Current status of biomedical waste management practices and barriers among private Jordanian dental clinics: A cross-sectional investigation of the capital Amman.

Biomedical waste management (BMWM) is vital in facilitating safe providing of healthcare. Developing countries suffer from the impact of mishandled biomedical waste (BMW) on the general public in addition to healthcare practitioners. Thus, this study aims to investigate the awareness and compliance of dental facilities to BMW regulations. Through a questionnaire designed as per the WHO guidelines on BMWM, we randomly recruited a total of 421 dental facilities representative of Jordan's capital. Mean BMWM practice scores were relatively high for the studied sample (0.748 ± 0.12). Nonetheless, while collection, transportation and storage standards were acceptable, those pertaining to segregation and disposal demonstrated lack of compliance to BMWM safety measures. An alarming number of participants dispose of infectious waste (40%), extracted teeth (48.5%), expired pharmaceuticals (44.4%), liquid chemicals (53.2%), X-ray films (35.0%) and solutions (48.7%) in the general trash or draining system. Such is attributed to either lack of resources, lack of proper equipment or poor awareness with BMWM guidelines. Moreover, it appears that location of the clinic (p < 0.001), occupation (p = 0.026) and presence of regulatory instructions (p = 0.048) were associated with higher BMWM scores. Overall, dental practitioners require proper training in terms of handling hazardous dental, chemical and radioactive wastes. Moreover, regulatory bodies should actively enforce regulations and monitoring, update current compliance legislations and subsidize eco-friendly practices.

Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis.

INTRODUCTION: The costs associated with cancer diagnosis, treatment and care present enormous financial toxicity. However, evidence of financial toxicity associated with cancer in low- and middle-income countries (LMICs) is scarce. AIM: To determine the prevalence, determinants and how financial toxicity has been measured among cancer patients in LMICs. METHODS: Four electronic databases were searched to identify studies of any design that reported financial toxicity among cancer patients in LMICs. Random-effects meta-analysis was used to derive the pooled prevalence of financial toxicity. Sub-group analyses were performed according to costs and determinants of financial toxicity. RESULTS: A total of 31 studies were included in this systematic review and meta-analysis. The pooled prevalence of objective financial toxicity was 56.96% (95% CI, 30.51, 106.32). In sub-group meta-analyses, the objective financial toxicity was higher among cancer patients with household size of more than four (1.17% [95% CI, 1.03, 1.32]; p = 0.02; I2 = 0%), multiple cycles of chemotherapy (1.94% [95% CI, 1.00, 3.75]; p = 0.05; I2 = 43%) and private health facilities (2.87% [95% CI, 1.89, 4.35]; p < 0.00001; I2 = 26%). Included studies hardly focused primarily on subjective measures of financial toxicity, such as material, behavioural and psychosocial. One study reported that 35.4% (n = 152 of 429) of cancer patients experienced high subjective financial toxicity. CONCLUSIONS: This study indicates that cancer diagnosis, treatment and care impose high financial toxicity on cancer patients in LMICs. Further rigorous research on cancer-related financial toxicity is needed.

Thromboembolic Events in Patients with HER2-Negative, Hormone Receptor-Positive, Metastatic Breast Cancer Treated with Ribociclib Combined with Letrozole or Fulvestrant: A Real-World Data.

Purpose: Cyclin dependent kinase (CDK) 4/6 inhibitors (palbociclib, ribociclib and abemaciclib) modulate endocrine resistance and are integral treatment for patients with advanced hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Since their approval, CDK4/6 inhibitors are widely used in clinical practice. Thromboembolic events (TEE) were not a major issue in patients treated on clinical trials utilizing these agents. However, conflicting data started to emerge describing higher than expected rates of both arterial and venous thrombosis in patients treated with CDK4/6 inhibitors. In this study, we report our experience on TEE in patients treated with one of these agents (ribociclib) in real-world settings. Patients and Methods: All consecutive patients with metastatic breast cancer (mBC) treated with ribociclib combined with letrozole or fulvestrant were retrospectively reviewed. All episodes of radiologically confirmed arterial or venous thrombosis were recorded. TEE was considered ribociclib-related if diagnosed while patients are on the drug, or within 4 weeks after the last dose. Results: A total of 305 patients, median age (range), 49 (22-87) years were enrolled. All patients had metastatic disease, and most (n=241, 79.0%) were with visceral metastasis. Ribociclib was used for a median duration of 7 months (range: 1-45) and was used beyond the first-line setting in 110 (35.9%) patients. TEE were confirmed on 6 (1.97%) patients; 3 were pulmonary embolism, 2 cerebral venous sinus thrombosis (CVST), and one case of limb ischemia and all were symptomatic. Similar rates of TEE were noted prior to initiation, and after stopping ribociclib. Conclusion: In real-world settings, breast cancer patients treated with ribociclib, combined with aromatase inhibitors or fulvestrant, may not be at higher risk for thromboembolic events. However, unusual sites of thrombosis, like CVST, may raise some concerns.

Urinary bladder metastasis from primary breast cancer, a rare and challenging diagnosis. A case report and literature review.

Introduction: and Importance: Liver, lung, bone and brain are usual sites for breast cancer metastases. However, colorectal, prostate and cervical tumors may directly invade the urinary bladder (UB), but hematogenous spread from distant organs like the breast, is extremely rare and may indicate poor prognosis. Case presentation: Here we describe the case of a 78-year-old female patient who was diagnosed with de novo metastatic breast cancer; initially to the bone and pleura with effusion, and then to the brain. Five years after her initial diagnosis, she presented with urinary symptoms and bilateral hydronephrosis. Work up showed diffuse thickening of the UB with no invasion from nearby structures; biopsy confirmed metastatic carcinoma of breast origin. Clinical discussion: Adenocarcinoma of the UB is uncommon. Distinguishing primary adenocarcinoma of the UB from secondary involvement is often challenging. When encountered, involvement by a secondary tumor, either by direct extension or distant metastasis, should be considered. Immunohistochemical stains are essential in reaching an accurate diagnosis. Conclusions: Breast cancer rarely metastasizes to the urinary bladder and prognosis is usually poor. Detailed medical history, imaging, and immunohistochemical studies on biopsy specimen should help reach accurate diagnosis.

Ether-a-go-go related gene-1a potassium channel abundance varies within specific skeletal muscle fiber type.

The ERG1A K+ channel, which is partially responsible for repolarization of the cardiac action potential, has also been reported in skeletal muscle where it modulates ubiquitin proteolysis. Because ERG1A protein appears variably expressed in muscles composed of mixed fiber types, we hypothesized that its abundance in skeletal muscle might differ with fiber type. Indeed, skeletal muscle fibers vary in speed of contraction (fast or slow), which is mainly determined by myosin heavy chain (MyHC) isoform content, but a sarcolemmal K+ channel might also modulate contraction speed. To test our hypothesis, we cryo-sectioned Soleus (SOL), Extensor Digitorum Longus (EDL), and Gastrocnemius muscles from five rats. These muscles were chosen because the SOL and EDL contain an abundance of slow- and fast-twitch fibers, respectively, while the Gastrocnemius has a more heterogeneous composition. The muscle sections were co-immunostained for the ERG1A protein and either the fast- or slow-twitch MyHC to identify fiber type. ERG1A fluorescence was then measured in the sarcolemma of each fiber type and compared. The data reveal that the ERG1A protein is more abundant in the fibers of the SOL than in the EDL muscles, suggesting ERG1A may be more abundant in the slow than the fast fibers, and this was confirmed with immunoblot. However, because of the homogeneity of fiber type within these muscles, it was not possible to get enough data from both fiber types within a single muscle to compare ERG1A composition within fiber type. However, immunohistochemistry of sections from the fiber type heterogeneous Gastrocnemius muscle reveals that slow fibers had, on average, a 17.2% greater ERG1A fluorescence intensity than fast fibers (p<0.03). Further, immunoblot reveals that ERG1A protein is 41.6% more abundant (p=0.051) in old than in young rat Gastrocnemius muscle. We postulate that this membrane bound voltage-gated channel may affect membrane characteristics, the duration of the action potential generated, and/or the speed of contraction. Indeed, ERG1A protein is more abundant in aged and atrophic skeletal muscle, both of which exhibit slower rates of contraction.