Laboratory Screening Tests Research Articles

A systematic review of management strategies for children’s mental health care in the emergency department: update on evidence and recommendations for clinical practice and research

ObjectiveChildren with mental health crises require access to specialised resources and services which are not yet standard in general and paediatric EDs. In 2010, we published a systematic review that...

Accuracy of ultrasonography compared to laboratory in fetal screening, which one is more reliable?

Background: The aim of this study is to compare the efficacy of nuchal translucency (NT) measurement with laboratory screening tests in prenatal diagnosis of Down syndrome (DS) and neonatal outcomes. Materials and Methods: In this cross-sectional-descriptive study, data were collected from 260 pregnancy files. Ages of pregnant women were 20–34 year old who referred for prenatal care. NT was measured by ultrasound at 11–13 + 6 and quad marker tests at 15–18 gestational week. Data analysis was performed by SPSS 21 (IBM, USA) that was considered significant with P

Hipotireoidismo congênito primário em cão: relato de caso

Canine congenital hypothyroidism is a rare and underdiagnosed endocrine disorder, their true incidenceis unknown because many dogs with this condition die before reaching three months of age. The disordercan cause a range of clinical signs as the lack of thyroid hormones on the animal’s body because of lowmetabolism signs of multiple organs. Affected dogs may have mental retardation and abnormalities inskeletal development. Diagnosis is made through the animal’s history, laboratory screening tests addedto the clinical and epidemiological findings and serum levels of thyroid hormones. This paper reportsa case of canine congenital hypothyroidism in a Chow-Chow dog, with one year old, diagnosed at theVeterinary Hospital of the Federal Rural University of Rio de Janeiro. The animal was submitted to hormonereplacement therapy with levothyroxine Sodium resulting in clinical improvement.

Datura poisoning, clinical and laboratory findings. Report of five cases

Introduction. Plants of Datura species contain belladonna alkaloids that can cause central and peripheral anticholinergic effects. Abuse of Datura plants for their hallucinogenic effects is growing among adolescents and young adults. Datura poisoning has caused a diagnostic challenge in medical emergency wards. In this article we report 5 cases of Datura toxicity at Clinical Toxicology Emergency of Baharloo Hospital, Tehran, Iran during Summer-Fall 2015, and discuss their clinical presentations and laboratory findings. Cases Description. All 5 cases with Datura toxicity were young males and had intentionally used the plants. Mean duration of hospitalization was 3.2 days. ree cases were multiple drug abusers. Mydriasis, tachycardia, tachypnea and ushing alongside with psychotic-like signs and symptoms were observed in all cases. Elevation of liver enzymes was present in three of cases but without clinical signi cance. Raised LDH or CPK in four patients were without myoglubinuria and evidence of rhabdomyolysis and these biomarkers returned to normal by supportive care. All patients discharged with complete recovery and there was no need to ICU admission. Discussion. With the absence of routine laboratory screening tests for alkaloids and complex and confusing presentations of Datura intoxication, diagnosis of such cases is difficult. Physicians' clinical suspicion and su cient knowledge plays the mainstay role in appropriate and timely diagnosis and management of cases with Datura toxicity. Since regulatory legislation wouldn't be successful in halting the availability of natural plants, the best strategy to prevent Datura abuse is informing people about the adverse e ects of these plants. Key Words: datura stramonium, poisoning, abuse, anticholinergic, laboratory ndings, liver function tests, rhabdomyolysis. Language: en

