Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia. Objectives of this study are: to study the demographic characteristics and indications for admission of surgical patients in palliative care unit, to study the options of treatment modalities and their complications, to identify the barriers in decision making in surgical treatment and finally to objectively assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire. Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast (30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers. Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions: Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere words.

Hepatitis C Virus (HCV) recently was identified as a major cause of post transfusion hepatitis world wide. To evaluate the role of blood transfusion on the prevalence of HCV infection, by testing antibody and RNA as well as the genotypes of HCV .Also to detect if Blood transfusion acts as unconfounding risk factor for HCV infection. Sera from 3491 pregnant women were investigated for the presence of HCV antibodies (anti-HCV) by using third generation enzyme immunoassay (EIA-3) as screening test, followed by immunoblot assay (Lia Tek-III). In addition 94 sera of studied women were subjected to molecular analysis (at laboratories of Sorin BioMedica – Italy) for the detection of viral RNA and genotypes of HCV. Using RT-PCR & DNA Enzyme immunoassay (DEIA) method. Our study revealed, that seroprevalence rate of HCV specific Ab & RNA were significantly higher (16.32 %, 80% respectively) among women with a history of blood transfusion, compared to those (2.53%, 56.5%) with no such history P=0.0001, P=0.01. And there is a significant direct linear correlation between number of blood transfused and the seropositive rate of anti-HCV(r=0.7, p=0.046). Based on multivariate analysis, interestingly, this study confirmed that, blood transfusion significantly acting as unconfounding risk factor for acquiring HCV infection (Adjusted OR=1.938,95% C.I=1.646-2.28). And the risk of exposure is increases with increased number of blood transfused. Although, we found no significant association between, HCV genotypic distribution and history of blood transfusion. However, high proportion of women with a history of blood transfusion were harboring HCV genotype –4 or 1b, 50%,40%, resepctively. Our study shows, evidence that, blood transfusion acts as unconfounding risk factor for acquiring and in a mode of transmission of HCV infection. Therefore strict screening of blood donor for HCV-Abs and / or RNA is highly recommended.
Hepacivirus ; Blood Transfusion

This cross-sectional study aimed to serve as a pilot investigation to identify the level of discomfort and awkward posture among the workers of a garments manufacturing industry. The study was conducted for both male (54) and female (26) workers working in two different departments - stitching and finishing. Data were collected using both questionnaire and direct observation. As discomfort cannot be measured directly, a questionnaire was used to measure it based on subjective ratings by the workers. For analyzing posture, two objective assessment tools were used – rapid upper limb assessment (RULA) to analyze sitting posture and rapid entire body assessment (REBA) for standing posture. The cumulative scores of discomfort for different body parts were measured. The lower back was found to be at the highest risk as compared to other body parts. Female workers had higher score of discomfort (mean = 2.9615, S.D. = 1.3931) as compared to their male counterparts (mean = 1.2693, S.D. = 0.6538). Similarly, standing workers suffered more discomfort (mean = 2.7272, S.D. = 1.3090) as compared to sitting workers (mean = 1.0909, S.D. = 0.3784). No worker received ergonomically acceptable score for both of postural assessment tools. The mean RULA score was 5.25 and mean REBA score was 5. The results of this study necessitate a company-wide ergonomic assessment immediately.

OBJECTIVE: To document the medicinal and other folk uses of native plants of the Bana Valley of district of Kotli-Azad Jammu Kashmir with a view to preserve the ethnobotanical knowledge of this area and to develop an ethnobotanical inventory of the species diversity. METHODS: The fieldwork was conducted during a period of one year. Data were collected through semi-structured questionnaire and interview of the informants including indigenous people, tribal people, and traditional health practitioners residing in the study area. RESULTS: The present study documented etnobotanical uses of 86 plant species belonging to 81 genera and 47 families. This study revealed that most of the species were used medicinally (74 spp; 42.29%). Leaves found to be the most frequently used part (56 spp., 36.13%) for preparation of indigenous recipes and fodder purpose. CONCLUSIONS: The current research provides a huge lump of ethnobotanical knowledge and depicts strong human-plant interaction. It is an urgent need to document indigenous uses of plants for future domestication.

Myeloid sarcoma (MS) is an extramedullary solid neoplasm of immature myeloid cells. These tumours usually develop in concurrence with or following acute leukemia. The breast is an uncommon site for presentation of this tumour, where it is often misdiagnosed as lymphoma or carcinoma.A 33- year-old female presented with a right breast lump in a private hospital, which was diagnosed as ductal carcinoma on lumpectomy. Subsequently she developed a lump in the left breast and a similar diagnosis of carcinoma was made on biopsy. A left mastectomy was performed. Histopathological examination revealed a tumour composed of mononuclear cells arranged in sheets and cords with round to oval vesicular nuclei and occasional prominent nucleoli. IHC for CK was very weak and focal. The tumour cells were immunonegative for ER, PR, Her2neu,epithelial membrane antigen, e-cadherin, CD3 and CD20. Diffuse immunopositivity for myeloperoxidase, CD34 and CD117 established a diagnosis of myeloid sarcoma. A histopathological review of the right breast lesion, with immunohistochemistry, also confirmed the diagnosis of myeloid sarcoma. Investigatory workup for acute myeloid leukemia, including bone marrow aspirate and biopsy and karyotypic studies, proved negative. The patient was treated with high dose cytarabine (HDAC) regimen and was disease free during the 12-month follow-up.Although extremely rare, awareness of such a presentation is crucial. This case also illustrates that careful histopathological review along with an expanded panel of immunohistochemistry is extremely important for recognizing such cases as a misdiagnosis can lead to unnecessary surgery and inappropriate therapy.

Background: Blood transfusion safety commences with healthy donor recruitment. The threat of transfusion transmitted infections is greatly minimized by serological tools but not entirely eliminated. Recently, nucleic-acid testing for blood donor screening has virtually eliminated this jeopardy. Methods: This prospective study was conducted from February 2015 to February 2016. Samples from seronegative donors were run on multiplex assay (Cobas, S-201 system platform, Roche) in a batch of six [MP-NAT]. In case of reactive pool, tests were run on every individual sample [IDNAT]. Results: Of 16957 donors, 16836 (99.2%) were replacement donors and the remaining 121 (0.7%) were voluntary donors, with a mean age of 29.09 ± 7.04 years. After serologic screening of all 16957 donors, 955 (5.6%) were found to be reactive; 291(1.71%) were reactive for hepatitis-B surface antigen, 361 (2.12%) for antibody to hepatitis C virus (anti-HCV), 14 (0.08%) for antibody to human immunodeficiency virus, 287 (1.69%) for syphilis and 2 (0.01%) for malaria. 14 (0.08%) NAT reactive donors were identified after testing the 16002 seronegative donors, with an overall NAT yield of one reactivity out of 1143 blood donations; 10 donors for HBV-DNA (HBV NAT yield-1:1600) and remaining 4 for HCV-RNA (HCV-NAT yield-1:4000). None were HIV positive. Conclusion: NAT has improved the safety attributes in blood products. Although the positivity rate for NAT testing is low but in view of the high prevalence of transfusion transmitted infections in our country, we recommend the parallel use of both serology and NAT screening of all donated blood.

Objective: To document the medicinal and other folk uses of native plants of the area with a view to preserve the ethnobotanical knowledge associated with this area. Methods: The fieldwork was conducted during a period of one year. Data were collected through a semi-structured questionnaire and interviews with indigenous tribal people and traditional health practitioners residing in the study area. Results: The present study documented ethnobotanical uses of 104 plant species belonged to 93 genera and 51 families. Results revealed that most of the documented species were used medicinally (78 spp., 44.07%). Leaves were found to be the most frequently used part (69 spp., 42.86%) for the preparation of indigenous recipes and for fodder. Conclusions: The current research contributes significantly to the ethnobotanical knowledge, and depicts a strong human-plant interaction. There is an urgent need to further document indigenous uses of plants for future domestication.

Anatomic Variation ; Catheterization ; Female ; Functional Laterality ; Hand ; Health Personnel ; Humans ; Jordan ; Lighting ; Male ; Upper Extremity ; Veins