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Background & Objective: Developing a global mindset and cultural competency is an important component of Internationalization in Medical Education (IoME) to prepare graduates ready to serve in interconnected global communities. To understand students' attitude towards IoME, this study explored their perceptions of international students, lecturers, and curriculum. Material & Methods: A cross-sectional study was conducted among medical students of the academic year 2018-2019 from University Kuala Lumpur, Royal College of Medicine Perak, Malaysia, using a self-administered validated questionnaire. All 569 students from years 1 to 5 were invited; out of 529 responses, 505 were eligible for analysis. Results: The vast majority (85.1%) of the respondents agreed that all medical schools should have international students. The combined ratings of "comfortable" and "very comfortable" with international students as classmates, as friends, and with international lecturers were 62.6%, 70.3%, and 66.7%, respectively. The transnational curriculum was selected as most appropriate by 45%. Good perception towards IoME was exhibited by 52.2% and was significantly associated with students' intention to do elective overseas among female (P = 0.002) and year 3 (P = 0.038) subgroups. Their perception was positively linked with their perceived preparedness to study or work overseas among females (P = 0.004). Conclusion: There is a positive association between the respondents' perceptions of IoME and their perceived readiness to study or work abroad more. Therefore, the design and implementation of curriculum should be in line with international standards to deliver both clinical and cultural competency that could be enhanced by race diversification among local students and having international students on campuses. [ABSTRACT FROM AUTHOR]

Background: Communication is an essential aspect of high-quality patient- and family-centered care. A model for pediatric cancer communication developed in the United States defined eight communication functions. The purpose of this study was to explore the relevance of these functions in Pakistan as part of an effort to understand the role of culture in communication. Materials and methods: Semi-structured interviews were conducted with 20 clinicians and 18 caregivers of children with cancer at two major cancer centers. Interviews were conducted in Urdu or English and transcribed and translated as necessary. Two independent coders used a priori codes related to the communication model as well as novel codes derived inductively. Thematic analysis focused on operationalization of the functional communication model. Results: Clinicians and caregivers in Pakistan discussed the importance of all eight communication functions previously identified including: information exchange, decision-making, managing uncertainty, enabling family selfmanagement, responding to emotions, supporting hope, providing validation, and building relationships. The operationalization of these functions was influenced by Pakistani cultural context. For example, information-exchange included the importance of addressing preconceptions and community myths, while managing uncertainty included strong references to religion and faithbased coping. Essential to all eight functions was trust between the family and the medical team. Discussion: These findings support the use of this functional communication model in diverse pediatric oncology settings and emphasize the importance of trust. Culturally sensitive operationalization of these functions could inform the adaptation of tools to measure communication and interventions aimed at supporting the needs of parents of children with cancer. [ABSTRACT FROM AUTHOR]

Background & Objective: Cross-border medical student mobility and doctor migration have become global trends. The aim of this study was to explore Malaysian medical students' attitudes towards studying and working overseas. Materials & Methods: A cross-sectional study was conducted among medical students of the academic year 2018-2019 from University Kuala Lumpur, Royal College of Medicine Perak, using a self-administered validated questionnaire that explored their opinions related to encouraging and deterring factors of studying and working overseas and their preferred destination for migration. All 569 students from years 1 to 5 were invited, and 505 completed responses were analyzed. Results: Financial factors were rated as most relevant for not studying overseas by 81.6% of the respondents, whereas language barriers and racial discrimination were considered less relevant. Doing electives overseas was favored by 68.9%. Regarding the benefits of further study abroad, learning international standards and experiencing diversity are rated as "very important" by 75.4% and 62.7%, respectively. They rated better earning (63.2%) and further learning (30.7%) as the most relevant reasons for doctors working overseas, and family commitment (49.9%), Medical Licensing Examinations (MLE) (38.4%), and loyalty to their home country (34.7%) for not working overseas. Their most preferred foreign destinations for further study and working are the UK, Ireland, and Australia. Conclusion: While appreciating the advantages of further study abroad, MLE was considered one of the deterring factors. As a result, consideration should be given to making changes to existing curricula to align with the expected standards of the destined countries. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is threefold: firstly, to compare Pakistani and French consumers' perceptions of well-being; secondly, to investigate how consumers in both countries relate to food; and thirdly, to assess whether they associate food with well-being. Design/methodology/approach: Thirty participants (15 French and 15 Pakistani) between the ages of 24 and 35 were interviewed, using convenience and snow bowling sampling. Data triangulation was performed by combining three qualitative techniques, word association, photo-elicitation-based interviewing and open-ended questions to explore consumer perceptions of well-being, food and food well-being. Findings: The study's findings suggest that well-being is a broad concept in which food is an ingredient. Food and well-being share common elements, and food well-being can be defined as an individual's psychological, physical, social and societal relationship with food ascribed by affordability and food literacy. Originality/value: Pleasure, sharing and respect emerged as dimensions of food well-being that can be applied to transfigure consumer behaviour and reduce over-consumption, food waste and hunger. The dimensions of well-being and food were explored for both countries to understand their cultural nuances and determine the influence of food on well-being. This comparative analysis will help researchers understand consumers' preferences for food in various aspects from two regions. This study can potentially contribute to scale development in food and well-being, which can help researchers measure the effects of food and well-being in different sectors of the economy, particularly in health care. The most aspiring aspect of the current research is the insights unveiled during interactions with research participants, which will help develop consumer baseline feelings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been a major health concern in Bangladesh until very recently. Although the Bangladesh government has employed various infection control strategies, more targeted Non-Pharmaceutical interventions (NPIs), including school closure, mask-wearing, hand washing, and social distancing have gained special attention. Despite significant long-term adverse effects of school closures, authorities have opted to keep schools closed to curb the spread of COVID-19 infection. However, there is limited knowledge about the impact of reopening schools alongside other NPI measures on the course of the epidemic. In this study, we implemented a mathematical modeling framework developed by the CoMo Consortium to explore the impact of NPIs on the dynamics of the COVID-19 outbreak and deaths for Bangladesh. For robustness, the results of prediction models are then validated through model calibration with incidence and mortality data and using external sources. Hypothetical projections are made under alternative NPIs where we compare the impact of current NPIs with school closures versus enhanced NPIs with school openings. Results suggest that enhanced NPIs with schools opened may have lower COVID-19 related prevalence and deaths. This finding indicates that enhanced NPIs and school openings may mitigate the long-term negative impacts of COVID-19 in low- and middle-income countries. Potential shortcomings and ways to improve the research are also discussed. [ABSTRACT FROM AUTHOR]

