C-reactive Protein Versus Neutrophil/lymphocyte Ratio in Differentiating Bacterial and Non-bacterial Pneumonia in Children

BACKGROUND

Pneumonia is a leading cause of childhood mortality in a low resource country. Simple laboratory markers can help differentiate between bacterial and non-bacterial pneumonias for appropriate management.

METHODS

In children aged one to 60 months with features of lower respiratory infection, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were used to differentiate between bacterial and non-bacterial pneumonias. The cutoff values for detecting bacterial pneumonias were evaluated by statistical tools.

RESULTS

Bacterial pneumonia was diagnosed in 285 (43.6%) children out of 654 studied. At a cut-off value of 36 mg/L CRP was predictive of bacterial pneumonias with sensitivity and specificity of 61.8% and 91.3% respectively while the sensitivity and specificity for predicting bacterial pneumonia using NLR was 45.6% and 64% respectively with 1.28 used as a cut-off.

CONCLUSIONS

Our study shows that CRP is superior to NLR in differentiating bacterial from non-bacterial pneumonias in children.

Carbon sequestration capacity of sediments, algae, and zooplankton from fresh water aquaculture ponds

The contribution of aquaculture and allied activities to the emission of green house gases and consequently to global warming is an emerging concern among environmentalists in the recent past. However, there exists ample scope for aquaculture activities to sequester carbon and thus compensate for the carbon emissions linked to aquaculture. This article attempts to elucidate the carbon sequestration capacity of sediments, algae, and zooplankton from fresh water aquaculture ponds. The percent organic carbon in the pond sediments ranged from 0.39 to 1.31 with an average value of 0.912 ± 0.321 whereas the carbon sequestration capacity ranged from 0.442 to 1.882 MgC/ha (1 Mg = 10(6) g) with an average value of 1.018 ± 0.447 MgC/ha. In the case of zooplankton and algae from pond, the percent organic carbon was 7.688 ± 0.196 and 2.354 ± 0.047, respectively, whereas the total estimated carbon burial rate was 0.009 ± 0.005 and 0.150 ± 0.003 MgC/ha, respectively. These findings are discussed with the previous reports available at present and are found to be in comparable ranges.

Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal

BACKGROUND

Scrub typhus is a neglected tropical disease and is under reported from Nepal. The objective of this study was to investigate the sero-epidemiology of scrub typhus in patients suffering from acute febrile illness.

METHODS

A total of 434 specimens collected from July to November 2015 at National Public Health Laboratory (NPHL) were investigated for detection of immunoglobulin M (IgM) antibody to Orientiatsutsugamushi.The Scrub Typhus Detect TM kit (InBios, USA) was used to detect the antibodies to O.tsutsugamushi in human serum. Randomly selected 10% positive specimens were used for confirmation by dot- enzyme-linked immunosorbent assay and indirect immunofluorescence assay.

RESULTS

Of the total, 175 (40.3%) were positive for IgM antibodies to O. tsutsugamushi. Positive results of scrub typhus were highest among female in 11-20 year followed by males in 41-50 years age group. The IgM antibodies to O. tsutusugamushi were positive in specimens of various geographical regions including 30 districts of Nepal. Positive cases were found in various ecological regions of Nepal.

CONCLUSIONS

Scrub typhus is one of the neglected tropical diseases in Nepal. Patients with acute febrile illness should be investigated for scrub typhus with high priority. There is an urgent need of reliable and affordable diagnostic tests at all level of health facilities of Nepal. Surveillance and public health awareness about the disease transmission and preventive measures needs to be initiated.

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu

INTRODUCTION

Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions.

METHODS

The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification.

RESULTS

Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01).

CONCLUSION

Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Urinary Tract Infection in Asymptomatic Newborns with Prolonged Unconjugated Hyperbilirubunemia: A Hospital based Observational study from Western Region of Nepal

