Trends in the Incidence and Treatment of Early-Onset Pancreatic Cancer

Background: Early-onset pancreatic cancer (EOPC) is relatively uncommon. It is unclear if the incidence of EOPC is evolving and how these patients are treated. Methods: We conducted a retrospective, population-based study using SEER 2004–2016. We evaluated annual age-adjusted incidence rate (AAIR), stage at presentation, and race/ethnicity among 7802 patients plus treatment patterns in 7307 patients (excluding neuroendocrine tumors) younger than 50. Results: The AAIR was higher in males while the rate increased faster in females. The AAIR was highest in Non-Hispanic Black patients and increased for all races/ethnicities over time. The percentage of patients diagnosed with distant-stage disease decreased over time but increased for localized-stage disease. Hispanic patients made up a larger proportion of patients over time compared to other groups. For localized-stage disease, primary surgery alone was the most utilized modality of therapy. For regional-stage disease, chemotherapy with radiation was the most utilized modality from 2004–2010, whereas chemotherapy alone was the most utilized from 2011–2016. For distant-stage disease, chemotherapy alone was the most utilized and used increasingly over time. Patients with EOPC received radiation and chemotherapy at similar rates to, and underwent surgery more frequently, than patients 50–69. Conclusions: The AAIR of EOPC increased over time, faster so in females. Groups who experience a higher burden of pancreatic cancer, particularly African Americans, experienced a higher burden of EOPC. Treatment of localized and regional-stage disease did not follow standard treatment guidelines for pancreatic cancer. Our findings indicate that EOPC patients received more treatment than their older counterparts.

A case report of lymphoepithelioma-like carcinoma in an adolescent

Here we report a case of EBV-positive lymphoepithelioma-like carcinoma of the abdominal and retroperitoneal lymph nodes in a 17-year-old girl. This case is of special interest because of the rarity of the diagnosis (especially in adolescents), the unusual location of the tumor, the patient’s history of infections and autoimmune diseases (autoimmune hepatitis, Crohn’s disease) and the absence of standard treatment guidelines for this tumor. The patient and her legal representatives gave their consent to the use of the patient’s data, including photographs, for research purposes and in publications.

Cost estimates of COVID-19 clinical management in Myanmar

Objective This study aims to estimate the cost of clinical management of COVID-19 infected patients based on their severity by exploring the resources used in health care provision in Myanmar. Methods A multicenter retrospective cost analysis of COVID-19 patients was performed using the micro-costing approach from the perspective of the health system. It covered two cost components, namely direct and indirect cost of treating a patient. Input data and their quantities were obtained from COVID-19 Standard Treatment Guidelines of Ministry of Health and Sports, and administrative and financial records of resource utilization of three designated health facilities in Yangon Region. Valuation of these resources was based on the price list from the Procurement Section of the Ministry. Results This study estimated the unit cost of clinical management of COVID-19 infected patients with no symptom to be 953,552 MMK(717 USD), with mild-moderate symptoms to be 1,155,222 MMK(869 USD) and with severe-critically ill conditions to be 5,705,052 MMK(4290 USD). Average cost for a patient par day was 86,687 MMK(65 USD) for asymptomatic patients, 105,020 MMK(79 USD) for mild-moderate patients and 283,252 MMK(214 USD) for severe-critically ill patients. Since the first case detected till December 31, 2020, COVID-19 clinical management cost was accounted for 139 Billion MMK (104 Million USD) for total 124,630 confirmed cases. Conclusions COVID-19 pandemic has caused health systems to incur the significant health care expenses. Timely implementation of the sustainable, affordable and efficient policy for COVID-19 responses is of utmost important for every nation especially in the face of a pandemic. This study provides the fundamental inputs for strategic planning, for future economic evaluations of different policy interventions, and policy recommendations for health systems to remain resilient during and after the COVID-19 pandemic in Myanmar.

Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

Background The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development. Method An observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software. Results 107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use. Conclusion This study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

Giant De-Differentiated Liposarcoma of the Ascending Colon – A Rare Entity

Background: Liposarcoma is one of the common malignant mesenchymal tumors of the retroperitoneum and soft tissue of the extremities. Liposarcoma primarily arising from the colon is extremely rare. De-differentiated liposarcoma, a high grade variant has high local recurrence and distant metastatic potential. At present no standard treatment guidelines are established for the colonic liposarcoma in view of the rarity of the condition. Case Presentation: In this article we report a case of 46-year-old female who presented with a large right sided abdominal lump. On cross sectional imaging, she was found to have a large heterogenous exophytic mass arising from the ascending colon. Colonoscopy showed a submucosal lesion of the ascending colon with luminal narrowing. She underwent a right radical hemicolectomy. Histopathology of the resected specimen was reported as a de-differentiated liposarcoma arising from the ascending colon, which is an extremely rare occurrence. Patient made an uneventful recovery and is under follow-up. Conclusion: Liposarcoma is a rare disease of large intestine. It should be considered in the differential diagnosis when there is a large, submucosal colonic swelling with no lymph nodal or peritoneal disease. Complete surgical resection with clear margins is the standard of treatment. Evidence on the benefits of adjuvant chemotherapy and radiotherapy in improving survival in liposarcoma of colon is currently evolving.

Rare chondroblastoma of the 6th left rib, video-assisted thoracoscopy resected: one case report and literature review

Introduction Chondroblastoma is a rare, benign locally but aggressive bone tumor. It accounts for < 1% of primary bony tumors, and mostly arises from long bones; the rib chondroblastoma is especial rare. Due to its rarity, there are no definitive or standard treatment guidelines. Case presentation A case of a 24-year-old male with a chondroblastoma located on the 6th posterior left rib. Computed tomography (CT) demonstrated a rib tumor that was a well-defined oval lesion of 20 mm × 18 mm, with lytic bone destruction. The imaging first diagnosis was Langerhans cell histiocytosis (LCH), a giant cell tumor, or other type of neoplasm. The whole tumor and a part of partial rib were resected by video-assisted thoracoscopy surgery (VATS). Pathological and immunohistochemical (IHC) examination made a diagnosis of chondroblastoma. Compared with traditional open thoracic surgery, VATS can achieve the same effects and cause less injury to patient. No postoperative adjuvant therapy was given, and had followed up 23 months after surgery, there was no recurrence or metastasis. Conclusion Chondroblastoma has a risk of recurrence and metastasis, surgery plays an important role in the treatment of chondroblastoma, VATS can achieve the same outcome as traditional open thoracic surgery with less pain and lung function. Close follow-up is needed postoperative.

Comparative analysis and evaluation of current antidiarrheal prescribing trends with representative brand in pediatric population of Pakistan

Background: Prevalence of carpal tunnel syndrome (CTS) among pregnant women is very much common among the Background: Inappropriate management of diarrhea is the main cause of morbidity and mortality in the pediatric population worldwide, more especially in developing countries including Pakistan. Method: The sample size was calculated using World Health Organization (WHO) and Expanded Program on Immunization (EPI) info calculator. 240 prescriptions were collected from eight hospitals including four public hospitals (Pakistan Institute of Medical Sciences, Polyclinic Hospital, Holy family Hospital and Benazir Hospital) and four private hospitals (Hearts International Hospital, Maroof Hospital, Railway hospital, Bilal Hospital) of twin cities of Pakistan (Islamabad and Rawalpindi). Objectives: The purpose of this study was to analyze current prescribing trends of diarrheal management followed by comparative pharmaceutical evaluation of representative brands Parameters recorded from prescriptions were demographics (age and gender), presenting complaints and medications prescribed. Prescriptions were evaluated by their comparison with standard treatment guidelines. Results: Data were evaluated using a statistical package for social sciences (SPSS version 16.0) for descriptive statistics and cross-tabulations along with Chi square test. Diarrhea was presenting complaint in 106 (44%) of peads among age group 0-2 years. Out of 106 (44%) cases of diarrhea, 52 (20%) cases have prescribed an antibiotic in combination with other medications, which was not indicated according to standard guidelines. The use of oral rehydration solutions (ORS) was also limited. Zinc supplementation with ORS is indicated treatment for diarrhea and was prescribed to 21 (9%) cases. Conclusion: Hence, it has been concluded that standard treatment guidelines were not followed thoroughly which leads to increased morbidity, complications and cost.

