Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial

Importance: Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks' or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective: To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants: A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks' or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions: Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures: The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. Results: Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks' gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, -1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance: Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effect of maternal tolerance on behavioral problems in children with enuresis

Objective: To determine the effect of maternal tolerance on behavioral problems in children with enuresis. Method: A cross sectional descriptive study was conducted from January 2018 to November 2018 at three outpatient hospital settings in Pakistan. The sample comprised of 80 mothers (aged 23-50 years) having children with enuresis, who were recruited from one public (tertiary care) and two private (secondary care) outpatient hospital settings in Punjab. Participants were recruited after a formal diagnosis of enuresis made by the consultant pediatrician or psychiatrist. The Tolerance Scale and The Children Behavioural Questionnaire were used to assess maternal tolerance and behavioural problems in children, respectively. A demographics questionnaire with demographic details regarding the mother and the child, was also designed for the study. Results: The mean age of mothers (N=80) and their children was 34.53 ±4.89 years and 8.16 ± 2.36, respectively. Results of correlation analysis revealed that maternal intolerance was positively and significantly correlated with rule-breaking (r=.25, p=.02) and aggressive behaviors (r=.31, p=.01) in children with enuresis. In addition, linear regression analysis was carried out to observe if maternal tolerance significantly contributed to behavioural problems in children with enuresis. Maternal intolerance emerged as significant and positive predictor of rule-breaking behaviors (?=.25, p=.02), aggressive behaviors (?=.31, p=.00) and attention problems (?=.29, p=.01) in the affected children. Conclusion: The study demonstrates that maternal intolerance and hostile attitudes towards children with enuresis leads to secondary behavioural and emotional difficulties. Key Words: Enuresis, Maternal tolerance, Child health care, Continuous...</jats:p

A Comparative Study on Communication Skills of Out of School and School Going Children with Intellectual and Developmental Disabilities

Purpose: Communication skills are essential for all individuals in the world to interact with each other. It is the beauty of communication skills to make the population of world capable to share thoughts, experiences, and views with one another. Meaningful communication is always constructed by effective coordination of cognitive, motor, social and linguistic skills. Underlying reasons of genetic or environmental factors affect the cognitive, motor, social and linguistic skills, causing delays in language and communication skills. This comparative study envisioned to find out the communication skills of school going children with IDDs and those who are out of school.&#x0D; Design/Methodology/Approach: This study was descriptive in nature. A sample of 120 children with IDDSs from which 60 were school going and 60 were out of school, was selected from Punjab province of Pakistan. Parents and teachers rated the communication skills of their children with IDDs.&#x0D; Findings: Communication skills in school going children with IDDs significantly and remarkably higher than children with IDDs who are out of school. Study recommends to make education accessible for all and provide all children with IDDs to equitable access to schools so that their cognitive, motor, linguistic and social needs can be fulfilled.&#x0D; Implications: Parental training and awareness campaigns for the development of communication skills will be indispensable. Schools are important for the whole life grooming of individuals with intellectual disabilities.</jats:p

Peer Relations and Positive Development in Students with Visual Impairment

Purpose: Peer relations is very important to facilitate social development of students. Peer relations also enhance other aspects i.e. societal, emotive and educational capabilities. Peers help each other to develop positively and groom their personality. This study aimed to explore the relationship between peer relations and positive development in students with visual impairment.  Students with visual impairment require more understanding peers to adjust in their classroom, school and social setting. Major objective of the study was to identify relationship between peer relation and positive development in students with visual impairment.&#x0D; Design/Methodology/Approach: Correlational research design was used in this study. Students with age range of 15 to 30 years were selected as a population of the study. Sample of the study was selected by using purposive sampling technique. Sample of 80 students with visual impairment was drawn from Punjab province including different educational institutions. Inferential statistical techniques were used to analyze the data.&#x0D; Findings: It was concluded that peer relation was a predictor of positive development for students with visual impairment.&#x0D; Implications/Originality/Value: This study will help to understand the importance of peer relation for the facilitation of positive development in students with visual impairment.</jats:p

Cognitive behaviour therapy with compulsive hoarding: a single case study

Abstract&#x0D; The current case study used cognitive behaviour treatment (CBT) for the management of a 35-year-old, married man who presented with complaint of compulsive hoarding. The complaint of compulsive hoarding (excessive acquisition, difficulty in discarding saved material and cluttering) was accompanied by feeling of anger, sad mood, low confidence, decreased sleep and appetite, poor problem solving ability, indecisiveness and interpersonal conflicts. The study was approved by the institutional research committee (Departmental Doctoral Programme Committee) and followed by the university research committee (Advance Studies and Review Board) as academic requirement for the duration of 2013-2020. Written consent was also taken from the individual to publish the results of the case. Twenty-eight CBT sessions of one-hour duration were conducted, over a period of six months. Continuous...&#x0D;  </jats:p