Background Urine culture is usually not a part of work-up for neonatal unconjugated hyperbilirubinemia; hence its prevalence remains unknown. Objective This study was done to determine the incidence of urinary tract infection (UTI) in asymptomatic newborns with prolonged unconjugated hyperbilirubinemia and to evaluate which other laboratory parameters are associated with UTIs. Method A prospective observational study where jaundiced newborns otherwise clinically well, were evaluated for UTI. The study was carried out in neonatal intensive care unit of Manipal Teaching Hospital, Pokhara from June 2012 -April 2013. The babies were divided in two groups group I- late prolonged jaundice and Group II - early physiological jaundice. Serum bilirubin, Septic screening and suprapubic urine sample analysis was performed for all subjects. Data was analyzed using SPSS version 16 and p 7lt; 0.05 was considered statistically significant. Result Of the 85 neonates, 33(38.8%) were females and 52(61.2%) males; 68(80%) were of term gestation and 17(20%) were preterms. The age at onset of jaundice for group I (n=53) was 13.6±4.88 days and for Group II (n= 32) was 5.0± 1.04 days. 11 /85 (12.9%) were diagnosed to have UTI [10 (90.9%) in group I and 1 in group II (9.01%] (p=0.04). UTI was more prevalent in group I [OR 7.20, 95% CI (0.87, 59.27)], more prevalent in male [OR 8.40, 95% CI (0.59, 74.13) and term babies of group I [OR 4.39, 95% CI (0.48, 39.82) when compared to Group II. Among other lab parameters only total WBC count was statistically significant (p=0.03). Escherichia coli was the predominant pathogen (45.45%) isolated. The sensitive antibiotics were aminoglycosides, fluroquinolones, nitrofurantoin and vancomycin and resistant antibiotics were most cephalosporins and penicillins for the isolated organisms. Conclusion The present study highlights significant association between late prolonged unconjugated hyperbilirubinemia and UTI. It is suggested that evaluation for UTI may be considered as a screening test for such cases.

Comparison of Initial Response of Nebulized Salbutamol and Adrenaline in Infants and young Children Admitted with Acute Bronchiolitis

Background Acute bronchiolitis is common cause of hospitalization in infants and young children. There are widespread variations in the diagnosis and management. Despite the use of bronchodilators for decades, there is lack of consensus for the benefit of one above another. Objective To compare initial response of nebulized adrenaline and salbutamol. Method Children aged two months to two years admitted with acute bronchiolitis in the department of Paediatrics of Manipal teaching hospital, Pokhara, Nepal, from 1st March 2014 to 28th February 2015 were enrolled. Patients fulfilling inclusion criteria received either adrenaline or salbutamol nebulization. Data were collected in a predesigned proforma. Respiratory distress assessment instrument (RDAI) scores were considered primary outcome measure and respiratory rate at 48 hours, duration of hospital stay, requirement of supplemental oxygen and intravenous fluid were considered secondary outcome measure. Result A total of 40 patients were enrolled in each study group. Mean RDAI scores at admission was in 9.75 with (CI- 9.01, 10.49) in adrenaline and 9.77 (CI- 9.05, 10.50) in salbutamol group. There was gradual decline in mean RDAI scores in both the groups over 48 hours to 4.15 (CI- 3.57,4.73) and 4.13 (CI- 3.69,4.56) in adrenaline and salbutamol group respectively. Hospital stay was 5.32 days in adrenaline and 5.68 days in salbutamol group. Patients nebulized with adrenaline required oxygen for 33.30 hours compared with 36.45 hours in salbutamol. Intravenous fluid duration was also less in adrenaline group compared to salbutamol group (33.15 vs 37.80 hours). Conclusion Patients of acute bronchiolitis nebulized with either salbutamol or adrenaline experienced similar decline in RDAI scores in the first 48 hours. Duration of supplementary oxygen and intravenous fluid was less in adrenaline group compared with salbutamol group.

Myopia in school children from high mountain region of Nepal

OBJECTIVE

Myopia is emerging as a public health problem in school going children. Prevalence of myopia differs in different geographical areas, race, ethnic groups and socioeconomic background. Purpose of this study was to find out myopia prevalence in schoolchildren from very high mountain region of Nepal.

MATERIALS AND METHODS

It was a cross sectional descriptive study. Vision screening was conducted in Snowland School among the children who come from high mountain region. Vision screening was done by volunteers using standard Snellen's chart. Those who failed screening test underwent a detailed ophthalmological examination by a pediatric ophthalmologist.

RESULTS

A total of 140 children had their vision assessed. Mean age was 13.9yrs (±2.8yrs SD). On screening, 28.5% children (n=40) had vision less than 6/9 in at least one eye. Seven children were already wearing myopic glasses, among which only 2 had vision 6/9 or better. Out of 40 children, 10% (n=4) had vision 6/9 or better and 90% (n=36) had refractive error. Out of these 36 children, myopia was present in all (100%).Hence prevalence of Myopia in total school population was 27% (n=38).All the children had simple Myopia from 0.5D-3.5D. After refractive correction, all the children had best corrected visual acuity of 6/9 or better. 86 % (n=120) children never had their eyes checked before. Conclusion The study showed high prevalence of myopia and was only ocular morbidity present in children. The result of this study can be a baseline in conducting large population based study in children from high mountains of Nepal.

