Implantable port devices in paediatric oncology patients: A clinical experience from a tertiary care hospital

Objective: To assess the frequency of infection of portacath in children having malignant tumours and undergoing chemotherapy, and to assess the association of the infection with already known risk factors.Methods: The retrospective review was conducted at Aga Khan University Hospital, Karachi, and involved patient data related to the period between January 2005 to December 2010. A questionnaire was designed to collect the required data. A total of 67 children were included having portacath inserted for chemotherapy. Children in which portacath was inserted under local anaesthesia in Radiology department, reinserted or inserted because of a reason other than childhood malignancy were excluded. SPSS 19 was used for statistical analysis.Results: Of the total, 46 (67%) patients were males and a majority of the total (n = 31; 46%) was between 6-10 years of age. Besides, 42 (63%) patients had leukaemia, 7 (11%) had lymphoma and 18 (26%) had various solid tumours. Six (8.95%) ports were removed due to infection. There was significant difference between infection and non-infection groups with respect to absolute neutrophilic count levels (p \u3c 0.001). Positive association was found between low absoulute neutrophilic count level (\u3c or = 500) and the occurrence of port infection.Conclusions: Port infection rate is higher in children with low absoulute neutrophilic count. The issue needs to be addressed and one may have to alter the timings of port insertion. It is recommended to insert port when absolute neutrophilic count is normal. To further evaluate the subject, a multicentre trial must be conducted

Simulation-based training in the paediatric surgery population: A review of current trends and future direction

In recent years, simulation-based training in surgery has emerged as a viable accompaniment to traditional teaching methods. Multiple studies have highlighted the benefits of simulation-based training in both learning and teaching aspects of surgical training, with a particular emphasis on the honing of technical skills. However, multiple issues still exist in widespread implementation of simulation-based training, especially in the developing countries. Furthermore, the existing literature needs to be expanded upon in both quantity and quality domains to ensure a more evidence-based transition to simulation-based training in surgery. The current review article was planned to take a look at the existing literature on the current state of simulation-based training in paediatric surgery, its potential to revolutionise paediatric surgical training, and to propose solutions to the issues that are delaying wider implementation

Willingness to pay for improved drinking water facility in Samsani Khui, Johar Town, Lahore, Pakistan

Quality of drinking water is a universal problem specifically faced by many developing countries. Willingness to pay for improved drinking water facility of the people of a rural settlement, Samsani Khui, Johar Town in Lahore, Pakistan was assessed by questionnaire survey. This article intends to scrutinize the strong relation of these dynamics with willingness to pay by correlating them using chi square and multiple regression. Conferring to results, health status of the people of selected area revealed that 50% adults and 31.9 % children suffered from diarrhea within last 6 months. Education level of 48.6% people is middle school. Income of people lies between 5000-30,000 Rupees per month. People with poor health status held strong association with willingness to pay while low income level and low education level had weak association with willingness to pay. The highest and lowest value calculated are 53.969, -4.83, respectively and the mean ratio of willingness to pay was 1.835. The average willingness to pay calculated was between Rs. 1 to 5. This study depicted that various dynamics including health status, monthly income and education level of the people are the determinants of willingness to pay (WTP) for improved drinking water facility

Global surgery: building healthy surgical systems.

Global Surgery (GS) is a movement that advocates access of every individual to safe and affordable surgery despite geographic location or socioeconomic status. It has recently received increased attention within the global health arena, but many patients are still without access to care because of geographical, social and economic disparities. Due to the multi-disciplinary nature of surgical services, GS requires that a worldwide network of healthy surgical systems be developed and sustained. Healthy surgical systems have many components, and this paper will briefly address 3 of those components: Improved access to care, safety and quality, and multidisciplinary strengthening

Methyl 4-{[(4-methyl­phen­yl)sulfon­yl]amino}­benzoate

In the mol­ecule of the title compound, C15H15NO4S, the dihedral angle between the two rings is 88.05 (7)°. The methyl ester group is nearly coplanar with the adjacent ring [dihedral angle = 2.81 (10)°], whereas it is oriented at 86.90 (9)° with respect to the plane of the ring attached to the –SO2– group. Weak intra­molecular C—H⋯O hydrogen bonding completes S(5) and S(6) ring motifs. The mol­ecules form one-dimensional polymeric C(8) chains along the [010] direction due to N—H⋯O hydrogen bonding and these chains are linked by C—H⋯O hydrogen bonds, forming a three-dimensional network

