Secondary Center Research Articles

P554 Assessment of corticosteroid prescribing trends and appropriateness for management of Inflammatory Bowel Disease in a secondary care centre in New Zealand

Abstract Background Corticosteroids are commonly used for inducing remission in Inflammatory Bowel Disease (IBD) but are considered ineffective for long-term maintenance1. Evaluating the appropriateness of corticosteroid usage is crucial in optimising IBD management given their common adverse effects. Methods This study aimed to assess the appropriateness of corticosteroid usage for patients with IBD in a secondary centre in New Zealand, using international standards2,3. A retrospective records’ audit was conducted in 2020, encompassing all IBD patients encountered in Nelson Hospital from 2005 to 2020. Ethical approval was obtained beforehand. The primary outcome measure evaluated was the appropriateness of corticosteroid prescriptions, in accordance with established international standards (UK2 and ECCO3). Key criteria included dosage (strength and/or duration), patient counselling on side effects and alternatives. Results We studied a group of 613 IBD patients with an average age of 55, comprising 311 males and 302 females. Crohn's Disease was the predominant diagnosis (297 cases), followed by Ulcerative Colitis (252 cases) and Indeterminate Colitis (64 cases). Of the patients included in the audit, 51.4% (315 out of 613) were prescribed steroids during the 15-year study period. Of the 315 total prescriptions, 52.1% (163) were considered inappropriate. Among these, 28.6% (90) were excessively long courses, 23.5% (74) were due to under-dosing or multiple short courses, and 6.3% (20) were because of corticosteroid dependence. Out of a total of 315 prescriptions, Gastroenterologists issued 36.5% (115), while General Practitioners were responsible for 24.1% (76). The remaining prescriptions were divided among General Surgery (9%), General Medicine (6%), and the Emergency Department (5%). Conclusion Corticosteroid prescribing for IBD patients in this secondary centre in New Zealand deviated from international guidelines, primarily in terms of dose and duration. It’s vital to adopt accessible, customized guidelines and enhance quality measures to ensure IBD patients receive evidence-based corticosteroid treatment when needed. References 1-Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 2011;106:590-599; quiz 600. 2- Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571-607. 3-Gomollon F, Dignass A, Annese V, et al. 3rd European evidencebased consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J CrohnsColitis. 2017;11:3-25

Influence of Medical Practitioners’ Attitude on the Prescription Behaviour for Generic Medicines

The study is an attempt to find out vital areas related to doctors’ attitude towards generic medicines limiting its mass use. Attitude of medical practitioners, one factor amongst several, was chosen to evaluate doctors’ behaviour towards generic medicines. Most of the countries in the world, rich or poor, are taking more interest in generic medicines due to rising healthcare costs. In India, out of pocket expenses towards healthcare costs are one of the highest in the world besides affordability issue due to its demographics. Generic medicines offer as an alternative to expensive medicines. Government is promoting use of generic medicines; doctors are being advised to write prescription in generic names; however, there are several challenges in its mass use. The study is of national importance as it addresses the issue of low generic prescriptions despite unaffordable access to expensive branded medicines. A questionnaire constructed descriptive, cross-sectional study was conducted in North India in 2020 amongst 228 medical practitioners at primary, secondary and tertiary healthcare centres. Spearman’s rank correlation computed to assess the association between attitude and prescription of generic medicines was found to be positively correlated between the two variables indicating a significant moderate association between them. Attitude of doctors towards generic medicines has been found to be playing a significant role in influencing doctors in prescribing generic medicines which explains limited use of generic drugs.

The Benefit of Open Rives-Stoppa Procedure in Complex Incisional Hernia.

