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| 1 | Clipping prevents perforation in large, flat polyps显示文摘AIM To determine if prophylactic clipping of post-polypectomy endoscopic mucosal resection(EMR) mucosal defects of large,flat,right sided polyps prevents perforations.METHODS IRB approved review of all colonoscopies,and prospective data collection of grasp and snare EMR performed by 2 endoscopists between January 1,2010 and March 31,2014 in a community ambulatory endoscopy center.The study consisted of two phases.In the first phase,all right-sided,flat polyps greater than or equal to 1.2 cm in size were removed using the grasp and snare technique.Clipping was done at the discretion of the endoscopist.In the second phase,all mucosal defects were closed using resolution clips.Phase 2 of the study was powered to detect a statistically significant difference in perforation rate with 148 EMRs,if less than or equal to 2 perforations occurred.RESULTS In phase 1 of the study,2121 colonoscopies were performed.Seventy-five patients had 95 large polyps removed.There were 4 perforations in 95 polypectomies(4.2%).The perforations occurred in polyps ranging in size from 1.5 cm to 2.5 cm.In phase 2,there were 2464 colonoscopies performed.One hundred and sixteen patients had 151 large polyps removed,and all mucosal defects were clipped.There were no perforations(P=0.0016).There were no post-polypectomy hemorrhages in either phase.An average of 2.15 clips were required to close the mucosal defects.The median time to perform the polypectomy and clipping was 13 min,and the median procedure duration was 40 min.Five percent of all patients undergoing colonoscopy in our community based,ambulatory endoscopy center had flat,right sided polyps greater than or equal to 1.2 cm in size.CONCLUSION Prophylactic clipping of the mucosal resection defect of large,right-sided,flat polyps reduces the incidence of perforation. | Daniel Luba Mona Raphael Dayna Zimmerman Joseph Luba Jon Detka James DiSario | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，3： | 1 |
| 2 | COVID-19 case management strategies: what are the options for Africa?显示文摘The ongoing coronavirus disease 2019(COVID-19)pandemic has put a strain on health systems globally.Although Africa is the least affected region to date,it has the weakest health systems and an exponential rise in cases as has been observed in other regions,is bound to overwhelm its health systems.Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic.The World Health Organization(WHO)recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility;however,where this is not possible due to the health system capacity,patients can be isolated in re-purposed facilities or at home.An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases,given the already limited health infrastructure and health workforce,and the risk of nosocomial transmission.Use of repurposed facilities requires additional resources,including health workers.Home isolation,on the other hand,would be a challenge given the poor housing,overcrowding,inadequate access to water and sanitation,and stigma related to infectious disease that is prevalent in many African societies.Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited.These unique cultural,social,economic and developmental differences on the continent,call for a tailored approach to COVID-19 case management strategies.This article proposes three broad case management strategies based on the transmission scenarios defined by WHO,and the criteria and package of care for each option,for consideration by policy makers and governments in African countries.Moving forward,African countries should generate local evidence to guide the development of realistic home-grown strategies,protocol and equipment for the management of COVID-19 cases on the continent. | Joy Luba Lomole Waya David Ameh Joseph Lou K.Mogga Joseph F.Wamala Olushayo Oluseun Olu | 2021 | Infectious Diseases of Poverty2021，10，2： | 0 |
| 3 | Moving from rhetoric to action: how Africa can use scientific evidence to halt the COVID-19 pandemic显示文摘The ongoing pandemic of the coronavirus disease 2019 has spread rapidly to all countries of the world.Africa is particularly predisposed to an escalation of the pandemic and its negative impact given its weak economy and health systems.In addition,inadequate access to the social determinants of health such as water and sanitation and socio-cultural attributes may constrain the implementation of critical preventive measures such as hand washing and social distancing on the continent.Given these facts,the continent needs to focus on targeted and high impact prevention and control strategies and interventions which could break the chain of transmission quickly.We conclude that the available body of scientific evidence on the coronavirus disease 2019 holds the key to the development of such strategies and interventions.Going forward,we recommend that the African research community should scale up research to provide scientific evidence for a better characterization of the epidemiology,transmission dynamics,prevention and control of the virus on the continent. | Olushayo Oluseun Olu Joy Luba Lomole Waya Sylvester Maleghemi John Rumunu David Ameh Joseph Francis Wamala | 2020 | Infectious Diseases of Poverty2020，9，5： | 0 |
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