Frequency of psychosocial stress and its relationship to safety attitude towards nurse's performance at tertiary care hospitals.

Background & Objectives: Psychosocial stress has a detrimental effect on nurses' work performance. A safe working environment is significant in providing nurses with safe and satisfactory care. The objective of study was to assess the frequency of psychosocial stress of nurses and determine the relationship between psychosocial stress of nurses and safety attitude towards nurses' performances at Tertiary Care Hospital, Karachi. Methods: Analytical cross-sectional study was conducted at Dr. Ruth KM Pfau Civil Hospital, Karachi, and Dow University Hospital Karachi for six months, from December 2020 to May 2021.A total 260 participants were approached by a non-probability purposive sampling. Pearson's correlation was used to establish the relationship between the psychosocial stress of nurses and different parameters of their safety attitude. The Chi-square test was applied for the association between demographic factors of nurses with their psychosocial stress levels. A p-value of ≤0.05 was considered as significant. Results: The majority of nurses, 180 (69.2%), described poor health, while 54 (20.8%) had good health, and only 10% (26) of nurses reported their best health status. Three parameters were negatively correlated and statistically significant with psychosocial stress, namely: teamwork (r-0.13<0.002), job satisfaction (r-0.15<0.028), and perception of management (r-0.34<0.000). The result of the study indicated that gender (P-value<0.000), marital status (P-value<0.0037), and institution (P-value <0.005) were significantly associated with safety attitude score. Conclusion: Most of the nurses had poor health, which was significantly related to teamwork, job satisfaction and perception of management, and stress recognition.

Impact of climate change on wheat grain composition and quality.

Wheat grain quality, an important determinant for human nutrition, is often overlooked when improving crop production for stressed environments. Climate change makes this task more difficult by imposing combined stresses. The scenarios relevant to climate change include elevated CO2 concentrations (eCO2 ) and extreme climatic events such as drought, heat waves, and salinity stresses. However, data on wheat quality in terms of climate change are limited, with no concerted efforts at the global level to provide an equitable and consistent climate risk assessment for wheat grain quality. Climate change induces changes in the quality and composition of wheat grain, a premier staple food crop globally. Climate-change events, such as eCO2 , heat, drought, salinity stress stresses, heat + drought, eCO2 + drought, and eCO2 + heat stresses, alter wheat grain quality in terms of grain weight, nutrient, anti-nutrient, fiber, and protein content and composition, starch granules, and free amino acid composition. Interestingly, in comparison with other stresses, heat stress and drought stress increase phytate content, which restricts the bioavailability of essential mineral elements. All climatic events, except for eCO2 + heat stress, increase grain gliadin content in different wheat varieties. However, grain quality components depend more on inter-varietal difference, stress type, and exposure time and intensity. The climatic events show differential regulation of protein and starch accumulation, and mineral metabolism in wheat grains. Rapid climate shifting impairs wheat productivity and causes grain quality to deteriorate by interrupting the allocation of essential nutrients and photoassimilates. © 2022 Society of Chemical Industry.

Exogenous application of glutathione enhanced growth, nutritional orchestration and physiochemical characteristics of Brassica oleracea L. under lead stress.

A major obstacle to agricultural production and yield quality is heavy metal contamination of the soil and water, which leads to lower productivity and quality of crops. The situation has significantly worsened as a result of the growing population and subsequent rise in food consumption. The growth of nutrient-rich plants is hampered by lead (Pb) toxicity in the soil. Brassica oleracea L. (broccoli) is a prominent vegetable crop in the Brassicaceae family subjected to a number of biotic and abiotic stresses that dramatically lower crop yields. Seed priming is a novel, practicable, and cost-effective method that can improve various abiotic stress tolerances. Many plant metabolic activities depend on the antioxidant enzyme glutathione (GSH), which also chelates heavy metals. Keeping in view the stress mitigation potential of GSH, current research work was designed to inspect the beneficial role of seed priming with GSH on the growth, morphological and gas exchange attributes of broccoli seedlings under Pb stress. For this purpose, broccoli seeds were primed with 25, 50, and 75 µM L-1 GSH. Plant growth and photosynthetic activity were adversely affected by Pb stress. Furthermore, Pb stress enhanced proline levels along with reduced protein and phenol content. The application of GSH improved growth traits, total soluble proteins, chlorophyll content, mineral content, and gas exchange parameters. The involvement of GSH in reducing Pb concentrations was demonstrated by an improved metal tolerance index and lower Pb levels in broccoli plants. The results of the current study suggest that GSH can be used as a strategy to increase broccoli tolerance to Pb by enhancing nutrient uptake, growth and proline.