Abstract 5451: Profiling inhibitors of MDM2:p53 and MDMX:p53 in relation to MDMX protein levels

Pharmacological antagonism of the interaction between MDM2 and/or MDMX with p53 has been pursued as a therapeutic strategy to restore p53 tumour suppressor activity in wild type TP53 tumours with amplification or over-expression of these negative regulators. The majority of small molecule approaches described to date inhibit MDM2 binding to p53, which has E3 ligase activity and through ubiquitination targets p53 for degradation. However, MDMX, although devoid of E3 ligase activity itself, forms heterodimers with MDM2 and augments its activity to induce polyubiquitination of p53. Further complexity in this regulatory network arises from the fact that MDM2 is a target gene of p53 transcription, and that MDM2 can also control the stability of MDMX. Since MDMX is widely reported to confer resistance to established MDM2:p53 antagonists, this study aimed to examine the activity of MDM2:p53 selective inhibitors across a panel of wild-type TP53 cell lines with variable MDM2 and MDMX protein expression, and to contrast this with recently described inhibitors with mixed MDM2:p53 and MDMX:p53 activity.

Growth inhibition studies (72h) were performed using XTT assays, but with verification by orthogonal methods (SRB, clonogenic assays). Gene expression was determined at the level of mRNA and protein. The selectivity of all inhibitors was confirmed initially in p53 wild-type and non-functional paired cell lines.

As anticipated, MDM2:p53 selective inhibitors (nutlin-3a, MI-773, RG7112) were active in MDM2 amplified cell lines with low MDMX expression (SJSA-1 and T778; GI50 range 0.2 to 1 uM). However, a similar level of activity was also evident in cell lines with low/medium MDM2 in the presence of medium/high MDMX expression (Pre B 697, A375, HCT116, MRK-NU1, and NGP cells: GI50 range 0.2 to 2 uM). Appreciable resistance was only evident in Jeg3 and MCF-7 cells (low MDM2 and high MDMX), averaged compound GI50 values ranging from 9 - 10 uM in Jeg3 and 6 - 14 uM in MCF-7. Whilst a concentration dependent degradation of MDMX was observed in some sensitive cell lines with medium/high MDMX expression, in others no change was evident, suggesting that there are multiple determinants of cellular sensitivity to such inhibitors. Importantly, the mixed MDM2:p53 and MDMX:p53 antagonist RO-5963, displayed a different spectrum of activity, with least growth inhibition evident in SJSA-1 and T778 MDM2 amplified cell lines, and activity being retained in MDMX amplified Jeg3 cells.

These studies support the concept that targeting MDMX may provide a different spectrum of antitumour activity to selective MDM2:p53 inhibition. However, MDMX protein levels per se do not constitute a universal resistance factor to selective MDM2:p53 inhibitors and, beyond MDM2 amplification, the identification of additional markers of sensitivity is warranted for this class of agent.

Citation Format: Sue Tudhope, Yan Zhao, Anita Wittner, Elaine Wilmore, Annalisa Bertoli, Santosh Adhikari, Suzannah J. Harnor, Fabio Del Bello, Alessandro Piergentili, John Lunec, Ian R. Hardcastle, Roger J. Griffin, Bernard R. Golding, Celine Cano, David R. Newell, Stephen R. Wedge. Profiling inhibitors of MDM2:p53 and MDMX:p53 in relation to MDMX protein levels. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5451. doi:10.1158/1538-7445.AM2014-5451

Rectovaginal Fistula of Different Etiologies: Clinical Case Reports

We report three cases of recto vaginal fistula (RVF) due to different etiologies. First case was due to sexual trauma (vaginal intercourse) which is not very common. The second case was due to obstetric trauma (the most common etiology of RVF) and the third case was caused by chronic lower genito-urinary infection in a HIV positive lady. We have included the successful surgical procedures of first two cases. But the repairing of the third case was failed hence planned to operate after six months. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11143   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 43-46

Prevalent Causes of Low Back Pain and its Impact among Nurses Working in Sahid Gangalal National Heart Centre

BACKGROUND

Nursing is considered as caring profession and nurse is a person who provides holistic care to the individual or community. Nurse's jobs vary from simple task to more complex one and are at risk of various occupational health problems. Among those, musculoskeletal problem including low back pain (LBP) is commonest one. Thus this study examines the prevalence and perceived causes of low back pain and its impact among the nurses working in national heart centre.

METHODS

A descriptive cross-sectional study design was used. After informed verbal consent, 50 nurses were selected purposively. Semi structured self administered questionnaires with single and multiple response items were distributed to them and were collected next day. Response rate was 100%. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 16 for windows. Descriptive statistics i.e., percentage, mean and chi square was used to interpret the data. For multiple responses, percentage was calculated in terms of total responses therefore exceeds 100%.

