Social and joint attention during shared book reading in young autistic children: a potential marker for social development

BACKGROUND

Atypical patterns of social engagement and joint attention behaviors are diagnostic criteria for people with autism spectrum disorder. Experimental tasks using eye-tracking methodologies have, however, shown inconsistent results. The development of tasks with greater ecological validity and relevance for developmentally appropriate social milestones has been identified as important for the field.

METHODS

We developed a novel, dynamic eye-tracking task emulating a shared book reading (SBR) scenario. Four SBR videos of an adult reader engaging with the viewer while reading a children's picture book and including sequenced bids for joint attention were developed. Participants included 90 children (N = 56 autistic children, N = 34 neurotypical children; aged 3-12). Social attention was also measured in a live free play task between participants and an experimenter.

RESULTS

Compared to neurotypical children, autistic children displayed reduced attention to socially salient stimuli including the reader's face and picture book across SBR videos and during joint attention bids specifically. In contrast, they showed increased attention to nonsalient background stimuli compared to their neurotypical peers. These attention patterns in autistic children were associated with reduced verbal and nonverbal cognitive skills and increased symptoms associated with autism. Interestingly, positive correlations in the frequency of eye gaze between SBR and free play suggested a potential predictive value for social attention in live social interactions.

CONCLUSIONS

Findings highlight the utility of SBR eye-tracking tasks in understanding underlying divergences in social engagement and joint attention between autistic and neurotypical children. This commonly practiced early childhood activity may provide insights into the relationship between social engagement and learning to reveal how such attentional patterns might influence broader developmental and educational outcomes.

Self-Assembly and the Properties of Micro-Mesoporous Carbon

This study introduces a new approach for constructing atomistic models of nanoporous carbon by randomly distributing carbon atoms and pore volumes in a periodic box and then using empirical and ab initio molecular simulation tools to find the suitable energy-minimum structures. The models, consisting of 5000, 8000, 12000, and 64000 atoms, each at mass densities of 0.5, 0.75, and 1 g/cm3, were analyzed to determine their structural characteristics and relaxed pore size distribution. Surface analysis of the pore region revealed that sp atoms exist predominantly on surfaces and act as active sites for oxygen adsorption. We also investigated the electronic and vibrational properties of the models, and localized states near the Fermi level were found to be primarily situated at sp carbon atoms through which electrical conduction may occur. Additionally, the thermal conductivity was calculated using heat flux correlations and the Green-Kubo formula, and its dependence on pore geometry and connectivity was analyzed. The behavior of the mechanical elasticity moduli (Shear, Bulk, and Young's moduli) of nanoporous carbons at the densities of interest was discussed.

Burden of paediatric hospitalisations to the health care system, child and family: a systematic review of Australian studies (1990-2022)

Background

Paediatric hospitalisations represent a significant cost to the health system and cause significant burden to children and their families. Understanding trends in hospitalisation costs can assist with health planning and support strategies across stakeholders. The objective of this systematic review is to examine the trends in costs and burden of paediatric hospitalisations in Australia to help inform policy and promote the well-being of children and their families.

Methods

Electronic data sources (Embase, Medline, Web of Science, PSYCH-Info, CINAHL and Scopus) were searched from 1990 until December 2022. Any quantitative or qualitative studies conducted in Australian tertiary hospitals were included in the review. Eligible studies were those that included paediatric (<18 years) hospitalisations and reported on economic and/or non-economic costs for the child, family unit and/or health system. Study quality and risk of bias for each study were assessed with the Joanna Briggs Critical Appraisal Tools. We present a summary of the findings of the hospitalisation burden across major diagnostic admission categories and for the child and family unit. The systematic review was registered with Prospero (ID: CRD42021276202).

Findings

The review summarises a total of 88 studies published between 1990 and December 2022. Overall, the studies identified that paediatric hospitalisations incur significant financial costs, which have not shown significant reductions over time. In-patient direct hospital costs varied depending on the type of treatment and diagnostic condition. The costs per-case were found to range from just below AUD$2000 to AUD$20,000 or more. The financial burden on the family unit included loss of productivity, transport and travel costs. Some studies reported estimates of these costs upward of AUD$500 per day. Studies evaluating 'hospital in the home' options identified significant benefits in reducing hospitalisations and costs without compromising care.

Interpretation

Increasing focus on alternative models of care may help alleviate the significant costs associated with paediatric hospitalisation.

Funding

This research was supported by Hospitals United for Sick Kids (formerly Curing Homesickness).

Evidence of a reduced role for circumscribed interests in the social attention patterns of children with Autism Spectrum Disorder

Reduced social attention is characteristic of Autism Spectrum Disorder (ASD). It has been suggested to result from an early onset and excessive influence of circumscribed interests (CIs) on gaze behaviour, compared to typically developing (TYP) individuals. To date, these findings have been mixed. The current eye-tracking study utilised a visual preference paradigm to investigate the influence of CI versus non-CI objects on attention patterns in children with ASD (aged 3-12 years, n = 37) and their age-matched TYP peers (n = 30). Compared to TYP, social and object attention was reduced in the ASD group irrespective of the presence of CIs. Results suggest a reduced role for CIs and extend recent evidence of atypical attention patterns across social and non-social domains in ASD.

