Developing emergency medical care policy across Kenya: A framework for policy development.

Background And Objectives: The Kenya Emergency Medical Care (EMC) Policy 2020-2030 was created to guide the advancement of EMC throughout Kenya. This report describes and maps the ongoing EMC policy development process across Kenya's 47 counties, serving as a real-world example of EMC policy development within a decentralized healthcare system in a low-or middle-income country (LMIC).

Methods: This report evaluates the development of county-specific EMC policies using the Kenya Institute for Public Policy Research and Analysis (KIPPRA) six stages for policy development: 1) problem identification, 2) agenda setting, 3) policy design, 4) approval, 5) implementation, and 6) monitoring and evaluation.

Outcomes following CyberKnife robotic radiosurgery for pituitary adenomas-a large single-centre study.

Introduction: The role of stereotactic radiosurgery (SRS) in pituitary adenomas (PAs) is evolving especially considering its safety. Existing literature is hampered by limited sample sizes and short-term follow-ups, impeding its preeminence in the clinical and radiological outcomes. We propose a comprehensive, single-centred study to evaluate the outcomes following CyberKnife stereotactic radiosurgery (CK SRS) for PAs in a larger patient population, incorporating meticulous clinical and radiological follow-up.

Diagnostic Accuracy of Creatinine-Based Equations for eGFR Estimation in Pakistanis: Evaluation of the European Kidney Function Consortium Equation vs the CKD-EPI Pakistan Equation.

Introduction: Chronic Kidney Disease (CKD) is prevalent in Pakistan, necessitating accurate diagnostic methods. This study evaluates the CKD-EPI 2009, CKD-EPI 2021, CKD-EPI Pak, MDRD, and EKFC equations against creatinine clearance (CrCl) to determine their diagnostic accuracy for CKD in the Pakistani population.

Methods: n a retrospective cross-sectional study, data from 2,310 participants aged 18-70 were analyzed at The Aga Khan University in Karachi.

Formulation of Quality Improvement Methodology for Risk Mitigation in Congenital Cardiac Catheterization.

The C3PO collaborative, with a history of successful quality improvement (QI) initiatives, leveraged registry participants to develop a multi-center QI initiative to reduce adverse events (AEs) in congenital cardiac catheterization. A 32-person, interdisciplinary working group analyzed audited data for all congenital cardiac catheterization cases from 2014-2017. The primary outcome was the occurrence of any high-severity (level 3/4/5) AE.

Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study.

Background: Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).

Aim: To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.

Methods: Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.

Identification of differentially expressed non-coding RNAs in the plasma of women with preterm birth.

This study aimed to identify differentially expressed non-coding RNAs (ncRNAs) associated with preterm birth (PTB) and determine biological pathways being influenced in the context of PTB. We processed cell-free RNA sequencing data and identified seventeen differentially expressed (DE) ncRNAs that could be involved in the onset of PTB. Per the validation via customized RT-qPCR, the recorded variations in expressions of eleven ncRNAs were concordant with the analyses.

Stewarding COVID-19 health systems response in Pakistan: what more can be done for a primary health care approach to future pandemics?

We apply a primary healthcare (PHC) perspective to gauge Pakistan's health systems response to COVID-19, to identify stewardship lessons for integrating the PHC pandemic response. Analysis of Pakistan's response against the Astana PHC framework shows that the imperative for national survival helped mobilise an agile response across a fragmented health security context. The findings show effective multisector governance in responding to the health and social aspects of the pandemic, as well as the rapid roll-out of several public health functions and emergency care.

Spinal impostor: Metastatic cervical paraganglioma presenting with paraparesis, a case report.

Introduction And Importance: Paragangliomas are rare neuroendocrine tumors, typically arising from extra-adrenal chromaffin cells. Primary intra-spinal paragangliomas are uncommon, and metastatic spinal paragangliomas without paraneoplastic symptoms are even rarer. This case highlights the diagnostic challenges posed by such rare tumors.

Doctors' knowledge, practices, challenges, and limitations regarding disclosure of bad news: A multicentre study from Pakistan.

Background: Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan.

Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan.

Indirect determination of hemoglobin A2 reference intervals in Pakistani infants using data mining.

Background: Reference intervals (RIs) are crucial for distinguishing healthy from sick individuals and vary across age groups. Hemoglobinopathies are common in Pakistan, making the quantification of hemoglobin variants essential for screening. Direct RIs are established by measuring values from a healthy reference population, whereas indirect RIs, use statistical analysis of routine lab data to estimate values, making it feasible in settings where direct data is unavailable.

Helping people with psychosis with a low-cost intervention DIALOG+: protocol for the economic evaluation in a randomised control trial in India and Pakistan.

Background: Approximately 69%-89% of people with severe mental illnesses, particularly psychosis, experience a treatment gap in low- and middle-income countries (LMICs) due to factors such as low public spending on health and weak healthcare systems. The PIECEs project aims to assess the effectiveness and cost-effectiveness of a solution-focused resource-oriented approach (DIALOG+) for improving the quality of life and mental well-being of people with psychosis in India and Pakistan.

Methods: The research design of this analysis is an economic evaluation piggybacked on the PIECEs randomised control trial to test the feasibility of DIALOG+ in India and Pakistan.

A cross-sectional study to correlate nasal profile and chin position with cephalometric lip profile.

Objective: To determine the effect of the nose and chin on the cephalometric lip profile.

Methods And Material: The pre-treatment lateral cephalograms of 177 adult patients with no history of orthodontic treatment were manually traced. The sample size was divided into three vertical and horizontal groups using angle ANB and MMA to assess the difference in nose and chin forms.

