The outcome of Radial Neck Fracture Treated with Closed/ Open Reduction and Retrograde Kirschner Wires Fixation in the Paediatric Age Group.

Background Radial neck fractures in children are rare injuries, representing 1 to 5% of all elbow pediatric fractures. Most of them are non-displaced or slightly displaced and treated conservatively. Severely displaced or angulated radial neck fractures (Judet type III and IV fractures or O'Brien type III radial neck fractures) requires surgical treatment. Objective To study the clinical and radiological outcomes of fractures following closed or open reduction and percutaneous intramedullary stabilization of the displaced radial neck fracture in children. Method There were 24 children with displaced radial neck fracture Judet type II, III and IV fractures O'Brien type II, III who underwent closed reduction and retrograde intramedullary stabilization with Kirschner wires. Functional outcomes were evaluated based on of Mayo Elbow Performance Score. Result The mean age of patients was 8.42 ± 1.82 years with boys 15(62.5%) and girls 9(37.5%) in number. An excellent result was seen in 5(20.8%) cases and good results in 15(62.5%) cases according to the Mayo elbow performance score. Analyzing a passive and active range of motion, 5 had excellent results, 15 had good results and 4 had fair results compared to the normal side. Radiological evaluation showed fracture healing in excellent or good alignment according to Ursei radiological evaluation classification. Conclusion Closed reduction and retrograde intramedullary Kirschner wires stabilization for the displaced radial neck fracture provide excellent clinical and radiological results with few complications.

Differential regulation of STP, LTP and LTD by structurally diverse NMDA receptor subunit-specific positive allosteric modulators.

Different types of memory are thought to rely on different types of synaptic plasticity, many of which depend on the activation of the N-Methyl-D Aspartate (NMDA) subtype of glutamate receptors. Accordingly, there is considerable interest in the possibility of using positive allosteric modulators (PAMs) of NMDA receptors (NMDARs) as cognitive enhancers. Here we firstly review the evidence that NMDA receptor-dependent forms of synaptic plasticity: short-term potentiation (STP), long-term potentiation (LTP) and long-term depression (LTD) can be pharmacologically differentiated by using NMDAR ligands. These observations suggest that PAMs of NMDAR function, depending on their subtype selectivity, might differentially regulate STP, LTP and LTD. To test this hypothesis, we secondly performed experiments in rodent hippocampal slices with UBP714 (a GluN2A/2B preferring PAM), CIQ (a GluN2C/D selective PAM) and UBP709 (a pan-PAM that potentiates all GluN2 subunits). We report here, for the first time, that: (i) UBP714 potentiates sub-maximal LTP and reduces LTD; (ii) CIQ potentiates STP without affecting LTP; (iii) UBP709 enhances LTD and decreases LTP. We conclude that PAMs can differentially regulate distinct forms of NMDAR-dependent synaptic plasticity due to their subtype selectivity.

Evaluation of Knowledge, Attitude, Practice and Hospital Experience Regarding COVID-19 among Post-partum Mothers at a Tertiary Care Center: A Cross-sectional Study.

Background Pregnant and breastfeeding women are more susceptible to viral infection and in the year 2020 they have to face the COVID-19 pandemic. Since, no successful treatment and vaccine has been developed so far, efforts to enhance the knowledge, attitudes, and practice of the public, especially the high-risk groups like pregnancy and postpartum period are crucial to manage COVID-19 pandemic. Objective To analyze the knowledge, attitude, practice and hospital experience regarding COVID-19 among post-partum mothers at a tertiary care center of Nepal Method The data collection was based on direct interview after receiving written consent from the research participants, using a semi-structured questionnaire. The questionnaire consisted of 4 major domains- knowledge (8 questions), attitude (6 questions), practice (5 questions) and experience (5 questions). Standard descriptive statistics were used for the data, mean and standard deviation for continuous variables whereas frequencies and percentages for categorical variables. Result A total of 203 post-partum women participated in the study. Almost all the participants had heard about COVID-19 (96.6%). A majority of them were aware about how COVID-19 gets transmitted and its preventive measures. Most of the participants (88.2%) knew that COVID-19 has effects on pregnancy. Almost all of participants (97%) wore mask during hospital stay. All of the women washed their hands with soap water or alcohol based sanitizer. A majority of the mothers (79.3%) wore mask while breastfeeding their baby. Conclusion The post-partum mothers have good knowledge, attitude, practice and experiences regarding the COVID-19 pandemic.

Clinico-demographic Profile of Poisoning Cases Admitted in Intensive Care Unit of Bharatpur Hospital, A Tertiary Referral Center in Nepal.

Background Poisoning is a major cause of death in young adults. The epidemiological factors such as geography, occupation, literacy rate can influence the clinical presentation and outcome of the poisoning patients. Poisoning has a significant impact on the economic and social life of individuals. Objective The main objective of this study is an effort to evaluate the characteristic of poisoning cases and identify the reasons for Intensive Care Unit (ICU) admission. Method This was a prospective observational study at Bharatpur Hospital ICU over a period of one year. Demographic profiles, poison characteristics, types and reasons for poisoning, duration of hospital stay, and outcome of the patients were studied. Result A total of 156 patients were admitted with poisoning. Females were affected more than males with a ratio of F:M= 1.6:1. The age group that consumed poison the most was 16-25 years, and the mean age group of males was 35±14 years and 29±11 years respectively. The main cause of poisoning was conflicts/quarrel. Organophosphorus compound was the most common poisoning with 53% of total cases due to it. There were 07 cases of accidental poisoning secondary to mushroom poisoning. The mean duration of stay in ICU of these patients was 04 days. The total fatality rate due to poisoning was 07%. Conclusion The significant proportion of Intensive Care Unit admission was due to organophosphorus compounds. It was more common among females and young age groups. This calls for special health education on chemical safety among vulnerable people along with efficient supervision in regulatory controls on chemicals and its use.

