Assessing nutritional status of critically Ill patients using serum prealbumin levels

Background: Malnutrition in hospitalized patients, contributes to poor outcomes. Biomarker serum prealbumin, can prevent the complications by commencement of nutritional support to improve clinical outcomes. This study was designed to assess the association between low serum prealbumin level (\u3c18 mg/dl), with length of stay and all cause intensive care unit mortality. Methods: This cross-sectional study was conducted from July 2016 to July 2017 at Aga Khan University Hospital Karachi Pakistan. All consecutive patients, aged between 18 to 70 years, admitted in medical or surgical intensive care unit were included. Demographic, clinical history and blood samples for analysing serum prealbumin were obtained on first day of admission. Patients were categorized into two groups based on their serum prealbumin level (taking \u3c18 mg/dl as low). Results: A total of 139 patients were included in this study; 95 (68.3%) were male. Median (Q3-Q1) prealbumin level of 12.3 mg/dl (18.8–8.7) was observed with low prealbumin level (\u3c18 mg/dl) in 100 (71.9%) patients. All-cause mortality was observed in 26 (26.0%) patients, mortality rate was significantly higher in patients with low prealbumin level (26.0% vs. 17.9%), p-value =0.31). Hospital and intensive care unit length of stay were statistically insignificantly different between the two groups with p-values of 0.27 and 0.44 respectively. Conclusion: We did not find association of low serum prealbumin with length of stay and mortality. Further research is warranted for the assessment of prealbumin as independent predictor of ICU mortality

ENHANCING CLIMATE RESILIENCE IN AGRICULTURAL PRACTICES: THE ROLE OF AGRICULTURAL EXTENSION WORKERS IN DISTRICT RAHIM YAR KHAN, PUNJAB, PAKISTAN

Abstract In recent years, the intricate relationship between climate change and its profound impact on agricultural productivity has garnered increasing attention, particularly concerning the pivotal role played by agricultural extension workers. This study delves into climate change mitigation strategies within the realm of agriculture, with a specific focus on the instrumental contributions of agricultural extension workers. Climate change presents a multifaceted challenge to global agricultural systems, exerting significant influences on productivity, crop yields, and food production. Amid these challenges, agricultural extension workers emerge as central figures bridging the chasm between technical knowledge and practical adaptation methods for farmers. This qualitative investigation draws upon a synthesis of existing research and incorporates insights from key informant interviews. By shedding light on the intricate interplay between climate change, agricultural productivity, and the pivotal function of agricultural extension workers, this research aspires to provide a comprehensive understanding of the dynamic relationships between these variables. By facilitating the adoption of climate-resilient techniques, such as cultivating drought-resistant crop varieties, implementing water-efficient irrigation methods, and promoting agroforestry, extension workers empower farmers to mitigate the severe impacts of climate change. Furthermore, extension workers play a pivotal role in bolstering farmers' adaptive capabilities and equipping them with essential skills to navigate increasingly volatile climatic conditions. Studies underscore that farmers who receive training from extension workers report heightened confidence in successfully implementing climate-adaptive strategies

Characterization of Hepatitis C Virus genotype 3a Hypervariable region 1 in patients achieved rapid virological response to alpha interferon and Ribavirin Combination therapy

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus roots a chronic liver disease. Currently approved treatment strategy includes administration of alpha interferon and ribavirin combined therapy for 24-48 weeks. One of the predictor of sustained virological response is an early virological response to treatment characterized as rapid response. Hyper variable region 1 (HVR1) of E2 protein is responsible for viral entry and acts as a target for neutralizing antibodies. Any mutation in this region would effect virus interaction with target cell and viral persistence.</p> <p>Methods</p> <p>Thirty one clones of six pre-treatment samples subjected to combination therapy were investigated. Three of the patients were rapid responders (R1, R2 and R3) and two were breakthrough responders (BT1 and BT2). Envelope 2 gene was amplified, cloned and sequenced. Amino acid substitution, frequency, composition and antigenic properties of HVR 1 of E2 protein were studied.</p> <p>Results</p> <p>In both rapid responders (R.R) (14 amino acid sites) and breakthrough responders (BT.R) (13 amino acid sites) half of the amino acid sites were either conserved or resistant to any physiochemical change due to amino acid substitution. It also indicated that average composition of hydrophilic and basic amino acids were comparatively lower in rapid responders than other samples affecting probable interaction of virus with target cells. A central non antigenic region was constant among the breakthrough responders but differed in length significantly among rapid responders reflecting the adaptive nature of HVR1 to the immune response.</p> <p>Conclusions</p> <p>We observed that although HVR1is quite variable region in HCV 3a patients responding differently to treatment it still maintains its physiochemical properties for its proper functioning and viability.</p

Mutations in the E2-PePHD region of hepatitis C virus genotype-3a and correlation with response to interferon and ribavirin combination therapy in Pakistani patients

Hepatitis C is a major health problem affecting more than 200 million individuals in the world. Current treatment regimen consisting of interferon alpha and ribavirin does not always succeed in eliminating the virus completely from patient's body. One of the mechanisms by which virus evades the antiviral effect of interferon alpha involves protein kinase (PKR) eukaryotic initiation factor 2 alpha (eIF2a) phosphorylation homology domain (PePHD). This domain in genotype 1 strains is reportedly homologous to PKR and its target eIF2a. By binding to PKR, PePHD inhibits its activity and therefore cause virus to evade antiviral activity of interferon (IFN). Many studies have correlated substitutions in this domain to the treatment response and lead to inconclusive results. Some studies suggested that substitutions favor response while others emphasized that no correlation exists. In the present study we therefore compared sequences of PePHD domain of thirty one variants of six hepatitis C virus patients of genotype 3. Three of our HCV 3a infected patients showed rapid virological response to interferon alpha and ribavirin combination therapy whereas the remaining three had breakthrough to the same combination therapy. It is found that PePHD domain is not entirely conserved and has substitutions in some isolates irrespective of the treatment response. However substitution of glutamine (Q) with Leucine (L) in one of the breakthrough responders made it more identical to HCV genotype 1a. These substitutions in the breakthrough responders also tended to increase average hydrophilic activity thus making binding of PePHD to PKR and inhibition of PKR more favorable

