Surgical Non-governmental Organizations: Global Surgery’s Unknown Nonprofit Sector

Background

Charitable organizations may play a significant role in the delivery of surgical care in low- and middle-income countries (LMICs). However, in order to quantify their collective contribution, to account for the care they provide in national surgical plans, and to maximize coordination between organizations, a comprehensive database of these groups is required. We aimed to create such a database using web-available data.

Methods

We searched for organizations that meet the United Nations Rule of Law definition of non-governmental organizations and provide surgery in LMICs. We termed these surgical non-governmental organizations (s-NGOs). We screened multiple sources including a listing of disaster relief organizations, medical volunteerism databases, charity commissions, and the results of a literature search. We performed a secondary review of each eligible organization’s website to verify inclusion criteria and extracted data.

Results

We found 403 s-NGOs providing surgery in all 139 LMICs, with most (61 %) incorporating surgery into a broader spectrum of health services. Over 80 % of s-NGOs had an office in the USA, the UK, Canada, India, or Australia, and they most commonly provided surgery in India (87 s-NGOs), Haiti (71), Kenya (60), and Ethiopia (55). The most common specialties provided were general surgery (184), obstetrics and gynecology (140), and plastic surgery (116).

Conclusions

This new catalog includes the largest number of s-NGOs to date, but this is likely to be incomplete. This list will be made publicly available to promote collaboration between s-NGOs, national health systems, and global health policymakers.

     

Role of Delta-Notch signaling in cerebral cavernous malformations

Cerebral cavernous malformations (CCM) commonly known as cavernous hemangioma are associated with abnormally enlarged thin-walled blood vessels. As a result, these dilated capillaries are prone to leakage and result in hemorrhages. Clinically, such hemorrhages lead to severe headaches, focal neurological deficits, and epileptic seizures. CCM is caused by loss of function mutations in one of the three well-known CCM genes: Krev interaction trapped 1 (KRIT1), OSM, and programmed cell death 10 (PDCD10). Loss of CCM genes have been shown to be synergistically related to decreased Notch signaling and excessive angiogenesis. Despite recent evidences indicating that Notch signaling plays a pivotal role in regulating angiogenesis, the role of Notch in CCM development and progression is still not clear. Here, we provide an update literature review on the current knowledge of the structure of Notch receptor and its ligands, its relevance to angiogenesis and more precisely to CCM pathogenesis. In addition to reviewing the current literatures, this review will also focus on the cross talk between Delta-Notch and vascular endothelial growth factor (VEGF) signaling in angiogenesis and in CCM pathogenesis. Understanding the role of Notch signaling in CCM development and progression might help provide a better insight for novel anti-angiogenic therapies.     

The Edmonton Obesity Staging System for Pediatrics: A proposed clinical staging system for paediatric obesity

Traditionally, clinical recommendations for assessing and managing paediatric obesity have relied on anthropometric measures, such as body mass index (BMI), BMI percentile and/or BMI z-score, to monitor health risks and determine weight management success. However, anthropometric measures do not always accurately and reliably identify children and youth with obesity-related health risks or comorbidities. The authors propose a new clinical staging system (the Edmonton Obesity Staging System for Pediatrics, EOSS-P), adapted from the adult-oriented EOSS. The EOSS-P is used to stratify patients according to severity of obesity-related comorbidities and barriers to weight management into four graded categories (0 to 3) within four main health domains: metabolic, mechanical, mental health and social milieu (the 4Ms). The EOSS-P is based on common clinical assessments that are widely available and routinely completed by clinicians, and has the potential to provide clinical and prognostic information to help evaluate and inform the management of paediatric obesity.     

Influence of Home Monitoring on the clinical status of heart failure patients: Design and rationale of the IN-TIME study

BACKGROUND: Despite optimal drug and device therapy, frequent hospitalisations due to decompensated heart failure remain an issue. Early detection of decompensation could prevent hospitalisation in patients with congestive heart failure. The recently introduced Home Monitoring functionality of implanted devices is a promising new telecardiology technique which provides information on the status of heart failure. Home Monitoring observation of heart failure patients could lead to early detection of preclinical decompensation, enable early intervention before clinical decompensation, and thus could prevent hospitalisations. OBJECTIVE: The IN-TIME study is designed to assess the impact of Home Monitoring on the early detection of worsening congestive heart failure and the clinical status of heart failure patients. STUDY DESIGN: Approximately 620 patients will be prospectively randomised to patient management guided by Home Monitoring analysis or standard care and followed for 12 months. The endpoints committee will adjudicate events in a blinded fashion. The primary endpoint is a composite of all-cause mortality, unplanned hospitalisation due to worsening heart failure, NYHA class and patient global self assessment (Packer score). The study should complete recruitment during 2009 and report in late 2010.     

Virchow and his triad: a question of attribution

Virchow's triad describes three factors that contribute to the development of venous thrombosis: hypercoagulability, stasis and endothelial injury. Yet, extensive review of the historical literature casts doubt on the existence of a triad described by Virchow in the form it is currently quoted throughout contemporary medical literature. Certainly his work involved extensive study of venous thrombosis and pulmonary embolism, with these two terms being coined by Virchow, but a triad of factors relating to the development of venous thrombosis is elusive. Interestingly, Virchow only began to be routinely credited with this triad one hundred years after publication of his work on venous thrombosis. This acknowledgement coincided with the accumulation of experimental evidence for the role these factors play in thrombogenesis. Controversial as the origins of Virchow's triad might be, it is apt given his substantial contribution to our knowledge of venous thromboembolism, and the fact that the triad continues to be clinically relevant today that a triad pertaining to Virchow should remain.     

Use of anti-craving agents in soldiers with alcohol dependence syndrome

Background: In a search for an effective ‘anti-alcohol pill’, three modern anti-craving agents have been studied in alcoholics of Army/DSC, Air Force, Navy and Coast Guard.     

Vector databank in the Indian armed forces

Background: Medical intelligence of disease vectors deals with understanding vector distribution and control.