Understanding the State of LGBTQIA+ Healthcare and Support in Camden County

4.5% of American adults identify as lesbian, gay, or bisexual and about 1.4 million adults identify as transgender. This demographic is impacted by many social determinants of health and health disparities, particularly for transgender patients. 33% of LGBTQIA+ patients ranging from a pool of 28,000 surveyed patients have had a negative experience with their health providers, and 8% of them had to educate their physicians about their needs due to physicians’ lack of knowledge about this demographic. Research suggests that there is a reluctance to access mental health services in the LGBTQIA+ community due to homophobia,, difficulties disclosing sexual and gender identity, and fears of being misunderstood

Epidermal growth factor receptor rs17337023 polymorphism in hypertensive gestational diabetic women: A pilot study

Background: Women with gestational diabetes mellitus have an increased risk of developing gestational hypertension, which can increase fetal and neonatal morbidity and mortality. In the past decade, single nucleotide polymorphisms in several genes have been identified as risk factors for development of gestational hypertension. The epidermal growth factor receptor activates tyrosine kinase mediated blood vessels contractility; and inflammatory cascades. Abnormalities in these mechanism are known to contribute towards hypertension. It is thus plausible that polymorphisms in the epidermal growth factor receptor gene would be associated with the development of hypertension in women with gestational diabetes.Aim: To determine whether the epidermal growth factor receptor rs17337023 SNP is associated with the occurrence of hypertension in gestational diabetic women.Methods: This pilot case-control study was conducted at two tertiary care hospitals in Karachi, from January 2017-August 2018. Two hundred and two women at 28 week of gestation with gestational diabetes were recruited and classified into normotensive (n = 80) and hypertensive (n = 122) groups. Their blood samples were genotyped for epidermal growth factor receptor polymorphism rs17337023 using tetra-ARMS polymerase chain reaction. Descriptive analysis was applied on baseline data. Polymorphism data was analyzed for genotype and allele frequency determination using chi-squared statistics. In all cases, a P value of \u3c 0.05 was considered significant.Results: Subjects were age-matched and thus no difference was observed in relation to age of the study subjects (P \u3e0.05). Body fat percentage was significantly higher in hypertensive females as compared to normotensive subjects (35.138 ± 4.29 Case vs 25.01 ± 8.28 Control; P \u3c 0.05). Similarly, systolic and diastolic blood pressures among groups were significantly higher in hypertensive group than the normotensive group (P \u3c 0.05). Overall epidermal growth factor receptor rs17337023 polymorphism genotype frequency was similar in both groups, with the heterozygous AT genotype (56 in Case vs 48 in Control; P = 0. 079) showing predominance in both groups. Furthermore, the odds ratio for A allele was 1.282 (P = 0.219) and for T allele was 0.780 (P = 0.221) in this study.Conclusion: This pilot study indicates that polymorphisms in rs17337023 may not be involved in the pathophysiology of gestational hypertension in gestational diabetes via inflammatory cascade mechanism. Further large-scale studies should explore polymorphism in epidermal growth factor receptor and other genes in this regard

Development and Presentation of a Lesson on Mental Health for High School Students During the 2021 COVID-19 Pandemic

With the support of the HRSA, the Health Careers Opportunity Program (HCOP) was established to increase the number of students from underrepresented backgrounds to pursue careers in healthcare. HCOP combines the efforts of high school, undergraduate, and medical students in creating an original project to serve a need within the community. In this HCOP project, we aim to address the issue of mental health with high school students at two New Jersey high schools: Pennsauken and Williamtown

Challenges to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in Primary Care Settings at Rowan-Virtua

