RESUMO
Malawi is one of the world's poorest countries, but despite this, has a dedicated paediatric oncology service. The service has been hampered by the inability to make a timely cytological diagnosis in the majority of patients. A telemedicine programme was commenced to help overcome this problem, and the results for the first 197 consecutive patients are described. The results are compared with the local reports where available. Most samples were fine needle aspirates (104/197-53%), but others included bone marrow aspirates, peripheral blood films and other fluid collections. A diagnosis was arrived at in 52% of the samples; there were 46 discordant results, 38 were when one or other of the local or distant teams were unable to make a diagnosis, and only 8 where the diagnoses of the 2 teams differed. Diagnoses were made and reports were compiled by the 'distant' team within 24â h and sent to the centre in Malawi. This simple telepathology initiative has had a positive impact on clinical management, and could be used in other less resourced centres twinned with better resourced ones.
Assuntos
Países em Desenvolvimento , Oncologia/métodos , Patologia Clínica/métodos , Pediatria/métodos , Telepatologia , Adolescente , Biópsia por Agulha Fina , Exame de Medula Óssea , Criança , Pré-Escolar , Países em Desenvolvimento/economia , Feminino , Custos de Cuidados de Saúde , Recursos em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Malaui , Masculino , Oncologia/economia , Patologia Clínica/economia , Pediatria/economia , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Telepatologia/economia , Fatores de TempoRESUMO
In a prospective study of pneumococcal carriage in 200 Malawian children under 5 years of age, 47.5% were carriers. The carriage rate was highest in those aged 3-12 months and did not vary with family size, nor was it higher in those who had recently been admitted to hospital. Nasopharyngeal swabs were significantly more efficient than throat swabs in detecting carriers (p < 0.001) but nasopharyngeal swabs alone would have missed seven (8%) carriers. Pneumococcal isolates from 22% of carriers and from eight cases of meningitis and one of empyema showed intermediate resistance to penicillin (MIC 0.1-1.0 mg/l). All were sensitive to the 3rd-generation cephalosporin cefotaxime but one of the penicillin-resistant pneumococci and two of the clinical isolates had increased MICs of cefuroxime (0.5 mg/l).
