Country-specific Guidelines Research Articles

Multisociety consensus recommendations on hepatitis delta virus infection.

Hepatitis D virus (HDV) prevalence data and country-specific HDV guidelines are not widely available in the Gulf Cooperation Council (GCC) states. We developed consensus recommendations to guide healthcare professionals, policymakers, and researchers in improving HDV management and patient health outcomes in three GCC states: Kuwait, Saudi Arabia, and the United Arab Emirates. A consensus panel comprising hepatology experts (n = 6) from the three GCC societies was formed. The panel identified two broader areas related to clinical practice (screening and diagnosis, and treatment and management), addressed critical questions, and developed draft recommendations in February 2024. The strength of the final set of recommendations was subjected to consensus voting in March 2024. A majority was defined a priori with a two-thirds vote (67%). The paper outlines those recommendations alongside showcasing the current epidemiology of HDV in the GCC states, emphasizing the variability in prevalence, demographic patterns, and region-specific risk factors. It also highlights the current state of screening and diagnosis practices, identifying key obstacles, such as access to advanced screening protocols and diagnostic tools. Furthermore, HDV treatment landscape and preventative strategies are outlined, focusing on vaccination, public health initiatives, and the crucial role of public awareness and education. Ethical and sociocultural considerations are discussed, underscoring the importance of culturally sensitive healthcare practices. These recommendations present a comprehensive overview of the challenges and strategies for managing HDV in these states. Policy recommendations are provided to support HDV management, including standardizing care protocols and promoting public health measures.

One-Year Insights into the GLOBOSTAD Multinational Prospective Observational Study of Patients Receiving Dupilumab for Atopic Dermatitis.

Currently, limited data are available on long-term use of dupilumab to treat atopic dermatitis (AD) in a multinational real-world setting. The aim of this analysis was to report the interim 1-year data for patients with AD enrolled in the GLOBOSTAD registry, including treatment patterns, dupilumab effectiveness and safety, and healthcare burden. GLOBOSTAD is an ongoing, 5-year, multinational, prospective, observational study of adult/adolescent (aged ≥ 12years at baseline) patients with AD who initiated dupilumab in real-world settings according to their local country-specific prescribing guidelines. Outcomes were evaluated at baseline and at 3, 6 and 12months and included Eczema Area and Severity Index (EASI) total score, SCORing Atopic Dermatitis (SCORAD) total score, percent body surface area (BSA) affected, Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI) total score for adults or Children's Dermatology Life Quality Index (CDLQI) total score for adolescents and pruritus Numeric Rating Scale (NRS) total score. At the interim 1-year cut-off (March 2023), 955 patients were enrolled in GLOBOSTAD, and follow-up data were obtained from 903 patients. After dupilumab initiation, mean improvements in effectiveness outcome measures from baseline to month 3 were EASI from 25.1 to 6.1, SCORAD 59.3 to 25.3, POEM 19.7 to 8.7, DLQI 13.7 to 5.3, CDLQI 12.2 to 2.7 and pruritus NRS 6.3 to 2.5, with each measure exceeding the minimal clinically important difference. These positive changes in effectiveness outcomes were maintained or further improved through 12months since treatment initiation. AD-related hospitalizations and emergency room or urgent care facility visits decreased from 11.1% to 1.7% from baseline to month 12. In a multinational real-world setting, dupilumab demonstrated rapid, robust and sustained effectiveness in patients with moderate-to-severe AD across multiple disease domains, including AD signs, symptoms, quality of life and emergency/urgent care visits. Safety was consistent with the known dupilumab safety profile. ClinicalTrials.gov Identifier NCT03992417.

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019).

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

Association Between Periconceptional Diet Quality and Hypertensive Disorders of Pregnancy: The Japan Environment and Children's Study.

Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non-Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women. Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country-specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73-0.94). The DASH score and HDP risk were inversely associated in a monotonic dose-response manner (aOR per 1-quintile increase in the DASH score, 0.92 [95% CrI, 0.89-0.95]). A high-quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

Running the enrollment numbers on ophthalmic clinical trials in the United States.

