Role of Color Doppler Ultrasonography in Benign and Malignant Adnexal Masses: A Systematic review.

Introduction: An adnexal mass is a mass in tissue of the adnexa of uterus such as the ovaries, fallopian tubes, or any of the surrounding connective tissue. Adnexal masses can be benign, premalignant and malignant. They can be further divided into simple or complex masses. In women, before menopause, adnexal masses are of large variety including ovarian cysts, ectopic pregnancy, non-cancerous and cancerous tumors, endometriomas and polycystic ovaries. In such women causes include follicular cysts, corpus luteum cysts and abscesses. Prevalence of malignant ovarian cancer is high in young women. After menopause, cancer, fibroids, fibromas or diverticular abscesses are potential causes. Purpose: The key purpose of the study was the role of color Doppler ultrasonography in diagnosis of benign and malignant adnexal masses in women. The data used in this study is based on previous existing studies.  Method: The Literature (google Scholar, science Direct, PUBMED) was searched using keywords adnexal masses, color Doppler ultrasonography. Found articles were a combination of retrospective and prospective studies and only prospective studies were selected from 1992 to 2012. Only relevant articles were assessed and selected. Results: Most Studies are of the opinion that color Doppler ultrasonography (Abdominal or transvaginal) has better accuracy than grey scale ultrasonography due to the evaluation of blood flow in center or periphery of the adnexal mass.  Conclusion: Color Doppler ultrasound is a better choice for initial evaluation and screening of adnexal masses because it is widely available, relatively cheaper than other investigations and is non-invasive. Keywords: Doppler Ultrasonography, Adnexal Masses DOI: 10.7176/JHMN/82-14 Publication date: November 30th 202

Evaluation the effectiveness of abridged IMNCI (7-Day) course v standard (11-Day) course in Pakistan

Background: The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.Methods: We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.Results: The improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was - 12.4 (95% CI - 18.5, - 6.4) and - 6.4 (95% CI - 10.5, - 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was - 6.3 (95% CI - 11.3, - 1.3) in the 7-day training group and - 9.1 (95% CI - 11.5, - 6.6) in the 11-day group, p = 0.308.Conclusion: An abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course

Nash-wo-Numa (childhood growth & development) study protocol: Factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan

Introduction: Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world\u27s largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study\u27s primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition.Methods: This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales.Ethics and Dissemination: The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals

Use of modern contraceptives in Lagos Nigeria during the COVID-19 pandemic

We estimated modern contraceptive prevalence rate (mCPR) and examined predictors of modern contraceptives utilization amongst 1,445 sampled reproductive age women in Lagos (Nigeria's epicenter) during the devastating COVID-19 pandemic. Estimated mCPR was 30.8%. Women aged 20-29 years were 50% (95%CI:0.37-0.71) less likely to use modern contraceptives during the pandemic than those 30-39 years. Married and divorced women were about three (95%CI:1.37-5.25) and over three (95%CI:1.32-7.79) times more likely to use modern contraceptives compared to single women. Though mCPR has not reduced, sustained contraceptive needs assessment of sometimes obscure sub-populations is required, especially if outbreaks like COVID-19 become our 'new normal'

Sustainable phosphorous management in two different soil series of Pakistan by evaluating dynamics of phosphatic fertilizer source

Phosphorous (P) plays the prominent role to promote the plants storage functions and structural roles, as it is recognized as a vital component of ADP, ATP, Cell wall as well as a part of DNA. Soils acts as the sink to supply P to plants because soil pH and its physical condition are the main factor which regulate the solubility and availability P element. Phosphorus is not deficient in Pakistani soils but its availability to plants is the serious matter of concern. A pot experiment was conducted to evaluate P dynamics in two different soil series of Pakistan (Bahawalpur and Lyallpur) using Maize as test crop. The treatments applied were T0: Control (without any fertilizer), T1: Recommended DAP @648 mg pot−1, T2: Half dose DAP @324 mg pot−1, T3: Recommended rate of TSP @900 mg pot−1, T4: Half dose TSP @450 mg pot−1. Soil analysis showed that Bahawalpur soil has sandy clay loam texture with 33% clay and Lyallpur series has sandy loam texture with 15.5% clay; furthermore, these soils contain 4.6 and 2.12% CaCO3, respectively. Results showed an increase in P concentration in roots (23 mg kg−1) with the application of half dose of TSP in Lyallpur series and lowest in Bahawalpur series (14.6 mg kg−1) at recommended dose of DAP. Concentration of P in shoots responded the same; increase at half dose of TSP (16.7 mg kg−1) and lowest at full dose of DAP in Bahawalpur series as (15.58 mg kg−1). Adsorbed P (17 mg kg−1) was recorded highest in Bahawalpur soil with more clay amount in pot with DAP application but lower in Lyallpur soil series (14 mg kg−1) with the application of applied TSP. The PUE was recorded highest in Lyallpur series with the application of half dose of TSP and it was 61% more than control and was Highest in Bahawalpur series was with the application of recommended dose of DAP is 72% more than control treatment. On estimation, results showed that applied sources made an increase in P availability than control, but TSP gave better P uptake than DAP unless of rates applied. Soil of Lyallpur series showed better uptake of P and response to applied fertilizers than Bahawalpur series which showed more adsorption of P by high clay and CaCO3 amount. Conclusively, the study suggested that soil series play a crucial role in choosing fertilizer source for field application

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Genetic diversity of Libyan date palms cultivars using amplified fragment length polymorphism and biochemical analysis

Phoenix dactylifera L. is a flowering plant species commonly known as the date palm and is widely cultivated in most Middle East countries, including Libya. The present study analysed the biochemical and genetic diversity of fully mature eight Libyan date palm cultivars grown in different regions using the amplified fragments length polymorphism (AFLP) technique. Six pairs of AFLP molecular marker combinations were utilised to discriminate the eight date palm genotypes. Fruit dimensions (length x diameter) varied based on the type; Majhool Alheelo fruit had the highest value (15.29 cm2), while the lowest value was for Alkhadraya fruits (7.9 cm2). Reducing sugar content ranged from 10.4 per cent of flesh dry weight in Umfetity cultivars to 61.2 per cent in Sufeer-genab, which also showed the highest polymorphism percentage (P%=4.9), while Alkhadarya was the lowest (P%=0.519). The phylogenetic tree indicated that the most distantly related cultivars were Sufeer-genab, Alhamraya and Majhool Alhelo. The two most closely related cultivars were the Alsaeedy Show and Alkhadarya, grown in different regions. Our results indicate that the nutritional and genetic diversity of Libyan cultivars is not closely matched with the growing region