Benefits and limitations of prenatal screening for Prader–Willi syndrome

This review summarizes the status of genetic laboratory testing in Prader-Willi syndrome (PWS) with different genetic subtypes, most often a paternally derived 15q11-q13 deletion and discusses benefits and limitations related to prenatal screening. Medical literature was searched for prenatal screening and genetic laboratory testing methods in use or under development and discussed in relationship to PWS. Genetic testing includes six established laboratory diagnostic approaches for PWS with direct application to prenatal screening. Ultrasonographic, obstetric and cytogenetic reports were summarized in relationship to the cause of PWS and identification of specific genetic subtypes including maternal disomy 15. Advances in genetic technology were described for diagnosing PWS specifically DNA methylation and high-resolution chromosomal SNP microarrays as current tools for genetic screening and incorporating next generation DNA sequencing for noninvasive prenatal testing (NIPT) using cell-free fetal DNA. Positive experiences are reported with NIPT for detection of numerical chromosomal problems (aneuploidies) but not for structural problems (microdeletions). These reports will be discussed along with future directions for genetic screening of PWS. In summary, this review describes and discusses the status of established and ongoing genetic testing options for PWS applicable in prenatal screening including NIPT and future directions for early diagnosis in PWS. © 2016 John Wiley & Sons, Ltd.

Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure.

Understanding the period of time between an exposure resulting in infection with human immunodeficiency virus (HIV) and when a test can reliably detect the presence of that infection, that is, the test window period, may benefit testing programs and clinicians in counseling patients about when the clinician and the patient can be confident a suspected exposure did not result in HIV infection. We evaluated the intervals between reactivity of the Aptima HIV-1 RNA test (Aptima) and 20 US Food and Drug Administration-approved HIV immunoassays using 222 longitudinally collected plasma specimens from HIV-1 seroconverters from the United States. Using interval-censored survival and binomial regression approaches a multi-model framework was implemented to estimate the relative emergence of test reactivity, referred to here as an inter-test reactivity interval (ITRI). We then combined ITRI results with simulated data for the eclipse period, the time between exposure and detection of HIV virus by Aptima, to estimate the window period for each test. The estimated ITRIs were shorter with each new class of HIV tests, ranging from 5.9 to 24.8 days. The 99th percentiles of the window period probability distribution ranged from 44 days for laboratory screening tests that detect both antigen and antibody to 65 days for the Western blot test. Our directly comparable estimates of the emergence of reactivity for 20 immunoassays are valuable to testing providers for interpreting negative HIV test results obtained shortly after exposure, and for counseling individuals on when to retest after an exposure.

Epidemiology of hepatitis C in the Moscow Region: data from the Moscow Regional Registry and screening for HCV antibodies

Background:Epidemiological characteristics of chronic hepatitis C virus (HCV) infection presented in the literature are not representative for the real situation with its incidence and prevalence in the Russian Federation. In the Moscow Region, which is the second largest population in the Russian Federation (7.2 million people), the Moscow Regional Registry of patients with hepatic disorders has been continuously maintained since 2010, as well as screening programs for anti-HCV positive individuals. Analysis of this data allows for generalization of the results obtain to the general population and for description of the prevalence of the infection among adult population of the Russian Federation.Aim:To analyze the epidemiological situation with chronic hepatitis C in the Moscow Region.Materials and methods:We analyzed data from the Moscow Regional Registry of patients with hepatic disorders as per April 2016, as well as the results of large scale screening of the population of the Moscow Region with oral express test for anti-HCV antibodies (OraQuick HСV Rapid Antibody Test). Based on the registry, we assessed the following parameters of the patient cohort with chronic HCV infection (n = 17 182): age, gender, HCV genotype, grade of liver fibrosis, allele variants of interleukin 28В. Within the large scale screening program among the population of the Moscow Region, 1447 individuals from 6 districts of the region were screened for anti-HCV antibodies.Results:As per April 2016, the proportion of patients with chronic viral hepatitis in the Registry was 75.3% (n = 12 938 of 17 182). The vast majority of them (80.3%, or n = 10 393) had chronic hepatitis C, with 84% (n = 8726) of referrals were patients of productive age (from 20 to 50 years). 8.4% (n = 873) of all HCV infected patients had liver cirrhosis. Although the proportion of patients with cirrhosis was negligibly low (< 1.5%) in patients below 30 years of age, it was progressively increasing with age, with a maximum of 23.8% in those above their 50-es. As far as the HCV genotype distribution is concerned, it was as follows: genotype 1, 54.1% (n = 5622) of patients, genotype 2, 7.2% (n = 747), genotype 3, 38.4% (n = 3990). According to the results of assessment of IL28B genetic polymorphisms (n = 3212), СС rs12979860, which is associated with the most favorable sensitivity to interferon α, was found in 27.5% (n = 883), СТ allele, in 58.4% (n = 1876), and ТТ in 14,1% (n = 453). Prevalence of HCV infection in the Moscow Region, assessed by the screening program, is 1.38% of adults, or 77 200 anti-HCV positive persons, whereas estimated number of patients with chronic hepatitis C may amount to 54 000 to 61 700.Conclusion:HCV infection is the most prevalent among other viral hepatites in the Moscow Region (80.3%), and the largest numbers of infected individuals are of productive age. Almost three quarters of these patients are referred for medical care at the stage of minimal liver injury, and antiviral therapy can be used on an elective basis. Knowing the proportion of patients with liver cirrhosis (8.4%) allows for planning of the need in emergency treatments. The true prevalence of HCV infection estimated from the results of the screening program is at least 5-fold higher than that in the Registry. This indicates the necessity to upgrade the system of primary assessments. In particular, it seems reasonable to include detection of anti-HCV antibodies into the list of obligatory screening laboratory tests.

