Maternal Health Services Utilisation in Panchkhal Municipality, Kavrepalanchok, Nepal

Background Maternal Health is a priority program of Nepal. The low utilization of maternal health services is one of the major contributing factors for high maternal morbidity and mortality in developing countries like Nepal. Objective To explore various maternal health services utilized by women and identify various factors affecting the utilization of maternal health services in Panchkhal Municipality. Method A descriptive cross-sectional study was conducted among 355 reproductive-age women who have given birth in the last 2 years in Panchkhal Municipality. The data collection period was from May to July 2020. A convenient sampling method was used to select the study population. The data analysis was done by using Statistical Package for Social Sciences (version 20.0). Variables were defined by the frequency in numbers and percentages. Result The findings from the study showed that the coverage of the antenatal care (ANC) visit was 77% and among them, 25.6% visited at least 4 antenatal care visits as recommended by the government of Nepal. Out of 355 respondents, 52.4% were delivered in the health institution, and only 20% visited postnatal care after the delivery. Among various factors, lack of treatment facilities and health facilities at a far distance were the most common factors for the underutilization of maternal health services. Conclusion The coverage of maternal health services is still low despite free maternal health services with an incentive scheme. A further detailed investigation is required to find the real scenario of the Panchkhal municipality to under-utilization of maternal health services.

The hitchhikers' guide to RNA sequencing and functional analysis

DNA and RNA sequencing technologies have revolutionized biology and biomedical sciences, sequencing full genomes and transcriptomes at very high speeds and reasonably low costs. RNA sequencing (RNA-Seq) enables transcript identification and quantification, but once sequencing has concluded researchers can be easily overwhelmed with questions such as how to go from raw data to differential expression (DE), pathway analysis and interpretation. Several pipelines and procedures have been developed to this effect. Even though there is no unique way to perform RNA-Seq analysis, it usually follows these steps: 1) raw reads quality check, 2) alignment of reads to a reference genome, 3) aligned reads' summarization according to an annotation file, 4) DE analysis and 5) gene set analysis and/or functional enrichment analysis. Each step requires researchers to make decisions, and the wide variety of options and resulting large volumes of data often lead to interpretation challenges. There also seems to be insufficient guidance on how best to obtain relevant information and derive actionable knowledge from transcription experiments. In this paper, we explain RNA-Seq steps in detail and outline differences and similarities of different popular options, as well as advantages and disadvantages. We also discuss non-coding RNA analysis, multi-omics, meta-transcriptomics and the use of artificial intelligence methods complementing the arsenal of tools available to researchers. Lastly, we perform a complete analysis from raw reads to DE and functional enrichment analysis, visually illustrating how results are not absolute truths and how algorithmic decisions can greatly impact results and interpretation.

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

Pharmacologically controlling protein-protein interactions through epichaperomes for therapeutic vulnerability in cancer

Cancer cell plasticity due to the dynamic architecture of interactome networks provides a vexing outlet for therapy evasion. Here, through chemical biology approaches for systems level exploration of protein connectivity changes applied to pancreatic cancer cell lines, patient biospecimens, and cell- and patient-derived xenografts in mice, we demonstrate interactomes can be re-engineered for vulnerability. By manipulating epichaperomes pharmacologically, we control and anticipate how thousands of proteins interact in real-time within tumours. Further, we can essentially force tumours into interactome hyperconnectivity and maximal protein-protein interaction capacity, a state whereby no rebound pathways can be deployed and where alternative signalling is supressed. This approach therefore primes interactomes to enhance vulnerability and improve treatment efficacy, enabling therapeutics with traditionally poor performance to become highly efficacious. These findings provide proof-of-principle for a paradigm to overcome drug resistance through pharmacologic manipulation of proteome-wide protein-protein interaction networks.

