Establishment of dry-chemistry-based reference intervals of routine liver function tests for the adult population of Gandaki Province, Nepal.

Every clinical laboratory should ideally establish its own population-specific reference intervals (RIs) to promote precision and evidence-based medicine. However, clinical laboratories in Nepal find it easier to follow external RIs than establish their own, leading to a lack of RIs specific to the local population. This study thus aimed to establish RIs of routine LFTs for the adult population of Gandaki Province, Nepal, and compare them with the current RIs used by our laboratory. We established the dry-chemistry-based reference intervals of 11 common LFT parameters for the adult population of Gandaki Province, Nepal using the direct priori-based method. The combined and sex-specific 95% double-sided RIs of total protein, albumin, globulin, A/G ratio, bilirubin, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), AST/ALT ratio, and alkaline phosphatase (ALP) were established using non-parametric percentile method. The new RIs were also compared with the currently used RIs that were adopted from the reagent kit inserts. The newly established RIs for each LFT were: Total proteins: 68.0-69.0g/L, albumin: 39.0-52.0g/L; globulin: 27.0-42.0g/L; A/G ratio: 1.1-1.8; total bilirubin: 5.13-25.65µmol/L (0.30-1.50mg/dl); unconjugated bilirubin: 1.71-17.10µmol/L (0.10-1.00mg/dl); conjugated bilirubin: 0.00-10.26 µmol/L (0.00-0.60mg/dl); AST: 20.0-43.2U/L; ALT: 11.0-53.0 U/L; AST/ALT ratio: 0.7-2.1; ALP: 42.0-135.4U/L. The RIs of albumin, globulin, A/G ratio, AST, ALT, and AST/ALT ratio differed significantly (p < 0.05) between males and females. Moreover, calculated out-of-range values showed that up to 4-40% of apparently healthy adults were classified as having abnormal test results based on current RIs. The newly established RIs fulfil the need for population and platform-specific RIs for the adult population of Gandaki Province of Nepal and bring more conformity and accuracy in interpreting the LFT results, diagnosis of hepatobiliary diseases, clinical decision-making, monitoring the success of therapy and future liver specific biomedical researches within the Gandaki Province of Nepal.

Mental Health of Mothers with Malnourished Children in Nepal: A Prospective Observational Study.

BACKGROUND: Maternal mental health may influence the nutritional status of their children. It was intended to assess the mental health status of the mothers of children admitted to a nutrition rehabilitation center. We specifically explored the relationship between maternal mental health and malnutrition of the child; to observe any change of maternal depressive/anxiety symptoms and weight gain in the child following admission. METHODS: In a prospective observational study, malnutrition of children was assessed based on weight for height z scores using the WHO Anthro-Survey-Analyser. We evaluated anxiety using the Generalized Anxiety Disorder Scale (GAD-7) and depression by Patient Health Questionnaire (PHQ-9). Demographic and clinical variables were collected. RESULTS: The degree of malnutrition of the children at admission and discharge was: mild (3.6% v 31.7%), moderate (37.7% v 26.3%), severe (58.7% v 8.4%), and no malnutrition (0.0% v 33.5%) (p<0.001). At admission, 12% of mothers had anxiety, depression, or both, which decreased to 3.0% at the time of discharge. There was no difference in malnutrition scores among children of mothers with or without anxiety/depression at admission or discharge, except that children of depressed mothers continued to have significantly greater levels of malnutrition at discharge compared with the mothers without depression. Maternal anxiety or depression was not associated with the severity of malnutrition. CONCLUSIONS: A proportion of mothers of children with malnutrition had clinical anxiety and depression; and maternal mental health concerns, especially depression may influence the nutrition of children. It is imperative to explore maternal mental health routinely for malnourished children.

