Essential Diagnostic Test Research Articles

Impact of insurance status on MRI phenotypes in MS

BackgroundHealth insurance in the United States varies in coverage of essential diagnostic tests, therapies, and specialists. Health disparities between privately and publicly insured patients with MS have not been comprehensively assessed. The objective of this study is to evaluate the impact of public versus private insurance on longitudinal brain outcomes in MS. MethodsLesional, thalamic, and gray and white matter volumes were extracted from longitudinal MRI of 710 MS patients. Baseline volumes and atrophy rates of lesional, thalamic, and gray and white matter volumes were compared across insurance groups. ResultsAfter image quality assessment, 376 (284 private / 92 public), 638 (499 / 139), and 331 (250 / 81), patients were in MS lesion, thalamic, gray and white matter analyses respectively. Baseline lesion volume was higher for publicly insured patients but increased at a slightly higher rate in those privately insured (p = 0.01). Baseline gray matter measurements were lower for patients with public insurance, but thalamic (p < 0.01) and gray matter (p < 0.01) atrophy rates were slightly higher in the private insurance group. ConclusionInsurance type was associated with lesion, thalamic, and gray matter volumes. The results suggest that patients with public insurance may present with more advanced disease.

Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview.

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.

Cervical Cancer Prediction Using Machine Learning

Cervical cancer constitutes a profound global health challenge, affecting a substantial number of women annually. If this cancer is not diagnosed and attended with hypervigilance, it can spread to other body parts, damage tissues, and typically deteriorate the immune system of the body. This ultimately becomes deadly and, in many cases, non-curable. This research paper looks into machine learning used to predict cervical cancer. The 5-year relative survival rate after the spread of the disease is almost 50%. Hence, detecting the tumor in advance can prevent its proliferation and consequently assist in the process of curing the disease. &#x0D; The study emphasizes the global impact of cervical cancer, shedding light on its prevalence and its connection to the human papillomavirus (HPV). In a managerial but approachable manner, this research discusses the factors like weakened immune systems, smoking, and contraceptive use that contribute to the risk of cervical cancer. Four essential diagnostic tests—Hinselmann, Schiller, Citology, and Biopsy—are discussed as integral components of the predictive model. Diverse Machine Learning algorithms used show promise in enhancing accuracy for early cervical cancer prediction. With potential implications for public health, this paper concludes by providing insights into future research directions.

Differences in integrated assessment and management of non-communicable diseases (NCDs) for people with HIV across the WHO European region.

We aimed to assess the extent of integration of non-communicable disease (NCD) assessment and management in HIV clinics across Europe. A structured electronic questionnaire with 41 multiple-choice and rating-scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March-May 2023. One response per clinic was collected. In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow-up responded. Thirty-seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55-95%; and 70%, IQR: 50-88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85-100%) and metabolic disorders (90%, IQR: 75-100%) were regularly assessed, while mental health (72%, IQR: 63-85%) and pulmonary diseases (52%, IQR: 40-75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%). Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests.

Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey

BackgroundInvasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. MethodsThe Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. ResultsInitial data was collected from 48 African countries covering 99.65 % of the population. Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population >850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. ConclusionsThere are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies.

Out-of-Pocket Expenditure in Hypertension Related Care in India: Estimates from National Sample Survey 2017-18

