Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients' conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient's mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.
Research paper 2020 of assessment of Financial Toxicity in Tunisian cancer patient using Compressive Score of Financial Toxicity. Journal Club Presentation. Its include FT in North Africa Population.
The Trend in Body Mass Index and Clinical Stage Response in HIV Patient after...ijtsrd
HIV infection remains a major global health concern. Antiretroviral therapy has been shown to be effective in improving the quality of patients’ health. Recovery of BMI scores following the initiation of ART for HIV infection is clinically important for long term health outcomes. It is necessary to find the effect of pre treatment BMI and clinical characteristics on early immune recovery among patients treated with ART. This study aimed to assess the change of BMI and clinical responses. In the study, 93 people provided informed consent to participate. Almost of participants had BMI in normal weight 60.2 . There were 25.8 of patients had underweight. After 6 months, most of the study participants 98.9 had BMI responses back to normal, and the proportions of patients who achieved clinical stages responses were increased significantly with p 0.05. Clinical stages responses is likely associated with patients baseline CD4 T cell. In conclusion, the present study finding that the majority of patients respond to first line ART. BMI and clinical stages recovery were significantly increase after 3 and 6 month treatment. Our findings in this study suggest that clinical recovery were likely associated with baseline T CD4 of patients. Tao Gia Phu "The Trend in Body Mass Index and Clinical Stage Response in HIV Patient after Initiation of Antiretroviral Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49530.pdf Paper URL: https://www.ijtsrd.com/medicine/other/49530/the-trend-in-body-mass-index-and-clinical-stage-response-in-hiv-patient-after-initiation-of-antiretroviral-treatment/tao-gia-phu
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
The effect of long-term traditional Chinese medicine treatment on disease-fre...LucyPi1
Abstract Objective: Traditional Chinese medicine (TCM) has been extensively used as one of popular alternative therapies for several cancers. However, it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients. In this study, we explored the effect of long-term TCM treatment on patients with different stages of lung cancer. Methods: All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study. Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group (control group). All patients were regularly followed up by clinic appointment or phone, and all survival data were collected from databases after the last follow-up in October 2017. Results: A total of 575 patients were included in this study, with 299 patients in the TCM group and 276 in the control group. For all patients, 5-year disease-free survival (DFS) was 62.2% in TCM group and 42.1% in the control group, and 6-year DFSs were 51.8% and 35.4%, respectively (HR = 0.51, 95% CI: 0.40 to 0.66, log-rank P ≤ 0.001). For patients with stage I, 5-year DFSs were 83.7% (TCM group) and 57.5% (control group) and 6-year DFSs were 73.7% and 51.9%, respectively (HR = 0.30, 95% CI: 0.18 to 0.50, log-rank P ≤ 0.001). For patients with stage II in the TCM group and the control group, 5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%, respectively (HR = 0.31, 95% CI: 0.19 to 0.52, log-rank P ≤ 0.001), and for patients with stage III, 5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group (HR = 1.06, 95% CI: 0.72 to 1.56, log-rank P = 0.76). Conclusions: This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients, especially in patients with stage I and II disease. However, these observational findings need being validated by large sample randomized controlled trials.
Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Can...Hugo Raul Castro Salguero
Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
risk factors for overall survival (OS).
Research paper 2020 of assessment of Financial Toxicity in Tunisian cancer patient using Compressive Score of Financial Toxicity. Journal Club Presentation. Its include FT in North Africa Population.
The Trend in Body Mass Index and Clinical Stage Response in HIV Patient after...ijtsrd
HIV infection remains a major global health concern. Antiretroviral therapy has been shown to be effective in improving the quality of patients’ health. Recovery of BMI scores following the initiation of ART for HIV infection is clinically important for long term health outcomes. It is necessary to find the effect of pre treatment BMI and clinical characteristics on early immune recovery among patients treated with ART. This study aimed to assess the change of BMI and clinical responses. In the study, 93 people provided informed consent to participate. Almost of participants had BMI in normal weight 60.2 . There were 25.8 of patients had underweight. After 6 months, most of the study participants 98.9 had BMI responses back to normal, and the proportions of patients who achieved clinical stages responses were increased significantly with p 0.05. Clinical stages responses is likely associated with patients baseline CD4 T cell. In conclusion, the present study finding that the majority of patients respond to first line ART. BMI and clinical stages recovery were significantly increase after 3 and 6 month treatment. Our findings in this study suggest that clinical recovery were likely associated with baseline T CD4 of patients. Tao Gia Phu "The Trend in Body Mass Index and Clinical Stage Response in HIV Patient after Initiation of Antiretroviral Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49530.pdf Paper URL: https://www.ijtsrd.com/medicine/other/49530/the-trend-in-body-mass-index-and-clinical-stage-response-in-hiv-patient-after-initiation-of-antiretroviral-treatment/tao-gia-phu
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
The effect of long-term traditional Chinese medicine treatment on disease-fre...LucyPi1
Abstract Objective: Traditional Chinese medicine (TCM) has been extensively used as one of popular alternative therapies for several cancers. However, it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients. In this study, we explored the effect of long-term TCM treatment on patients with different stages of lung cancer. Methods: All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study. Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group (control group). All patients were regularly followed up by clinic appointment or phone, and all survival data were collected from databases after the last follow-up in October 2017. Results: A total of 575 patients were included in this study, with 299 patients in the TCM group and 276 in the control group. For all patients, 5-year disease-free survival (DFS) was 62.2% in TCM group and 42.1% in the control group, and 6-year DFSs were 51.8% and 35.4%, respectively (HR = 0.51, 95% CI: 0.40 to 0.66, log-rank P ≤ 0.001). For patients with stage I, 5-year DFSs were 83.7% (TCM group) and 57.5% (control group) and 6-year DFSs were 73.7% and 51.9%, respectively (HR = 0.30, 95% CI: 0.18 to 0.50, log-rank P ≤ 0.001). For patients with stage II in the TCM group and the control group, 5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%, respectively (HR = 0.31, 95% CI: 0.19 to 0.52, log-rank P ≤ 0.001), and for patients with stage III, 5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group (HR = 1.06, 95% CI: 0.72 to 1.56, log-rank P = 0.76). Conclusions: This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients, especially in patients with stage I and II disease. However, these observational findings need being validated by large sample randomized controlled trials.
Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Can...Hugo Raul Castro Salguero
Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
risk factors for overall survival (OS).
A retrospective study on ovarian cancer with a median follow-up of 36 months ...AI Publications
Ovarian cancer is relatively common but serious and has a poor prognosis. The aim of this study is to highlight the epidemiological, diagnostic, therapeutic and evolutionary aspects of this malignant pathology managed at the Bejaia university hospital center. This is a retrospective and descriptive study over a period of 3 years (2019 - 2022) carried out on 20 patients who developed ovarian cancer. The average age of the patients was 50 years old, 53.23% of whom were over 45 years old. The CA-125 blood test was positive in 18 out of 20 patients. The tumors were discovered on ultrasound in 87.10% of cases and at laparotomy in 12.90%. Total hysterectomy with bilateral adnexectomy was the most performed procedure (64.52%). The early postoperative course was simple. 15 patients underwent second look surgery (16.13%) for locoregional recurrences. Epithelial tumors were the most frequent histological type (93.55%), including 79% in the advanced stage ( IIIc -IV) and 21% in the early stage (Ia- Ib ). Adjuvant chemotherapy was administered in 80% of patients. With a median follow-up of 36 months, 2 patients were lost to follow-up. The evolution was favorable in 27.42% and in 25.81% deaths occurred late postoperatively. Ovarian cancer is not common but serious given the advanced stages and the high rate of late postoperative deaths which were largely observed in patients deprived of adequate neoadjuvant or adjuvant chemotherapy.
Secondary Malignancy after Treatment of Prostate Cancer. Radical Prostatectom...asclepiuspdfs
Background: This study aims to determine whether the treatment of locally confined prostate cancer (PCa) with external radiotherapy (EBRT) increases the risk to develop secondary malignancies (SM) compared to radical prostatectomy (RPE). Materials and Methods: Data from patients who were treated curatively with RPE or EBRT from 2010 to 2018 and who did not have distant metastases, previous malignancy, or previous treatment with radiotherapy or chemotherapy at the time of diagnosis were reviewed to determine the incidence of SM over a median follow-up period of 47 months (range 12–96 months). Regression models were used to correlate the clinicopathological factors with the incidence of SM.
In recent years, the province's health sector has applied and applied many scientific and technical advances in health, information technology (IT) into its activities. As a result, it has brought about great achievements in professional work, especially in disease prevention and treatment, and IT application is also one of the breakthroughs of the provincial health sector. Our study objectives: showing Achievements in cancer treatment in Bai Chay hospital-Quang Ninhand presenting Lessons from other countries such as Japan in cancer treatment. By using methods of cross-sectional descriptive study. For Research period: from June 2019 to May 2020, Our study results and conclusions: We see from above figure that the highest ratio of 40% belong to health status in stage 1 (with not influence). And then, the lowest ratio of 12.9% is belonging to patients in stage 1 with very much influence, and so on.
Then, Patients living quality at levels of no effect, little influence, great influence and great influence all accounts for about 25%.
Test positivity – Evaluation of a new metric to assess epidemic dispersal med...Olutosin Ademola Otekunrin
Epidemic control may be hampered when the percentage of asymptomatic cases is high. Seeking remedies for this problem, test positivity was explored between the first 60 to 90 epidemic days in six countries that reported their first COVID-19 case between February and March 2020: Argentina, Bolivia, Chile, Cuba, Mexico, and Uruguay.
Test positivity (TP) is the percentage of test-positive individuals reported on a given day out of all individuals tested the same day. To generate both country-specific and multi-country information, this study was implemented in two stages. First, the epidemiologic data of the country infected last (Uruguay) were analyzed. If at
least one TP-related analysis yielded a statistically significant relationship, later assessments would investigate the six countries. The Uruguayan data indicated (i) a positive correlation between daily TP and daily new cases (r = 0.75); (ii) a negative correlation between TP and the number of tests conducted per million inhabitants (TPMI, r = 0.66); and (iii) three temporal stages, which differed from one another in both TP and TPMI medians (p < 0.01) and, together, revealed a negative relationship between TPMI and TP. No significant relationship
was found between TP and the number of active or recovered patients. The six countries showed a positive correlation between TP and the number of deaths/million inhabitants (DMI, r = 0.65, p < 0.01). With one exception –a country where isolation was not pursued , all countries showed a negative correlation between
TP and TPMI (r = 0.74). The temporal analysis of country-specific policies revealed four patterns, characterized by: (1) low TPMI and high DMI, (2) high TPMI and low DMI; (3) an intermediate pattern, and (4) high TPMI and
high DMI. Findings support the hypothesis that test positivity may guide epidemiologic policy-making, provided that policy-related factors are considered and high-resolution geographical data are utilized.
Hepatitis C elimination in HIV-infected men who have sex with men: reality and challenges
Edward Cachay MD, MAS
February 23rd, 2018
UCSD HIV & Global Health Rounds
minimze social and improve productivity.pptxMona Quenawy
many advantages you can harvest when minimizing the usage of social,like best time managements ,increase productivity,maintain your self esteem and keep relaxant
.many methods could help to control the extensive and addictive nature of social media.try some
investing in commercial property can offer several advantages over residential property investment, including higher net rental yields, long-term leases, diversification, and potential for higher capital gains
One tip is to create a mind-map of the things you enjoy doing – and see where they cross over with your current responsibilities. “If you value targets but lack these at work, you will quickly become disinterested. In this situation, you could try introducing your own goals to keep you on track,” explains LaRue.
Likewise, if you enjoy working in a team but your current role requires you to work alone – set up regular interaction with co-workers to make your job more social. You’ll find making small changes to the way you work, and playing to your strengths, will make you feel much more satisfied in your job.
Staying excited and focused when you are working can have a big impact on productivity and overall success. But regardless of how much you love your job, we all have days when we need extra motivation. Some simple motivational strategies can help you do your best and give your work a 100% effort. In this article, we discuss different kinds of motivation, some specific strategies for how to motivate yourself to work harder and include some bonus tips.
Self-acceptance is essential for your mental and emotional well-being. It’s important to learn to love yourself and the things that make you unique.
