The Indus Hospital and Health Network formerly Indus Hospitals is a tertiary care multidisciplinary hospital and healthcare system in Pakistan. Construction began in 2004 and it opened in July 2007. It is located in Korangi. It is the first paperless hospital in the country; the hospital has an e-cardiology system.It is privately run but offers services free of charge. The idea of a "free public hospital" was conceived by four medical students after they visited the 1987 Bohri Bazaar bomb blast site and experienced much frustration by the limited capacity of the nearby Civil Hospital Karachi's emergency ward.
Background Anthropometry and biochemical parameters as diagnostic measures of metabolic syndrome (MetS) are of high repute in clinical settings. However, statistics capable of predicting MetS explicitly in young adults are the least discussed in the literature. We, therefore, aimed to establish the profile and identify the associated predictors of MetS among young adults enrolled in a public medical institute in Quetta city, Pakistan.Methods This was a cross-sectional study. Along with the demographics, anthropometric measures were examined as per World Health Organization' criteria. Biochemical measures were assessed using standardized protocols. In addition to the non-parametric tests, the binary logistic regression was used to identify the predictors of MetS. For all analyses, p < 0.05 was taken significantly.Results Three hundred and fifty-one young adults responded to the study with a response rate of 77.1%. Majority of the respondents were females (55%) with 19 years age (82.1%) dominating the cohort. Almost 50% of the respondents had higher triglyceride levels and high-density lipoproteins were below normal in 42.7%. Nearly 31% were obese and 25% had higher HbA1c. Logistic regression analysis revealed fourteen independent variables that accounted for 75.2% of the model explanation. Glycated haemoglobin and body mass index were identified as significant predictors of MetS (adjusted OR = 5.014, p < 0.001 and adjusted OR = 3.323, p < 0.042, respectively). An increase in HbA1c level and body mass index of one point was associated with the development of MetS by a factor of 5.014 and 3.323 respectively.Conclusion The prevalence of MetS was high, whereas HbA1c and BMI were shaped as predicting factors of MetS. Therefore, while addressing MetS-related issues among young adults, healthcare and preventive professionals, and policymakers should consider the identified factors while designing individualized or targeted interventions.
Introduction Heart failure, opioid overdose, and cardiac arrest remain major causes of mortality in the U.S. While deaths from heart failure and cardiac arrest have declined, opioid-related deaths have surged. Disparities based on sex, ethnicity, and geography remain poorly described. Understanding these factors can help identify at-risk populations. Hypothesis Mortality from heart failure, opioid overdose, and cardiac arrest varies over time and region, with significant disparities by sex, race/ethnicity, urbanization, and place of death. Method We examined mortality trends for heart failure, opioid overdose, and cardiac arrest (1999-2020) using CDC-WONDER data. ICD-10 codes classified cases: F11.1, F11.2, F11.9 for opioid use disorder; I50.9 for heart failure; I46.9 for cardiac arrest; and T40.0-T40.6 for opioid-related poisoning/overdose. Join point regression estimated APC and AAPC, with stratified analysis by age, sex, race, region, urbanization, and death location. Results Between 1999-2020, 8,157,352 deaths occurred from heart failure and cardiac arrest, including 8,591 opioid-related deaths. AAMR for heart failure and cardiac arrest declined from 208.72 (1999) to 191.14 (2020) (AAPC: -0.64%; 95% CI: -1.07, -0.22), while opioid-related AAMR increased from 0.05 to 0.46 (AAPC: 11.00%; 95% CI: 10.00, 13.00). Males experienced a greater AAMR increase (0.07 to 0.62, AAPC: 9.62%) than females (0.05 to 0.30, AAPC: 10.12%). Regionally, the West had the highest AAMR in 1999 (0.13), while the South had the lowest (0.03). By 2020, the Midwest had the highest AAMR (0.53), while the South remained the lowest (0.38). The Midwest had the steepest increase (APC: 14.29%), whereas the South saw fluctuations (APC: 28.73% from 2014-2017, followed by a decline of -3.47% from 2017-2020). Among racial groups, NH White and NH Black populations had AAPCs of 10.80% (95% CI: 9.60, 12.04) and 9.70% (95% CI: 6.33, 13.20), respectively. Urban areas had a higher increase (APC: 15.17%) than non-metro areas (APC: 9.22%). Among age groups, 65-74 years had the highest increase (APC: 21.92%; 95% CI: 17.82, 26.17), while 75-84 years declined (APC: -16.57%). The highest crude mortality rate was in the 35-44 years group (0.11 in 1999, 0.57 in 2020) and the lowest in the 65-74 years group (0.37 in 2020). Conclusion While heart failure and cardiac arrest mortality declined, opioid-related deaths increased sharply, with significant disparities by sex, region, and urbanization level. Between 2019-2020, COVID-19 exacerbated opioid overdose and heart failure mortality trends. These findings underscore the critical influence of socioeconomic factors and healthcare access, highlighting the need for targeted public health interventions.
Typhoid has been a major infectious health threat for the masses in Pakistan with increasing antimicrobial resistance, socio-economic decline, and environmental challenges. Since 2019, the percentage of cases has reduced with the implementation of Typhoid Conjugate Vaccine (TCV) program but reports of widened geographical spread particularly as aftermath of flooding in 2022 and resistance to Azithromycin or Meropenem in adult population are a matter of serious concern. Now is the right time to reconsider whether strategies like mass immunization or health infrastructure development solely can combat the hazards of Extensively Drug-Resistant (XDR)-Typhoid. Public health policies developed due to COVID-19, such as incorporating all stakeholders especially the public through community engagement, may provide a collaborative effort to lessen the prevailing threat of antibiotic resistance.
