The Impact of Trade Liberalization on Health: Evidence from Pakistan

The literature predicts both positive and negative health outcomes in developing economies as a result of increasing trade. Does openness to trade help to improve health indicators in the case of Pakistan? This study attempts to answer this question using data from 1975 to 2016. This study uses life expectancy and infant mortality as health indicators while trade to GDP ratio as trade openness indicator. For robustness analysis, the study uses international trade taxes, exports to GDP ratio and imports to GDP ratio. The empirical results of the study show that 1% increase in trade to GDP ratio significantly decreases life expectancy by 0.05 years and significantly increases infant mortality by 0.47 deaths. Thus, trade causes adverse effects on health indicators in the case of Pakistan

Pediatric leukemia related depression in Pakistan

The purpose of this letter is to describe the problem facing during and after the treatment of pediatric leukemia. Depression and anxiety are the most leading challenges faced by children and its family. Anti-depressant used to cope this problem but they have many side effects. So, timely proper diagnosis, good healthy behavior of health care professionals and nurses and positive psychological therapy may be useful to reduce the stress level, effectiveness of social stigma, anxiety and hopelessness in Pediatric leukemia survivor children. By implementation of positive psychological therapy in government hospitals of Pakistan rate of better progression recovery after chemotherapy in pediatric leukemic patients towards the stress free life could be possible.Pediatric leukemia is preponderant malignancy in children under age 18 in Punjab, Pakistan. It is most eminent cancer among the children in which body produces abnormal immature lymphoblast which do not form a mature lymphocyte for normal functioning of body [1]. Leukemia is an assemblage of disorders that affect the blood making tissues in spleen and in many other parts such as bone marrow and lymphatic system. The leukemia means “white blood” because it is specifically associated with the white blood cell (leukocytes) proliferation. Production of specified blood cells from stem cells are formed according to requirement of body by hematopoiesis process. In leukemia myeloid or lymphoid cells are defected.According to Punjab Cancer Registry report 2018, 3.5% leukemia frequently reported in all age groups in both genders, 3.4% in adult males and 14.9% acute lymphoblastic leukemia in children age group less than 18 years old. This is a most common cancer among children in 2018 [1]. From 2018 to 2022 the rate of leukemia is increased among all groups such as 3.9% in all age groups including both genders and 25% (acute lymphoblastic leukemia) in childrenPediatric type of cancers such as leukemia are mostly treated by parental expenses and many variables related to family, are strongly associated with the health outcome, morbidity and mortality of children. Its diagnosis and therapies may have confrontational psychological executes on child and his family. Anxiety is first significant problem faced by Leukemic patient and its parents at post diagnosis of disease and depression is continuous mental state during treatment [3]. Cancer survivors have deep fear of loneliness, hopelessness, depression, anxiety and social stigma. Family caregivers are the hidden sufferer of this psychological disorder. Their social, economic and emotional life are strongly disturbed and neurotic [4, 5]. The whole process from duration of treatment of children to their survival after illness is challenging task for both parents and children, physically and psychologically which influenced the family structure and function [6].Mostly people in developing countries like Pakistan has no formal care on this issue, this can lead towards depressed life even after successful treatment. Pharmacological treatments such as antidepressant drugs are used to cure for depression. But due to side effects of anti-depressant, patients are not adhering to this type of cure and prefer to choose non pharmacological treatments to reduce the anxiety. Positive thinking is one of the best psychiatric treatments [7]. Positive psychotherapy relief the patients from stress by encouraging more positive emotions and meetings rather direct targeting the symptoms of depression and anxiety [8].Positive psychological conciliation and healthy behavior of health care professionals is the good contrivance for cultivating positive behavior, emotions and cognition for healthy quality of life in leukemia survival. Psycho educational programs are eloquently escalated hope in child and his family and return towards the healthy happy life after depressed process of treatment [9]. Routine mental screening for anxiety and evaluation of parental functioning are significant methods which is helpful to identify the target patient with family who suffered with high level of depression. Psychological assessment surveys and distress thermometer may be important useful tool can be used by health care professional or nurses during checkup for better evaluation [10]. A significant number of leukemia patients in different hospitals of Pakistan experienced with disturbed depressed psychological mental state. Government of Pakistan should take all these approaches with positive psychological conciliation, practically in hospitals in different phases of cancer such as pediatric leukemia treatment, to help the child to cope with depression and escalating stress-free life expectancy.Keywords: Leukemia; Depression   

Improved clinical competence and patients satisfaction: Comparison of patient-centered, interdisciplinary collaborative round versus traditional post-partum round

