Challenges and Opportunities for Universal Health Coverage in South Asia: A Scoping Review.

With a significant proportion of the population facing considerable deficits in access to health care and financial protection, progress toward universal health coverage (UHC) continues to be a challenge in South Asia. The objective of this scoping review is to examine the challenges and opportunities for UHC in South Asia. We used the six-stage Arksey and O'Malley methodological framework for investigation and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist to structure and report the review.

Rural-urban inequalities in health care utilization in Bhutan: a decomposition analysis.

Background And Objective: On the trajectory towards universal health coverage in Bhutan, health equity requires policy attention as significant disparities exist between urban and rural health outcomes. This paper examines health services utilization patterns, inequalities and their socio-economic determinants in rural and urban areas and decomposes the factors behind these differences.

Methods: We used the Bhutan Living Standard Survey 2017 to profile health services utilization patterns and equalities.

Catastrophic health care expenditure and impoverishment in Bhutan.

Monitoring financial hardship due to out-of-pocket spending on health care is a critical determinant of progress towards universal health coverage. This study investigates the occurrence, intensity and determinants of catastrophic health expenditure and impoverishment in Bhutan using three rounds of the cross-sectional Bhutan Living Standard Surveys carried out in 2007, 2012 and 2017. We use a composite financial hardship measure defined as households experiencing either catastrophic health expenditure or impoverished/further impoverished due to health spending or both.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends.

An assessment of fiscal space for health in Bhutan.

Several factors are expected to put a strain on health financing in Bhutan. In a predominantly public-financed healthcare, ensuring that the health system gains sufficient fiscal space to ensure the sustainability of its financing is a critical policy concern. This fiscal space assessment bases its analysis on national surveys and statistics, international databases and review of official documents and reports.

Acute myopericarditis in an adolescent mimicking acute myocardial infarction.

Acute myopericarditis is primarily a pericarditic syndrome with variable myocardial involvement, as evidenced by elevated cardiac enzymes. It is a rare entity, exclusively seen in male adolescents and accounts for less than 2% of the cases of inpatient admissions for chest pain/pericarditis in the pediatric age group. The electrocardiographic changes of pericarditis include J point/ST segment elevation, which needs to be differentiated from the benign early repolarization pattern that is common in young adolescents and the subtle anterior ST segment elevation myocardial infarction.

Measuring universal health coverage: a three-dimensional composite approach from Bhutan.

Background: In the early 1960s, the Kingdom of Bhutan began to develop its modern health-care system and by the 1990s had developed an extensive network of health-care facilities. These developments, in tandem with wider social and economic progress encapsulated in the Gross National Happiness concept, have resulted in major gains in child survival and life expectancy in the past 50 years. In order to sustain these gains, the country has identified a constitutional and health-policy mandate for universal access to health.

Chronic disease management in the South-East Asia Region: a need to do more.

Chronic diseases account for a substantial proportion of deaths in the South-East Asia Region, ranging from 34% in Timor-Leste to 79% in Maldives. Fuelled by the epidemiological shift towards noncommunicable diseases, the burden of chronic conditions is steadily increasing. Care structures for chronic diseases in most of these countries focus only on certain conditions and are often oriented towards episodic illnesses.

Acute myocardial infarction induced by concurrent use of adderall and alcohol in an adolescent.

Adderall (amphetamine, dextroamphetamine mixed salts), a widely prescribed stimulant for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, is considered safe with due precautions. Nonmedical use of Adderall is prevalent and rising in high school and college students. Use of prescribed Adderall without intention to overdose as a cause of myocardial infarction is extremely rare, and to our knowledge, only 3 cases have been reported in the pediatric literature.

Libman-Sacks endocarditis as the first manifestation of systemic lupus erythematosus in an adolescent, with a review of the literature.

Libman-Sacks endocarditis is rare in children and adolescents, more so as a first manifestation of systemic lupus erythematosus. Currently, sterile verrucous lesions of Libman-Sacks endocarditis are recognised as a cardiac manifestation of both systemic lupus erythematosus and antiphospholipid syndrome. They are clinically silent in a majority of the cases.

Pyrilamine-induced prolonged QT interval in adolescent with drug overdose.