Egg sensitization, allergy and component patterns in African children with atopic dermatitis

Egg allergy is the most common food allergy in children with atopic dermatitis (AD). This study aimed to determine the prevalence of egg allergy, component patterns and predictive values of screening tests in egg allergy in South African children with AD. This was a prospective, observational study in a paediatric university hospital in Cape Town. Children with AD, aged 6 months to 10 years, were recruited randomly. They were assessed for sensitization and allergy to egg by questionnaire, skin prick tests (SPT), Immuno Solid Phase Allergen Chip (ISAC 103® ) test, ImmunoCAP component tests to egg and ovomucoid (Gal d 1) and incremental food challenges. Hundred participants (59 Black Africans and 41 of mixed ethnicity) were enrolled, median age 42 months. There was a high rate of egg sensitization of 54% and prevalence of confirmed egg allergy of 25%. History and screening laboratory tests overestimated egg allergy significantly. SPT to fresh egg white was significantly more sensitive in diagnosing egg allergy than SPT to the commercial egg white extract and produced the highest area under the receiver operator characteristics curve of all the screening tests in predicting true egg allergy. In those participants sensitized to egg, the component ovomucoid was best at differentiating true egg allergy from tolerance. Commonly used 95% positive predictive values (PPVs) for SPT to egg and ImmunoCAP egg white produced low PPV of 57% and 74%, respectively, in this population overall, with generally poorer predictive values amongst the Black Africans than the mixed ethnicity participants. A SPT to fresh egg of 17 mm and ImmunoCAP egg white of 13 kU/l produced the best PPV for egg allergy in this population. The prevalence of egg allergy is high in African children with AD, but history of egg allergy and sensitization to egg significantly overestimate the true egg allergy rate. SPT to fresh egg white was more sensitive than that to commercial egg white extract; hence, fresh egg white should be recommended in an egg allergy screening panel. The component ovomucoid was useful for differentiating allergy from tolerance in egg-sensitized participants. Population-specific 95% PPV for egg allergy tests may need to be established in developing world populations.

Getting Burned by Lactic Acid.

A 13-year-old boy with a history of moderate, persistent asthma was transferred to our facility from an outside hospital with shortness of breath and cough of 2 days’ duration. In the emergency department at the other facility, initial vitals were temperature, 98.9°F; heart rate, 120 beats per minute; respiration rate, 40; pulse oxygen saturation, 87% on room air; and blood pressure, 191/63 and 128/41 upon repeat. Screening laboratory tests were performed: the complete blood count was within reference ranges, serum chemistry was notable for a bicarbonate concentration of 29 mEq/L, and peripheral venous lactate was 2.8 mmol/L. Chest x-ray showed central peribronchial cuffing consistent with viral infection. Because of persistent wheezing and moderately increased work of breathing, the patient was placed on continuous nebulized albuterol (20 mg/h) and given 125 mg intravenous methylprednisolone, 250 mg oral azithromycin, and 1 g intravenous magnesium sulfate. Symptoms significantly improved per their report. Given the elevated lactate on the initial laboratories, he was given a 1-L bolus of intravenous crystalloid. Multiple repeat point-of-care capillary lactate levels were obtained: 7.2, 7.5, and 7.9 mmol/L. The persistently elevated lactate levels triggered additional fluid boluses and order for blood culture. The treatment team believed the patient was ready to be …

Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger.

Young febrile infants are at substantial risk of serious bacterial infections; however, the current culture-based diagnosis has limitations. Analysis of host expression patterns ("RNA biosignatures") in response to infections may provide an alternative diagnostic approach. To assess whether RNA biosignatures can distinguish febrile infants aged 60 days or younger with and without serious bacterial infections. Prospective observational study involving a convenience sample of febrile infants 60 days or younger evaluated for fever (temperature >38° C) in 22 emergency departments from December 2008 to December 2010 who underwent laboratory evaluations including blood cultures. A random sample of infants with and without bacterial infections was selected for RNA biosignature analysis. Afebrile healthy infants served as controls. Blood samples were collected for cultures and RNA biosignatures. Bioinformatics tools were applied to define RNA biosignatures to classify febrile infants by infection type. RNA biosignatures compared with cultures for discriminating febrile infants with and without bacterial infections and infants with bacteremia from those without bacterial infections. Bacterial infection confirmed by culture. Performance of RNA biosignatures was compared with routine laboratory screening tests and Yale Observation Scale (YOS) scores. Of 1883 febrile infants (median age, 37 days; 55.7% boys), RNA biosignatures were measured in 279 randomly selected infants (89 with bacterial infections-including 32 with bacteremia and 15 with urinary tract infections-and 190 without bacterial infections), and 19 afebrile healthy infants. Sixty-six classifier genes were identified that distinguished infants with and without bacterial infections in the test set with 87% (95% CI, 73%-95%) sensitivity and 89% (95% CI, 81%-93%) specificity. Ten classifier genes distinguished infants with bacteremia from those without bacterial infections in the test set with 94% (95% CI, 70%-100%) sensitivity and 95% (95% CI, 88%-98%) specificity. The incremental C statistic for the RNA biosignatures over the YOS score was 0.37 (95% CI, 0.30-0.43). In this preliminary study, RNA biosignatures were defined to distinguish febrile infants aged 60 days or younger with vs without bacterial infections. Further research with larger populations is needed to refine and validate the estimates of test accuracy and to assess the clinical utility of RNA biosignatures in practice.

45. Evidence-based guidelines regarding the role of laboratory and genetic test for the assessment of DSP. What is the perspective in 2016?

Distal symmetric polyneuropathy (DSP) is a relatively common variety of neuropathy. The AAN, AANEM and AAPMR the recommendations where: (1) Screening laboratory tests may be considered for all patients with polyneuropathy (Level C). The highest yield of abnormality were found in blood glucose, serum B12 with metabolites and serum protein immunofixation electrophoresis (Level C). If there is no definite evidence of diabetes mellitus on routine testing of blood glucose, testing for impaired glucose tolerance may be considered in DSP (Level C). (2) Genetic testing should be conducted for the accurate diagnosis and classification of hereditary neuropathies (Level A). Also, in patients with cryptogenic polyneuropathy who exhibit an hereditary neuropathy phenotype (Level C). Initial genetic testing should be guided by the clinical phenotype, inheritance pattern, and electrodiagnostic features and should focus on the most common abnormalities which are CMT1A duplication/HNPP deletion, Cx32 (GJB1), and MFN2 mutation screening. There is insufficient evidence to determine the usefulness of routine genetic testing in patients with cryptogenic polyneuropathy who do not exhibit a hereditary neuropathy phenotype (Level U).