The management of medulloblastoma in children has dramatically changed over the past four decades, with the development of chemotherapy protocols aiming at improving survival and reducing long-term toxicities of high-dose craniospinal radiotherapy. While the staging and treatment of medulloblastoma were until recently based on the modified Chang's system, recent advances in the molecular biology of medulloblastoma have revolutionized approaches in the management of this increasingly complex disease. The evolution of systemic therapies is described in this review. [ABSTRACT FROM AUTHOR]

Alpha-mannosidosis is a rare genetic lysosomal storage condition leading to the systemic buildup of oligomannoside. Clinical presentation and associated conditions, as well as the full extent of histopathologic changes associated with this disease process, are not fully understood. We present the case of an 8-year-1-month old patient with persistent anemia and who was initially diagnosed with Celiac disease before ultimately being diagnosed with alpha-mannosidosis. As part of his diagnostic work-up, duodenal and bone marrow biopsies were examined by pathology. Duodenal biopsies showed foamy plasma cells expanding the lamina propria which triggered a workup for a genetic storage disease; features suggestive of Celiac disease which resolved on gluten-free diet were also noted by pathology. Bone marrow analysis via electron microscopy showed cytoplasmic granules and inclusions in multiple immune cell lines. Alpha-mannosidosis can occur with Celiac disease and milder forms may only be suspected from incidental pathology findings. The ultrastructural bone marrow findings from this case, the first to be reported from human, show numerous disease-associated changes in multiple immune cell lines whose contribution to disease-associated immunodeficiency is unclear. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has highlighted the importance of a well-equipped and supported healthcare workforce, and Bangladesh still faces challenges in providing adequate and well-equipped healthcare services. Therefore, the study aims to assess the level of working conditions of the clinical health workers in Bangladesh and their relative importance in delivering quality healthcare services. Methods: The study followed a cross-sectional study design and collected primary data adopting a quantitative method. A total of 319 clinical workforces from four districts and eight sub-districts were randomly selected using a multi-stage sampling technique. A 26-component questionnaire used to assess various components of working conditions. Descriptive statistics, and bivariate analysis were used to analyze the data. Results: The study found that the working conditions of clinical health workers in primary and secondary healthcare facilities in Bangladesh were quite poor (3.40), with almost two-thirds of respondents showing negative views in 23 out of 26 indicators. The results also showed that working conditions were significantly (p ≤ 0.05) higher in primary compared to secondary level facilities. Moreover, men, younger workforce, and workforce with shorter length of service were more likely to report poor working conditions than their counterparts. Lastly, receiving monthly salary in due time was top-ranked (99.15) in terms of importance for delivering quality healthcare, followed by availability of medicines (98.04), and medical and surgical requisites (97.57), and adequate mentoring and support to perform duties (97.50). Conclusion: The study highlights the poor working conditions of clinical health workers in public health facilities in Bangladesh. It recommends that policymakers should prioritize improving working conditions by addressing the factors that are crucial for delivering quality healthcare. Improving working conditions will have a positive impact on the retention and motivation of workers, which will ultimately lead to better health outcomes for the population. [ABSTRACT FROM AUTHOR]