Introduction: Ventral hernia is one of the most common general surgical pathologies. An incisional hernia will develop in 10–15% of patients with an abdominal incision, and the risk increases to up to 23% in those who develop surgical site infections.
 Ventral hernia repairs are mostly elective (90%) procedures, but the repair methods are highly variable.
 Popularized in Europe by Rives and Stoppa, the retromuscular technique has proven to be very effective, with a 94.2% probability of having the lowest odds for recurrence and a 77.3% probability of having the lowest odds for SSI.
 The study aimed to evaluate our experience at a secondary care center performing Rives-Stoppa repair for abdominal ventral and incisional hernias.
 Materials and Methods: Between April 2019 and August 2021, 46 patients in the practice at a secondary regional hospital, Teni Konomi, Korce, Albania, underwent a Rives-Stoppa incisional hernia repair.
 Results: There were 14 (31%) males and 32(69%) females (age range 31-75).
 Most incisional hernias were midline xiphoid-pubic incision and supraumbilical, with several subcostals (2 right and 1 left) hernias.At the time of repair, most incisional hernias were symptomatic and evident on physical exam. In four cases, the hernia sac was incarcerated at the presentation time.
 Conclusion: The Rives-Stoppa technique has excellent long-term results and low morbidity in patients with large primary or recurrent incisional hernias. It is the gold standard for most surgeons.
 Keywords: Incisional Hernia, mesh, polypropylene, abdominal wall surgery, rectus muscle

Delayed cord clamping vs cord milking in elective cesarean delivery at term: a randomized controlled trial

BackgroundDelayed cord clamping has significant beneficial effects for the neonate and its transition to extrauterine life and is therefore common practice at vaginal births in the Netherlands. In 2015, 16% of neonates were born by caesarean section, in 81% of these cases the umbilical cord was clamped and cut immediately. Neonatal benefits of delayed cord clamping are an increased circulating volume of 25-30ml/kg, leading to a higher preload of both right and left ventricle during transition from umbilical to pulmonary circulation, thus maintaining a stable left ventricle output, and to higher neonatal hemoglobin and hematocrit levels 24 to 48 hours postpartum. At present, little is known about whether the above-mentioned neonatal benefits of delayed cord clamping could apply to neonates delivered by caesarean section. In these cases, possible negative effects on neonatal outcomes (i.e., neonatal hypothermia, lower APGAR scores and hyperbilirubinemia) and maternal outcomes (i.e., increased maternal blood loss and higher postoperative infection rate) should also be taken into consideration. ObjectivesTo determine if clamping the umbilical cord after two minutes is superior when compared to cord milking during elective caesarean sections at term, taking both short and long term neonatal and maternal outcomes into consideration. Additionally, to determine if cord milking could be an appropriate alternative to delayed cord clamping. Study DesignA randomized controlled trial was performed in a large secondary care centre in the Netherlands (Amphia Hospital in Breda) from October 2020 to April 2022. A total of 115 patients who underwent an elective caesarean section between 37+0 and 41+6 weeks of gestation were included. Primary outcomes were neonatal hemoglobin and hematocrit levels at 48 hours postpartum, secondary outcomes were divided into neonatal and maternal outcomes. ResultsAfter randomization 58 participants were treated with cord milking and 57 with delayed cord clamping. There were no significant differences regarding demographic characteristics between both groups. There was no significant difference in primary outcomes, with a mean hemoglobin level 48 hours postpartum of 12.1 mmol/L in the delayed cord clamping group and 12.2 mmol/L in the cord milking group (p=0.80). Regarding our secondary outcomes, there were no significant differences regarding Apgar score, neonatal body temperature, maternal blood loss and post-operative infection rate between our intervention groups. ConclusionsHemoglobin and hematocrit levels at 48 hours postpartum showed no significant differences when comparing delayed cord clamping to cord milking. Delayed cord clamping does not lead to increased maternal blood loss or postoperative infections when compared to a method with a much shorter timeframe between delivery and clamping of the umbilical cord, namely cord milking. Additionally, delayed cord clamping did not lead to lower APGAR score or neonatal temperature compared to cord milking. Our research suggests that delayed cord clamping can be safely performed during elective caesarean sections at term. If per operative circumstances do not allow for delayed cord clamping, cord milking can be an appropriate alternative for the neonate at term.

Youth soccer players: patterns of injury involving the primary growth plates of epiphyses.

Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying theapophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving theprimary growth platesunderlying epiphyses.