This is one of the first reports to summarize the enrollment metrics for ophthalmology trials completed in the United States (US). This study aimed to describe US ophthalmology clinical trial enrollment metrics to facilitate planning and budgeting of US Food and Drug Administration-regulated ophthalmological drugs trials. A GlobalData PLC search was conducted on or before February 27, 2024, to evaluate the clinical trial landscape for completed ophthalmology clinical trials conducted in the US. The primary search contained only the term "ophthalmology," which was restricted to trials that were completed and were conducted within the US. Trials were classified as multicenter when trials included three sites or more, and when the enrollment search resulted in ≥30 multicenter trials for an individual indication, enrollment data were further broken down by Food and Drug Administration trial phase. The search yielded 2229 trials, which analyzed 980 different drugs produced by 854 different sponsors. The most common indications evaluated in US trials were macular degeneration, glaucoma, macular edema, allergies, and keratoconjunctivitis. Multicenter trials by indication had an overall median enrollment period range of 4.8 to 35.1 months; number of subjects enrollment, range of 36 to 518 subjects; number of sites utilized, range of 4 to 74 sites; and enrollment rate, range of 0.11 to 4.04 subjects/sites per month. There were 17 indications with ≥30 multicenter trials, which allowed for enrollment metric calculation by trial phase. This study provides sponsors with an understanding of the number of subjects and sites needed to complete a trial while also setting realistic enrollment timelines. Although this work represents the US market, more work is needed to better understand other countries given that country-specific guidelines and subject beliefs may impact enrollment metrics.

Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews

IntroductionThe Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation...

Implementing pharmacogenetic testing to optimize proton-pump inhibitors use among Indian population based on CPIC-CYP2C19-PPI dosing guidelines: The need of the hour.

Proton-pump inhibitors (PPIs) are widely prescribed to decrease stomach acid and treat various acid-related Gastrointestinal tract (GIT) diseases. However, genetic variations, particularly in the CYP2C19 gene, affect PPIs metabolism and efficacy. Variants in CYP2C19 can result in different rates of PPI metabolism, influencing their effectiveness. Personalized medicine strategies, such as genotyping for CYP2C19, have the potential to enhance the effectiveness of PPI therapy and patient safety. This review aims to describe the relevance of CYP2C19 genetic profiling in the indian population, including normal function (e.g. CYP2C19*1, *11, *13, *15, *18, *28, and 38), decreased function (e.g., CYP2C19*9, *10, *16, *19, *25, and 26), loss of function (e.g., CYP2C19*2, *3, *4, *5, *6, *7, *8, *22, *24, *35, *36, and *37), and increased function (e.g., CYP2C19*17) variants. This review also examines the clinical pharmacogenomics implementation consortium (CPIC)-CYP2C19-PPI guidelines to highlight the importance of pharmacogenomics (PGx)-informed personalized PPI therapy for gastroesophageal reflux disease and peptic ulcer disease treatment. On average, each person in India possesses eight pharmacogenetic (PGx) variants that can be clinically significant, underscoring the need for preemptive testing. Implementing CYP2C19 genetic testing in India requires expanding laboratory capacity, increasing accessibility in primary care, increasing public awareness, collaboration between pharmacovigilance and PGx programs, investing in advanced sequencing technologies, data management systems, and integration with electronic health records and clinical decision support systems. Addressing challenges such as genetic diversity, socioeconomic factors, health-care access issues, and shortage of trained professionals is essential for implementation. Due to the lack of definitive country-specific policies and PGx guidelines from Indian drug regulatory agencies, guidelines from international consortia such as the Clinical Pharmacogenetics Implementation Consortium and drug labeling offer crucial foundational evidence. This evidence can be used to enhance patient outcomes and ensure the safe and effective use of PPIs in India.

Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia.

