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ABSTRACT This report describes the status of childhood cancer control initiatives in Latin America and the Caribbean (LAC). Progress between 2017 and 2023 is measured using the outcome indicators from the Pan American Health Organization (PAHO) childhood cancer logic model aligned with the World Health Organization Global Initiative for Childhood Cancer (GICC). This report also describes the advances, barriers, and facilitators for the implementation of the GICC at the Regional level. Methods used in this report encompassed a comprehensive approach, incorporating a literature review, interviews, surveys, and a Delphi study developed by the technical team of the PAHO Non-Communicable Diseases and Mental Health Department and by the GICC LAC working group. Since 2017, there has been a substantial increase in the number of countries that have included childhood cancer in their national regulations. Currently, 21 LAC countries are involved in the GICC implementation, activities, and dialogues. However, the objectives for 2030 will only be achieved if Member States overcome the barriers to accelerating the pace of initiative implementation. There is an urgent need to increase the efforts in childhood cancer control in LAC, especially regarding the prioritization of timely detection, essential diagnostics, access to cancer treatment, palliative care, and close follow-up of children and adolescents with cancer.
RESUMEN En este artículo se describe la situación de las iniciativas para el control del cáncer infantil en América Latina y el Caribe. Para medir los progresos entre el 2017 y el 2023, se utilizan los indicadores de resultados del modelo lógico del cáncer infantil de la Organización Panamericana de la Salud (OPS) que es coherente con la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. También se describen los avances, los obstáculos y los elementos que han facilitado la aplicación de esa iniciativa en la Región Los métodos utilizados en este trabajo incluyeron un enfoque integral que incorporó una revisión bibliográfica, entrevistas, encuestas y un estudio de tipo Delfos llevado a cabo por el equipo técnico del Departamento de Enfermedades No Transmisibles y Salud Mental de la OPS y por el grupo de trabajo de América Latina y el Caribe de la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. Desde el 2017 ha habido un incremento considerable en el número de países que incorporan el cáncer infantil en sus regulaciones nacionales. En la actualidad, 21 países de América Latina y el Caribe participan en la puesta en práctica, las actividades y las deliberaciones de la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. No obstante, los objetivos para el 2030 solo podrán alcanzarse si los Estados Miembros son capaces de superar los obstáculos que dificultan la aceleración del ritmo de aplicación de esta iniciativa. Existe una necesidad urgente de aumentar las actividades dirigidas al control del cáncer infantil en América Latina y el Caribe, en especial en lo que respecta a priorizar la detección temprana, los medios de diagnóstico esenciales, el acceso a los tratamientos oncológicos, los cuidados paliativos y el seguimiento estricto de la población infantil y adolescente con cáncer.
RESUMO Este relatório descreve a situação das iniciativas de controle do câncer infantil na Região da América Latina e do Caribe (ALC). O progresso alcançado entre 2017 e 2023 foi medido usando os indicadores de resultados intermediários do modelo lógico de câncer infantil da Organização Pan-Americana da Saúde (OPAS), em linha com a Iniciativa Global para o Câncer Infantil (GICC) da Organização Mundial da Saúde. O relatório também descreve os avanços, as barreiras e os facilitadores para a implementação da iniciativa em nível regional. Os métodos utilizados neste relatório aplicaram uma abordagem abrangente que incluiu revisão da literatura, entrevistas, levantamentos e um estudo Delphi desenvolvido pela equipe técnica do Departamento de Doenças Não Transmissíveis e Saúde Mental da OPAS e pelo grupo de trabalho da GICC para a ALC. Desde 2017, houve um aumento significativo no número de países que passaram a incluir o câncer infantil em regulamentações nacionais. Atualmente, 21 países da América Latina e do Caribe estão envolvidos na implementação da GICC, bem como em atividades e diálogos relacionados. No entanto, os objetivos para 2030 só serão alcançados se os Estados Membros superarem as barreiras ao aceleramento do ritmo de implementação da iniciativa. Existe uma necessidade urgente de intensificar os esforços de controle do câncer infantil na ALC, especialmente no tocante à priorização da detecção em tempo hábil, diagnósticos essenciais, acesso a tratamentos oncológicos, cuidados paliativos e acompanhamento cuidadoso de crianças e adolescentes com câncer.