The widespread availability of antihistamines in many over-the-counter preparations can lead to significant hazard to the public because of their possible link to potential ventricular arrhythmias secondary to prolongation of QT interval. The effect can be further compounded by the use of other commonly used medications such as macrolides, antifungal agents, antipsychotics, and other antihistamine-containing preparations. The effect of antihistamines on QT interval is not a class effect but is unique to certain medications.

Symptomatic myocardial bridges in children: a case report with review of literature.

Myocardial bridge is a rare congenital coronary anomaly in children, usually seen in the setting of hypertrophic cardiomyopathy and in left ventricular hypertrophy. Most myocardial bridges are believed to represent a benign anatomical variant; however, symptomatic myocardial bridge is a distinct subgroup of pathological variant, linked to myocardial ischaemia, ventricular arrhythmia, and sudden cardiac death. We present a case of a symptomatic myocardial bridge in a 5-year-old boy with mild hypertrophic cardiomyopathy who underwent supra-arterial myotomy, automatic defibrillator placement, and long-term Beta-blocker therapy.

Obstructive right ventricular outflow tract hemangioma in an adolescent.

Cardiac tumors are rare in children, but they are being diagnosed with increasing frequency and great accuracy with wide array of imaging modalities. Cardiac rhabdomyoma and myxoma are the most common tumors in children and adults, respectively. Cardiac hemangiomas comprise about 2.

Aborted sudden cardiac death in adolescent.

Sudden cardiac death is rare in children and adolescents but accounts for 19% to 30% of sudden deaths until 21 years of age. Fatal ventricular arrhythmias are usual common pathways in such tragic events, and underlying etiologies include cardiac ion channelopathies in majority of cases. We present a case of aborted sudden cardiac death in field, resuscitated successfully, and a clinical event in the pediatric emergency department that led to the diagnosis of the underlying rare condition.

Spontaneous resolution of marked dilatation of cerebral duro-venous system in newborn presenting with fetal hydrops.

A newborn with antenatal diagnosis of fetal hydrops at 36 wk of gestation, presented with congestive heart failure (CHF) and generalized edema. Computed tomographic angiography showed marked dilatation of cerebral duro-venous system including vein of Galen (VOG), straight sinus, torcula and transverse sinus without evidence of arteriovenous fistulae at the vein of Galen. Dilatation of duro-venous system resolved with concomitant improvement in biventricular function and CHF with decongestive therapy.

Aortic distensibility and dilation in Turner's syndrome.

Background: Aortic dilation and dissection is reported in patients with Turner's syndrome, both with and without cardiovascular risk factors. The bicuspid aortic valve is closely associated with dilated aortic root, although expression of aortic dilation is variable. The determinants for variable expression of aortic dilation in individuals with Turner's syndrome, however, are unknown.

Surgical repair in neonatal life of cardiac haemangiomas diagnosed prenatally.

Although cardiac tumours are rare, such tumours are increasingly being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. Cardiac haemangiomas account for less than one-twentieth of all primary cardiac tumours, with most being diagnosed in the neonatal period. We report 3 instances of successful neonatal resection of cardiac haemangioma subsequent to prenatal diagnosis.

Severe failure to thrive in infant.

Failure to thrive in an infant has multiple etiologies and at times, is only manifestation of underlying serious disease. Bartter syndrome is a rare disease that manifests as failure to thrive. It can be diagnosed by a careful history, physical examination, and abnormal electrolyte pattern.

Atrial flutter in a premature infant with a structurally normal heart.

Isolated postnatal atrial flutter (AF) with a structurally normal heart is rare in the neonatal period. Central lines have their inherent risks and are frequently used in the management of growing premature newborns. Some new antimicrobial agents do have pro-arrhythmic effects, proven in adults but with limited data available for the newborn.

Management of a large organized intraatrial catheter-tip thrombus in a child with acquired immunodeficiency syndrome using escalating tissue plasminogen activator infusions.

Objectives: To describe the dissolution of a large organized intraatrial catheter-tip thrombus using a novel aggressive dose escalation of tissue plasminogen activator infusion.

Design: Case report.

Setting: A six-bed pediatric intensive care unit (ICU) at a university hospital.

Cardiac rhabdomyoma and tuberous sclerosis: prenatal diagnosis and follow-up.

This article reports 4 cases with cardiac rhabdomyomas diagnosed during intrauterine life. Echocardiographic follow-up at 9-30 months showed regression of the tumors in 3 cases (75%). Two cases (50%) developed tuberous sclerosis during that period.