Locally developed external fixators as definitive treatment of open tibia diaphyseal fractures: a clinical prospective study conducted in Ivory Coast.

BACKGROUND: This study sought to evaluate the effectiveness of locally developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast. METHODS: Gustilo I, II, and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with LDEF. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct's integrity. Predictive factors of failure or poor results were assessed. RESULTS: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II, and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome. CONCLUSION: LDEF improved significantly the OTDF management, as it provided better stability and superior fracture healing rates than what is observed with the standard of care in the same environment. PTI remains an essential problem but with, hopefully, limited negative consequences.

Developing a cardiac surgery unit in the Caribbean: A reflection.

BACKGROUND AND AIM: Access to specialized cardiac surgery is a problem in emerging countries. Here, we reflect on the approach we used to establish a cardiac surgery unit in Trinidad and Tobago. METHODS: The program started in 1993 with monthly visits by a team from Bristol Heart Institute. A group of local doctors, nurses, and perfusionists were identified for training, and a senior nurse moved to the island to start a teaching program. The visiting support was gradually reduced, and the local team gained independence in managing the service in 2006. RESULTS: The initial low volume surgery increased to around 380 cases a year with the implementation of comprehensive service in 2006. Most patients required coronary artery bypass graft (CABG). In-hospital mortality declined from 5% in the nascent years to below 2% thereafter. In the last 5 years (2015-2019), 1764 patients underwent surgery (mean age 59.6 ± 10.8 years, 66% male). The majority were East-Indian-Caribbean (79.1%) or Afro-Caribbean (16.7%), half had diabetes, and two-thirds hypertension (EuroScore II 1.8 ± 1.9). The majority (1363 patients) underwent CABG (99.5% off-pump; conversion to on-pump 1.5%). The mean number of grafts was 2.5 ± 0.7 with 98.5% and 23.1% receiving one and two or more arterial grafts, respectively. In-hospital mortality was 1.1%, re-exploration for bleeding 2%, stroke 0.1%, mediastinitis 0.2%. The length of the postoperative hospital stay was 5.8 ± 2 days. CONCLUSION: Frequent outside visits complemented by training in an overseas center, and transfer of knowledge proved to be an effective strategy to develop a cardiac surgery unit in an emerging country with results comparable to accepted international standards.

Impact of government interventions on the stock market during COVID-19: a case study in Indonesia.

This paper aims to examine the short-term impact of government interventions on 11 industrial sectors in the Indonesian Stock Exchange (IDX) during the COVID-19 pandemic. Whereas earlier studies have widely investigated the impact of government interventions on the financial markets during the pandemic, there is lack of research on analysing the financial impacts of various interventions in different industrial sectors, particularly in Indonesia. In this research, five key types of government interventions are selected amid the pandemic from March 2020 to July 2021, including economic stimulus packages, jobs creation law, Jakarta lockdowns, Ramadan travel restrictions, and free vaccination campaign. Based on an event study methodology, the research reveals that the first economic stimulus package was critical in reviving most sectors following the announcement of the first COVID-19 case in Indonesia. Jakarta lockdowns impacted stock returns negatively in most sectors, but the impacts were relatively insignificant in comparison to other countries in the region. The recurrence of lockdowns in Jakarta had a minor detrimental impact, showing that the market had acclimated to the new normal caused by the COVID-19 pandemic. Additionally, Ramadan travel restrictions caused minor negative impacts on the stock market. Furthermore, the second Ramadan travel restrictions generated a significant reaction from the technology sector. Finally, while free vaccination campaign and job creation law did not significantly boost the stock market, both are believed to result in a positive long-term effect on the country's economy if appropriately executed. The findings are critical for investors, private companies, and governments to build on recovery action plans for major industrial sectors, allowing the stock market to bounce back quickly and efficiently. As this study limits its analysis to the short-term impact of individual interventions, future studies can examine long-term and combined effects of interventions which could also help policy makers to form effective portfolios of interventions in the event of a pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s43546-022-00312-4.

Responsible Leadership and the Reflective CEO: Resolving Stakeholder Conflict by Imagining What Could be done.

In light of grand societal challenges, most recently the global Covid-19 pandemic, there is a call for research on responsible leadership. While significant advances have been made in recent years towards a better understanding of the concept, a gap exists in the understanding of responsible leadership in emerging countries, specifically how leaders resolve prevalent moral dilemmas. Following Werhane (1999), we use moral imagination as an analytical approach to analyze a dilemmatic stakeholder conflict (between indigenous communities in rural India and an emerging market multinational enterprise headquartered in the same country) through the lense of different responsible leadership mindsets and in light of different ethical principles and moral background theories. Based on this analysis, we arrive at a tentative moral judgement, concluding that the instrumental approach is morally inferior and recommending the integrative approach as the morally superior choice. In the subsequent discussion-focussed on what "could" (instead of "should") be done, we apply the integrative script and use moral imagination as a pathway for generating morally justifiable solutions. Through this analysis, we provide novel insights on how to apply an integrative responsible leadership approach to a stakeholder conflict situation, using the single case study to expand the responsible leadership discussion to emerging markets.