The Postural Effects on Electrical Activities of Heart in Apparently Healthy Young Adults

Background The electrical activities of heart recorded as electrocardiogram (ECG) are mostly done in supine postures. The body postural changes have effects in these electrical activities in heart which needs to be properly recognized. Objective To find the variations in electrocardiogram during postural changes from supine to upright i.e. sitting and standing postures among apparently healthy young adults. Method A cross sectional study was carried out in Manipal College of Medical Sciences after the institutional ethical clearance. The apparently healthy 30 Nepalese male medical students between 18-25 years of age were enrolled. The electrocardiography was elicited in supine, sitting and standing postures in the participants after 5 minutes' interval between each procedure in each participant. Result The highest mean amplitudes of Q wave were seen in sitting postures (0.12±0.04 mm), R wave in standing postures (1.46±0.55 mm) and S wave also in standing postures (0.23±0.2 mm). The mean amplitudes of Q and S waves showed statistically significant difference when compared between supine and upright postures. The maximum QRS duration was found while sitting (0.08±0.01 ms)and maximum heart rate in standing posture (82.43±10.59/min). The mean comparison of heart rate was statistically highly significant when compared between supine and standing postures. The mean QRS frontal axis was comparatively increased while standing (64.30±39.29). Conclusion The electrical activities of heart vary during postural changes among apparently healthy young adults. These changes are most prominent when compared between supine and standing postures which urges for careful interpretation of electrocardiogram if it is done in upright postures.

Optimization of western blotting for the detection of proteins of different molecular weight

Protein samples electroblotted onto nitrocellulose membranes and quenched with a mixture of blocking agents produced a strong signal for cystic fibrosis transmembrane-conductance regulator (CFTR), a high-molecular-weight protein, in western blotting. Optimized conditions for CFTR were then extended to medium- and low-molecular-weight proteins (LAMP1 and Rab11a, respectively) to determine the effects of methanol concentration (0-20%) in Towbin's transfer buffer (TTB). Methanol in TTB appears to have little to no effect on CFTR signal. However, for medium-sized (LAMP1) and small (Rab11a) proteins, a lower concentration of methanol (10%) was sufficient to produce a maximal signal. Therefore, methanol, a toxic solvent, can be removed from or reduced in TTB without compromising signal strength. Here, we show modifications that may be useful in detecting and/or improving the signal of low-abundance proteins.

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal

BACKGROUND

In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding practices of pre-school children and their associated factors.

METHODS

A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured questionnaire was administered to 145 mothers. Descriptive analyses were conducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers' perception of their current feeding practices.

RESULTS

We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01-0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices.

CONCLUSIONS

Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-economic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures.

Pulmonary Functions are Impaired among Carpet Factory Workers: A Spirometric Evaluation

INTRODUCTION

Carpet factory produces various types of dusts and workers occupationally get exposed to them continuously. It has adverse health effects and most notably to the pulmonary functions. Nepal is one of the carpet exporter developing countries and still does have many factories within Kathmandu valley. However, the health hazards especially the status of pulmonary function of carpet factory workers from Nepal has not been studied.

METHODS

A cross-sectional comparative study was designed to recruit carpet factory workers and healthy controls to assess their pulmonary functions. A total of 118 subjects (59 males and 59 females) were recruited (60 carpet factory workers and 58 controls). Pulmonary function tests were carried out using Medical International Research Spirolab II portable spirometer.

RESULTS

The carpet factory workers had significantly less FEV1 (90.37 ±16.6 % vs. 103.89±9.79%, p<0.001), FVC (87.78 ± 15.48 % vs. 102.81 ± 8.41 %, p < 0.001) and PEFR (66.19 ± 20.29 % vs. 102.81 ± 11.09 %, p < 0.001) as compared to control group. Similarly the carpet factory workers had significantly higher FEV1/FVC ratio (89.96 ± 6.42 % vs. 87.12 ± 4.58 %, p = 0.007) as compared to control.

CONCLUSIONS

Carpet industry dusts exposure adversely affects pulmonary functions among its workers. The findings significant increase in the FEV1/FVC ratio and decrease in FEV1, FVC, and PEFR suggest that the effects are both restrictive and obstructive patterns of lung disease.

