REVIEW - Advancements in combination therapy of Hepatitis C virus.

Hepatitis C virus (HCV) is a primary cause of chronic liver disease along with various complications like liver cirrhosis and malignancy which leads to death. It has infected more than 185 million people worldwide. There is no congruence established for the treatment of various genotypes of HCV infection owing to diversity in prevalence globally. Assessment of affected individuals with HCV by polymerase chain reaction (PCR), viral load of HCV and liver enzyme levels (i.e., ALT and AST) are the foundation to evaluate the safety and efficacy of HCV therapies. The antiviral efficacy has been greatly improved and sustained viral response (SVR) rates increased from 6% with interferon monotherapy to 50-80% with PEG-interferon/ribavirin combination therapy to >95% after the approval of all interferon free oral direct acting antiviral agents. The main objective of this review article is to compile data from reference sources regarding the old and current therapeutic strategies used to manage HCV infection. It is accepted that chronic HCV infection increases patient's thrombocytopenia and neutropenia risk and complications increased in co-morbid disorders like in tuberculosis, HIV, diabetes etc. In past treatment associated side effects were the major consequences and many patients have to stop the treatment. But after the approval of direct acting antiviral drugs create a revolution in the treatment of HCV infection. So, it could be concluded that current combination therapies are a promising hope to eradicate and to control HCV but some safety concerns required more considerations Therefore, this review focus on the available latest combination therapies and their effectiveness to eradicate HCV infection.

Establishing Effective Resident and Family Councils: A Pilot Project to Increase Family and Resident Engagement in Alberta's Continuing Care Sites.

Resident and family councils aim to improve resident and family satisfaction, but guidelines for councils are scarce. This project developed a toolkit and tested its ability, along with networking meetings, to promote successful councils. Nine continuing care sites participated with residents, family and staff from each site who received the toolkit, completed surveys, attended meetings and participated in post-pilot interviews. Participants found that the toolkit helped improve council function and, with the networking meetings, increased participation. All sites found the toolkit and networking meetings to be valuable resources and had a strong desire to have them available in the future.

Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country.

BACKGROUND: Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important. OBJECTIVES: To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital. METHODS: Retrospective review of medical records of all children (age 1 month-16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19. RESULTS: All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1-7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h. CONCLUSION: This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.

REVISED TRAUMA SCORE AS A PREDICTOR OF OUTCOME IN TRAUMA CASES: EXPERIENCES AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN.

BACKGROUND: Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised Trauma Score (RTS) is widely used internationally but its effectiveness as a tool for predicting outcome in paediatric trauma patients in our setting, has yet to be established, mainly owing to lack of use. The aim of this study was to determine the effectiveness of RTS as a predictor of outcome in paediatric trauma patients in Pakistan. METHODS: We conducted a retrospective review of patient medical records at Aga Khan University Hospital, Karachi, from October 2006 to October 2009 and all patients aged less than 14 years, presenting with trauma were selected. Information was collected regarding demographics, vital signs at the time of presentation, length of stay (LOS) in the ward, ICU and the hospital, complications during hospital stay and mortality. Data was analysed in SPSS-17.0. RESULTS: The sample was 501 patients with a mean age of 5.3 years. Two third (66%) were males and 34% were females. Using available data, RTS was calculated for 394 patients, who were then divided into two groups based on the RTS. For 32 patients with a RTS less than 10, the length of stay in the ward, ICU and the hospital were all shorter than the 363 patients with a RTS greater than 10 (p-value <0.001). CONCLUSION: In our setting, RTS is a good predictor of outcome in paediatric trauma patients. It can aid in the assessment of severity of injury in, and objective assessment and triaging of paediatric trauma patients.

FREQUENCY OF HOSPITAL ACQUIRED HYPONATREMIA IN A PEDIATRIC TERTIARY CARE SETTING.