Background: Studies estimating treatment cost associated with hypertension care in the Indian context are limited and show considerable variations. Objective: To estimate the extent of out-of-pocket expenditure (OOPE) for hypertension care at the population level and its financial impact on households in India. Methods: We analysed the data of the 75th round of the of NSSO survey (India) on the social consumption of health care conducted in 2017-18. OOPE was assessed after deducting the amount reimbursed by insurance from the total medical expenditure per episode of hypertension-related hospitalisation and outpatient visit during the survey period. OOPE for hypertension care was considered catastrophic if exceeding 10% of the household’s monthly per capita expenditure. The determinants of catastrophic health expenditures were examined using a multivariate logistic regression analysis. Results: A total of 1,351 and 6,379 individuals reported hypertension-related hospitalization and outpatient care, respectively, in the survey. The overall hypertension-related hospitalization rate was 54 per 100,000 persons. OOPE associated with hypertension-related hospitalisation were on an average INR 3,491 (SD 6,176) and INR 24,565 (SD 37,343) in public hospitals and private hospitals, respectively. The OOPE for hypertension related to outpatient visit was INR 277 (SD 571) in public facilities but was in the range of INR 457 (SD 556) – INR 695 (SD 1,431) based on the type of private hospitals/clinics. OOPE on medicines constituted on an average 43% (95% CI: 32-52%) and 66% (95% CI: 54-64%) of public sector hospitalisation and outpatient care respectively. The risk of catastrophic expenditure due to hypertension care was 41% among the poorest households. Conclusion: Direct expenses on drugs and diagnostic tests contribute significantly to OOPE. The on-going public health efforts towards controlling hypertension need to ensure better access to essential hypertensive drugs and diagnostic tests in public facilities.

P366 Developing an in-house and integrated sweat testing service for the routine management of adults with cystic fibrosis

Since 1959, the sweat test has become an essential diagnostic test for cystic fibrosis (CF). In 2012, the CFTR potentiator, ivacaftor became available on the National Health Service (NHS) in England. Commissioning guidance advised that all eligible patients should have a sweat test within 6 months of starting treatment and then at least annually. Historically at Leeds Teaching Hospitals NHS Trust, sweat tests were performed by the biomedical team.

Application of Precordial Lead ECG SafOne to Patients with Cardiovascular Disease: Evidence-based Practice

Electrocardiography (ECG or EKG) is one of the essential cardiac diagnostic tests to record the heart’s electrical activities. However, errors in precordial lead placement causes invalid ECG recordings. The invention of precordial lead ECG SafOne aims to reduce these errors. This study aimed to apply the precordial lead ECG SafOne to patients with cardiovascular diseases and compare it to the standard ECG in relation to the presence of artefacts and placement time duration. This study employed the experimental research design with a post-test-only equivalent control group approach with a sample size of 60 outpatients undergoing an ECG test. Data on artefacts and placement time duration from ECG SafOne and standard ECG were identified and measured. Data were analyzed using descriptive statistics and the Wilcoxon test to examine the difference in all the variables collected. The results showed no substantial difference related to the artefacts emerging from ECG SafOne and standard ECG with a p-value of 0.083 (&gt; 0.005). In addition, placement time duration using ECG SafOne is faster than standard ECG (p=0.000). To conclude, ECG SafOne is more practical and efficient than standard ECG. This tool produces ECG recordings with no significant difference from standard ECG. Therefore, ECG SafOne is applicable for electrocardiography recording for patients with cardiovascular diseases.&#x0D; Keywords: cardiovascular diseases, electrocardiography, diagnostic test, SafOne, precordial lead

Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique.

To tackle the increasing burden of non-communicable diseases (NCDs) and reduce premature cardiovascular (CV) mortality by a third by the year 2030, countries must achieve 80% availability of affordable essential medicines (EMs) and technologies in all health facilities. To evaluate access to EMs and diagnostics for CV diseases in Maputo City, Mozambique. Using a modified version of World Health Organization (WHO)/Health Action International (HAI) methodology, we collected data on availability and price of 14 WHO Core EMs and 35 CV EMs in all 6 public-sector hospitals, 6 private-sector hospitals, and 30 private-retail pharmacies. Data on 19 tests and 17 devices were collected from hospitals. Medicine prices were compared with international reference prices (IRPs). Medicines were considered unaffordable if the lowest paid worker had to spend more than one day's wage to purchase a monthly supply. Mean availability of CV EMs was lower than that of WHO Core EMs in both public (hospitals: 20.7% vs. 52.6%) and private sectors (retail pharmacies: 21.5% vs. 59.8%; hospitals: 22.2% vs. 50.0%). Mean availability of CV diagnostic tests and devices was lower in public (55.6% and 58.3%, respectively) compared to private sector (89.5% and 91.7%, respectively). Across WHO Core and CV EMs, the median price of lowest priced generic (LPG) and most sold generic (MSG) versions were 4.43 and 3.20 times the IRP, respectively. Relative to the IRP, median price of CV medicines was higher than that of Core EMs (LPG: 4.51 vs. 2.93). The lowest paid worker would spend 14.0 to 17.8 days' wage monthly to undergo secondary prevention. Access to CV EMs is limited in Maputo City owing to low availability and poor affordability. Public-sector hospitals are not well equipped with essential CV diagnostics. This data could inform evidence-based policies for improving access to CV care in Mozambique.

