Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p

Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries

Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion

Increased HIV-1 transcriptional activity and infectious burden in peripheral blood and gut-associated CD4+ T cells expressing CD30

HIV-1-infected cells persist indefinitely despite the use of combination antiretroviral therapy (ART), and novel therapeutic strategies to target and purge residual infected cells in individuals on ART are urgently needed. Here, we demonstrate that CD4+ T cell-associated HIV-1 RNA is often highly enriched in cells expressing CD30, and that cells expressing this marker considerably contribute to the total pool of transcriptionally active CD4+ lymphocytes in individuals on suppressive ART. Using in situ RNA hybridization studies, we show co-localization of CD30 with HIV-1 transcriptional activity in gut-associated lymphoid tissues. We also demonstrate that ex vivo treatment with brentuximab vedotin, an antibody-drug conjugate (ADC) that targets CD30, significantly reduces the total amount of HIV-1 DNA in peripheral blood mononuclear cells obtained from infected, ART-suppressed individuals. Finally, we observed that an HIV-1-infected individual, who received repeated brentuximab vedotin infusions for lymphoma, had no detectable virus in peripheral blood mononuclear cells. Overall, CD30 may be a marker of residual, transcriptionally active HIV-1 infected cells in the setting of suppressive ART. Given that CD30 is only expressed on a small number of total mononuclear cells, it is a potential therapeutic target of persistent HIV-1 infection

Seismic performance evaluation of plastered cellular lightweight concrete (CLC) block masonry walls

Abstract The current research presents a novel and sustainable load-bearing system utilizing cellular lightweight concrete block masonry walls. These blocks, known for their eco-friendly properties and increasing popularity in the construction industry, have been studied extensively for their physical and mechanical characteristics. However, this study aims to expand upon previous research by examining the seismic performance of these walls in a seismically active region, where cellular lightweight concrete block usage is emerging. The study includes the construction and testing of multiple masonry prisms, wallets, and full-scale walls using a quasi-static reverse cyclic loading protocol. The behavior of the walls is analyzed and compared in terms of various parameters such as force–deformation curve, energy dissipation, stiffness degradation, deformation ductility factor, response modification factor, and seismic performance levels, as well as rocking, in-plane sliding, and out-of-plane movement. The results indicate that the use of confining elements significantly improves the lateral load capacity, elastic stiffness, and displacement ductility factor of the confined masonry wall in comparison to an unreinforced masonry wall by 102%, 66.67%, and 5.3%, respectively. Overall, the study concludes that the inclusion of confining elements enhances the seismic performance of the confined masonry wall under lateral loading

Improving the lateral load resistance capacity of cellular lightweight concrete (CLC) block masonry walls through ferrocement overlay

Cellular lightweight concrete (CLC) block masonry is an eco-friendly building material gaining popularity in both developed and developing countries. Despite its increasing use, the material's behavior under seismic loading remains insufficiently understood. This research involved quasi-static testing of two full-scale CLC blocks masonry walls strengthened with ferrocement overlay. One of the strengthened walls was subjected to confinement, while the other was unconfined. The aim was to assess their seismic performance by comparing force deformation curves, damping, stiffness degradation, and structural performance levels with non-strengthened walls. The findings indicate that the strengthened masonry outperformed the unreinforced version, suggesting that CLC block masonry exhibits potential for effective performance in low to moderate seismic zones

Utilization of waste marble powder as partial replacement of cement in engineered cementitious composite

AbstractThe current study focuses on the utilization of Marble Waste Powder (MWP) as a partial substitution of cement along with local sand instead of microsilica sand in Engineered Cementitious Composite (ECC). The aim was to reduce the environmental concerns of ECC by reducing the cement content without adversely affecting the desired properties. Four mixes were evaluated; the control mix which has no MWP and three test mixes having cement replacement with MWP by 10%, 15%, and 20% were used, respectively. The properties of ECC mixes were found in terms of compressive, tensile, and flexural characteristics. The trend of change in the basic properties of ECC with an increased percentage of MWP as partial substitution of cement was found along with the hypothesis test on the experimental data. From this study, it was concluded that the increased percentage of MWP reduces on the compressive strength of ECC. The maximum reduction in compressive strength of ECC was recorded as 49% with 20% replacement of cement with MWP, as compared to the control sample at 91 days of test age. The tensile strain of ECC increases with the increase in MWP content, while the tensile stress increases only with the increase of MWP content up to a specified limit. The ultimate load in the force–deflection curve first increases with the increase in MWP content up to a certain percentage, while upon further increase in MWP content from 15% to 20%, the ultimate load decreases. The study suggests that the properties do not vary significantly for the modified ECC samples containing MWP, especially the 10% and 15% MWP samples, and can be utilized instead of normal ECC, thus mitigating environmental concerns without compromising the ECC’s performance

Lack of Sprouty 1 and 2 enhances survival of effector CD8+ T cells and yields more protective memory cells.

