Ocular Survey in Kathmandu University Medical Students.

Background Medical students spend long time in academic activities that increases the risk of developing refractive errors and dry eyes that can affect their learning and social abilities. Only a few studies are available regarding ocular problems and its contribution to visual impairment among medical students in Nepal. Objective To evaluate the ocular problems among the medical students in a University hospital. Method An observational, descriptive, cross-sectional study was conducted among five batches undergraduate medical students until 2022 of Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. A self-administered questionnaire was used to obtain demographic data and information on visual problems followed by a detailed ocular examination that included refraction, color vision and Schirmer test. Result Total of 284 medical students (with 568 eyes) with mean age of 22.8 years, 179 males and 105 females were enrolled. Among them, 270 (47.5%) eyes were emmetropic. Simple Myopia was the commonest followed by Compound Myopic Astigmatism. The mean spherical equivalent in right and left eye were -0.914 ± 1.54 and -0.886 ± 1.53 respectively. Approximately 18% students had some form of dry eye. Nineteen students (6.7%) had color vision deficiency and 13 (4.6%) had deuteranomalia, 3(1.1%) had deuteranopia and 3(1.1%) had protanomalia. Conclusion Eye defects, like refractive errors, dry eyes and color blindness, are common among medical students. They need to be advised for frequent eye check up in order to diagnose eye defects timely and arrest visual impairment at early stage.

Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal.

Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.

Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal.

Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.

Prevalence of Refractive Error and Ocular Pathologies among School Children: Finding from the School Eye Program of Dhulikhel Hospital.

Background Childhood blindness and visual impairments could lead to the onset of blindness among children and adolescents. New cases appear particularly between the ages of 6-15 years and if uncorrected, runs a risk of developing Amblyopia, strabismus. There exists a mounting need to strengthen and modify established school eye health programs in Nepal as per the local needs and conditions. Objective To determine the prevalence of refractive error and ocular pathologies among school children in rural Nepal. Method This cross-sectional study was conducted in nine schools of Kavrepalanchowk and Bhaktapur district with 953 students screened from December 2018 to February 2020. The team of optometrist, ophthalmic assistants and ophthalmologist applied a standard protocol for screening of refractive error as a part of the school eye program of Dhulikhel Hospital. Other standard eye examinations were performed to note the ocular pathologies. The association of socio-demographic factors of students having refractive errors with that in emmetropes was identified using logistic regression analysis. Result A total of 953 students were screened in nine study sites, age ranged from 5-19 years. There were 183 students (19.2%) with refractive errors. Blurred vision was the common complaint reported by 2.5% of students. Multivariate logistic regression analysis showed higher age group children (aOR=2.93; 95% CI: 1.62-5.29; P=0.01) and urban area children (aOR=4.37; 95% CI: 0.87-21.98; P=0.07) to have higher odds of refractive error. Conclusion Refractive error is the major eye problem among school children. Despite its high prevalence, there is still a major gap in timely diagnosis and treatment. Regular vision screening and timely treatment is required for better addressing refractive error among school-going children.

Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study.

BACKGROUND: Leprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system's situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future. METHODS: The study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007). RESULTS: In all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year. CONCLUSIONS: The findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.

Inferring causal relationships between reproductive and metabolic health disorders and production traits in first-lactation US Holsteins using recursive models.

Health disorders in dairy cows have a substantial effect on the profitability of a dairy enterprise because of loss in milk sales, culling of unhealthy cows, and replacement costs. Complex relationships exist between health disorders and production traits. Understanding the causal structures among these traits may help us disentangle these complex relationships. The principal objective of this study was to use producer-recorded data to explore phenotypic and genetic relationships among reproductive and metabolic health disorders and production traits in first-lactation US Holsteins. A total of 77,004 first-lactation daughters' records of 2,183 sires were analyzed using recursive models. Health data contained information on reproductive health disorders [retained placenta (RP); metritis (METR)] and metabolic health disorders [ketosis (KETO); displaced abomasum (DA)]. Production traits included mean milk yield (MY) from early lactation (mean MY from 6 to 60 d in milk and from 61 to 120 d in milk), peak milk yield (PMY), day in milk of peak milk yield (PeakD), and lactation persistency (LP). Three different sets of traits were analyzed in which recursive effects from each health disorder on culling, recursive effects of one health disorder on another health disorder and on MY, and recursive effects of each health disorder on production traits, including PeakD, PMY, and LP, were assumed. Different recursive Gaussian-threshold and threshold models were implemented in a Bayesian framework. Estimates of the structural coefficients obtained between health disorders and culling were positive; on the liability scale, the structural coefficients ranged from 0.929 to 1.590, confirming that the presence of a health disorder increased culling. Positive recursive effects of RP to METR (0.117) and of KETO to DA (0.122) were estimated, whereas recursive effects from health disorders to production traits were negligible in all cases. Heritability estimates of health disorders ranged from 0.023 to 0.114, in accordance with previous studies. Similarly, genetic correlations obtained between health disorders were moderate. The results obtained suggest that reproductive and metabolic health disorder and culling due to metabolic and reproductive diseases have strong causal relationships. Based on these results, we concluded that a health disorder (either reproductive or metabolic) occurring in early lactation has a moderate causal effect on the reproductive or metabolic health disorder occurring in later lactation. In addition, direct, indirect, and overall effects of reproductive and metabolic health disorders on milk yields for cows that avoid culling are weak.