Prognostic accuracy of time to sputum culture conversion in predicting cure in extensively drug-resistant tuberculosis patients: a multicentre retrospective observational study.

BACKGROUND: There was a lack of information about prognostic accuracy of time to sputum culture conversion (SCC) in forecasting cure among extensively drug-resistant tuberculosis (XDR-TB) patients. Therefore, this study evaluated the prognostic accuracy of SCC at various time points in forecasting cure among XDR-TB patients. METHODS: This retrospective observational study included 355 eligible pulmonary XDR-TB patients treated at 27 centers in Pakistan between 01-05-2010 and 30-06-2017. The baseline and follow-up information of patients from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. Time to SCC was analyzed by Kaplan-Meier method, and differences between groups were compared through log-rank test. Predictors of time to SCC and cure were respectively evaluated by multivariate Cox proportional hazards and binary logistic regression analyses. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 226 (63.6%) and 146 (41.1%) patients respectively achieved SCC and cure. Median time to SCC was significantly shorter in patients who achieved cure, 3 months (95% confidence interval [CI]: 2.47-3.53), than those who did not (median: 10 months, 95% CI: 5.24-14.76) (p-value < 0.001, Log-rank test). Patient's age > 40 years (hazards ratio [HR] = 0.632, p-value = 0.004), baseline sputum grading of scanty, + 1 (HR = 0.511, p-value = 0.002), + 2, + 3 (HR = 0.523, p-value = 0.001) and use of high dose isoniazid (HR = 0.463, p-value = 0.004) were significantly associated with early SCC. Only SCC at 6 month of treatment had statistically significant association with cure (odds ratio = 15.603, p-value < 0.001). In predicting cure, the sensitivities of SCC at 2, 4 and 6 months were respectively 41.8% (95%CI: 33.7-50.2), 69.9% (95%CI: 61.7-77.2) and 84.9% (95%CI: 78.1-90.3), specificities were respectively, 82.8% (95%CI: 76.9-87.6), 74.6% (95%CI: 68.2-80.4) and 69.4% (95%CI: 62.6-75.5) and prognostic accuracies were respectively 65.9% (95%CI: 60.7-70.8), 72.7% (95%CI: 67.7-77.2) and 75.8% (95%CI: 71.0-80.1). CONCLUSION: In forecasting cure, SCC at month 6 of treatment performed better than SCC at 2 and 4 months. However, it would be too long for clinicians to wait for 6 months to decide about the regimen efficacy. Therefore, with somewhat comparable prognostic accuracy to that SCC at 6 month, using SCC at 4 month of treatment as a prognostic marker in predicting cure among XDR-TB patients can decrease the clinicians waiting time to decide about the regimen efficacy.

Evaluation of potential drug-drug interactions in cancer patients at a tertiary care hospital in Pakistan.

BACKGROUND: Despite harboring a high burden of cancer patients who are at high risk of potential drug-drug interactions (pDDIs), there is scarcity of published information about pDDIs in cancer patients from Pakistan. OBJECTIVE: To evaluate frequency, pattern, mechanism and factors associated with pDDIs in cancer patients treated at a tertiary care hospital in Pakistan. METHODS: In this cross-sectional analytical study, a total of 253 eligible ambulatory cancer patients treated at Center for Nuclear Medicine and Radiotherapy Hospital Quetta were evaluated for pDDIs using IBM Micromedex® Drug Interactions. SPSS (version 26) was used for conducting multivariate analysis to find factors associated with the presence pDDIs. A p-value <0.05 was considered statistically significant. RESULTS: A total of 141/253 (55.7%) patients were exposed to at-least one pDDI. A total of 251 pDDIs were noted with a median of one pDDI/per patient (interquartile range:1-2) Majority interactions were of major severity (72.9%), pharmacodynamic (49.8%) and had fair documentation level (64.1%). Anti-cancer drugs were involved in 73.0% pDDIs with doxorubicin as the most commonly involved (40.0%) anti-cancer followed by cyclophosphamide (27.6%) and cisplatin (13.5%). Potential cardiac adverse events made the bulk (33.8%) of predicted events. Receiving >2 anti-cancer (OR = 5.19, p-value = 0.001) and >6 ancillary drugs (OR = 4.16, p-value = 0.033) emerged as the risk factors of pDDIs. CONCLUSIONS: The prevalence of pDDIs was within the range reported in published literature. Solid medication review, availability of DDI detecting tools and clinical pharmacist, and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study site.

A Machine-Learning-Blockchain-Based Authentication Using Smart Contracts for an IoHT System.

Nowadays, finding genetic components and determining the likelihood that treatment would be helpful for patients are the key issues in the medical field. Medical data storage in a centralized system is complex. Data storage, on the other hand, has recently been distributed electronically in a cloud-based system, allowing access to the data at any time through a cloud server or blockchain-based ledger system. The blockchain is essential to managing safe and decentralized transactions in cryptography systems such as bitcoin and Ethereum. The blockchain stores information in different blocks, each of which has a set capacity. Data processing and storage are more effective and better for data management when blockchain and machine learning are integrated. Therefore, we have proposed a machine-learning-blockchain-based smart-contract system that improves security, reduces consumption, and can be trusted for real-time medical applications. The accuracy and computation performance of the IoHT system are safely improved by our system.

Study Correlating Neutrophil-Lymphocyte Ratio with Clinical Staging in Mucormycosis Patients.

Rhino-orbital mucormycosis is an aggressive fungal opportunistic infection of the immune-compromised, debilitated patients. The presence of neutrophilia and lymphocytopenia in patients affected with mucormycosis have been reported. Not much study has been done to establish the ratio of neutrophil to lymphocyte as a possible indicator for the severity of Rhino-orbital mucormycosis which is clinical staged. As such, this study aims to find out the relationship of the neutrophil-lymphocyte ratio with the clinical staging of Rhino-orbital mucormycosis in COVID19 recovered patient and if such a ratio can help to identify the severity of the opportunistic fungal infection. MATERIAL: This is a Cross-sectional study done on 100 patients who were diagnosed with Mucormycosis based on radiological findings, post-COVID19 recovery. The neutrophil-lymphocyte ratio was estimated after obtaining the complete blood count of the patient and calculating the ratio by the division of differential Neutrophil by the differential Lymphocyte count. The clinical staging of Mucormycosis was done based on radiological findings. OBSERVATION: The median value of Neutrophil Lymphocyte ratio was found to be elevated in all the clinical stages of Mucormycosis (from stage 2 to 4) at the time of admission as well as discharge considering the normal value of N/L ratio in a healthy individual to be 3. The median N/L ratio was also found to be in decreasing trend as compared from the time of admission to discharge in all the stages 2 to 4 of mucormycosis and was statistically significant (p=0.00) in stage 3 of mucormycosis. CONCLUSION: The Neutrophil-Lymphocyte ratio can be used as a viable marker of severity of mucormycosis and is a good prognostic indicator for resolution of disease especially in stage 3 of mucormycosis. This study helps to reiterate the importance of N/L ratio in the treatment protocol of mucormycosis.

Visceral Fat Volume is a Better Predictor of Insulin Resistance than Abdominal Wall Fat Index in Patients with Prediabetes and Type 2 Diabetes Mellitus.

Diabetes mellitus is a global pandemic. India, China and USA will be the countries with major diabetic population in the year 2040. Age of onset is a decade earlier in India compared to other European countries. Relative increase in visceral fat vs. subcutaneous fat in Asians and Asian Indians may explain the greater prevalence of metabolic syndrome in those population than in African American men, in whom Subcutaneous fat predominates. It is possible that visceral fat is a marker for excess postprandial free fatty acids in obesity, which is an early major contributor to the development of insulin resistance. Present study attempts to compare and co-relate the association of visceral fat and abdominal wall fat index to Insulin resistance in patients suffering from T2DM and prediabetes. Material and Objectives: To study the relationship between insulin resistance (HOMA-IR) and abdominal wall fat index (AFI) in Prediabetes and type II Diabetes Mellitus patients. To compare the visceral fat volume (VFV) with abdominal wall fat index in relation to insulin resistance in same subset of patients. METHOD: Cross sectional, observational study in 75 subjects (25 T2DM, 25 Prediabetes, 25 Controls). Detailed history including physical examination was performed. Patients were subjected to these investigations; FBS, HbA1C, S. Fasting Insulin levels, Lipid Profile, USG Abdomen to assess Visceral Fat Volume and Abdominal Wall Fat Index. Data were collected and analysed. OBSERVATION: Mean age of T2DM & prediabetes subjects was a decade higher than controls (T2DM 53 ±11.62 years, Prediabetes 55.76±11.97 years, Controls 45.72±10.42 years). Mean Systolic BP in T2DM subjects was 138.56±14.69, subjects with Prediabetes were 139.2±19.63 which is higher (p 0.02) compared to Controls(128±8.26). Average fasting serum insulin levels (mu/ml) of three groups; for T2DM: 25.41±13.7, for Prediabetes: 8.76 ±2.55, Controls: 6.07±2.55. The highest levels were in patients with T2DM, when compared to Prediabetes and controls. There was significant difference in the value of HOMA-IR, AFI, and the parameters of VFV (length between interior of abdominal muscle and splenic vein, length between interior of abdominal muscle and posterior wall of Aorta, Fat thickness of posterior renal wall) p<0.05. A significant correlation between HOMA-IR levels and VFV was found with a p value of <0.05. CONCLUSION: VFV acted as an independent marker in predicting Insulin resistance in subjects with prediabetes and T2DM. Fasting Insulin levels were highest in T2DM group amongst all three groups reflecting inadequate response of the body to appropriate levels of Insulin.

Formulation and evaluation of an ointment from Pinus gerardiana extracts indigenous to Balochistan.

In skin disorders such as microbial and fungal infections, plants and their parts are used. However, there have been very few scientific reports of herbal extracts of the plant Pinus gerardiana to be administered transdermally. The antifungal activity was assessed using poisoned food method against the strains of three pathogenic fungi, namely Alternaria alternata, Curvularia lunata and Bipolaris specifera. Ointment was prepared according to British pharmacopeia and physiochemical evaluation tests were performed. The GCMS was used to determine the chemical composition of the essential oil of Pinus gerardiana. 27 components were obtained. Monoterpenes= 89.97%, Oxygenated monoterpenes = 8.75%, Sesquiterpenes = 2.21% out of 100% of the total composition. The extract of pinus gerardiana showed a zone of inhibition on organism Bipolaris specifera 2.98±0.1µg/ml, Alternaria alternate 3.48±0.21µ/ml and Curvularia lunata 5.04±0.24µg/ml. Ointment was prepared with pH 5.9, conductivity 0.1, viscosity 22.24 and tested for stability. Franz cells were used in vitro and release was determined from 30 minutes to 12 hours.

Fe toxicity in plants: Impacts and remediation.

