Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.

OBJECTIVE: We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM). DESIGN: Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews. SETTING: Data were collected from October to December 2021 in Tando Allah Yar District, Sindh. SUBJECTS: All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews. RESULTS: Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood. CONCLUSION: In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.

Association of consanguinity with neonatal asphyxia at birth: Evidence from Pakistan.

Consanguinity commonly known as inbreeding is a state of offspring borne to couple sharing same ancestors. It is a least researched non-obstetric determinant of adverse birth outcome in developing countries like Pakistan. This hospital based study was designed to investigate the association between consanguineous status and neonatal asphyxia measured measured as low APGAR scores after birth in 879 newborns.The data regarding consanguineous status was obtained retrospectively. Potential covariates were incorporated for finding confounding effects. Data was analyzed in SPSS version 26.0 as mean ± standard deviation, unadjusted & adjusted odds ratios by logistic regression at P-values ≤ 0.05 significance for associations. Over 36.1% newborns were consanguineous, delivered with APGAR < 6 at 1-minute compared to 5.2% born to non-consanguineous parents. Premature birth was the single most important factor associated with neonatal asphyxia and low APGAR at 1 & 5-minute after birth. After adjusting for confounding variables, first cousin couples' offsprings showed OR of 9.1 & 4.1 for APGAR score ≤ 6 at 1 & 5-minutes after birth, respectively (P < 0.001 & P =0.001). We conclude that consanguinity is a strong determinant for neonatal asphyxia reported as low APGAR scores in this population of new borns.

Bioinformatics, RNA sequencing, and targeted bisulfite sequencing analyses identify the role of PROM2 as a diagnostic and prognostic biomarker.

OBJECTIVES: Prominin 2 (PROM2) gene has been reported as a molecular biomarker of human cancers; however, its role is still controversial. This study was therefore arranged to seek the role of PROM2 in different cancers with Bioinformatics and in vitro analyses. METHODS: A combination of bioinformatics and molecular experiments. RESULTS: Through the utilization of Bioinformatics analysis, it was observed that in 19 out of the 24 human cancers studied, there was a significant increase in the expression of PROM2 compared to the respective control samples. Additionally, the overexpression of PROM2 was linked specifically to a decrease in overall survival (OS) among breast cancer (BRCA), lung adenocarcinoma (LUAD), and uterine corpus endometrial carcinoma (UCEC) patients. Furthermore, advanced molecular investigations were conducted, encompassing RNA sequencing (RNA-seq) as well as targeted bisulfite sequencing (bisulfite-seq) assessments of PROM2. These analyses were performed across an array of lung cancer cell lines (A549, ABC-1, EBC-1, and LK-2) and a normal control lung cell line (MRC-9). Results of these analysis revealed overexpression and reduced methylation of PROM2 within lung cancer cell lines, relative to the corresponding control cell line. This suggests that PROM2 assumes a substantial function in the advancement and course of BRCA, LUAD, and UCEC cancers. Subsequent pathway analysis revealed that genes enriched by PROM2 are actively engaged in four pivotal pathways. Additionally, intriguing associations were observed between PROM2 expression, tumor purity, infiltration of CD8+ T immune cells, and genetic modifications. Moreover, we also predicted a few MicroRNAs (miRNAs), transcription factors (TFs), and potential drugs that could help to understand and better manage these cancers via designing appropriate therapies targeting PROM2. CONCLUSION: Via this study, we effectively revealed PROM2 overexpression as a potential diagnostic and prognostic biomarker of survival in BRCA, LUAD, and UCEC.

BED OCCUPANCY RATE AND LENGTH OF STAY OF PATIENTS IN MEDICAL AND ALLIED WARDS OF A TERTIARY CARE HOSPITAL.

BACKGROUND: A good hospital management includes an effective allocative planning for beds in a hospital. Bed-occupancy rates and length of stay are the measures that reflect the functional ability of a hospital. METHODS: A cross sectional study of two months' duration was carried out in eight medical and allied wards of Liaquat University Hospital (LUH) Jamshoro with objective to estimate the bed occupancy rate and the average length of stay of patients. Data was collected by filling a predesigned check list and bed occupancy rate and average length of stay were computed. Associations were analysed by using SPSS version 16. The p-value 50.05 Was taken as level of significance. RESULTS: One hundred & seven admissions were recorded against 235 available beds. Average bed occupancy rate was 51.33%. The 51.4% of the patients in medical wards except paediatrics ward were of the age >50 years; the mean age was 45 years and standard deviation +/-6.4 years. Mean age in paediatrics was 3.89 years and standard deviation of +/-0.8 years. 55.1% patients had infectious diseases. The 32.7% patients stayed in hospital for up to 3 days showing significant association between nature of diseases and duration of stay (p=0.03). There was male preponderance, i.e., 54.2% males against 45.8% females. Showing significant association between gender and length of stay (p=0.01). CONCLUSIONS: Bed occupancy rate and average stay in hospital were found within recommended range; more improvement may be brought by doing further research on this issue.