GENETIC VARIATION AND HERITABILITY ESTIMATES IN CHICKPEA SEEDLING TRAITS: IMPLICATIONS FOR BREEDING PROGRAMS

Chickpea, also known as Bengal gram, Channa, or garbanzo bean, is a vital pulse crop that offers wholesome food to the growing population. Originating from modern-day southeast Turkey and Syria, chickpea germplasm is abundant in Ethiopia, serving as a secondary centre of genetic diversity for various dietary legumes. Two main varieties are desi and Kabuli. A study at the University of Punjab Lahore found significant genetic variations in chickpea seedlings, with high genetic components and a broad-sense heritability of 87.04%. Root length showed a significant genotypic effect, with a PCV of 16.39% and a larger GCV than SL. The root-to-seedling length ratio showed a significant genotypic variance, with a heritability estimate of 69.98% and a genetic advance of 5.740%. Seedling biomass did not show significant genotypic variation. Leaf characteristics showed substantial genotypic differences, indicating extensive genetic heterogeneity. The correlation matrix showed substantial correlations between seven qualities in chickpea seedlings, suggesting genetic and physiological links between the qualities. These findings can inform breeding efforts, improve breeding programs, and generate new varieties with improved features.

Knowledge, attitude, and practice of diabetes in patients with and without sight-threatening diabetic retinopathy from two secondary eye care centres in India.

Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India. 400 consecutive patients (mean age = 58.5years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria. Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month. Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.

Drug Supply Chain Management in Public Secondary Health Facilities in Lagos State Nigeria

This study was conducted to analyze the drug supply chain at nineteen selected public secondary health centers (SHC) commonly referred to as General Hospitals, in Lagos State. Data was collected from both primary and secondary sources. The primary data were collected through a well-structured questionnaire while the secondary data were sourced from journals, Lagos State Ministry of Health, Lagos Bureau of Statistics (LBS), National Agency for Food and Drug Administration and Control (NAFDAC), etc. A descriptive statistical method was employed for data analysis using the statistical package for Social Science (SPSS) version 2.0 and ArcGIS 10.8 version. Maps, frequency counts, percentages, and analysis of variance (ANOVA) were also used to test the hypothesis The study contributed to the existing body of knowledge by establishing the Euclidean distance of SHC from Central Medical Store (CMS) Oshodi, the residences within and outside the buffer zone of 2km radius around the SHC in Lagos state and the distribution and accessibility of patients to essential drugs in the study area. Findings confirmed that 79.6% of Pharmacists have received training on supply chain practices. The respondents also said that SHC in Lagos gets about 75% of their drug supplies from Central Medical Store. The result also revealed there is a significant relationship between the number of dispensing outlet and the amount paid for drug by patients. Also, 57.5% of the patients preferred to have their drugs delivered at home and 49.5% were willing to pay extra cost for home delivery. The study suggests strong regulation and strict enforcement of National Drug Distribution Guidelines of 2012 (NDDG) by the regulator. The study concludes that effective supply chain will deliver safe, efficient, and quality drugs to meet the health need of the patients.

Normal Development and Variants in Pediatric Bone

Normal variants refer to imaging findings that are generally asymptomatic and discovered incidentally, yet may exhibit findings similar to those observed in pathological conditions. Recognizing normal variants in pediatric bone requires comprehension of the developmental process of long tubular bones and secondary ossification centers. Familiarity with various radiological findings of normal variants can prevent unnecessary follow-up imaging tests, as well as incorrect diagnosis and treatment. In this review, we will discuss the characteristic imaging findings of normal variants seen in growing pediatric bones, along with strategies for distinguishing them from pathologic conditions.

Health-care Utilisation among Elderly People with Chronic Medical Conditions in a Secondary Health-care Center, Southwestern Nigeria

Abstract Background: The elderly population of the world is projected to continue to increase. There is an anticipated increase in the utilisation of health-care services due to chronic diseases and other impairments with resulting pressure on health systems. Aims: This study aimed to determine the health-care utilisation of elderly patients with chronic medical diseases attending a secondary health facility in southwestern Nigeria. Materials and Methods A structured questionnaire was administered to gather the data from 300 older people by random sampling during follow-up care for those receiving care for more than 6 months following a diagnosis of a chronic disease. SPSS software version 26 was used for the data analysis, and the results are presented in the tables. The Chi-square test was applied to test for associations between the categorical variables, and a logistic regression model was used to rule out confounders, while P &lt; 0.05 was considered to indicate statistical significance. Results: The mean age (standard deviation) in the study was 68.26 (7.01) years and 58.3% were females. The average number of routine clinic visits was 4.12, whereas 20.7% had emergency room visits, 6.6% were referred to specialists, and 33.3% had laboratory investigations. After logistic regression was applied, living conditions, average monthly income, and treatment for diabetes were found to be significant factors for the utilisation of care. Conclusion: The provision of rich social support, improving economic empowerment, and performing screening and timely management for diabetes will improve preventive care while reducing the use of expensive and specialised care for older people.