Self-acceptance is learning to love yourself, inside and out. It’s about letting go of the things you can’t change and appreciating what makes you unique. However, being comfortable in your own skin isn’t always easy. Here are some ways you can practice self-acceptance in your day-to-day life:
Communication is an inseparable aspect of daily life and we cannot live without communicating with anyone. Communication can take place in both ways; either in-person communication or communication through various social media platforms. However, effective communication is something that you need to know for various business purposes. As we communicate with innumerable people daily, we do not know what is the percentage of communication and how well it reaches the desired audience.
Effective communication means where we know what we are trying to communicate and the audience is getting exactly what we are trying to say. This communication is a very important aspect of both our professional and personal lives. It involves developing certain skills with the help of which we can exchange information with more clarity, understanding, and empathy. To know all about what is effective communication and how it can improve your career, do go for Project Management course as it will be a plus point in your career ahead.
improve work effeciency and outcome.pptxMona Quenawy
need to perform at your best in the workplace? Improve work performance and increase productivity with strategies tailored to the fast-paced and competitive work environment of today. Don't let distractions and stressors get in the way of your success.While seemingly straightforward, the concept of work performance holds immense significance in the realm of professional achievement. It serves as a pivotal determinant of job success, enabling the assessment of an individual's prowess in executing tasks and effectively meeting the expectations of their role.
Diverse methodologies come into play when gauging work performance, encompassing factors like task completion time, execution efficiency, job accuracy, and the ability to adhere to deadlines. Employers frequently resort to performance reviews to evaluate employees' job performance and ascertain their eligibility for promotions or salary increments.
•
Your perception of yourself is very complex. Similar to how you cannot see your own nose, you may often be blinded to the things that you are best at. It can be really hard to identify your brightest talents and they are often in the places you least expect. You may even be very good at things that you perceive yourself as being bad at. There are many good reasons to want to explore your talents but it's going to take a little work.
One good thing to think about was what your childhood was like. What did you do a lot as a kid? What did you enjoy? What were you known for? Sometimes this can reveal some of your deepest talents and certainly will reveal interests that can be probed further. Think about your hobbies as your personality is made by them they are the things you do regularly and your hidden talent is that which you can do better than everyone so focus on your hobbies and how you do them every single step.
• Another thing you can think about are the times in your life that you've been challenged. Think about the tough situations that you've had to deal with. Times of trial can often reveal your hidden skills. For example, when your dad had a heart attack, maybe you kept your head and called 911. Staying alert and calm in an emergency is a really useful talent.
global leaders .different world expectation (1) (1).pptxMona Quenawy
The traits a good leader in general and globally do not necessarily render him/her as an effective global business leader.
In a domestic setting, leadership plays out within the context of updated cultural beliefs and practices. Other countries’ economies, politics, and cultures may be vastly different than those of the U.S., so business leaders who operate on a global stage need to be well versed in the complexities and minutiae of host countries’ cultures.
Thus, an evolved sense of global economies and priorities is necessary for aspiring global business leaders. Global strategies require:
1. An understanding and sensitivity to cultural diversity
2. A versatile personality
3. Great negotiation and communication skillsConcentrating on expanding knowledge, learning the duties of your peers and superiors, and thinking in terms of what’s best for everyone involved are what set true global leaders apart from the pack,” says digital thought leader Pearl Zhu, in her Future Of CIO blog post, “Seven Characteristics of Global Leaders.”
In addition to expanding one’s skill set and responsibility, Zhu also focuses on transition areas, which include evolving from problem solver to agenda setter, or from tactician to strategist. In the scenarios she describes, employees, leaders, and managers can learn to expand their horizons and step naturally into a leadership mentality.
Grooming oneself to become a global leader means striving to move upward, beyond the scope of your current position and into a position of greater responsibility and rewards. The common phrase, “Learn the duties of the person above you” is just as applicable today as it was 100 years ago. A leader with a full understanding of a company’s entire organization, capabilities, and future direction, as well as the knowledge and sensitivity to act on the global stage, will make the greatest impact
Lung cancer practical point of view.pptxMona Quenawy
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for the highest mortality rates among both men and women.
Smoking is the leading cause of lung cancer, responsible for approximately 85% of all cases.
Lung cancer is often diagnosed at advanced stages when treatment options are limited.
Screening high risk individuals has the potential to allow early detection and to dramatically improve survival rates.
Primary prevention (such as tobacco control measures and reducing exposure to environmental risk factors) can reduce the incidence of lung cancer and save lives.
A retrospective study on ovarian cancer with a median follow-up of 36 months ...AI Publications
Ovarian cancer is relatively common but serious and has a poor prognosis. The aim of this study is to highlight the epidemiological, diagnostic, therapeutic and evolutionary aspects of this malignant pathology managed at the Bejaia university hospital center. This is a retrospective and descriptive study over a period of 3 years (2019 - 2022) carried out on 20 patients who developed ovarian cancer. The average age of the patients was 50 years old, 53.23% of whom were over 45 years old. The CA-125 blood test was positive in 18 out of 20 patients. The tumors were discovered on ultrasound in 87.10% of cases and at laparotomy in 12.90%. Total hysterectomy with bilateral adnexectomy was the most performed procedure (64.52%). The early postoperative course was simple. 15 patients underwent second look surgery (16.13%) for locoregional recurrences. Epithelial tumors were the most frequent histological type (93.55%), including 79% in the advanced stage ( IIIc -IV) and 21% in the early stage (Ia- Ib ). Adjuvant chemotherapy was administered in 80% of patients. With a median follow-up of 36 months, 2 patients were lost to follow-up. The evolution was favorable in 27.42% and in 25.81% deaths occurred late postoperatively. Ovarian cancer is not common but serious given the advanced stages and the high rate of late postoperative deaths which were largely observed in patients deprived of adequate neoadjuvant or adjuvant chemotherapy.
Secondary Malignancy after Treatment of Prostate Cancer. Radical Prostatectom...asclepiuspdfs
Background: This study aims to determine whether the treatment of locally confined prostate cancer (PCa) with external radiotherapy (EBRT) increases the risk to develop secondary malignancies (SM) compared to radical prostatectomy (RPE). Materials and Methods: Data from patients who were treated curatively with RPE or EBRT from 2010 to 2018 and who did not have distant metastases, previous malignancy, or previous treatment with radiotherapy or chemotherapy at the time of diagnosis were reviewed to determine the incidence of SM over a median follow-up period of 47 months (range 12–96 months). Regression models were used to correlate the clinicopathological factors with the incidence of SM.
In recent years, the province's health sector has applied and applied many scientific and technical advances in health, information technology (IT) into its activities. As a result, it has brought about great achievements in professional work, especially in disease prevention and treatment, and IT application is also one of the breakthroughs of the provincial health sector. Our study objectives: showing Achievements in cancer treatment in Bai Chay hospital-Quang Ninhand presenting Lessons from other countries such as Japan in cancer treatment. By using methods of cross-sectional descriptive study. For Research period: from June 2019 to May 2020, Our study results and conclusions: We see from above figure that the highest ratio of 40% belong to health status in stage 1 (with not influence). And then, the lowest ratio of 12.9% is belonging to patients in stage 1 with very much influence, and so on.
Then, Patients living quality at levels of no effect, little influence, great influence and great influence all accounts for about 25%.
Test positivity – Evaluation of a new metric to assess epidemic dispersal med...Olutosin Ademola Otekunrin
Epidemic control may be hampered when the percentage of asymptomatic cases is high. Seeking remedies for this problem, test positivity was explored between the first 60 to 90 epidemic days in six countries that reported their first COVID-19 case between February and March 2020: Argentina, Bolivia, Chile, Cuba, Mexico, and Uruguay.
Test positivity (TP) is the percentage of test-positive individuals reported on a given day out of all individuals tested the same day. To generate both country-specific and multi-country information, this study was implemented in two stages. First, the epidemiologic data of the country infected last (Uruguay) were analyzed. If at
least one TP-related analysis yielded a statistically significant relationship, later assessments would investigate the six countries. The Uruguayan data indicated (i) a positive correlation between daily TP and daily new cases (r = 0.75); (ii) a negative correlation between TP and the number of tests conducted per million inhabitants (TPMI, r = 0.66); and (iii) three temporal stages, which differed from one another in both TP and TPMI medians (p < 0.01) and, together, revealed a negative relationship between TPMI and TP. No significant relationship
was found between TP and the number of active or recovered patients. The six countries showed a positive correlation between TP and the number of deaths/million inhabitants (DMI, r = 0.65, p < 0.01). With one exception –a country where isolation was not pursued , all countries showed a negative correlation between
TP and TPMI (r = 0.74). The temporal analysis of country-specific policies revealed four patterns, characterized by: (1) low TPMI and high DMI, (2) high TPMI and low DMI; (3) an intermediate pattern, and (4) high TPMI and
high DMI. Findings support the hypothesis that test positivity may guide epidemiologic policy-making, provided that policy-related factors are considered and high-resolution geographical data are utilized.
Hepatitis C elimination in HIV-infected men who have sex with men: reality and challenges
Edward Cachay MD, MAS
February 23rd, 2018
UCSD HIV & Global Health Rounds
minimze social and improve productivity.pptxMona Quenawy
many advantages you can harvest when minimizing the usage of social,like best time managements ,increase productivity,maintain your self esteem and keep relaxant
.many methods could help to control the extensive and addictive nature of social media.try some
investing in commercial property can offer several advantages over residential property investment, including higher net rental yields, long-term leases, diversification, and potential for higher capital gains
One tip is to create a mind-map of the things you enjoy doing – and see where they cross over with your current responsibilities. “If you value targets but lack these at work, you will quickly become disinterested. In this situation, you could try introducing your own goals to keep you on track,” explains LaRue.
Likewise, if you enjoy working in a team but your current role requires you to work alone – set up regular interaction with co-workers to make your job more social. You’ll find making small changes to the way you work, and playing to your strengths, will make you feel much more satisfied in your job.
Staying excited and focused when you are working can have a big impact on productivity and overall success. But regardless of how much you love your job, we all have days when we need extra motivation. Some simple motivational strategies can help you do your best and give your work a 100% effort. In this article, we discuss different kinds of motivation, some specific strategies for how to motivate yourself to work harder and include some bonus tips.
Self-acceptance is essential for your mental and emotional well-being. It’s important to learn to love yourself and the things that make you unique.
Self-acceptance is learning to love yourself, inside and out. It’s about letting go of the things you can’t change and appreciating what makes you unique. However, being comfortable in your own skin isn’t always easy. Here are some ways you can practice self-acceptance in your day-to-day life:
Communication is an inseparable aspect of daily life and we cannot live without communicating with anyone. Communication can take place in both ways; either in-person communication or communication through various social media platforms. However, effective communication is something that you need to know for various business purposes. As we communicate with innumerable people daily, we do not know what is the percentage of communication and how well it reaches the desired audience.
Effective communication means where we know what we are trying to communicate and the audience is getting exactly what we are trying to say. This communication is a very important aspect of both our professional and personal lives. It involves developing certain skills with the help of which we can exchange information with more clarity, understanding, and empathy. To know all about what is effective communication and how it can improve your career, do go for Project Management course as it will be a plus point in your career ahead.
improve work effeciency and outcome.pptxMona Quenawy
need to perform at your best in the workplace? Improve work performance and increase productivity with strategies tailored to the fast-paced and competitive work environment of today. Don't let distractions and stressors get in the way of your success.While seemingly straightforward, the concept of work performance holds immense significance in the realm of professional achievement. It serves as a pivotal determinant of job success, enabling the assessment of an individual's prowess in executing tasks and effectively meeting the expectations of their role.
Diverse methodologies come into play when gauging work performance, encompassing factors like task completion time, execution efficiency, job accuracy, and the ability to adhere to deadlines. Employers frequently resort to performance reviews to evaluate employees' job performance and ascertain their eligibility for promotions or salary increments.
•
Your perception of yourself is very complex. Similar to how you cannot see your own nose, you may often be blinded to the things that you are best at. It can be really hard to identify your brightest talents and they are often in the places you least expect. You may even be very good at things that you perceive yourself as being bad at. There are many good reasons to want to explore your talents but it's going to take a little work.
One good thing to think about was what your childhood was like. What did you do a lot as a kid? What did you enjoy? What were you known for? Sometimes this can reveal some of your deepest talents and certainly will reveal interests that can be probed further. Think about your hobbies as your personality is made by them they are the things you do regularly and your hidden talent is that which you can do better than everyone so focus on your hobbies and how you do them every single step.
• Another thing you can think about are the times in your life that you've been challenged. Think about the tough situations that you've had to deal with. Times of trial can often reveal your hidden skills. For example, when your dad had a heart attack, maybe you kept your head and called 911. Staying alert and calm in an emergency is a really useful talent.
global leaders .different world expectation (1) (1).pptxMona Quenawy
The traits a good leader in general and globally do not necessarily render him/her as an effective global business leader.
In a domestic setting, leadership plays out within the context of updated cultural beliefs and practices. Other countries’ economies, politics, and cultures may be vastly different than those of the U.S., so business leaders who operate on a global stage need to be well versed in the complexities and minutiae of host countries’ cultures.
Thus, an evolved sense of global economies and priorities is necessary for aspiring global business leaders. Global strategies require:
1. An understanding and sensitivity to cultural diversity
2. A versatile personality
3. Great negotiation and communication skillsConcentrating on expanding knowledge, learning the duties of your peers and superiors, and thinking in terms of what’s best for everyone involved are what set true global leaders apart from the pack,” says digital thought leader Pearl Zhu, in her Future Of CIO blog post, “Seven Characteristics of Global Leaders.”
In addition to expanding one’s skill set and responsibility, Zhu also focuses on transition areas, which include evolving from problem solver to agenda setter, or from tactician to strategist. In the scenarios she describes, employees, leaders, and managers can learn to expand their horizons and step naturally into a leadership mentality.
Grooming oneself to become a global leader means striving to move upward, beyond the scope of your current position and into a position of greater responsibility and rewards. The common phrase, “Learn the duties of the person above you” is just as applicable today as it was 100 years ago. A leader with a full understanding of a company’s entire organization, capabilities, and future direction, as well as the knowledge and sensitivity to act on the global stage, will make the greatest impact
Lung cancer practical point of view.pptxMona Quenawy
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for the highest mortality rates among both men and women.
Smoking is the leading cause of lung cancer, responsible for approximately 85% of all cases.
Lung cancer is often diagnosed at advanced stages when treatment options are limited.
Screening high risk individuals has the potential to allow early detection and to dramatically improve survival rates.
Primary prevention (such as tobacco control measures and reducing exposure to environmental risk factors) can reduce the incidence of lung cancer and save lives.
Clinical oncology basic fundamental For undergraduate studies part I .pdfMona Quenawy
Cancer is a disease of uncontrolled growth and proliferation whereby cells have escaped the body’s normal growth control mechanisms and have gained the ability to divide indefinitely. It is a multi-step process that requires the accumulation of many genetic changes over time (Figure 1). These genetic alterations involve activation of proto-oncogenes to oncogenes, deregulation of tumour suppressor genes and DNA repair genes and ‘immortalisation
Cancer ranks as a leading cause of death and an important barrier to increasing life expectancy in every country of the world.1 According to estimates from the World Health Organization (WHO) in 2019, cancer is the first or second leading cause of death before the age of 70 years in 112 of 183 countries and ranks third or fourth in a further 23 countries . Cancer's rising prominence as a leading cause of death partly reflects marked declines in mortality rates of stroke and coronary heart disease, relative to cancer, in many countries.
Between 30–50% of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer. WHO works with Member States to strengthen national policies and programmes to raise awareness and, reduce exposure to cancer risk factors, and also ensure that people are provided with the information and support they need to adopt healthy lifestyles.
To strengthen national efforts to address the burden of cancer and other noncommunicable diseases (NCDs), the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020 provides a road map to reduce premature mortality from NCDs by 2025 through targeting many of the risk factors below:
Tobacco
Worldwide, tobacco use is the single greatest avoidable risk factor for cancer mortality and kills more than 8 million people each year, from cancer and other diseases. Nearly 80% of the 1.1 billion smokers in the world live in low- and middle-income countries.
Alcohol
Alcohol, as classified by the International Agency for Research on Cancer, is a toxic, psychoactive, and dependence-producing substance and a Group 1 carcinogen that is causally linked to 7 types of cancer, including oesophagus, liver, colorectal, and breast cancers. Alcohol consumption is associated with 740 000 new cancer cases each year. Globally, 1 in 20 breast cancers is attributed to alcohol consumption.
Physical inactivity,infection with HPV,Environmental pollution,Industrial carcinogen and radiation exposure are also global preventable causes.
this basic discussion highlight the topics of the main types of cancer and cancer theory.prevention cancer staging with TNM and other methods .management of emergency situation in clinical oncology .basics of surgical oncology and chemotherapy handling.
global leaders .different world expectation (1) (1).pptxMona Quenawy
understand that everything they do directly affects the people they lead. In other words, the best leaders lead with their followers in mind. And one of the most important leadership traits is engaging your followers.Anyone can sit in a corner office and delegate tasks, but there is more to effective leadership than that. Effective leaders have major impacts on not only the team members they manage, but also their company as a whole. Employees who work under great leaders tend to be happier, more productive and more connected to their organization .I think a great leader is one who makes those around them better,” Dana Brownlee, founder of Professionalism Matters, told Business News Daily. “There are many litmus tests for a great leader, but I really look to those around them: Are they growing, becoming better leaders themselves, motivated, etc.?”
If you look around and see that your team members have become disengaged or stagnant in their work, it may be time to reassess and reform your strategies. According to Brownlee, the following behaviors are signs that you may have a poor leadership strategy:
global leaders .different world expectation (1) (1).pptxMona Quenawy
Have you ever worked with someone who knows how to encourage you to make the impossible totally possible? Maybe they seem attuned to what it takes to get the best work out of you, or they’re always ready to share exactly the right thing to make you feel like you can do anything. This highly effective approach to management has a name: charismatic leadership.
As you find yourself moving forward in your career and stepping into management or leadership roles, it helps to choose an approach that meshes with your personality while supporting the company you work for. But it can be difficult to choose and refine a leadership style if you’re unfamiliar with the options that are available to you. By utilizing the knowledge gained from attaining a business degree or by taking online courses, business leaders like you can understand the psychology behind managing teams and utilizing the principles and characteristics of leadership to help refine your charismatic management style
Cancer and its treatment may lead to a range of potentially life-threatening conditions that require urgent action to correct them. Most oncological emergencies can be classified as metabolic, haematological, structural, or treatment-relatedFebrile neutropenia is most often seen as an effect of cytotoxic therapy. The neutrophil count usually reaches its lowest level 5 to 10 days after the last dose of chemotherapy. Febrile neutropenia is defined as an oral temperature ≥38.5°C or two consecutive readings of ≥38.0°C for two hours and an absolute neutrophil count ≤0.5 x 109/L.
Up to 80% of patients receiving chemotherapy for haematological malignancies will develop neutropenic fever at least once during the course of therapy. Patients with solid tumors are reported to develop neutropenic fever at a rate of 10-50% during the course of chemotherapy. The likelihood of fever increases with the duration and the severity of neutropenia as well as the rate of decline of the absolute neutrophil count.
n general, quantitative research seeks to understand the causal or correlational relationship between variables through testing hypotheses, whereas qualitative research seeks to understand a phenomenon within a real-world context through the use of interviews and observation
scientific protocol.the Idea and Process.Mona Quenawy
In a clinical trial, the protocol is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of population may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the duration of the study.means time frame.statistical analysis and outcome measurement.
the clinical application of evidence based clinical practice.Breast cancer indications of treatment Based on high level evidence .and colon cancer adjuvant chemotherapy .the effect of adjuvant chemotherapy in certain stages and the survival benefit for stages of colon cancer ,stage II and Stage III as reveled by MOSAIC TRIAL AND Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Meta-analysis.the high level evidence always relies on the meta analyses and phase III of well designed randomized controlled clinical trials.
The goal of EBP is to improve patient outcomes and lower healthcare costs. medical staff are in an excellent position to practice evidence-based care, since they have the most contact with patients and understand their mental, physical, and emotional conditions.
Communication skills are some of the most utilized and the most sought after in the workplace. They’re essential for leaders and individual contributors to hone. Looking at our largely remot and hybrid work environments, great communication skills make the difference between connected, agile teams, and teams who fail to collaborate, stay aligned, and achieve common goals.
The good news is that improving communication skills is easier than you might imagine. Here are some basic principles worth following in order to communicate better.
Making a mistake is a natural part of life. If you’re like most people, you probably view your mistakes negatively, but they allow you to learn about the limits of your skills, knowledge, and yourself through direct experience. Learning to handle a mistake gracefully and using it to your advantage is a valuable life skill.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdf
Breast cancer and Covid ERA.pdf
1. AIN SHAMS MEDICAL JOURNAL Vol. 73, No., 2, June, 2022
305
IMPACT OF COVID-19 PANDEMIC ON MANAGEMENT OF STAGE I,
II, AND III BREAST CANCER IN FEMALE EGYPTIAN PATIENTS: A
SINGLE INSTITUTIONAL STUDY
Mohamed Ali Abdel Daiem, Hany M. Abdel Aziz, Mohamed Y. Moustafa, Ahmed S.
Ibrahim Abdelmotal, Mona Quenawy
ABSTRACT:
Background: Corona virus disease 2019 has stressed regular
healthcare worldwide. Measures to alleviate the burden on healthcare
systems were implemented. This posed a challenge to breast cancer
care which is the most prevalent cancer and the leading cause of
cancer death in women worldwide. Multiple studies showed the
impact of pandemic on management of breast cancer.
Aim of the Work: To evaluate the impact of the COVID-19
pandemic on the management of non-metastatic breast cancer.
Patients and Methods: This is a retrospective study which
included total 196 non-metastatic breast cancer female patients
attending the breast clinic at the Clinical Oncology Department, Ain
Shams University during 2 periods from March 1st
, 2020, to end of
July 2020 for recruitment of study group (GROUP A) and from March
1st
, 2019, to end of July 2019 for the recruitment of comparative group
(GROUP B).
Result: There was a statistical difference between the 2 groups
regarding number of patients attending (55 in Group A vs 141 in
Group B); in referral route (42.9% of patients referred in Group A
was due to transforming the treating hospital to become quarantine
hospital while none in Group B with majority of patients were
referred as there was for radiotherapy); in details of treatment
protocols and time delay between decisions taken and start of the
treatment including total interrupted time with no treatment with more
delay before receiving any treatment (neoadjuvant, adjuvant or
surgery) in the study 2020 group
Conclusion: The impact of the COVID-19 pandemic over
different health care systems around the globe was remarked, Cancer
care was affected due to need of multidisciplinary teams to formulate
the best plan of management and breast cancer care were among
those affected.
Key Words: Non-metastatic, breast cancer, COVID-19 pandemic,
Delay of treatment, cancer management during pandemic.
INTRODUCTION:
Corona virus disease 2019 (COVID-
19) is a highly infectious disease caused by
acute respiratory syndrome corona virus 2
(SARS-CoV-2) and responsible for the
ongoing pandemic1.SARS-CoV-2 can
mostly be detected with polymerase chain
reaction from or opharyngeal swabs2. At the
beginning of January 2022, there are more
than 298,194,606 cases and more than
5,468,069 deaths had been confirmed
Department of Clinical
Oncology and Nuclear
Medicine, Faculty of Medicine,
Ain Shams University
Cairo, Egypt.
Corresponding author
Mohamed Ali Abdel Daiem
Mobile: +201004299380
E.mail:
m7amd1993@hotmail.com
Received: 18/3/2022
Accepted: 7/4/2022
Online ISSN: 2735-3540
2. Mohamed Ali Abdel Daiem, et al.;
306
worldwide3. Corona virus disease 2019 has
had enormous effects on healthcare systems
worldwide.
Breast cancer is the most common
cancer and the leading cause of cancer death
in women worldwide4. Early-stage breast
cancer is defined as disease confined to the
breast with or without regional lymph node
involvement, and the absence of distant
metastatic disease. This is since early-stage
breast cancer is potentially curable. In
developed countries more than 80% of
patients with early-stage breast cancer have
long-term survival after surgery, and in
some cases systemic therapy as chemo-
therapy, hormone therapy, and targeted
therapy, and local radiation5.
Surgery alone will result in long-term
survival for some patients. Systemic therapy
and local radiation can significantly improve
the chances for long term survival,
depending on the stage of disease, and
biologic subtype of breast cancer. Therefore,
the benefit of systemic therapy should be
viewed as incremental benefit above surgery
alone6&7. The measures required to alleviate
the burden on healthcare systems due to
COVID-19 have strongly affected patients
with breast cancer, especially the postponed
surgeries8.
AIM OF THE WORK:
To evaluate the impact of the COVID-
19 pandemic on the management of stage I,
II, and III breast cancer according to 8th
edition AJCC breast cancer staging.
PATIENTS AND METHODS:
For our study, it is a descriptive single
institutional study, we used Breast Unit files
at the Clinical oncology department, Ain
Shams University Hospitals, Cairo, Egypt, to
review differences in management of cancer
breast between 2 different groups. One
group was managed during COVID-19
pandemic (Group A) from the start of March
1st, 2020, to end of July 2020 while the
other group was seen before the pandemic
(Group B), from the start of March 1st,
2019, to end of July 2019. The study
elaborated the impact of the pandemic on
management decisions.
All cases were eligible for the study by
the inclusion criteria for the recruitment of
both comparative and study groups, so there
was no sample method as all cases included.
The study included females with Stage I, II,
and III breast cancer above 18 years old with
P.S. ECOG <3.
The study was approved by Ain Shams
University research ethics committee and all
our extracted data which included name,
age, sex, pathological diagnosis, time of
surgery &details of treatment were kept
confidential and the patients were kept
unidentified.
Statistical-analysis: The quantitative
data will be presented as mean, standard
deviations and ranges when their distribution
found parametric and median with inter
quartile range when their distribution found
nonparametric. Qualitative variables will be
presented as number and percentages.
RESULTS:
In this study, data of 196 patients were
collected and divided into 2 groups, Group
A (study population during 2020 time
period) 55 patients and group B
(comparative population of during 2019 time
period) 141 patients.
Demographic data: In (Table 1) there
was a significant difference as regards
residence (12.7 % of Group A were outside
of Greater Cairo compared to 0.7% of Group
B) due to referral from multiple centers
converted to quarantine hospitals.
3. Impact Of Covid-19 Pandemic On Management Of Stage I, Ii, And Iii Breast Cancer In Female …
307
Table (1)
Route of referral: In (table 2) there
was no statistical difference between 2
groups regarding number of patients referred
(45.5% in Group A vs 55.3% in Group B)
however there was significance in the reason
of referral with 42.9% of patients referred to
our center in Group A was due to
transforming the treating hospital to become
quarantine hospital specialized to treat the
increasing COVID cases while in Group B
majority of patients were referred as there
was no radiotherapy center at their treating
hospital constituting 78.2 % of patients
referred compared to 35.7% In Group A.
Table (2)
Group A
(N=55)
Group B
(N=141)
X2
* P Value
N % N %
Referred From
Other Center
No 30 54.5% 63 44.7% 1.54 0.21 NS
Yes 25 45.5% 78 55.3%
Cause of
Referral
Referring Hospital
Became Quarantine
12 42.9% 0 0.0%
35.54
FE
<0.001
HS
No RTH At
Referring Hospital
10 35.7% 61 78.2%
Financial Issues 5 17.9% 15 19.2%
Other 1 3.6% 2 2.6%
Details of treatment (A): In (Table 3)
there was statistically significant difference
between the 2 groups regarding time delay
since decision till surgery with mean in
Group A 7.8 weeks and in group B 4.6
weeks, same applies to start neoadjuvant or
adjuvant treatment (3.14 weeks Group A vs
1.39 weeks Group B) and (3.66 weeks
Group A vs 2.5 weeks Group B)
respectively, with mean total interruption
time delay without any type of treatment
was much more evident in Group A 7.25
weeks vs 2.93 in Group B.
Table (3)
Group A
(N=55)
Group B
(N=141)
t* P
Value
Mean SD Mean SD
Number of weeks passed since decision of
surgery and till it’s done
7.83 3.64 4.64 1.82 2.87 0.01
HS
Time passed from decision to start
neoadjuvant (weeks)
3.14 .36 1.39 .79 9.07 <0.001
HS
Weeks passed since decision till start adjuvant
treatment
3.66 1.61 2.57 1.08 3.61 0.001
HS
Interruption time with no treatment weeks 7.25 4.63 2.93 3.39 6.30 <0.001
HS
Group A
(N=55)
Group B
(N=141)
t* P Value
Mean SD Mean SD
Age 51.84 13.59 53.95 11.31 1.02 0.31 NS
N % N % X2**
P Value
Residence Greater Cairo 48 87.3% 140 99.3% 13.60
FE
<0.001
HS
Lower Egypt 4 7.3% 0 0.0%
Upper Egypt 2 3.6% 1 0.7%
Suez 1 1.8% 0 0.0%
4. Mohamed Ali Abdel Daiem, et al.;
308
Diagram (1): details of treatment (A)
Details of treatment (B): In (Table 4)
There was statistical difference between 2
groups regarding supportive bisphos-
phonates with adjuvant hormonal with no
patients received at Group A, there was no
statistical difference between 2 groups
regarding fractionation in radiotherapy but
there was not a single patient received
conventional fractionation in Group A.
Table (4):
Group A
(N=55)
Group B
(N=141)
X2* P
Value
N % N %
Bisphosphonates / 6
months for osteopenia
No 45 100.0% 74 76.3% 12.73 <0.001
HS
Yes 0 0.0% 23 23.7%
Fractionation
conventional 0 0 6 4.6% 2.01
FE
0.34 NS
hypofractionation 42 100% 124 95.4%
Details of treatment (C): In (Table 5)
In neoadjuvant setting as shows there was
statistically difference between 2 groups
regarding type of Taxans used, number of
cycles used and duration between cycles
with most common protocol in Group A was
3 cycles Taxol/21 days with only one patient
received the weekly regimen and in Group B
were Taxotere/21 days and 12 Taxol weekly
were almost equal. Regarding anthracycline
based chemotherapy there was no statistical
difference between 2 groups however, triplet
regimen was less common than duplet
regimens in Group A vs Group B (30% in
Group a vs 41% in Group B) in Group A and
4 cycles protocol were more common in
Group B than A (38% in Group A vs 59% in
group B).