Background and Purpose: Implementing the SBIRT model for substance use in a primary care setting has many benefits including normalizing conversations about alcohol and other substance use into patients’ visits, thereby reducing harm, reducing consumption and its negative impact, and promoting system changes to overcome barriers to treatment access. The full scope of the current SBIRT project involves the recruitment, hiring, training, and integration of health educators in 9 primary care sites throughout South Jersey, as well as a project supervisor serving as implementation lead and liaison to medical and administrative staff at all 9 primary care sites. Initial barriers to implementation within sites included challenges regarding work-flow between providers, CMA’s, and health educators (integration-of-care challenges between allied health professionals from varying disciplines); and variations in administrative processes across 9 different primary care settings serving diverse patient demographics. Challenges to implementation with personnel included unexpected loss of key project personnel and changeover in project leadership. Additionally, legalization of medical and recreational cannabis in the state of New Jersey has made implementation of the grant (as written) challenging, as cannabis remains a Schedule 1 substance at the federal level and is included in the writing of this federally funded grant as an illicit substance. Due to Covid, a decrease of in-person visits in primary care settings as well as the normalization of telehealth visits have challenged the Health Educators’ ability to see potential pre-screen-positive patients. This lower volume of in-person patients has also subsequently resulted in more efficient processing of patient visits, affording less time to incorporate health education and brief intervention within each patient visit. There is a distinct need to develop a protocol for intervention with telehealth patients who screen positive for SBIRT services. Strategies for addressing these challenges, future directions of the project, and lessons learned will also be presented. References: Kamath, C. C., Kelpin, S. S., Patten, C. A., Rummans, T. A., Kremers, H. M., Oesterle, T. S., Williams, M. D., & Breitinger, S. A. (2022). Shaping the Screening, Behavioral Intervention, and Referral to Treatment (SBIRT) Model for Treatment of Alcohol Use Disorder in the COVID-19 Era. In Mayo Clinic Proceedings (Vol. 97, Issue 10, pp. 1774–1779). Elsevier Ltd. https://doi.org/10.1016/j.mayocp.2022.07.006 Substance Abuse Overview 2021 Statewide - NJ.GOV. (n.d.). Retrieved April 18, 2023, from https://nj.gov/humanservices/dmhas/publications/statistical/Substance%20Abuse%20Overview/2021/statewide.pd Moore, Ramey PhDa; Purvis, Rachel S. PhDa; Hallgren, Emily PhDa; Reece, Sharon MD, CCFPa; Padilla-Ramos, Alan MDa; Gurel-Headley, Morgan BSb,c; Hall, Spencer MAd; McElfish, Pearl A. PhD, MBAa,*. “I am hesitant to visit the doctor unless absolutely necessary”: A qualitative study of delayed care, avoidance of care, and telehealth experiences during the COVID-19 pandemic. Medicine 101(32):p e29439, August 12, 2022. | DOI: 10.1097/MD.000000000002943

Clinical Utility of N-Terminal Prohormone B-Type Natriuretic Peptide Levels in Patients of Type 2 Diabetes Mellitus with Heart Failure

Objective: To evaluate the effect of type 2 diabetes mellitus on plasma N-terminal prohormone B-type natriuretic peptide levels in patients with heart failure and correlate it with glycosylated haemoglobin levels. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology in collaboration with the Department of Cardiology,Combined Military Hospital, Multan Pakistan, from Feb to Sep 2021. Methodology: We assayed plasma NT-pro BNP levels in 194 individuals with established heart failure, (98 non-diabetics, and 96 patients with diabetes). Plasma NT-pro BNP levels were compared between groups in addition, the correlation of glycosylated haemoglobin with plasma NT-pro BNP levels was explored. Results: The mean plasma NT-pro BNP values were higher in patients with diabetes (15826.08 ±8143.434pg/mL) than in nondiabetics (12534.06±6323.92pg/mL) with a p-value 0.02. When NT-pro BNP was compared there was no significant found difference between the non-diabetic group and the Controlled Diabetes-Group (p-value 0 .882), but it was significantly higher in the Uncontrolled Diabetes-Group (p-value<0.001). A moderate positive association was found between NT-pro BNP and glycosylated haemoglobin (r=0.541, p-value<0.001). Conclusion: Although obesity has an inverse relation with plasma natriuretic peptides level and most patients with diabetes are overweight, the plasma NT-pro BNP is still a very informative tool and holds its significance as a diagnostic and prognosis marker in diabetic patients with heart failure

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Development of stem cell ethics and legislation in the world and in Pakistan: A narrative review

Stem cells can transform into specialized types of cells, and their capability of self-renewal is limitless. The advancements in stem cell therapy have encountered various hurdles. Considering the massive scope of stem cells applications in health, an effective regulation and monitoring system should be implemented. It is important to ensure that stem cell research projects in Pakistan work closely with the ethics committees as respecting human rights are of paramount importance. It is also necessary that the ethics and legislation guidelines are reviewed, updated, and monitored effectively at every evolving step