Preterm Neonates Admitted in the Neonatal Intensive Care Unit at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Preterm birth, one of the leading causes of admissions to the Neonatal intensive care unit, is a major contributor to neonatal morbidity and mortality in developing countries. This study aimed to find out the prevalence of premature neonates admitted to the Neonatal Intensive Care Unit of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from clinical records of preterm neonates (born before 37 completed weeks of gestation) admitted in the Neonatal Intensive Care Unit from 16 July 2020 to 14 July 2021. Following ethical approval from the Institutional Review Committee (Reference number: 077/78-018), the patient's clinical characteristics and systemic morbidities were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 646 admissions, the prevalence of preterm neonates was found to be 147 (22.75%) (19.52-25.98, 95% Confidence Interval). The male: female ratio was 1.53:1. The median gestational age and birth weight were 33 weeks (Range: 24-36 weeks) and 1680 g respectively. A total of 73 (49.65%) delivery was followed by premature rupture of membrane. The morbidity due to respiratory problems was highest at 127 (86.39%), followed by metabolic at 104 (70.74%) and sepsis at 91 (61.90%). The renal system was the least affected 5 (3.40%). Conclusions: The prevalence of preterm neonates in the neonatal intensive care unit was higher than in other studies done in similar settings. Keywords: morbidity; neonatal; neonatal intensive care unit; premature birth.

Matching the Symptom Profile of Adolescent Disaster Survivors with Changing Diagnostic Criteria of Posttraumatic Stress Disorder: Focus on ICD-11.

BACKGROUND: Considering recent changes in the diagnostic guidelines for posttraumatic stress disorder (PTSD), it has become imperative to review their influence, especially on the symptoms related to children and adolescent victims of disasters. We intended to assess the profile of posttraumatic stress symptoms (PTSS) of adolescents following an earthquake, especially the gender differences, in relation to the changing diagnostic guidelines, particularly ICD-11. METHODS: In a cross-sectional study, PTSS and functional impairments were evaluated in school-going adolescents in Nepal, one year after the 2015 earthquake, using the Child Posttraumatic Stress Scale (CPSS). RESULTS: A considerable proportion of adolescent survivors of the earthquake had PTSS. Most common ones were intrusive thoughts (46.7%), avoiding thoughts, conversations and feelings about the disaster (44.2%), decreased interest in activities (40.0%), distress with reminders (35.6%), and concentration problems (35.6%). Females had a higher prevalence for all the PTSS compared with males, except for avoiding thought, conversations, feelings, and being overly careful/vigilant. Proportion of adolescents who met symptomatic criteria for PTSD diagnosis in different systems ranged from 14.7% in DSM-5 to 15.6% in ICD-11 three-factor model, and 22.2% in DSM-IV and 31.7% in ICD-10. Inclusion of the criterion of significant functional impairment changed the proportions to 10.0%, 10.3%, 12.8%, and 16.4%, respectively. In all of the diagnostic systems, higher proportions of females had possible PTSD. CONCLUSION: Adolescent females had a higher prevalence for most of the PTSS and at the diagnostic level. It appears that for adolescents, diagnosis of PTSD in ICD-11 has become more robust with a focus on core symptoms and having a functional impairment criterion.

Posttraumatic Stress, Depression, and Coping Following the 2015 Nepal Earthquake: A Study on Adolescents.

OBJECTIVE: The study aimed to gather data on posttraumatic stress and depression in adolescents following the 2015 Nepal earthquake and explore the adolescents' coping strategies. METHODS: In a questionnaire-based, cross-sectional study about 1 year after the earthquake, adolescents in two districts with different degrees of impact were evaluated for disaster experience, coping strategies, and symptoms of posttraumatic stress and depression measured with the Child Posttraumatic Stress Scale and the Depression Self Rating Scale. RESULTS: In the studied sample (N=409), the estimated prevalence of posttraumatic stress disorder (PTSD) (43.3%) and depression (38.1%) was considerable. Prevalence of PTSD was significantly higher in the more affected area (49.0% v 37.9%); however, the prevalence figures were comparable in adolescents who reported a stress. The prevalence of depression was comparable. Female gender, joint family, financial problems, displacement, injury or being trapped in the earthquake, damage to livelihood, and fear of death were significantly associated with a probable PTSD diagnosis. Various coping strategies were used: talking to others, praying, helping others, hoping for the best, and some activities were common. Drug abuse was rare. Most of the coping strategies were comparable among the clinical groups. CONCLUSIONS: A considerable proportion of adolescents had posttraumatic stress and depression 1 year after the earthquake. There is a need for clinical interventions and follow-up studies regarding the outcome. Disaster Med Public Health Preparedness. 2019;13:236-242).

