Conceptualising the empowerment of caregivers raising children with developmental disabilities in Ethiopia: a qualitative study.

BACKGROUND: Caregivers of children with developmental disabilities (DDs) in Ethiopia experience stigma and exclusion. Due to limited existing services and substantial barriers to accessing care, they often lack support. Caregiver empowerment could help address injustices that hinder their capacity to support their child as they would like. The aim of this study was to explore the meaning and potential role of empowerment for caregivers raising a child with a DD and how empowerment was situated in relation to other priorities in service development. METHODS: This was a qualitative phenomenological study. Semi-structured interviews were conducted in Amharic and English with caregivers of children with a DD (n = 15), clinicians (n = 11), community-based health extension workers (n = 5), representatives of non-governmental organisations working with families with DDs (n = 17), and representatives of local authorities in health, education, and social care (n = 15). Data were analysed thematically. RESULTS: Three main themes were developed: "Barriers to exercising caregivers' agency"; "Whose decision is it to initiate empowerment?"; and "Supporting caregivers through support groups". Caregiver capacity to do what they thought was best for their child was undermined by poverty, a sense of hopelessness, experience of domestic abuse and multiple burdens experienced by those who were single mothers. Caregivers were nonetheless active in seeking to bring about change for their children. Caregivers and professionals considered support groups to be instrumental in facilitating empowerment. Participants reflected that caregiver-focused interventions could contribute to increasing caregivers' capacity to exercise their agency. A tension existed between a focus on individualistic notions of empowerment from some professionals compared to a focus on recognising expertise by experience identified as vital by caregivers. Power dynamics in the context of external funding of empowerment programmes could paradoxically disempower. CONCLUSION: Caregivers of children with DDs in Ethiopia are disempowered through poverty, stigma, and poor access to information and resources. Shifting power to caregivers and increasing their access to opportunities should be done on their own terms and in response to their prioritised needs.

Evaluation of SnO2 for sunlight photocatalytic decontamination of water.

The broad bandgap tin (IV) oxide (SnO2) is the least investigated semiconductor material for photocatalytic water decontamination in sunlight exposure. A detailed study covering the synthesis, characterization and the evaluation of photocatalytic activity of SnO2, in the natural sunlight exposure, is presented. The structural characterization by XRD revealed the formation of phase pure tetragonal SnO2 with the average crystallite size of ∼41.5 nm whereas minor Sn2+ states in the material were identified by XPS analysis. As explored by diffuse reflectance (DR) and photoluminescence (PL) spectroscopy, the material exhibited a distinct absorption edge at ∼3.4 eV. The morphological and microstructure analysis of the synthesized SnO2 was carried out by FESEM and HRTEM. The electrochemical impedance spectroscopy (EIS) and chronopotentiometry (CP) predicted the better charge transport and retention ability of the material under illumination whereas the Mott-Schottky extrapolation prophesied the n-type behavior with the flat-band potential of -0.60 V. The photocatalytic activity of SnO2 was assessed in the exposure of complete spectrum natural sunlight for the removal of 2,4,6-trichlorophenol. The HPLC and TOC analysis monitored the progress of degradation and mineralization whereas the released chloride ions were evaluated by ion chromatography. The effect of the transition metal ions (Fe3+, Cu2+, Ni2+, and Zn2+) as electron capture agents and H2O2 as ROS generator was explored during the degradation process. The utility of the material for the simultaneous removal of chlorophenols in the mixture was also investigated. The SnO2 exhibited sustained activity in the repeated use. Based on experimental evidence congregated, the mechanism of the removal process and the efficacy of SnO2 for sunlight photocatalytic decontamination of water was established.

Ethnobotanical study on medicinal plants in Melit area (North Darfur), Western Sudan.

