Heat Transport Exploration for Hybrid Nanoparticle (Cu, Fe3O4)-Based Blood Flow via Tapered Complex Wavy Curved Channel with Slip Features

Curved veins and arteries make up the human cardiovascular system, and the peristalsis process underlies the blood flowing in these ducts. The blood flow in the presence of hybrid nanoparticles through a tapered complex wavy curved channel is numerically investigated. The behavior of the blood is characterized by the Casson fluid model while the physical properties of iron (Fe₃O₄) and copper (Cu) are used in the analysis. The fundamental laws of mass, momentum and energy give rise the system of nonlinear coupled partial differential equations which are normalized using the variables, and the resulting set of governing relations are simplified in view of a smaller Reynolds model approach. The numerical simulations are performed using the computational software Mathematica's built-in ND scheme. It is noted that the velocity of the blood is abated by the nanoparticles' concentration and assisted in the non-uniform channel core. Furthermore, the nanoparticles' volume fraction and the dimensionless curvature of the channel reduce the temperature profile.

Molecular Pathogenesis of Chewable Tobacco

In Pakistan, extensive use of several precarious chewable tobacco formulations has made oral cancer the second leading malignancy. Selection of literature was done by a survey of studies published from 1990 to 2017 mainly, from PUBMED and few from other search engines, on naswar, gutka, areca nut and betel quid, which included published reviews, original articles and other data sources on chewable tobacco, its epidemiology, pathological implications, and psychological effects. These studies have revealed that the chemicals in these formulations bind and mutate DNA of oral mucosa through down regulating cellular repair pathways and upregulating genetic networks associated with pathogenesis. Areca nut, having aercoline (the major alkaloid) causes carcinogenicity, mutagenicity, and genotoxicity of oral mucosa through increased production of growth factors and corticotrophin-releasing hormone, and genetic alteration in expression of CASP8, APAF-1, BAX, BAD, and upregulation of caspas-3. Gutka addiction leads to precancerous lesions resulting in characteristic facial abnormalities, following trismus. Naswar, in addition to oral cancer, causes adverse cardiovascular events by reducing glutathione per oxidase (GPx) and super-oxide dismutase (SOD), serum levels of HDL, whereas, increasing the ratio of cholesterol, LDL, triglycerides and LDL-C/HDL-C. Betel quid (Paan), causes psychoactivity affecting central and autonomic nervous systems leading to dependence with decreased cognition, euphoria, sweating, salivation, palpitation, heightened alertness and zest to work. Metabolically, cardio-acceleration, cortical desynchronisation of EEG, elevated plasma noradrenaline and adrenaline were found. This review highlights the corrosive effects of various most popular chewable tobacco formulations; and damage done by their cocktail of carcinogenic substances and added ingredients, leading to oropharangeal cancer.

The frequency of shisha (waterpipe) smoking in students of different age groups

OBJECTIVE

To determine the frequency of waterpipe smoking in students of different age groups.

STUDY DESIGN

Cross-sectional survey.

PLACE AND DURATION OF STUDY

Karachi, Pakistan, from February 2012 to February 2013.

METHODOLOGY

The subjects were divided into two age groups. Group-I comprised of 13 - 17 years old randomly selected students from O' Level schools in Karachi and group-2 included 23 - 27 years old undergraduate and postgraduate students again randomly selected from various institutions in Karachi. A questionnaire was filled with prior consent, basic education on waterpipe smoking was given, and all the questions of the survey form were explained to the subjects according to context.

RESULTS

In group-1, 39% students smoked waterpipe. Most students had been smoking waterpipe for the last 2 years. In group-2, 48% individuals smoked waterpipe, majority of smokers indulged in the last 5 years and among them, most were falling within the last 2 years.

CONCLUSION

The frequency of waterpipe smoking in teenage students was 39% and older students for 48%. Social and recreational use of waterpipes is widespread among both groups despite being acknowledged by majority as a health hazard.

Epidemiology and clinical characteristics of adult patients presenting to a low resource, tertiary care emergency department in Pakistan: Challenges & Outcomes

Objectives

Emergency Departments (EDs) play a major role in managing acute and chronic illnesses, especially in low-to-middle-income countries like Pakistan, which lacks effective primary healthcare. This study reports the epidemiology and clinical characteristics of patients presenting over a two-year period at the Indus Hospital and Health Network (IHHN) adult ED in Karachi, Pakistan.

Methods

This is a retrospective observational study conducted through chart review of 264,859 patients, aged 16 years and above, who presented to the IHHN ED, Korangi Campus, from January 2019 to December 2020 after obtaining approval from IHHN IRB.

