Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks.……
Background:Many simple,affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations(urban and rural)and inadequate community participation.A proven ...Background:Many simple,affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations(urban and rural)and inadequate community participation.A proven strategy to address the problem of access to health interventions is the Community Directed Interventions(CDI)approach,which has been used successfully in rural areas.This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan,Nigeria.Methods:A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State.Qualitative methods comprising 12 focus group discussions(FGDs)with community members and 73 key informant interviews(KIIs)with community leaders,programme managers,community-based organisations(CBOs),non-government organisations(NGOs)and other stakeholders at federal,state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services,as well as to explore the potential resources for a CDI strategy.All interviews were audio recorded.Content analysis was used to analyse the data.Results:Malaria,upper respiratory tract infection,diarrhoea and measles were found to be prevalent in children,while hypertension and diabetes topped the list of diseases among adults.Healthcare was financed mainly by out-of-pocket expenses.Cost and location were identified as hindrances to utilisation of health facilities;informal cooperatives(esusu)were available to support those who could not pay for care.Immunisation,nutrition,reproductive health,tuberculosis(TB)and leprosy,environmental health,malaria and HIV/AIDs control programmes were the ongoing interventions.Delivery strategies included house-to-house,home-based treatment,health education and campaigns.Community participation in the planning,implementation and monitoring of development projects was reported as common practice.The resources available for these activities and which constitute potential resources for the CDI process include community volunteers,CBOs and NGOs.Others are landlords;professional,women and youth associations;social clubs,religious organisations and the available health facilities.Conclusion:This study’s findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.展开更多
BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery.Furthermore,acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previous...BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery.Furthermore,acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously.Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach.Traditionally,this necessitates surgical intervention.Recently,however,the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management.CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension,nausea,and melena of two days duration.His imaging illustrated a massively distended stomach.A nasogastric tube did not result in drainage of fluid or decompression of his abdomen.His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended"fluid"-filled gastric remnant.An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant.Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum.The patient underwent emergent angiography with embolization of the gastroduodenal artery.He was discharged with a stable hemoglobin level and resolution of symptoms.Healing superficial gastric ulcers were visualized on a follow-up endoscopy.Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated,and successful eradication was achieved.CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound directed transgastric intervention.展开更多
文摘 Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks.……
基金This study received financial support from the UNDP/World Bank/WHO Special Programme on Training in Tropical Diseases(IER/TDR/CIR).
文摘Background:Many simple,affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations(urban and rural)and inadequate community participation.A proven strategy to address the problem of access to health interventions is the Community Directed Interventions(CDI)approach,which has been used successfully in rural areas.This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan,Nigeria.Methods:A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State.Qualitative methods comprising 12 focus group discussions(FGDs)with community members and 73 key informant interviews(KIIs)with community leaders,programme managers,community-based organisations(CBOs),non-government organisations(NGOs)and other stakeholders at federal,state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services,as well as to explore the potential resources for a CDI strategy.All interviews were audio recorded.Content analysis was used to analyse the data.Results:Malaria,upper respiratory tract infection,diarrhoea and measles were found to be prevalent in children,while hypertension and diabetes topped the list of diseases among adults.Healthcare was financed mainly by out-of-pocket expenses.Cost and location were identified as hindrances to utilisation of health facilities;informal cooperatives(esusu)were available to support those who could not pay for care.Immunisation,nutrition,reproductive health,tuberculosis(TB)and leprosy,environmental health,malaria and HIV/AIDs control programmes were the ongoing interventions.Delivery strategies included house-to-house,home-based treatment,health education and campaigns.Community participation in the planning,implementation and monitoring of development projects was reported as common practice.The resources available for these activities and which constitute potential resources for the CDI process include community volunteers,CBOs and NGOs.Others are landlords;professional,women and youth associations;social clubs,religious organisations and the available health facilities.Conclusion:This study’s findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.
文摘BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery.Furthermore,acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously.Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach.Traditionally,this necessitates surgical intervention.Recently,however,the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management.CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension,nausea,and melena of two days duration.His imaging illustrated a massively distended stomach.A nasogastric tube did not result in drainage of fluid or decompression of his abdomen.His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended"fluid"-filled gastric remnant.An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant.Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum.The patient underwent emergent angiography with embolization of the gastroduodenal artery.He was discharged with a stable hemoglobin level and resolution of symptoms.Healing superficial gastric ulcers were visualized on a follow-up endoscopy.Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated,and successful eradication was achieved.CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound directed transgastric intervention.