Background/ObjectivesThere is no specialist retinoblastoma (Rb) treatment centre in Afghanistan. We aimed to describe the first-year experience and outcome of referring Afghani children with Rb to Pakistan for treatment via the Afghanistan-Pakistan Rb "Silk-Road" referral pathway.MethodsA 12-month prospective analysis (January 2023-January 2024) was conducted on children with suspected Rb presenting at National Organisation for Ophthalmic Rehabilitation (NOOR) eye care centres. Online consultations with specialists from the Rb-NET were used to confirm Rb diagnoses, and eligible patients were identified for referral to Rb treatment centres in Pakistan. Data on clinical presentation and outcomes were recorded using a structured Microsoft Excel spreadsheet, which was monitored by the entire team to ensure accuracy and completeness. The primary outcomes included successful transfer to Rb treatment centres in Pakistan and child survival at 1-year follow-up. Secondary outcomes focused on identifying barriers to successful patient transfer.ResultsOf the 23 children included in the study, 12/23 (52%) were referred due to leukocoria, 11/23 (48%) were female, 7/23 (30%) presented with bilateral Rb, and none had familial Rb. Overall, 5/23 (22%) children were diagnosed with extraocular disease, and 6/23 (26%) had distant metastases at the time of diagnosis. Only 9/23 (39%) children successfully reached Rb treatment centres in Pakistan. At the last follow-up, 5/23 (22%) children had died, 6/23 (26%) were confirmed alive, and 12/23 (52%) were lost to follow-up. The most common obstacles to patient transfer included difficulty crossing the Afghani/Pakistani border (12/23; 52%) and economic barriers (11/23; 48%) throughout the referral process.ConclusionsThis report highlights the immense difficulties in improving child survival from a treatable childhood cancer in a country with poor health care systems. The first-year experience of this referral pathway offers valuable lessons, which can guide the creation of a dedicated Rb treatment centre within Afghanistan.
e23508 Background: Bone and articular cartilage malignant neoplasms are rare, yet they contribute an important contribution to the overall morbidity and mortality brought about by cancer globally. Geographical and socioeconomic factors have been linked with variations in the disease burden of these cancers, which primarily impact the skeleton and joints. From 1990 to the year 2021, this study focuses on worldwide variations in the number of cases of cartilage and bone cancers. Methods: 204 different countries and territories' datasets from the Global Burden of Disease (GBD) 2021 study have been reviewed over a 31-year timeframe. Linear regression was used on the Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLLs), Age-Standardized Mortality Rates (ASMRs), and Years Lived with Disability (YLDs) to determine the Average Annual Percent Changes (AAPC). Results: The analysis revealed regional differences in the burden of bone and cartilage malignancies. The regions with the highest positive AAPC in ASMR included Saint Vincent and the Grenadines (3.59), China (3.27), and Puerto Rico (2.65). Conversely, countries with the steepest declines in ASMR included the Russian Federation (-4.51), Estonia (-3.75), and the Republic of Moldova (-3.60). The global ASMR for bone malignancies declined with an AAPC of -0.72%. For DALYs and YLLs, the global AAPC was -0.54% and -0.59%, respectively. Increases in DALYs and YLLs were observed in countries such as Guyana (DALY: 4.14, YLL: 4.11) and Zimbabwe (DALY: 3.11, YLL: 3.14). In contrast, declines were recorded in Norway (DALY: -5.42, YLL: -5.55) and Costa Rica (DALY: -2.48, YLL: -2.58). The trend in YLDs showed a global increase with an AAPC of +0.09%. The largest increases in YLDs were seen in Guyana (YLD: 4.74) and Mauritius (YLD: 3.54), while Norway (-4.40) and Saint Vincent and the Grenadines (-1.57) showed reductions. Conclusions: Despite the relatively small incidence rates, the global burden of bone diseases, as gauged by ASMR, DALY, and YLL, has steadily decreased in recent decades. Saint Vincent and the Grenadines, and China, identified among the increasing regions, may benefit from further investigation into the disease burden trends. Further studies should focus on identifying factors contributing to these changes. Outcome Global AAPC (95% CI) P-value Highest Increase AAPC (95% CI) Highest decline AAPC (95% CI) (Lowest) ASMRs -0.55 (-0.62 to -0.48) < 0.001 Saint Vincent and the Grenadines 3.59 (2.00 to 5.18) Russian Federation -4.51 (-5.10 to -3.92) DALYs -0.54 (-0.59 to -0.49) <0.0001 Saint Vincent and the Grenadines 4.23 (2.44 to 5.87) Estonia -3.65 (-4.12 to -3.18) YLLs -0.59 (-0.64 to -0.53) <0.0001 Saint Vincent and the Grenadines 4.11 (2.41 to 5.84) Russian Federation -5.55 (-5.96 to -5.14) YLDs 0.09 (0.04 to 0.14) 0.001 Saint Vincent and the Grenadines -1.57 (-2.10 to -0.50) Norway -4.40 (-4.87 to -3.93)
