Right-sided weakness in a Rwandan patient with untreated Tetralogy of Fallot.

BACKGROUND: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease encountered in pediatrics with surgical repair being the definitive treatment. Long-term survival after surgical repair has improved; however, reported mortality rates in untreated TOF are significant. Associated complications include neurological sequelae such as brain abscess and stroke. In countries without early intervention for congenital heart disease (including TOF), delayed presentations and complications require recognition by healthcare workers. CASE PRESENTATION: A 22-year-old male with a history of untreated TOF presented to Rwanda's tertiary university hospital, University Teaching Hospital of Kigali, with acute right-sided hemiparesis. Diagnostic imaging identified a left-sided brain lesion consistent with brain abscess and cardiac mass, concerning endocardial vegetation. He was managed with intravenous antibiotics but subsequently died due to complications of septicemia. DISCUSSION: In countries where surgical repair of TOF is not available, early recognition and medical management are key in temporizing the development of devastating sequelae. Describing the prevalence of CHD in Rwanda is urgent, requiring further research by which effective prevention and treatment strategies can be developed.

SARS-CoV-2 PCR and antibody testing for an entire rural community: methods and feasibility of high-throughput testing procedures.

BACKGROUND: Early in the pandemic, inadequate SARS-CoV-2 testing limited understanding of transmission. Chief among barriers to large-scale testing was unknown feasibility, particularly in non-urban areas. Our objective was to report methods of high-volume, comprehensive SARS-CoV-2 testing, offering one model to augment disease surveillance in a rural community. METHODS: A community-university partnership created an operational site used to test most residents of Bolinas, California regardless of symptoms in 4 days (April 20th - April 23rd, 2020). Prior to testing, key preparatory elements included community mobilization, pre-registration, volunteer recruitment, and data management. On day of testing, participants were directed to a testing lane after site entry. An administrator viewed the lane-specific queue and pre-prepared test kits, linked to participants' records. Medical personnel performed sample collection, which included finger prick with blood collection to run laboratory-based antibody testing and respiratory specimen collection for polymerase chain reaction (PCR). RESULTS: Using this 4-lane model, 1,840 participants were tested in 4 days. A median of 57 participants (IQR 47-67) were tested hourly. The fewest participants were tested on day 1 (n = 338 participants), an intentionally lower volume day, increasing to n = 571 participants on day 4. The number of testing teams was also increased to two per lane to allow simultaneous testing of multiple participants on days 2-4. Consistent staffing on all days helped optimize proficiency, and strong community partnership was essential from planning through execution. CONCLUSIONS: High-volume ascertainment of SARS-CoV-2 prevalence by PCR and antibody testing was feasible when conducted in a community-led, drive-through model in a non-urban area.

SARS-CoV-2 PCR and antibody testing for an entire rural community: methods and feasibility of high-throughput testing procedures.

High-volume, community-wide ascertainment of SARS-CoV-2 prevalence by PCR and antibody testing was successfully performed using a community-led, drive-through model with strong operational support, well-trained testing units, and an effective technical platform.

The practice of physical medicine and rehabilitation in sub-Saharan Africa and Antarctica: a white paper or a black mark?

INTRODUCTION: The medical specialty of Physical Medicine and Rehabilitation (PM&R) has had a proven impact on persons with disability and on healthcare systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However in some continents the practice has not been well defined. OBJECTIVE: To explore the practice of PM&R in sub-Saharan Africa and Antarctica. METHODS: Medline searches, membership data searches, fax survey of medical schools, Internet searches and interviews with experts. RESULTS: The continents are dissimilar in terms of climate and government. However both Antarctica and sub-Saharan Africa have no PM&R training programs, no professional organisations, no specialty board requirements and no practicing physicians in the field. Since there are no known disabled children in Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of sub-Saharan Africa including approximately 78 million persons with disability are left unserved. CONCLUSIONS: Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups and policymakers can impact the crisis. However government--specifically national ministries of health--is ultimately responsible for the health and well-being of citizens.

The practice of physical and rehabilitation medicine in sub-Saharan Africa and Antarctica: a white paper or a black mark?

INTRODUCTION: The medical specialty of physical and rehabilitation medicine has had a proven impact on people with disabilities and on healthcare systems. Documents such as the White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, in some regions the practice has not been well defined OBJECTIVE: To explore the practice of physical and rehabilitation medicine in Sub-Saharan Africa and Antarctica. METHODS: Medline searches, membership data searches, fax survey of medical schools, internet searches, and interviews with experts. RESULTS: The continents are dissimilar in terms of climate and government. However, both Antarctica and Sub-Saharan Africa have no physical and rehabilitation medicine training programs, no professional organizations, no specialty board requirements, and no practising physicians in the field. Since there are no known disabled children on Antarctica and adults are air-lifted to world-class healthcare, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of Sub-Saharan Africa, including approximately 78 million people with disabilities, are left unserved. CONCLUSION: Antarctica is doing fine, but Africa is in a crisis. Local medical schools, hospitals doctors, and people with disabilities, along with foreign volunteers, aid groups, and policymakers can have an impact on the crisis. However, governments, specifically national ministries of health, are ultimately responsible for the health and well-being of their citizens.

The practice of physical medicine and rehabilitation in subSaharan Africa and Antarctica: A white paper or a black mark?

OBJECTIVE: The medical specialty of physical medicine and rehabilitation (PM&R) has had a proven impact on persons with disability and on health care systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, on some continents, the practice has not been well defined. DESIGN: To explore the practice of PM&R in subSaharan Africa and Antarctica. METHODS: Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. RESULTS: The continents are dissimilar in terms of climate and government. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Because there are no known disabled children on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of subSaharan Africa, including approximately 78 million persons with disability, are left unserved. CONCLUSIONS: Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government-specifically national ministries of health-is ultimately responsible for the health and wellbeing of citizens.