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Introduction: This investigation assessed the clinical characteristics of patients who received care through telemedicine and the clinical impact telemedicine service had on breast cancer patients in a low-income country. Materials and Methods: This natural experimental study assessed the impact of telemedicine service on cancer outcomes among breast cancer patients at Shaukat Khanum Memorial Trust (SKMT), Pakistan, between January 1st, 2018, to December 31st, 2022. The study group (hybrid group) consisted of patients that had both face-to-face and telemedicine appointments, and the control group (physical group) included patients with only face-to-face encounters. Results: A total of 3,205 patients were included in the analysis. Among those included in the analysis, 3,188 (99.5 %) were females, and the mean age of the cohort was 48.10 ± 11.94 years. Statistically significant differences were observed between the two groups in age, demographic distribution, disease stage, average number of emergency room visits, mean length of stay in the Intensive care unit, and the final patient status (alive at the end of observation period). However, the binary logistic regression model (forward-LR) suggested that the final patient outcome was related to disease relapse, COVID-19 infection, and age. Conclusion: Telemedicine clinics, when conducted in parallel with physical clinics (hybrid setup), are safe and have a clinical impact similar to having just physical encounters among breast cancer patients in a low-income country.

Background: Triple negative Breast tumor (TNBC) is an aggressive tumor with sparse data worldwide. Methods: We analyzed non-metastatic TNBC from 2013 to 2019 for demographics, practice patterns, and survival by the Kaplan Meir method. Prognostic factors for OS and DFS were evaluated using Cox Proportional Hazard model estimator for univariate and multivariable analysis after checking for collinearity among the variables. Results: There were 1297 patients with median age of 38 years; 41 (33.3%) among 123 tested were BRCA-positives. Among these 593 (45.7%) had stage III disease, 1279 (98.6%) were grade III, 165 (13.0%) had peri-nodal extension (PNE), 212 (16.0%) lympho-vascular invasion (LVI), and 21 (1.6%) were metaplastic; 1256 (96.8%) received chemotherapy including 820 (63.2%) neoadjuvant with 306 (40.0%) pCR. Grade ≥3 toxicities occurred in 155 (12.4%) including two deaths and 3 s-primaries. 1234 (95.2%) underwent surgery [722 (55.7%) breast conservations] and 1034 (79.7%) received radiotherapy.At a median follow-up of 54 months, median disease-free (DFS) was 92.2 months and overall survival (OS) was not reached. 5-year estimated DFS and OS was 65.9% and 80.3%. There were 259 (20.0%) failures; predominantly distant (204, 15.7%) - lung (51%), liver (31.8%).In multivariate analysis presence of LVI (HR-2.00, p-0.003), PNE (HR-2.09 p-0.003), older age (HR-1.03, p-0.002) and stage III disease (HR-4.89, p-0.027), were associated with poor OS. Conclusion: Relatively large contemporary data of non-metastatic TNBC confirms aggressive biology and predominant advanced stage presentation which adversely affects outcomes. The data strongly indicate the unmet need for early detection to optimize care.

Triple negative Breast tumor (TNBC) is an aggressive tumor with sparse data worldwide. We analyzed non-metastatic TNBC from 2013 to 2019 for demographics, practice patterns, and survival by the Kaplan Meir method. Prognostic factors for OS and DFS were evaluated using Cox Proportional Hazard model estimator for univariate and multivariable analysis after checking for collinearity among the variables. There were 1297 patients with median age of 38 years; 41 (33.3%) among 123 tested were BRCA-positives. Among these 593 (45.7%) had stage III disease, 1279 (98.6%) were grade III, 165 (13.0%) had peri-nodal extension (PNE), 212 (16.0%) lympho-vascular invasion (LVI), and 21 (1.6%) were metaplastic; 1256 (96.8%) received chemotherapy including 820 (63.2%) neoadjuvant with 306 (40.0%) pCR. Grade ≥3 toxicities occurred in 155 (12.4%) including two deaths and 3 s-primaries. 1234 (95.2%) underwent surgery [722 (55.7%) breast conservations] and 1034 (79.7%) received radiotherapy. At a median follow-up of 54 months, median disease-free (DFS) was 92.2 months and overall survival (OS) was not reached. 5-year estimated DFS and OS was 65.9% and 80.3%. There were 259 (20.0%) failures; predominantly distant (204, 15.7%) - lung (51%), liver (31.8%). In multivariate analysis presence of LVI (HR-2.00, p-0.003), PNE (HR-2.09 p-0.003), older age (HR-1.03, p-0.002) and stage III disease (HR-4.89, p-0.027), were associated with poor OS. Relatively large contemporary data of non-metastatic TNBC confirms aggressive biology and predominant advanced stage presentation which adversely affects outcomes. The data strongly indicate the unmet need for early detection to optimize care. • TNBC affects young women and majority are locally advanced at presentation. • Multimodal management achieves favorable survival with limited resources. • Most relapses are at distant visceral sites, outcomes dismal after relapse. • Challenges in implementing resource intensive interventions. [ABSTRACT FROM AUTHOR]