Machine Learning Differentiation of Autism Spectrum Sub-Classifications

PURPOSE

Disorders on the autism spectrum have characteristics that can manifest as difficulties with communication, executive functioning, daily living, and more. These challenges can be mitigated with early identification. However, diagnostic criteria has changed from DSM-IV to DSM-5, which can make diagnosing a disorder on the autism spectrum complex. We evaluated machine learning to classify individuals as having one of three disorders of the autism spectrum under DSM-IV, or as non-spectrum.

METHODS

We employed machine learning to analyze retrospective data from 38,560 individuals. Inputs encompassed clinical, demographic, and assessment data.

RESULTS

The algorithm achieved AUROCs ranging from 0.863 to 0.980. The model correctly classified 80.5% individuals; 12.6% of individuals from this dataset were misclassified with another disorder on the autism spectrum.

CONCLUSION

Machine learning can classify individuals as having a disorder on the autism spectrum or as non-spectrum using minimal data inputs.

Novel on-site follow-up and enhancement program (FEP) improves knowledge, clinical skills and enabling environment of skilled birth attendants in Nepal

INTRODUCTION

Although great strides have been made in maternal and newborn health in Nepal, the maternal mortality ratio (MMR) is still high at 186 per 100,000 births. Many maternal deaths are preventable if there is access to a skilled birth attendant (SBA). The Ministry of Health and Population of Nepal launched the in-service SBA training program in 2007 and has trained over 10,000 SBAs to date. Evidence shows that one episode of training is not enough to retain skills. Therefore, the Nick Simons Institute (NSI) in collaboration with National Health Training Center (NHTC) devised a Follow-Up and Enhancement Program (FEP) in 2011 where the knowledge, clinical skills, and working environment of SBA graduates were assessed directly at their worksites. FEP allows on-site coaching and feedback so that graduates may continue to improve upon any gaps in their knowledge, skills, and working environment. This study aims to assess the effectiveness of FEP.

METHODS

We used a mixed-methods research design. A total of 73 SBAs who had a pre-FEP assessment in 2016 were followed up for a post-FEP assessment in 2017. We also collected data from 3 additional districts (115 SBAs) that had not previously had FEP, to compare SBAs in FEP versus non-FEP districts. Qualitative data was collected from 16 health facilities on the perceptions, motivation, and satisfaction of stakeholders.

RESULTS

Of the total 188 SBAs that were sampled, a one-time FEP increased knowledge scores by 9%, clinical skills scores by 29%, and enabling environment scores by 7%. The number of deliveries conducted improved with a one-time FEP, although this increase was not statistically significant. We found a trickle-down effect of working in a facility that has had prior FEP, with SBAs that have never had FEP improving their clinical skills. FEP was found to be a highly accepted program and is beneficial to SBAs, trainers, and the Hospital Management Committee (HFOMC). However, a one-time FEP is not sufficient in retaining clinical skills and knowledge.

CONCLUSION

FEP is a highly effective program by both quantitative and qualitative evaluation. Our study suggests that FEP should be frequent and continuous to retain the knowledge and clinical skills of SBAs, motivate them through on-site coaching, and improve their working environment through direct feedback to the Ministry of Health and Population.

Statistical Validation of An Automated Method for Calculating Time Domain Heart Rate Variability on The QT Dataset

Heart rate variability measures calculated from electrocardiography recordings reflect social competence. Clinical assessments of social skills have found that reduced heart rate variability is related to differences in the development of social skills in children and increase the risk of mental disorders. Limited by widespread manual signal processing and R-peak detection in current clinical assessments, most literature reports only short-term baseline studies, with fewer studies reporting social interaction settings with prolonged recording. There is an urgent need for an automated physiological signal processing toolbox to detect R-peaks and perform heart rate variability measurements in social settings. This paper proposes a modified automated Neurokit2 toolbox with signal processing procedures similar to the MindWare software that requires manual inspection of R-peak locations. We calculate time domain heart rate variability metrics from the publicly available QT database by PhysioNet collected at resting states and under stress tests, mimicking social interaction stress scenarios. Statistical analysis conveys that heart rate variability metrics calculation applying both signal processing approaches using the Neurokit2 toolbox are statistically equivalent in comparison to the hand-labelled R-peaks from the QT database (n= 10 in the normal sinus rhythm group, and n= 6 in the ST Change group). Such validation results are crucial for the adoption of automated toolboxes for heart rate variability measures in social interaction assessments, where more movement and mood changes of participants are expected.Clinical Relevance- This contributes to the body of evidence of the reliability of the Neurokit2 toolbox for automatic cleaning of prolonged cardiac electrophysiological signals and calculation of heart rate variability in time-domain characterization in social interaction stress assessment.