Newborn screening and prophylactic interventions for sickle cell disease in 47 countries in sub-Saharan Africa: a cost-effectiveness analysis

BackgroundSickle cell disease (SCD) constitutes a major public health problem in sub-Saharan Africa (SSA). Newborn screening and early subsequent clinical intervention can reduce early mortality and increase life expectancy, but have not been widely implemented in SSA. This analysis assesses the cost-effectiveness of a newborn screening and prophylactic intervention (NSPI) package for SCD in 47 SSA countries.MethodsA lifetime Markov model with annual cycles was built with infants either being screened using isoelectric focusing (IEF) or not screened. Confirmed positive cases received interventions including insecticide-treated mosquito bed nets, folic acid supplementation, prophylactic antimalarial and penicillin therapy, and vaccinations against bacterial infections. Estimates for the local incidence of SCD, the life expectancy of untreated children, the SCD disability weight, and the cost of screening laboratory tests were based on published sources. Among treated infants, the annual probability of mortality until 30 years of age was derived from a pediatric hospital-based cohort. The outcome of interest included a country-specific cost per Disability Adjusted Life Year (DALY) averted.ResultsOf 47 modeled countries in SSA, NSPI is almost certainly highly cost-effective in 24 countries (average cost per DALY averted: US$184); in 10 countries, it is cost-effective in the base case (average cost per DALY averted: US$285), but the results are subject to uncertainty; in the remaining 13, it is most likely not cost-effective. We observe a strong inverse relationship between the incidence rate of SCD and the cost per DALY averted. Newborn screening is estimated to be cost-effective as long as the incidence rate exceeds 0.2–0.3 %, although in some countries NSPI is cost-effective at incidence rates below this range. In total, NSPI could avert over 2.4 million disability adjusted life years (DALYs) annually across SSA.ConclusionsUsing IEF to screen all newborns for SCD plus administration of prophylactic interventions to affected children is cost-effective in the majority of countries in SSA.

Illicit substance use among persons admitted to probation polyclinic of a regional mental hospital in the Eastern Anatolia, Turkey.

Objectives:To investigate the illicit substance use trends by gender and year in Eastern Turkey, Elazığ.Methods:This is a retrospective study designed to assess the drug use prevalence in persons who admitted to the Probation Policlinic of Elazig Mental Health Hospital between January 2011 and December 2014 in Eastern Turkey, Elazığ. Laboratory screening tests for drugs were studied using the cloned enzyme donor immunoassay technique in urine.Results:The study consisted of 10267 males (95.3%) and 510 females (4.7%), with a mean age of 30.42±10.83 years. Overall prevalence was 32.1% for cannabis, 3.8% for opiate, 0.35% for cocaine and 1.2% for polydrug usage. The prevalence of cannabis was significantly higher in males (32.7%, p=0.000). The prevalence of cannabis use was the lowest in the age group of 50-59 while it was significantly higher in the age groups of 20-29 and 30-39 (p=0.000). The prevalence of opiate use showed a significant difference among the years (p=0.000). There was a significant difference in the prevalence of cocaine use among the years (p=0.02). The prevalence of polysubstance use showed a significant difference among years (p=0.000).Conclusion:Cannabis was the most common illicit drug in the east of the Turkey. Further studies are required for comparing the results of various regions of the country and developing early interventions and treatment facilities.

Repetitive element hypermethylation in multiple sclerosis patients.