Corporate Social Responsibility (CSR)" has become a focal point of interest in contemporary times. While much research has focused on the impact of "CSR" on consumers, there remains a gap in understanding its effects on Organizational Citizenship Behavior (OCB) amongst public sector employees. This study examines how "Employees' CSR persuasion (ECP)" influences job felicity and Responsive Assurance (RA) on "OCB" in the public sector. By considering the four dimensions of CSR--economic, legal, ethical, and philanthropic--we explore the relationships amongst ECP, job felicity, RA, and OCB. Many countries are implementing public sector reforms to enhance government employees' OCB, which is vital for program success. We categorize "citizenship behavior" into "altruism, conscientiousness, courtesy, civic virtue", and "sportsmanship". Our findings indicate a positive link between ECP and OCB (B=0.199, p<0.01), a negative association with External Job Felicity (EJF) (B=-0.412, p<0.01), and a substantial negative impact of EJF on OCB (B=-0.158, p<0.01). Additionally, RA (B=0.274, p<0.01) and Inbuilt Job Felicity (IJF) (B=0.261, p<0.01) are positively and significantly related to OCB amongst public sector employees in Pakistan. These results highlight the importance of CSR initiatives for public sector employees, as they have the potential to promote positive workplace behaviors. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals' involvement and reporting of adverse drug reactions are essential for the success of a pharmacovigilance program. The aim of this study was to assess healthcare professionals (medical doctors, pharmacists, nurses, dentists, midwives, and paramedics) current knowledge, attitude, practices, and barriers regarding pharmacovigilance and adverse drug reactions reporting in multicentral healthcare settings. Methods: A cross-sectional face-to-face survey was conducted among currently working healthcare professionals in various hospitals in ten districts of Adana province, Türkiye from March to October 2022. A self-administered, pretested questionnaire (Cronbach's alpha = 0.894 for knowledge, attitudes and practices variables) was used for data collection. The questionnaire's final draft included five sections (sociodemographic/general information, knowledge, attitude, practices, and barriers) with 58 questions. The collected data was analyzed in SPSS (version 25) using descriptive statistics, the chi-square test, and logistic regression. Results: Of the total 435 distributed questionnaires, 412 completed the entire questionnaire, yielding a 94% response rate. The majority of healthcare professionals (60.4%; n = 249) had never received pharmacovigilance training. Among healthcare professionals 51.9% (n = 214), 71.1% (n = 293) and 92.5% (n = 381) had poor knowledge, positive attitudes and poor practices, respectively. Only 32.5% of healthcare professionals kept the record of an adverse drug reaction and only 13.1% reported adverse drug reactions. The profession (medical doctors, pharmacists, nurses, dentists, midwives, and paramedics) of healthcare professionals and a lack of training were predictors of poor adverse drug reaction reporting (p < 0.05). A statistically significant difference in healthcare professionals and knowledge, attitude and practices scores was also observed (p < 0.05). The main barriers which were supposed to discourage adverse drug reactions reporting by the healthcare professionals were higher workload (63.8%) followed by thinking that a single adverse drug reaction report makes no impact (63.6%) and lack of a professional atmosphere (51.9%). Conclusion: In the current study, most healthcare professionals had poor knowledge and practice, but they had a positive attitude toward pharmacovigilance and adverse drug reactions reporting. Barriers to under-reporting of adverse drug reactions were also highlighted. Periodic training programs, educational interventions, systematic follow-up of healthcare professionals by local healthcare authorities, interprofessional links between all healthcare professionals, and the implementation of mandatory reporting policies are critical for improving healthcare professionals knowledge, practices, patient safety and pharmacovigilance activities. [ABSTRACT FROM AUTHOR]

The Canadian healthcare system has successfully enabled the average Canadian to live a longer life since the early 1980s. Yet, the prevalence of chronic diseases among Canadians is higher than ever, thereby increasing pressure on the healthcare system to develop a new vision based on the realities of the post-COVID-19 pandemic. The responsibility for Canada's healthcare is allocated amongst multiple actors and/or agencies, as the federal government and provinces/territories have significantly different responsibilities. Our study aims to discuss digital health strategies in Ontario, Canada. We examine best practices across the world and propose a digital health vision for Ontario and elsewhere. The lack of an integrated healthcare system often limits access to digital health tools, thus creating a fragmented digital health environment with organizational silos of health information. As a result, healthcare services may not use the advantages of digital health tools efficiently and effectively. We discuss some of the challenges of creating a digital health vision, such as financial feasibility, privacy, ease of use, and reaching vulnerable populations. [ABSTRACT FROM AUTHOR]

With the increasing growth of online shopping, businesses are intertwining to establish new shopping antecedents. Customer experience has steadily become the most important source of retailers' long-term competitive advantage via difference. To preserve long-term and sustained consumer loyalty, retailers must continually improve the customer experiences. This study presents a framework for online retailing in a digital environment called the Online Customer Experience-Engagement Context model in the presence of value co-creation (VCC). Data was gathered from 189 people who purchased products online. For additional analysis, testing the hypothesis, and model construction, SPSS 26 and Smart-PLS were used. The data was then evaluated further using descriptive statistics, path analysis, measurement, and structural model. The findings show that the online customer experience (measured as shopping environment, shopping procedure, staff service experience, and product experience) substantially influenced customer engagement, which improved customer loyalty. The VCC strengthened the link between online customer experience and customer engagement. It suggests that including consumers in co-creating a delightful online customer experience from time to time may be a valuable strategy for online retailers to increase customer engagement and loyalty. To create an overarching outcome, information integration theory (IIT), multi-attribute utility theory (MAUT), and the attitudebehavior-context theory (ABC) theories are converged to explain the proposed model in the study. [ABSTRACT FROM AUTHOR]

