Aman Ullah

BACKGROUND: Heart failure (HF) is associated with high mortality rates and substantial health care costs. While there is growing emphasis on integrating palliative care for patients with HF, limited data exist on the locations where adults with HF spend their final days. The study aimed to analyze the location and circumstances of death among adults with HF in the United States using Centers for Disease Control and Prevention’s Wide-ranging Online Data for epidemiological Research data. METHODS: Mortality data from individuals aged ≥20 years, with HF listed as the cause of death between 1999 and 2023, were analyzed. The places of death were categorized as the emergency room, hospice/nursing home, inpatient medical facility, or home. Multinomial logistic regression was performed to examine the associations between demographic factors and death location. RESULTS: HF-related mortality rates declined from 1999 (3.60% and 143.6 age-adjusted mortality rate) to 2010 (3.47% and 123.1 age-adjusted mortality rate). However, rates gradually increased thereafter, reaching 5.18% and 168.1 age-adjusted mortality rate in 2023. Deaths at home nearly doubled, rising from 18.41% (50 648 of 275 132) in 1999 to 33.47% (132 470 of 395 826) in 2023. Hospice/nursing home deaths increased from 30.95% (85 144 of 275 132) in 1999 to 34.71% (116 634 of 336 014) in 2017, but declined to 29.54% (116 931 of 395 826) by 2023. Young adults (20–34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities. CONCLUSIONS: This study underscores the shifting trends in the locations of death among patients with HF, with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. The recent decline in hospice/nursing home deaths, following a period of steady growth, calls for an in-depth examination of contributing barriers. Further research is essential to understand the sociodemographic factors driving disparities in HF-related death locations.

Foot and Mouth disease (FMDV) is one of highly contagious diseases of cloven footed animals, although mortality is low in adult animals, but still causing heavy economic losses. Importance of this project is the effective control of disease which is based on quick and sensitive diagnostic assays. The objectives of this particular study is to evaluate the propagation of FMD viruses on two different cell lines and find out not only the rapid and accurate diagnosis as well as isolation of FMD virus on cell lines. For this study, oropharyngeal fluid (OF) samples were collected from 20 buffaloes from peri urban dairy farms in Islamabad. Probang cups were used for sampling. Probang sampling was first time introduced in Pakistan. These OF samples were treated with tricholotriflouroethane (TTE). Afterwards, these samples were inoculated onto two different cell lines, BHK-21 (Baby Hamster Kidney) and bovine kidney (BK) cells. A sample was declared positive for FMD virus when FMD virus specific cytopathic effects (CPEs) were observed. The virus was passaged for five passages level on BHK-21 and three passage level on BK cells. If a sample did not show any CPEs after this, it was declared as negative for FMD. The agreement, between the two cell lines on the presence of FMD virus in OF samples, was estimated by Cohen's kappa statistics (κ). Of the 20 OF samples passaged on BHK21 cell line, 8 (40%) showed characteristic CPEs within 5 blind passages; the BK cells showed characteristic CPEs for 15 (75%) samples within 3 blind passages. Kappa value was -1.13 (p= 0.99) showing that both cell lines moderately disagree on the status of OF fluids regarding FMD but there was no evidence against the null hypothesis that both cell lines are equally good at detecting the FMD virus in OF samples. The results suggest that both cell lines may largely disagree on the status of a OF sample for FMD. It was clearly evident from the infectivity titres of BK cell line that is 2.25 it is more suitable for vaccine production than BHK-21, but will need further studies with large sample size to evaluate these findings.