A 40 days old male baby born to a consanguineous couple was admitted in NICU of a Children Hospital in Saudi Arabia with mild febrile illness to rule out sepsis. The baby was youngest of 3 siblings, was born at term by normal vaginal delivery with a birth weight of 3.3 kg and was being exclusively fed breast milk. During phlebotomy, his blood was found to be highly viscous and milky. Serum was thick and milky with caking of chylomicrons on refrigeration. Serum was analyzed using serial on board dilutions on Cobas Integra 400 and following results were obtained A second sample was received for the same baby after keeping him on intravenous fluids and no oral intake for 5 days. Cholesterol 406.8 mg/dl(10.54mmol/L) Triglycerides 6191 mg/dl(68.10mmol/L) Lipid electrophoresis showed a band of chylomicrons.Baby was active, pink and afebrile from 2 nd day of admission and did not have any hepatospleenomegaly, xanthomas or dysmorphic features. His blood, urine and stool cultures showed no growth and CSF examination was normal and Thyroid functions were as follows: TSH 7.8 mIU/ml (Normal range 1-30) T 4 21 pmol/L (Normal range 11-17)There was positive family history of hypertriglyceridemia in a first cousin who presented with hypertriglyceridemia and multiple renal cysts at the age of 1 month. He was found to have normal renal functions and renal cysts which responded to lipid lowering drugs (Gemfibrozil), Niacin and Aspirin.His cholesterol levels were within normal range but, triglycerides remained high 663.6mg/dl (7.3 mmol/L) even 3 years after treatment.Both siblings and both parents of the index case had normal lipid profiles. There was no family history of premature myocardial infarction or stroke.This child was referred to higher centre in Riyadh for further investigations and treatment, where he was put on Lipid lowering drugs (Gemfibrozil), Iron drops and special formula for feeding containing medium chain fatty acids. Gemfibrozil
Prostate specific antigen (PSA) has long been used as a biological marker for prostatic cancer. Recent studies have demonstrated that PSA synthesis can be induced by steroid hormones in several tissues of women. Menstrual cycle is regulated by the cyclic variation of estradiol and progesterone. This study was undertaken in order to study the correlation of serum PSA to both these corpus luteal hormones. 110 serum samples and 10 saliva samples were collected from healthy women aged 18-45 years of age having normal menstrual cycles. Active PSA DSL-9700 ultrasensitive kit with detection limit 0.001 ng/ml was used to analyze PSA. 38.2 % of all serum samples and 10 % of saliva samples had detectable concentrations of PSA. The serum PSA was highest during mid follicular phase (between 4th and 8th days of cycle). Variation in PSA levels seemed to follow the variations in progesterone with a lag period of 12-14 days, but did not appear to bear any relationship with the estradiol levels.
Recent studies have demonstrated the presence of prostate specific antigen (PSA) in cord blood of male as well as female babies. The placental progesterone and estradiol up-regulate the synthesis and secretion of PSA in Placenta. This PSA is presumed to play a role in intrauterine growth of fetus by virtue of its proteolytic action on several substrates including insulin-like-growth-factorbinding-protein-3, insulin chains and Interleukin-2. This study was planned with the objective of correlating the levels of PSA in cord blood to gestation at delivery, the type of delivery and gender of the fetus. Fifty-seven cord blood samples were collected from the umbilical cord during delivery or mid-trimester abortion and analyzed for PSA using 'Active PSA DSL-9700 ultra sensitive' kit employing two-site immuno-radiometric assay principle and having a detection limit of 0.001 ng/ml. Mean PSA levels in cord blood were found to be 0.112 ± 0.027 ng/ ml. The concentration of PSA in cord blood was found to be higher in case of higher gestational age, male baby and operative delivery. 50 % of cord bloods for female babies had PSA below detection limit (range \0.001-0.460 ng/ ml), while all the male samples had detectable PSA (range 0.11-0.973 ng/ml). Higher Progesterone levels found in prenatal maternal blood in case of male babies may be responsible for the higher cord blood PSA. Mean cord blood PSA was 0.150 ± 0.150 ng/ml in forceps delivery and 0.078 ± 0.012 ng/ml in normal vaginal delivery. Forceps delivery causes much more stress and strain as compared to a normal vaginal delivery, resulting in increased levels of adrenal glucocorticoids, and therefore, higher cord blood PSA.
Nursing is one of the professions which requires knowledge along with clinical competence to provide high quality nursing care. Student nurses are exposed to various clinical areas from their undergraduate period to gain all these competencies under supervision and mentorship. Many evaluation methods are in vogue to assess the knowledge of nursing students. But when it comes to the assessment of skills these evaluation methods are reduced as few in numbers such as clinical examination, simulation, Objective Structured Practical Examination (OSPE), and Objective Structured Clinical examination (OSCE).
Background: With ever increasing pressure on hospitals to provide quality medicine cost effectively, clinicians and laboratorians must team up to ensure that the most appropriate laboratory investigations are ordered at the most appropriate time and frequency to significantly reduce length of stay, improve patient outcomes, improve hospital and laboratory efficiencies, reduce hospital costs and minimize insurance claim denials.
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