This study assessed antibiotic prescribing patterns in primary healthcare facilities and antimicrobial resistance (AMR) profiles of commensal Escherichia coli and enterococci isolated from pregnant women and children under 5 years of age. This cross-sectional study was conducted in Lusaka and Ndola districts of Zambia. Prescription pattern data were obtained from hospital pharmacies. Identification and antimicrobial susceptibility profiles of E. coli and enterococci were determined by conventional methods, while confirmation of both pathogens and AMR genes were determined by PCR. Data were analysed using WHONET and SPSS version 25.0. Most prescribed antibiotics at the primary healthcare facilities belonged to the Access group of the WHO Access, Watch and Reserve (AWaRe) classification. All the primary healthcare facilities adhered to the AWaRe framework of ≥60% prescribed antibiotics belonging to the Access group. However, resistance was highest in the Access group of antibiotics. E. coli resistance to ampicillin ranged from 71% to 77% and to co-trimoxazole from 74% to 80%, while enterococcal resistance to tetracycline was 59%-64%. MDR was highest in E. coli (75%) isolates, while XDR was highest in enterococcal isolates (97%). The identified AMR genes in E. coli included blaCTX-M, sul2 and qnrA, while those of enterococci included erm(B), erm(C) and erm(A). Resistance was highest in the prescribed WHO Access group of antibiotics. These findings highlight the need to use local susceptibility data to formulate country-specific treatment guidelines in line with WHO AWaRe classification and enforce regulations that prohibit easy access to antibiotics.

BRAF-Mutated Melanoma Journey in Latin America: Expert Recommendations From Diagnosis to Treatment.

• Gather a panel of Latin American experts in testing and treating BRAF-melanoma. • Describe the current landscape of BRAF-mutated melanoma in Latin America. • Outline the current gaps in testing and recommend improvements for testing and treating BRAF-mutated melanoma in the region. Melanoma prevalence in Latin America is lower than in high- and middle-income countries. However, recent data indicate that the region's incidence and mortality are rising, with more stage IV patients being diagnosed. According to international clinical practice guidelines, conducting BRAF-mutation testing in patients with stage III or stage IV melanoma and high-risk resected disease is imperative. Still, BRAF-mutation testing and targeted therapies are inconsistently available in the region. Americas Health Foundation convened a meeting of Latin American experts on BRAF-mutated melanoma to develop guidelines and recommendations for diagnosis through treatment. Some recommendations for improving diagnostics through improving access and reducing the cost of BRAF-mutation testing, enhancing efficiency in pathology laboratories, and creating country-specific local guidelines. The panel also gave treatment recommendations for neo-adjuvant therapy, adjuvant therapy, and therapy for patients with metastatic disease in Latin America.

Comparison of various protocols and dosage schedules of rituximab used by various researchers in pemphigus: A review article

Abstract Objective: To compare the effectiveness of various protocols available in literature, dose, schedules, and the side effect profile of rituximab in pemphigus (vulgaris and foliaceus) patients. Materials and Methods: Publications related to treatment with rituximab in pemphigus were identified by searches of electronic databases in PubMed from January 2002 to June 2023. A total of 43 papers, which included 35 case series and retrospective studies, four randomized control trials, and four open-label pilot studies, were analyzed, and a narrative review of the studies was presented. Results: There are a total of 13 different protocols by which the rituximab infusion has been given. The most common is the rheumatoid arthritis (RA) protocol (53.4%) followed by the lymphoma protocol (15.5%) and low-dose RA protocol (7.4%). Low-dose RA protocol showed complete remission (CR)—82.6%, relapse rate (RR)—20.4%, duration of remission (DOR)—75.95 weeks, and time to relapse—76.35 weeks, while with RA protocol, CR was seen in 78.3% patients with RR being 28.57%, DOR—79.96 weeks and time to relapse—78.38 weeks. In lymphoma protocol, we noticed CR in 66.7% of patients with RR of 32.1% while the time to relapse is 63.3 weeks. Conclusion: We have observed good results with RA protocol and low-dose RA protocol than other regimens of rituximab used to treat pemphigus vulgaris and foliaceus. However, there is a need for a multicentric trial on a large scale for detecting the effective dose of rituximab depending upon the severity of the pemphigus and will help to lay down effective protocol for induction and maintenance of disease-free period, as there are no country-specific guidelines available for the Indian subcontinent.

