Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: A cross-sectional survey in Karachi, Pakistan

Background: Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.Method: A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence\u27s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant.Results: Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes.Conclusion: Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers

Chemical profiling and anti-breast cancer potential of hexane fraction of Sphaeranthus indicus flowers

Purpose: The current study aimed to determine the phytochemicals and anti-breast cancer potential of Sphaeranthus indicus.Methods: S. indicus flowers were extracted with methanol followed by fractionation using n-hexane. For the chemical composition of n-hexane fraction, qualitative phytochemical and GC-MS analysis were performed. The anti-proliferative activity was measured by MTT assay, whereas, cytotoxic and proapoptotic effects in MCF-7 (breast cancer) cells were determined using propidium iodide, 4′,6-diamidino- 2-phenylindole, dichlorofluorescin diacetate, and JC-1 staining through fluorescent microscopy.Results: The phytochemical analysis indicated presence of phytosterols, oils and resins in the nhexane fraction. GC-MS analysis showed that n-hexane fraction comprises of 11 compounds including methyl esters of caprylic acid, myristic acid, pentadecanoic acid, palmitic acid, margaric acid, stearic acid, oleic acid, elaidic acid, linoleic acid, linolenic acid and behanic acid. The tested fraction showed remarkable cytotoxic activity against breast cancer (MCF-7) cells while it was found less toxic towards non-cancerous (BHK-21) cells. Furthermore, morphological assessment through fluorescent microscopy revealed cytotoxic and apoptotic effects by improved cell membrane permeability, increased reactive oxygen species level, compromised mitochondrial activity and condensation of chromatin network.Conclusion: The n-hexane fraction of S. indicus contains phytosterols, oils and fatty acid methyl esters and produced apoptotic effect against breast cancer cells

Effect of Pretreatment and Substrate Ratios in Biorefinery Employing Co-digestion of Plant Biomass and Poultry Waste

The current study investigated the optimization of biogas generation during co-digestion of various plant biomasses with poultry waste at different ratios and pretreatment of plant biomass. The biochemical tests were executed at 35°C in a thermostat. Water hyacinth was found as the suitable substrate for mono and co-digestion due to high volatile solids (VS) and total soluble contents. However, poultry waste was appropriate only if it was co-digested with other biomasses. The experiments evaluating biogas generation at different ratios of plant biomasses and poultry waste demonstrated that water hyacinth and poultry (50:50) produced 262 mL g−1VS, giant reed and poultry (80:20) produced 235 mL g−1VSwhile maize and poultry (60:40) generated 193 mL g−1VS. However, the pretreating the plant biomass with either Fenton's or Fenton's plus ultrasonic had no effect on biogas generation. The volumes of biogas generated after various pretreatment were low as compared to condition without pretreatment. The codigestion can be classified as WH:P (50:50 > GR:P (80:20) > M:P (60:40). So, these ratios can be applied at decentralized scale for better waste management and biogas generation due to balanced C:N ratio of plant biomass and poultry manure. Co-digestion can also be applied at large scale with optimized ratio in Pakistan and other developing countries for biogas generation and waste management and reduce the methane emission through landfills

IRRITABLE BOWEL SYNDROME MANAGEMENT: BUMPY ROAD FOR PHYSICIANS

Irritable bowel syndrome is a complex gastrointestinal disorder related to over activity of nerves supplying the gut. 1It has been matter of enormous concern for both the patients and treating physicians’ .The clinical course is diverse and takes different twist and turns. Sometimes it does present with typical symptoms like bloating, flatulence and altered bowel habits. At times there is mental illness like severe depression that comes in the way which is real challenge for the physicians to treat as mere reassurance doesn’t suffice. The longer the history of symptoms, more complicated it gets. There are multiple obstacles before making in rows in treatment.2 The most frustrating point is when the patient fails to show any improvement after months of treatment. They have symptoms in relapsing and remitting manner. Post infectious IBS is more agonizing as the patient need antibiotics in an era of increasing resistance .3Failure of one antibiotic to resolve symptoms leads to usage of multiple ones at the same time .The cramping abdominal pain and the sleepless nights leading to daytime fatigue do have an enormous and disastrous impact on the activities of daily living. After the decades of research, optimization of treatment for irritable bowel syndrome is still a daunting task even for experienced gastroenterologists.4 The emergence of alarm symptoms like bleeding per rectum,uninetentional weight loss and feeling of abdominal mass in individuals who have altered bowel for years do ring the bell for physicians to act vigilantly who were otherwise complacent. 4They were relying on traditional treatment regimens like giving laxatives,anti spasmodic and medications for depression. Some of them do consider expeditious referral to psychiatrist without getting to the bottom of the situation. Colonoscopy is advised at the end when much damaged have been caused already .It will be excellent practice to advised stool routine examination ,culture.ESR,CRP and calprotectin levels.5 They will give an idea of level of inflammation in the gut as invasive investigations are always dangerous in setting of acute flare of disease such as inflammatory bowel diseas