A study of CGA- (cryptographically generated address) signature based authentication of binding update messages in low-end MIPv6 node

It is well known that the existing weak mechanism for authenticating binding update messages is one of the biggest security weaknesses in MIPv6. The best candidate to replace this weak mechanism is CGA signatures. CGA signatures require generating a digital signature of a binding update message. It is also known that public-key cryptographic operations (like digital signatures) are computationally expensive for low-end nodes. This study presents the initial effort in investigating the feasibility of using CGA signature based authentication on low-end nodes. It is found that the commonly used RSA cryptosystem should be replaced with an alternative cryptosystem (esp. because of the computationally intensive operations of key generation and the signature generation

Characterization, dose dependent assessment of hepatorenal oxidative stress, hematological parameters and histopathological divulging of the hepatic damages induced by Zinc oxide nanoparticles (ZnO-NPs) in adult male Sprague Dawley rats

Nanoparticles are beneficial in many aspects to human life but their excessive use can cause various abnormalities. They dispose in the environment through transport, industrial and agricultural usage and enter in living body through dermal, respiratory route or ingested with the lipsticks and there higher concentration produces toxicity. Therefore, current study characterized ZnO-NPs to evaluate toxic ability by X-rays diffraction (XRD) and Scanning Electron Microscopy (SEM) techniques and showed 29.83 and 35 nm size, respectively with hexagonal crystalline structure. LC50 value of ZnO-NPs was also evaluated as 72.48 ± 10.33 mg/kg BW. Male Sprague Dawley (Post weaning) rats were divided into five groups with five rats in each group. Control (C) group received no treatment, placebo (S) group received normal saline (0.9% sodium chloride) intraperitoneally and three treated groups received different levels of ZnO- NPs intraperitoneally at the dose of either 10 or 20 or 30 mg/kg for 21 days on alternate days and named as 1G1, 1G2 and 1G3, respectively for the assessment of toxicity for better understanding of precautionary measures in future. Oxidative stress enzymes of liver and kidney, hepatorenal function enzymes and hematological parameters along with hepatic histology were measured at the end of the experiment. Results showed highly significant variations in all parameters in a dose dependent manner as compared to control group while groups receiving 10 or 20 mg/kg of ZnO-NPs showed low to moderate pathological changes in both organs. Liver histological analysis showed congestion, necrosis, hemorrhage, RBC’s accumulations; inflammatory cells infiltration and severe abnormalities in high dose group while medium, low dose group showed moderate and least effects, respectively. It is concluded that ZnO-NPs are highly toxic at more concentration so their careful usage is needed in daily routine

Thermal Discomfort Levels, Building Design Concepts, and Some Heat Mitigation Strategies in Low-Income Communities of a South Asian City

Heat stress provokes thermal discomfort to people living in semiarid and arid climates. This study evaluates thermal discomfort levels, building design concepts, and some heat mitigation strategies in low-income neighborhoods of Faisalabad, Pakistan. The outdoor and indoor weather data are collected from April to August 2016 using a weather station installed ad hoc in urban settings, and the 52 houses of the five low-income participating communities living in congested and less environment-friendly areas of Faisalabad. The discomfort index values, related to the building design concepts, including (i) house orientation to sunlight and (ii) house ventilation, are calculated from outdoor and indoor dry-bulb and wet-bulb temperatures. Our results show that although June was the hottest month of summer 2016, based on the monthly mean temperature of the Faisalabad region, the month of May produced the highest discomfort levels, which were higher in houses exposed to sunlight and without ventilation. The study also identifies some popular heat mitigation strategies adopted by the five participating low-income communities during various heat-related health complaints. The strategies are gender-biased and have medical, cultural/customary backgrounds. For example, about 52% of the males and 28% of the females drank more water during dehydration, diarrhea, and eye infection. Over 11% and 19% of the males and females, respectively, moved to cooler places during fever. About 43% of the males and 51% of the females took water showers and rested to combat flu (runny nose), headache, and nosebleed. The people did not know how to cure muscular fatigue, skin allergy (from a type of Milia), and mild temperature. Planting trees in an area and developing open parks with greenery and thick canopy trees can be beneficial for neighborhoods resembling those evaluated in this study