Enhanced chiroptical activity for narrow deep-blue emission in axial chiral frameworks via three-dimensional interlocking.

The advancement of desirable circularly polarized luminescence (CPL) emitters is predominantly constrained by the effective regulation of magnetic and electric transition vectors, particularly within the deep-blue spectral domain. Herein, we present four pairs of novel chiral emitters with systematically varied molecular rigidity, symmetry, and chiral centers to elucidate the intrinsic coupling of key molecular parameters influencing their chiroptical properties. Notably, the incorporation of appropriate intramolecular 3D-interlocking within a natural binaphthyl chirality skeleton offers an effective approach to achieving both significantly narrowed full width at half maximum (FWHM, as low as 18 nm) and substantially enhanced chiroptical activity (luminous dissymmetry factor, g PL, up to 3.0 × 10-3). Additionally, introducing a secondary chiral center closely parallel to the primary chiral plane facilitates strong chiral-chiral interactions, further affording a 50% improvement in their g PL values. As a demonstration, vacuum-deposited circularly polarized organic light-emitting diodes incorporating these pure fluorescent emitters exhibit outstanding electroluminescent performance, with maximum external quantum efficiency exceeding 5.35%, favorable FWHM of approximately 25 nm, and extreme CIE y values below 0.03.

Investigating Challenges and Countermeasures in the Reverse Supply Chain of E-commerce Returns: Case Study of Jingdong Self-operated Mall

With the rapid development of e-commerce, online shopping has gradually become the mainstream method. At the same time, the return rate of commodities is also much higher than the traditional business model, and the reverse logistics problem of e-commerce has attracted much attention. This paper discusses the cost of reverse logistics in depth and extends to the general situation, taking Jingdong Self-operated Mall as an example. Reverse logistics is more expensive, more difficult and involves more complex factors than forward logistics, making it challenging to control costs while ensuring customer satisfaction. Several solutions to the cost problem of reverse logistics are currently available in the market, but they have certain limitations and drawbacks. This paper proposes some optimization strategies, including introducing self-mailing and self-pick-up, strengthening quality inspection mechanisms, setting up specialized commodity certification and secondary sales centers, and commissioning third-party reverse logistics to improve the efficiency of reverse logistics, reducing costs, minimizing losses and regulating order. It is also recommended that the fairness and reasonableness of the platform be maintained by strengthening the audit mechanism, adjusting the return and exchange policy and taking stringent measures against negative returns.

A Retrospective Record-Based Study to Identify the Indications and Outcomes of Obstetric Referrals to A Tertiary Care Centre in Gujarat, India

Background: Obstetric referral services in the public health system play a crucial role in managing obstetric emergencies. However obstetric referrals to tertiary care centres should be used judiciously and effectively and not convenience-based. Objectives: To study the indications of obstetric referrals from primary and secondary care centres and to assess the referral communications and outcome of referred mothers. Methods: This was a retrospective record-based study done at a tertiary care centre in Gujarat from January to December 2022. All obstetric referrals during the study period were included in the study. Non-obstetric referrals and registered antenatal cases were excluded from the study. Results: Of 1227 mothers referred 62.7% were referred from CHC and 34.7% from SDH. 96.7% of them were referred to in the first stage of labour. There was no pre-referral communication in about 44% of referrals. Referral slip was incomplete in 15% of the mothers. Two-thirds of them had normal delivery (64.5%). Only 3.7% of mothers needed ICU support. 97.91% of the mothers had live births. Conclusion: Unjustified, unindicated, and convenience-based referrals from peripheral health centres and poor referral communication were noted. This study highlights the need for formulation, implementation and monitoring of an obstetric referral policy to avoid clogging tertiary care centres with patients that can be managed at peripheral health centres.

A Comparative Study of ε-constraint, LP-metric, and Weighted Sum Multi-objective Optimization Methods in a Circular Economy

Approximately 74.7 Mt (Million Metric Tonnes) of e-waste is expected to be produced in 2030, and laptop e-waste is one of the major constituents of this. The goal of this paper is to develop and optimize a mixed-integer linear programming (MILP) mathematical model for a laptop manufacturer in India, based on a framework that integrates secondary reuse concept associated with traditional circular economy waste avoidance strategies. The multi-objective solution techniques of ε-constraint, LP-metric, and weighted sum methods are used to optimize the circular economy model. The proposed model aids as a policy tool to decide the optimum number of inspection/collection centers, sales/distribution centers, disassembly centers, refurbishing centers, recycling centers, and their optimum locations and allocations. This study results suggest that reuse, secondary customer centers, refurbishing, and recycling of the laptops is not only economically beneficial to the organization but also environment friendly and helps to create more jobs in the rural economy.

Use of cyclin-dependent kinase 4 and 6 inhibitors in treating metastatic breast cancer - a year-long experience of Subotica General Hospital in patient follow-up

Introduction. According to GLOBOCAN data from 2020, breast cancer ranks first in the number of newly diagnosed malignancies. The treatment of advanced, hormone-positive breast cancer has evolved with the use of cyclin-dependent kinase 4 and 6 inhibitors in first- and second-line treatment for metastatic, hormone-positive, HER2-negative breast cancers, in combination with endocrine therapy. As of May 31, 2022, these drugs have become available in the Republic of Serbia. This paper aims to present a one-year experience of a secondary health center in monitoring patients using the treatments. Material and Methods. The data analysis included patients treated with cyclin-dependent kinase 4 and 6 inhibitors from June 1, 2022, to June 1, 2023, at General Hospital Subotica. The analysis covered demographic data, disease presentation, previous therapies, drug usage, side effects, duration, and therapy outcomes. Patients were categorized into two groups based on age (&lt;60 and &gt;60 years) and by the nature of their disease (relapsed or initially metastatic). Results. A total of 43 patients were treated with cyclin-dependent kinase 4 and 6 inhibitors: 23 (53.5%) in the first line and 20 (46.5%) in the second line. The median therapy duration was eight cycles for patients younger than 60 years. A good therapeutic response was observed in 53.5% of patients. Patients younger than 60 years with late relapse exhibited statistically significantly better treatment outcomes compared to those older than 60 years (p=0.04). The most common site of metastases was the bones (51%, 22 patients), with half of these patients showing a good therapeutic response. Conclusion. Although the observed period is short, ongoing monitoring and further research are planned to share experiences on the use of these drugs.

Profile of Amoebic vs. Pyogenic Liver Abscess and Comparison of Demographical, Clinical, Radiological, and Laboratory Profiles of These Patients from Three Secondary Care Centers in Senegal

Profile of Amoebic vs. Pyogenic Liver Abscess and Comparison of Demographical, Clinical, Radiological, and Laboratory Profiles of These Patients from Three Secondary Care Centers in Senegal

Protocol of a cross-sectional, multicentre and multidisciplinary study describing phenotype and burden of a midfacial segment pain

Background: Midfacial segment pain is a term used in the past in the diagnosis of patients mainly from ear, nose and throat clinics. This type of pain cannot be attributed to other primary or secondary facial pain, but is to a large extent similar to tension-type headache with midfacial location. The purpose of this study is to describe midfacial segment pain phenotype, burden and comorbidities in a multicentre and multidisciplinary setting. The ultimate goal is a comprehensive description of this type of pain allowing for its implementation in future classifications. Methods: This cross-sectional study is designed to describe midfacial segment pain in a clinical setting. Patients from rhinologic, headache and facial pain or oral medicine/dentistry secondary care centres will be recruited during a 1 year period. Individuals with other facial pain according to current classification such as sinonasal disorders, neoplasms, local infections, history of significant trauma associated with pain onset will be excluded. Data will be collected through a structured questionnaire covering pain characteristics, coexisting diagnoses, pain-related burden and consequences, physical examination and paranasal sinuses imaging.

National survey questionnaire on the diagnosis and treatment status of Helicobacter pylori in peptic ulcer bleeding disease.