Morphological and dimensional characteristics of dental arch in children with beta thalassemia major.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the arch dimensions of beta thalassemia major patients in comparison with normal individuals. MATERIALS AND METHODS: Dental arch dimensions were compared between thalassemic patients and normal individuals in the age group of 12-16 years in the maxillary and mandibular arch corresponding to each other regarding age, sex and Angle's molar relationship. A total number of sixty cases in each group were taken. Maxillary and mandibular impressions were made with alginate for all the sixty participants in each group and poured with die stone. Measurement of inter incisor, inter canine, inter premolar and intermolar arch width, arch depth, right anterior, right posterior, left anterior, and left posterior arch length was carried out from each cast using digital Vernier caliper. RESULTS: Unpaired t-test was used for comparison between the two groups. Statistically, a significant difference was found between the case and control groups in the maxillary arch in intercanine width, inter premolar width, intermolar width, right anterior arch length, right posterior arch length, and left anterior arch length. However, no statistically significant difference was found between the groups in inter incisor width, left posterior arch length, and arch depth in the maxillary arch. In the mandibular arch, statistically significant difference was found between the case and control groups in inter canine width, inter premolar width, inter molar width, and left anterior arch length. However, no statistically significant difference was found between the case and control groups in the mandibular arch in interincisor width, right anterior arch length, right posterior arch length, and left posterior arch length. CONCLUSION: Dental arch widths and arch lengths were significantly reduced in thalassemic patients as compared to normal individuals for the maxillary and mandibular arches.

Formation of furan along with HO2 during the OH-initiated oxidation of 2,5-DHF and 2,3-DHF: an experimental and computational study.

Experimental characterization of products during OH-initiated oxidation of dihydrofurans (DHF) confirms the formation of furan accompanied by the formation of HO2 to be a significant channel in 2,5-DHF (21 ± 3%), whereas it is absent in 2,3-DHF. Theoretical investigations on the reaction of OH with these molecules are carried out to understand this difference. All possible channels of reaction are studied at M06-2X level with 6-311G* basis set, and the stationary points on the potential energy surface are optimized. The overall rate coefficients calculated using conventional TST with Wigner tunneling correction for 2,5-DHF and 2,3-DHF are 2.25 × 10(-11) and 4.13 × 10(-10) cm(3) molecule(-1) s(-1), respectively, in the same range as the previously determined experimental values. The branching ratios of different channels were estimated using the computed rate coefficients. The abstraction of H atom, leading to dihydrofuranyl radical, is found to be a significant probability, equally important as the addition of OH to the double bond in the case of 2,5-DHF. However, this probability is very small in the case of 2,3-DHF because the rate coefficient of the addition reaction is more than 10 times that of the abstraction reaction. This explains the conspicuous absence of furan among the products of the reaction of OH with 2,3-DHF. The calculations also indicate that the abstraction reaction, and hence furan formation, may become significant for OH-initiated oxidation of 2,3-DHF at temperatures relevant to combustion.

Pulse radiolysis studies of 3,5-dimethyl pyrazole derivatives of selenoethers.