Prevalence of amblyopia and patterns of refractive error in the amblyopic children of a tertiary eye care center of Nepal.

INTRODUCTION: Refractive error is a common cause of amblyopia. OBJECTIVE: To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. MATERIALS AND METHODS: A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. RESULTS: Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p less than 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. CONCLUSION: The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes.

Effect of IL-1ß and TNF-α vs IL-13 on bronchial hyperresponsiveness, ß2-adrenergic responses and cellularity of bronchial alveolar lavage fluid.

1 Levels of IL-13, IL-1ß and TNF-α are increased in bronchial lavage fluid of asthmatics and induce certain significant features of bronchial asthma including airway hyper-responsiveness (AHR). In this study, we have investigated the effect of these cytokines in naïve mice and those sensitized to ovalbumin (OVA) on bronchoconstrictions to methacholine (MCh) and the functional antagonism induced by ß2 -adrenoceptor agonism. 2 Naïve or OVA-sensitized mice were treated for 3 days with IL-1ß (250 U), TNF-α (150 ng), IL-13 (5 µg) or combinations of IL-1ß with TNF-α or IL-1ß with IL-13. MCh-induced bronchoconstriction and its sensitivity to albuterol, a ß2-adrenoceptor agonist, was assessed 24 h after the last cytokine administration. 3 In naïve mice, responsiveness to MCh was significantly increased by the combination of IL-1ß and TNF-α, IL-13 alone or in combination with IL-1ß, but not by treatment with IL-1ß or TNF-α alone. Similar results were obtained in OVA-sensitized mice except that treatment with IL-13 alone did not increase sensitivity to MCh. 4 In naïve mice, albuterol sensitivity was only significantly attenuated by treatment with IL-1ß and TNF-α in combination. In mice sensitized to OVA, albuterol sensitivity was significantly attenuated by treatment with TNF-α, IL-13 or IL-13 in combination with IL-1ß. 5 Inflammatory cell influx was increased by all cytokines and combinations except IL-13 in OVA-sensitized mice. 6 Our data do not support a link between inflammatory cell influx and AHR. In addition, the mechanism of IL-13-induced AHR might involve decreased ß2-adrenoceptor responsiveness.

Kaempferol acts through mitogen-activated protein kinases and protein kinase B/AKT to elicit protection in a model of neuroinflammation in BV2 microglial cells.

BACKGROUND AND PURPOSE: Kaempferol, a dietary flavonoid and phyto-oestrogen, is known to have anti-inflammatory properties. Microglial activation has been implicated in various neurodegenerative diseases. Anti-inflammatory effects of kaempferol and the underlying mechanisms were investigated by using LPS-stimulated microglial BV2 cells. EXPERIMENTAL APPROACH: Cell viability was measured using MTT and neutral red assays. elisa, Western blot, immunocytochemistry and electrophoretic mobility-shift assay were used to analyse NO, PGE(2) , TNF-α and IL-1ß production, inducible NOS (iNOS), COX-2 expression and the involvement of signalling pathways such as toll-like receptor-4 (TLR4), MAPK cascades, PKB (AKT) and NF-κB. Accumulation of reaction oxygen species (ROS) was measured by nitroblue tetrazolium and 2'7'-dichlorofluorescein diacetate assay. Matrix metalloproteinase activity was investigated by zymography and immunoblot assay. Phagocytotic activity was assessed by use of latex beads. KEY RESULTS: Kaempferol significantly attenuated LPS-induced NO, PGE(2) , TNF-α, IL-1ß and ROS production and phagocytosis in a concentration-dependent manner. Kaempferol suppressed the expression of iNOS, COX-2, MMP-3 and blocked the TLR4 activation. Moreover, kaempferol inhibited LPS-induced NF-κB activation and p38 MAPK, JNK and AKT phosphorylation. CONCLUSION AND IMPLICATIONS: Kaempferol was able to reduce LPS-induced inflammatory mediators through the down-regulation of TLR4, NF-κB, p38 MAPK, JNK and AKT suggesting that kaempferol has therapeutic potential for the treatment of neuroinflammatory diseases.

Health impacts and research ethics in female trafficking.

Female trafficking is a social and public health problem, associated with physical and sexual abuse, psychological trauma, injuries from violence, sexually transmitted infections, adverse reproductive outcomes and substance misuse. It faces several challenges ranging from the hidden nature of the problem to ethical and human rights issues. The objectives of this paper are to analyze health impact of trafficking; ethical and research issues and anti-trafficking strategies in the Nepalese context. We collected published and unpublished data assessing the public health, ethical burden and research needs from different sources. Trafficked female involved in sex-industry that face grave situation as depicted and it might a reservoir of sexually transmitted diseases. Ethical issues related to survey of assessing the burden are difficult to carry out. The best ways to prevent and control these problems are to enhance anti- trafficking laws and raise awareness, empower and mobilize females and establish organizational capacity.

Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children.

BACKGROUND: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. OBJECTIVES: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. MATERIALS AND METHODS: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. RESULTS: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%). CONCLUSION: Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance.