Randomized controlled pilot trial with ion-exchange water softeners to prevent eczema (SOFTER trial).

BACKGROUND: Observational studies suggest an increased risk of eczema in children living in hard versus soft water areas, and there is, therefore, an interest in knowing whether softening water may prevent eczema. We evaluated the feasibility of a parallel-group assessor-blinded pilot randomized controlled trial to test whether installing a domestic ion-exchange water softener before birth in hard water areas reduces the risk of eczema in infants with a family history of atopy. METHODS: Pregnant women living in hard water areas (>250 mg/L calcium carbonate) in and around London UK, were randomized 1:1 antenatally to either have an ion-exchange water softener installed in their home or not (ie to continue to receive usual domestic hard water). Infants were assessed at birth and followed up for 6 months. The main end-points were around feasibility, the primary end-point being the proportion of eligible families screened who were willing and able to be randomized. Clinical end-points were evaluated including frequency of parent-reported doctor-diagnosed eczema and visible eczema on skin examination. Descriptive analyses were conducted, and no statistical testing was performed as this was a pilot study. RESULTS: One hundred and forty-nine families screened were eligible antenatally and 28% (41/149) could not have a water softener installed due to technical reasons or lack of landlord approval. Eighty of 149 (54%) were randomized, the primary end-point. Two participants withdrew immediately after randomization, leaving 39 participants in each arm (78 total). Attrition was 15% (12/78) by 6 months postpartum. All respondents (n = 69) to the study acceptability questionnaire reported that the study was acceptable. Fifty-six of 708 (7.9%) water samples in the water softener arm were above the hard water threshold of 20 mg/L CaCO3 . At 6 months of age 27/67 infants (40%) developed visible eczema, 12/36 (33%) vs. 15/31 (48%) in the water softener and control groups, respectively, difference -15% (95% CI -38, 8.3%), with most assessments (≥96%) remaining blinded. Similarly, a lower proportion of infants in the water softener arm had parent-reported, doctor-diagnosed eczema by 6 months compared to the control arm, 6/17 (35%) versus 9/19 (47%), difference -12% (95% CI -44, 20%). CONCLUSION: A randomized controlled trial of water softeners for the prevention of atopic eczema in high-risk infants is feasible and acceptable. TRIAL REGISTRATION: NCT03270566 (clinicaltrials.gov).

Unique Crystal Structure of Ca_{2}RuO_{4} in the Current Stabilized Semimetallic State.

The electric-current stabilized semimetallic state in the quasi-two-dimensional Mott insulator Ca_{2}RuO_{4} exhibits an exceptionally strong diamagnetism. Through a comprehensive study using neutron and x-ray diffraction, we show that this nonequilibrium phase assumes a crystal structure distinct from those of equilibrium metallic phases realized in the ruthenates by chemical doping, high pressure, and epitaxial strain, which in turn leads to a distinct electronic band structure. Dynamical mean field theory calculations based on the crystallographically refined atomic coordinates and realistic Coulomb repulsion parameters indicate a semimetallic state with partially gapped Fermi surface. Our neutron diffraction data show that the nonequilibrium behavior is homogeneous, with antiferromagnetic long-range order completely suppressed. These results provide a new basis for theoretical work on the origin of the unusual nonequilibrium diamagnetism in Ca_{2}RuO_{4}.

Scleral Fixation of Intraocular Lens with Ab Interno Technique.

INTRODUCTION: Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure. METHODS: Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016. RESULTS: The age range was from 15 to 79 years; mean age was 47.56 ± 20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months. CONCLUSIONS: SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.

Hereditary Spherocytosis with Splenomegaly and Cholelithiasis in a Young Male of Western Region of Nepal - A Case Report.

Hereditary spherocytosis is an autosomal dominant congenital hemolytic anemia due to defect in RBC membrane protein that commonly presents with intermittent jaundice, anemia, abdominal pain, splenomegaly and sometimes cholelithiasis. Due to the membrane defect, there is increased fragility, hemolytic anemia, marked splenomegaly and hyperbilirubinemia. This is a report of an 11 years old male diagnosed case of hereditary spherocytosis who presented with jaundice, splenomegaly and cholelithiasis. He underwent elective open splenectomy and cholecystectomy after prophylactic immunization for capsulated organisms and was advised lifelong oral penicillin prophylaxis post-splenectomy.