Challenges with Molecular Waste Management in sub-Saharan Africa – HIV Viral Load and COVID

Introduction: Waste generated from HIV viral load testing and SARS CoV-2 for diagnosis of COVID-19 contains potentially hazardous guanidinium thiocyanate. Guanidinium thiocyanate may be toxic to humans and if not properly disposed of can pollute waters and harm aquatic life. Sub-Saharan African countries are particularly challenged by limited resources to suitably manage waste generated at health care facilities and laboratories. There is a need to identify waste management challenges and develop strategies to mitigate this type of laboratory testing waste in resource limited countries. Methods: HIV viral load data used for this analysis were standardized monitoring evaluation and reporting Presidents Emergency Plan for AIDS Relief datasets for Malawi, Mozambique, South Africa, and Zimbabwe. COVID-19 data was obtained from the Johns Hopkins Coronavirus Resource Center. Discussion: Inadequate management of HIV viral load and COVID-19 guanidinium thiocyanate waste due to lack of policy, guidelines and appropriate procedures for containment, poses a significant public health threat to the environment. Recognizing this gap, the United States Centers for Disease Control and Prevention has decided to provide technical expertise, raise awareness, and work with other international partners to disseminate knowledge and find solutions for the Presidents Emergency Plan for AIDS Relief supported countries in sub-Saharan Africa. The World Health Organization guidelines on safe management of waste from healthcare activities were proposed as a starting point to develop country specific guidelines. Conclusions: The United States Centers for Disease Control and Prevention, in collaboration with other international partners, is diligently working to provide technical assistance to countries for training and development of mitigation strategies to appropriately manage guanidinium thiocyanate containing waste. Waste management is a growing problem as molecular testing for HIV, COVID-19, and other emerging diseases increase.

The Impact of Alternate Methodological and Structural Assumptions on Results of Cost-effectiveness Analysis: Empirical Evidence using Three Indian Economic Evaluations.

Despite advancement in methods and application of economic evaluations (EEs), there are several uncertainties. To assess the impact of alternate methodological and structural assumptions for four key principles of EE, on the results of cost-effectiveness analysis. Three previously published model-based EEs were used: (1) Integrated Management of Neonatal and Childhood Illnesses (IMNCIs) intervention; (2) intervention for multiple myeloma, and (3) safety-engineered syringes (SES) intervention. A series of empirical analyses was undertaken to assess the impact of alternate assumptions for discount-rate, time-horizon, study perspective, and health outcome measure, on incremental cost-effectiveness ratio (ICER), and interpretation of cost-effectiveness. Increasing discount rate resulted in an increase in ICERs, for all three case-studies; however, there was no change in the conclusions. Using shorter time-horizons resulted in a significant increase in ICERs, the multiple myeloma intervention remained cost-ineffective, SES intervention became cost-ineffective, whereas IMNCI intervention remained cost-effective, despite a three-fold increase in ICER. On using disability adjusted life years instead of quality adjusted life years, ICERs increased to 0.04, 2 and 4 times for SES, IMNCI and multiple myeloma interventions, respectively. On analyzing results from a societal perspective, a decline in ICERs was observed. The decline was significant for IMNCI where the intervention turned dominant/cost-saving. In the other two case-studies decline in ICERs was modest, 32% for multiple myeloma, and 4% for SES. We observed a significant impact of using alternate assumptions on ICERs which can potentially impact resource-allocation decisions. Our findings provide strong argument in favor of standardization of processes and development of country-specific guidelines for conduct of EE.