Results

Men were found to be the predominant presenting gender, with a slight rise in the number of women in 2020. The most frequent age group in 2019 was 15-25 (27.7%), whereas it was 25-35 years in 2020 (24.1%), with a decline in total number of elderly visits seen in comparison to previous years. The most frequently seen disposition was 'referral to clinic' in 2019 (48.4%) and 'discharged' in 2020 (39%). Out of all dispositions, maximum Length of stay (LOS) was seen in patients who left against medical advice in both years. Patient acuity showed the highest number of P3 (moderately ill) patients in both years. Infectious diseases accounted for greater than 10% of patients in both years (17.2% and16.5%), followed by gastrointestinal complaints (15.7% and 11.3%), genitourinary complaints (14.9% and 7.9%), and trauma (11.9% and 12.4%).

Conclusion

Knowledge of epidemiology and clinical characteristics of patients can help facilitate timely planning of staff deployment and allocation of resources to avoid overcrowding, improve patient outcomes, and increase patient satisfaction through timely management.

Assessing and Implementing Nursing Standards in Pediatric Oncology Units in a Low- to Middle-Income Country

Oncology nurses are stakeholders in the global fight against childhood cancer. In low- to middle-income countries, the burden of care on nursing staff is high, and nurses face several unique challenges. To optimize pediatric.

Characteristics of relapsed and refractory paediatric Hodgkin lymphoma; a 10-year retrospective study of an LMIC

Background

With conventional standard treatment modalities, children and adolescents with Hodgkin lymphoma (HL) have long-term overall survival rates of over 90%. However, primary refractory disease may occur in 5%-10% of HL patients, while relapse occurs in 5%-10% of patients with early stage disease and up to 30% in an advanced stage. This retrospective study evaluated patient characteristics in cases of HL relapse and refractory and their response to second-line treatment of standalone chemotherapy or in combination with radiotherapy.

Methodology

A retrospective study was conducted by Indus Hospital and Health Network to determine the outcomes of paediatric patients with first and second relapses of HL between 2013 and 2022.

Results

A total of 742 patients were diagnosed with HL at Indus Hospital & Health Network. Of these, 48 (6.5%) patients presented with relapse and 35 (4.7%) with refractory disease after initial chemotherapy. In HL relapse patients, 57% were stage IV at initial diagnosis with the most common pathology being nodular sclerosis constituting 42.9% of patients. The most common age group was 6-10 years, 45.8%. B symptoms were experienced by 25 (52%) patients. A time to relapse of >12 months following diagnosis was seen in 69% and 3-12 months was seen in 31%.After receiving second-line treatment, complete remission was achieved by 34 (70.8%) patients, partial remission (PR) was seen in 5 (10.4%), disease progression in 5 (10.4%), 3 (6.3%) patients left during treatment and 1 (2.1%) had a treatment-related mortality. Re-radiation in second-line treatment was only required for 2 patients. The second relapse was seen in 11 (28.2%) of 39 complete and PR patients.

Conclusion

Major limitations in the treatment of HL relapse in a low-resource setting are the non-availability of immunotherapy and autologous stem cell transplantation due to extreme financial burden and lack of capacity in facilities. Dedicated efforts are required to provide these facilities free of cost in low-middle income countries (LMICs).

Implementation of evidence-based psychosocial care in six pediatric oncology units across Pakistan

BACKGROUND

Despite rising childhood cancer incidence, low-middle income countries often fall short of quality resources to prioritize and develop psycho-oncology services. Patients and families suffering from cancer are subject to great psychological distress and require continuous psychosocial support. Unfortunately, a lack of mental health awareness and trained providers remains a pertinent issue in resource-strained countries such as Pakistan.

METHODS

IHHN has a well-established Psychosocial Department for pediatric oncology patients. Mental health counseling, child life, palliative care, bereavement and, social support are provided by a team of trained psychologists and social workers. In an effort to promote the implementation of this psychosocial model, partnerships were formed with public-sector pediatric oncology units and a structured one week online training module was conducted followed by a 1 week hands-on training.

RESULTS

Of the total 67 participants registered, 24 were eligible for certificates. The course was open to healthcare workers around the country, considering that dedicated psychosocial personnel are not present in all units. The highest number of participants were from Karachi, accounting for 56.7% and were psychologists, 32.8%. On feedback, all participants said they would recommend this course to others and 80% chose self-motivation as the reason for enrolling compared to 12% who chose workplace requirement and 4% chose certification. Psychosocial workers selected for hands-on training were empowered to implement the POD model at their units and mentorship was continued after the training.

CONCLUSION

Establishment of counseling and mental health services must be prioritized and integrated into childhood cancer healthcare delivery. Further studies are needed for establishing psychosocial models in low resource settings.