BACKGROUND: The documentation of ethnobotanical knowledge in Sudan is restricted to specific regions, and there is a far-reaching lack of written information on the traditional use of medicinal plants in other places like Darfur State, in western Sudan. The present study was designed to document the medicinal plants used in traditional medicine of Melit area in North Darfur State. METHOD: Ethnomedicinal information was collected from 135 local informants through semi-structured questionnaires. Data were analysed for use value (UV), informant consensus factor (ICF) and fidelity level. RESULTS: A total of 59 medicinal plants, belonging to 32 families and 55 genera, were recorded for their traditional uses in Melit area. Fabaceae were represented by highest number of species (13) followed by Asteraceae and Malvaceae (4 each) and Poaceae (3). Herbs comprise the main sources (50.8%) of traditional remedies. Fruits and stem bark (17.9% each) were the major plant parts used. Decoction (36.5%) is the most mode of preparation used. Geigeria alata was most commonly used species with UV of 2.37. The highest ICF values were recorded for swellings (ICF = 1.00) and respiratory system (ICF = 0.95) categories. Ten plants, namely Carica papaya, Corchorus trilocularis, Eragrostis cilianensis, Heliotropium sudanicum, Mollugo cerviana, Psiadia punctulate, Rhynchosia minima, Solanum coagulans, Solanum forskalii and Tephrosia purpurea, were cited for the first time as medicinal plants used in Sudan traditional medicine. Resins of Boswellia papyrifera, seeds of Nigella sativa, pods of Vachellia nilotica (syn. Acacia nilotica) and clove of Syzygium aromticum were used to make different preparations for the treatment of the corona virus. CONCLUSION: This is the first ethnobotanical survey conducted in this region which is always suffering from security issues, and results indicated that Melit area harbours high diversity of plants used traditionally to cure different health conditions. The present study aids in conserving such rich heritage, and it is recommended that the newly reported species worth further studying over their phytochemical and biological properties.

Haematological malignancies as disorders negatively impacting specificities of the direct agglutination and rapid rK39 strip tests as reference diagnostics for visceral leishmanisis.

Introduction: During several years of work in Sudan, we occasionally had been confronted with patients who presented clinical features highly suggestive of visceral leishmaniasis (VL) however direct agglutination test (DAT) readings that were either at the high negative or low positive titre range. Inquiries on the fate of those particular patients revealed mortality, undetermined diagnosis or that in some of them leukaemia was finally diagnosed. Gap statement: Investigate as to what extent haematological malignancies (HMs) interfere with VL diagnosis. Aim: Evaluate specificity of DAT version newly developed in this study wherein sodium dodecyle sulphate (SDS) was incorporated as a test sample denaturant in comparison with a standard reference wherein ß-mercaptoethanol (ß-ME) was used in test execution. Methodology: Seventy plasma samples from patients with HMs were collected and tested in a primary DAT version (P-DAT). The results obtained were compared with those of the rK39 strip test as VL reference diagnostic. HM samples revealing titres higher than the start dilution (1 : 100) in P-DAT were further tested in a ß-ME- and urea-modified DAT versions. The specificity of the newly developed SDS-DAT was assessed against that of ß-ME-DAT and rK39 strip tests as current reference diagnostics for VL. Results: Seven out of 70 patients with HMs scored positive outcomes (titre ≥1 : 3200) in P-DAT and four in the reference rK39 strip test. Of the seven that tested positive in P-DAT or four in the reference rK39, none reacted at titre >1 : 100 in the SDS-DAT. Significant reduction in non-specific agglutination reactions was achieved as a result in respect to the HM plasma samples (P value <0.05). Conclusion: To establish desired specificity for VL diagnosis in respect to HMs and subsequently minimize or avoid serious side effects due to unjustified anti-leishmanials prescription the combined application of the SDS-DAT here described and an improved version of the rK39 for confirmation is recommended.

Investigations to Explore Molecular Interactions and Sweetness Response of Polyhydroxy Compounds with Amino Acids in Aqueous Systems.