BackgroundMultiple sclerosis (MS) is a complex disorder of the central nervous system whose cause is currently unknown. Evidence is increasing that DNA methylation alterations could be involved in inflammatory and neurodegenerative diseases and could contribute to MS pathogenesis. Repetitive elements Alu, LINE-1 and SAT-α, are widely known as estimators of global DNA methylation. We investigated Alu, LINE-1 and SAT-α methylation levels to evaluate their difference in a case–control setup and their role as a marker of disability.ResultsWe obtained blood samples from 51 MS patients and 137 healthy volunteers matched by gender, age and smoking. Methylation was assessed using bisulfite-PCR-pyrosequencing. For all participants, medical history, physical and neurological examinations and screening laboratory tests were collected. All repetitive elements were hypermethylated in MS patients compared to healthy controls. A lower Expanded Disability Status Scale (EDSS) score was associated with a lower levels of LINE-1 methylation for ‘EDSS = 1.0’ and ‘1.5 ≤ EDSS ≤ 2.5’ compared to an EDSS higher than 3, while Alu was associated with a higher level of methylation in these groups: ‘EDSS = 1.0’ and ‘1.5 ≤ EDSS ≤ 2.5’.ConclusionsMS patients exhibit an hypermethylation in repetitive elements compared to healthy controls. Alu and LINE-1 were associated with degree of EDSS score. Forthcoming studies focusing on epigenetics and the multifactorial pathogenetic mechanism of MS could elucidate these links further.Electronic supplementary materialThe online version of this article (doi:10.1186/s12863-016-0395-0) contains supplementary material, which is available to authorized users.

Infections and skin diseases mimicking diaper dermatitis

Diaper dermatitis is a common condition that often prompts parents to seek medical attention. Irritant diaper dermatitis is by far the most common cause, but numerous potentially serious diseases can present with changes of the skin in the diaper area. The differential diagnosis can include psoriasis, metabolic disorders, rare immune diseases and infection. Clinical examination can be helpful in distinguishing the underlying cause. General screening laboratory tests, as well as select testing when a specific condition is suspected, can be used to challenge or confirm the putative diagnosis.

Frequent laboratory abnormalities in CIDP patients.

The role of screening laboratory tests in chronic inflammatory demyelinating polyneuropathy (CIDP) is currently unknown. The objectives of this study are to explore common laboratory test abnormalities in CIDP patients. CIDP subjects attending the Neuromuscular Clinic between 01/2013 and 12/2014 were evaluated. Demographic data, clinical history, physical examination, and laboratory test results were extracted from their charts. Seventy-nine charts were reviewed. Mean age was 61 ± 11 years. Most (84%) CIDP patients had laboratory test abnormalities; the most frequent were paraproteinemia (29%) and elevated HbA1C (28%) and creatine kinase (27%). Additional abnormalities included anemia in 19%, and elevated anti-neutrophil cytoplasmic antibody, erythrocyte sedimentation rate, and urate in 17%, elevated antinuclear antibodies, rheumatoid factor, and thyroid-stimulating hormone in 11%, and abnormal C3 in 10%. Laboratory test abnormalities were found in most CIDP patients. The most common were paraproteinemia, higher than expected frequency of diabetes, and unexpected CK elevation. Additional abnormalities included anemia, high urate levels, and common biomarkers for vasculitic neuropathies. Muscle Nerve 53: 862-865, 2016.

Obtención de tejido corneal para queratoplastia

Cornea transplant is the most common tissue transplant in the world. In Spain, tissue donation activities depend upon transplant coordinator activities and the well-known Spanish model for organ and tissue donation. Tissue donor detection system and tissue donor evaluation is performed mainly by transplant coordinators using the Spanish model on donation. The evaluation of a potential tissue donor from detection until recovery is based on an exhaustive review of the medical and social history, physical examination, family interview to determine will of the deceased, and a laboratory screening test. Corneal acceptance criteria for transplantation have a wider spectrum than other tissues, as donors with active malignancies and infections are accepted for kearatoplasty in most tissue banks.Corneal evaluation during the whole process is performed to ensure the safety of the donor and the recipient, as well as an effective transplant. Last step before processing, corneal recovery, must be performed under standard operating procedures and in a correct environment.

Management of Depression in Parkinson’s Disease

Management of Depression in Parkinson’s Disease

English

Salinity is one of the most alarming abiotic stress affecting crop productivity and significant crop loss globally. It impedes plant performance by inducing deleterious effects on germination and plant vigor. Moreover, 6% of total land area and 30% in irrigated lands are affected by salinity (Fahad et al., 2014). This leads to massive loss in terms of productivity and arable land, as most of the economically important particularly horticultural crops are sensitive to salinity. Chilli is an important cash crop due to its high economical and nutritional value of its fruit (Howard et al., 2000). It is generally categorized as salt sensitive crop. Salt stress reduces chilli production (Navarro et al., 2002). Salinity stress cause changes in physiological processes that cause reduction in plant growth and productivity. Salt stress, increased osmotic potential, generates water deficit conditions in the soil (Navarro et al., 2003), ionic toxicity, because of high concentration of toxic ions (Na and Cl) that accumulate within the plant, ionic imbalance due to the accumulation of ions in the plant cells, which cause the deficiency of the others nutrients (Lycoskoufis et al., 2005). Under salinity stress increased level of reactive oxygen species (ROS) in cells causes K efflux from the cells. Increased ROS concentrations weakens the defense mechanism which leads to oxidative stress. ROS are very destructive to plants at higher concentrations. Under salinity stress ROS increases and can pose a threat to plant cells by causing lipids peroxidation, proteins oxidation, impairment of nucleic acids, inhibit activation of enzymes, activates programmed cell death and ultimately leading to death of the cells (Sharma et al., 2012). There are different approaches used to combat salt stress like conventional breeding, genetic manipulation and foliar application of osmoprotectants. The complexity and polygenic nature of salt tolerance in crops are important factors contributing to the difficulties in breeding salt tolerant crop varieties. Breeding efforts have been hampered by a lack of understanding to salt tolerance mechanisms as well as a lack of field and laboratory screening tests (Zhu, 2000). Genetic screening technique includes diverse plant genetic resources that provides opportunity to develop improved and resistant cultivars with desirable features, that are beneficial for farmers (yield potential and large seed) as well as for breeders (abiotic stress tolerance potential, disease and pest resistance and photosynthesis) (Govindaraj et al., 2015). Proline which is usually considered as an osmoprotection agent is also known to be involved in reducing the oxidative damage by scavenging the free radicals. Proline may also play a role as protein compatible hydrotrope (Ashraf and Foolad, 2007). It supports cytoplasmic acidosis and maintain Pak. J. Agri. Sci., Vol. 53(1), 43-49; 2016 ISSN (Print) 0552-9034, ISSN (Online) 2076-0906 DOI: 10.21162/PAKJAS/16.4623 http://www.pakjas.com.pk

Growth and growth hormone: An overview

Growth is a good indicator of a child's health. Growth disturbances, including short stature or growth failure, could be indications of illnesses such as chronic disease, nutritional deficits, celiac disease or hormonal abnormalities. Therefore, a careful assessment of the various requirements for normal growth needs to be done by history, physical examination, and screening laboratory tests. More details will be reviewed about the GH-IGF axis, its abnormalities with special emphasis on GH deficiency, its diagnosis and treatment. GH treatment indications in the US will be reviewed and a few only will be highlighted. They will include GH deficiency, as well as the treatment of children born SGA, including the results of a US study using FDA approved dose of 0.48mg/kg/week. GH deficiency in adults will also be briefly reviewed. Treatment of patients with SHOX deficiency will also be discussed. Possible side effects of GH treatment and the importance of monitoring safety will be highlighted.