The Association Between Acute Kidney Injury and Intensive Care Unit Mortality in a Resource-Limited Setting.

Introduction: Acute kidney injury (AKI) affects over 13 million people annually, with 85% of cases occurring in low- and middle-income countries. In sub-Saharan Africa, limited access to renal replacement therapy and constrained intensive care unit (ICU) capacity may contribute to disproportionately high AKI-related mortality. We evaluated the association between AKI and ICU mortality at a tertiary hospital in Malawi.

Improved Mortality in Gastroschisis Patients After Implementation of a Standardized Management Bundle in Central Malawi: A Single-center Follow-up at Four Years.

Background: Gastroschisis is a congenital anomaly with >90% survival in high-income countries. Despite advances in neonatal care, survival remains below 20% in much of sub-Saharan Africa. We evaluate temporal changes in mortality and current predictors of mortality after implementing a standardized care bundle at a tertiary facility in Malawi.

Esophageal Cancer Staging in Malawi: The Feasibility of Chest Radiography and Abdominal Ultrasound for Initial Evaluation.

Background: Esophageal cancer (EC) is the third leading cause of cancer-related morbidity and mortality in Malawi. Given limited imaging capacity and high costs, staging is not routinely performed. One proposed staging algorithm is to first evaluate for metastatic disease using low-cost chest radiography (CXR) and abdominal ultrasound (US) followed by confirmatory computerized tomography (CT) of the chest and abdomen if no metastases identified on initial screening.

Factors Associated With Early Versus Late Mortality Following Pediatric Burn Injury in a Resource-Limited Setting.

Introduction: Although burn injury survival has improved significantly in high-income countries (HICs) over the past 3 decades, low- and middle-income countries (LMICs) continue to experience high mortality rates. Prior studies have attributed burn mortality to factors, such as total body surface area burned, inhalation injury, and under-resuscitation, primarily focusing on late deaths in HICs. This study examines the characteristics of early versus late burn deaths in LMICs.

Sustained outcomes after enhanced recovery pathway implementation in pediatric colorectal surgery.

Introduction: Previous studies have demonstrated improvements in length of stay and opioid utilization after implementing Enhanced Recovery After Surgery Pathways (ERPs) for pediatric colorectal surgery. However, the long-term impact of ERPs on postoperative outcomes following the implementation of specific ERP components has not been examined.

Methods: In this single-institution retrospective and longitudinal cohort review of pediatric patients undergoing colorectal surgery before (Pre-ERP - 4/2014-8/2015) and after an ERP implementation (ERP - 9/2015-1/2024).

Sex Dimorphism in Intensive Care Unit Mortality at a Resource-Limited Setting.

Introduction: There is a paucity of critical care resources in limited-resource settings. Managing patients with potentially recoverable illnesses and injuries is still inconsistent with evidence-based practices in high-income countries. Given the limited healthcare workforce and practically nonexistent critical care workforce, ICU mortality is high.

Identifying the Surgical to Nonsurgical Care Transition for Trauma Patients: Time to Redesign Trauma Workflow.

IntroductionThe burden of traumatic injury in the United States continues to outpace the rate of trauma surgeons entering practice within a larger surgical workforce crisis. Furthermore, a trauma length of stay can be prolonged by many nonsurgical factors, including nonsurgical procedures, medical comorbidities, and socioeconomic barriers to discharge. We hypothesize that using a time-series analysis to predict the likelihood of surgeon-directed procedures can aid trauma centers in redesigning the trauma workflow and more efficiently deploying surgical resources.

Racial disparities in the management of gallstone pancreatitis: deviations from standard of care.

Objective: To evaluate racial disparities in managing gallstone pancreatitis.

Background: Gallstone pancreatitis, responsible for 40 ​% of U.S.

Flash Pulmonary Edema and Respiratory Failure in a Preeclamptic Patient Requiring Intrapartum Extracorporeal Membrane Oxygenation.

Flash pulmonary edema can affect up to 10% of women with preeclampsia. Although there is growing literature describing the use of extracorporeal membrane oxygenation (ECMO) in pregnant patients, there is very little research describing its use in the setting of preeclampsia. In this case report, an encouraging story of a woman with this complication who was successfully managed is described.

The Unmet Critical Care Burden at a Central Hospital in a Resource-Limited Setting: A Point Prevalence Study.

Introduction: The unmet burden of critical illness in low-resource settings is unknown. The Modified Early Warning Score (MEWS) is a validated tool that quantifies patient risk for critical illness and higher level of care. This study evaluates the burden of critical illness outside of the ICU using MEWS and predictors of mortality among adult inpatients at a central hospital in Malawi, where ICU capacity is limited.

The effect of allogeneic blood transfusion on burn mortality in a resource-limited setting.