Customer experience is a source of retailers’ long-term competitive advantage. This study has examined the relationship between online customer experience and brand love through the mechanism of relationship quality in the context of online shopping in Pakistan. The moderating effect of value co-creation on the relationship of online customer experience with relationship quality and brand love has also been examined. Data were collected from a purposive sampling of 189 online customers in an online survey. Results showed that online customer experience significantly impacts customer relationship quality, which leads to brand love. The relationship between online customer experience and relationship quality is found more robust at high levels of value co-creation. However, we observed a significant negative moderating effect of value co-creation on the direct relationship between online customer experience and brand love. It suggests that including customers in the value co-creation process and affording them a pleasurable online shopping experience may be an excellent way to enhance customer relationship quality and brand love. Theoretical and practical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Transfer ribonucleic acids (tRNAs) serve not only as amino acid carriers during translation but also as a template for the biogenesis of short fragments that can regulate gene expression. Despite recent progress in the function of tRNA-derived fragments (tRFs), their intracellular localization, protein partners, and role in regulating translation are not well understood. We used synthetic tRFs to investigate their localization and function in Drosophila S2 cells. Under our experimental setting, all synthetic tRFs tested were localized at distinct sites within the cytoplasm in a similar manner in Drosophila S2 cells. Cytoplasmically-localized tRFs were positioned in close proximity to GW182 and XRN1 proteins. Functionally, tRFs, which slightly suppressed proliferation in S2 cells, inhibited translation without any major shift in the polysome profile. These results suggest that 5'-tRFs are cytoplasmically-localized and regulate gene expression through inhibition of translation in Drosophila. [ABSTRACT FROM AUTHOR]

Patients with chronic obstructive pulmonary disorder (COPD) experience increased risk of readmission following hospitalization. A quality improvement project was implemented using a COPD bundle within a transitional care clinic to improve outcomes and reduce readmissions. [ABSTRACT FROM AUTHOR]

Fragile X Mental Retardation protein (FMRP), widely known for its role in hereditary intellectual disability, is an RNA‐binding protein (RBP) that controls translation of select mRNAs. We discovered that endoplasmic reticulum (ER) stress induces phosphorylation of FMRP on a site that is known to enhance translation inhibition of FMRP‐bound mRNAs. We show ER stress‐induced activation of Inositol requiring enzyme‐1 (IRE1), an ER‐resident stress‐sensing kinase/endoribonuclease, leads to FMRP phosphorylation and to suppression of macrophage cholesterol efflux and apoptotic cell clearance (efferocytosis). Conversely, FMRP deficiency and pharmacological inhibition of IRE1 kinase activity enhances cholesterol efflux and efferocytosis, reducing atherosclerosis in mice. Our results provide mechanistic insights into how ER stress‐induced IRE1 kinase activity contributes to macrophage cholesterol homeostasis and suggests IRE1 inhibition as a promising new way to counteract atherosclerosis. Synopsis: Targeting IRE1 function and substrate(s) provides a novel therapeutic approach to atherosclerosis. We found a key role for IRE1‐mediated FMRP phosphorylation that suppresses the expression of cholesterol transporters and efferocytosis receptors in macrophages and promotes atherosclerosis progression. FMRP is a novel IRE1 kinase substrate.Lipid‐induced, IRE1‐mediated FMRP phosphorylation leads to post‐transcriptional suppression of cholesterol transporters and efferocytosis regulators.Ablation of IRE1 kinase activity or suppression of FMRP expression enhances efferocytosis and cholesterol transport in vitro and in vivo.IRE1 kinase inhibition by a small molecule inhibitor or genetic deletion of FMRP in macrophages alleviates atherosclerotic plaque formation. [ABSTRACT FROM AUTHOR]

Historically, qualitative research has complemented quantitative biologic and epidemiologic studies to provide a more complete understanding of pandemics. The COVID-19 pandemic has generated unique and novel challenges for qualitative researchers, who have embraced creative solutions including virtual focus groups and rapid analyses to continue their work. We present our experience conducting a multilingual global qualitative study of healthcare resilience among teams of pediatric oncology professionals during the COVID-19 pandemic. We provide an in-depth description of our methodology and an analysis of factors we believe contributed to our study's success including our use of technology, engagement of a large multilingual team, global partnerships, and framework-based rapid analysis. We hope these techniques may be useful to qualitative researchers conducting studies during the current pandemic, as well as for all pediatric oncology studies including multiple languages or geographically disparate subjects. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection is a debilitating chronic health problem and can be fatal if left untreated. Illness perceptions are self-manifested beliefs that influence the ability of individuals to cope with their disease and perceive it as manageable or threatening condition. Limited evidence is available from low resource settings regarding patient perception about HCV. In this study, we aimed to assess the perception of individuals with HCV, the impact of their sociodemographic and clinical characteristics on their HCV perception, and its link to patient-oriented treatment outcomes.Methods: A cross-sectional survey was undertaken enrolling individuals with HCV who attended Hepatitis C clinics at two hospitals of Khyber Pakhtunkhwa, Pakistan. Illness perception was measured using Brief Illness Perception Questionnaire (BIPQ). Descriptive statistics, Kruskal Wallis tests and Mann Whitney U tests were performed to study patient sociodemographic and clinical characteristics and to analyze the questionnaire results. Multivariable linear regression was used to assess determinants associated with perception scores.Results: Participants represented poor HCV perception and their overall mean BIPQ score was 43.35, SD = 13.15. Participants had a low degree of understanding about their illness (mean coherence score = 2.92, SD = 1.85). Individuals with more than four years, compared to less than one year, of estimated HCV infection were more likely to view that their illness would continue (mean timeline score = 6.27, SD = 2.50 versus 5.36, SD = 2.53; respectively, p < 0.01). Similarly, individuals with hepatic cirrhosis, compared to without, were more likely to attribute symptoms to their disease (mean identity score = 5.48, SD = 2.14 versus 4.89, SD = 2.38; respectively, p = 0.04). Female participants reported higher degrees at which the illness affected them emotionally (i.e., emotional representation) and lower coherence about HCV than males (p = 0.04 and 0.006, respectively). Individuals who did not achieve sustained virological response 24 weeks after treatment with interferon-based therapy, compared to treatment naïve individuals, reported lower trust in being successfully treated with newer anti-HCV agents (i.e., direct acting antivirals) (p = 0.029). However, multivariable linear regression revealed that no sociodemographic or clinical determinants were associated with a higher BIPQ score (i.e., more threatening, or negative perceptions).Conclusion: Individuals with HCV in Pakistan generally report threatening or negative views about HCV infection. Lack of trust in treatment efficacy was also apparent, especially in those who experienced failed anti-HCV treatments in the past. Healthcare professionals should consider these perceptions when treating individuals with HCV to optimize their compliance by aligning their perception with the high effectiveness of current anti-HCV therapies. [ABSTRACT FROM AUTHOR]

Historically, qualitative research has complemented quantitative biologic and epidemiologic studies to provide a more complete understanding of pandemics. The COVID-19 pandemic has generated unique and novel challenges for qualitative researchers, who have embraced creative solutions including virtual focus groups and rapid analyses to continue their work. We present our experience conducting a multilingual global qualitative study of healthcare resilience among teams of pediatric oncology professionals during the COVID-19 pandemic. We provide an in-depth description of our methodology and an analysis of factors we believe contributed to our study's success including our use of technology, engagement of a large multilingual team, global partnerships, and framework-based rapid analysis. We hope these techniques may be useful to qualitative researchers conducting studies during the current pandemic, as well as for all pediatric oncology studies including multiple languages or geographically disparate subjects. [ABSTRACT FROM AUTHOR]

This study surveys 622 Bangladeshi civil servants of all administrative jurisdictions and elicits their preference for health insurance schemes. The latter vary in the amount of sum assured as well as in terms of premium sharing rules with the government. The paper also explores the financial burden that the premium subsidy may impose on the exchequer and the state's fiscal capacity to shoulder it. We discover a very high willingness to join the scheme. Though all three premium-sharing options posit flat rates common for all employment ranks, respondents appear to prefer premiums proportional to their basic salary. [ABSTRACT FROM AUTHOR]

COVID-19 has affected university medical students, resulting in the new norm of learning and practice. Understanding these students' knowledge, attitude and their practice would be essential as they would serve as the future doctor in Malaysia. The study attempted to evaluate medical students' knowledge, attitude and practice (KAP) in the east coast states of Peninsular Malaysia. An online and multi centre cross-sectional study was undertaken among all the three public medical schools in the east coast region of Peninsular Malaysia, between 8th July to 21st July 2020. The questionnaire consisted of sociodemographic data and the three domains which included COVID-19 KAP. Students were invited to participate via social media platform such as WhatsApp and students' email. A total of 1,008 medical students voluntarily participated in the study with female to male ratio of 2.6:1. A total of 356 (35.3%) of the medical students had satisfactory knowledge score, with 75% of them were female. The majority of the students had positive attitude towards COVID-19 and practiced meticulous social distancing during the pandemic. We noted that seniority influenced knowledge score, and this was evident as 264 (26.2%) of the students were in their clinical year. Overall, the knowledge scores regarding COVID-19 among the medical students in East Coast of Peninsular Malaysia was reasonable and there were opportunities to augment these standards. Meticulous plans are needed to enhance knowledge and preparedness of the current crops of medical students to be competent future frontliner for Malaysia. [ABSTRACT FROM AUTHOR]

The overall survival of Acute Promyelocytic Leukemia (APL), reported in recent studies, is approaching to 90% wherein, arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) are used as the mainstay of treatment with either limited or no use of anthracycline and cytarabine. This study is aimed to ascertain the outcome of children with APL using similar approach. A total of 30 patients with APL, registered from January 2015 to December 2018, were reviewed. Diagnosis was established on bone marrow aspirate and confirmed by the presence of PML-RARA translocation. Treatment protocol was based on Australian APML 4 study performed by Australian Leukemia Lymphoma Group (ALLG). Lumbar puncture was not performed as it was not part of the protocol due to the risk of bleeding. The mean age in current cohort was 9 years with 53% males. Seven (23.3%) patients died and three (10%) abandoned treatment during induction. Twenty patients completed the intensive phase of chemotherapy and all (100%) of them attained molecular remission (MR). One patient dropped out after MR whereas, 19 remain on follow up with no evidence of disease, reflecting disease free survival (DFS) of 95%. With a median follow up of 2.5 years (range 2.1–4.8 years) the 5 years Kaplan–Meier estimate of OS was 63% and 73%, with and without abandonment, respectively. Analysis of outcome according to risk groups revealed inferior outcome of high risk (HR) group (38% and 50% with and without abandonment, respectively) in contrast to standard risk (SR) group which showed better outcome (82% and 88% with and without abandonment, respectively). The attainment of 100% molecular remission and absence of relapse supports the effectiveness of this regimen. Moreover, it is found to be less toxic and therefore, can be conveniently managed in day-care settings. [ABSTRACT FROM AUTHOR]

Introduction: Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh. Materials and methods: This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure. Results: About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare. Conclusion: The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas. [ABSTRACT FROM AUTHOR]

Mitochondrial quality control depends upon selective elimination of damaged mitochondria, replacement by mitochondrial biogenesis, redistribution of mitochondrial components across the network by fusion, and segregation of damaged mitochondria by fission prior to mitophagy. In this review, we focus on mitochondrial dynamics (fusion/fission), mitophagy, and other mechanisms supporting mitochondrial quality control including maintenance of mtDNA and the mitochondrial unfolded protein response, particularly in the context of the heart. [ABSTRACT FROM AUTHOR]

The ER‐bound kinase/endoribonuclease (RNase), inositol‐requiring enzyme‐1 (IRE1), regulates the phylogenetically most conserved arm of the unfolded protein response (UPR). However, the complex biology and pathology regulated by mammalian IRE1 cannot be fully explained by IRE1's one known, specific RNA target, X box‐binding protein‐1 (XBP1) or the RNA substrates of IRE1‐dependent RNA degradation (RIDD) activity. Investigating other specific substrates of IRE1 kinase and RNase activities may illuminate how it performs these diverse functions in mammalian cells. We report that macrophage IRE1 plays an unprecedented role in regulating phosphatidylinositide‐derived signaling lipid metabolites and has profound impact on the downstream signaling mediated by the mammalian target of rapamycin (mTOR). This cross‐talk between UPR and mTOR pathways occurs through the unconventional maturation of microRNA (miR) 2137 by IRE1's RNase activity. Furthermore, phosphatidylinositol (3,4,5) phosphate (PI(3,4,5)P3) 5‐phosphatase‐2 (INPPL1) is a direct target of miR‐2137, which controls PI(3,4,5)P3 levels in macrophages. The modulation of cellular PI(3,4,5)P3/PIP2 ratio and anabolic mTOR signaling by the IRE1‐induced miR‐2137 demonstrates how the ER can provide a critical input into cell growth decisions. Synopsis: miR‐2137 is a new RNA substrate of IRE1, the master regulator of the Unfolded Protein Response, and connects IRE1 to phosphatidylinositide‐derived signaling lipid metabolism and growth signaling. Endoplasmic reticulum‐anchored IRE1's endoribonuclease activity leads to maturation of a micro RNA, miR‐2137.IRE1 plays an unprecedented role in regulating the metabolism of phosphatidylinositide‐derived signaling lipids in macrophages.miR‐2137 is induced by high fat diet‐activated IRE1 in lipid‐laden, foamy macrophages that are found in atherosclerotic plaques and is blocked by an IRE1 endoribonuclease‐specific inhibitor, suggesting miR‐2137 could be a mediator of macrophage IRE1's known pro‐atherogenic action. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To observe morphological changes in testicular tissue of adult male BALB/c mice after administration of Cannabis sativa extract and to investigate the protective role of vitamin-C against cannabis-induced histopathological changes. METHODS: Eighteen BALB/c mice (31-40 g) were divided into 3 groups. Group- I was control group, Group-II received oral cannabis extract (14 mg/kg) and Group-III received cannabis extract (14 mg/kg) orally along with vitamin-C (100 mg/kg) for 45 days. At the end of experiment, variations in body weight, testicular weight and histological changes in testicular tissues of mice were observed. RESULTS: Average increase in weight was 7.000±0.77 gm, 4.833±0.87 gm & 5.833±0.79 gm in group-I, group-II and group-III respectively. Weight reduction in right and left testis was 42.30±0.465mg and 42.45±0.424mg in group-I, 38.85±0.523 mg and 39.35±0.520 mg in group-II, and 42.38±0.465 mg and 42.23±0.424 mg in group-III animals respectively (p<0.01). Mean seminiferours epithelium thickness was 4.367±0.302 µm in group-II, 5.683±0.104 µm and 6.417±0.116 µm in Group-I and group-III respectively (p<0.001). Average germ cells count (cells/tubule) in group-II was reduced (256.25±6.58) as compared to group-I (373.50±4.063) and group-III (366.25±3.442). Histological changes observed after the treatment were decreased height of germinal epithelium, basal lamina disruption, seminiferous tubules shrinkage, scanty cytoplasm with shrunken nuclei and germinal epithelium detachment from basal lamina in group-II animals as compared to group-I and group-III. CONCLUSION: The cannabis administration significantly declines the weight, size of testes, germ cells count and the height of seminiferours epithelium in animals. Vitamin-C had a protective role on cannabis induced toxic changes in the testes of the mice. [ABSTRACT FROM AUTHOR]

Background and objective: Surgical site infections (SSIs) are among the common problems associated with paediatric surgeries and significantly contribute to postsurgical morbidity and mortality. This study was conducted to assess antimicrobial prophylaxis practices and compliance rates with international guidelines in common paediatric surgical procedures. Methods: A retrospective cross-sectional study was conducted in paediatric patients aged < 18 years in whom four common surgeries (inguinal hernia, appendectomy, bariatric surgery and pancreaticoduodenectomy) were performed at paediatric wards during August 2015 to August 2016 in two tertiary care teaching hospitals. Compliance with antimicrobial prophylaxis practice guidelines (selection, timing and pattern of antimicrobial usage) was evaluated. Results: The charts of 1152 eligible paediatric patients were reviewed. Among these, 66.5% (n = 766) were male and 33.5% (n = 386) were female, with a mean age of 8.4 years (standard deviation ± 5.6). Inguinal hernia was the most frequent surgical procedure conducted (36.3% of patients), followed by appendectomy (25.4%), bariatric surgery (21.9%) and pancreaticoduodenectomy (16.5%). Complete compliance with guidelines was observed in 11.2% of patients (129 of 1152). The choice of antimicrobial prophylaxis administration was appropriate in 380 cases (33%), with a higher rate of guideline adherence with appendectomy than with inguinal hernia, pancreaticoduodenectomy, and bariatric surgical procedures (55.8% vs 32%, 23.1% and 15.5%; p < 0.0001). The timing was appropriate in 490 patients (42.5%), with a higher rate in appendectomy (51%) than in other paediatric procedures (p < 0.0001). The majority of patients were managed with ceftriaxone (46%) or cefazolin (26.5%). A statistically significant difference was observed regarding antimicrobial prophylaxis prescribing practices in the hospitals (p < 0.0001). Conclusion: Low rates of adherence to guidelines in selected paediatric surgeries were observed. Increased awareness among surgeons and formulation of institutional and national antimicrobial prophylaxis guidelines are required. [ABSTRACT FROM AUTHOR]

Background: appropriate prescribing of antimicrobial prophylaxis (AP) is a main strategy of the antimicrobial stewardship programme. Aim: to investigate the prescribing practices of antimicrobial prophylaxis and adherence to recommended protocols in older patients in the surgical wards at a 600-bed teaching hospital in Islamabad, Pakistan. Method: researchers selected 240 surgical procedures retrospectively for patients aged 65 years and older admitted to four surgical specialties (abdominal, orthopaedic, urological and neurosurgery) during 1 year. The different parameters of antimicrobial prescription were compared with international clinical practice guidelines. Findings: There were more 'clean' surgical wound procedures (n=104; 43.3%) than 'clean contaminated' (n=97; 40.4%) and most of these were elective surgical procedures (n=226; 94%). The indication, selection, route, dose, and timing of antimicrobial were found to have adhered with the standard guidelines in 89.6%, 32.5%, 100%, 100% and 55.3% of cases, respectively (optimal value 100%). A statistically significant difference was observed between antimicrobial practices and surgical procedures (P< 0.001). The commonly prescribed antimicrobials were ceftriaxone followed by cefazolin. Conclusion: about 89% of participants who underwent surgical procedures received antimicrobials. The selection of therapeutic agent, the timing and use of broad-spectrum antimicrobial were the common problems in our setting. [ABSTRACT FROM AUTHOR]

Many social services exist to address the prevalent social issues being faced by their stakeholders, yet the processes which social services employ need to be crystallized. If the process of social services becomes specifiable, it may help social services become a social brand. In this regard, social marketing is inherently considered as a strategic tool which ensures the sustainability of business only not for profit based organizations but also for nonprofit organizations. Marketing scholars thus urge to refine the application of social marketing particularly with reference to the process in order for social problems to be addressed cogently. This study posits that the process which social marketing entails should be contextualized as value co-creation. An empirical research was conducted using grounded theory as a research approach to explore the phenomenon of value co-creation. Grounded theory has been employed with a view to provide theoretical underpinning to the concept of social branding. A social service was considered to be a research unit of analysis. Focus group discussions were conducted followed by comparative contrast analysis. The findings reveal that collective participation, mutual interaction, and reciprocal engagement of the stakeholders of social services are the baseline of social marketing. The thematic analysis of focus group discussion resulted in eight key factors to be considered as constituents of the social marketing process. Thus, these factors are considered as part of value co-creation and instrumental for social services' branding. [ABSTRACT FROM AUTHOR]

Disease trajectory in children can be difficult to determine. This is primarily, despite the life limiting condition, healthcare professionals are unable to pin the exact time when these children's lives will end. We illustrate an unusual case of dicephalic parapagus, an inseparable conjoined twin which was complicated by anomalies, psychosocial and safeguarding issues. Such case posed a challenge even to paediatric palliative care team as the trajectory of the disease, in this case, is rather difficult to predict. Anticipatory symptoms management perhaps is the best way forward, despite having to face many ethical challenges and medical enigma. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Melioidosis is a rare tropical bacterial infection caused by the Gram-negative soil saprophyte, Burkholderia pseudomallei. Melioidosis can mimic a variety of diseases due to its varied presentation, and unless it is treated rapidly, it can be fatal. A rare case of melioidosis, with pericarditis and pericardial effusion, is described, which demonstrates the value of early diagnosis with echocardiography and pericardiocentesis. Case Report: A 38-year-old native (Iban) East Malaysian man presented with shortness of breath and tachycardia. Transthoracic echocardiography (TTE) showed cardiac tamponade. Urgent pericardiocentesis drained a large amount of purulent pericardial fluid that grew Burkholderia pseudomallei. Despite appropriate dose and duration of intravenous treatment with ceftazidime followed by meropenem, the patient developed recurrent pericardial effusion and right heart failure due to constrictive pericarditis. The diagnosis of constrictive pericarditis was confirmed by computed tomography (CT) and surgical exploration. Following pericardiectomy, his symptoms resolved, but patient follow-up was recommended for possible sequelae of constrictive pericarditis. Conclusions: After the onset of melioidosis pericarditis, the authors recommend follow-up and surveillance for possible complication of constrictive pericarditis. [ABSTRACT FROM AUTHOR]

Background: One of the rare presentations of active pulmonary or even extrapulmonary tuberculosis is polyarthropathy which is the involvement of multiple large and small joints in the body; a reactive constellation known as Poncet's disease. This may sometimes be the sole manifestation of the disease before more obvious features develop. The pain experienced during polyarthritis can be crippling thereby limiting the mobility and activities of patients. Polyarthritis as a symptom of active tuberculosis can be easily misinterpreted for more common causes of polyarthritis such as rheumatological diseases that present similarly.Case Presentation: We describe the case of a 25-year-old Asian woman and a 45-year-old Asian man who presented with active tuberculosis where polyarthralgia was the first and only symptom for many months followed by pulmonary and pleural manifestations. Both patients showed dramatic improvement with anti-tuberculous therapy. The total duration of therapy was 6 months.Conclusions: Based on our observations, we propose that tuberculosis be included among the differentials for patients with unusual presentation of joint pains, especially in endemic regions and/or susceptible populations. [ABSTRACT FROM AUTHOR]

Metaflammation, an atypical, metabolically induced, chronic lowgrade inflammation, plays an important role in the development of obesity, diabetes, and atherosclerosis. An important primer for metaflammation is the persistent metabolic overloading of the endoplasmic reticulum (ER), leading to its functional impairment. Activation of the unfolded protein response (UPR), a homeostatic regulatory network that responds to ER stress, is a hallmark of all stages of atherosclerotic plaque formation. The most conserved ER-resident UPR regulator, the kinase/endoribonuclease inositol-requiring enzyme 1 (IRE1), is activated in lipid-laden macrophages that infiltrate the atherosclerotic lesions. Using RNA sequencing in macrophages, we discovered that IRE1 regulates the expression of many proatherogenic genes, including several important cytokines and chemokines. We show that IRE1 inhibitors uncouple lipid-induced ER stress from inflammasome activation in both mouse and human macrophages. In vivo, these IRE1 inhibitors led to a significant decrease in hyperlipidemia-induced IL-1ß and IL-18 production, lowered T-helper type-1 immune responses, and reduced atherosclerotic plaque size without altering the plasma lipid profiles in apolipoprotein E-deficient mice. These results show that pharmacologic modulation of IRE1 counteracts metaflammation and alleviates atherosclerosis. [ABSTRACT FROM AUTHOR]

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The prevalence of pulmonary artery catheter (PAC) entrapment in open-heart surgery is scarce with a prevalence rate of 0.065%. Challenges in managing such cases lie particularly in choosing the modalities (chest roentgenogram, fluoroscopy, and transesophageal echocardiography) to accurately identify the anatomic location and cause of entrapment. In this case, we report a 42-year-old man who underwent mitral valve replacement with PAC entrapment discovered on postoperative day 2 and subsequently underwent retrieval after re-sternotomy. This case also highlights the usefulness of transesophageal echocardiography by the cardiac anesthetist in aiding the surgeons to locate the anatomic location where the catheter was entrapped. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most frequently diagnosed malignant neoplasm in men in the developed countries. Although the progression of prostate cancer and the processes of invasion and metastasis by tumor cells are comparatively well understood, the genes involved in these processes are not fully determined. Therefore, a common area of research interest is the identification of novel molecules that are involved in these processes. In the present study, we have used in silico and experimental approaches to compare the expression of embryonal Fyn-associated substrate (EFS) between normal prostate and prostate cancer. We showed that EFS expression is remarkably downregulated in prostate cancer cells, compared to normal prostate cells. We also found that decreased expression of EFS in prostate cancer cells is due to DNA methylation. In addition, we showed that high EFS expression is important to suppress a malignant behavior of prostate cancer cells. Therefore, we suggest that EFS should be considered as a novel tumor suppressor gene in prostate cancer. [ABSTRACT FROM AUTHOR]

This paper analyses inequity in formal health care use in rural Bangladesh using data from a survey conducted of 4010 households drawn from 120 villages. We find that the use of formal health care is incredibly low (40 per cent); about two-thirds of which is private health care, and only one-fourth utilises public sector facilities. Inequity favours the better off, although the level of inequity is modest. Prevailing inequity resides mainly in the utilisation of private health care while non-communicable diseases contribute significantly. Thus, the main public health concern in rural areas of Bangladesh is the low utilisation of formal health care (especially public health care), not inequity. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]