Leveraging Health Informatics and Parental Empowerment: Perspectives from Parents and Caregivers of Medically Complex Children

This research paper focuses on the barriers that parents and caregivers of special-needs children patients face with leveraging technology and informatics as they attempt to communicate with their child’s healthcare specialists regarding specialized and critical oversight and management of complex medical conditions and the need for empowerment for this population of parents and caregivers. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of electronic applications. A review of the literature showed that the special needs population has not been represented. This study surveys a range of parents and caregivers to include a various age ranges, genders, education and socioeconomic statuses to identify the barriers this unique population has encountered

Role of cancer antigen-125 in diagnosing malignant adnexal masses: a prospective observational study

Background: Adnexal masses present a diagnostic and therapeutic dilemma across age-groups. This study aimed to evaluate the performance of cancer antigen-125 (CA-125) in distinguishing between benign and malignant adnexal masses.Methods: This was a prospective, observational, single tertiary-care center study, done in North India from January, 2011 till December, 2012. Serum CA-125 levels was obtained preoperatively in consecutive patients presenting with ultrasonography confirmed adnexal masses. The cut-off value between benign and malignant was taken as 35 IU/ml. Histopathological diagnosis was obtained in all patients.Results: A total of 126 patients presented with adnexal masses, of which 100 were enrolled (mean age: 37.5±14.4 years, range: 18-80 years). Most of the masses were benign 81% (malignant=19%). Dermoid cyst (25.9%) and endometriomas (21%) were the most common benign masses. Serous (21%) and mucinous cystadeno-carcinoma (15.8%) were the most common malignant masses, more often seen in elderly, married, parous and post-menopausal patients. Mean CA-125 levels were significantly higher in malignant masses (257.30 [105.68-408.92] versus 19.26 [16.53-22.00], p<0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CA-125 for diagnosing malignant adnexal mass was 94.7%, 87.65%, 64.28%, 98.6%, and 88.91% respectively. The same was 100%, 85.1%, 54.5%, 100%, 87.3% in premenopausal and 85.7%, 100%, 100%, 93.3%, 95.2% in postmenopausal women respectively.Conclusion: Benign masses form the bulk of the adnexal masses in all age groups. CA-125 levels has high sensitivity and negative predictive value in premenopausal patients while as high specificity and positive predictive value in postmenopausal patients

Sheehan’s syndrome: a case report

Sheehans syndrome or necrosis of pituitary gland is a rare complication of postpartum haemorrhage, initially described in 1937. Sheehans syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. We present a case of young lady with this syndrome who presented with classical symptoms of hypopituitarism within 1 year of her delivery which was complicated by postpartum haemorrhage

Alternative pre-treatment of raw molasses by metal complexing agents for citric acid productivity by Aspergillus niger

The present study deals with the pre-treatment of sugar cane molasses for the enhanced production of citric acid by Aspergillus niger NG-4. For this purpose, the acids and metal complexing agents were added in the molasses medium, alternatively prior to heating at 90°C for 1 h. Among them, the maximum amount of citric acid (53.2 g/l) was produced when the ratio between H2SO4+K4Fe(CN)6 was maintained at 1.0:250 for the pre-treatment of cane molasses which is approximately 3.1 fold higher than the control (17.0 g/l citric acid). The kinetic parameters such as growth yield coefficients (Yp/s, Yp/x, Yx/s in g/g), volumetric rates (Qp, Qs, Qx in g/l/h) and specific substrate rates (qp, qs in g/g cells/h) of the research work were also undertaken. The value of Qp (0.134 g/l/h) is highly encouraging (p≤0.05)

Prevention of Ovarian Hyper stimulation Syndrome by using gonadotrophic releasing hormone analogue to induce final ovulation trigger in invitro fertilization cycles

Objectives: To find out occurrence of ovarian hyperstimulation in patients who were hyper responders in in vitro fertilization cycles. Secondary outcome was to assess number of metaphase II oocyte and fertilization rate, cleavage rate and pregnancy outcome when GnRHa is used for final maturation and triggering ovulation. STUDY DESIGN, SIZE, and DURATION: This is retrospective descriptive analysis of cases managed at single center from June 2017 till May 2018. PATIENTS & METHODS: Twenty patients were identified as hyper responders based on baseline, ovarian reserve characteristics, that is antral follicle count, (AFC) > 25, AMH > 4ng/ml and on day  of  trigger,  follicles  >-25  in  number  of  ≥  11mm  were administered GnRHa trigger and 1500IU hCG on oocyte retrieval day while luteal phase was supported with daily vaginal  progesterone and twice daily estradiol valerate. Sixteen patients underwent fresh transfer while four patients had their embryos frozen. MAIN RESULTS: Twenty patients were identified as high risk and their baseline characteristics were, mean age 31.7 ± 4.50, mean antral follicle count 25.7 ± 5.01, Anti Mullerian hormone level mean 4.64 ± 2.52 and PCOS was present in 35% cases. Peak estradiol level mean 13455-± 6632pmol/l and mean follicles count of 25.45 ± 8.78 confirmed a high response. Oocyte yield was 11.45+ Metaphase oocyte retrieved were 85.5% and cleavage rate of 93%. No case of early onset OHSS was identified. Only one patient developed moderate OHSS. Pregnancy rate was 31.25%. Miscarriage rate was 6.3% and ongoing pregnancy was 25%. CONCLUSION:  This small retrospective descriptive analysis supports the view of current literature that GnRH trigger not only prevents early onset OHSS also achieves increase of M11 oocytes. In addition, pregnancy outcome is not statistically different to those cycles where hCG is used as trigger.