Short communication: Genomic selection for hoof lesions in first-parity US Holsteins.

Hoof lesions contributing to lameness are crucial economic factors that hinder the profitability of dairy enterprises. Producer-recorded hoof lesions data of US Holsteins were categorized into infectious (abscess, digital and interdigital dermatitis, heel erosion, and foot rot) and noninfectious (korn, corkscrew, sole and toe ulcer, sole hemorrhage, white line separation, fissures, thin soles, and upper leg lesions) categories of hoof lesions. Pedigree- and genomic-based univariate analyses were conducted to estimate the variance components and heritability of infectious and noninfectious hoof lesions. A threshold sire model was used with fixed effects of year-seasons and random effects of herd and sire. For genomic-based analysis, a single-step procedure was conducted, incorporating H matrix to estimate genomic variance components and heritability for hoof lesions. The pedigree-based analysis produced heritability estimates of 0.11 (±0.05) for infectious hoof lesions and 0.08 (±0.05) for noninfectious hoof lesions. The single-step genomic analysis produced heritability estimates of 0.14 (±0.06) for infectious hoof lesions and 0.12 (±0.08) for noninfectious hoof lesions. Approximated genetic correlations between hoof lesion traits and hoof type traits along with productive life and net merit were all low and ranged between -0.25 and 0.14. Sire reliabilities increased, on average, by 0.24 and 0.18 for infectious and noninfectious hoof lesions, respectively, with incorporation of genomic data.

Fiber-optic two-photon optogenetic stimulation.

Optogenetic stimulation of genetically targeted cells is proving to be a powerful tool in the study of cellular systems, both in vitro and in vivo. However, most opsins are activated in the visible spectrum, where significant absorption and scattering of stimulating light occurs, leading to low penetration depth and less precise stimulation. Since we first (to the best of our knowledge) demonstrated two-photon optogenetic stimulation (TPOS), it has gained considerable interest in the probing of cellular circuitry by precise spatial modulation. However, all existing methods use microscope objectives and complex scanning beam geometries. Here, we report a nonscanning method based on multimode fiber to accomplish fiber-optic TPOS of cells.

Calf birth weight, gestation length, calving ease, and neonatal calf mortality in Holstein, Jersey, and crossbred cows in a pasture system.

Holstein (HH), Jersey (JJ), and crosses of these breeds were mated to HH or JJ bulls to form purebreds, reciprocal crosses, backcrosses, and other crosses in a rotational mating system. The herd was located at the Center for Environmental Farming Systems in Goldsboro, North Carolina. Data for calf birth weight (CBW), calving ease (0 for unassisted, n=1,135, and 1 for assisted, n=96), and neonatal calf mortality (0 for alive, n=1,150, and 1 for abortions recorded after mid-gestation, stillborn, and dead within 48 h, n=81) of calves (n=1,231) were recorded over 9 calving seasons from 2003 through 2011. Gestation length (GL) was calculated as the number of days from last insemination to calving. Linear mixed models for CBW and GL included fixed effects of sex, parity (first vs. later parities), twin status, and 6 genetic groups: HH, JJ, reciprocal F(1) crosses (HJ, JH), crosses >50% Holsteins (HX) and crosses >50% Jerseys (JX), where sire breed is listed first. The CBW model also included GL as a covariate. Logistic regression for calving ease and neonatal calf mortality included fixed effects of sex, parity, and genetic group. Genetic groups were replaced by linear regression using percentage of HH genes as coefficients on the above models and included as covariates to determine various genetic effects. Year and dam were included as random effects in all models. Female calves (27.57±0.54 kg), twins (26.39±1.0 kg), and calves born to first-parity cows (27.67±0.56 kg) had lower CBW than respective male calves (29.53±0.53 kg), single births (30.71±0.19 kg), or calves born to multiparous cows (29.43±0.52 kg). Differences in genetic groups were observed for CBW and GL. Increased HH percentage in the calf increased CBW (+9.3±0.57 kg for HH vs. JJ calves), and increased HH percentage in the dams increased CBW (+1.71±0.53 kg for calves from HH dams vs. JJ dams); JH calves weighed 1.33 kg more than reciprocal HJ calves. Shorter GL was observed for twin births (272.6±1.1 d), female calves (273.9±0.6 d), and for first-parity dams (273.8±0.6 d). Direct genetic effects of HH alleles shortened GL (-3.5±0.7 d), whereas maternal HH alleles increased GL (2.7±0.6 d). Female calves had lower odds ratio (0.32, confidence interval=0.10-0.99) for neonatal calf mortality in second and later parities than did male calves. Maternal heterosis in crossbred primiparous dams was associated with reduced calf mortality.