Ab Initio Simulation of Amorphous Graphite

An amorphous graphite material has been predicted from molecular dynamics simulation using ab initio methods. Carbon materials reveal a strong proclivity to convert into a sp^{2} network and then layer at temperatures near 3000 K within a density range of ca. 2.2-2.8  g/cm^{3}. Each layer of amorphous graphite is a monolayer of amorphous graphene including pentagons and heptagons in addition to hexagons, and the planes are separated by about 3.1  Å. The layering transition has been studied using various structural and dynamical analyses. The transition is unique as one of partial ordering (long range order of planes and galleries, but topological disorder in the planes). The planes are quite flat, even though monolayer amorphous graphene puckers near pentagonal sites. Interplane cohesion is due partly to non-Van der Waals interactions. The structural disorder has been studied closely, especially the consequences of disorder to electronic transport. It is expected that the transition elucidated here may be salient to other layered materials.

Atypical sensory processing features in children with autism, and their relationships with maladaptive behaviors and caregiver strain

Atypical sensory processing occurs in up to 97% of children on the autism spectrum. Children who are on the autism spectrum also commonly demonstrate challenging behaviors, and their caregivers report increased levels of strain in daily life. The aim of this study was to explore four sensory processing features; seeking, avoiding, sensitivity, and registration, and their relationships with maladaptive behaviors in children with autism, as well as with caregiver strain. Participants comprised 75 children with autism aged 7–12 years (M = 7.81). Caregivers completed three questionnaire measures examining child sensory processing, maladaptive behaviors, and perceptions of caregiver strain. We found avoiding significantly associated with irritability. Avoiding also displayed the strongest relationship with global caregiver strain. Avoiding and seeking were strongly related to hyperactivity/noncompliance (components of maladaptive behavior). A multiple regression was performed to explore how atypical sensory processing features and maladaptive behaviors together predicted caregiver strain. Together, maladaptive behaviors and sensory features accounted for 58% of the variance in total caregiver strain. The only significant individual predictor of total caregiver strain was sensory avoiding, which uniquely accounted for 5.76% of the variation. The findings suggest that atypical sensory processing is associated with overall caregiver strain, above that explained by maladaptive behaviors. Implications for targeted support for the benefit of the child, parents and family unit are discussed.

An evaluation of homesickness in children: A systematic review and meta-analysis

OBJECTIVE

To provide a systematic review and meta-analysis of the quantitative literature on homesickness in children, including how it is assessed and relationship to other negative states.

STUDY SELECTION AND SYNTHESIS

A literature search was conducted using Medline, PsychINFO and Scopus databases. Studies were included if they assessed homesickness in children under eighteen years of age and were published in peer reviewed journals in the English language between 1990 and December 2020. A total of 176 studies were screened for relevance and 17 met the inclusion criteria for the systematic review with five studies included in the meta-analysis.

MAIN OUTCOMES AND MEASURES

The primary outcome measure was homesickness severity, and it was examined in relation to measures of depression and anxiety. The literature in relation to known risk and protective factors was also reviewed.

RESULTS

Homesickness was reported in the majority of children who were separated from their home. It was associated with negative emotional states. A total of seventeen studies were included in the quantitative review. The meta-analysis showed a significant relationship between homesickness and depression r=0.431 (95% CI 0.344-0.510; p<0.001) and homesickness and anxiety r=0.426 (95% CI 0.369-0.479; p<0.001). Age was not a significant moderator of homesickness severity. Consideration of effective interventions to address homesickness was limited.

CONCLUSIONS AND RELEVANCE

Homesickness significantly impacts children's well-being regardless of age and is associated with overall distress, depression and anxiety. Future studies are required to examine homesickness interventions and supports to improve well-being in children.

Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study

SETTING

Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.

OBJECTIVES

To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.

DESIGN

This was a cross-sectional study.

RESULTS

Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.

CONCLUSION

We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.

The Feasibility of Magnetic Resonance Imaging in a Non-Selective Comprehensive Clinical Trial in Pediatric Autism Spectrum Disorder

There is an increasing interest in using magnetic resonance imaging (MRI) as a tool for precision medicine in autism spectrum disorder (ASD). This study investigated the feasibility of MRI scanning in a large comprehensive, inclusive and test heavy clinical trial for children (aged 3-12 years) with ASD, without functioning constraints for participation. Of the 71 participants enrolled who consented to the MRI, 24 participants (38%) successfully completed an MRI scan at baseline along with other assessments. This scanning followed a familiarization procedure at two preceding visits. At post-treatment, 21 participants successfully completed the MRI scan. This study highlights the challenge of completing MRI assessments in ASD populations when conducted as one of a number of tests in a clinical trial.

