Establishment Of Treatment Protocols Research Articles

Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S.

Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant. We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints. A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three. The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care.

Pattern, Management, and Outcomes of Chest Injury At Kilimanjaro Christian Medical Centre.

Chest trauma is a major cause of morbidity and mortality in the region. Lacking data in our environment has been a challenging part of knowing the burden of the problem. Long hospital stays and associated injuries are an essential measure of morbidity. The study results will provide a basis for planning prevention strategies and establishment of treatment protocols. To determine the prevalence, pattern, and management outcomes of chest injury patients at Kilimanjaro Christian Medical Center (KCMC), a Tertiary Hospital in Northern zone Tanzania from October 2021 to April 2022. A hospital-based cross-sectional study was conducted among patients with chest injuries who were admitted and managed at Tertiary Hospital Northern Zone (Kilimanjaro Christian Medical Center-KCMC) in the Emergency medicine and General Surgery departments. Using a designated data collection tool, details of the mechanism of injury, radiological and laboratory investigations, management, and outcomes were recorded. A total of 114 chest injury patients were studied. Males outnumbered females by a ratio of 7.14:1. Their ages ranged from 2 to 83 years (mean = 36.18 years). The Majority of patients (95.58%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 65.79% of patients. Lung contusion, hemothorax, and rib fractures were the most common type of injuries accounting for 54.4%, 27.2%, and 21.1%, respectively. Associated injuries were noted in 85.7% of patients, and head injury (60.5%) was found in most patients. The Majority of patients (60.5%) were treated successfully with a non-operative approach. Underwater seal drainage was performed at (38.9%). One Patient (0.9%) underwent a thoracotomy. 14% of patients had complications of surgical site infection, and 69% were found in the Majority of patients. The median length of hospital stay was 4.5 days. The mortality rate was 21. Motor traffic crash was the principal cause of chest trauma. Young male patients were most affected by chest trauma and the majority of patients were treated conservatively. Chest X-ray remains to be the main imaging modality for diagnosing thoracic trauma lesions. Associated injuries such as head injuries, were found to contribute to a high mortality rate.

What the time has taught about Hyperteleorbitism

Introduction: Hypertelorbitism is a clinical feature that may be present in various types of pathologies and degrees of manifestation. Observing the evolution of techniques over time and understanding the specific characteristics of each case demonstrates the difficulty of establishing treatment protocols.
 Material and method: Retrospective analysis of over 150 cases of hypertelorbitism operated on over 44 years by the main author. The increased interorbital distance had varied etiologies: dysplasia, meningoencephaloceles, and dysostosis. 
 Results: Retrusion of the facial middle third throughout growth in congenital hypertelorbitism was present in both dysplasia and dysostosis groups. In cases of early treatment with Tessier's glasses osteotomy there was zygomaticmaxillary atrophy with trapping of tooth germs. The cases of grade III and IV Hyperteleorbitism, with or without meningoencephalocele, which were treated without concomitant skullcap expansion, evolved to endocranial hypertension and required further treatment. Retrospective evaluation of their CT scans revealed craniosynostosis of one or more sutures, associated with predominant dysplasia. Patients treated after adolescence showed more stable late postoperative results.
 Discussion: Hypertelorbitism is a clinical feature that may be present in various types of pathologies and in varying degrees of intensity. Many treatment options have been proposed over the past 50 years. The opportunity to watch and experience the evolution of these techniques made it possible to choose the most appropriate treatment for each patient's clinical characteristics.
 Conclusion: Due to the variability of manifestation of hypertelorbitism, the massification of procedures and the establishment of treatment protocols are quite limited.