Comparison of Phacotrabeculectomy and Phacotrabeculectomy with Subconjunctival 5-Fluorouracil.

INTRODUCTION: Glaucoma is the second leading cause of blindness worldwide. Phacotrabeculectomy is a technique in which glaucoma and cataract surgery performed. METHODS: Prospective study was carried out in the department of glaucoma at Lumbini Eye Institute, Bhairahawa.100 patients who underwent phacotrabeculectomy within a period of two years. Patients were divided into two groups those who received 5FU (n=47) and no antifibrotic agent (n= 53) RESULTS: The age range was from 38 to 80 years; mean age of 62.97±9.14 SD. 55% were male and 45% were female.The postoperative IOP reduction in last follow- up group A was mean=13.08±1.57SD and mean=13.23±1.73SD in group B. This was statically significant with P <0.001. Bleb survival was almost similar in two groups 3.17(78.31%) in group A and 3.20 (78.93%) in group B. 85% visual acuity was improved in both groups. CONCLUSIONS: Phacotrabeculectomy and phacotrabeculectomy with inj. 5FU, both were equally effective surgical techniques in terms of visual acuity, IOP control and bleb survival.There was no significant statistical difference vis-à-vis the success of Phacotrabeculectomy using of either these two techniques.

Effects of pine bark supplementation on performance, rumen fermentation, and carcass characteristics of Kiko crossbred male goats.

Twenty-two Kiko crossbred male goats (Capra hircus; initial BW = 27.5 ± 1.04 kg) were used in a randomized complete block design to determine the effects of feeding pine bark (PB; Pinus taeda L.) on animal performance, rumen fermentation, blood parameters, fecal egg counts (FEC), and carcass characteristics in goats. Experimental treatments included the control diet [0% PB plus 30% wheat straw (WS)], 15% PB plus 15% WS, and 30% PB plus 0% WS (on as-fed basis), where PB replaced WS. Freshly air-dried PB and WS were finely (1.5 to 3.0 mm) ground and incorporated in the grain mixes. Experimental diets provided a total of 1.9, 16.3, and 32 g of condense tannins (CT)/kg DM in 0%, 15%, and 30% PB diets, respectively. The grain mixes were fed daily at 85% of the feed offered, with remaining 15% consisting of Bermuda grass hay (Cynodon dactylon). Animals were fed once a day at 0800 h, and feed offered and refused was monitored for an 83-d performance period. Rumen and blood samples were collected at d 0, 50, and 80 of the study. Carcass traits were assessed after slaughter at the end of performance period. There was no difference in initial BW, hay, and total NDF intake among treatments; however, final BW (P = 0.06), ADG (P < 0.01), grain mix intake (P < 0.001), total DMI (P < 0.001), and G:F (P < 0.04) increased linearly as the PB increased in the diets. Rumen ammonia N, acetate, isovalerate and acetate-to-propionate ratio were reduced linearly (P < 0.05). There was no difference in carcass traits except cold carcass weight (P = 0.06), which tended to increase linearly in goats fed 15% and 30% PB. Breast, sirloin, trim trait, liver, and hide weight increased (linear; P < 0.01) with addition of PB. Blood basophils, alanine transaminase, aspartate aminotransferase, albumin, Na, and Cl concentrations decreased (linear; P < 0.02 to 0.01) as PB supplementation increased. Supplementation of PB reduced (linear; P < 0.01) average FEC. Addition of PB in the diets improved performance, reduced FEC, and favorably modified rumen fermentation.

Population-based cancer incidence in Sikkim, India: report on ethnic variation.

BACKGROUND: A Population-Based Cancer Registry (PBCR) was set up in Sikkim (a state in the North Eastern India) in 2003. We examined incidence rates by ethnic groups from 2003-2008. METHODS: Age-adjusted incidence rates (AARs) per 100,000 person-years were calculated by direct method using the world standard population, and analysed by ethnic group (Bhutia, Rai and other). RESULT: There were a total of 1148 male and 1063 female cases of cancer between 2003 and 2008 on the Sikkim PBCR. The overall AARs were 89.4 and 99.4 per 100,000 person-years in males and females, respectively. Incidence rates were highest amongst the Bhutia group (AAR=172.4 and 147.4 per 100,000 person-years in males and females, respectively), and the largest difference in rates were observed for stomach cancers with AARs being 12.6 and 4.7 times higher in the Bhutia group compared with other ethnic groups in males and females, respectively. CONCLUSION: These observations call for further epidemiological investigations and the introduction of screening programmes.