Introduction and evolution of dengue virus type 2 in Pakistan: a phylogeographic analysis

Discrete Bayes Factors from SPREAD. Locations are denoted with two letter codes (Additional file 5: Table S3). The upper half of the matrix shows the mean (standard deviation) for the discrete Bayes Factor calculated for the 12 discrete trait models. The lower half of the matrix shows how many times a linkage had a Bayes Factor greater than 3.0. (XLSX 9 kb

A Review on Pharmaceutical Waste Pollution in Water: Extent, Management and Removal Strategies

Pharmaceutical waste and presence of hazardous pollutants in them is a growing concern due to their fate, origin, higher rate of utilization and varying nature of active ingredients resulting in water contamination. However, there is few research on the graving nature of the problem. Cascading impacts on human and ecosystems can be expected from contaminated groundwater and other aquatic channels. While, various technologies used and studied for the removal/reduction/sedimentation of pharmaceutical pollutants. At the initial stages, level of toxicity should check with respect to flora, fauna, environment, and human health. Furthermore, the production of by-products from pharmaceutical pollutants should also be checked and regulated. These by-products can be much more toxic, than the original contaminants and can exert significant toxic effects. It was concluded that there should be ongoing efforts to reduce the cost associated with pharmaceutical waste and their pollutants removal processes to ensure sustainability in the environment and human being

Effects of Host and virus related factors on Interferon-α+ribavirin and Pegylated-interferon+ribavirin treatment outcomes in Chronic Hepatitis C patients

<p>Abstract</p> <p>Background</p> <p>Current standard therapy commonly followed for chronic Hepatitis C Virus (HCV) in Pakistan is interferon alpha plus ribavirin combination therapy (IFN α/ribavirin) and pegylated interferon plus ribavirin (PegIFN/ribavirin). PegIFN/ribavirin has increased rate of sustained virological response than standard IFN α/ribavirin therapy. Objective of current study was to analyze rate of early and delayed response to antiviral treatment as well as rate of relapse response in patients following standard treatment IFN α/ribavirin and in patients following pegylated interferon treatment.</p> <p>Methods</p> <p>Baseline serum samples of 153 patients enrolled for IFN α/ribavirin and 50 patients for PegIFN/ribavirin were collected. After total RNA extraction, genotyping was and HCV RNA viral load was done. Subsequently HCV RNA viral load was estimated at 4 weeks of treatment, at 12 weeks, at 24 or 48 weeks and finally after 6 months follow up period. All the data was statistically analyzed using fisher's exact test.</p> <p>Results</p> <p>Total 86 patients out of 153 patients following conventional IFN α/ribavirin therapy completed treatment and 69% of them showed Rapid Virological Response (RVR). Whereas 50 patients following PegIFN/ribavirin treatment completed treatment and 80% of them achieved RVR. Total 64 out of 86 patients following IFN α/ribavirin therapy completed follow up period and 53.5% of them achieved Sustainded Virologcal Response (SVR). Forty-five out of total 50 patients who received PegIFN/ribavirin treatment completed 6 months follow up period and among these 70% achieved SVR. SVR rates were significantly associated with RVR (p < 0.001), age (p < 0.001) and gender (p < 0.01)</p> <p>Conclusions</p> <p>Rate of sustained virological response can be determined by factors like rapid virological response and age since they share significant association with one another. More over rate of SVR was more prominent in males than in females.</p

True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach

Hepatitis Delta Virus (HDV) infects only patients that are already infected by hepatitis B virus (HBV) because this is sub satellite virus which depends on and propagate only in the presence of HBV. HDV causes co-infection or super infection with sever complication as compared to only HBV infection. No study on molecular level on HDV is available from this region; therefore, the aim of this study was to found out the molecular epidemiology of HDV (as a co-infection with HBV) in different geographical regions of Pakistan

Hepatitis C Treatment: current and future perspectives

Hepatitis C virus (HCV) is a member of Flaviviridae family and one of the major causes of liver disease. There are about 175 million HCV infected patients worldwide that constitute 3% of world's population. The main route of HCV transmission is parental however 90% intravenous drug users are at highest risk. Standard interferon and ribavirin remained a gold standard of chronic HCV treatment having 38-43% sustained virological response rates. Currently the standard therapy for HCV is pegylated interferon (PEG-INF) with ribavirin. This therapy achieves 50% sustained virological response (SVR) for genotype 1 and 80% for genotype 2 & 3. As pegylated interferon is expensive, standard interferon is still the main therapy for HCV treatment in under developed countries. On the other hand, studies showed that pegylated IFN and RBV therapy has severe side effects like hematological complications. Herbal medicines (laccase, proanthocyandin, Rhodiola kirilowii) are also being in use as a natural and alternative way for treatment of HCV but there is not a single significant report documented yet. Best SVR indicators are genotype 3 and 2, < 0.2 million IU/mL pretreatment viral load, rapid virological response (RVR) rate and age <40 years. New therapeutic approaches are under study like interferon related systems, modified forms of ribavirin, internal ribosome entry site (HCV IRES) inhibitors, NS3 and NS5a inhibitors, novel immunomodulators and specifically targeted anti-viral therapy for hepatitis C compounds. More remedial therapies include caspase inhibitors, anti-fibrotic agents, antibody treatment and vaccines