Neurorehabilitation in time of COVID 19: a perspective from Pakistan

A global public health emergency, the coronovirus disease-2019 pandemic has impacted every way of life, including neuro-rehabilitation, worldwide. Issues related to increased service demand in primary care, exhausted or insufficient healthcare facilities were significantly high in low and middle-income countries, like Pakistan, with already a struggling health infrastructure. This required major change in health service delivery and impacted rehabilitation care of vulnerable patients with neurological conditions and impairments. For the current review, relevant key words and their combinations were used for literature search, including ‘COVID 19’, ‘SARS-CoV-2’, ‘Corona Virus’, ‘rehabilitation’, ‘physical rehabilitation’, ‘pandemic’, ‘NCOC’, ‘lockdown’, ‘health services’, ‘physical therapy’, ‘disability’, ‘access’, ‘tele-rehabilitation’, ‘research’, ‘human resource’, ‘healthcare’, etc. The platforms searched were Google search, Google Scholar and PubMed. The idea was to highlight how the pandemic impacted neuro-rehabilitation care in countries like Pakistan throughout the pandemic duration and during the lockdowns. Key Words: COVID 19, Disability, Health services, Neuro rehabilitation, Pakistan

The UN Incheon strategy Implementation and the Pakistani quagmire; ground realities

Abstract “Economic and Social Commission for Asia and the Pacific” (ESCAP) is the regional developmental arm of “United Nations” (UN). There are over 650 million persons with disabilities (PWDs) living in the region. In 2012, the members of the ESCAP, including Pakistan gathered and launched the new decade of PWDs from 2013 to 2022 adopting the Incheon Strategy to “Make the Right Real” for PWDs, which is based on the “Convention on the rights of Persons with Disabilities” (CRPD) and aims to accelerate the disability inclusive development with 10 measurable time-bound goals and targets. The year 2017 marked the mid-point of the decade, and a “Government Members Report on the Implementation of Incheon Strategy” was submitted to UN-ESCAP by the member countries

Correlation of kinesiophobia and upper extremity parameters in post mastectomy patients

Breast cancer, if diagnosed at advanced stages, often leads to surgical intervention, i.e. mastectomy, which later presents complications that add to morbidity. A cross-sectional analytical study was conducted to determine pain, upper limb ROM, grip strength, lymphoedema, and their co-relation with kinesiophobia in post mastectomy patients. A sample of 55 female patients was selected via non-probability purposive sampling. Kinesiophobia was assessed using Tampa Scale of kinesiophobia (TSK-11) and pain via Numeric Pain Rating Scale. Upper extremity ROM was measured using a plastic goniometer, grip strength by Jamar Hydraulic dynamometer, and limb volumes were calculated by summed truncated cone volume via circumferential tape measurements. Wilcoxon signed rank test and Spearman co-relation test was used for analysis. Significant difference between the limb volumes was noted (p=0.02) and a reduction in overall upper extremity ranges was seen (p<0.05). A positive significant co-relation between pain and TSK score (r= 0.300, p=0.026) was observed

36-month clinical outcomes of patients with venous thromboembolism: GARFIELD-VTE

Background: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide.Methods: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries.Findings: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE +/- DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %).Interpretation: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially