Implications for the practice of a patient expectation and satisfaction survey, at a teaching hospital in Karachi, Pakistan

Objective: To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. Methodology: A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected.Results: The mean age was 33.81 years, with 105 (33.2%) women, and 211 (66.8%) men. The majority were married, with education above intermediate level and were in private or government service or were housewives. The median for the patient waiting time was 30 minutes, against an expectation of 12.69 minutes. Reading newspaper, watching television, reading magazine, reading Quran and listening to music were quoted as ways to lessen the burden of waiting to see a physician. The average consultation time with the physician was 13.89 minutes, against an expectation of 16.37 minutes. Patient expectation in terms of listening by the doctor with patience, explanation of the diagnosis and treatment, prescription of medicines, ordering of investigations and specialist referral has been documented. Objections to the presence of medical student, nursing student, resident doctor, nurse and an observer, in the consultation room have also been documented. Reasons quoted for the objection include issues of privacy/confidentiality, lack of justification, discomfort, and interference with the consultation process. The expected average cost for doctor’s consultation was Pakistani Rs. 124, while 196 (61.8%) of the respondents were satisfied with the consultation based on Rs. 70. Conclusion: We have collected important information to improve the services offered at our Family Practice clinics (JPMA 53:122;2003)

High prevalence of alpha thalassemia in the tribal community of the western part of India! Reality or myth? Can simple hematology parameters; MCV and MCH act as screening tools at birth?

Background: The majority of adult tribal subjects in the western part of India, show microcytic hypochromic red cells, and borderline anemia with a normal iron profile, suggesting a high prevalence of thalassemia in this population. Methods: The current study was designed to perform qualitative (to screen for Hb Bart’s) and quantitative (to estimate percentage of Hb Bart’s) hemoglobin electrophoresis with modification of the method, to evaluate the prevalence of α thalassemia and to determine gene frequency of α+ thal gene. Furthermore, the present study also aimed to evaluate common hematology parameters like MCV and MCH as screening tools to suspect α thalassemia at birth. Results: Based on hemoglobin electrophoresis, the prevalence of α thalassemia in all its forms was found to be 66.66%. The estimated gene frequency for α+ thal was found to be 0.7453 and based on that, the extrapolated prevalence of α thalassemia was 93.52% (55.55% homozygous and 37.97% heterozygous). MCV<100 fl and MCH<31 pg were found to be reliable screening tools to predict α thalassemia at birth in full-term uncomplicated pregnancy. Conclusions: Tribal community in the western part of India bears a very high prevalence of α thalassemia, it’s a reality and not a myth. Simple hematological parameters like MCV (<100 fl) and MCH (<31 pg) measured at birth can prove to be cost-effective surrogate markers for α thalassemia. Large scale study using confirmatory genetic analysis is required to validate the findings.

Muscle-Specific Adaptations, Impaired Oxidative Capacity and Maintenance of Contractile Function Characterize Diet-Induced Obese Mouse Skeletal Muscle

BACKGROUND:The effects of diet-induced obesity on skeletal muscle function are largely unknown, particularly as it relates to changes in oxidative metabolism and morphology. PRINCIPAL FINDINGS:Compared to control fed mice, mice fed a high fat diet (HFD; 60% kcal: fat) for 8 weeks displayed increased body mass and insulin resistance without overt fasting hyperglycemia (i.e. pre-diabetic). Histological analysis revealed a greater oxidative potential in the HFD gastrocnemius/plantaris (increased IIA, reduced IIB fiber-type percentages) and soleus (increased I, IIA cross-sectional areas) muscles, but no change in fiber type percentages in tibialis anterior muscles compared to controls. Intramyocellular lipid levels were significantly increased relative to control in HFD gastrocnemius/plantaris, but were similar to control values in the HFD soleus. Using a novel, single muscle fiber approach, impairments in complete palmitate and glucose oxidation (72.8+/-6.6% and 61.8+/-9.1% of control, respectively; p<0.05) with HFD were detected. These reductions were consistent with measures made using intact extensor digitorum longus and soleus muscles. Compared to controls, no difference in succinate dehydrogenase or citrate synthase enzyme activities were observed between groups in any muscle studied, however, short-chain fatty acyl CoA dehydrogenase (SCHAD) activity was elevated in the HFD soleus, but not tibialis anterior muscles. Despite these morphological and metabolic alterations, no significant difference in peak tetanic force or low-frequency fatigue rates were observed between groups. CONCLUSIONS:These findings indicate that HFD induces early adaptive responses that occur in a muscle-specific pattern, but are insufficient to prevent impairments in oxidative metabolism with continued high-fat feeding. Moreover, the morphological and metabolic changes which occur with 8 weeks of HFD do not significantly impact muscle contractile properties