Age-related parietal GABA alterations in children with autism spectrum disorder

GABA is the primary inhibitory neurotransmitter in the brain, and is essential to the balance of cortical excitation and inhibition. Reductions in GABA are proposed to result in an overly excitatory cortex that may cause, or contribute to, symptoms of autism spectrum disorder (ASD). This study employed a cross-sectional design to explore GABA+ differences in ASD and the impact of age, comparing 4-12 year olds with ASD (N = 24) to typically developing children (N = 35). GABA+ concentration was measured using edited magnetic resonance spectroscopy in the left parietal lobe. This study used a mixed model to investigate group differences between children with ASD and typically developing children. There was a significant difference in GABA+ levels between the groups, a significant effect of age and interaction between age and diagnostic group. The ASD group showed an association between GABA+ and age, with GABA+ levels gradually increasing with age (r = 0.59, p = 0.003). Typically developing children did not show age-related change in GABA+ concentration (r = 0.09, p = 0.60). By the age of 9, children with ASD showed GABA+ levels that were comparable to their typically developing peers. This study suggests that children with ASD have initially lower levels of GABA+ in the left parietal lobe compared to typically developing children, and that these initially lower levels of GABA+ increase with age in ASD within this region. It is suggested that this developmental shift of GABA+ levels within the left parietal lobe provides a possible explanation for the previously found reductions in childhood that does not persist in adults. LAY SUMMARY: This study measured levels of GABA in the left parietal lobe using magnetic resonance spectroscopy in children with ASD and typically developing children. GABA levels were initially lower in the ASD group, and increased with age, while GABA did not change with age in the typically developing group. This suggests that alterations in GABA signaling may be associated with ASD in childhood. Autism Res 2021, 14: 859-872. © 2021 International Society for Autism Research, Wiley Periodicals LLC.

Heart Rate Variability in Children With Autism Spectrum Disorder and Associations With Medication and Symptom Severity

Decreased heart rate variability (HRV) is considered a common marker of autonomic dysfunction that contributes to poor health outcomes. While some studies have suggested that children with autism spectrum disorder (ASD) show reduced HRV, research is yet to consider whether this may be associated with medication use and symptom severity. This study examined the relationship between resting state HRV, medication use and symptom severity in children diagnosed with ASD. Children with ASD (N = 86), aged between 3 and 12 years (M = 8.09), were compared to 44 neurotypical children of similar age (M = 7.15). Laboratory assessment of HRV involved 5 min of non-invasive baseline electrocardiogram assessments while participants viewed an age-appropriate non-verbal animated video. Time-domain and frequency-domain HRV measures were analyzed. ASD symptom severity was assessed using the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Social Responsiveness Scale (SRS-2). Results indicated that children with ASD exhibited reduced resting HRV relative to neurotypical children. Subsequent analyses within the ASD group suggested that this group difference was greater in children who were taking psychotropic medication (N = 36). Our data also provides tentative evidence of a relationship between HRV and social impairment symptoms in children with ASD, with more severe repetitive behaviors (as measured by the ADOS-2) associated with decreased resting HRV. Overall, these findings suggest that HRV may be atypical in children with ASD and suggest the importance of exploring HRV as a risk factor for cardiovascular health in this group. LAY SUMMARY: Cardiac activity, such as heart rate variability (HRV), can provide insight into the autonomic nervous system. This study reports on the association between resting-state HRV and autonomic nervous system activity in young children with autism spectrum disorder (ASD) compared to neurotypical children. These results may help us understand what underlies autonomic nervous system dysfunction and the potential pathophysiological mechanisms leading to increased cardiovascular risk in ASD.

Reduced heart rate variability in adults with autism spectrum disorder

A growing body of research has suggested heart rate variability (HRV) may be reduced in autism spectrum disorder (ASD) in comparison to neurotypical cohorts. While there have been several studies investigating HRV in children diagnosed with ASD, few studies have been conducted in adults. The objective of the current study was to investigate autonomic nervous system activity as assessed by HRV in adults diagnosed with ASD. We hypothesized that adults with ASD would show a reduction in HRV compared to neurotypical participants. Participants diagnosed with ASD (n = 55) were recruited from the Autism Clinic for Translational Research at the Brain and Mind Centre (University of Sydney) between 2013 and 2017. Neurotypical participants were recruited from advertisements and online media. Resting state heart rate was measured for 5 min while participants sat in an upright position. Results showed there was an overall significant difference in resting-state HRV between adults diagnosed with ASD compared to the neurotypical control group. Logarithmically transformed high frequency (HF) and root mean square of successive differences were particularly decreased in the ASD group, suggesting lower parasympathetic activity. The use of psychotropic medications and comorbidities were associated with reductions in low frequency of HRV. Our data suggest an overall dysregulation in resting autonomic activity in adults with ASD. This may represent an important physiological mechanism leading to potential cardiovascular risk in ASD, which warrants further investigation. Autism Res 2019, 12: 922-930. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: ASD is commonly associated with a range of physical and mental health comorbidities. Autonomic disruptions underlying reductions in heart rate variability (HRV) have been linked to a range of mental and physical health conditions. We assessed resting-state HRV in adults diagnosed with ASD in comparison to healthy individuals. Our results showed reduced heart rate variability in people diagnosed with ASD compared to adults without ASD. These findings implicate a role for autonomic activity as a potentially modifiable risk factor for ASD.