Introduction: There are nearly 9 million new burn cases worldwide, with a disproportional burn burden in low- and middle-income countries. Patients with significant burn injury frequently require multiple blood transfusions; however, there is a paucity of data regarding the effect of allogeneic blood transfusion following burn injury in a resource-limited setting with a high anemia prevalence at baseline. This study aimed to determine the effect of blood transfusion on burn mortality.

Racial and ethnic disparities in discharge planning among trauma patients in the United States.

Introduction: Trauma patients often require post-discharge services, including home health, nursing care, or inpatient rehabilitation, but disparities may exist.

Methods: We analyzed the US National Trauma Data Bank (2011-2021). Insured patients that survived to discharge were stratified by race and ethnicity (non-Hispanic White; non-Hispanic Black; Hispanic; non-Hispanic Asian), and propensity score matched based on age, sex, insurance type, Charlson Comorbidity Index, and Injury Severity Score (ISS).

Traumatic gallbladder injury and its treatment: Changing management of a rare injury.

Introduction: Traumatic gallbladder injury has historically been associated with high morbidity and mortality. Whether treatment patterns have changed over time as non-operative management has been adopted for abdominal trauma care remains unclear. We sought to evaluate trends in cholecystectomy as a treatment for traumatic gallbladder injury and estimate the association between operative or non-operative management of traumatic gallbladder injury and patient outcomes.

Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation.

Background: Prior studies have compared outcomes and costs between bedside tracheostomy (BT) and operating room tracheostomy (ORT). However, studies have not performed a formal cost-effectiveness analysis of BT versus ORT.

Methods: We present a cost-effectiveness study using Markov microsimulation for BT versus ORT.

Real-world breast cancer treatment patterns and guideline-concordant treatment completion among Malawian women.

Purpose: In Sub-Saharan Africa (SSA), resource-stratified guidelines for breast cancer treatment are increasingly recommended, but treatment receipt and outcomes according to these guidelines are underreported. Here, we describe breast cancer treatment patterns by stage and curative-intent guideline-concordant treatment (GCT) receipt among Malawian women.

Methods: A prospective cohort of breast cancer patients were enrolled from December 2016 to October 2018 at Kamuzu Central Hospital with an assessment of demographics, stage, and treatment received, including neoadjuvant (NAC), adjuvant (AdC) and palliative chemotherapy and breast surgery.

General surgeon workforce density is not associated with treatment-incidence ratios at the county or hospital service area level in North Carolina.

Background: General Surgeon Workforce Density (WFD) is used to approximate surgical access. Treatment-incidence ratios (TIR) provide a novel measure of care access. TIR's association with General Surgeon WFD has not been evaluated.

Predicting In-hospital Mortality of Pediatric Surgical Admissions in Central Malawi.

Background: Kamuzu Central Hospital (KCH), a tertiary care facility, serves as 1 of 2 pediatric surgical centers in Malawi, a resource limited country in southeastern Africa. We sought to understand the impact of clinical and access-related factors on in-hospital mortality at KCH.

Methods: Pediatric surgical admissions (<15 years) to KCH from April 1-December 1, 2023, were retrospectively analyzed.

COVID-19 highlights the need to improve resilience and equity in managing small-scale fisheries.

The COVID-19 pandemic exposed the fragility of global and domestic seafood markets. We examined the main impacts and responses of the small-scale fisheries (SSF) sector, and found that mitigation and preparedness strategies should be prioritised to boost resilience in SSF. We provide five policy options and considerations: (1) improving access to insurance and financial services; (2) strengthening local and regional markets and supporting infrastructure; (3) recognising fisheries as an essential service; (4) integrating disaster risk management into fisheries management systems; and (5) investing in Indigenous and locally-led fisheries management.

Antibiotic Stewardship through Use of a Preferred Antibiotic Regimen is Associated with Decreased Organ Space Surgical Site Infections in Uncomplicated and Complicated Pediatric Appendicitis.

There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022.

The utility of alcohol saliva test strips compared to the breathalyzer in trauma patients in a resource-limited setting.

Introduction: The correlation between alcohol consumption and injury is undeniable. However, past research relying on self-reporting alcohol use likely resulted in underreporting and emphasizing the need to increase alcohol testing, especially in resource-limited settings where the burden of injuries is highest.

Methods: This is a prospective analysis of injured patients presenting to the trauma center at Kamuzu Central Hospital in Lilongwe, Malawi.

The treatment effect of operative intervention for flame versus scald burns in resource-limited settings.

Introduction: In resource-limited environments, it is critical to triage burn patients most likely to benefit from operative intervention. This study sought to identify patients with a more significant treatment effect after operative intervention following burn injury at a tertiary burn center in Lilongwe, Malawi.

Methods: This is a retrospective analysis of burn patients presenting to Kamuzu Central Hospital from 2011 to November 2022.