Rare chondroblastoma of the 6th left rib, video-assisted thoracoscopy resected: one case report and literature review

Introduction: Chondroblastoma is a rare, benign locally but aggressive bone tumor. It accounts for < 1% of primary bony tumors, and mostly arises from long bones; the rib chondroblastoma is especial rare. Due to its rarity, there are no definitive or standard treatment guidelines. Case presentation: A case of a 24-year-old male with a chondroblastoma located on the 6th posterior left rib. Computed tomography (CT) demonstrated a rib tumor that was a well-defined oval lesion of 20 mm × 18 mm, with lytic bone destruction. The imaging first diagnosis was Langerhans cell histiocytosis (LCH), a giant cell tumor, or other type of neoplasm. The whole tumor and a part of the rib were resected by video-assisted thoracoscopy surgery (VATS). Pathological and immunohistochemical (IHC) examination made a diagnosis of chondroblastoma. Compared with traditional open thoracic surgery, VATS can achieve the same effects and cause less injury to patient. No postoperative adjuvant therapy was given, and had followed 23 months after surgery, there was no recurrence or metastasis.Conclusion: Chondroblastoma has a risk of recurrence and metastasis, surgery plays a role in the treatment of chondroblastoma, and VATS can achieve the same outcome as open thoracic surgery with less pain and lung function. Close follow-up is needed postoperative.

How do we can control SARS-CoV-2/ Covid -19 pandemic through various clinical and public health approaches? What are the agent (Covid-19 virus), host & environmental factors responsible for continuation & recurrence of SARS-CoV-2/ Covid -19 pandemic?

Background – The SARS-CoV-2/ Covid -19 pandemic is still going on and globally healthcare system is overstressed with this new burden added with previous NCD &amp; CD in existence. The First human case of this global pandemic was reported from Wuhan city of China in December 2019. There are two main approaches to control this pandemic. The clinical approach based on individuals &amp; standard treatment guidelines-protocols and public health approach based on population strategy to control this pandemic. Objective – The main objective of this study is to illustrate the key features of Covid -19 virus &amp; other factors responsible for continuation and recurrence of this pandemic. The next objective is to illustrate various strategies and approaches to prevent epidemic through assessment of important parameters and indicators (see figure 1) to control the ongoing disaster and hazards of pandemic. Setting and design – Different aspects of Covid -19 structural variations and its effect is analysed. Text and figure details about epidemiological triad and various steps to be monitored and modified are outlined. The clinical and public health approaches is explained in stepwise manner in figure1. Methodology – The methods to control the pandemic under clinical and public health approach is discussed here. The methods to control perpetuation of Covid -19 can be achieved by the controlling and modifying way of infections spread and other determinant. Both clinical and public health approach methods are outlined with their importance in this article in brief. Result- Several factors are responsible for the continuation of the pandemic. The CCP (Covid -19control plan) with public health and clinical approaches can be utilized to prevent further spread in different settings.Conclusion – In the epidemiological triad we have agent/host/environment; the public health approach will deal with these three parameters. The clinical approach targets sick individuals (host) infected with SARS-Cov-2/Covid-19.The control of pandemic can be achieved only through a definite universal control plan incorporating both clinical and public health approach. See figure 1.Keywords – SARS-Cov-2, Covid-19, Pandemic, Epidemiology, Strain, CCP