Two new species of genus Leucoagaricus (Agaricaceae, Agaricales) from Pakistan

The genus of basidiomycetous fungi, Leucoagaricus, occurs worldwide, from subtropical to boreal latitudes. Several collections of Leucoagaricus were made during mycological field trips conducted in different forests of Margalla, Pakistan. An integrative framework combining morphological and phylogenetic data was employed for their study. As a result, the two species La. margallensis and La. glareicolor are here described as new to science. Detailed macro- and micro-morphological descriptions, and a molecular phylogenetic reconstruction based on nrITS and LSU sequence data are provided and used to discriminate the new species from morphologically and phylogenetically close taxa. Whereas, our phylogenetic tree inference gave unequivocal support for the inclusion of these two species within the section Leucoagaricus

The Response of Maize Physiology under Salinity Stress and Its Coping Strategies

Maize is a cross-pollinated, polymorphic plant in nature. It is commonly a moderately salt-sensitive crop. Salinity stress is the main abiotic factor that arrests the physiological characteristics and plant growth of a maize plant. It causes the osmotic effect, associated with an increase in phytotoxic ions, oxidative stress by increased reactive oxygen species (ROS) production, and ionic effect in the cytosol. These salinity effects hinder the maize plant’s physiological processes such as respiration, photosynthesis, transpiration, stomatal functioning, hormone regulation, and functioning, seed germination, and dormancy and water relation with plants and ultimately reduce the plant growth and yield. However, the physiology of maize subjected to salinity shows various responses that depend on the genetic responses and growth stages. Maize plant undergoes many physiological changes and adapts some mechanism internally to cope with salinity stress. Numerous mitigating strategies such as application of chemicals, application of plant growth-promoting rhizobacteria (PGPR), application of hormones, and use of genetic and molecular techniques are used to handle salinity. This chapter will cover the effect of salinity on maize growth, its physiology, and physiological adaptations of maize plants with management strategies

Renewable Energy Consumption, Water Crises, and Environmental Degradation with Moderating Role of Governance: Dynamic Panel Analysis under Cross-Sectional Dependence

This study aims to investigate the relationship between renewable energy consumption, water availability, and environmental degradation with the moderating effect of governance in the South Asian region. This study collected data for renewable energy, water availability, governance, and environmental degradation for the period of 1988 to 2018 from the World Development Indicator. In panel data estimation, if cross-sectional dependence exists, it produces biased estimates. Therefore, this study applied a newly developed technique, dynamic common correlated effect, which produces efficient estimates in the presence of cross-sectional dependence. This study found that foreign direct investment positively and significantly increases environment degradation (β = 0.69 *, * indicates the significance level at less than 1%) while renewable energy and water availability cause to reduce environment degradation (β = −0.08 **, β = −0.09 **, **indicates the significance level at less than 5%). Moreover, the study also found that governance significantly strengthens the relationship of renewable energy and water availability with environment degradation (β = 0.37 **, β = 0.24 **) while governance significantly weakens the relationship of foreign direct investment and environmental degradation (β = −0.34 *). The study suggests that South Asian countries should improve political institutions, and promote renewable energy, water availability, and clean production to improve the environment quality

Association of Serum Ferritin with Risk of Anemia in Non-Diabetic Adolescents with Family History of Type 2 Diabetes Mellitus

Background: Controversy occurs in the relationship between serum ferritin levels, insulin resistance and risk of developing anemia in adolescents with family history of diabetes. Aims & Objectives: This study was designed to find out the association between serum ferritin levels with risk of developing anemia in non-diabetic adolescents with family history of type 2 diabetes mellitus (T2DM). Materials & Methods: A descriptive cross-sectional was conducted in a local medical institute of Lahore. Study included 50 non-diabetic, non-obese male / female adolescent with family history of type 2 diabetes mellitus and 50 healthy male/female non-obese adolescents without family history of T2DM considered as controls. Level of serum ferritin and serum insulin was estimated by Enzyme Linked Immunosorbent Assay. Blood glucose was estimated by auto-analyzer. Insulin resistance was calculated by HOMA-IR index and beta cell function was assessed by HOMA- beta index. Results: Levels of fasting blood sugar, insulin resistance were found to be increased with decreased level of serum ferritin and decrease beta cell function in both male as well as female cases as compared to controls. Negative correlation was found between serum ferritin and insulin resistance while a positive correlation was found between serum ferritin and beta cell function. Conclusions: Low level of serum ferritin is associated with reduced beta cell function and increased insulin resistance. This may increase the risk of developing iron deficiency anemia that can affect both immune system as well as increase susceptibility to infections