Better Social-emotional Behavior in Young Nepali Children is Associated with Household Wealth, Child Age, and Family Participation in a Community Development Intervention

Background Mental health and behavior problems are under-recognized in low- and middleincome countries, especially in young children. Early identification of these problems could encourage governments to address the shortages of child mental health professionals and promote early intervention programs to help children achieve their full developmental potential. Objective Describe the social-emotional development of young rural Nepali children; explore risk factors for poor development. Method The study was embedded in a longitudinal intervention trial comparing control households with those who received training in family nutrition+livestock management (Partial Package) or family nutrition+livestock management+community mobilization (Full Package). At midline, enumerators completed a 145-item household questionnaire, child anthropometry, and Administered the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE) to all enrolled children age 33-47 months (n=310). Bivariate and regression analyses examined the relationship of child and household risk factors to administered the Ages and Stages QuestionnaireSocial-Emotional scores. Result Administered the Ages and Stages Questionnaire-Social-Emotional scores were below age cutoffs in 24% of children, suggesting worse social-emotional development. In bivariate analyses and the adjusted linear regression model, older child age, greater household wealth, and Full Package Intervention status were all associated with better social-emotional development scores. Partial Package Intervention status was associated with worse scores. Conclusion The Administered the Ages and Stages Questionnaire-Social-Emotional is a potential tool to assess child social-emotional development in the context of household and community level interventions. Further work is necessary to validate the administered the Ages and Stages Questionnaire-Social-Emotional and similar tools in Nepal, and to better understand the prevalence of challenges to optimal socialemotional development in young children in order to use this information to design and monitor needed interventions.

Associations between biomass fuel use and child health: a community-based study in Bhaktapur, Nepal

Background

Biomass fuel use for cooking is widespread in low- and middle-income countries. Previous studies have mainly focused on adverse health outcomes in adults or specific diseases. In a cohort among young children living in Bhaktapur, Nepal, we aimed to describe the association between the use of biomass cooking fuels in families with child health using measures of linear growth, cognition and chronic illness.

Methods

Caregivers of 600 marginally stunted children aged 6-11 months were interviewed about their primary source of cooking fuel at enrolment into a randomized controlled trial. Children's body length (n = 572) was measured at age 18-23 months. At the same time, blood samples (n = 497) were taken, and we measured leukocyte telomere length (LTL) as a marker of chronic disease risk. We chose LTL expressed as z-scores as a measure of chronic disease. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and NEPSY-II subtests when the children were 4 years old (n = 531). Associations were estimated in multiple regression models.

Results

About 18% of all families used biomass as primary cooking fuel. Children from families using biomass fuel were on average slightly shorter (mean difference 0.14 Z-scores, 95% CI: 0.28, 0.00), had lower IQ scores (mean difference 2.2 (95% CI: 0.5, 3.9), and shorter LTL (mean difference: 0.09 (95% CI: 0.05 to 0.13) compared to those not using biomass fuel. The observed associations were unaltered after adjusting for relevant confounders.

Conclusions

In children from households in poor, urban neighborhoods in Nepal, biomass fuel use for cooking was associated with health indicators for child growth and cognition as well as longevity and chronic illnesses reflected in shortening of telomeres. As this was an observational study, residual confounding cannot be excluded. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings.

Key messages

Flower colour and size signals differ depending on geographical location and altitude region

Bees are major pollinators of angiosperms and have phylogenetically conserved colour vision but differ in how various key species use achromatic information that is vital for both flower detection and size processing. We modelled green contrast and colour contrast signals from flowers of different countries where there are well established differences in availability of model bee species along altitudinal gradients. We tested for consistency in visual signals as expected from generalization in pollination principles using phylogenetically informed linear models. Patterns of chromatic contrast, achromatic green contrast and flower size differed among the three floras we examined. In Nepal there is a significant positive correlation between flower size and colour contrast in the subalpine region, but a negative correlation at the lower altitudes. At high elevations in Norway, where pollinators other than bees are common, flower size was positively correlated with colour contrast. At low and medium altitudes in Norway and in Australia, we did not observe a significant relationship between size and colour contrast. We thus find that the relationship between size, green and colour contrast cannot be generalized across communities, thus suggesting that flower visual signal adaptations to local pollinators are not limited to chromatic contrast.

Rewardlessness in orchids: how frequent and how rewardless?