Effects of breed and harvest age on feed intake, growth, carcass traits, blood metabolites, and lipogenic gene expression in Boer and Kiko goats.

The objectives of this experiment were to determine the effects of 2 different breeds (BR), Boer and Kiko, and 4 post-weaning harvest ages (HA; Days 0, 29, 56, and 85) on growth, carcass traits, blood metabolites, and lipogenic gene expression. Forty-eight goat (Capra hircus) kids (BW = 23.9 ± 1.50 kg; 3 to 4 mo) were used in a 2 × 4 factorial arrangement of treatments. Goats were stratified by BW within BR and randomly assigned to 4 HA. Kids were born between March 15 and April 7 to purebred does, and were represented by at least 3 purebred sires within each BR. They were fed a grain/hay (80:20) diet once per day. At designated HA, randomly pre-assigned goats (n = 6) from each BR were transported to the Meat Science Lab at Mississippi State University, Starkville, MS, and were harvested. There were no interactions (P > 0.10) between BR and HA. Boer tended (P = 0.08) to have greater initial BW, final BW (P = 0.05), and G/F ratio (P = 0.05). Although the 80:20 grain/hay diet was reinforced by adjusting DMI, both BR had similar total DMI, Boer kept that ratio, while Kiko consumed more (P = 0.001) hay (70:30, grain/hay) and had more (P = 0.001) DMI when expressed as g/kg BW. Boer tended to have greater transportation shrink (P = 0.07), HCW (P = 0.08), and cold carcass weights (CCW; P = 0.08), with greater (P = 0.001) carcass fat. No differences (P > 0.10) were observed in carcass shrink, dressing percentage, 12th rib fat thickness, and LM area between the 2 BR. When expressed as percentage empty BW, carcass bone was similar (P = 0.25), whereas muscle percentage (P = 0.02) was greater for Kiko and fat percentage was greater (P = 0.001) for Boer. Fat as a percentage of CCW remained relatively similar (P > 0.10) for both BR for the 2nd and 3rd HA. Differences were more evident (P = 0.01) at the 4th HA. Boer reached targeted harvest weight (29 kg) at the 3rd HA, while fat deposition continued (P = 0.01) during the 4th HA. Breed had no effect (P > 0.10) on meat color (L*, a*, b*) but HA affected (P = 0.001) all color values. Boer had similar 3-hydroxyl-3-methylglutaryl-CoA synthase mRNA abundance, but was greater (P < 0.03) in acetyl CoA carboxylase compared with Kiko. There was no difference (P = 0.52) in total serum fatty acids (FA, mg/mL) between the 2 BR. As animals aged, their total serum FA increased (P < 0.05) and changed to an undesirable profile. Kiko had a greater (P = 0.02) percentage of muscle and less (P = 0.001) fat in the carcass. We concluded that different BR might need different harvest endpoints and feed input according to consumer acceptability.

Reasons underlying the extraction of permanent teeth in patients attending Peoples Dental College and Hospital.

Extraction of permanent teeth is common in Nepal. The study was undertaken to determine the causes and pattern of missing permanent teeth among patients attending Peoples Dental College and Hospital (PDCH) and to see if there is any association between variables like socio economic status, patient education level, dental visit and extraction of permanent teeth. A prospective cross sectional survey was carried out in patients attending the Department of Oral Surgery in PDCH between August 2006 and October 2006. The data was collected by trained clinician through clinical examination and using semi- structured questionnaires. Computer software SPSS 15 was used for statistical analysis. In age groups < or = 30 years, 90.0% it was reported that Dental caries was the most common reason for extraction of teeth. In age groups > 30 years, 55.6% periodontal disease was the most common reason for extraction of teeth. Distribution by type of teeth and dental disease was highly significant where. Dental caries was the reason for extraction of first permanent molar. Distribution by education level and visit to dentist was highly significant. About 93.1% of the people who were illiterate visited the dental surgeon while in pain and 76.0% of the university level graduates visited the dentist while in pain. Caries and its sequel remain the most important cause of tooth loss throughout adult life along with periodontal diseases at later stages.