One electron redox reaction of two asymmetric 3,5-dimethyl pyrazole derivatives of selenoethers attached to ethanoic acid (DPSeEA) and propionic acid (DPSePA) were studied by pulse radiolysis technique using transient absorption detection. The reaction of the hydroxyl ((•)OH) radical with DPSeEA or DPSePA at pH 7 produced transients absorbing at 500 nm and at 300 nm, respectively. The absorbance at 500 nm increased with increasing parent concentration indicating formation of dimer radical cations. From the absorbance changes, the equilibrium constants for the formation of dimer radical cation of DPSeEA and DPSePA were estimated as 2020 and 1608 M(-1), respectively. The rate constants at pH 7 for the reaction of the (•)OH radical with DPSeEA and DPSePA were determined to be 9.6 × 10(9) and 1.4 × 10(10) M(-1) s(-1), respectively. The dimer radical cation of DPSeEA and DPSePA decayed by first order kinetics with a rate constant of 2.8 × 10(4) and 5.5 × 10(3) s(-1), respectively. The yield of radical cations of DPSeEA and DPSePA were estimated from the secondary electron transfer reaction, which corresponds to 38% and 48% of (•)OH radical yield, respectively. Some fraction of monomer radical cation undergoes decarboxylation reaction, and the yield of decarboxylation was 25% and 20% for DPSeEA and DPSePA, respectively. These results have implication in understanding their antioxidant activity. The reaction of trichloromethyl peroxyl radical, glutathione, and ascorbic acid further support their antioxidant behavior.

Clinical evaluation of the plaque-removing ability of four different toothbrushes in visually impaired children.

PURPOSE: To evaluate the efficacy of plaque removal of four different toothbrushes in visually disabled children. Three manual toothbrushes with different bristle designs (Oral-B CrossAction 40-regular, Oral-B ShinyClean 40-soft, Oral-B Advantage 40-soft) were compared with an electric toothbrush with an oscillating rotating head (Colgate Motion). MATERIALS AND METHODS: Forty visually impaired children in a professional education center participated in the study and were divided into 4 groups of 10 participants each. To obtain a plaque-free condition at baseline, professional toothcleaning was performed on each participant. After instructions on how to use the toothbrushes, each group started the experiment using a differently designed toothbrush. After 1 week of application, the Quigley Hein plaque index (QHI) was used to assess the oral hygiene status of each participant. Student's t-test was chosen for comparing brushes. P < 0.01 was considered as the significance level. Results were presented as mean ± standard deviation. RESULTS: The QHI values obtained with the electric Colgate Motion brush were the lowest (0.088 ± 0.051) and Advantage (0.801 ± 0.132) the highest. Although the QHI values with the manual Oral-B CrossAction (0.439 ± 0.094) were lower than those with the Oral-B shiny clean (0.503 ± 0.098), there was no statistical difference between the two. CONCLUSION: The electric toothbrushes are still the most effective in the visually disabled group. However, because of cheaper cost, easier availability and use, the Oral-B CrossAction toothbrush with criss-cross bristles could be a suitable alternative.

Variable products in dielectric-barrier discharge assisted benzene oxidation.

Atmospheric-pressure dielectric-barrier discharge (DBD) assisted control of benzene((g)) oxidation into different classes of products is presented in this study. The gas-phase products were directly analyzed online by GC-FID and GC-MS. In addition, a solid yellowish surface deposit also formed, which was dissolved in 10 mL ethanol after each 10 min DBD cycle for GC analyses. One of the gas-phase products, phenol was also separately collected and estimated by Folin-Ciocalteu's wet-colorimetric method. In the gas phase only phenol and biphenyl were detected at maximum total conversion of approximately 3%, while in the ethanolic solution furthermore 1,2- and 1,4-dihydroxybenzene, 2,2'-biphenol, 2- and 4-phenylphenol and 4-phenoxyphenol were estimated at microM to mM level, and reveal approximately 30% total conversion. Products' types hint at the phenyl radical as the primary precursor. However, with the use of mesoporous molecular sieve 10X packing in unison with DBD, while the concentrations of such phenolic products decreased drastically, a number of open chain and non-aromatic ethers, aldehydes and esters, and also naphthalene and biphenylene were formed. In addition to high DBD process efficiency, the latter results suggest modification of discharge characteristics, and also strong physicochemical effects of cavity size and surface property on the intermediate reactions therein. Thus, use of such packing highlights a novel and practical methodology for control of chemical reactions towards useful product types, vis-à-vis pollutant mitigation.