BackgroundBurn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment.MethodsWe performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021.ResultsThere were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0–18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1–5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as “limited” for 23% of pediatric patients.ConclusionsChildren represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.

INTRODUCTION The purpose of antenatal care is to ensure that a woman has a safe pregnancy and that does not mean absence of any disease during this period. Antenatal care allows screening of preeclampsia, fetal abnormalities and other prevention strategies to be incorporated. The purpose of this study was to assess the reason for attending antenatal care clinics and knowledge of antenatal care content package in women. METHODS A cross-sectional study was conducted on 395 pregnant women attending antenatal care clinic at the Ruth K. M. Pfau Civil hospital, Karachi, Pakistan from 1 July 2019 to 31 December 2019. Each eligible woman was asked about the reason for attendance and her knowledge about WHO standardized antenatal care package. RESULTS The commonest reason for utilizing antenatal care in booked attendees was place of birth concern (25.9%) and in not booked was referral from private centers (33.6%) which was statistically significant (p=0.006). Both booked and not booked women (67.9% vs 59.1%, p=0.409) stated avoidance of complication during pregnancy and labor as the commonest reason for attendance. Women with higher parity were more likely to identify weight measurement (p=0.001), iron and folic acid supplementation (p=0.001), and urine detailed report (p=0.002), as content of the standard package. CONCLUSIONS Our study shows that women did not utilize antenatal care clinics for improving their health or the health of their fetus. The knowledge of the antenatal care package was limited to weight measurement and supplements. Moreover, attendance and visits at an antenatal care facility do not equate to good service provision. [ABSTRACT FROM AUTHOR]

Abstract Background Out-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery. Methods We performed a systematic review of the peer reviewed literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low and low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Data were collected using an electronic form and results were aggregated to produce a descriptive summary. Results A total 1927 titles were identified, 31 of which met inclusion criteria. Barriers to OHEC were divided into six categories that included: culture/community, infrastructure, communication/coordination, transport, equipment and personnel. Lack of transportation was a common problem, with 55% (17/31) of articles reporting this as a hindrance to OHEC. Ambulances were the most commonly mentioned (71%, 22/31) mode of transporting patients. However, many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Sixty-one percent (19/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Forty percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation. Conclusions Policy makers and researchers seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse geographic areas.

Background: Studies suggest that immigrants have higher rates of anxiety-depression than compatriots in low-middle income countries and lower rates than populations in host high income countries. Elucidating the factors that underlie these stepwise variations in prevalence may throw new light on the pathogenesis of anxiety-depressive disorders globally. This study aimed to examine whether quantitative differences in exposure to, or the interaction between, risk factors account for these anxiety-depression prevalence differences amongst immigrant relative to source and host country populations. Methods: Multistage population mental health surveys were conducted in three groups: 1) a Vietnamese-immigrant sample settled in Australia (n = 1161); 2) a Vietnamese source country sample residing in the Mekong Delta region (n = 3039); 3) an Australian-born host country sample (n = 7964). Multivariable logistic regression analyses compared risk factors between the Vietnamese-immigrant group and: 1) the Mekong Delta Vietnamese; and 2) the Australian-born group. Twelve month anxiety-depression diagnoses derived from the Composite International Diagnostic Interview (CIDI), supplemented by an indigenously derived measure - the Phan Vietnamese Psychiatric Scale (PVPS) in both Vietnamese groups, were the main outcome measures. Results: The 12-month prevalence of anxiety-depression showed a stepwise increase across groups: Mekong Delta Vietnamese 4.8%; Vietnamese-immigrants 7.0%; Australian-born 10.2%. The two Vietnamese populations showed a similar risk profile with older age, exposure to potentially traumatic events (PTEs), multiple physical illnesses and substance use disorder (SUD) being associated with anxiety-depression, with the older Vietnamese-immigrants reporting greater exposure to these factors. The interaction between key risk factors differed fundamentally when comparing Vietnamese-immigrant and Australian-born samples. Age emerged as the major discriminator, with young Vietnamese-immigrants exhibiting particularly low rates of anxiety-depression. Conclusions: The findings reported here suggest that core risk factors for anxiety-depression may be universal, but their patterning and interaction may differ fundamentally between country groups. That variation in prevalence of anxiety-depression was underscored by specific risk factor interactions according to country-of-origin could have significant implications for understanding the etiology of these disorders at a global level. The study highlights the importance of including both standard international and culturally-specific measures to index cross-cultural manifestations of common mental disorders. [ABSTRACT FROM AUTHOR]

Aim: Examine the state of the science for pain management in children living in low‐middle income countries (LMIC). Background: Significant challenges exist in pain management for children living in LMIC. Methods: An integrative review was conducted using PRISMA guidelines for quality of reporting. Literature searches were completed using Medline, PubMed, Scopus, and CINAHL databases for publications between January 2006 and August 2016 using MeSH and primary search terms pain and LMIC. Full text publications were evaluated using GRADE criterion and methodology specific evaluation tools. Results: Of 1510 publications identified, 31 met the criteria for inclusion. Data were categorized into three broad themes: (1) magnitude of the pain problem with subthemes describing the burden of and resources for paediatric pain management; (2) perceptions, experience, and practices for managing pain in children residing in LMIC with subthemes addressing health care providers, parent/caregiver and children, respectively; and (3) pain management practices with pain assessment and treatment strategies as subthemes. Conclusion: Current data on paediatric pain management in LMIC are limited with respect to describing the burden of pain, children's pain perceptions and experiences, and pain management practices. Rigorous investigations are needed to expand knowledge and address the pervasive problem of pain for children in LMIC. SUMMARY STATEMENT: What is already known about this topic? There is consensus that inadequate pain management is a major global challenge particularly for children residing in low‐middle income countries (LMIC).Evidence suggests that limited pain management resources are a significant barrier towards managing paediatric pain in LMIC.What this paper adds? Report on the current state of the science of paediatric pain management in LMICElucidates on the evidence and the gaps regarding identification of the burden of pain for children living in LMIC.Explore the available evidence and discuss additional gaps in the contribution and impact of environmental and sociocultural beliefs and practices related to pain assessment and management for children in LMIC.The implications of this paper: Provides a synthesis of the available data to inform the development of evidence‐based practices and policies to address paediatric pain in LMIC.Identify limited studies and the existing gaps in research related to paediatric pain management that urgently need to be addressed to facilitate change in practice and policy development. [ABSTRACT FROM AUTHOR]

Background: Out-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery.Methods: We performed a systematic review of the peer reviewed literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low and low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Data were collected using an electronic form and results were aggregated to produce a descriptive summary.Results: A total 1927 titles were identified, 31 of which met inclusion criteria. Barriers to OHEC were divided into six categories that included: culture/community, infrastructure, communication/coordination, transport, equipment and personnel. Lack of transportation was a common problem, with 55% (17/31) of articles reporting this as a hindrance to OHEC. Ambulances were the most commonly mentioned (71%, 22/31) mode of transporting patients. However, many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Sixty-one percent (19/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Forty percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation.Conclusions: Policy makers and researchers seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse geographic areas. [ABSTRACT FROM AUTHOR]