Validation of simulation of calcifications for observer studies in digital mammography

Studies using simulated calcifications can be performed to measure the effect of different imaging factors on calcification detection in digital mammography. The simulated calcifications must be inserted into clinical images with realistic contrast and sharpness. MoCa is a program which modifies the contrast and sharpness of simulated calcification clusters extracted from images of mastectomy specimens acquired on a digital specimen cabinet at high magnification for insertion into clinical mammography images. This work determines whether the use of MoCa results in simulated calcifications with the correct contrast and sharpness. Aluminium foils (thickness 0.1-0.4 mm) and 1.60 µm thick gold discs (diameter 0.13-0.8 mm) on 0.5 mm aluminium were imaged with a range of thicknesses of polymethyl methacrylate (PMMA) using an amorphous selenium direct digital (DR) system and a powder phosphor computed radiography (CR) system (real images). Simulated images of the tests objects were also generated using MoCa. The contrast of the aluminium squares and the degradation of the contrast of the gold discs as a function of disc diameter were compared in the real and simulated images. The average ratios of the simulated-to-real aluminium contrasts over all aluminium and PMMA thicknesses were 1.03 ± 0.04 (two standard errors in the mean) and 0.99 ± 0.03 for the DR and CR systems, respectively. The ratio of the simulated-to-real degradations of contrast averaged over all disc diameters and PMMA thicknesses were 1.007 ± 0.008 and 1.002 ± 0.013 for DR and CR, respectively. The use of MoCa was accurate within the experimental errors.

Geriatric health in Nepal: concerns and experience

Ageing is a natural phenomenon and an inevitable process. Population ageing is pervasive since it is creating humanitarian, social and economic problems in many countries of the world including Nepal. Nepalese society is in a phase of modernization. There is modification in the cultural norms and traditional family support systems for elderly in Nepal which have placed substantial strain in caring elderly people. In Nepal, there were 1.5 million in 2001 and 2.1 million in 2011, elderly inhabitants, which constitute 6.5 percent and 8.1% of the total population in the country. During the years 1991-2001, the annual elderly population growth rate was 3.39 percent, higher than the annual population growth rate of 2.3 percent. Growing numbers of elderly people are suffering problems in different aspect, but there are limited studies in relation to general morbidities as well as specific in this group of people. The government of Nepal has formulated a National policy, act and regulations on ageing and the problems of elderly; however, this has not been operationalised because of limited resources. In this background of problems that elderly people are facing and government slow initiatives, this paper is illustrated with the objective to explore the different dimensions of ageing and health and health related services for aging people in Nepal using different information for the purpose of further concrete steps in the benefits for elders.

Oxygen saturation of hemoglobin in healthy children of 2-14 years at high altitude in Nepal

BACKGROUND

Individuals residing at higher altitude may have oxygen saturation of hemoglobin different to those living at lower altitude.

OBJECTIVES

To find out the baseline value of SpO2 in healthy Nepali children (2-14 years) living permanently at high altitude using pulse oximeter and also to study the relation of SpO2 with age, sex and ethnicity.

METHODS

A descriptive observational study was conducted at 4 different altitudes ranging from 2700 to 3800 m in Mustang district. The mean pulse oximery values at different altitudes were calculated and compared.

RESULTS

One hundred six children were enrolled with the median age of 10 years. The mean SpO2 value of children permanently residing at altitude 2700m was 95.18%, at 2800m was 94.82%, at 3550m was 94.1% and 3800m was 93.1%.The difference in the SpO2 values at different altitude was statistically significant. No sex or age wise differences were noted on the mean SpO2 values in the study group.

CONCLUSIONS

The mean SpO2 values were higher than several other studies done in the altitude above 2500 meters. Enrollment of older children and the different ethnic background could be the contributing factors for the differences.

Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review

Introduction: The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia. J. Nepal Paediatr. Soc. 32(2) 2012 150-153 doi: http://dx.doi.org/10.3126/jnps.v32i2.6898

Prevalence study of H. pylori infection in dyspeptic patients coming to Nepal Medical College Teaching Hospital, Jorpati, Kathmandu

Helicobacter pylori (H. pylori) is one of the most common human infections worldwide particularly in the developing countries. It has been established as etiology of chronic gastritis and peptic ulcer disease, gastric adenocarcinoma and mucosal associated lymphoid tissue lymphoma (MALT). During this decade, there have been some reports showing a decline in global prevalence of H. pylori infection and peptic diseases including many Asian countries. Hence to determine prevalence of Helicobacter pylori infection in dyspeptic patients, this descriptive, non-interventional study was carried out at the Endoscopy sub-unit of the Surgery Department from April 2011 to February 2012. Three hundred nineteen dyspeptic patients (Male 161 and female 152) with a mean age of 20.12 years were examined for the presence of H. pylori infection by histology staining. The prevalence of H. pylori infection was 50.47%. The most common endoscopic findings was gastritis (47.6%) followed by normal findings 57 (17.87%). A total of 8.47% of gastric Ulcer, oesophagitis 5.64% and gastric cancer 0.94% were detected. All three cases of gastric cancer were positive for H. pylori infection. Among gastritis, H. pylori was observed in 67 (44%) cases and 18 out of 57 (5.6%) of normal gastric mucosa showed H. pylori. The endoscopic findings such as gastritis, gastric ulcer, duodenal ulcer and gastro duodenal reflux are significantly associated with H. pyloric infection. The prevalence of H. pylori infection is still high in peptic diseases. H. pylori infection is significantly correlated with peptic ulcer diseases than with non-ulcer dyspepsia. Further studies are required to establish the H. pylori positive cases with that of other tests such as serological detection of anti H. pylori antibody by ELISA/ICT and culture to establish a diagnosis quickly without any invasive method and institute proper management thus reducing morbidity.

Vitamin D status among individuals attended in Health Home Care Centre, Lalitpur, Nepal

There is widespread prevalence of vitamin D deficiency from new-born to infancy, childhood and adult male and female. Despite the numerous reports of the association of vitamin D with spectrum of development, disease treatment and health maintenance, vitamin D deficiency is common. There is limited information of the vitamin D status in Nepalese people. Based on the information in relation to importance of Vitamin D, we proposed to see the level of vitamin D among the care seeker individuals attended in this Health Home Care Centre, Nepal. Within three months interval (March to May 2012), whole blood test was done by 148 individuals. Among them vitamin D3 test was recommended for 50 individuals done by doctor on the basis of relevant health problems in relation to vitamin D deficiency. Analysis was done with SPSS package 17 version to see the relation between Vitamin D deficiency and other health related tests. The study found significant association between vitamin D deficiency with calcium level and hemoglobin level. There are presences of studies with evidences regarding relation of vitamin D with different health outcomes in different parts of the world. The widespread deficiency of vitamin D merits consideration of widespread policies including increasing the awareness among the public and health care professionals. In addition the study results highlight the need for additional high quality studies in Nepal in order to prevent the impacts of vitamin D deficiency and also to plan for prevention of vitamin D deficiency.

Hospital-based study in children with rotavirus gastroenteritis and other enteropathogens

BACKGROUND

Rotavirus is the most common cause of life threatening gastroenteritis in infants and young children in the world. The objective of the study is to find out current trends and incidents of rotavirus, including other enteropathogens related with children diarrhoea and lastly identify the most common rotavirus serotypes that circulate in Nepal.

METHODS

A total of 1721 stool samples from less than 5 years of children were collected. Rotavirus in the stool samples were detected by Enzyme Immuno Assay (EIA) and strains were genotyped by Reverse-Transcription Polymerase Chain Reaction (RT-PCR). Bacteria and parasites were detected by following standard microbiological procedures.