About one-third of orchid species are thought to offer no floral reward and therefore attract pollinators through deception. Statements of this idea are common in the botanical literature, but the empirical basis of the estimate is rarely mentioned. We traced citation pathways for the one-third estimate in a sample of the literature and found that the paths lead to empirical foundations that are surprisingly narrow. Moreover, recent measurements have detected minute quantities of sugar available to insect visitors in some orchids thought to be rewardless, raising the possibility of a pollination strategy that is largely deceitful but different to absolute rewardlessness. The orchids are a well-studied group and there is no doubt that rewardlessness is common in the family. However, greater empirical effort is needed to verify rewardlessness in orchids and to explore geographic and environmental variation in the proportion of rewardless species.

Colour evolution within orchids depends on whether the pollinator is a bee or a fly

Orchids are a classic angiosperm model for understanding biotic pollination. We studied orchid species within two species-rich herbaceous communities that are known to have either hymenopteran or dipteran insects as the dominant pollinators, in order to understand how flower colour relates to pollinator visual systems. We analysed features of the floral reflectance spectra that are significant to pollinator visual systems and used models of dipteran and hymenopteran colour vision to characterise the chromatic signals used by fly-pollinated and bee-pollinated orchid species. In contrast to bee-pollinated flowers, fly-pollinated flowers had distinctive points of rapid reflectance change at long wavelengths and a complete absence of such spectral features at short wavelengths. Fly-pollinated flowers also had significantly more restricted loci than bee-pollinated flowers in colour space models of fly and bee vision alike. Globally, bee-pollinated flowers are known to have distinctive, consistent colour signals. Our findings of different signals for fly pollination is consistent with pollinator-mediated selection on orchid species that results from the distinctive features of fly visual systems.

Spectrum of Infections in Living Donor Kidney Transplant Recipients: An Experience From a Tertiary Center in Nepal

BACKGROUND

Kidney transplant recipients are always at risk of infections because they are on lifelong immunosuppressive medications. The spectrum of infections in this special population is not the same as in the general population. Post-transplant infections are extensively studied in the developed world. Publications about post-transplant infections from Nepal are scarce. This study was carried out to study the spectrum of infections, the trends in treatment, and the incidence of tuberculosis in kidney transplant recipients.

METHODS

This is a retrospective analysis of the patient data in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Follow-up data from the first 100 kidney transplant recipients was recorded in a Microsoft Excel worksheet and descriptive analysis was done.

RESULTS

In the first 100 transplants done until 21 September 2011, 92 patients' data were recorded and 8 patients' data were missing. The mean follow-up period was 61.03 months. The population was 76.09% male (n = 70) and 23.91% female (n = 22). A total of 641 episodes of infections were recorded. Urinary tract infections were the most common type of infection. Escherichia coli was the most common organism isolated (36% of all cultures). There were 17 (2.65%) episodes of viral and 42 (6.6%) episodes of fungal infections. Tuberculosis was diagnosed in 6 (6.5%) patients.

CONCLUSION

Urinary tract infection is the most common type of infection in post-kidney transplant patients. Quinolones were the most common agents used to treat urinary tract infections. The incidence of tuberculosis in kidney transplant recipients is 6.5% in 5 years' follow-up.

Abnormalities in Protocol Graft Kidney Biopsy 6 Months Posttransplantation in a Tertiary Care Center Hospital of Nepal

BACKGROUND

Increasing graft survival is the prime focus of every transplantation program. Detection of subclinical abnormalities with the help of protocol renal graft biopsies performed at predetermined intervals after transplantation has been one of the approaches. The objective was to study the abnormalities in protocol renal graft biopsy specimens at 6 months posttransplantation.

METHODS

This was a hospital-based observational descriptive study. It included the recipients who underwent kidney transplantation between October 2014 and September 2015. The recipients were followed up postoperatively on an outpatient basis, as per the institution protocol. At 6 months posttransplantation, protocol graft biopsy was performed in all patients with normal functioning allograft without proteinuria after obtaining informed written consent.

RESULTS

A total of 57 patients with chronic kidney disease underwent renal transplantation during the study period. Protocol biopsy was performed in 47 recipients. Subclinical rejection was found in 4 (8.5%) recipients. Two recipients had significant tubulitis and interstitial inflammation. One of them showed features of Banff Type IA cellular rejection (t2, i2) and another showed Banff Type IB cellular rejection (t3, i2). Biopsy specimen of 1 recipient showed significant glomerulitis and peritubular capillaritis (g3, ptc1). Another recipient showed significant peritubular capillaritis (ptc2) with C4d positivity. IgA nephropathy was present in 6 (12.8%) recipients. BK virus nephropathy was found in 2 (4.3%) recipients.