Evaluating the Serum Markers for Early Diagnosis of HCV Induced Hepatocellular Carcinoma

Hepatocellular carcinoma is a global public health problem which is intensified at developing countries due to lack of early diagnosis. Since Hepatitis C virus related morbidity accounts five million people in Pakistan, rate of morbidity and mortality of HCV related Hepatocellular carcinoma infections is high in Pakistan, and it is attributed to its diagnosis after its development. The public has the lack of awareness about the importance and benefits of liver biopsy testing; therefore, improved, and non-invasive methods of HCC diagnosis are urgently needed. The aim of the present study was to evaluate the importance of serum markers in early diagnosis of HCV induced Hepatocellular carcinoma and to develop a robust set of serological markers for their early detection and diagnosis. A total of 60 HCV positive patients including Chronic Liver disease (n=20), Cirrhosis (n=20), HCC patients (n=20) and 20 healthy volunteers (n=20) were enrolled in this study after an extensive screening process. Blood samples were collected from all the subjects and processed for serum separation followed by immunological, molecular, and biochemical analysis using Enzyme Linked Immunosorbant Assay, Real-Time PCR, complete blood picture, and a range of biochemical tests. Results showed gender wise variability among the subjects from each of the study groups where in the male subjects remained dominant with male and female ratio as 61.75:38.75. The average age of male subjects was observed between 42y, 43y, 49y and 37 years in comparison of female subjects who were 46y, 53y, 50y and 47y in CLD, cirrhosis, Hepatocellular carcinoma, and control groups, respectively. The data has also demonstrated that Hepatocellular carcinoma patients having Alpha Fetoprotein level &gt;1000 showed the increased level of ALP and GGT with decreased HB and HCT. However, the Hepatocellular carcinoma patients having AFP level in the range of 100-500 had total bilirubin level &gt; 3.0, while those having AFP level &lt;100 has all serological markers in normal range. In addition, the patients of HCC showed increased PT with decreased albumin level. The increases level of albumin level (&gt;3-&lt;4.0) was observed from the serum samples of cirrhosis and Chronic liver disease patients. The increase in albumin up to 4.0 accompanied with the increased level of ALP and PT while decreased HB. In conclusion, different biochemical parameters may be used to distinguish the patients having Hepatocellular carcinoma from those suffering from cirrhosis and chronic liver disease induced by HCV infection. The findings of present study may help to enhance the outcome for patients with HCC by enabling the diagnosis to be made at an earlier stage of the disease.</jats:p

Genetic Variability and Aggressiveness of Tilletia indica Isolates Causing Karnal Bunt in Wheat

Karnal bunt caused by Tilletia indica is a quarantine disease of wheat causing huge economic losses due to the ban on the import of bunted grains. This study was designed to characterize pathogenicity, aggressiveness and genetic diversity of 68 Tilletia indica isolates collected from different geographic regions of Pakistan. Forty-six isolates were tested for their pathogenicity on eight wheat varieties, out of which three were non-aggressive. The coefficient of infection (CI) ranged from 15.73% (PB-25) to 10% (PB-68, PB-60, and PB-43). The isolates collected from central Punjab showed higher infestation compared to other isolates. Among the wheat varieties used for the aggressiveness study, WL-711 showed susceptible reaction with 10.88% CI, while NIFA-Barsat, HD-29, Janbaz, Bakhtawar-92, Tatara, and AARI 2011 showed resistance to the highly resistant response. These isolates were amplified using 31 random amplified polymorphic DNA (RAPD) markers and 32 inter-simple sequence repeat (ISSR) markers for diversity analysis. The principal component analysis (PCA) and analysis of molecular variance (AMOVA) showed greater divergence among isolates collected from Punjab and Khyber Pakhtunkhwa (KPK), with a moderate level of admixture. The isolates from Faisalabad (Punjab) were more aggressive compared to isolates from KPK and were clearly separated based on PCA, indicating the significant genetic distance in the populations. Our findings will assist breeders and pathologists in better understanding the pathogenic variability in Tilletia indica and in subsequent disease management.</jats:p