RESULTS

In between 2009 to 2010, of the total 1721, the prevalence of rotavirus was 24.7%. Of them, 906 (52.6%) were collected in the year 2009 and 815(47.5%) in the year 2010. Rotavirus was frequently detected in inpatients (31.6%) than outpatient (16.8%). Rotavirus detection was higher in female (26.4%) than male (23.7%). The prevalence was seen higher in age group 0-23 months in both years. Among six different bacterial isolates, Escherichia coli was most frequently isolated (6.5%). Similarly, Giardia lamblia (1.3%) was most common among six different parasites detected. A total of rotavirus positive 425 stool samples were detected over 2 years (2009-230, and 2010-195), G12P6 was the predominant strain circulating in both (45% in 2009 and 28% in 2010) years. G9P6 emerged in 2010 (6%). There were significant numbers of mixed infections (14.0% in 2009 and 29.8% in 2010). Thirty five samples were partially typed and 15 were completely untyped over the two year period.

CONCLUSIONS

The study helps comprehend the prevalence of rotavirus along with other intestinal pathogens including bacteria and parasites. Major genotypes of rotavirus are also introduced in the study.

A case of precocious puberty in a setting with limited resources

Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.

Changing tuberculosis trends in Nepal in the period 2001-2008

To assess the trends on indicators of TB control in Nepal over a period from 2001-2008. Retrospective analysis of information from Annual Reports of NTP, Nepal from 2001-2008. The incidence of New Smear Positive (NSP) TB declined from 58.9 in 2001 to 53.4 in 2006 per 100000 populations then reversed in the period 2006-2008. This TB incidence decreased in males and the age group <45 years (except 0-14 years). The notification rate of all cases of TB declined by 3 % overall over the entire period from 2001 to 2008. Mortality among smear negative and extra pulmonary declined significantly. The failure rate and defaulter rate were declined significantly and the case detection rate (CDR) was increased significantly within the study period. Increasing trend in CDR, Treatment success rate and decreasing trend in failure rate, defaulter rate are the evidence of progress of NTP, in Nepal. Since there is reversal of incidence of NSP from 2006, a detailed analysis of existing TB control measures is required. If the success is continued and quality care is provided as per International Standard of TB Care, the Millennium Development Goals will be an achievable target.

Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal

We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter-observer variability testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neurodevelopmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post-test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post-test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%.

CONCLUSIONS

It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.

Outcome at 1 year of neonatal encephalopathy in Kathmandu, Nepal

To determine the outcome at 1 year of neonatal encephalopathy (NE) and to estimate the possible contribution of birth asphyxia to childhood disability in a low-income South Asian country, a prospective cohort study was undertaken in the principal maternity hospital of Kathmandu, where over 50% of local women give birth. From a total population cohort of 21609 live births, 131 term infants with NE (after exclusion of cases associated with neonatal sepsis, congenital malformations, or primary hypoglycaemia) and 208 term control infants were recruited. Of these, 102 (78%) infants with NE and 106 (51%) control infants were followed-up to 1 year of age. Outcome measures were death or neurodevelopmental impairment, graded as major, minor or none. Of the 131 term infants with NE, 83 were graded with moderate or severe NE according to conventional definition. By 1 year of age, 45 (44%) of the infants with NE had died, 18 (18%) had severe impairments, and two (2%) had minor impairments; four (4%) of the control subjects had died and two (2%) had minor impairments. Most deaths in subjects with NE occurred in the early neonatal period; NE carried no excess risk of death beyond the neonatal period. Of the 18 children with major impairment, 14 (78%) had spastic tetraplegic cerebral palsy and eight (44%) had multiple impairments. Compared with the control group the relative risk of death by 1 year was 5 (95% CI 1.4 to 15) for mild NE, 8 (95% CI 3 to 23) for moderate, and 26 (95% CI 10 to 67) for severe. Twenty-seven of 38 (71%) infants with moderate NE either died or survived with major impairment. An upper estimate for the prevalence of major neuroimpairment at 1 year attributable to birth asphyxia is 1 per 1000 live births in this population.