Spectrum of histomorphological diagnosis in cystoscopic bladder biopsies

Background:  Urinary bladder lesions are the main source of significant clinical symptoms which are more disabling than lethal. Bladder tumors constitute one of the most common urological pathology. Urothelial carcinoma accounts for 90% of all primary tumors of the bladder. This study aimed to determine the frequency of different types of lesions of the urinary bladder and to determine the grade and stage of urothelial tumors.Materials and Methods: This is a 2 years cross sectional study of cystoscopic biopsies carried out in the Department of Pathology, Medicare National Hospital and Research Centre, Kathmandu, Nepal.Results:  Out of 87 cases, 58 (66.67%) cases were neoplastic lesions and 29(33.33%) cases were non- neoplastic lesions. Majority of neoplastic lesions 96.55% were urothelial (transitional cell) tumors comprising predominantly of low grade papillary urothelial carcinoma 50.91%. Muscle invasion was seen only in high grade papillary urothelial carcinomas.Conclusion: Among bladder tumors low grade papillary urothelial carcinoma is the most common. 

Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal

Introduction: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among the diabetics. Objective: to study the systemic association of proliferative diabetic retinopathy. Materials and methods: A prospective, case-series study was conducted among the newly diagnosed proliferative diabetic retinopathy cases presenting at the Tilganga Institute of Ophthalmology (TIO) from January 2012 to January 2013. Diabetic retinopathy was classi¿ed using the Early Treatment Diabetic Retinopathy Study criteria. Blood pressure, fasting and postprandial blood sugar, glycosylated hemoglobin, lipid pro¿le, urine for microalbumin, urea, and creatinine were evaluated at the time of diagnosis.Results: A total of 104 type 2 diabetic patients with newly diagnosed PDR presented during the study period. Concurrent macular edema was present in 93 cases (89.42 %). The mean age was 56.96 ± 9.394 (range 32 - 78) years. Males and females comprised of 75.7 % and 24.3 % respectively. The majority (37.5 %) were involved in business, followed by government service (17.30 %), and housewives (16.34 %). Mean duration of diabetes was 11.42 ± 5.356 years (range 1 month - 26 years). Concurrent hypertension was found in 55.76 %, uncontrolled fasting and or postprandial blood sugar in 72.54 %, poor glycemic control (HbA1C > 7 %) in 73.97 %, abnormal lipid profile in 52.56 %, microalbuminuria in 67.85 %, and positive urine albumin in 50 % of the cases.Conclusion: Despite the short duration of diabetes, the concurrent hypertension, poor glycemic control, proteinuria and dyslipidemia were the main systemic associations for PDR at our clinical set-up. Awareness, identification and management of these systemic problems could reduce the rapid progression to PDR.

Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

INTRODUCTION

Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal.

OBJECTIVES

The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients.

MATERIALS AND METHODS

A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients' detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria.

MAIN OUTCOME MEASURES

The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed.

RESULTS

A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004).

CONCLUSION

The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection.

Clinico-microbiological Profile and Visual outcome in Traumatic Endophthalmitis following Pars Plana Vitrectomy at a Tertiary Eye Care Centre of Nepal

INTRODUCTION

Endophthalmitis is a potentially devastating ocular complication of perforating eye injury (PEI) where prompt intervention can save some vision. This study aims to explore the clinico-microbiologic profile and visual outcome following pars plana vitrectomy (PPV) in traumatic endophthalmitis.

METHODS

This is a retrospective interventional case series study conducted at a tertiary eye care centre of Nepal. A total of 49 consecutive cases (49 eyes) of endophthalmitis following PEI, who underwent PPV from January 2007 to June 2010 were included in the study.

RESULTS

Mean age was 14.7 years (S.D. 14.27). Twenty seven patients (55%) were of age group below 10 years. Male to female ratio was 2.75:1. Mean duration of presentation was 8.9 days. Nineteen eyes (36.73%) had injuries with wooden sticks, followed by injury with metallic objects in 16 patients (32.56%). PEI involving zone I was found in 31 eyes (63.25%). The retained intraocular foreign body was found in seven patients (14.2%). The post operative vision improved in almost 24 cases (49%) with visual recovery of 20/200 and better in six cases (12.24%). The vitreous culture was positive in five cases (12.8%) with predominant streptococcus pneumonia in four cases (10.25%).

CONCLUSIONS

Children were the mostly affected group with males outnumbering females. Wooden sticks and metallic objects were the commonest insulting agents. Despite the late presentation and predominant zone I injury, eye could be salvaged in majority with visual recovery of 20/200 and better in six cases (12.24%).

Short term results of intra-vitreal bevacizumab for the treatment of macular edema secondary to retinal vein occlusion

INTRODUCTION

Macular edema (ME) is the leading cause of visual impairment in retinal vein occlusion (RVO).