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Nephrectomy brings in relief to patients from various chronic and life threatening diseases and in some cases makes way for renal transplant. Renal cell carcinoma accounts for 3% of all cancer deaths. Staging and grading remain the most useful indicators. Hence the present study was undertaken to become familiar with the morphological features and to explore, elucidate and document the kidney lesions at nephrectomy. We wanted to study the spectrum of renal lesions post nephrectomy, obtain the overall frequency, the age and sex incidence of various lesions at nephrectomy along with detailed histomorphology study of various lesions encountered in nephrectomy specimens and evaluate the histomorphological study of renal tumours including the classification of cell type, architectural pattern and grading. MethodsThis prospective study was done on 85 nephrectomy specimens received in the department of pathology, N.I.M.S. Medical College, Jaipur, over a period of three years (2016 to 2019). ResultsOf these 85 nephrectomy specimens, 44 cases (51.7%) were neoplastic and remaining 41 cases (48.2%) were non-neoplastic. ConclusionsThe youngest patient was 40 days and oldest was 75 years. Chronic pyelonephritis was the commonest non-neoplastic lesion. Renal cell carcinoma was the commonest tumour and was commoner in males with clear cell variant being the most frequent. Monophasic Wilms tumour was the commonest neoplastic lesion in the paediatric population.
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Pain is an unpleasant sensation as a consequence of injury, disease along with emotional disorder occurring in varying degrees of severity. Poor control of pain is complete unethical, clinically unsound and economically disastrous. Effective pain control in postoperative period is one of the essential components of post-operative care for those patients who have undergone surgery. Inadequate and inappropriate pain control results in significant increase in post-operative morbidity or mortality. Methods: An prospective, observational analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the post- operative ward of department of general surgery from the bed side tickets of the patients. Results: In our current study we observed out of 515 postoperative patients 49.5% (255) were male and 50.5 % (260) were female, on the other hand more Hindu(85.4%) than Muslim(14.6%). On the day of surgery Monotherapy was prescribed for 440(67%) patients and 33% received both combination analgesic therapies. A total of 33% patients who received dual analgesic therapy immediate post-operative period most commonly used combination was Tramadol+Diclofenac (130/170), followed by Tramadol+ Paracetamol (40/170). In the following post-operative days increase in use of Diclofenac+Paracetamol was noted. No Triple drug therapy observed in this study. Conclusion: The results of current study shows that diclofenac was the most commonly prescribed analgesic. It is due to high efficacy of diclofenac in post operative pain control with better safty profile; i.e. lesser side effects compared to other analgesic.
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Cholecystectomy, one of the most common operative procedures done in our institution. In a developing country like India, choice of antibiotics should be rational to reduce the burden of cost. There are no standard treatment guidelines to follow regarding antibiotic usage causing indiscriminate use of this antibiotic. Methods: An observational, prospective analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the department of general surgery from the bed side tickets of the patients after taking a short history and informed consent from the patient. Cost of the therapy was calculated from CIMS (Current Index of Medical Specialities) and institutional pharmacy. Results: More commonly single antibiotic (190/320) prescribe followed by two antibiotic (80/320) and three antibiotic (50/320). Piperacillin + Tazobactum most commonly prescribe antibiotic as a single agent and overall. Ceftriaxone / Tazobactum + Metronidazole preferred combination when two antibiotic use at a time. Mean hospital stay 3.78 days. Average duration for prescribing of antibiotic 3.25 days. Mean cost for antibiotic in 984 INR, with a range 115-2700 INR. The average duration of stay in open Cholecystectomy was 7 days whereas the mean duration of stay in cases of laparoscopic Cholecystectomy was reduced to 3.07 days. Average antibiotic prescribing duration was 4.75 days significantly higher than Lap. Cholecystectomy (1.4 days). Conclusion: As there is no standard treatment protocol and antibiotic policy to follow antibiotics are used as pick and choose method due to lack of standard treatment protocol.