The origin of the patient-centered interdisciplinary collaborative round, which involves health care members of all levels at a time, is an effective and emerging approach to offer inpatient healthcare. Traditionally, post-partum rounds at teaching hospitals consisted of separate visits from all members of the obstetric team that resulted in patient inconvenience, care insufficiencies, and communication gaps. The main objective of this study was to assess the patient\u27s satisfaction level from the traditional post-partum round versus the patient-centered collaborative care (PCCC) round. This study showed that in the traditional round, the patient\u27s satisfaction with the treatment was 95.1%; whereas, in PCCC rounds it was 96.9%. Patients were more satisfied with the treatment options discussed with them and the results of the medical tests explained to them. In conclusion, the survey showed that the implementation of the PCCC round improved patient satisfaction

Intrauterine growth retardation - small events, big consequences

Intrauterine growth retardation refers to a rate of growth of a fetus that is less than normal for the growth potential of a fetus (for that particular gestational age). As one of the leading causes of perinatal mortality and morbidity, intrauterine growth retardation has immense implications for the short term and long term growth of children. It is an important public health concern in the developing countries. Health statistics encompassing parameters for maternal and child health in the Indian subcontinent have shown improvement in the past few years but they are still far from perfect. Maternal health, education and empowerment bears a strong influence on perinatal outcomes including intrauterine growth retardation and should be the primary focus of any stratagem targeted at reducing the incidence of intrauterine growth retardation. A concerted liaison of various medical and social disciplines is imperative in this regard

Genotypic and computational sequence analysis of ALADIN gene causing Allgrove syndrome

Background: Allgrove syndrome is autosomal recessive disorder, the gene involved in this syndrome is known as ALADIN located close to type 2 keratin gene cluster on chromosome 12q13 whose function is to control the nucleocytoplasmic trafficking and also affects the nuclear pore complexes. Mutation in this gene cause triple A syndrome. The aim of research was to analyze the mutational changes in ALADIN gene, formation of 3D Structure of normal and mutated protein and differentiation of normal and mutated protein.Methods: Genotyping by using tetra arm PCR and Sequence analyses of coding region of ALADIN gene was done in two families having affected children with Allgrove’s syndrome.Results: Point mutation in exon 1 and alteration in 3D structure of protein was observed by using VMD (Visual molecular dynamics) that shows truncation, absence of few amino acid and structural modification of proteins which alters in transportation ability.Conclusion: It is concluded from the study that proper structure and function of NPC (nuclear pore complex) binding protein is necessary in normal body function and if any mutation is present in ALADIN gene it can cause symptoms of rare Allgrove’s syndrome.Keywords: ALADIN gene; 3D protein structure; Triple A syndrom

Age, Comorbidities, and Mortality Correlation in COVID-19 Patients: A Review

Background: The risk of death due to COVID-19 among hospitalized patients is known to be higher in older adults and those with underlying health conditions. Understanding the percentage of patients who are at increased risk of death due COVID-19 and how this varies between age groups will inform the healthcare community how to evaluate the risk of COVID-19, and better design healthcare and economic policies. Methods: We conducted a literature search for studies published between December 2019 until May 16, 2020 in PubMed, Embase, and Cochrane (CENTRAL). Descriptive statistics were performed. Results: We reviewed 14 studies of which 13 were retrospective and one was prospective. Eleven studies were conducted in Wuhan, China. A grand total of 11,938 COVID-19 confirmed patients were reviewed. Among these patients, 7637 (64%) were males. Our review reported hypertension (41%), diabetes (21%), cardiac diseases (14%), COPD (8%), chronic kidney disease (4%) and cerebrovascular disease (10%) as the most common underlying diseases among patients who died during hospitalization due to COVID-19. The total number of patients died in the hospital was 1744 (15%). Among patients who died in the hospital, 1% patients were 30-39 years, 16% patients were 40-59 years and 83% patients were more than 60 years of age. Conclusions: Older patients with underlying diseases appear to be at higher risk of mortality from COVID-19. Comorbidities are significant predictors of mortality in COVID-19 patients. There is an urgent need to know the epidemiology of the novel virus and characterize its potential impact

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

A living WHO guideline on drugs for covid-19

CITATION: Agarwal, A. et al. 2022. A living WHO guideline on drugs for covid-19. British Medical Journal, 370. doi:10.1136/bmj.m3379The original publication is available at https://jcp.bmj.com/This living guideline by Arnav Agarwal and colleagues (BMJ 2020;370:m3379, doi:10.1136/bmj.m3379) was last updated on 22 April 2022, but the infographic contained two dosing errors: the dose of ritonavir with renal failure should have read 100 mg, not 50 mg; and the suggested regimen for remdesivir should have been 3 days, not 5-10 days. The infographic has now been corrected.Publishers versio

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt