Reasons for Admission and Outcome to an Acute Palliative Care Unit in Patients with Advanced Malignancy in a Cancer Hospital

Introduction: The alleviation of suffering is a primary goal of palliative care team for patients with terminal cancer. In some cases, patients experience symptoms requiring inpatient care. The purpose of this investigation was to assess the clinical presentation and outcomes of hospitalization in patients that were admitted to the acute palliative care service. Materials and Methods: This is a retrospective descriptive study looking at admissions to an acute palliative care unit in a single center over a 24-month period. Medical records of all patients, admitted in palliative care unit from 1st January 2013 till 31st December 2014, were reviewed for reason of admission and outcome. Results: A total of 226 patients were identified and included in the present investigation. Among these 55.5 % (125) were females. The median age of the cohort was 48 (15 - 86) years. The most common reasons for admission were alteration in consciousness (19.5 %), respiratory tract infection (18 %), diarrhea and/or vomiting (14.2 %) and respiratory distress (not related to infection) (13.4 %). The median duration of hospital stay was 4 (0-27) days. Majority of the patients were discharged home (65.1 %). However, a significant portion (33.1 %) of the patients did not survive the hospitalization. Following discharge from the hospital, at 4-weeks follow-up the survival rate was 38.7 %. This dropped to 21.7 % at 8-weeks. Conclusion: Patients with advanced disease have a multitude of reasons to seek acute inpatient care. Majority of the patients were discharged following care. However, the survival rate of patients following discharge was low

Probiotic Supplement Improves the Health Status and Lactation Performance in Dairy Animals

Probiotics are essential for the effective growth of beneficial bacteria present in enteric line. They help in the physiological functions of new-born calves that are highly susceptible to a variety of fatal syndromes. The criterion for the selection of strains for the design of probiotic products are based on retaining functional health characteristics. Samples from Nili-Ravi buffaloes were collected, and rumen strains are identified for probiotic product. Microscopic techniques with different biochemical tests and molecular techniques such as BLAST have performed for identification. Following species of Weisella has been identified based on genotypic analysis (16S rRNA) under accession number MK336765 (F2) and MK336779 (F4) in the NCBI GenBanK. The strains sharing some of the specific properties evaluated were identified genetically, and their compatibility and exopolysaccharide production were assayed. All of this will be helpful in the production of multi-stain-probiotic product for the nourishment of dairy calves

Common Methods to Understand and Develop Indigenous Probiotics Yeast for Ruminant

Probiotic yeast enhanced the ruminal gut microbial balance by producing intercellular effectors and important metabolites. The impact of yeast addition on animal health is influenced by different interlinked factors including animal genomics, its gut microbiota, and environment. Therefore, all factors should be considered regarding achieving the maximum outputs from animal probiotic yeast. In the situation of a high feeding cost, microbial feed supplements provide a suitable nutritional approach, which allows increased nutrient digestion rate and accordingly improves animal performance. Many yeast products are commercially available, but their efficiency as probiotic dietary addition in a particular breed is mostly questionable. Therefore, identification of ideal probiotic yeast strain is of great interest in this context. Innovative methods in relation to develop new probiotic are mainly focused on the exploring novel microbial strains from indigenous sources. It has been noted that for the identification of best probiotic strain for the host, a linkage between culture-independent and culture-dependent methods is a functional step. In this chapter, we will discuss the mode of action of probiotic yeast on animal lower gut microbiota and identification of ideal probiotic yeast by using advanced molecular methods

Factors Responsible for Resistance in Okra against Aphid, Aphis Gossiypii Glover (Homoptera: Aphididae)