Pregnant Women With Uncorrected Congenital Heart Disease: Heart Failure and Mortality.

OBJECTIVES: The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD). BACKGROUND: Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD. METHODS: The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed. RESULTS: Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001). CONCLUSIONS: Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.

Association between heavy metal exposure and poor working memory and possible mediation effect of antioxidant defenses during aging.

BACKGROUND: Inverse associations have been observed between memory performance and blood concentrations of cadmium (Cd) and lead (Pb). Low antioxidant cell activity has also been linked to decline in memory due to aging. However, it has not yet been established whether the heavy metal-memory relationship is mediated by differences in antioxidant activity. METHODS: We examined Cd and Pb levels, as well as oxidative stress parameters, in blood samples from 125 older adults (age range 50-82years). The Counting Span Test (CST) was used to evaluate working memory capacity (WMC). The Monte Carlo Method for Assessing Mediation (MCMAM) was used to analyze the mediation role of antioxidant activity in the heavy metals-memory association. RESULTS: High blood Cd (BCd) concentration alone, and in combination with elevated blood Pb (BPb) concentration, was associated with poor WMC (p≤0.001) and low enzymatic antioxidant defenses (p≥0.006). The variance in WMC accounted for by BCd or by BCd combine with BPb was 20.6% and 18.6%, respectively. The MCMAM revealed that the influence of BCd and BPb concentrations on WMC was mediated by low antioxidant capacity (confidence interval - CI: 0.072 to -0.064 for BCd; CI: -0.062 to -0.045 for BPb). CONCLUSION: These findings showed Pb and Cd blood concentration in older adults, even at levels below the current recommended threshold, was negatively associated with WMC and that this relationship may be partly mediated by low antioxidant defenses. Knowledge on the environmental factors that negatively influence brain and cognition during aging can help inform public policy strategies to prevent and control the adverse effects of environmental contaminant exposure during aging.

Successful pregnancy in a CKD patient on a low-protein, supplemented diet: an opportunity to reflect on CKD and pregnancy in Mexico, an emerging country.

Pregnancy is probably the most important challenge in young women with chronic kidney disease (CKD). The challenge is greater in developing countries, in which access to dialysis is uneven, and prenatal care for CKD patients is not uniformly available. This case report summarizes some of the challenges faced by pregnant CKD women in a developing country. A 35-year-old woman, affected by an undiagnosed kidney disease, experienced preeclampsia at 24 years of age, and started dialysis in emergency at age 31 in the context of severe preeclampsia in her second pregnancy. Following slow recovery of kidney function, after 18 months of dialysis she started a moderately restricted, supplemented, low-protein diet, which allowed her to discontinue dialysis. A few months after dialysis discontinuation, she started a new pregnancy in the presence of severely reduced kidney function (serum creatinine 4.6 mg/dl at the last pre-pregnancy control). Interestingly, she discontinued nephrology and nutritional follow-up, mainly because she was worried that she would be discouraged from continuing the pregnancy, but also because she continued to feel well. She self-managed her diet in pregnancy and delivered a healthy baby, with normal intrauterine growth, at term; while the last laboratory data confirmed the presence of severe kidney function impairment, she is still dialysis-free at the time of the present report. Her story, with its happy ending, underlines the importance of dedicated programs for CKD pregnancies in developing countries and confirms the safety of moderately protein-restricted diets in pregnancy.

Fifteen Years' Experience of the Brazilian Osteosarcoma Treatment Group (BOTG): A Contribution from an Emerging Country.

PURPOSE: Little information is available regarding the tumor features, prognostic factors, and treatment results in children and adolescents and young adults (AYAs) with osteosarcoma diagnosed in developing countries. We reviewed the results of three observational cohorts of osteosarcoma patients treated in an emerging country. METHODS: A total of 604 patients below the age of 30 years with high-grade osteosarcoma were prospectively enrolled in the Brazilian Osteosarcoma Treatment Group (BOTG) studies III, IV, and V. Gender, age, time from onset of symptoms to diagnosis, primary tumor site, presence or absence of metastases at diagnosis, tumor size, type of surgery (limb-sparing or amputation), treatment protocol, and histological response were correlated with survival. RESULTS: The estimated 5-year overall survival and event-free survival (EFS) rates for the 553 eligible patients were 49% and 39% respectively; of the 390 non-metastatic patients included in the total, overall- and event-free survival were 59% and 48% respectively. Metastases at diagnosis, primary tumor site, type of surgery, and histological response were significant predictors of overall survival and EFS in univariate and multivariate analysis, whereas tumor size and treatment protocol lost prognostic significance in multivariate analysis. CONCLUSION: We report on the outcome of three consecutive studies for the treatment of osteosarcoma carried out in Brazil over 15 years. Although the survival rates presented are below those reported in current literature, it represents the result of a favorable experience gathered from the national collaborative work.