The "ready-to-hand" test: Diagnostic availability and usability in primary health care settings in Sierra Leone.

This article assesses the availability of essential diagnostic tests in primary health care facilities in two districts in Sierra Leone. In addition to evaluating whether a test is physically present at a facility, it extends the concept of availability to include whether equipment is functional and whether infrastructure, systems, personnel and resources are in place to allow a particular test to be "ready to hand", that is, available for immediate use when needed. Between February 2019 and September 2019, a cross-sectional mixed-methods survey was conducted in all 40 Community Health Centres (CHCs) in Western Area, one of five principal divisions in Sierra Leone. The number of rapid diagnostic tests (RDTs) available ranged from 1-12, with 75% of facilities having 9 or less RDTs available out of a possible 17. While RDTs were overall more widely present than manual assays, there was wide variation between tests. The presence of RDTs at individual facilities was associated with having a permanent laboratory technician on staff. Despite CHCs being formally designated as providing laboratory services, no CHC fulfilled standard World Health Organisation (WHO) criteria for a laboratory. Only 9/40 (22.5%) CHCs had a designated laboratory space and a permanently employed laboratory technician. There was low availability of essential equipment and infrastructure. Supply chains were fragmented and unreliable, including a high dependency (>50%) on informal private sources for the majority of the available RDTs, consumables, and reagents. We conclude that the readiness of diagnostic services, including RDTs, depends on the presence and functionality of essential infrastructure, human resources, equipment and systems and that RDTs are not on their own a solution to infrastructural failings. Efforts to strengthen laboratory systems at the primary care level should take a holistic approach and focus on whether tests are "ready-to-hand" in addition to whether they are physically present.

Prevalence and Missed Cases of Respiratory Distress Syndrome Disease Amongst Neonatal Deaths Enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) Program Between 2017 and 2021

Objectives. To describe RDS in neonatal deaths at the CHAMPS-Kenya site between 2017 and 2021. Methods. We included 165 neonatal deaths whose their Causes of death (COD) were determined by a panel of experts using data from post-mortem conducted through minimally invasive tissue specimen testing, clinical records, and verbal autopsy. Results. Twenty-six percent (43/165) of neonatal deaths were attributable to RDS. Most cases occurred in low birthweight and preterm neonates. From these cases, less than half of the hospitalizations were diagnosed with RDS before death, and essential diagnostic tests were not performed in most cases. Most cases received suboptimal levels of supplemental oxygen, and critical interventions like surfactant replacement therapy and mechanical ventilation were not adequately utilized when available. Conclusion. The study highlights the urgent need for improved diagnosis and management of RDS, emphasizing the importance of increasing clinical suspicion and enhancing training in its clinical management to reduce mortality rates.

Testing modalities for ALK-driven lung cancer: A narrative review

ABSTRACT Anaplastic lymphoma kinase (ALK) rearranged non-small-cell lung cancer (NSCLC) comprises a distinct molecular entity with a reported global prevalence of 5–7%. The development and rapid approvals of small molecule ALK tyrosine kinase inhibitors (TKIs) have led to the development of diagnostic strategies with robust methodology and superior attributes. Owing to myriad alterations which can be present in the ALK gene in NSCLC, it is important to understand the principal attributes as well as limitations of each to aid in optimal therapeutic decision making. To prepare this review, we used the keywords, “ALK detection,” “ALK NGS,” “ALK TKI,” and “EML4 (echinoderm microtubule-associated protein-like 4)-ALK,” to search within scientific databases like Scopus, PubMed, and Embase. We chose 55 articles that we identified from this search. Detection of ALK is an essential frontline diagnostic test as per all international and national recommendations. The various modalities available include immunohistochemistry, fluorescence in situ hybridization, reverse transcriptase polymerase chain reaction, and DNA/RNA-based next-generation sequencing. Each has its own advantages and limitations with respect to test metrics like sensitivity and specificity, as well as ease of use, availability, and cost. This is a detailed review of these various techniques and their attributes.