Lipid profile of adult Nepalese population.

Dyslipidemia is one of the major risk factors of coronary artery disease. Present study was aimed to find out the lipid profile of non-diabetic adult Nepalese population (n = 454; M: 180 and F: 274; Mean age: 42.8+/-15.5 years). The mean +/- SD (mg/dl) level of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 184+/-50.7, 147.4+/-79.9, 111.9+/-42.0 and 45.0+/-11.7, respectively. All lipid levels except LDL were higher among 41 to 60 years age group while LDL was higher among participants aged >60 years. Desirable TC level (<200 mg/dl) was found in 78.0% of the total population while the normal TG (<150 mg/dl) and LDL (<129 mg/dl) was found in 61.5% and 72.0%, respectively. High TC (> or =240 mg/dl) and very high TG (> or =500 mg/dl) and LDL (> or =190 mg/dl) were found in 8.8%, 2.6% and 5.8% of participants, respectively. Higher HDL level (40 mg/dl) was seen in 60.0% of the total population. Higher percentage of women than men (65.3% vs 52.2%) had >40 mg/dl HDL level. Nornal lipid profile (TC <200 mg/dl, TG <150 mg/dl, LDL <129 mg/dl, HDL >40 mg/dl) was seen in 26.7% of participants, and was higher in females (32.1%) than in males (18.3%). The overall mean cholesterol level was within normal limit. Mean LDL level showed increasing trend with age and about one fourth of participants had normal lipid profile.

In vitro ruminal disappearance of fumonisin B1 and its effects on in vitro dry matter disappearance.

Fumonisins were produced by inoculating corn with Fusarium moniliforme M-1325 and incubating for 5 w. Fumonisin B1 (FB1) concentration determined by high performance liquid chromatography was 5,087 ppm. Ruminal fluid inoculum obtained from 2 ruminally cannulated steers and tubes containing 0, 50 or 100 ppm of FB1 were incubated in vitro with ruminal fluid and artificial saliva for 72 h in a 39 C oscillating incubator. Supernatant was analyzed for FB1 concentration, and in vitro dry matter disappearance (IVDMD) was calculated in the remaining precipitates. There was minimal degradation of FB1 by ruminal microbes (about 10%) irrespective of concentration of FB1 used when incubated for the 72 h. No differences in IVDMD rates, were found between treatments, and the rates were normal, indicating that microbial efficiency was unaffected by the presence of FB1 at diet concentrations up to 100 ppm.

Effects of fumonisin B1-contaminated feeds on weanling angora goats.

Two diets containing no (<1.0 mg/ kg) or 95 mg of fumonisin B1 (FB1)/kg were fed to eight weanling Angora goats for 112 d. Dry matter intake, apparent nutrient digestibilities, serum chemistry profiles, sphingolipid concentrations, and persistency of FB1 in tissues were evaluated. No differences (P>.10) were found between control and treated goats in terms of DMI, apparent nutrient digestibilities, or ADG. Elevated concentrations (P<.10) of blood-borne enzymes such as aspartate aminotransferase, lactate dehydrogenase, and gamma glutamyl transpeptidase and increased concentrations of cholesterol and triglycerides indicated mild liver damage and kidney dysfunction in treated goats. Linear relationships (P<.10) were observed between these serum constituents and duration of FB1 exposure. The sphingolipid analysis of liver, kidney, and heart tissues showed elevated free sphinganine:free sphingosine ratios in the treated group. The elevated sphingolipid ratios were mainly due to increased concentrations of free sphinganine in tissues. However, without serum profile and sphingolipid analyses, fumonisin toxicosis would not have been recognized because treated animals showed no clinical signs of toxicosis throughout the trial. No measurable FB1 was present in liver, kidney, and heart tissues (detection limit of 1 ppm). However, further research is needed to analyze tissues for FB1 or its metabolites with a lower detection limit. In conclusion, goats can be fed for up to 112 d with diets containing 95 mg FB1/kg of diet without any overt signs of toxicosis and also without any effect on live weight gain.