OBJECTIVE

To evaluate the efficacy and safety of intravitreal bevacizumab (Avastin; Genentech) on ME secondary to RVO.

MATERIALS AND METHODS

A prospective, interventional study was conducted among patients with ME due to RVO from June 2008 to February 2010. Intravitreal bevacizumab (1.25 mg/0.05 ml) was given at 4 to 6 weekly intervals until the ME subsided. Complete ophthalmic evaluation and measurement of central retinal thickness (CRT) by optical coherence tomography (OCT) were performed at baseline and follow up visits.

RESULTS

Thirty four eyes (18 CRVO and 16 BRVO) were included in the study. The mean duration of visual symptoms and follow up period were 5.1 months (range 0.3 - 24 months) and 7.5 ± 4.8 months respectively. In CRVO, the CRT improved from 652 ± 206 ?m at the baseline to 257 ± 132 ?m (p less than 0.0001) at the final follow up, and in BRVO, the CRT improved from 540 ±197 ?m to 219 ± 135 ?m (p 0.0001). The improvement in BCVA was significant at each follow up interval for BRVO; in CRVO, there was only a significant improvement between the baseline and the 6 weeks' follow up. BCVA was improved in 75 % cases of BRVO and in 61.6 % in CRVO at the final follow up. There were no ocular or systemic adverse effects.

CONCLUSION

Intravitreal bevacizumab is an effective and safe drug for reducing ME and improving visual acuity secondary to RVO in the short term follow up.

Accuracy of fine needle aspiration cytology in diagnosis of thyroid swelling

Background: Fine needle aspiration cytology has been shown to be simple, safe, cost effective and quick to perform procedure with excellent patient compliance. It is a well established technique for preoperative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. The aim of this study was to determine the accuracy of fine needle aspiration cytology of thyroid swellings performed at our institution. Materials and Methods: This study was carried out at Kathmandu Medical College and Teaching hospital, department of Pathology over a period of 3 years (January 2010 to December 2012). Two hundred and seventy three patients of all age groups and both sexes who underwent fine needle aspiration cytology for thyroid swelling were evaluated. Out of 273 patients, histopathological diagnosis was available in 45 patients. Results: Fine needle aspiration cytology result revealed 245 cases (89.7%) as non-neoplastic, 21 cases (7.7%) as neoplastic and 7 cases (2.6%) inadequate due to lack of cellularity. The commonest lesion in the thyroid gland was colloid goiter. Among the malignant neoplasms the commonest was papillary carcinoma. Out of 273 patients, histopathological diagnosis was available in 45 patients. Statistical analysis of our data shows the diagnostic accuracy of fine needle aspiration cytology to be 95.7%. Fine needle aspiration cytology showed a sensitivity of 96.4% and a specificity of 94.4%. Conclusion: Fine needle aspiration cytology is a well established technique for pre operative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8988Journal of Pathology of Nepal (2013) Vol. 3, 433-436  

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.

Vitreo-retinal disorders at high altitude in Nepal

INTRODUCTION

Nepal has many mountains including the highest one in the world. People living in high altitude are often involved in climbing mountains.

OBJECTIVE

To explore the pattern of vitreo-retinal disorders at high altitude in Nepal.

MATERIALS AND METHODS

Consecutive patients aged 40 years and older who presented at the micro-surgical eye camp at Lukla of Solukhumbu district (2,860 metres) were included. Detailed ocular and systemic histories and ocular examination including dilated fundus evaluation were done.

RESULTS

There were a total 81 patients with the mean age of 56.7 years (S.D 11.15). Females (51.9 %) outnumbered males. Sherpa comprised of 76.5 % followed by Rai (9.8 %). The main occupation was agriculture (51.9 %) followed by mountain trekking (28.4 %). Smokers comprised of 13.5 %. Hypertension was the predominant systemic problem (28 %). The best corrected visual acuity of 6/18 and better was found in 86.4 % of cases and less than 3/ 60 in 3.6 % of cases. Age-related macular degeneration (AMD) was found in 19.6 % of cases with a predominant mild AMD (16 %), hypertensive retinopathy in 12.2 %, with grade I hypertensive change in 8.6 %, retinal vein occlusion (RVO) in 7.1 % of cases and with a branch RVO in 4.9 %. Dilated and tortuous retinal vessels were present in 25.9 % of cases; out of this, 9.8 % of the cases had concurrent AMD and/or hypertensive retinopathy. Other retinal problems were macular hole (2.46 %), solar retinopathy (2.46 %) and choroidal tear (1.2 %).

CONCLUSION

AMD, hypertensive retinopathy, and RVO are the main vitreo-retinal disorders besides the dilated and tortuous retinal vessels in people living at high altitude in Nepal.

Demographics and awareness of diabetic retinopathy among diabetic patients attending the vitreo-retinal service at a tertiary eye care center in Nepal

INTRODUCTION

Diabetic retinopathy (DR) is one of the leading causes of blindness in Nepal.

OBJECTIVE

To investigate the demographic characteristics and awareness of diabetic retinopathy among new cases of diabetes mellitus (DM) attending the vitreo-retinal service of a tertiary eye care centre in Nepal.

MATERIALS AND METHODS

A hospital-based, cross-sectional study including all consecutive new cases of DM was carried out. Detailed demographics of the subjects and their awareness of potential ocular problems from diabetes mellitus were noted.

RESULTS

A total of 210 patients with a mean age of 57 +/- 10.4 years were included. Brahmins (34.8 %) and Newars (34.3 %) were the predominant ethnic groups. Housewives (38.6 %) and office workers (18.6 %) were the major groups affected. Two-fifths (37 %) of the cases were unaware of DR and its potential for blindness. Awareness was significantly higher among literate patients (P = 0.006). Fundus evaluation was done for the first time in 48.6 %, although almost four-fifths had a duration of diabetes of five years or more. DR was found in 78 % of the cases, with 16.7 % already at the proliferative stage and about 40 % exhibiting clinically significant diabetic macular edema.

CONCLUSION

A lack of awareness of DR coupled with a high proportion of cases already at a sight-threatening stage of retinopathy at their first presentation reflects the need for improved awareness programs to reduce the burden of blindness from DR in Nepal.

Age-related macular degeneration in Nepal

BACKGROUND

The Age related Macular Degeneration (AMD) is a common cause of visual impairment and blindness worldwide in elderly.

OBJECTIVE

This study aimed to explore the demographic characteristics, pattern and risk factors for AMD at a tertiary referral eye centre in Nepal.

METHODS

This is a hospital-based prospective study, conducted at Tilganga Institute of Ophthalmology, Nepal from September 2008 to May 2009. All the consecutive cases of AMD diagnosed at the institute were included.

RESULTS

A total of 141 patients (266 eyes) with AMD recruited for the study. The mean age was 69.5 years (9.1SD) with three fifth males (58.9%). Housewives and occupations like agriculture comprised of 38.3% and 42.5% respectively. Three fourth (75.6%) of the patients were illiterate. The proportion of dry and wet AMD were found in 62.4% and 37.6% respectively. Bilateral involvement was seen in 88.7% of the subjects. Three fourth (71.4%) of the AMD eyes had presenting visual acuity less than 6/18. History of smoking was found in 69.9% of patients. Hypertension was the predominant systemic problem (45.4%) followed by diabetes mellitus (12.8%).

CONCLUSION

AMD is correlated with ageing in our study as well. Dry AMD is more in age groups 45-64 years and wet AMD at 65 years and older. Bilateral involvement with one eye dry and fellow eye wet AMD is more predominant (44%). Smoking and occupations like agriculture and housewife are significant risk factors for AMD. Likewise male sex, illiteracy and hypertension are other risk factors for AMD in hospital settings.

Clinical profile and visual outcome following pars plana vitrectomy in acute post-operative endophthalmitis

INTRODUCTION

Endophthalmitis following cataract surgery is a rare but devastating ocular complication where delay in treatment not only results in vision loss but also in difficulty to save the eye ball.

OBJECTIVE

To explore the clinical profile and visual outcome following pars plana vitrectomy (PPV) in acute endophthalmitis after cataract surgery.

MATERIALS AND METHODS

This is a retrospective interventional case series study conducted at Tilganga Institute of Ophthalmology (TIO), Nepal. All consecutive cases of acute endophthalmitis following cataract surgery treated with PPV from January 2005 to August 2010 were included in the study.

RESULTS

There were a total of 34 cases (34 eyes) treated with PPV. The age range was 8 - 93 years with mean age of 56.9 ± 19.5 years. The mean duration of presentation and duration following cataract surgery was 7.7 ± 8.1 days and 13 ± 11.6 days respectively. Small incision cataract surgery was done in 75 % of cases followed by phacoemulsification (15.6 %). The mean duration of the last follow -up was 4.3 months. Vision was improved in two-thirds of cases (67.67 %) with a good vision of 6/18 or better in 17.6 %. Among the available vitreous samples of 22 cases, 36.36 % had an abnormality in Gram and Giemsa stains and culture was positive in 13.6 % of cases.

CONCLUSION

Despite the late presentation, the majority of eyes were salvaged with improvement of vision in 67.67 %, with a good vision of 6/18 or better in 17.6 4 % of cases following PPV in acute post operative endophthalmitis.

Anatomical and visual outcome following macular hole surgery at a tertiary eye care centre in Nepal

INTRODUCTION

Macular hole (MH) leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal.

METHODS

This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8) from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA) and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT) at six weeks, three months and at the last follow-up following surgery were recorded.

RESULTS

A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D) were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D). Idiopathic macular hole comprised of 31 cases (86.1 %) and traumatic of five cases (13.9 %). The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 %) at six weeks and in 28 cases (77.8%) at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 %) than in the traumatic (60 %) and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases.

CONCLUSIONS

The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic.