Aphids are herbivores that feed on plant’s sap and are widespread throughout the globe. To assess the factors affecting the infestation of Aphis gossypii (Glover) and to use antixenosis a trial was conducted using 5 okra genotypes (Sabz Pari, Advanta, Durga, Kaveri, and Shandar) during spring, 2017 at “Agriculture Research Institute” (ARI) Tarnab, under Random Complete Block Design (RCBD) in field and Completely Randomized Design (CRD) in lab with 3 and 8 replications, respectively. Weekly data gathering for mean percent infestation of A. gossypii on each genotype to note variation among genotypes. The aphid infestations (2.5 Aphid leaf-1) recorded on Shandar was higher than others and lowest (2.0 Aphids leaf-1) was recorded on Durga. Initially the infestation was lesser (0.5) but with time it reaches to peak (3.62) on 1st May and then gradually declined to least (2.0 aphid leaf-1) in the 10th week. A statistically significant negative relationship existed between aphid abundance and crop yield. In the antixenosis trial, the Durga variety showed significant antixenosis resistance towards aphids after 12, 24, and 48 hours. Furthermore, the maximum yield of Durga variety (8.3 Tons (t)/ha) and the least yield (5.2 tons/ha) Shandar was obtained. Relating to aphid infestation and yield, the Durga variety performed exceptionally well. It is concluded from the results that the varieties showing antixenosis resistance towards insects must be recommended to not only reduce insect attacks but also to enhance yield

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Reasons for Admission and Outcome to an Acute Palliative Care Unit in Patients with Advanced Malignancy in a Cancer Hospital

Introduction: The alleviation of suffering is a primary goal of palliative care team for patients with terminal cancer. In some cases, patients experience symptoms requiring inpatient care. The purpose of this investigation was to assess the clinical presentation and outcomes of hospitalization in patients that were admitted to the acute palliative care service. Materials and Methods: This is a retrospective descriptive study looking at admissions to an acute palliative care unit in a single center over a 24-month period. Medical records of all patients, admitted in palliative care unit from 1st January 2013 till 31st December 2014, were reviewed for reason of admission and outcome. Results: A total of 226 patients were identified and included in the present investigation. Among these 55.5 % (125) were females. The median age of the cohort was 48 (15 - 86) years. The most common reasons for admission were alteration in consciousness (19.5 %), respiratory tract infection (18 %), diarrhea and/or vomiting (14.2 %) and respiratory distress (not related to infection) (13.4 %). The median duration of hospital stay was 4 (0-27) days. Majority of the patients were discharged home (65.1 %). However, a significant portion (33.1 %) of the patients did not survive the hospitalization. Following discharge from the hospital, at 4-weeks follow-up the survival rate was 38.7 %. This dropped to 21.7 % at 8-weeks. Conclusion: Patients with advanced disease have a multitude of reasons to seek acute inpatient care. Majority of the patients were discharged following care. However, the survival rate of patients following discharge was low

Loss-to-follow-up and delay to treatment initiation in Pakistan’s national tuberculosis control programme

Abstract Background Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. Methods This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. Results One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). Conclusion Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Data Quality: A Negotiator between Paper-Based and Digital Records in Pakistan’s TB Control Program

Background: The cornerstone of the public health function is to identify healthcare needs, to influence policy development, and to inform change in practice. Current data management practices with paper-based recording systems are prone to data quality defects. Increasingly, healthcare organizations are using technology for the efficient management of data. The aim of this study was to compare the data quality of digital records with the quality of the corresponding paper-based records using a data quality assessment framework. Methodology: We conducted a desk review of paper-based and digital records over the study duration from April 2016 to July 2016 at six enrolled tuberculosis (TB) clinics. We input all data fields of the patient treatment (TB01) card into a spreadsheet-based template to undertake a field-to-field comparison of the shared fields between TB01 and digital data. Findings: A total of 117 TB01 cards were prepared at six enrolled sites, whereas just 50% of the records (n = 59; 59 out of 117 TB01 cards) were digitized. There were 1239 comparable data fields, out of which 65% (n = 803) were correctly matched between paper based and digital records. However, 35% of the data fields (n = 436) had anomalies, either in paper-based records or in digital records. The calculated number of data quality issues per digital patient record was 1.9, whereas it was 2.1 issues per record for paper-based records. Based on the analysis of valid data quality issues, it was found that there were more data quality issues in paper-based records (n = 123) than in digital records (n = 110). Conclusion: There were fewer data quality issues in digital records as compared with the corresponding paper-based records of tuberculosis patients. Greater use of mobile data capture and continued data quality assessment can deliver more meaningful information for decision making

A Common Ancestral Mutation in CRYBB3 Identified in Multiple Consanguineous Families with Congenital Cataracts.

This study was performed to investigate the genetic determinants of autosomal recessive congenital cataracts in large consanguineous families.Affected individuals underwent a detailed ophthalmological examination and slit-lamp photographs of the cataractous lenses were obtained. An aliquot of blood was collected from all participating family members and genomic DNA was extracted from white blood cells. Initially, a genome-wide scan was performed with genomic DNAs of family PKCC025 followed by exclusion analysis of our familial cohort of congenital cataracts. Protein-coding exons of CRYBB1, CRYBB2, CRYBB3, and CRYBA4 were sequenced bidirectionally. A haplotype was constructed with SNPs flanking the causal mutation for affected individuals in all four families, while the probability that the four familial cases have a common founder was estimated using EM and CHM-based algorithms. The expression of Crybb3 in the developing murine lens was investigated using TaqMan assays.The clinical and ophthalmological examinations suggested that all affected individuals had nuclear cataracts. Genome-wide linkage analysis localized the causal phenotype in family PKCC025 to chromosome 22q with statistically significant two-point logarithm of odds (LOD) scores. Subsequently, we localized three additional families, PKCC063, PKCC131, and PKCC168 to chromosome 22q. Bidirectional Sanger sequencing identified a missense variation: c.493G>C (p.Gly165Arg) in CRYBB3 that segregated with the disease phenotype in all four familial cases. This variation was not found in ethnically matched control chromosomes, the NHLBI exome variant server, or the 1000 Genomes or dbSNP databases. Interestingly, all four families harbor a unique disease haplotype that strongly suggests a common founder of the causal mutation (p<1.64E-10). We observed expression of Crybb3 in the mouse lens as early as embryonic day 15 (E15), and expression remained relatively steady throughout development.Here, we report a common ancestral mutation in CRYBB3 associated with autosomal recessive congenital cataracts identified in four familial cases of Pakistani origin

Missense Mutations in CRYAB Are Liable for Recessive Congenital Cataracts.

This study was initiated to identify causal mutations responsible for autosomal recessive congenital cataracts in consanguineous familial cases.Affected individuals underwent a detailed ophthalmological and clinical examination, and slit-lamp photographs were ascertained for affected individuals who have not yet been operated for the removal of the cataractous lens. Blood samples were obtained, and genomic DNA was extracted from white blood cells. A genome-wide scan was completed with short tandem repeat (STR) markers, and the logarithm of odds (LOD) scores were calculated. Protein coding exons of CRYAB were sequenced, bi-directionally. Evolutionary conservation was investigated by aligning CRYAB orthologues, and the expression of Cryab in embryonic and postnatal mice lens was investigated with TaqMan probe.The clinical and ophthalmological examinations suggested that all affected individuals had nuclear cataracts. Genome-wide linkage analysis suggested a potential region on chromosome 11q23 harboring CRYAB. DNA sequencing identified a missense variation: c.34C>T (p.R12C) in CRYAB that segregated with the disease phenotype in the family. Subsequent interrogation of our entire cohort of familial cases identified a second familial case localized to chromosome 11q23 harboring a c.31C>T (p.R11C) mutation. In silico analyses suggested that the mutations identified in familial cases, p.R11C and p.R12C will not be tolerated by the three-dimensional structure of CRYAB. Real-time PCR analysis identified the expression of Cryab in mouse lens as early as embryonic day 15 (E15) that increased significantly until postnatal day 6 (P6) with steady level of expression thereafter.Here, we report two novel missense mutations, p.R11C and p.R12C, in CRYAB associated with autosomal recessive congenital nuclear cataracts