Background and Aim:Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.Materials and Methods:Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month – 16 years of age who died in PICU, from January 2007 to December 2012.Results:A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period.Conclusion:We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making.

Morus nigra Linn. (black mulberry) is used in gastrointestinal ailments. This study demonstrates gut modulatory properties of M. nigra. The prokinetic, laxative, and antidiarrheal activities of M. nigra were assessed in mice, while isolated rabbit jejunum and guinea-pig ileum were used to explore insight into mechanism(s). At 30 and 70 mg/kg, the crude extract of M. nigra (Mn.Cr) exhibited atropine-sensitive prokinetic and laxative effects, similar to carbachol (CCh). While at higher doses (100, 300, and 500 mg/kg), Mn.Cr offered protection against castor oil-induced diarrhea. In rabbit jejunum, Mn.Cr and its chloroform fraction inhibited CCh-induced contractions more potently compared with high K(+) (80 mm). Conversely, petroleum fraction was more potent against high-K(+) -induced contractions. At 0.01 mg/mL, Mn.Cr caused a parallel shift in acetylcholine concentration-response curves (CRCs) followed by a non-parallel shift at 0.03 mg/mL, similar to dicyclomine. At further tested concentrations, Mn.Cr (0.1 and 0.3 mg/mL) and petroleum fraction suppressed Ca(2+) CRCs, similar to verapamil. In guinea-pig ileum, Mn.Cr, its aqueous and ethyl acetate fractions exhibited atropine-sensitive gut stimulant activity along with additional uncharacterized excitatory response in the aqueous fraction only. These results suggest that black mulberry possesses prokinetic, laxative, and antidiarrheal effects, putatively mediated through cholinomimetic, antimuscarinic, and Ca(2+) antagonist mechanisms, respectively. Copyright © 2016 John Wiley& Sons, Ltd.

Introduction: The World Health Organization declared the COVID-19 epidemic an international public health emergency on January 30th, 2020. Many patients required ICU admission for advanced respiratory support, including high flow nasal oxygen, and non‐invasive, and invasive mechanical ventilation. Lower Ct values may be associated with disease severity Objective: To observe the Cycle threshold (Ct) value and outcome of the COVID-19 patients admitted in Intensive Care Unit (ICU). Methods: Nasopharyngeal/ oropharyngeal samples were collected via swabs from suspected COVID-19-positive patients admitted to Corona ICU of Teaching Hospital, Dera Ghazi Khan (DG Khan). Samples were proceeded for RNA extraction and amplification and were declared positive on basis of the S-shaped amplification curve at FAM (ORF1) and ROX channel, and a Ct value of ≤40. Results: Out of 59 ICU admissions, 17 were females and 42 males. The highest percentage of mortality was observed in the 60 and above years of age group (78.98%). Ct values were lower in patients who expired as compared to the patients who were discharged (mean 21.052 vs 23.739). Conclusion: Males were more frequently admitted to ICU for management of severe infection by COVID-19 than females. Mortality is associated with increasing age. Cycle threshold (Ct) values were lower in patients who expired than those who recovered Keywords: Cycle threshold, RT-PCR, COVID-19, ICU

<p>Health care professionals (HCPs) remain the most vulnerable population while performing their duties they inadvertently put themselves at high risk for any pandemic. During COVID-19 outbreak, scarce supply of personal protective equipment (PPEs) and prolonged exposure of HCPs with large number of COVID-19 positive cases in healthcare settings, long stressful duty hours and insufficient infection prevention and control (IPC) training given to them has led to a large number of infected cases. Policies should be designed and implemented for more screening and better protection with provision of optimal resources to these valuable personnel of health care system.</p>