy volunteers (6 male, 4 female; ages 29-33). The system utilizes a water seal and high-flow air to create airway pressure; it was set to provide a pressure of 5 cmH2O for the purposes of this pilot study. Subjects used the system in a monitored setting for 30 min. Airway pressure, heart rate, oxygen saturation, and end-tidal CO2 were monitored. Comfort with the device was assessed via questionnaire.Results: The system maintained positive airway pressure for the full trial period in all subjects, with a mean expiratory pressure (EP) of 5.1 cmH2O (SD 0.7) and mean inspiratory pressure (IP) of 3.2 cmH2O (SD 0.8). There was a small decrease in average EP (5.28 vs 4.88 cmH2O, p = 0.03) and a trend toward decreasing IP (3.26 vs 3.07 cmH2O, p = 0.22) during the trial. No significant change in heart rate, O2 saturation, respiratory rate, or end-tidal CO2 was observed. The system was well tolerated, ranked an average of 4.0 on a 1-5 scale for comfort (with 5 = very comfortable).Conclusions: This improvised CPAP system maintained positive airway pressure for 30 min in healthy volunteers. Use did not cause tachycardia, hypoxia, or hypoventilation and was well tolerated. This system may be a useful adjunctive treatment for respiratory distress in low-resource settings. Further research should test this system in settings where other positive pressure modalities are not available. [ABSTRACT FROM AUTHOR]