PS-P07-6: ACCESS TO ESSENTIAL MEDICINES AND DIAGNOSTIC TESTS FOR HYPERTENSION AND HEART FAILURE IN MAPUTO CITY, MOZAMBIQUE

Objective: To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique. Design and method: In a cross sectional survey, using a modified version of World Health Organization (WHO)/Health Action International methodology, data from a representative sample comprising 6 public and 6 private sector hospitals and 30 private sector retail pharmacies was collected. Upon reviewing WHO Model EM List (EML), Priority Medicines for Children and Women list, Mozambique National EML and guidelines, 50 EMs, including 14 WHO Core and 36 cardiovascular diseases (CVD) EMs were selected. Of those, data for 19 EMs (including different formulations and dosages) for management of hypertension and HF are presented here. Data on 19 diagnostic tests and 17 devices was collected from hospitals. Availability was calculated as percentage of surveyed facilities where a medicine or diagnostic tool was found on the day of survey. Median price ratio (MPR) refers to median consumer price of a medicine compared to respective international reference price (IRP). Medicines were considered unaffordable if to purchase a monthly supply, the lowest paid government worker had to spend more than one day wage. Results: Mean availability of anti hypertensive and HF medicines combined was far below WHO target (80%), both in private (retail: 35.0%, hospital pharmacies: 30.6%) and public sectors (hospital pharmacies: 27.8%). Only two surveyed medicines were available in over 80% of public-sector hospital pharmacies. Most (11/19) medicines were available in less than 50% of retail pharmacies. Median MPR (range) of medicines was high [Lowest Priced Generic (LPG): 3.2 (0.98;19.84); Most Sold Generic (MSG): 4.8 (1.67;19.98)] compared to WHO recommendation (no one should pay greater than 4 times the IRP). LPG versions above that recommendation included amlodipine, enalapril, spironolactone. The lowest paid worker, on average, would spend more than one day wage to purchase a monthly supply of most EMs. Mean availability of CVD diagnostic tests and devices was lower in public (54.6% and 61.1%, respectively) compared to private (89.5% and 91.7%, respectively) sector. Conclusion: Access to EMs for management of hypertension and HF is very limited in Maputo City, characterized by high prices, low availability and affordability. Access to CVD diagnostic tests and devices is particularly low in public-sector. These data raise important concerns and may guide policies and interventions for improving access to cardiovascular care and serve as benchmark for future comparations.

Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa

To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model meta-analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8%-49.2%, I2 = 95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3%-39.9%, I2 = 91.6%), premixed insulin 49.4% (95% CI: 24.9%-73.9%, I2 = 90.57%), glibenclamide 55.9% (95% CI: 43.8%-68.0%, I2 = 96.7%), and metformin 47.0% (95% CI: 34.6%-59.4%, I2 = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%-61.1%, I2 = 97.43%), for HbA1c 24.6% (95% CI: 3.1%-46.1%, I2 = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%-51.9%, I2 = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7-7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7-0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin. The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.

Gorlin Goltz Syndrome- A Rare Disease Reported In Bangladesh

Gorlin-Goltz syndrome is an infrequent multisystemic disease with an autosomal dominant trait with complete penetrance and various expressivity. Gorlin Goltz Syndrome is a rare autosomal characterized by an increased predisposition to basal cell carcinoma and associated with multiorgan anomalies having a high level of penetrance. We report here a 60-year-old patient with positive findings of Gorlin-Goltz Syndrome.The following report emphasizes the identification of all the essential clinical diagnostic criteria ,radiological manifestations, and possible genetic tests to be performed for setting up an adequate treatment plan. Update Dent. Coll. j: 2022; 12(2): 32-36

Epidemiological study of human brucellosis among febrile patients in Erbil-Kurdistan region, Iraq.

