Knowledge and practice of radiation safety among invasive cardiologists

OBJECTIVE: To assess the availability, practices and knowledge of radiation safety measures among invasive cardiologists in a tertiary care hospital. METHOD: A cross sectional survey of invasive cardiologists working in academic institutions was conducted using a questionnaire. RESULTS: A total of 28 cardiologists completed the questionnaire with a mean working experience of 10.5 + 7.6 years. All were of the opinion that radiation safety is extremely important and 93% always used lead aprons. Less than half of them used other radiation protective measures including thyroid collar, lead eyeglasses and lead shields. Only 7% regularly utilized a radiation dose badge to monitor the exposure. This may be related to the availability, as lead aprons are readily available but other devices i.e. lead glasses, lead shield and radiation dose badge is available to less than a third of them. On evaluating knowledge only one fourth knew more than 60% of the answers to questions testing the basic principles of radiation safety. When working experience of cardiologists was correlated with their knowledge and practice of radiation safety surprisingly a paradoxical relationship was noted. Mean number of correct answers in those with experience of \u3e 10 years vs \u3c 10 years was 45% vs 56%, p \u3c 0.03. All of the above findings are probably because less than 50% have received any formal education in this important field. CONCLUSIONS: There is a lack of standard radiation safety measures and equipments in cardiac catheterization laboratories. Significant lapses exist in practice and lack of knowledge of radiation safety among invasive cardiologists in this part of the world. With rapid growth in the number of cardiac catheterization laboratories in developing countries significant improvement in knowledge, practice and availability of radiation safety measures is needed

Effect of teriparatide on bone regenerate after distraction osteogenesis

Abstract OBJECTIVE: To determine the effect of teriparatide on new bone formation in a rat model of distraction osteogenesis. METHODS: The experimental study was conducted at the Aga Khan University Hospital, Karachi, in November-December 2010, and comprised male Sprague-Dawley rats weighing 250gm each who were allocated to two treatment groups, teriparatide and saline, both given subcutaneously for 7 weeks. Femoral distraction was done for 3 weeks at the rate of 0.4mm/day, followed by a further 4 weeks for consolidation. New bone formation was assessed using X-ray scoring system, bone densitometry and histology. RESULTS: The 12 rats in the study were divided into two groups of 6(50%) each. All rats in the teriparatide group showed new bone formation whereas bone formation was present only in 2(33.3%) rats in the saline group. Bone densitometry showed that area (size) of the new bone formed adjacent to the margins of the osteotomy site as well as the total bone mineral content of the new bone was significantly higher (p\u3c0.05) in the teriparatide group. Histological analysis showed larger but statistically insignificant (p\u3e0.05) area of woven and trabecular new bone in the teriparatide group. CONCLUSIONS: The results suggested a promising role of parathyroid analogue therapy in distraction osteogenesis for promoting bone formation and consolidation. This may have strong clinical implications in cases of limb lengthening and bone transport

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

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

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

PREVALENCE OF MULTI-DRUG RESISTANT BACTERIAL GASTROENTERITIS IN KARACHI, PAKISTAN

Multidrug resistant Escherichia coli (E. coli) associated diarrheal diseases are the most prevalent health problems in Karachi, Pakistan. The main objective of the present study was to evaluate the clinical experiences of individuals suffered from gastroenteritis and also to determine the prevailing sensitivity / resistance pattern of E. coli among the population of Karachi. A cross-sectional retrospective survey was conducted by distributing questionnaires to a total of 150 individuals in December, 2014. The data collected from the questionnaire was statistically analyzed. Majority of the surveyed population was found to be infected by gastroenteritis lately or sometime in their life. On asking the questions about the possible reasons for being infected, it was revealed that the use of untreated water was the major source for the occurrence of the infection. Diagnostic tests were not carried out in most of the cases. Evaluation of questionnaire also indicated that physicians prescribed 2nd line of drug therapy due to the failure of treatment by cephalosporins, quinolones and fosfomycin. The susceptibility pattern of E. coli against selective antimicrobials agents was determined by using disc diffusion method. A total of 50 non-duplicate isolates of bacteria were collected from clinical laboratory of tertiary care hospital. The results were evaluated according to the guidelines of Clinical and Laboratory Standards Institute (CLSI). The findings of sensitivity determination supported the retrospective data indicating that cefexime and ceftriaxone failed to inhibit the growth of 80% of the bacterial sample while ciprofloxacin was also found to be less effective since 65% of the isolates showed resistance to it. A 50% resistance pattern was observed against cefoperazone and sulbactam. The most effective antibiotic against E. coli was found to be colistin (100% sensitive) followed by amikacin (90%), merepenem (90%) and gentamicin (70%). Hence, the in-time monitoring of infection through diagnostic procedures is suggested to avoid treatment failure

PROTOCOL: Effectiveness of public-private partnerships on educational access and quality of primary and secondary schooling in low- and middle-income countries: A systematic review

This protocol serves as a guiding source for a Campbell registered systematic review aiming to assess the effectiveness of Public-Private Partnerships (PPPs) in education in Low- and Middle-Income Countries (LMICs). The primary question for this review is: What is known about the impact of PPPs on improving access (i.e., enrolment, attendance, drop-out, and completion) and quality (i.e., students’ learning outcomes and teachers’ teaching practices) of primary and secondary schooling in LMICs? Using a predefined search query, we will retrieve studies from various databases including Scopus, Campbell Library, EBSCO Education Research Complete, NBER, Dissertation and Theses Global (ProQuest), along with other sources of grey literature. Covidence will be used for screening and extraction. A bias assessment tool will be used for the included studies. A standardised mean difference (SMD) effect size of Hedges’ g will be calculated for the outcome variables using RevMan. This review will provide updated evidence about the impact of PPP in school education across LMICs, which will be instrumental for policy and practice level decisions for education improvement

Detection of Babesia bovis in blood samples and its effect on the hematological and serum biochemical profile in large ruminants from Southern Punjab

Objective: To determine the presence of Babesia bovis (B. bovis) in large ruminants in southern Punjab and its effect on hematological and serum biochemical profile of host animals. Methods: Blood samples were collected from 144 large ruminants, including 105 cattle and 39 buffaloes, from six districts in southern Punjab including Multan, Layyah, Muzaffar Garh, Bhakar, Bahawalnagar and Vehari. Data on the characteristics of animals and herds were collected through questionnaires. Different blood (hemoglobin, glucose) and serum (ALT, AST, LDH, cholesterol) parameters of calves and cattle were measured and compared between parasite positive and negative samples to demonstrate the effect of B. bovis on the blood and serological profile of infected animals. Results: 27 out of 144 animals, from 5 out of 6 sampling districts, produced the 541-bp fragment specific for B. bovis. Age of animals (P=0.02), presence of ticks on animals (P=0.04) and presence of ticks on dogs associated with herds (P=0.5) were among the major risk factors involved in the spread of bovine babesiosis in the study area. ALT concentrations were the only serum biochemical values that significantly varied between parasite positive and negative cattle. Conclusions: This study has reported for the first time the presence of B. bovis in large ruminant and the results can lead to the prevention of babesiosis in the region to increase the livestock output