4-Methyl-N-{4-[(5-methyl-1,2-oxazol-3-yl)sulfamo­yl]phen­yl}benzene­sulfonamide

In the title compound, C17H17N3O5S2, the dihedral angle between the two benzene rings is 81.27 (8)° and the heterocyclic ring is oriented at 9.1 (2) and 76.01 (9)° with respect to these rings. Mol­ecules are connected via N—H⋯N and N—H⋯O hydrogen bonds, generating an R 2 2(8) motif, into chains running along the [001] direction. There is also an intra­molecular C—H⋯O hydrogen bond completing an S(6) ring motif. The polymeric chains are inter­linked through inter­molecular C—H⋯O hydrogen bonds

Experimentation on Optimal Configuration and Size of Thin Cylinders in Natural Convection

In this paper, an experimental study of laminar, steady state natural convection heat transfer from heated thin cylinders in an infinite air medium has been reported. Two electrically heated cylinders having the same slenderness ratio (L/D) i.e. 6.1 but different diameters i.e. 3.8 cm and 5.08 cm were used. 105 experiments were carried out to study the effect of diameter and inclination angle of thin cylinder on natural convection heat transfer. After mandatory corrections of radiation and endcap heat losses, convective heat transfer results were presented in the form of local and average dimensionless numbers. For vertical configuration of thin cylinder, Nusselt number was varied from 52.99 to 95.10 corresponding to 1.28×108≤Ra*L≤1.08×1010. While for horizontal configuration,Nusselt number was varied from 10.74 to 17.78 corresponding to 9.42×104≤Ra*D≤8.17×106. Results were compared with the published data and found satisfactory as the maximum percentage difference was only 3.09%. The essence of research is that the heat transfer coefficient increases with decrease in diameter and increase in inclination angle. Smoke flow visualization was done to capture patterns of fluid flow. Finally, comparison was made to quantify increase in Nusselt number from slender cylinder as compared to the flat plate

Laparoscopic total colectomy in an eight-year-old with familial adenomatous polyposis: A case report

Familial Adenomatous Polyposis accounts for20 years of age. Endoscopy is essential for the diagnosis with definitive treatment involving prophylactic total colectomy. With current surgical advances, this is routinely being performed with the aid of laparoscopy. Due to resource limitations and non-availability of the screening programs in the developing world, such cases remain under diagnosed. Genetic testing is necessary for prognostication of both the index case and their at-risk family members. Thus, we present a rare case of an eight-year-old female, with an early onset progression to colorectal cancer with Familial Adenomatous Polyposis. We performed a prophylactic laparoscopic total procto-colectomy with ileo-anal anastomosis, which to our knowledge is the first ever-performed procedure in Pakistan. We conclude that progression to colorectal carcinoma in familial adenomatous polyposis can present at an earlier age than that reported in the literature. Laparoscopic total colectomy has similar outcomes than open surgical methods with better cosmetic results

Heat pain detection threshold is associated with the area of secondary hyperalgesia following brief thermal sensitization:a study of healthy male volunteers

INTRODUCTION: The area of secondary hyperalgesia following brief thermal sensitization (BTS) of the skin and heat pain detection thresholds (HPDT) may both have predictive abilities in regards to pain sensitivity and clinical pain states. The association between HPDT and secondary hyperalgesia, however, remains unsettled, and the dissimilarities in physiologic properties suggest that they may represent 2 distinctively different pain entities. The aim of this study was to investigate the association between HPDT and BTS-induced secondary hyperalgesia. METHODS: A sample of 121 healthy male participants was included and tested on 2 separate study days with BTS (45°C, 3 minutes), HPDT, and pain during thermal stimulation (45°C, 1 minute). Areas of secondary hyperalgesia were quantified after monofilament pinprick stimulation. The pain catastrophizing scale (PCS) and hospital anxiety and depression scale (HADS) were also applied. RESULTS: A significant association between HPDT and the size of the area of secondary hyperalgesia (p<0.0001) was found. The expected change in area of secondary hyperalgesia due to a 1-degree increase in HPDT was estimated to be −27.38 cm(2), 95% confidence interval (CI) of −37.77 to −16.98 cm(2), with an R(2) of 0.19. Likewise, a significant association between HADS-depression subscore and area of secondary hyperalgesia (p=0.046) was found, with an estimated expected change in secondary hyperalgesia to a 1-point increase in HADS-depression subscore of 11 cm(2), 95% CI (0.19–21.82), and with R(2) of 0.03. We found no significant associations between secondary hyperalgesia area and PCS score or pain during thermal stimulation. CONCLUSION: HPDT and the area of secondary hyperalgesia after BTS are significantly associated; however, with an R(2) of only 19%, HPDT only offers a modest explanation of the inter-participant variation in the size of the secondary hyperalgesia area elicited by BTS