Human brucellosis is one of the most common zoonosis infections, with an important impact on the health and economy worldwide. This study aimed to update and provide epidemiological information on this infection and evaluate Rose Bengal Test, which is used as an essential diagnostic test for brucellosis in Erbil. A total of 325 participants seeking care and reporting fever at Rizgary Teaching Hospital were enrolled. Blood samples were tested for Brucella spp. antibodies using Rose Bengal Test and blood culture followed by species identification. A questionnaire was administered to detect the risk factors. The prevalence of probable and confirmed brucellosis was 12.3% (95% CI 9.2-16.3) and 9.5% (95% CI 6.8-13.2) respectively. The majority of cases were in the age group of 18-39 years. Brucellosis was significantly associated with raw milk consumption (OR = 10.3 95% CI 5-22.4) and contact with livestock (OR = 11.5 95% CI 5.6-23.9). Brucella melitensis (58.1%) and Brucella abortus (41.9%) are the dominant species in the area. The sensitivity, specificity, positive predictive value, and negative predictive value of the Rose Bengal Test in comparison to the blood culture were 100%, 96.9%, 77.5 %, and 100% respectively. Brucellosis is a significant cause of fever in Erbil and could be diagnosed by the Rose Bengal Test taking into account the compatibility of clinical features with the positive result. The vaccination of livestock and boiling or pasteurization of milk are essential procedures to reduce the frequency of human brucellosis.

Defining availability of 100 essential diagnostic items for children with cancer and gaps in implementing WHO recommendations: Global CEDx Working Group survey

WHO has established recommendations to guide governments' prioritisation of essential diagnostic tests, technologies, and priority medical devices for patients with cancer. Despite many countries committing to expanding resources for children with cancer since the WHO Global Initiative for Childhood Cancer was launched in 2018, data on the availability of essential diagnostics and on local awareness and adoption of WHO recommendations in low-income and middle-income countries are scarce. A purposive group of providers and policy makers was invited to review national interventions for access to diagnostics as part of their national cancer control plan or involvement in the WHO Global Initiative for Childhood Cancer. More than 800 diagnostic items (ie, diagnostic tests and diagnostic devices or equipment) from WHO recommendations for priority medical devices for cancer and essential in-vitro diagnostics list were iteratively summarised into 100 items relevant for children with cancer. A survey (in English, Spanish, French, and Russian) was developed to assess diagnostics availability and COVID-19 impact on access; out-of-pocket needs, or financial burden on families to pay for diagnostics; perception of the WHO recommendations with respect to completeness and relevance, use and usefulness for children with cancer; and factors affecting recommendation adoption and implementation. 380 participants from 16 low-income and middle-income countries in six WHO regions (Costa Rica, Dominican Republic, El Salvador, Ghana, Guatemala, Haiti, Honduras, Morocco, Myanmar, Nicaragua, Panama, Peru, Philippines, Sri Lanka, Ukraine, and Zambia), were invited. The median response rate across the 16 countries was 80%. 231 (80%) of 289 eligible respondents were multidisciplinary clinicians (including 101 paediatric haematologist-oncologists), and 58 (20%) self-identified primarily as administrators, non-governmental organisation representatives, and policy makers. Although some diagnostic items were not available in all settings, disparities were evident. Diagnostic items were significantly more available in the private than in the public setting across all three categories of laboratory and pathology (+25%), surgery and anaesthesia (+19%), and imaging (+43%; p<0·0015 for all categories). Most respondents indicated that at least one in four patients were affected by varying availability of diagnostic items, and that families paid out-of-pocket for essential diagnostic items. Top-ranked priorities by respondents included addressing access to advanced and basic diagnostics, delays in tests, and families' need to pay out-of-pocket. 119 (85%) of 140 eligible respondents considered that the 100 distilled core items reflected a complete list for laboratory and pathology, surgery and anaesthesia, and imaging. Although 69 (87%) of 79 respondents and 155 (90%) of 172 respondents found WHO recommendations useful and relevant, 228 (83%) of 276 had little previous familiarity with the recommendations, and only 82 (29%) of 278 had previously used them, mainly as personal references. Top factors affecting adoption and implementation of WHO recommendations included awareness and ease of extracting and applying recommendations to childhood cancer and to local contexts. This study established the availability of a core set of 100 essential diagnostic items recommended by WHO in low-income and middle-income countries in different phases of expanding access to care for children with cancer. A scarcity of essential laboratory and pathology, surgery and anaesthesia, and imaging diagnostics in all settings were identified, as well as a disproportionate lack of access for patients in the public setting, further disrupted by the COVID-19 pandemic. This study explored local awareness and factors affecting adoption and implementation of WHO recommendations and priorities for policy action. Our findings point to the utility of an essential diagnostics list for children analogous to WHO's essential medicines list. American Lebanese Syrian Associated Charities and St Jude Children's Research Hospital.