Anatomical and Visual Outcome following Macular Hole Surgery at a Tertiary Eye Care Centre in Nepal

Introduction: Macular hole (MH) leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal. Methods: This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8) from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA) and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT) at six weeks, three months and at the last follow-up following surgery were recorded. Results: A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D) were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D). Idiopathic macular hole comprised of 31 cases (86.1 %) and traumatic of five cases (13.9 %). The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 %) at six weeks and in 28 cases (77.8%) at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 %) than in the traumatic (60 %) and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases. Conclusions: The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic. Keywords: Anatomical success, macular hole, perfluoropropane gas, visual acuity, vitrectomy

Luxation of Eye Ball Following Trauma - A Rare Case Presentation

Luxation of the eye globe is a rare event but it carries a risk of threat to permanent vision loss if appropriate intervention is not initiated on time. Although a rare presentation following minor trauma, it is usually associated with other ocular conditions like shallow orbital socket, oppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We herein report a case of luxation of the eye ball following trauma in a 15-year-old girl, who recovered completely after the surgrical correction and a review of the relevant literature. Keywords: eye ball, luxation, trauma  

Luxation of eye ball following trauma--a rare case presentation

Luxation of the eye globe is a rare event but it carries a risk of threat to permanent vision loss if appropriate intervention is not initiated on time. Although a rare presentation following minor trauma, it is usually associated with other ocular conditions like shallow orbital socket, floppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We herein report a case of luxation of the eye ball following trauma in a 15-year-old girl, who recovered completely after the surgical correction and a review of the relevant literature.

Van Gogh syndrome

Self injury is the intentional and direct injury to self that include bite, burn, ulceration and head banging. These injuries are rarely fatal and are usually not suicidal in nature. This behavior is common among adolescents, psychiatric patients and in females. Bipolar disorder, drug abuse and metabolic syndromes like LeschNyhan and Munchausen's syndrome are often associated with this disorder. Repetitive self mutilation is termed the Van Gogh syndrome after the famous painter who cut off his ear and gave it to a prostitute. We describe two such cases of self mutilation in schizophrenic patients.

Flexible cold cathode with ultralow threshold field designed through wet chemical route

A flexible cold cathode based on a uniform array of ZnO nanowires over carbon fabrics was designed via a simple wet chemical route. The structural parameters of the nanowires (i.e. length, diameter) as well as their arrangement over the carbon fibers were tailored by adjusting nutrient solution composition and growth duration. The optimized arrays of ZnO nanowires exhibit excellent electron emission performance with ultralow turn-on as well as threshold fields of 0.27 and 0.56 V µm(-1). This threshold field value is the lowest compared to any of the previous zinc-oxide-based cold cathodes realized through either chemical or vapor phase processes. In addition, the current density can reach an exceptionally high value of ∼ 11 mA cm(-2) at an applied electric field of only 0.8 V µm(-1). Flexible electronic devices based on a field emitter cold cathode may thus be realized through chemical processing at low budget but having high efficiency.

Refractive Error, Srabismus and Amblyopia in Congenital Ptosis

INTRODUCTION: Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error,strabismus and amblyopia in patients with congenital ptosis in a hospital setting. METHODS: This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study. RESULTS: Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonestrefractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivationamblyopia (6.7%). CONCLUSIONS: Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis. Keywords: amblyopia, congenital ptosis, refractive error, strabismus.

Refractive error, strabismus and amblyopia in congenital ptosis

INTRODUCTION

Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error, strabismus and amblyopia in patients with congenital ptosis in a hospital setting.

METHODS

This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study.

RESULTS

Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonest refractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivation amblyopia (6.7%).

CONCLUSIONS

Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.

Waardenburg syndrome associated with laryngomalacia

Waardenburg syndrome (WS) is a rare autosomal dominant condition characterised by sensorineural hearing loss, in conjunction with pigmentary abnormalities and defects of the neural crest-derived tissues. Depending on the additional phenotypic characteristics, WS is classified into four types, viz. WS1, WS2, WS3 and WS4. We report a 45-day-old male infant with WS1, who presented with inspiratory stridor associated with difficulty in respiration. Direct flexible laryngoscopic examination during evaluation confirmed laryngomalacia as the cause of the symptoms. The baby was managed conservatively and was discharged with appropriate advice to the mother, including the need for evaluation at regular intervals. There was gradual improvement in his symptoms, and by one year of age, he was completely symptom free. To our knowledge, laryngomalacia as a part of WS has not been documented to date in the English literature. We also briefly discussed the probable embryological basis for the observed association.

Central retinal vein occlusion in young women: rare cases with oral contraceptive pills as a risk factor

Central retinal vein occlusion in young people is a rare entity. Here we present two cases of central retinal vein occlusion in young women using oral contraceptive pills. We found no other systemic problems and all routine investigations were within normal limits. The cases were managed with further avoidance of oral contraceptives and intravitreal injections of Bevacizumab (Avastin) to reduce the macular edema.