Optimising Preconception Care

Women with PCOS are at an increased risk of infertility and a range of pregnancy complications. It is therefore important to understand how to optimise preconception care to reduce these risks. A reproductive life plan and age-appropriate education on optimising reproductive health is recommended in adolescents and women with PCOS. This should occur across the domains of appropriate nutritional intake (dietary and supplement sources), optimising physical activity, considering the effects of excess weight on fertility and being aware of the effects of substances on fertility. Dietary intake should be consistent with population guidelines for healthy eating with appropriate intake of core food groups and limited intake of discretionary foods high in added sugar, sodium, trans and saturated fats. Recommendations exist for preconception micronutrient supplementation including folic acid and iodine (in the Australian context) with others (e.g., vitamin D, iron, calcium and B12) as per deficiencies or other country specific guidelines. Recommendations for physical activity should also be consistent with general population guidelines comprising moderate intensity physical activity of >150 minutes/week or vigorous intensity physical activity of 75 minutes/week or a combination of both, engaging in muscle strengthening activities [Formula: see text]2 days/week and minimising the amount of time spent in prolonged sitting. The association of excess weight on reduced fertility are recognised from epidemiological literature and current guidelines highlight strategies of modest weight loss at higher BMIs. This is an important and emerging field of literature where future research can elucidate efficacy in randomised controlled trials across different interventions and populations. When working with all women preconception, and in particular women with PCOS, it is important to consider weight stigma, disordered eating and eating disorders when discussing the relationship of infertility and weight and potential modification of weight. Substance use can be considered across limiting high intake of caffeine and avoiding alcohol and illicit substance intake and smoking.

Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment.

Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.

Efforts to improve the surgical outcome for exotropia and investigation of the insertion locations of the extraocular muscles.

In our previous retrospective study, we found that using the strabismus surgery dosages established by western strabismus mentors tends to result in undercorrection of Taiwanese exotropia (XT) patients compared with those in western populations. We also discovered that the location of extraocular muscle (EOM) insertion could vary by ethnicity. In this study, using a generalized estimation equation model, we compared the XT surgery outcome between augmented and original strabismus surgery dosages in Taiwanese patients. We also conducted an observational study to investigate the horizontal EOM insertion location in a Taiwanese population and compared the data with Dr. Apt L.'s study. For Taiwanese XT patients, augmented surgical dosages resulted in significantly better outcome at 6 months and 1 year postoperatively compared with original surgical dosages (p = 0.003 and p < 0.001, respectively). The distance from the lateral recuts muscle (LR) insertion location to the limbus was significantly shorter in Taiwanese than in white Americans (6.5 vs. 6.9 mm, respectively, p = 0.0001). Furthermore, the medial rectus muscle and LR insertion locations differed significantly between males and females (p < 0.001 and p = 0.023, respectively). The patients' sex did not affect the surgery outcome. Augmented surgery doses modified from western strabismus mentors produce better surgery outcome for Taiwanese XT patients. Surgeons may require country-specific guidelines for strabismus surgery dosage. We also demonstrated a simple method for young ophthalmologists to establish their own normograms to improve their surgical success rate. Our study confirms that LR insertion locations differ between Taiwanese and White Americans.

Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above.

This scientific review paper explores international and country-specific healthcare guidelines for non-communicable diseases with the highest burden among individuals aged 75 years and above. The study aims to identify the best vaccination practices and standardize healthcare practices to improve vaccination adherence in this vulnerable population. Given that older people are more prone to infectious illnesses and have higher rates of morbidity and mortality, vaccinations are essential for disease prevention. Despite the proven efficacy of vaccinations, adherence has plateaued in recent years, partly due to a lack of accessibility, public education, and variability in disease-specific guidelines. This paper highlights the need for a more robust and standardized international vaccination model to improve quality of life and reduce disability-adjusted life years among the elderly. The findings of this study call for further research to review the guidelines as more implementations are put in place, including non-English guidelines.

