Noma: neglected, forgotten and a human rights issue

Noma, an orofacial gangrene and opportunistic infection, affects primarily malnourished children living in extreme poverty. Neglected, forgotten, unknown by most health workers, noma results in death, disfigurement and disability of some of the world's most vulnerable children. Noma is a biological indicator of multiple human rights violations, including the right to food. International support and national attention in countries with noma are lacking. The end of neglect of noma can lead to the elimination of this horrific childhood diseas

Early outcome of facial reconstructive surgery abroad: a comparative study

Every year, many medical missions are undertaken in the developing world but there is almost a universal lack of outcome data on the quality of these missions. The present study compares early clinical outcome and complication rate in two consecutive missions (facial reconstruction) undertaken to Ethiopia in 2007 and 2008. The object was to establish if measures adopted following feedback from the first mission led to improvement of the results. A significant improvement was observed in early clinical outcome and there were less severe complications in the 2008 compared to the 2007 mission. On both occasions, significantly more complications were experienced after complex compared to simple procedures. Despite improved outcome in 2008, 50% of the complex cases had an unfavourable clinical result. The data suggest that early outcome studies are a useful method of critically evaluating the quality of surgical mission. The unsatisfactory outcome of complex procedures underlines the need for feedback on the quality of these missions

Longtransplantatie bij de rat

Op grond van de resultaten van het hierboven beschreven onderzoek en de eraan gewijde beschouwingen zijn de volgende conclasies getrokken: 1. Orthotope linkszijdige longtransplantatie bij de rat is operatietechnisch mogelijk. 2. Longpercusiescintigrafie met radioactief ,,gelabelde" microbolletjes is een betrouwbare methode om bij de rat de functie van een getransplanteerde long te bepalen. 3.Bij de ingeteelde rat verloopt de uitstoting na allogene longtransplantatie,functioneel en histologisch gezien, meer eenvormigdan bij de (bastaard) hond. Als slotsom kan gesteld worden dat orthotope linkszijdige longtransplantatie bij de rat een praktisch bruikbaar en goedgestandaardiseerd diermodel is, geschikt voor immunologisch gericht longtransplanratie-onderzoek, waarvan de noodzaak in de inleidende hoofdstukken is aangegeven ... Zie: Samenvatting en conclusies

Noma: Overview of a Neglected Disease and Human Rights Violation

Noma is an orofacial gangrene affecting malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa. Epidemiological data on noma are scarce, but a current estimate of the global incidence is 30,000-40,000 cases per year, with a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1-10 million disability-adjusted life years. The etiology of noma is multifactorial with malnutrition as an ever present factor, often in combination with concomitant diseases, such as measles, malaria, and human immunodeficiency virus (HIV), and poor oral hygiene. The pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis. Rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms. Prevention lies in food security, measles vaccination, prevention of malaria and HIV, including the early detection and treatment of necrotizing gingivitis and stomatitis. Early treatment with antibiotics may prevent gangrene or reduce its extent. Late treatment consists of surgical rehabilitation, which is often complex. However, access to medical care is very limited for noma patients due to the extremely poor conditions in which they live that are frequently located in remote rural areas. The authors support the United Nations Human Rights Council Resolution 19/7 adopted on March 22, 2012 "The right to food," and advocate for the inclusion of noma on the list of neglected tropical diseases to encourage more medical and institutional attention for this often lethal or very mutilating infectious gangrene

Noma: neglected, forgotten and a human rights issue

Noma, an orofacial gangrene and opportunistic infection, affects primarily malnourished children living in extreme poverty. Neglected, forgotten, unknown by most health workers, noma results in death, disfigurement and disability of some of the world's most vulnerable children. Noma is a biological indicator of multiple human rights violations, including the right to food. International support and national attention in countries with noma are lacking. The end of neglect of noma can lead to the elimination of this horrific childhood disease

Facial reconstruction in the developing world:a complicated matter

Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinical objectives had been achieved in 14/17 who had simple procedures but in only 5/18 who had complex operations (p = 0.004). We conclude that complex procedures are technically possible within an under-privileged health care system but successful outcome depends on paying attention to multiple factors in patients' care and wound management. Early outcome studies may be a useful way to measure the quality of humanitarian surgical missions. (C) 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved

Impact of short-term reconstructive surgical missions: A systematic review

Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates. Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months' follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics. Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems. PROSPERO registration number CRD42018099285