Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal.

BACKGROUND: Nutrition is the science of food and its relationship to health. Nutritional status is one of the key indicators of health Nutritional status of Nepal is not satisfactory. Especially Protein Energy Malnutrition (PEM) in Nepal is a very common problem in children under fi ve years of age. There are number biochemical parameters which become altered during protein energy malnutrition. OBJECTIVES: The objectives of the study are to determine biochemical nutritional indicators among children suffering from PEM and to compare all biochemical parameters with well nourished children and also to determine the factors affecting PEM among children under five years. MATERIALS AND METHODS: The study design was cross sectional, descriptive study with control. Children between ages 6 to 59 months attending outpatient department (OPD) and wards of Kanti Children's Hospital (KCH), Maharajgunj, Kathmandu, Nepal were purposively selected. The sample size was calculated by using prevalence of malnutrition in Nepalese context and allowable error of 10 %, a total of 120 cases which include 60 PEM cases and 60 controls were selected. They were grouped into two groups based on whether they are above or below the 80% of 50th percentile of weight for height based on growth chart of National Centre of Health Statistics (NCHS), USA. RESULTS: The educational status of parents of children with PEM was found to be significantly less (p<0.05) as compared to their non-PEM counterparts. Occupations of parents whose children were in PEM group include mainly housewives and labourers. Larger proportions of children in our study were born at home and exact birth weights of children were not known. Most of the children are colostrum fed. Most of the children in our study were immunized. Almost equal proportion of children belonged to nuclear family type and joint family type. The mean serum glucose, sodium, potassium, cholesterol, haemoglobin was not significantly different in both groups while mean total protein, albumin, and calcium were significantly (p<0.05) low in PEM group when compared to well nourished children (control). There was significantly (p<0.05) higher incidence of hypoproteinemia, hypoalbuminaemia, and hypocalcaemia, in PEM group when compared to control group. CONCLUSION: A significant proportion of children with protein energy malnutrition had altered biochemical parameters which were related to food intake and biochemical metabolism mandatory during growth and development of children less than five years of age. There was significantly higher proportion of hypoglycaemia, hypoproteinemia, hypoalbuminaemia, anaemia, hypocholesterolemia and hypocalcaemia in children with PEM when compared to normally nourished children.

Identification of Novel Interaction Partners of AIF Protein on the Outer Mitochondrial Membrane.

In response to the wide variety of external and internal signals, mammalian cells undergo apoptosis, programmed cell death. Dysregulation of apoptosis is involved in multiple human diseases, including cancer, autoimmunity, and ischemic injuries. Two types of apoptosis have been described: the caspase-dependent one, leading to digestion of cellular proteins, and caspase-independent apoptosis, resulting in DNA fragmentation. The latter type of apoptosis is executed by AIF protein and is believed to have appeared first during evolution. The key step in the caspase-independent apoptosis program is the dissociation of AIF from the outer mitochondrial membrane (OMM). However, the molecular mechanism of interaction between AIF and OMM remains poorly understood. In this study, we demonstrated that AIF can bind to OMM via mortalin protein. We confirmed interaction between AIF and mortalin both in vitro and in vivo and mapped the amino acid sequences that are important for the binding of these proteins. Next, we showed that apoptosis induction by chemotherapy leads to downregulation of AIF-mortalin interaction and dissociation of AIF from the OMM. Finally, a bioinformatic analysis demonstrated that a high level of mortalin expression correlates with a worse survival prognosis for glioma patients. Altogether, our data revealed that mortalin plays an important role in the regulation of the caspase-independent apoptotic pathway and allowed us to speculate that inhibition of AIF-mortalin interaction may induce a dissociation of AIF from the OMM and subsequent apoptosis of cancer cells.

Conditions in rural Nepal for which depot-medroxyprogesterone acetate initiation is not recommended: implications for community-based service delivery.

The presence of medical conditions that might affect the use of depot-medroxyprogesterone acetate (DMPA) as a contraceptive method was assessed in a rural district in Nepal. A general health survey was conducted in nonpregnant and noncontracepting women aged 15-44 years to determine the presence of any health problems. The survey included a general assessment interview by nonphysicians, followed by formal medical histories and physical exams by female gynecologists. Possible pregnancy (nine cases) and abnormal uterine bleeding (one case) were the only conditions identified in which DMPA should not be used, based on the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use. Five additional cases of cardiovascular problems, in which DMPA initiation is not usually recommended, were also detected. Recently developed checklists based on the WHO criteria for DMPA use would have identified all of these health conditions. This checklist would allow the safe delivery of DMPA at the community health worker level, and increase the availability and accessibility of DMPA in rural Nepal.

PIP: A general health survey was conducted in nonpregnant and noncontracepting women aged 15-44 years to determine the presence of any health problems that might affect the use of depot-medroxyprogesterone acetate (DMPA) as a contraceptive method in rural district in Nepal. The survey included a general assessment interview by nonphysicians, followed by formal medical histories and physical exams by female gynecologists. Findings revealed that a possible pregnancy (9 cases) and abnormal uterine bleeding (1 case) were the only conditions identified in which DMPA should not be used based on the WHO Medical Eligibility Criteria for Contraceptive Use. 5 additional cases of cardiovascular problems, in which DMPA initiation was not usually recommended, were also detected. The reports included heart disease (2 cases), past history of hypertension (1 case), current hypertension (1 case), and headache and hypertension (1 case).

Factors affecting retention of child health card in a rural area.

BACKGROUND: The child health card is a tool used by Health Management Information System in Nepal. It contains records on immunization, vitamin A and a weight-for-age growth chart. The objective of this study was to identify the magnitude of and the factors affecting retention of child health card. METHODS: A cross sectional descriptive design using quantitative methodology was applied. Divyapuri VDC was selected purposively and simple random sampling was applied to obtain a sample of 282 households with children between one to 36 months. Information was collected by interview with mothers of one to 36 months children and by observation of child health cards. Descriptive analysis was performed to assess the magnitude of retention of child health card. Then, bivariate analysis was performed; odds ratio and corresponding 95% confidence interval were used to test the significance of association. Logistic regression model was used for control of confounding. RESULTS: Only 41% of the mothers produced child health card at the time of survey. For about 7% respondents, child health card was not issued and only 45% of the respondents who were issued child health card have retained it. Younger age group of the child, mothers living nearer to health facility, mothers with knowledge on use of child health card for recording immunization and recording growth monitoring; and mothers who were explained child health card by health worker were found significantly higher odds of retaining it. CONCLUSIONS: The retention of child health card was low in the study area. Health workers should be trained to educate mothers on retention and use of child health cards.

Iodine supplementation in pregnancy and its effects on perinatal outcome.

Iodine is an important micronutrient for mental growth and development. Limited information is available on the role of iodine supplementation in pregnancy and its effect on perinatal outcome. We designed intervention study to assess the effect of iodine supplementation during second half pregnancy and its effect on perinatal outcomes (maternal and neonatal health). Among 60 intervened with oral iodine tablet in pregnancy and 60 control pregnant women in Sindhupalchowk District Hospital Chautara, we assessed maternal and neonatal health after the delivery. The significant differences were found among duration of pregnancy, weight of pregnant mother before and after intervention of at least three months duration (56.1 kg vs. 59.6 kg, p < 0.001), weight of neonate (3.3 kg in intervention vs. 3.0 kg in control, p < 0.001), and thyroxin hormone (1.1 ng in intervention vs. 1.2 ng in control, p < 0.001) of women between intervened and control subjects. Therefore, regular supplementation of iodine in oral form for more than three months during pregnancy preferably during early stage will bring significant positive changes in perinatal outcomes.