BACKGROUND: Hyponatremia is the most commonly encountered electrolyte disorder in children. In our country the epidemiology of hospital acquired hyponatremia has hardly ever been explored whereas the administration of hypotonic IV fluids is widely practiced here. Therefore we pioneered to conduct this study to determine the frequency of hospital acquired hyponatremia. METHODS: This was a cross sectional study carried out at Aga Khan University Hospital, Karachi in paediatric ward and ICU over a period of 12 months. All children (>1 month and <15 years of age) admitted in paediatric units and on maintenance IV fluids who had serum sodium level measured on admission were included in the study and followed to identify patients who had a drop in serum sodium during hospitalization. Informed consent was taken from parents and collected data was recorded on a pro forma. RESULTS: A total of 865 patients were enrolled in the study. Hyponatremia was recorded in 405 patients on admission (46.8%) while hospital acquired hyponatremia was documented in 240. children (27.7%). Out of these 142 (59.2%) were male and 98 (40.8%) were female. Mean age of children in hospital acquired hyponatremia group was 60.67 months. Severity of hospital acquired hyponatremia was recorded as mild in 191 (79.6%), moderate in 35 (14.6%) and severe in 14 (5.8%) children. Major disease categories included gastrointestinal disorder (30.4 %), respiratory illness (12.5%), oncological disease (16.3%), cardiovascular disease (11.7%), infectious disease (9.2%) and neurological illness (8.3%). CONCLUSION: Hospital acquired hyponatremia is frequently encountered in our hospitalized children with majority of them receiving hypotonic IV solutions.

Deficiency of ADAMTS-13 in pediatric patients with severe sepsis and impact on in-hospital mortality.

BACKGROUND: The enzyme involved in regulating the size of vWF (von Willebrand factor) in plasma is ADAMTS-13 (A disintegrin and metalloprotease with thrombospondin type-1 motives). Deficient proteolysis of ULvWF (ultra large von Willebrand factor) due to reduced ADAMTS-13 activity results in disseminated platelet-rich thrombi in the microcirculation characteristic of thrombotic thrombocytopenic purpura. Reduced ADAMTS-13 has also been observed in severe sepsis and is associated with poor survival. We conducted this study to detect ADAMTS-13 deficiency and its impact on in-hospital mortality in pediatric patients with severe sepsis. METHODS: Pediatric patients diagnosed with severe sepsis were recruited for the study. Baseline clinical characteristics were noted. ADAMTS-13 antigen levels were assayed by ELISA. According to ADAMTS-13 levels, patients were grouped as deficient and non-deficient. Comparison was done with regard to some clinical and biological characteristics and in-hospital mortality between the two groups. RESULTS: A total of 80 patients were enrolled in the study. The median age of the patients was 3.1 years (Range: 0.1-15 years). ADAMTS-13 deficiency with levels less than 350 ng/dl was found in 65% patients. In patients with ADAMTS-13 deficiency, 75.6% had low platelets of less than 150 × 109/L. In-hospital mortality was 42.3% and 35.7% in ADAMTS-13 deficient and non-deficient group, respectively. CONCLUSION: Majority of the pediatric patients admitted to hospital with severe sepsis exhibit ADAMTS-13 deficiency. ADAMTS-13 deficiency might play a role in sepsis-induced thrombocytopenia. More studies are needed to evaluate the role of ADAMTS-13 deficiency on in-hospital mortality.

Predictors of Mortality in Patients With Dengue Fever: Insights From a Comparative Analysis.

Objective To determine the clinical and biochemical predictors of mortality in patients with dengue fever. Methods This was an analytical, cross-sectional study conducted at Hayatabad Medical Complex, Peshawar, Pakistan. The study participants were patients admitted to the hospital for the management of dengue fever. Clinical parameters (age, gender, duration of hospital stay, and the presence of complications) and biochemical parameters [white blood cells count (WBC), platelet count, serum c-reactive protein (CRP) level, serum alanine aminotransferase (ALT) level, and serum creatinine] were recorded. These parameters were compared between the survivors and non-survivors of dengue fever. Results Out of 115 patients, the majority (n=82, 71.3%) were up to 45 years and the mean age was 38.40 ± 18.1 years. Most of the patients (n=105, 91.3%) survived. On univariate logistic regression analysis, age more than 45 years [odds ratio (OR) 0.141, 95% confidence interval (CI) 0.034 - 0.585, p = 0.007), leukocytosis (> 11,000/mcL) (OR 0.187, 95% CI 0.049 - 0.719, p = 0.015), and acute kidney injury (creatinine > 1.5 mg/dL) (OR 0.124, 95% CI 0.029 - 0.531, p = 0.005)] at the time of admission reduced the likelihood to survive. Leukocytosis and acute kidney injury remained significant independent predictors of mortality on multivariate logistic regression analysis. [(OR 0.201, 95% CI 0.042 - 0.960, p = 0.044) and (OR 0.148, 95% CI 0.026 - 0.857, p = 0.033) for survival, respectively]. Gender, duration of inpatient stay, thrombocytopenia (platelets < 30,000/mcL), and acute liver injury (ALT > 200 IU/L) were not associated with mortality from dengue fever. Conclusion Age over 45 years, leukocytosis, and acute kidney injury at presentation increased the likelihood of mortality from dengue fever in this study. Gender, duration of hospital stay, thrombocytopenia, and acute liver injury did not affect the odds of mortality.

A2LiGaI6 (A = Cs, Rb): New lead-free and direct bandgap halide double perovskites for IR application.

Recently, all inorganic double perovskites have drawn a lot of interest as promising solar materials. The optical, structural, thermoelectric, electronic, and mechanical properties of double halide perovskites A2LiGaI6 (A = Cs, Rb) are explored via first-principles calculations with the WIEN2k code, using GGA PBEsol and TB-mBJ potentials. The majority of perovskite materials utilized in the highest-performing solar cells have bandgaps ranging between 1.48 and 1.62 eV. The compounds A2LiGaI6 (A = Cs, Rb) have a direct bandgap of 1.51 eV and 1.55 eV, respectively, and are expected to be useful in solar cells. The optical study shows that there are large absorption bands in the visible region, as determined by the dielectric constant, absorption, and other dependent factors. Their potential for use in solar cells is increased by their absorption in the visible part. The BoltzTraP code has been used to perform thermoelectric studies to assess the electrical, thermal conductivities, and Seebeck coefficient. They are important for construction of thermoelectric generators that harvest heat energy because of their high figure of merit and incredibly low thermal conductivity of lattice at ambient temperature. Furthermore, by examining the spectroscopic limit maximum efficiency, up to 30 % efficiency is predicted for both compositions, which paves the way for the applicability of them in solar energy conversion.

Surface-enhanced Raman spectroscopy for monitoring antibacterial activity of imidazole derivative (1-benzyl-3-(sec­butyl)-1H-imidazole-3-ium bromide) against Bacillus subtilis and Escherichia coli.

BACKGROUND: Bacterial resistance against antibiotics remains a challenge and Raman Spectroscopy (SERS) may provide critical information concerning this. OBJECTIVES: In the current study, surface enhances Raman spectroscopy (SERS) has been used to determine the biochemical changes induced during the antibacterial activity of the in house synthesized imidazole derivative (1-benzyl-3-(sec­butyl)-1H-imidazole-3-ium bromide) in comparison to commercially available drugs (fasygien) against both gram-positive and gram-negative bacteria. METHODS: For this purpose, the antibacterial activity of this compound was assessed on Bacillus subtilis and Escherichia coli. The SERS spectral changes are detected which can be associated with the biochemical changes in the bacterial cells as a result of the application of both drugs, including fasygien and the imidazole derivative drug demonstrating the technique's potential for analyzing the antibacterial activities of drug candidates. RESULTS: The chemometric techniques such as Principal Component Analysis (PCA) and Partial Least Squares-Discriminant Analysis (PLS-DA) were performed for the differentiation of SERS spectral data sets of unexposed, exposed with imidazole derivative and commercially available antibacterial drugs for two different bacteria including E. coli and Bacillus. CONCLUSIONS: PCA was found helpful for the qualitative differentiation of all drug-treated E. coli and Bacillus in the form of separate clusters of spectral data sets and PLS-DA discriminated the unexposed and the exposed bacteria with imidazole derivative and commercially available drug with 93% sensitivity and 96% specificity for Bacillus and with 90% sensitivity and 89% specificity for E. coli.

Pediatric endotracheal intubations for airway management in the emergency department.

OBJECTIVE: The objective of this study was to determine indications, type of medications used, and immediate complications of pediatric endotracheal intubations in the emergency department. METHODS: A retrospective chart review was done on all pediatric patients (0-14 years old) who required endotracheal (ET) intubation for airway management in the Department of Emergency Medicine at Aga Khan University Hospital from January to December 2009. Data were collected on a preformed questionnaire for age, sex, indications, drugs used, and complications of pediatric ET intubations done in the emergency department. Dead-on-arrival patients and those intubated elsewhere were excluded. RESULTS: A total of 83 pediatric intubations were done during the study period. Indications for ET intubations were respiratory failure in 51 (61%), unresponsiveness in 18 (22%), cardiac arrest in 8 (10%), and trauma in 6 cases (7%). Comorbid conditions were present in 28 (34%). Of 83 ET intubations, drugs were used in 48 cases (58%). Both sedation and neuromuscular blockade were used in 42 cases (51%), 4 cases (5%) received sedation only, and 2 cases (2%) received relaxation without sedation, and in 35 cases (42%), intubation was done without drugs. Drugs used for sedation/induction were ketamine in 22 (26%), midazolam in 14 (17%), propofol in 7 (8%), and etomidate in 3 cases (4%). Neuromuscular blockades used were rocuronium in 27 cases (32%), succinylcholine in 11 cases (13.5%), and atracurium in 5 cases (6%). Complications were noted in 16 cases (19%). CONCLUSIONS: Respiratory failure was found to be the main presenting complaint. Drugs for sedation and relaxation to facilitate ET intubation were underused.

Surface-enhanced Raman spectroscopy (SERS) for monitoring colistin-resistant and susceptible E. coli strains.

The emergence of drug-resistant bacteria is a precarious global health concern. In this study, surface-enhanced Raman spectroscopy (SERS) is used to characterize colistin-resistant and susceptible E. coli strains based on their distinguished SERS spectral features for the development of rapid and cost-effective detection and differentiation methods. For this purpose, three colistin-resistant and three colistin susceptible E. coli strains were analyzed by comparing their SERS spectral signatures. Moreover, multivariate data analysis techniques including Principal component analysis (PCA) and Partial Least Squares-Discriminant Analysis (PLS-DA) were used to examine the SERS spectral data of colistin-resistant and susceptible strains. PCA technique was employed for differentiating colistin susceptible and resistant E.coli strains due to alteration in biochemical compositions of the bacterial cell. PLS-DA is employed on SERS spectral data sets for discrimination of these resistant and susceptible E. coli strains with 100% specificity, 100% accuracy, 99.8% sensitivity, and 86% area under receiver operating characteristics (AUROC) curve.

Geographic accessibility to childhood tuberculosis care in Pakistan.

BACKGROUND: Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. OBJECTIVE: We aimed to determine the geographical access to child TB services in Pakistan. METHOD: We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization's (WHO) recommended 5-km distance. RESULT: At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. CONCLUSION: With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.

Quantitative analysis of solid dosage forms of Losartan potassium by Raman spectroscopy.

Raman spectroscopy is an outstanding analytical tool increasingly utilized in the pharmaceutical field for the solid-state pharmaceutical drug analysis. In current study, the potential of Raman spectroscopy has been investigated for qualitative and quantitative analysis of solid dosage form of Losartan potassium. For this purpose, different solid dosage forms/concentrations of losartan potassium were prepared to compensate the commercially available pharmaceutical drug formulations and their Raman spectral data showed a gradual change in the specific Raman spectral features associated with the active pharmaceutical ingredient (API) of Losartan potassium as a function of change in the concentration. The Raman spectral data was analyzed by using Principal Component Analysis (PCA) for the classification of different spectral data sets of different concentrations of drug. Moreover, partial least square regression (PLSR) analysis was performed for monitoring the quantitative relation among different concentrations of Losartan potassium API and spectral data by constructing a predictive model. From the model, the value of root mean square error of calibration (RMSEC) and root mean square error of prediction (RMSEP) were observed to be 0.38 and 2.98 respectively and the value of goodness of fit was found to be 0.99. Furthermore, the quantity of unknown/blind sample of Losartan potassium formulation was also estimated by using PLSR model. From these results, it is demonstrated that Raman spectroscopy can be considered to be used for quick and reliable quantitative analysis of pharmaceutical solids.

Knowledge gaps in stroke care: results of a survey of family physicians in Pakistan.

Family physicians play a pivotal role in stroke prevention (primary and secondary) and early management of stroke in developing countries. The objective of this study was to evaluate whether Pakistani family physicians' approach to stroke prevention and management was in accordance with established international guidelines. This was a cross-sectional survey of randomly selected family physicians in Pakistan, conducted in 2007. A total of 588 family physicians participated in the study. The data reveal that 88% of the physicians are aware of at least one of the 5 major symptoms of stroke, but only 46% are able to correctly idenitfy all 5 symptoms; 93% of the physicians check blood pressure in their adult patients regularly, and 63% use a cutoff of 140/90 mm Hg to start antihypertensive therapy in routine clinical practice; 90% ask their patients about cigarette smoking or tobacco use, but only 64% regularly advise their patients to quit smoking; 75% do not routinely check cholesterol levels in their patients; 36% treat patients with stroke by themselves, whereas 64% prefer to refer these patients to a specialist or hospital; 57% use intravenous or sublingual antihypertensive medications in patients with acute stroke with blood pressure >160/100 mm Hg; and 95% use antiplatelet agents for stroke prevention, with 70% using aspirin and 28% using clopidogrel as first-line antiplatelet therapy. These data indicate a substantial gap between international guidelines and Pakistani family physicians' management of stroke patients. There is an urgent need for stroke-related continuing medical education to propagate stroke management guidelines.

Seizure outcome in moyamoya after indirect revascularization in pediatric patients: Retrospective study and literature review.

BACKGROUND: Moyamoya disease (MMD) is a unique cerebrovascular disorder characterized by progressive stenosis of anterior cerebral circulation. Moyamoya is not an uncommon disease in Saudi Arabia. Although a less common symptom of the disease, the incidence of seizure in MMD ranges from 6 to 30%. Indirect revascularization through Encephaloduroarteriosynangiosis technique is one of the surgical treatment options for MMD. In our cohort, we aim to evaluate seizure outcome in pediatric patients with moyamoya. METHODS: Eleven patients with seizure as primary presentation for MMD over a period of 10 years were included in the study. All patients underwent EDAS surgery. All patients underwent pre- and postoperative assessment of multiple factors contributing to seizure outcome. Patients were evaluated for surgery control clinically and radiologically. RESULTS: About 73% of MMD patients with seizures improved after EDAS surgery (P < 0.0005). Six patients out of 11 became seizure free. Patients with bilateral involvement of disease undergoing bilateral surgery had better seizure control than those undergoing unilateral surgery (P < 0.07). CONCLUSION: Patients with controlled seizure before surgery are more likely to be seizure free after intervention. Seizure outcome is favorable after indirect surgical revascularization in pediatric moyamoya patients.

Application of generated mask method based on Mask R-CNN in classification and detection of melanoma.