Fe is the fourth abundant element in the earth crust. Fe toxicity is not often discussed in plant science though it causes severe morphological and physiological disorders, including reduced germination percentage, interferes with enzymatic activities, nutritional imbalance, membrane damage, and chloroplast ultrastructure. It also causes severe toxicity to important biomolecules, which leads to ferroptotic cell death and induces structural changes in the photosynthetic apparatus, which results in retardation of carbon metabolism. However, some agronomic practices like soil remediation through chemicals, nutrients, and organic amendments and some breeding and genetic approaches can provide fruitful results in enhancing crop production in Fe-contaminated soils. Some quantitative trait loci have been reported for Fe tolerance in plants but the function of underlying genes is just emerging. Physiological and molecular mechanism of Fe uptake, translocation, toxicity, and remediation techniques are still under experimentation. In this review, the toxic effects of Fe on seed germination, carbon assimilation, water relations, nutrient uptake, oxidative damages, enzymatic activities, and overall plant growth and development have been discussed. The Fe dynamics in soil rhizosphere and role of remediation strategies, that is, biological, physical, and chemical, have also been described. Use of organic amendments, microbe, phytoremediation, and biological strategies is considered to be both cost and environment friendly for the purification of Fe-contaminated soil, while to ensure better crop yield and quality the manipulation of agronomic practices are suggested.

High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis.

BACKGROUND: There was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan. METHODS: This was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of "cured" and "treatment completed" were collectively grouped as successful, whereas "death", "treatment failure" and "lost to follow-up" were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings. RESULTS: A total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10-14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1-4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02). CONCLUSIONS: In this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients.

Treatment Outcomes of Childhood Tuberculosis in Three Districts of Balochistan, Pakistan: Findings from a Retrospective Cohort Study.

BACKGROUND: This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years). METHODS: This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value <0.05 was considered statistically significant. RESULTS: Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were <5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value < 0.001), rural residence (OR = 3.126, p-value < 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes. CONCLUSION: The study sites collectively reached the World Health Organization's target of treatment success (>85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further.

Short-Term Outcome of Early Primary Total Knee Arthroplasty for Fractures Around the Knee in the Elderly Population: The Experience of a Secondary Healthcare Centre in Malaysia.

BACKGROUND: The management of fractures around the knee in the elderly population can be challenging due to the complexity of the patients and the fracture characteristics. In this study, we aimed to investigate the short-term outcome of elderly patients who had fractures around the knee and who were treated with primary total knee arthroplasty. The study included patients who were at least 70 years old with poor bone quality and who presented with a fracture around the knee that would be difficult to treat with open reduction and internal fixation (ORIF) as well as patients who were at least 55 years old presenting with severe concomitant knee osteoarthritis. METHODS: This is a cross-sectional study in which all the elderly patients who underwent early primary total knee replacement due to trauma around the knee at the Segamat Hospital between January 2015 and June 2019 were identified. Data were collected from clinical and operative notes. The clinical outcomes of these patients were evaluated by the range of motion of the knee and the Knee Society Score (KSS). RESULTS: Ten patients were identified to have undergone this procedure. Six patients sustained supracondylar femur fractures, two patients had tibial plateau fractures and two patients had concurrent supracondylar femur and tibial plateau fractures. The mean follow-up duration was 22.3 ± 13.9 months, the mean knee score was 87.7 ± 10.0 and the mean functional knee score was 56 ± 41.9. CONCLUSION: In this cohort, good short-term outcomes close to pre-fracture condition was noted in patients who did not suffer from any complications during the post-operative period. Two patients who had surgical site infection had lower functional knee scores. Another two patients with lower knee scores experienced surgical site infection of the distal tibia and contralateral fixed flexion deformity of the knee. Early primary total knee replacement remains a viable option in treating fractures around the knee in the elderly. Infection, which in this study affected 20% of the patients, is the main deterring factor in performing this procedure.

A comparison of patient safety culture at two campuses of Riyadh based dental College.