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Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.
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Background: Accurate preparation of recipient area is a critical step in melanocyte-keratinocyte transplantation procedure for vitiligo. It is an important potential step for adaptation in the quest to achieve better results and ablative lasers potentially offer excellent precision over margin and depth control in achieving that. Objective: To compare between the two techniques used for recipient site preparation: Er:YAG laser ablation and mechanical dermabrasion for melanocyte-keratinocyte transplantation procedure in terms of re-pigmentation achieved and adverse effects seen. Methods: A randomized comparative trial was performed among 32 patients of stable vitiligo undergoing melanocyte-keratinocyte transplantation procedure. In Group A (n = 15), recipient site preparation was done with Er:YAG laser, and in Group B (n = 17), it was done with a motorized dermabrader. Patients of both groups were objectively assessed for re-pigmentation at 1, 3 and 6 months. Results: A total of 253.696 cm2 of depigmented surface was operated upon and re-pigmentation of 125.359 cm2 (49.4%) was achieved. On comparison between two groups, no statistical difference was found with respect to total re-pigmentation achieved (Group A: 54.67% vs Group B: 48.841%, P = 0.663) and grades of re-pigmentation achieved (P = 0.796). Occurrence of adverse events was also statistically similar in both the groups. Conclusion: This study did not reveal any statistically different outcome (in terms of re-pigmentation and adverse effects) between the two methods of recipient site preparation – motorized dermabrasion and Er:YAG ablation. Limitations: This study is small and larger studies are needed to ascertain the benefit of Er:YAG for recipient site preparation. Future studies may also ascertain variables such as time taken to prepare the recipient area, nature of bleeding, postoperative healing, difficulties in specific area, cost of the procedure, patient comfort and ease of the surgeon, rather than comparing the re-pigmentation alone.
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Background: Aspiration of enlarged lymph node is commonly done. Although open biopsy with histopathological examination of tissue still remains the gold standard yet F.N.A.C. is an integral part of initial diagnosis. Objective: To highlight the role of F.N.A.C. in the diagnosis of etiological profile of lymphadenopathy and to find out the accuracy of F.N.A.C. in comparison to histopathological diagnosis. Methods: The prospective study was done for two years. The results of lymph node F.N.A.C. were compared and evaluated taking histopathology as gold standard. Results: Cervical lymph node were most commonly involved. Most common cause of lymphadenopathy in children was reactive hyperplasia and tuberculosis in adults.Conclusion: The sensitivity and diagnostic accuracy of F.N.A.C. results were high when compared with histopathological findings.
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Background: Pterion is present in floor of temporal fossa which is a meeting point of four bones, frontal and parietal bone superiorly and the greater wing of sphenoid and squamous temporal bone inferiorly. It is ‘H-shaped’ in most of the skulls. The most common variation is in its shape and presence of epipteric bone. Aim : To report the various types of pterion and incidence of epipteric bones in the human skulls and to compare with other racial groups from previous study. Methods: The present study was conducted using 311 dry, grossly normal human skulls from sources in Gujarat. Different types of pterion and the presence of epipteric bones were observed. Results: In the present study sphenoparietal variety of pterion was predominant and the incidence of epipteric bone was 11.73%. Conclusion: Knowledge of the presence of epipteric bones are important to prevent complications during burr hole surgery and to prevent misdiagnosis of fracture skull at the site of pterion.
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Skin is well recognized as an important somatic mirror of one's emotion and a site for the discharge of one's anxieties. We present a case of a 42-year-old female patient presenting with a vague history of generalized body pain and skin lesions in the form of cotton threads buried under the skin, crusted plaque, multiple keloids and rusted pin buried through the skin mostly in the easily accessible areas of the body. Histopathology from the crusted plaque revealed foreign body granuloma. To satisfy her psychological or emotional need, it is the deliberate and conscious production of self-inflicted skin lesions through overvalued ideation of acupuncture on her part.