Cache Memory: An Analysis on Replacement Algorithms and Optimization Techniques

Caching strategies can improve the overall performance of a system by allowing the fast processor and slow memory to at a same pace. One important factor in caching is the replacement policy. Advancement in technology results in evolution of a huge number of techniques and algorithms implemented to improve cache performance. In this paper, analysis is done on different cache optimization techniques as well as replacement algorithms. Furthermore this paper presents a comprehensive statistical comparison of cache optimization techniques.To the best of our knowledge there is no numerical measure which can tell us the rating of specific cache optimization technique. We tried to come up with such a numerical figure. By statistical comparison we find out which technique is more consistent among all others. For said purpose we calculated mean and CV (Coefficient of Variation). CV tells us about which technique is more consistent. Comparative analysis of different techniques shows that victim cache has more consistent technique among all

Microbial Ecology of Anaerobic Digesters: The Key Players of Anaerobiosis

Anaerobic digestion is the method of wastes treatment aimed at a reduction of their hazardous effects on the biosphere. The mutualistic behavior of various anaerobic microorganisms results in the decomposition of complex organic substances into simple, chemically stabilized compounds, mainly methane and CO2. The conversions of complex organic compounds to CH4 and CO2 are possible due to the cooperation of four different groups of microorganisms, that is, fermentative, syntrophic, acetogenic, and methanogenic bacteria. Microbes adopt various pathways to evade from the unfavorable conditions in the anaerobic digester like competition between sulfate reducing bacteria (SRB) and methane forming bacteria for the same substrate. Methanosarcina are able to use both acetoclastic and hydrogenotrophic pathways for methane production. This review highlights the cellulosic microorganisms, structure of cellulose, inoculum to substrate ratio, and source of inoculum and its effect on methanogenesis. The molecular techniques such as DGGE (denaturing gradient gel electrophoresis) utilized for dynamic changes in microbial communities and FISH (fluorescent in situ hybridization) that deal with taxonomy and interaction and distribution of tropic groups used are also discussed

Plants as Useful Vectors to Reduce Environmental Toxic Arsenic Content

Arsenic (As) toxicity in soil and water is an increasing menace around the globe. Its concentration both in soil and environment is due to natural and anthropogenic activities. Rising arsenic concentrations in groundwater is alarming due to the health risks to plants, animals, and human beings. Anthropogenic As contamination of soil may result from mining, milling, and smelting of copper, lead, zinc sulfide ores, hide tanning waste, dyes, chemical weapons, electroplating, gas exhaust, application of municipal sludge on land, combustion of fossil fuels, As additives to livestock feed, coal fly ash, and use of arsenical pesticides in agricultural sector. Phytoremediation can be viewed as biological, solar-driven, pump-and-treat system with an extensive, self-extending uptake network (the root system) that enhances the natural ecosystems for subsequent productive use. The present review presents recent scientific developments regarding phytoremediation of arsenic contaminated environments and its possible detoxification mechanisms in plants

Multifunctional Silver-based Nanomaterials for Non-conventional Oral Cancer Therapy through Simultaneous LOX and Selective COX-2 inhibition

Neoplastic cells have co-opted inflammatory receptors and signaling molecules that potentiate inflammation. Activated inflammatory pathways lead to neo-angiogenesis, lymph-angiogenesis, immunosuppression, tumor growth, proliferation and metastasis. This cancer-sustaining inflammation is a critical target to arrest cancer growth. Multiple drug resistance, high cost, low oral bioavailability and serious side effects have rendered conventional cytotoxic chemotherapeutics less impressive. The aim of this research was to achieve cancer debulking and proliferation prevention by limiting ‘cancer-sustaining’ tumor niche inflammation through non-conventional oral approach employing anti-inflammatory agents and avoiding conventional cytotoxic agents. Synergistic anti-inflammatory agents, i.e. celecoxib as selective COX-2 inhibitor and montelukast as cysteinyl leukotriene receptor antagonist, were selected. Silver nanoparticles (AgNPs) were used as nanocarriers because of their efficient synergistic anti-neoplastic effects and excellent oral drug delivery potential. Specifically, selected drugs were co-conjugated onto AgNPs. Synthesized nanoparticles were then surface-modified with poly (vinyl alcohol) to control particle size, avoid opsonization/preferred cellular uptake and improve dispersion. Surface plasmon resonance analysis, particle size analysis, DSC, TGA, XRD, FTIR and LIBS analysis confirmed the successful conjugation of drugs and efficient polymer coating with high loading efficiency. In-vitro, the nanoparticles manifested best and sustained release in moderately acidic (pH 4.5) milieu enabling passive tumor targeting potential. In-vivo, synthesized nanoparticles exhibited efficient dose-dependent anti-inflammatory activity reducing the dose up to 25-fold. The formulation also manifested hemo-compatibility, potent anti-denaturation activity and dose-dependent in-vitro and in-vivo anti-cancer potential against MCF-7 breast cancer and Hep-G2 liver cancer cell lines in both orthotopic and subcutaneous xenograft cancer models. The anti-inflammatory nanoparticles manifested tumor specific release potential exhibiting selective cytotoxicity at cancerous milieu with slightly acidic environment and activated inflammatory pathways. The formulation displayed impressive oral bioavailability, sustained release, negligible cytotoxicity against THLE-2 normal human hepatocytes, low toxicity (high LD50) and wide therapeutic window. Results suggest promise of developed nanomaterials as hemo-compatible, potent, cheaper, less-toxic oral anti-inflammatory and non-conventional anti-cancer agents