The Maastricht VI/Florence Consensus and Chinese National Consensus Report provide comprehensive guidelines for treating Helicobacter pylori infection. This study aimed to assess physicians' understanding of and adherence to this consensus in different hospitals. Chinese medical staff attending gastrointestinal conferences across various regions were selected for this study. The questionnaire included: 1. the number of patients with peptic ulcer bleeding in hospitals of different levels annually and the diagnostic methods used for H. pylori; 2. whether routine H. pylori examination was conducted and the specific methods employed; and 3. Treatment plans for H. pylori eradication; 4. The mean follow-up duration after treatment 5. Plans for re-eradication in cases of H. pylori treatment failure. Across all levels of Chinese hospitals, the urea breath test was the most commonly used method for detecting H. pylori infection. Most primary (81.53%), secondary (89.49%), and tertiary (91.42%) centers opted for a 14-day quadruple regimen. The preferred antibiotic regimen at all hospital levels was amoxicillin+clarithromycin, with rates of 63.69, 58.08, and 59.27% in the primary, secondary, and tertiary hospitals, respectively. The rates of H. pylori re-examination were 68.15, 87.07, and 87.46% in the primary, secondary, and tertiary hospitals. If H. pylori eradication failed, hospitals at different levels choose to replace the initial plan. There is a need for an enhanced understanding of and adherence to guidelines for H. pylori among physicians in hospitals at all levels.

Survival after resection of malignant peripheral nerve sheath tumors: Introducing and validating a novel type-specific prognostic model.

This study aimed to assess the performance of currently available risk calculators in a cohort of patients with malignant peripheral nerve sheath tumors (MPNST) and to create an MPNST-specific prognostic model including type-specific predictors for overall survival (OS). This is a retrospective multicenter cohort study of patients with MPNST from 11 secondary or tertiary centers in The Netherlands, Italy and the United States of America. All patients diagnosed with primary MPNST who underwent macroscopically complete surgical resection from 2000 to 2019 were included in this study. A multivariable Cox proportional hazard model for OS was estimated with prespecified predictors (age, grade, size, NF-1 status, triton status, depth, tumor location, and surgical margin). Model performance was assessed for the Sarculator and PERSARC calculators by examining discrimination (C-index) and calibration (calibration plots and observed-expected statistic; O/E-statistic). Internal-external cross-validation by different regions was performed to evaluate the generalizability of the model. A total of 507 patients with primary MPNSTs were included from 11 centers in 7 regions. During follow-up (median 8.7 years), 211 patients died. The C-index was 0.60 (95% CI 0.53-0.67) for both Sarculator and PERSARC. The MPNST-specific model had a pooled C-index of 0.69 (95%CI 0.65-0.73) at validation, with adequate discrimination and calibration across regions. The MPNST-specific MONACO model can be used to predict 3-, 5-, and 10-year OS in patients with primary MPNST who underwent macroscopically complete surgical resection. Further validation may refine the model to inform patients and physicians on prognosis and support them in shared decision-making.

Prescribing Patterns of Antibiotics in Pediatric Wards of Secondary Care Centers: A Retrospective Study Based on WHO AWaRe Classification.

Objectives. Antimicrobial resistance (AMR) poses a significant threat to global public health, with substantial mortality rates attributed to AMR-related infections. Pediatric populations face heightened vulnerability due to prevalent antimicrobial misuse. This study aimed at addressing the significant threat of antimicrobial resistance (AMR) and its associated mortality rates. Methods. This retrospective cross-sectional multicentric study investigated antibiotic prescribing patterns in pediatric wards of 4 secondary care hospitals affiliated with Aga Khan University Hospital. The study utilized the WHO Access, Watch, and Reserve (AWaRe) classification framework. Data from 6934 encounters were analyzed. Results. Antibiotics were prescribed in 78.1% of encounters, with intravenous administration being predominant (98.6%). Ceftriaxone was the most prescribed antibiotic agent (45.8%), and third-generation cephalosporins constituted the most prevalent antibiotic class (54.4%). Pneumonia exhibited the highest prescription rate (99.9%), with Watch group antibiotics being predominantly prescribed (>80%) across hospitals. Conclusion. These findings underscore the urgency for targeted interventions to optimize prescribing practices and mitigate resistance.