In conjunction with the development of people's living standards, the modern world demands good-quality food such as sweets, candies, chocolates, diet drinks, beverages, and so on, but because of obesity and other health issues people concentrate more on sugar-free or low-calorie products. Polyols are such a kind of food with desirable qualities, and they play a role in controlling the blood glucose level in diabetic patients. The density (ρ) and sound speed (u) of sugar alcohol in water and in (0.02, 0.04, and 0.06) mol kg-1l-arginine solutions at different temperatures (293.15-318.15 K) and atmospheric pressure were measured by using Anton Paar DSA5000M. Experimental density and sound velocity data were further used to compute volumetric and acoustic parameters such as apparent molar volume (ØV), partial molar volume (Ø V 0), compressibility (Ø k 0), expansibility (Ø E 0), and so on. The positive trends of apparent molar volume (Ø V ), and partial molar volume Ø V 0), values indicate strong hydrophilic interactions in ternary solutions. These interactions give a complete picture about solvation behavior, the effect of temperature, and hydrogen bonding present among (galactitol + l-arginine) mixtures. The apparent specific volume values were calculated, and it was found that these values of the investigated mixtures lie on the borderline with the reported values of sweeteners. This study may offer a new vision in elucidation of mechanistic modifications between sugar alcohol, amino acid, and their mode of interactions.

Correlation Between Doppler Echocardiography and Right Heart Catheterization Derived Pulmonary Artery Pressures: Impact of Right Atrial Pressures.

OBJECTIVE: To evaluate the correlation between Doppler echocardiography (DE) and right heart catheterization (RHC) derived pulmonary artery pressures and to assess the impact of right atrial (RA) pressures on this correlation. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Cardiology Department, Tahir Heart Institute, Chenab Nagar, from June 2013 to December 2014. METHODOLOGY: All patients undergoing RHC were included. Relevant data were collected from hospital database. Continuous variables were expressed as the mean and SD or as the median and interquartile range where the distributions were skewed. Pearson correlation coefficient and Bland-Altman method were used to correlate DE derived right ventricular systolic pressure (RVSP) and RHC derived systolic pulmonary artery pressures (sPAP). Adjusted RVSP was calculated by replacing default value of RA pressure (10 mmHg) with RHC derived mean RA pressure. Receiver operating characteristic curve (ROC) was used to identify the best cut-off value of RVSP in predicting pulmonary hypertension. RESULTS: Fifty-one patients completed the study protocol. Mean age of study population was 45.22 &plusmn;15.25 years with male to female ratio of 1.47:1. Median error was 13 mmHg (7 to 20). Pearson correlation coefficient (r) between RVSP and sPAP was 0.72. Bland-Altman method of correlation showed bias of +4.43 mmHg with 95% limits of agreement ranging from -34.61 to +43.47. Using ROC curve, the best cut-off value of RVSP was greater than 52 mmHg with accuracy of 75% (sensitivity: 81%, specificity: 69%) in predicting pulmonary hypertension. Adjusted RVSP showed only little improvement in correlation (r = 0.75), adjusted error (13.65 &plusmn;13.05) and diagnostic accuracy (79%). CONCLUSION: Doppler echocardiography can frequently overestimate pulmonary artery pressures. Though correctly estimated RA pressure may improve this correlation, yet its contribution is only minimal.

Brugada Syndrome: An Electrical Storm without Warning.

Brugada Syndrome (BrS) is an inherited channelopathy causing sodium channel dysfunction in cardiac myocyte. These patients are prone to develop Ventricular Fibrillation (VF) or polymorphic Ventricular Tachycardia (VT). Next to coronary artery disease and cardiomyopathies, BrS is an important cause of sudden cardiac death. We report here a case of 22 year unmarried female with "unexplained" cardiac arrest without prior history of syncope and family history of sudden cardiac death. She was resuscitated out of hospital in some local dispensary in rural settings and after prolonged hypoxia with its neurological sequelae, she eventually died. BrS should be considered in differentials of unexplained cardiac arrest even in patients without family history of sudden cardiac death. First episode of VT/VF in BrS patients can be life threatening. Only prompt cardioversion / defibrillation can save life. We have suggested some measures to identify patients of BrS.