OBJECTIVE: To identify potential shortcoming(s) in relevance to patient safety culture at dental clinics. METHODS: The cross-sectional study was conducted from March to June 2016 at two clinics of a dental teaching college in Riyadh, Saudi Arabia, and comprised subjects who had either direct or indirect contact with patients in the dental clinics. The subjects were handed over a questionnaire based on the Patient Safety Culture Hospital Questionnaire. SPSS 21 was used for data analysis. RESULTS: Of the 149 subjects, 96(64.4%) were male, and 130(87%) were in direct contact with patients, while 19(13%) were in indirect contact. Overall, 52(35%) subjects stated that their unit did not have enough staff to handle the workload, and 71(47.7%) said that not encountering serious errors in their unit was pure luck. An encouraging finding was that 104(69.8%) subjects said their managers appreciated them when they followed the established patient safety protocol. Conclusion: There was a variation in the perception of patient safety culture among professionals.

Barriers and facilitators influencing death at home: A meta-ethnography.

BACKGROUND: In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM: To identify and understand the barriers and facilitators influencing death at home. DESIGN: Meta-ethnography. DATA SOURCES: The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS: A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION: Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.

Terminal drought and seed priming improves drought tolerance in wheat.

Plants retain the preceding abiotic stress memory that may aid in attainment of tolerance to subsequent stresses. This study was conducted to evaluate the influence of terminal drought memory (drought priming) and seed priming in improving drought tolerance in wheat (Triticum aestivum L.). During first growing season, wheat was planted in field under optimal (well-watered) and drought stress imposed at reproductive stage (BBCH growth stage 49) until maturity (BBCH growth stage 83). Seeds collected from both sources were subjected to hydropriming or osmopriming (with 1.5% CaCl2 solution); while, dry seed was taken as control. Treated and control seeds, from both sources, were sown in soil filled pots. After the completion of seedling emergence, pots were maintained at 50% water holding capacity (drought) or 100% water holding capacity (well-watered). Drought stress suppressed the plant growth (2-44%), perturbed water relations (1-18%) and reduced yield (192%); however, osmolytes accumulation (3-14%) and malondialdehyde contents (26-29%) were increased under drought. The crop raised from the seeds collected from terminal drought stressed plants had better growth (5-63%), improved osmolyte accumulation (13-45%), and lower lipid peroxidation (3%) than the progeny of well-watered crop. Seed priming significantly improved the crop performance under drought stress as compared to control. However, osmopriming was more effective than hydropriming in this regard as it improved leaf area (9-43%), tissue water status (2-47%), osmolytes accumulation (6-48%) and grain yield (14-79%). In conclusion, terminal drought induced modifications in seed composition and seed priming improved transgenerational drought tolerance through improvement in tissue water status and osmolytes accumulation, and decrease in lipid peroxidation.

Temperature on admission among cases of neonatal sepsis and its association with mortality.

OBJECTIVE: To ascertain the prevalence of hyperthermia and different categories of hypothermia among the cases of probable and culture-proven neonatal sepsis, and to evaluate association of mortality rate with axillary temperature at admission. METHODS: This analytical study was conducted at Fazl-e-Omar Hospital, Rabwah, Pakistan, from January to December 2013, and comprised all cases of culture-proven and probable neonatal sepsis admitted in the neonatal intensive-care unit of the hospital. Using World Health Organisation classification, cases were categorised according to their temperature on admission, and outcome was recorded. SPSS 20 was used for data analysis. RESULTS: Of the 374 patients, 47(12.6%) died. Besides, 217(58%) cases had normal temperature, 49(13.1%) had hyperthermia, 50(13.4%) had mild hypothermia, and 58(15.5%) had moderate hypothermia. Mortality rate was high among cases with mild and moderate hypothermia i.e. 15(32.6%) and 15(33%), compared with the mortality rate in cases with normal temperature i.e. 12(6.1%). Mortality rate among cases with hyperthermia was 5(11.6%). In early onset cases, 33(16.2%) had mild and 45(22.1%) had moderate hypothermia. In late onset cases, 37(21.8%) had hyperthermia. CONCLUSIONS: Most cases with neonatal sepsis had normal temperature. Mild and moderate hypothermia were found to be associated with higher mortality rate.