CONCLUSION

This study demonstrates that abnormal histologic findings occur in protocol graft biopsy specimens at 6 months post renal transplantation in patients without any clinical or laboratory abnormalities.

Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery

Background

Acute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery.

Methods

During a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI.

Results

Thirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m² (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI.

Conclusions

Serum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.

Protease-activated receptor-1 inhibits proliferation but enhances leukemia stem cell activity in acute myeloid leukemia

Eradication of leukemia stem cells (LSCs) is the ultimate goal of treating acute myeloid leukemia (AML). We recently showed that the combined loss of Runx1/Cbfb inhibited the development of MLL-AF9-induced AML. However, c-Kit⁺/Gr-1^- cells remained viable in Runx1/Cbfb-deleted cells, indicating that suppressing RUNX activity may not eradicate the most immature LSCs. In this study, we found upregulation of several hemostasis-related genes, including the thrombin-activatable receptor PAR-1 (protease-activated receptor-1), in Runx1/Cbfb-deleted MLL-AF9 cells. Similar to the effect of Runx1/Cbfb deletion, PAR-1 overexpression induced CDKN1A/p21 expression and attenuated proliferation in MLL-AF9 cells. To our surprise, PAR-1 deficiency also prevented leukemia development induced by a small number of MLL-AF9 leukemia stem cells (LSCs) in vivo. PAR-1 deficiency also reduced leukemogenicity of AML1-ETO-induced leukemia. Re-expression of PAR-1 in PAR-1-deficient cells combined with a limiting-dilution transplantation assay demonstrated the cell-dose-dependent role of PAR-1 in MLL-AF9 leukemia: PAR-1 inhibited rapid leukemic proliferation when there were a large number of LSCs, while a small number of LSCs required PAR-1 for their efficient growth. Mechanistically, PAR-1 increased the adherence properties of MLL-AF9 cells and promoted their engraftment to bone marrow. Taken together, these data revealed a multifaceted role for PAR-1 in leukemogenesis, and highlight this receptor as a potential target to eradicate primitive LSCs in AML.

Floral colours in a world without birds and bees: the plants of Macquarie Island

We studied biotically pollinated angiosperms on Macquarie Island, a remote site in the Southern Ocean with a predominately or exclusively dipteran pollinator fauna, in an effort to understand how flower colour affects community assembly. We compared a distinctive group of cream-green Macquarie Island flowers to the flora of likely source pools of immigrants and to a continental flora from a high latitude in the northern hemisphere. We used both dipteran and hymenopteran colour models and phylogenetically informed analyses to explore the chromatic component of community assembly. The species with cream-green flowers are very restricted in colour space models of both fly vision and bee vision and represent a distinct group that plays a very minor role in other communities. It is unlikely that such a community could form through random immigration from continental source pools. Our findings suggest that fly pollination has imposed a strong ecological filter on Macquarie Island, favouring floral colours that are rare in continental floras. This is one of the strongest demonstrations that plant-pollinator interactions play an important role in plant community assembly. Future work exploring colour choices by dipteran flower visitors would be valuable.

UBASH3B/Sts-1-CBL axis regulates myeloid proliferation in human preleukemia induced by AML1-ETO

The t(8;21) rearrangement, which creates the AML1-ETO fusion protein, represents the most common chromosomal translocation in acute myeloid leukemia (AML). Clinical data suggest that CBL mutations are a frequent event in t(8;21) AML, but the role of CBL in AML1-ETO-induced leukemia has not been investigated. In this study, we demonstrate that CBL mutations collaborate with AML1-ETO to expand human CD34+ cells both in vitro and in a xenograft model. CBL depletion by shRNA also promotes the growth of AML1-ETO cells, demonstrating the inhibitory function of endogenous CBL in t(8;21) AML. Mechanistically, loss of CBL function confers hyper-responsiveness to thrombopoietin and enhances STAT5/AKT/ERK/Src signaling in AML1-ETO cells. Interestingly, we found the protein tyrosine phosphatase UBASH3B/Sts-1, which is known to inhibit CBL function, is upregulated by AML1-ETO through transcriptional and miR-9-mediated regulation. UBASH3B/Sts-1 depletion induces an aberrant pattern of CBL phosphorylation and impairs proliferation in AML1-ETO cells. The growth inhibition caused by UBASH3B/Sts-1 depletion can be rescued by ectopic expression of CBL mutants, suggesting that UBASH3B/Sts-1 supports the growth of AML1-ETO cells partly through modulation of CBL function. Our study reveals a role of CBL in restricting myeloid proliferation of human AML1-ETO-induced leukemia, and identifies UBASH3B/Sts-1 as a potential target for pharmaceutical intervention.