Identifying novel pathways that promote robust function and longevity of cytotoxic T cells has promising potential for immunotherapeutic strategies to combat cancer and chronic infections. We show that sprouty 1 and 2 (Spry1/2) molecules regulate the survival and function of memory CD8+ T cells. Spry1/2 double-knockout (DKO) ovalbumin (OVA)-specific CD8+ T cells (OT-I cells) mounted more vigorous autoimmune diabetes than WT OT-I cells when transferred to mice expressing OVA in their pancreatic β-islets. To determine the consequence of Spry1/2 deletion on effector and memory CD8+ T cell development and function, we used systemic infection with lymphocytic choriomeningitis virus (LCMV) Armstrong. Spry1/2 DKO LCMV gp33-specific P14 CD8+ T cells survive contraction better than WT cells and generate significantly more polyfunctional memory T cells. The larger number of Spry1/2 DKO memory T cells displayed enhanced infiltration into infected tissue, demonstrating that absence of Spry1/2 can result in increased recall capacity. Upon adoptive transfer into naive hosts, Spry1/2 DKO memory T cells controlled Listeria monocytogenes infection better than WT cells. The enhanced formation of more functional Spry1/2 DKO memory T cells was associated with significantly reduced mTORC1 activity and glucose uptake. Reduced p-AKT, p-FoxO1/3a, and T-bet expression was also consistent with enhanced survival and memory accrual. Collectively, loss of Spry1/2 enhances the survival of effector CD8+ T cells and results in the formation of more protective memory cells. Deleting Spry1/2 in antigen-specific CD8+ T cells may have therapeutic potential for enhancing the survival and functionality of effector and memory CD8+ T cells in vivo

Dampened antiviral immunity to intravaginal exposure to RNA viral pathogens allows enhanced viral replication.

Understanding the host immune response to vaginal exposure to RNA viruses is required to combat sexual transmission of this class of pathogens. In this study, using lymphocytic choriomeningitis virus (LCMV) and Zika virus (ZIKV) in wild-type mice, we show that these viruses replicate in the vaginal mucosa with minimal induction of antiviral interferon and inflammatory response, causing dampened innate-mediated control of viral replication and a failure to mature local antigen-presenting cells (APCs). Enhancement of innate-mediated inflammation in the vaginal mucosa rescues this phenotype and completely inhibits ZIKV replication. To gain a better understanding of how this dampened innate immune activation in the lower female reproductive tract may also affect adaptive immunity, we modeled CD8 T cell responses using vaginal LCMV infection. We show that the lack of APC maturation in the vaginal mucosa leads to a delay in CD8 T cell activation in the draining lymph node and hinders the timely appearance of effector CD8 T cells in vaginal mucosa, thus further delaying viral control in this tissue. Our study demonstrates that vaginal tissue is exceptionally vulnerable to infection by RNA viruses and provides a conceptual framework for the male to female sexual transmission observed during ZIKV infection

Realistic dielectric response of high temperature sintered ZnO ceramic: A microscopic and spectroscopic approach

High temperature sintering (1200-1400 °C) has been performed on ZnO ceramics. An X-ray Absorption Fine Structure (XAFS) study shows that high sintering temperature introduces a constant amount of VO and VZn defects without any significant effect on the crystal or electronic structure of Wurtzite ZnO. The combined effects of grain boundaries and voids are considered responsible for the apparent colossal dielectric constant (ϵ′) &gt; 104 at low frequency (∼102 Hz) for all the sintered ZnO ceramics. The superior contact among grains of the ZnO-1200 sample enhances both the interfacial and orientational polarization of the Zn2+-VO dipoles, which results in the increase of low and high frequency dielectric constants (ϵ′) and the corresponding dielectric loss (tan δ) also increases. On the other hand, high temperature sintering of ZnO at 1300 °C and 1400 °C introduces voids at the expense of reduced grain and grain boundary contact areas, thus affecting both the interfacial and orientational polarization with corresponding reduction of dielectric constant (ϵ′) and dielectric loss. Orientational polarizations due to Zn2+-VO dipoles are suggested to remain fixed and it is the microstructure which controls the dielectric properties of high temperature sintered ZnO ceramics. This journal i

Pharmacological Justification for the Medicinal Use of Plumeria rubra Linn. in Cardiovascular Disorders

Plumeria rubra (L.) is a traditional folkloric medicinal herb used to treat cardiovascular disorders. The present investigation was methodically planned to investigate the pharmacological foundations for the therapeutic effectiveness of P. rubra in cardiovascular illnesses and its underlying mechanisms. Ex vivo vaso-relaxant effects of crude leaf extract of P. rubra were observed in rabbit aorta ring preparations. Hypotensive effects were measured using pressure and force transducers connected to the Power Lab data acquisition system. Furthermore, P. rubra displayed cardioprotective properties in rabbits when they were exposed to adrenaline-induced myocardial infarction. In comparison to the intoxicated group, the myocardial infarction model showed decreased troponin levels, CK-MB, LDH, ALT, ALP, AST, and CRP, as well as necrosis, apoptosis, oedema, and inflammatory cell enrollment. P. rubra has revealed good antioxidant properties and prolonged the noradrenaline intoxicated platelet adhesion. Its anticoagulant, vasorelaxant, and cardioprotective effects in both in vivo and ex vivo investigations are enabled by blocking L-type calcium channels, lowering adrenaline, induced oxidative stress, and tissue tear, justifying its therapeutic utility in cardiovascular disorders