Occult Breast Cancer in High-Risk Gene-Positive Pakistani Women Undergoing Contralateral Prophylactic Mastectomy/Prophylactic Mastectomy: Implications for Sentinel Lymph Node Biopsy.

Introduction: Sentinel lymph node biopsy (SLNB) of the axilla is standard in breast cancer (BC) management; however, its role in prophylactic/contralateral prophylactic mastectomy (CPM) is still questioned. To avoid future consequences on surgical morbidity and socioeconomic aspects in low and middle-income countries (LMICs), we intend to determine the prevalence of occult breast cancer (OBC) among CPM cases.

Objective: To determine the prevalence of OBC in patients undergoing prophylactic mastectomy (PM).

Self -reported bruxism in patients undergoing Orthodontic treatment - a cross-sectional study.

Background: Orthodontic treatment involves manipulation of tooth position that can temporarily lead to occlusal interferences capable of inducing bruxism. The objectives of this study were to determine the self-reported incidence of bruxism and its association with factors such as facial type, divergence, skeletal and dental malocclusions in orthodontic patients.

Materials And Methods: 80 patients who underwent a minimum of six months of orthodontic treatment were surveyed using a validated self-reported bruxism questionnaire for the presence or absence of bruxism.

Radiological Outcomes According to the Matta Score After the Surgical Fixation of Acetabular Fractures.

Background Acetabular fractures, a rising concern in developing countries, pose a significant challenge due to their complexity and association with post-operative complications. Often caused by high-energy mechanisms like falls and motor vehicle accidents, these fractures require accurate reduction to prevent long-term issues and the potential need for hip replacement. This study investigates the radiological outcomes of acetabular fracture surgery at six months, focusing on the effectiveness of achieving anatomical reduction using the Matta criteria in a low-and middle-income country (LMIC) setting.

Beyond the Tragedy: Illuminating Challenges in Disaster Management and Mental Health Support in Resource-Constrained Environments.

In the aftermath of the 2022 Pakistan flooding, disaster management faced critical challenges, particularly in mental health support. This study analyzed an incident where eighteen internally displaced individuals lost their lives in a bus fire. The current approach involves a comprehensive analysis of the incident, exploring the difficulties encountered in managing relief efforts, and providing mental health support.

Further evidence of biallelic NAV3 variants associated with recessive neurodevelopmental disorder with dysmorphism, developmental delay, intellectual disability, and behavioral abnormalities.

Neuron navigators (NAVs) are cytoskeleton-associated proteins well known for their role in axonal guidance, neuronal migration, and neurite growth necessary for neurodevelopment. Neuron navigator 3 (NAV3) is one of the three NAV proteins highly expressed in the embryonic and adult brain. However, the role of the NAV3 gene in human disease is not well-studied.

The influence of orthodontist change on treatment duration and outcomes in patients treated with Clark's twin block appliance followed by non-extraction fixed mechanotherapy - a retrospective cohort study.

Background: Post-graduate resident turnover in public and teaching hospital orthodontic clinics often leads to challenges in maintaining the same level of efficacy when a care provider changes during orthodontic treatment. This retrospective cohort study aimed to compare the duration and quality of treatment outcomes between two patient groups: the transfer group, who underwent orthodontic care from multiple residents, and the non-transfer group, whose entire treatment was overseen by a single resident.

Methods: Sixty-six patients were enrolled and equally divided into transfer and non-transfer groups.

Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial.

The third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target <140mmHg), glucose control (target 6.1-7.

Clinical and genetic characterization of a progressive RBL2-associated neurodevelopmental disorder.

Retinoblastoma (RB) proteins are highly conserved transcriptional regulators that play important roles during development by regulating cell-cycle gene expression. RBL2 dysfunction has been linked to a severe neurodevelopmental disorder. However, to date, clinical features have only been described in six individuals carrying five biallelic predicted loss of function (pLOF) variants.

From Harmless to Harmful: A Case Series of Hepatic Abscess Induced by Gut Microbiota Due to Fish Bone.

Accidental ingestion of fish bones can lead to serious complications, such as gastrointestinal perforation and hepatic abscesses. This case series presents three instances where fish bone ingestion led to secondary GI tract perforation and the development of hepatic abscesses. It also emphasizes the importance of prompt diagnosis and intervention to prevent serious consequences.

Marketing Strategies and Consumer and Sellers Perception About Oral Nicotine Pouches in Karachi, Pakistan.

The availability of novel nicotine products like oral nicotine pouches (ONP) has been rising in South Asian countries, including Pakistan. We aimed to assess ONP marketing strategies at point-of-sale (POS) and understand the perceptions among consumers and sellers regarding its use in Karachi, Pakistan. We conducted a mixed-methods study in low, middle, and high socioeconomic neighborhoods of District East Karachi.

A Decade of Achievements: International Society of Paediatric Oncology Baseline Nursing Standards.

The six International Society of Paediatric Oncology (SIOP) Baseline Nursing Standards provide the first evidence-based framework for assessing and improving pediatric oncology nursing practice settings in low-, middle-, and high-income countries. Over the past 10 years, the standards have been translated to six languages, endorsed by 13 organizations, surveyed at 101 hospitals in 54 countries, and initiatives have been documented at over 63 institutions in 31 countries. Going forward, the SIOP Nursing Network's Baseline Standards Special Interest Group has established a 5-year strategic plan to guide advocacy, research, and standards implementation through global multidisciplinary collaboration.

Effect of high-efficiency particulate air filter on children with asthma: a systematic review protocol of RCTs.

Introduction: Asthma has been classified as a major non-communicable disease by the WHO. With the worsening air quality index worldwide, the burden of asthma has increased specifically in children. The focus of the management strategy of asthma has shifted from traditional pharmacological treatments towards non-pharmacological preventive and control therapy in recent decades.