Assessment of knowledge and practice of community pharmacy personnel on diabetes mellitus management in Kathmandu district: a cross sectional descriptive study

Background

Pharmacists are the most reachable healthcare professionals to many chronically ill patients. It has been found that pharmacists see patients with diabetes up to five times more often than any other healthcare provider. Therefore, to provide quality health care to patients it is important that they have appropriate knowledge and practice on diabetes mellitus management. Thus, this study was conducted to assess the knowledge and practice of diabetes mellitus management among community pharmacy personnel involved in retail community pharmacies of Kathmandu.

Methods

Three hundred and fifteen community pharmacies, selected by systematic random sampling were surveyed by using pre-validated self-administered questionnaires. The first set of questionnaire evaluated the community pharmacy personnel’s diabetes knowledge based on a pre-validated 20-item questionnaire. The second set of questionnaire documented about the practice of community pharmacy personnel on diabetes mellitus management which contained 22 questions. Data was entered in EPI Data and analyzed by using SPSS version 20.

Results

This survey demonstrated that 76.5 % respondents had poor knowledge and 86.4 % had negative practice on diabetes mellitus (DM) management. Only 26.2 % respondents had good knowledge as well as good practice. 31.4 % of respondents had poor knowledge as well as poor practice on DM management.

Conclusions

Laws and regulations regarding community pharmacy personnel need to be implemented. There should be more advanced and experiment based training. Additionally, the provision for further education curriculum in pharmacy education should be implemented which should intensively include disease and proper management. Guidelines covering diabetes care should be distributed and implemented throughout community pharmacies.

A cytomorphometric analysis of the oral mucosa in patients with type 2 diabetes mellitus

Background:  Although many of the pathological conditions of oral mucosa are clinically distinguishable, most lesions require a definitive diagnosis. This article tried the use of exfoliative cytology as an alternative tool in the screening, diagnosis and follow-up of diabetes mellitus.Materials and Methods: After rinsing the mouth with normal saline, slides were prepared from buccal mucosa and dorsum of tongue and fixed in 95% ethyl alcohol. The slides were stained with Papanicolaou stain and Acridine orange. Fifty clearly defined cells in each slide were visualized under light microscope for cytomorphometric analysis of cells using Image J software and under fluorescence microscope for assessment of nuclear alterations like micronuclei, nuclear budding, binucleation, multinucleation and karyorrhexis.Results: Statistically significant increase in Nuclear area BM (p = 0.000057), Nuclear Area Tongue (p= 0.0000113), total Nuclear Area (p= 000079), Cellular Area BM (p= 0.0475), Cellular Area Tongue (p= 0.0105), Total Cellular Area (p= 0.00496), Cytoplasmic Area Tongue (p= 0.00358), Total Cytoplasmic Area (p= 0.00268) were obtained from epithelial cells in the diabetic group when compared with the control group. Also the epithelial cells from the diabetic group showed features such as nuclear budding, micronuclei, binucleation, karyorrhexis and perinuclear halo. Conclusion:  The objective demonstration of cytomorphometric and nuclear alterations by the oral exfoliated cells indicate the presence of cytological changes in the oral mucosa of diabetic patients despite the apparently normal clinical appearance. Hence, cytomorphometric analysis would aid the health professional as an additional non-invasive tool for the screening and monitoring of Diabetes Mellitus.

