Late Morbidity Among Survivors of Childhood Cancers; Experience at Tertiary Care Cancer Hospital

Background: Long-term survivors of childhood malignancies are at increased risk of experiencing treatment-related morbidities. Survival into late adulthood in these children provides ample time for the acquisition of long-term sequelae. This study aimed to determine late adverse effects among long-term survivors of childhood cancer from a low-income country perspective. Methods: Data were retrospectively collected from review of charts of patients aged under 18 years at the time of their primary diagnosis between January 1, 1995, to December 31, 2008, and who survived for at least 5 years after completion of their treatment. Analyzed data included demographics, cancer type, treatment modality, types of chemotherapy agents administered and specific late morbidities including frequency of azoospermia, oligospermia, endocrine abnormalities, hearing and pulmonary function impairment, and cardiac dysfunction among the long-term survivors of cancer. Results: The total number of patients was 300 with a mean age of 18 ± 2 years. The male to female ratio was 2.7:1. Median follow up duration was 18 years (range: 5-25 years). Seventy-seven percent of patients were from Punjab, 20% were from Khyber Pakhtunkhwa and 3% were from other provinces. Fifty percent had a diagnosis of Hodgkin Lymphoma, 17% Acute Lymphoblastic Leukemia, 13% Non-Hodgkin Lymphoma, 10% Germ cell tumors and 10% had other tumors. Fifty-seven percent received chemotherapy, 23% chemotherapy and radiotherapy, 15% chemotherapy and surgery, 3% chemotherapy, surgery and radiotherapy and 2% had only surgery. Notable long-term documented sequelae were; azoospermia/oligospermia in 64%, endocrine abnormalities in 25% with hypothyroidism in 13.5% and follicle-stimulating hormone and luteinizing hormone abnormalities in 11.5%, ototoxicity in 6.5%, impaired pulmonary function tests in 4.6%, cardiotoxicity in 2.4% and second malignancies (acute myeloid Leukemia and myelodysplastic syndrome)  in 1%. Conclusion: Childhood cancer survivors are at increased risk of adverse treatment-related sequelae and a long-term follow-up plan should be in place in centers where they receive treatment for their primary disease

Clinical Characteristics and Treatment Outcome of Pediatric Rhabdomyosarcoma; Retrospective Review

Introduction: Rhabdomyosarcoma is the most common soft tissue sarcoma in children. This paper aimed to assess the stage, site, and treatment outcome among rhabdomyosarcoma (RMS) patients. Materials and Methods: A retrospective chart review was completed from January 2011 to December 2017 of patients that presented to the Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, for the management of RMS. Data collection included clinical characteristics, staging, grouping, risk stratification, treatment plan, radiotherapy doses, and treatment outcome. Results: Among 24 subjects, there were a total of 13 (54.2%) males and 11 (45.8%) females. The median age at the time of diagnosis was 2.5 years (range: 0.75 - 17 years). The majority of the subjects (91.7%) were less than 10 years of age. The median follow-up time was 0.6 years. According to the Children's Oncology Group Classification, 4 (16.7%) subjects were classified as low risk, 14 (58.3%) subjects were rated as intermediate risk, and 6 (0.25%) subjects were stratified as high risk. The most common primary tumor site were genitourinary (62.5%) and abdomen/retroperitoneal (20.8%) regions. At the time of analysis, nine (37.5%) subjects had died because of the disease, twelve (50%) were alive with no evidence of disease, and one subject had a recurrence of disease and was alive. One subject had abandoned the therapy, and another was lost to follow-up. Conclusion: Patients with Rhabdomyosarcoma presented at the late stages of the disease, and it most frequently affected genitourinary and abdomen or retroperitoneal areas. Overall, Rhabdomyosarcoma was found to have a poor outcome to therapy

Education, Poverty, and Unemployment: A Way Forward to Promote Sustainable Economic Growth in Pakistan

Research at hand used a generalized method of moments (GMM) to examine the relationship between economic growth, education, poverty, and unemployment in Pakistan. The study has looked at four different ways to analyzed and compared them with the growth path of Pakistan for the period under study 1990-2020 by providing the integrated approach. This research concluded that education hasan impact on unemployment and poverty, and all have an impact on economic growth in the long run. It shows that there isa fundamentalassociation betweenthe gross domestic product (GDP) and poverty (POV) and amongEducation enrollment. The findings of the research confirmed the positive effect of Education, Trade on economic growth, and unemployment have a negative influence on determining economic growth. This study is of particular concentration topolicymakers as it helps to formulate comprehensive economic policies to support economic development

Frequency of colistin and fosfomycin resistance in carbapenem-resistant Enterobacteriaceae from a tertiary care hospital in Karachi

Introduction: Management of infections with carbapenem-resistant Enterobacteriaceae (CRE) is challenging. In recent times, agents such as colistin and fosfomycin have been used in combination with other antibiotics to treat such infections. In this study, we aim to seek frequency of colistin and fosfomycin resistance in CRE from Pakistan. Methods: This study was conducted at clinical laboratories, Aga Khan University Hospital. In total, 251 CRE were included in the study. Colistin minimum inhibitory concentrations (MICs) were performed using broth microdilution (BMD) method and VITEK 2 system, whereas fosfomycin susceptibility was performed using Kirby-Bauer method. MIC50 and MIC90 were calculated for colistin and agreement between VITEK and BMD was also calculated. Results: Out of 251 strains colistin MIC of ≥4 g/mL was seen in 40 (15.9%). Of these strains 20 (50%) were Klebsiella pneumoniae. Colistin MIC50 and MIC90 were found to be 0.5 and 16 g/mL, respectively. BMD and VITEK 2 showed 100% categorical agreement. Essential agreement was 88.5% with kappa score 0.733 indicating strong agreement between VITEK and BMD. 31 out of 251 (12.3%) CREs were resistant to fosfomycin. Conculsion: Study shows frequency of colistin and fosfomycin resistance to be 15.9% and 12.3%, respectively. In countries where rate of CREs is high, emerging resistance against these last resort antibiotics is alarming as it leaves clinicians with almost no options to manage such multidrug resistant and extensively drug resistant infections