Hsp90 binds directly to fibronectin (FN) and inhibition reduces the extracellular fibronectin matrix in breast cancer cells:

Heat shock protein 90 (Hsp90) has been identified in the extracellular space and has been shown to chaperone a finite number of extracellular proteins involved in cell migration and invasion. We used chemical cross-linking and immunoprecipitation followed by tandem mass spectrometry (MS/MS) to isolate a complex containing Hsp90 and the matrix protein fibronectin (FN) from breast cancer cells

Genomic characterization of Nontuberculous Mycobacteria

YesMycobacterium tuberculosis and Mycobacterium leprae have remained, for many years, the primary species of the genus Mycobacterium of clinical and microbiological interest. The other members of the genus, referred to as nontuberculous mycobacteria (NTM), have long been underinvestigated. In the last decades, however, the number of reports linking various NTM species with human diseases has steadily increased and treatment difficulties have emerged. Despite the availability of whole genome sequencing technologies, limited effort has been devoted to the genetic characterization of NTM species. As a consequence, the taxonomic and phylogenetic structure of the genus remains unsettled and genomic information is lacking to support the identification of these organisms in a clinical setting. In this work, we widen the knowledge of NTMs by reconstructing and analyzing the genomes of 41 previously uncharacterized NTM species. We provide the first comprehensive characterization of the genomic diversity of NTMs and open new venues for the clinical identification of opportunistic pathogens from this genus

Not Available

Not AvailableWater is limited vital natural resource which is indispensable for the existence of all living of all matter; plant, animal and man. Farmers of the Saurashtra region are tempted to use more irrigation water from the tube well due to erratic and uneven rainfall to meet the requirement if intensive cropping, this has been resulted in very heavy withdrawal of ground water therefore, it is a need to recharge the runoff water on their field. The study has been undertaken at the Instructional Farm, College of Agricultural Engineering and Technology, Junagadh agricultural University, Junagadh. The aquifer properties like transmissibility, storage coefficient and specific capacity of the well was found through pumping test at Instruction farm well. Similarly, they were found through recovery test.. The determined aquifer properties were verified by the recovery test. The observed data on drawdown at various times since pumping started was analyzed by the Jacob approximation method. The observed data on residual drawdown at various times since pumping stopped were analyzed to determine the aquifer properties using Theis recovery method. The potential rate of ground water recharge for the aquifer of this region through tube well was found higher as the depth of tube well increases. The cost of ground water recharge was found nominal as compared to that of under surface storage water. The benefit cost ratio for wheat, cumin and green gram grown by utilizing recharged water was found higher, so one can go for bore well recharging for getting higher yield.Not Availabl

Trends in donation after circulatory determination of death donor utilization: Lessons from Houston

Background: Modern advancements have made organ transplantation an increasingly viable option for patients with organ failure. The resulting increases in patients awaiting transplant has resulted in significant morbidity and mortality due to increasing waiting time for transplant. The use of Donation after Circulatory Determination of Death (DCD) organ donors has been the most successful avenue to address the increased need for organ allografts. This review provides a brief history of DCD organ donation in the United States as represented by the experience of the Houston-based LifeGift Organ Procurement Organization (OPO). Methods: Organ donation data from the Scientific Registry of Transplant Recipients (SRTR) and OPO specific data to include all available DCD donors for LifeGift were obtained for analysis. Trends in DCD donation were analyzed in the context of United Network for Organ Sharing policy. Results: By the end of 2021 20% of organs donated in the United States were from DCD donors, in a steadily increasing trend since the mid-1990′s. Metrics utilized by UNOS to monitor organ donation rates and OPO performance do not clearly capture potential DCD donors. Individual OPOs have varying success in utilization of DCD donors, with OPOs like LifeGift focusing on increased DCD utilization. Conclusion: DCD utilization remains the most successful avenue for increasing the deceased donor organ pool in the United States. Increased utilization of DCD organs by transplant centers and focused efforts by OPOs to promote DCD donation can improve the organ shortage nationally. Improved clarity in UNOS metrics can further facilitate OPO performance evaluation and promote further DCD donation in the United States