Assessment of Candidal carriage in patients with Type II Diabetes Mellitus

Background: It is generally acknowledged that patients with diabetes mellitus are more susceptible to fungal infections, particularly with Candida albicans. Oral infection by Candida can result in a number of clinical lesions, including median rhomboid glossitis (central papillary atrophy), denture stomatitis, squamous cell carcinoma, Radiation therapy, immunocompromised status, etc. Different studies have shown that patients with diabetes mellitus have increased frequency of oral candidal carriage and increased risk of candidiasis, which is related to poor metabolic control, neutrophil dysfunction, reduced salivary flow, high glucose concentration in blood and saliva and in medications.Materials and Methods: Subjects of both the groups were given 10 ml of sterile normal saline and asked to rinse the mouth for one minute. The subjects were then asked to return the oral rinse in a sterile clean, broad-mouthed container which was capped, labelled and taken to the laboratory. The samples were then inoculated onto the culture medium (Sabouraud’s dextrose agar with Chloramphenicol) with minimal delay (within 6-8 hours of collection of oral rinse). Candidal colonies were counted and compared with non-diabetics.Results: Statistically significant increase in colony forming units (p=0.0324) were obtainedin patients with diabetes mellitus.Conclusion: The results indicate significant increase in colonization and carriage of candida in the oral cavity among diabetics when compared with non-diabetics. However, further research using larger samples is required which may lend credibility to the suggestion of increased candidal CFUs in diabetics serving as a surrogate marker of serum glucose levels.Journal of Pathology of Nepal (2015) Vol. 5, 733-738

Difficult journey from delivery to discharge, case of congenital diaphragmatic hernia

We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient.

Prevention of Mother to Child Transmission (PMTCT) Program at Paropakar Maternity and Women’s Hospital: A Review

Aims: Vertical transmission from mother to fetus is the main route of HIVinfection among children. This study is an effort to review utilization of prevention of mother to child transmission (PMTCT) services by pregnant women seeking care in Paropakar Maternity and Women’s Hospital (PMWH). Methods: Case records of 165 pregnant women with HIV positive status who delivered at Paropakar Maternity and Women’s Hospital, Kathmandu from April 2005 to Dec 2011 were reviewed. Demographic profile of these women and interventions to prevent mother to child transmission (MTCT) including antiretroviral prophylaxis (ARV), mode of delivery, infant feeding practice as well as HIV status of their children were recorded. Results: Hospital records showed 109262 antenatal attendees and 120823 deliveries including 165 HIV infected women who delivered in this facility. Prevalence of HIV infection among antenatal attendees was 0.11 % and 0.13% in hospital deliveries. Migrant worker spouse (44.2%) was the main source of infection in their wives. Eighty eight (55.7%) out of 150 eligible women received ARV drugs and 97% babies received antiretroviral prophylaxis . Spontaneous vaginal delivery occurred in 60% women and caesarean section performed in the rest. While 60.8% women opted for exclusive breast feeding, remaining 39.2% chose formula feeding. For prophylaxis of opportunistic infection, Cotrimoxazole was given to 70.3% children. The incidence of HIV infection in babies born to HIV infected mother was 5.1%. Conclusions: Integrating PMTCT services into existing maternal and child health system can significantly reduce perinatal transmission of HIV infection to children. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11138 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 25-28

Bacterial Isolates and its Antibiotic Susceptibility Pattern in NICU

Background Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world. Objectives To determine the common bacterial isolates causing sepsis in neonatal intensive care unit and its antibiotic susceptibility pattern. Methods A one year discriptive prospective study was conducted in neonatal intensive care unit to analyse the results of blood culture and to look into the sensitivity of the commonly used antibiotics. Results The blood culture yield by conventional method was 44.13% with nosocomial sepsis accounting for 10.79%. 84.08% were culture proven early onset sepsis and 15.95% were late onset sepsis. Klebsiella infection was the commonest organism isolated in early, late and nosocomial sepsis but statistically not significant. Gram positive organisms were 39.36% in which Staphylococcus aureus was the leading microorganism followed by coagulase negative staphylococcus areus. Gram negative organisms were 60.64% amongst them Klebsiella was the most often encountered followed by Pseudomonas. The most common organism Klebsiella was 87.5% and 78.3% resistance to ampicillin and gentamycin respectively. Among gram negative isolates 87.5% and 77.2% were resistance to ampicillin and gentamycin respectively. Among gram positive isolates 58.5% and 31.5% resistance were noted to ampicillin and gentamycin respectively. Resistance to cefotaxim to gram negative and gram positive isolates were 87.34% and 59.35% respectively. Conclusion Klebsiella is most common organism which is almost resistance to first line antibiotics. Resistance to both gram negative and gram positive isolates among firstline antibiotics and even with cefotaxim is emerging and is a major concern in neonatal intensive care unit. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11030 Kathmandu University Medical Journal Vol.11(1) 2013: 66-70