OBJECTIVE: Melanoma is a type of malignant skin cancer with high mortality, and its incidence is increasing rapidly in recent years. At present, the best treatment is surgical resection after early diagnosis. However, due to the high visual similarity between melanoma and benign melanocytic nevus, coupled with the scarcity and imbalance of data, traditional methods are difficult to achieve good recognition and detection results. Similarly, many machine learning methods have been applied to the task of skin disease detection and classification. However, the accuracy and sensitivity of the experiments are still not satisfactory. Therefore, this paper proposed a method to identify melanoma more efficiently and accurately. METHOD: We implemented a Mixed Skin Lesion Picture Generate method based on Mask R-CNN (MSLP-MR) to solve the problem of data imbalance. Besides, we designed a melanoma detection framework of Mask-DenseNet+ based on MSLP-MR. This method used Mask R-CNN to introduce the method of mask segmentation, and combined with the idea of ensemble learning to integrate multiple classifiers for weighted prediction. Compared with the ablation experiments, the accuracy, sensitivity and AUC of the proposed network classification are improved by 2.56%, 29.33% and 0.0345. RESULT: The experimental results on the ISIC dataset shown that the accuracy of the algorithm is 90.61%, the sensitivity reaches 78.00%, which is higher than the original methods; the specificity reaches 93.43%; and the AUC reaches 0.9502. CONCLUSION: The method is feasible and effective, and achieves the preliminary goal of melanoma detection. It is greatly improved the detection accuracy and reached the level of visual diagnosis of doctors.

Surface-enhanced Raman spectroscopy for comparison of serum samples of typhoid and tuberculosis patients of different stages.

BACKGROUND: Surface-enhanced Raman spectroscopy (SERS) is a reliable tool for the identification and differentiation of two different human pathological conditions sharing the same symptomology, typhoid and tuberculosis (TB). OBJECTIVES: To explore the potential of surface-enhanced Raman spectroscopy for differentiation of two different diseases showing the same symptoms and analysis by principal component analysis (PCA) and partial least square discriminate analysis (PLS-DA). METHODS: Serum samples of clinically diagnosed typhoid and tuberculosis infected individuals were analyzed and differentiated by SERS using silver nanoparticles (Ag NPs) as a SERS substrate. For this purpose, the collected serum samples were analyzed under the SERS instrument and unique SERS spectra of typhoid and tuberculosis were compared showing notable spectral differences in protein, lipid and carbohydrates features. Different stages of the diseased class of typhoid (Early acute and late acute stage) and tuberculosis (Pulmonary and extra-pulmonary stage) were compared with each other and with healthy human serum samples, which were significantly separated. Moreover, SERS data was analyzed using multivariate data analysis techniques including principal component analysis (PCA) and partial least square discriminate analysis (PLS-DA) and differences were so prominent to observe. RESULTS: SERS Spectral data of typhoid and tuberculosis showed clear differences and were significantly separated using PCA. SERS spectral data of both stages of typhoid and tuberculosis were separated according to 1st principle component. Moreover, by analyzing data using partial least square discriminate analysis, differentiation of two disease classes were considered more valid with a 100% value of sensitivity, specificity and accuracy. CONCLUSION: SERS can be employed for identification and comparison of two different human pathological conditions sharing same symptomology.

Surface-enhanced Raman spectral analysis for comparison of PCR products of hepatitis B and hepatitis C.

BACKGROUND: Surface-enhanced Raman spectroscopy is a reliable tool for identification and differentiation of two diseases showing similar symptoms, hepatitis B (HBV) and hepatitis C (HCV). OBJECTIVES: To develop a polymerase chain reaction technique (PCR) based SERS technique for differentiation of two human pathological conditions sharing the same symptoms using multivariate data analysis techniques e.g. principle component analysis (PCA) and partial least square discriminate analysis (PLS-DA). METHODS: PCR products of HBV and HCV were differentiated by SERS using silver nanoparticles (AgNPs) as a SERS substrate. For this analysis, PCR products of both the diseases with predetermined viral loads were collected and analyzed under SERS instrument and unique SERS spectra of HBV and HCV was compared showing many differences at various points. Diseased classes of HBV and HCV and their negative control classes (viral load less than 1) were compared. PCR products of true healthy DNA and RNA were also compared, which were significantly separated. Moreover, SERS data was analyzed using multivariate data analysis techniques including principle component analysis (PCA) and partial least square discriminate analysis (PLS-DA) and differences were so prominent to observe. RESULTS: SERS spectral data of HBV and HCV showed clear differences and were significantly separated using PCA. Negative control samples of both disorders and their true healthy samples of DNA and RNA were separated according to 1st principle component. By analyzing data using partial least square discriminate analysis, differentiation of two disease classes was considered more valid with sensitivity, specificity and accuracy value of 96%, 94% and 98% respectively. Value of area under curve (AUROC) was 0.7527. CONCLUSION: SERS can be employed for identification and comparison of two human pathological conditions sharing the same symptomology.

Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care.

OBJECTIVES: We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs). DESIGN: In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs. SETTING AND PARTICIPANTS: There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings. RESULTS: Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub-themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models. CONCLUSIONS AND IMPLICATIONS: Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported.

Effects of solvation on the spin state of iron(III) in 2,8,12,18-tetrabutyl-3,7,13,17-tetramethyl-5,10-diazaporphyrinatoiron(III) chloride.

The chloroiron(III) complex of 2,8,12,18-tetrabutyl-3,7,13,17-tetramethyl-5,10-diazaporphyrin, [(Cl)FeMBDAP], was prepared and studied by X-ray crystallography and by solution (1)H NMR and UV-vis measurements. In the crystal structure of hemisolvate [(Cl)FeMBDAP] x 0.5CHCl(3), two nonequivalent [(Cl)FeMBDAP] units containing Fe1 and Fe2 are arranged in pi-dimers with considerable overlap on their concave sides. Axial chloride bonded to Fe2 is solvated by hydrogen bonding with CHCl(3). Parameters of the coordination pyramid have typical values for the spin-mixed (S = 3/2 / 5/2) Fe(III) complexes in the case of Fe1 and are characteristic for the pure intermediate-spin state for Fe2 (displacement from the (N(Pyr))(4) planes - 0.385 and 0.290 A and the average N(Pyr)-Fe bond lengths -1.992 and 1.954 A for Fe1 and Fe2, respectively). Effective magnetic moments in CHCl(3) and CH(2)Cl(2) capable of specific solvation of chloride by hydrogen bonding (4.5-4.6 micro(B) at 298 K) are indicative about mixed intermediate/high-spin state S = 3/2 / 5/2, with the S = 3/2 contribution increasing upon lowering of the temperature (4.02 micro(B) in CD(2)Cl(2) at 193 K). In nonsolvating CCl(4), C(6)D(6), and THF-d(8), the mu(eff) values are consistent with the predominantly high-spin state at ambient temperature (5.5-5.75 micro(B) at 298 K) and almost pure S = 5/2 state at low temperature (ca. 5.9 micro(B) in THF-d(8) below 270 K). Downfield isotropic shifts from 35 to 50 ppm are observed for alpha-alkyl protons and upfield shifts from -5 to -15 ppm for meso-CH protons, which is characteristic for the presence of the intermediate-spin state. The splitting of signals of the diastereotopic alpha-CH(2) protons is increased with growth of the S = 3/2 state contribution from 1.5 to 4 ppm in nonsolvating to 11 ppm in specifically solvating solvents at 298 K and further to 31 ppm at 193 K (in CD(2)Cl(2)). In the presence of DMSO addition and in methanol solution, the single CH(2) signal is observed at 25-28 ppm, and the meso-CH resonance is also shifted downfield to ca. 30 ppm, indicating the formation of six-coordinated complexes [(DMSO)(2)FeMBDAP](+) and [(MeOH)(2)FeMBDAP](+), the latter having the mu(eff) value of 4.92 micro(B) at 291 K is a spin-mixed species. The electron spin resonance spectra recorded at 77 K indicates that in frozen glasses in CD(2)Cl(2) and THF molecules in the high-spin state (g( perpendicular) approximately 6) and the predominantly intermediate-spin state (g( perpendicular) approximately 4.2-4.3) coexist together.