Efforts to improve diagnosis of bacteraemia by reducing blood culture contamination in an emergency department: Strategies and outcome

Objective: To assess the strategies and outcome for reducing blood culture contamination in order to improve the diagnosis of bacteraemia.Methods: The interventional study was conducted at a tertiary care hospital in Karachi from January 1, 2013, to December 31, 2016. The blood culture contamination data related to the first year of the study was taken as the baseline pre-intervention data. Strategies were planned as intervention for improvement by consolidating training and education in the form of dedicated lectures, practising on mannequins and developing in-house video, replacing povidone with 2% chlorhexidine preparation spray plus 70% isopropyl alcohol swabs and inducting dedicated phlebotomy team whose only responsibility was blood sample collection and minimising the probability of error.Results: In 2013, there were 8868 samples; 7402 in 2014; 6897 in 2015; and 9756 samples in 2016. The contamination rate in 2013 was 8% which went down to 7.75% in 2014, 4.25% in 2015 and 3.9% in 2016. The decline became statistically significant (p\u3c0.001) after implementing a dedicated phlebotomy team in the emergency department.Conclusions: Apart from teaching and training, the concept of blood culture collection kit with checklist and dedicated blood collection team was found to be vital in reducing blood culture contamination

Discrepancy between PCR based SARS-CoV-2 tests suggests the need to re-evaluate diagnostic assays

Objective: We investigated the discrepancy between clinical and PCR-based diagnosis of COVID-19. We compared results of ten patients with mild to severe COVID-19. Respiratory samples from all cases were tested on the Roche SARS-CoV-2 (Cobas) assay, Filmarray RP2.1 (bioMereiux) and TaqPath™ COVID19 (Thermofisher) PCR assays.Results: Laboratory records of ten patients with mild to severe COVID-19 were examined. Initially, respiratory samples from the patients were tested as negative on the SARS-CoV-2 Roche® assay. Further investigation using the BIOFIRE® Filmarray RP2.1 assay identified SARS-CoV-2 as the pathogen in all ten cases. To investigate possible discrepancies between PCR assays, additional testing was conducted using the TaqPath™ COVID19 PCR. Eight of ten samples were positive for SARS-CoV-2 on the TaqPath assay. Further, Spike gene target failures (SGTF) were identified in three of these eight cases. Discrepancy between the three PCR assays could be due to variation in PCR efficiencies of the amplification reactions or, variation at primer binding sites. Strains with SGTF indicate the presence of new SARS-CoV-2 variant strains. Regular modification of gene targets in diagnostic assays may be necessary to maintain robustness and accuracy of SARS-CoV-2 diagnostic assays to avoid reduced case detection, under-surveillance, and missed opportunities for control

Block-Chain Based Unified Identity Authentication System in Medical Report for Health-Cares

Organisations and individuals can efficiently manage their identity management operations with the help of identity management software. 'Identity Management' (IdM) software assists the administrators of an organisation in clearly defining and modifying a person's role in the organisation and authorising the relevant access to them. An identity management process is designed to identify, authenticate, and authorise individuals to access organisational software resources. Using this programme, administrators are also able to monitor user login and activity on the corporate computer network. Thus, operational security is improved. The healthcare industry has grown at the quickest rate in terms of revenue and data. Security is now more crucial than ever because electronic medical records are so common. The security of each patient's medical records is a top priority in current medical systems. Furthermore, there are efforts to increase safety of this confidential data by encrypting it. Therefore, we advocated for implementation of block chain systems as decentralized approach to protecting patients' health information. It has three parts: data retrieval, encryption, and authentication using block chain technology. While assuring patient protection, the suggested framework might also keep the healthcare system's security and legitimacy

Fungal isolation from wound samples submitted for culture at a tertiary care hospital laboratory

Fungal wound infections are increasing worldwide. The aim of this retrospective study, conducted at the Aga Khan University laboratory, Karachi, Pakistan, was to determine the frequency of fungal isolation in wound specimens. Data of wound samples received for culture from all over the country between September and October 2018 was reviewed. Samples were processed for bacterial cultures and additionally inoculated on Sabouraud’s dextrose medium. Demographic information, medical history and information on the type of wound was collected. A total of 140 cases were included, of which 87 (81%) were culture positive, while 10 (7%) cases yielded fungi. Burn and blast wounds had the highest proportion of fungal isolation, i.e. 2 out of 4 (50%). Candida species were the most common fungi (n=4), followed by Fusarium species (n=3). This study reports an alarming rate of fungal wound infections. As fungal necrotising wound infections have high morbidity and mortality, it is, therefore, important to accurately diagnose and treat such infections in local setting. Keywords: Wounds and Injuries, Fungal Infections, Diabetic Foot, Infections, Skin and Soft Tissue Infections