In adjuvant setting there was similar
results to neoadjuvant setting regarding
Taxans but with statistical difference in
anthracycline based regimen were only 10%
in Group A received triplet regimen vs 50%
in Group B
5. Impact Of Covid-19 Pandemic On Management Of Stage I, Ii, And Iii Breast Cancer In Female …
309
Table (5):
Group A Group B X2* P Value
N % N %
Protocol of taxans based
chemotherapy in neoadjuvant
setting
TAXOL 10 83.3% 11 50.0% 3.65 0.06
TAXOTERE 2 16.7% 11 50.0%
Duration between taxans based
chemotherapy in neoadjuvant
settings wks
1.00 1 8.3% 11 50.0% 5.90 0.02
3.00 11 91.7% 11 50.0%
Number of taxans based
chemotherapy cycle in neoadjuvant
setting
3.00 8 66.7% 8 36.4% 6.11
FE
0.05
4.00 3 25.0% 3 13.6%
12.00 1 8.3% 11 50.0%
Protocol of anthracyclin based
chemotherapy in neoadjuvant
FEC 4 30.8% 9 40.9% 1.02
FE
0.66
AC 7 53.8% 8 36.4%
EC 2 15.4% 5 22.7%
Number of anthracyclin based
chemotherapy cycle in neoadjuvant
setting
1.00 1 7.7% 0 0.0% 2.55
FE
0.29
3.00 7 53.8% 9 40.9%
4.00 5 38.5% 13 59.1%
Protocol of taxans based
chemotherapy in adjuvant setting
TAXOL 15 68.2% 12 33.3% 6.67 0.01
TAXOTERE 7 31.8% 24 66.7%
Duration between taxans based
chemotherapy in adjuvant wks
1.00 2 9.1% 12 33.3% 4.38 0.04
3.00 20 90.9% 24 66.7%
Number of taxans based
chemotherapy cycle in adjuvant
3.00 9 40.9% 19 52.8% 10.18 0.01
4.00 11 50.0% 5 13.9%
12.00 2 9.1% 12 33.3%
Protocol of anthracyclin based
chemotherapy in adjuvant
FEC 2 10.5% 18 50.0% 15.29 <0.001
AC 6 31.6% 14 38.9%
EC 11 57.9% 4 11.1%
Number of anthracyclin based
chemotherapy cycle in adjuvant
3.00 9 47.4% 19 51.4% 0.08 0.78
4.00 10 52.6% 18 48.6%
Type Of G-Csf Prophyalxis primary 20 90.9% 26 72.3% 2.9 0.08
secondary 2 9.1% 10 27.7%
DISCUSSION:
The impact of the COVID-19
pandemic over different health care systems
around the globe was remarked, and the
significance of impact varies from a country
to another.
Similarly, A multicenter retrospective
cohort study in Netherlands investigated the
effects of COVID-19 on patients with breast
cancer who had undergone surgery from
March 9 to May 17, 2020, the primary
endpoints were the number of surgical
procedures performed during the study
period, tumor characteristics, surgery type,
and route of referral. The results showed a
total of 217 consecutive patients with breast
cancer requiring surgery were included. An
overall decrease in the number of patients
with breast cancer who were undergoing
surgery. The most significant decline was
seen in surgery for T1-T2 and N0 tumors9.
Similarly, Veronesi et al stated, The
COVID-19 viral pandemic responsible for
the severe acute respiratory syndrome
corona virus 2 (SARS-CoV-2) disease has
dramatically impacted our work worldwide
in the management of patients in terms of
6. Mohamed Ali Abdel Daiem, et al.;
310
diagnosis and surgical treatment of cancer -
including breast cancer. It has led to a rapid
and unprecedented reorganization of surgical
units to ensure that those patients with
respiratory distress disease received optimal
care. From this global situation, we can
observe two important consequences that
affect clinical practice. In the short term,
researchers and related resources have been
reassigned to managing the test procedures
of COVID-19 patients, and routine research
activities have been suspended. Moreover,
studies and clinical trials for COVID-19
have become a priority. In addition, travel
restrictions have meant that several
international conferences, audits, and student
training have been cancelled. In the medium
to longer term, recruitment delays resulting
from the pandemic will negatively affect the
early diagnosis of cancer and surgical
procedures, with implications that are
damaging not only financially, but also in
terms of potential diagnosis of more
advanced cancers, reducing possibilities of
survival and optimal care delivery10.
Similarly, A retrospective multicentric
study by Li J. et al, recently published in E
Clinical Medicine, clearly demonstrated that
the management of breast cancer patients
suffered from a lack of care in terms of
diagnosis and surgical procedures. They
collected data on 8397 breast cancer patients
from 97 Chinese cancer centers. In detail,
Hubei province recorded the lowest
incidence of early breast cancer (5.3%) in
comparison to the other provinces (15.3%).
Surgical procedures decreased dramatically
from 16.4% (December 2019) to 2.6%
(February 2020), and there was also a delay
in timelines from surgery to adjuvant
therapy11.
In our study there were some
statistically significant variables between the
2 groups studied regarding the flow and
route of referral of the patients, treatment
details and decisions. The noticed variation
in number between the 2 study populations,
with only 55 patients in group A enrolled
with the inclusion criteria compared to the
comparative group in 141 patients, this
maybe dt the halted screening programs, the
occurrence of non-painful breast lump (most
common presentation) is not an emergency
during the national and international wide
restrictions over hospital outpatient care and
services with delayed presentation of cases,
there was statistically significant results
regarding residence with Group A more
heterogenous population than group B with
the documented reason of referral for those
patients; where the treating district hospitals
were transformed to quarantine hospitals.
The biggest difference between the 2
groups was in the details of treatment
starting with delay to start any type of
treatment, neoadjuvant, adjuvant or
performing surgery with total interrupted
time with no ongoing treatment was much
higher in Group A, this is maybe due to the
halted governmental services and financial
paperwork to non-emergency medical
services during the pandemic, regarding the
surgical delay maybe also due to reservation
of limited operating theaters to emergency
surgeries, all the decision were made in an
attempt to decrease the flow of the patients
unless critically indicated. The vast majority
of the patients who received Taxans either
neoadjuvant or adjuvant was in form of
Taxol/3 weeks regimen to avert weekly
visits to the hospital, Taxol was preferred
over Taxotere due to less risk of
neutropenia, regarding Anthracyclins, the
duplet regimens were more commonly used
than the triplet ones with comparable side
effects over all regimens. Regarding G-CSF
prophylaxis, primary prophylaxis was more
commonly used to avoid the need of hospital
admission neutropenia.
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