Evaluation of task sharing as a workforce optimization strategy in pediatric oncology

Task sharing is a pragmatic response to the growing shortage of pediatric oncologists globally, especially in low- and middle-income countries (LMICs). However, there have been limited evaluations of how task sharing has been implemented. In this study, we sought to determine the roles and responsibilities of task-sharing physicians (TSPs) in one LMIC, Pakistan. A multicenter cross-sectional study was conducted across 16 hospitals with secondary- to quaternary-level pediatric oncology facilities. An online survey was used to determine task-sharing models, the responsibilities of TSPs, and the level of supervision. Pediatric oncologists were present at 13 of the 16 centers, with a median of 2 pediatric oncologists per center. We found that TSPs included tiers of medical officers/general physicians and pediatricians. They provided inpatient, outpatient, overnight and emergency room coverage. TSPs could participate in defining cancer diagnosis and risk-stratification (n = 9; 56%), selecting initial chemotherapy plans for patients with newly diagnosed cancer (n = 6; 38%) and modifying chemotherapy on the basis of toxicities (n = 6; 38%) under supervision of a pediatric oncologist. In addition, TSPs could write intravenous chemotherapy orders (n = 10; 63%) and prescribe oral chemotherapy (n = 10; 63%). Furthermore, they could independently perform procedures, such as lumbar punctures (n = 15; 94%), intrathecal chemotherapy administration (n = 11; 69%), and bone marrow aspirates and biopsies (n = 11; 69%). TSPs are critical in the pediatric oncology workforce with responsibilities across the pediatric cancer care continuum.

Irish Prostate Cancer Outcomes Research (IPCOR) registry: cohort profile

PURPOSE

To describe the Irish Prostate Cancer Outcomes Research (IPCOR) registry. The cohort was collected to inform and improve the prostate cancer journey of men in Ireland.

PARTICIPANTS

Established in 2015, IPCOR was a unique large-scale prospective cohort study registering men with prostate cancer in Ireland. From 2016 to 2020, IPCOR collected data on 6816 men who were newly diagnosed with prostate cancer across 16 hospitals, both public and private. A comprehensive clinical dataset was collected, capturing detailed information on men's diagnosis, treatments and follow-up. In addition, a subset of 873 men completed patient-reported outcome measures.

FINDINGS TO DATE

The IPCOR study has revealed several key insights into prostate cancer diagnosis and treatment in Ireland. The data indicate a high rate of diagnosis through opportunistic Prostate-Specific Antigen screening, with many cases identified at an early stage.

FUTURE PLANS

IPCOR invites collaboration from the global cancer research community to use this resource to advance prostate cancer research and improve patient outcomes worldwide. IPCOR aims to continue updating long-term survival follow-up data for this cohort. It also plans to continue its collaborative approach with patients, engaging with the Lived Experience Advisory Panel in interpreting results emerging from this dataset. Moving forward, IPCOR is planning its next phase of the project, IPCOR 2.0. This will be a prospective, longitudinal, multi-centre clinical quality registry and biorepository.

Achievements and pitfalls in improving Pediatric Oncology Nursing standards: A public-private partnership project

RATIONALE

Approximately 8,000 new cases of pediatric cancer arise annually in Pakistan. However, there is a dire survival rate of 30-35% due to various factors, especially a lack of competent nurses in pediatric oncology care. Public-private partnerships (PPP) supported by a My Child Matters (MCM) Grant from Sanofi Espoir Foundation was granted to Indus Hospital & Health Network (IH&HN) to improve pediatric nursing standards.

METHODS

Starting in 2016, nurses from hospitals across Pakistan were enrolled in a continuing education program, which included a comprehensive, hands-on training component. A group chat was created following the training for communication and mentorship regarding challenges faced locally.

RESULTS

Seventy-seven pediatric oncology nurses were successfully trained by IH&HN over three years.

DISCUSSION

Challenges included lack of government funding, shortage of specialist nurses, frequent shifting of nurses away from pediatric care, and indifferent attitudes. Success of the project could have been maximized if trained nurses were motivated and retained by hospitals.

CONCLUSION

Development and maintenance of PPP in national healthcare systems is essential to improve pediatric oncology nursing care.

Enhancement of paediatric oncology pharmacy practices in a low-middle-income country through teaching and training using the My Child Matters Grant

The development of a successful oncology pharmacy system includes competency training, cost-efficient procurement, proper storage, preparation and administration of chemotherapy, and appropriate waste disposal. Low-middle-income countries such as Pakistan face several challenges within the realm of oncology pharmacy such as the unavailability of training programmes, resources and financial support, and inconsistencies in the safe handling of cytotoxic drugs. The Indus Hospital and Health Network (IHHN) is among the pioneers of oncology pharmacy practices in Pakistan, with a well-established Oncology Pharmacy Team and chemotherapy preparation in accordance with the United States Pharmacopeia 797 and 800 safety guidelines. The My Child Matters Grant was awarded by the Sanofi Espoir Foundation to the Department of Paediatric Hematology and Oncology at IHHN for holistic improvement in childhood cancer care through teaching, training and capacity building. Partnerships were formed with five public-sector paediatric oncology units nationwide. Initiatives were taken to improve oncology pharmacy practices including teaching and training courses, in-person assessment visits, and mentorship and liaison efforts. Despite prevailing challenges, promising improvements were noted at each centre. However, Pakistan needs to establish a national plan for childhood cancer with the creation of regional organisations for the training and monitoring of oncology pharmacists. Centralisation of pharmacy operations within hospitals is essential to maintain the availability, storage, preparation and administration standards of chemotherapy.