Case report of multiple concomitant infections (HCV, HEV, Typhoid and Oral thrush) and their treatment challenges in a developing country

It is important to diagnose multiple infections timely, to avoid potential treatment complications. We report a case here with multiple infections, admitted to the ICU of a private healthcare facility, for ventilatory support. On admission, he had reactive hepatitis E and hepatitis C, was suspected of oral thrush, acute and chronic typhoid associated with headache, fever for one month, nausea for the last three days, yellow colored urine for seven days, and difficulty breathing. He was treated for four days, and afterward, removed from hospital care without the consent of the doctor in-charge while his condition was not stable. Several essential diagnostic tests were recommended but were not provided for by the caretakers. Unfortunately, the telephonic follow up brought the news of his sad demise a day after his discharge from the hospital. Poor financial conditions, lack of public funding, lack of awareness amongst caretakers, as well as the absence of trust in the national healthcare system, pose serious challenges for healthcare providers and lead to many such sad instances quite routinely in developing countries.

Osteoporosis del varón

Osteoporosis in men is an underdiagnosed and undertreated disease that is highly prevalent. Up to 25% of men will present with an osteoporotic fracture throughout their life. Secondary forms of the disease are common and it is necessary to rule them out in the diagnostic evaluation process. The most common secondary causes and risk factors of osteoporosis in men include various endocrine diseases (particularly hypogonadism), lifestyle-related diseases, and some pharmacological treatments. Dual-energy X-ray absorptiometry (DXA) is an essential diagnostic test. Laboratory determinations should be aimed at ruling out secondary forms of the disease. Treatment should involve optimization of calcium and vitamin D intake and correction of the etiological abnormalities identified. Bisphosphonates, denosumab, and teriparatide have been shown to be effective in increasing bone mass in these patients

Determinants of life expectancy in most polluted countries: Exploring the effect of environmental degradation.

Better understanding of the determinants of national life expectancy is crucial for economic development, as a healthy nation is a prerequisite for a wealthy nation. Many socioeconomic, nutritional, lifestyle, genetic and environmental factors can influence a nation's health and longevity. Environmental degradation is one of the critical determinants of life expectancy, which is still under-researched, as the literature suggests. This study aims to investigate the determinants of life expectancy in 31 world's most polluted countries with particular attention on environmental degradation using the World Bank annual data and British Petroleum data over the period of 18 years (2000-2017). The empirical investigation is based on the model of Preston Curve, where panel corrected standard errors (PCSE) and feasible general least square (FGLS) estimates are employed to explore the long-run effects. Pairwise Granger causality test is also used to have short-run causality among the variables of interest, taking into account the cross-sectional dependence test and other essential diagnostic tests. The results confirm the existence of the Preston Curve, implying the positive effect of economic growth on life expectancy. Environmental degradation is found as a threat while health expenditure, clean water and improved sanitation affect the life expectancy positively in the sample countries. The causality test results reveal one-way causality from carbon emissions to life expectancy and bidirectional causalities between drinking water and life expectancy and sanitation and life expectancy. Our results reveal that environmental degradation is a threat to having improved life expectancy in our sample countries. Based on the results of this study, we recommend that: (1) policy marker of these countries should adopt policies that will reduce carbon emissions and thus will improve public health and productivity; (2) environment-friendly technologies and resources, such as renewable energy, should be used in the production process; (3) healthcare expenditure on a national budget should be increased; and (4) clean drinking water and basic sanitation facilities must be ensured for all people.