A Survey of National Practices of Anaesthesia for Live Donor Renal Transplantation

Objective: To compare the institutional practices among patients undergoing living-related renal transplants in different hospitals throughout Pakistan.&#x0D; Study Design: Cross-sectional survey.&#x0D; Place and Duration of Study: Armed Forces of Institute of Urology, Rawalpindi Pakistan, from Jun 2020 to Jan 2021.&#x0D; Methodology: Pakistan's leading kidney transplant centres were sent data electronically to ask about their anaesthetic practices. The methodology adopted was a simple questionnaire model that included 26 questions encompassing all the steps the anaesthesia team took for renal transplant. Uniformity in anaesthetic practices was expected in large centres through rigorous training and workload management. The teams responded according to their standard operating procedures and compared their answers using statistical formulas.&#x0D; Results: Nine out of 11(81.8%) institutes responded. Marked heterogeneity in Anaesthesia practices was found among different institutes. Only 2(18.2%) institutes had Anaesthesia guidelines for a kidney transplant.&#x0D; Conclusion: There is a need for centralized country-specific homogeneous guidelines for Anaesthesia for the kidney transplant to improve outcomes.

Appraisal of published guidelines in European countries addressing the clinical care of childhood sexual abuse: protocol for a systematic review

IntroductionChildhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators...

Consensus Recommendations of the Asia Pacific Cardiometabolic Consortium on Secondary Prevention Strategies in Myocardial Infarction: Recommendations on Pharmacotherapy, Lifestyle Modification and Cardiac Rehabilitation

Secondary prevention of acute MI, both ST elevated and non-ST elevated is essential to reduce cardiovascular mortality and hospital readmission, ensuring patients return to normality with an improved quality of life. Thus far, professional associations and country-specific guidelines have provided guidance suited to their respective populations. The Asia Pacific Cardiometabolic Consortium has developed these consensus recommendations to unify the approach to long-term care of patients after MI, which can be applied across the Asia-Pacific region. The consensus statements, which were developed by an expert panel, took into account international and local guidelines and current evidence, along with the opinions and professional experience offered by regional experts. These statements were then put to an online vote to achieve a consensus. The resulting 13 statements discuss secondary prevention strategies encompassing pharmacotherapy, lifestyle modifications, cardiac rehabilitation and discharge management for the effective long-term care of patients with a history of type 1 MI, specifically relating to atherosclerotic plaque rupture and thrombosis.

Bridging the cancer care gap and inequities in radiation treatment in India: A narrative review

Cancer is the fifth leading cause of death in India, yet India's cancer care landscape remains fragmented. In this paper, we review the current state of access to radiation therapy and the inequities involved, as well as identify potential solutions to improve access to radiation therapy in cancer. We undertook this narrative literature review, which encompassed database searches (PubMed, Embase, Scopus) and scrutiny of the grey literature (Google Scholar, OpenGrey), using the search terms: “cancer care access disparities,” “radiotherapy accessibility challenges,” “out-of-pocket expenditure in cancer treatment,” “value-based cancer care models,” “cost-effective radiotherapy strategies,”and“resource-limited cancer care solutions.” Our search strategy focused on articles addressing barriers to radiation treatment, inequities in radiation treatment equipment, and optimal radiation techniques in resource-limited settings in India, thereby identifying key challenges and potential interventions. Of the 1933 articles initially retrieved, we included 46 for the preparation of this review. Among the various modalities utilized for the management of cancer, radiation treatment is the most resource-intensive, requiring expensive and dedicated infrastructure. Scarce infrastructure, perpetuating inequities across geographical regions and socioeconomic strata, is responsible for inequities in access to radiation treatment in India. With the advent of newer radiation techniques requiring specialized equipment for the delivery of advanced radiation treatment, these inequities widen in low- and middle-income countries such as India. The challenge lies in providing affordable and equitable radiation treatment without compromising on quality within India's diverse and populous expanse. Bridging these gaps mandates the improvement of the existing infrastructure, fostering local production of quality medical equipment like linear accelerators, establishing and adhering to country-specific standardized treatment guidelines based on volumes, optimally utilizing available equipment like indigenous telecobalt machines and cost-effectiveness evidence, establishment of rural cancer care centers, optimization of private sector capacities and economic support through national insurance schemes.