The effect of divorce on intergenerational transfers: new evidence

This paper draws on new data on intergenerational transfers of time and money that were collected in the Panel Study of Income Dynamics. We use these data to examine the effects of divorce on these transfers. We find that the timing of divorce is critical. Fathers and mothers involved in late divorces have similar levels of transfers with their adult children, while divorce during a child's childhood years increases transfers with mothers and sharply lowers them with fathers. Somewhat surprisingly, we find no evidence that divorced fathers who paid child support are more likely to be involved in intergenerational transfers than those who did not pay child support.

Type 2 diabetes mellitus with early phase acute inflammatory protein on serum protein electrophoresis

Background: The onset of Type 2 diabetes has been associated with low grade systemic inflammation. The inflammatory status has been studied by measuring acute phase reactant proteins like hsCRP, α1- antitrypsin, α1-acid glycoprotein, ceruloplasmin, fibrinogen. Most of these acute phase reactants form α1 and α2 bands on electropherogram of serum proteins. The aim of this study was to evaluate inflammatory status in controlled and uncontrolled type 2 diabetes using cellulose acetate electrophoresis and to find the impact of glycemic status as indicated by HbA1c on inflammation process. Materials and Methods: Serum protein electrophoresis was done on serum samples of 60 cases of Diabetes [controlled and uncontrolled] using cellulose acetate paper technique. The electropherogram obtained was stained with Ponseu S and then quantitated using densitometer. Glycemic status was studied by HbA1c analysis. The density of α1and α2 bands in electropherogram were correlated with HbA1c level. Result: A significant increase in the percentage of α1 and α2 band proteins (0.765 and 0.716, p<0.001) were found with the increasing level of HbA1c. With cutoff of HbA1c 7% (American Diabetic Association recommended), the α1 and α2 serum proteins concentration are significantly higher (p<0.001) in uncontrolled diabetes mellitus compared to controlled diabetes mellitus Conclusion: Cellulose acetate electrophoresis of serum proteins show early phase acute inflammatory status in uncontrolled type 2 diabetes mellitus. The process of systemic inflammation worsens with uncontrolled glycemia as indicated by HbA1c. Inflammatory status should be studied adjunct to glycemic status. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6024 JPN 2012; 2(3): 211-214

Profile of Asphyxiated Babies at Tribhuvan University Teaching Hospital

Objective: To assess risk factors and outcome in the early neonatal period of babies who were asphyxiated at birth. Methodology: This was a retrospective study conducted at Tribhuvan University Teaching Hospital (TUTH) over a period of one year from 15th Feb 2007 to 14th Feb 2008. All the term babies who had Apgar score of less than < 6 at 1 minute of birth were included. Detailed maternal risk factors during pregnancy and labor were analyzed. The newborn babies who required admission in neonatal unit were again analyzed for development of hypoxic ischemic encephalopathy (HIE) and their outcome. Results: During the study period, out of 3594 term babies, 327 babies (9%) were asphyxiated. Of the total asphyxiated babies, 85% and 15% had moderate and severe asphyxia, respectively, at 1 minute of birth. Out of these asphyxiated babies, 51% and 7% had intrapartum and maternal risk factors, respectively. Intrapartum risk factors like meconium stained liquor, non-vertex presentation, and fetal heart rate abnormalities accounted for 4 fold risk of asphyxia. Of these babies, 26% required admission in nursery and 29% developed hypoxic ischemic encephalopathy. Among the admitted babies 6% expired, 2% left against medical advice and rest were discharged. Conclusion: Early identification and close monitoring of high risk mothers studies with maintaining partograph during labor will help to reduce neonatal asphyxia. Key words: Asphyxiated babies doi:10.3126/jnps.v29i1.1592 J. Nepal Paediatr. Soc. Vol.29(1) p.3-5