RESULTS

Among 50 nurses, 78% of nurses were suffering from LBP. Study found that LBP was predominant among married nurses (88%) compared to unmarried (69%). Prolonged standing (82%), heavy physical workload and frequent bending & twisting (51% each) were some perceived causes of low back pain. Due to LBP, 44% were not able to perform their job properly, 33% became less productive, 28% had restriction in work and 26% could not provide quality care to the patient.

CONCLUSIONS

Three fourth of nurses working at national heart centre were suffering from low back pain which indicates high prevalence. Therefore it is recommended to maintain proper body mechanics and use supportive devices like back belts, knee cap, and chair with back rest during patient care.

Facile and green synthesis of CdSe quantum dots in protein matrix: tuning of morphology and optical properties

Herein, we have demonstrated a facile and green approach for the synthesis of Cadmium selenide (CdSe) quantum dots (QDs). The process was mediated by bovine serum albumin (BSA) and it was found that BSA plays the dual role of reducing agent as well as a stabilizing agent. The QDs exhibited sharp excitonic absorption features at ~500 nm and subsequently showed reasonably good photoluminescence (PL) at room temperature. The PL is seen to be strongly dependent on the concentration of the precursors and hence, the luminescence of these QDs could be conveniently tuned across the visible spectrum simply by varying molar ratio of the precursors. It can be envisaged from the fact that a red-shift of about 100 nm in the PL peak position was observed when the molar ratio of the precursors ([Cd2+]:[Se2-], in mM) was varied from 10:5 to 10:40. Subsequently, the charge carrier relaxation dynamics associated with the different molar ratio of precursors has been investigated and very interesting information regarding the energy level structures of these QDs were revealed. Most importantly, in conjunction with the optical tuning, the nanomorphology of these nanoparticles was found to vary with the change in molar ratios of Se and Cd precursors. This aspect can provide a new direction of controlling the shape of CdSe nanoparticles. The possible mechanism of the formation as well as for the shape variation of these nanoparticles with the molar ratios of precursors has been proposed, taking into account the role of amino acid residues (present in BSA). Moreover, the QDs were water soluble and possessed fairly good colloidal stability therefore, can have potential applications in catalysis and bio-labeling. On the whole, the present methodology of protein assisted synthesis is relatively new especially for semiconducting nanomaterials and may provide some unique and interesting aspects to control and fine tune the morphology vis-à-vis, their optical properties.

A Hybrid Atomistic Approach for the Mechanics of Deoxyribonucleic Acid Molecules

The paper proposes a new modeling approach for the prediction and analysis of the mechanical properties in deoxyribonucleic acid (DNA) molecules based on a hybrid atomistic-finite element continuum representation. The model takes into account of the complex geometry of the DNA strands, a structural mechanics representation of the atomic bonds existing in the molecules and the mass distribution of the atoms by using a lumped parameter model. A 13-base-pair DNA model is used to illustrate the proposed approach. The properties of the equivalent bond elements used to represent the DNA model have been derived. The natural frequencies, vibration mode shapes, and equivalent continuum mechanical properties of the DNA strand are obtained. The results from our model compare well with a high-fidelity molecular mechanics simulation and existing MD and experimental data from open literature.

A preliminary report on the genetic variation in pointed gourd (Trichosanthes dioica Roxb.) as assessed by random amplified polymorphic DNA

Pointed gourd (Trichosanthes dioica Roxb.) is an economically important cucurbit and is extensively propagated through vegetative means, viz vine and root cuttings. As the accessions are poorly characterized it is important at the beginning of a breeding programme to discriminate among available genotypes to establish the level of genetic diversity. The genetic diversity of 10 pointed gourd races, referred to as accessions was evaluated. DNA profiling was generated using 10 sequence independent RAPD markers. A total of 58 scorable loci were observed out of which 18 (31.03%) loci were considered polymorphic. Genetic diversity parameters [average and effective number of alleles, Shannon's index, percent polymorphism, Nei's gene diversity, polymorphic information content (PIC)] for RAPD along with UPGMA clustering based on Jaccard's coefficient were estimated. The UPGMA dendogram constructed based on RAPD analysis in 10 pointed gourd accessions were found to be grouped in a single cluster and may represent members of one heterotic group. RAPD analysis showed promise as an effective tool in estimating genetic polymorphism in different accessions of pointed gourd.

Recurrent pneumonia-H type Tracheoesophageal fistula, diagnostic dilemma

Tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is a rare congenital anomaly.  Most of the children are treated for episodes of pneumonia prior to definitive diagnosis.  A 5 months infant presented with recurrent pneumonia and diagnosis of H type TEF was made with contrast esophagram.DOI: http://dx.doi.org/10.3126/jnps.v34i1.8517   J Nepal Paediatr Soc 2014;34(1):71-73