Surgeon Experience as Predictors of Outcome of Dacryocystorhinostomy Surgery.

BACKGROUND: Dacryocystorhinostomy surgery aims to treat nasolacrimal duct obstruction and are often performed by general ophthalmologists in developing countries. The aim of this study is to estimate the clinical burden, surgeon's experience, and outcome of dacryocystorhinostomy surgery. METHODS: A cross-sectional survey of Nepalese Ophthalmologists registered with the Nepal Ophthalmic Society was conducted after ethical clearance from Nepal Health Research Council. The survey form consisted of a single mail-shot questionnaire information including the age and experience, average case per month, and participant-reported post-operative complications and failures. Data were entered onto Microsoft excel (Microsoft Corp) and analyzed using SPSS 22.0. The data were presented in graphical and tabular format and appropriate statistical tools were employed for the analysis. RESULTS: Out of 300 practicing ophthalmologist, 135 (45%) comprising male 60 (44.4%) and female 75(55.6%) responded to the survey. Majority of respondents were general ophthalmologists (37 ,41.6%) followed by oculoplastic surgeons (27,30.3%) and other subspecialties (25,28.1%). More than 70% respondents perform 1-10 surgeries /month and only 3% perform >50 surgeries /month. The success rate of 75-90% was reported by 45(50%) respondents whereas > 90% success rate by 41 (46.1%). More than 80% surgeons experienced an infection rate of <1% regardless of the intubation status. CONCLUSIONS: This survey revealed huge differences in surgery practice patterns among ophthalmologists in Nepal. The surgical success rate and post-operative infection rate depends upon surgeon experience. Moreover, uniform surgery protocols and training budding ophthalmologists/ young Oculoplastic surgeons in the best modern dacryocystorhinostomy surgery are required.

Hypothyroidism among Children with Nephrotic Syndrome Admitted to a Tertiary Care Centre.

Introduction: Nephrotic syndrome is a glomerular disease characterized by massive urinary protein loss occurring in children. Proteinuria also leads to loss of thyroid binding globulin affecting thyroid function. This study aimed to find out the prevalence of hypothyroidism among children with nephrotic syndrome admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children with nephrotic syndrome admitted to a tertiary care centre from 06 July 2020 to 06 June 2021 after obtaining ethical approval from the Ethical Review Committee. They were tested for free T3, free T4 and TSH. A convenience sampling method was used. The point estimate was calculated at a 90% Confidence Interval. Results: Among 69 children with nephrotic syndrome, the prevalence of hypothyroidism was 49 (71.01%) (62.03-80.00, 90% Confidence Interval). Conclusions: The prevalence of hypothyroidism among children with nephrotic syndrome was higher than other studies done in similar settings. Keywords: children; hypothyroidism; nephrotic syndrome; prevalence.

Characteristics of fine particles from incense burning at temple premises of Kathmandu Valley, Nepal.

The impact of incense burning on ambient air quality was investigated by measuring the concentrations of fine particles (PM2.5), elemental carbon (EC), organic carbon (OC), and their oxidative potential (OP) at three temple premises in Kathmandu Valley, Nepal. These temples, namely, Bajrabarahi, Bagalamukhi, and Bhadrakali, are located in three distinct environments: forest, residential, and roadside, respectively. During the incense burning event days, the PM2.5 concentration at Bhadrakali (431.4 µgm-3) was significantly higher than that measured at the Bagalamukhi (135.2 µgm-3) and Bajrabarahi (84.7 µgm-3) temple premises. This observation is consistent with the fact that Bhadrakali Temple had the highest intensity of incense burning. Additionally, the temple premises were also influenced by vehicular emissions from transportation facilities. Carbonaceous aerosols significantly increased during incense burning events, indicating that incense burning contributes significantly to the formation of primary and secondary OC. Moreover, the OP of PM2.5 during the incense burning event days was higher compared to non-event days (p < 0.05), suggesting an elevated health risk due to the increased concentration and toxicity of fine particles. These findings highlight the substantial impact of incense burning on air quality in temple premises, emphasizing the need to implement effective strategies to mitigate the associated health risks.

Conducting a phase III clinical trial in children during the COVID- 19 pandemic: Experience and lessons learnt from a clinical research facility of Nepal.

Clinical trials in humans are vital to test safety and efficacy of new interventions and are accompanied with the complexity of related regulatory guidelines, stringent time frame and financial burden particularly when participants are children. Conducting clinical trials in low and middle income countries, where 90% of global diseases occur, increases the complexity as resources, infrastructures, and experience related to clinical trials may be limited in some countries. During the COVID-19 pandemic, due to multiple infection control measures such as social distancing, lock-down of the societies, and increased work load of hospital workers, conducting clinical trials seemed very challenging. Related guidelines and recommendations on clinical trials required updates to adapt the situation for ongoing clinical trials to be continued and new clinical trials to be initiated. In this review report, we described the lessons learnt through our experiences, challenges we faced, and the mitigation measures implemented as a response while conducting a phase III clinical trial on a non-COVID-19 vaccine at a government children's hospital during the COVID-19 pandemic. We hope this report will contribute in lowering the obstacles to allow the successful completion of future studies, in countries where people live with the burden of vaccine-preventable diseases.

Phylogenomic analysis supports Mycobacterium tuberculosis transmission between humans and elephants.

Introduction: Tuberculosis is an infectious disease caused by a group of acid-fast bacilli known as Mycobacterium tuberculosis complex (MTC), which has a major impact on humans. Transmission of MTC across the human-animal interface has been demonstrated by several studies. However, the reverse zoonotic transmission from humans to animals (zooanthroponosis) has often been neglected. Methods: In this study, we used Nanopore MinION and Illumina MiSeq approaches to sequence the whole genome of M. tuberculosis strains isolated from two deceased Asian elephants (Elephas maximus) and one human in Chitwan, Nepal. The evolutionary relationships and drug resistance capacity of these strains were assessed using the whole genome data generated by the stand-alone tool Tb-Profiler. Phylogenomic trees were also constructed using a non-synonymous SNP alignment of 2,596 bp, including 94 whole genome sequences representative of the previously described M. tuberculosis lineages from elephants worldwide (lineages 1 and 4) and from humans in Nepal (lineages 1, 2 and 3). Results and Discussion: The new genomes achieved an average coverage of 99.6%, with an average depth of 55.67x. These M. tuberculosis strains belong to lineage 1 (elephant DG), lineage 2 (elephant PK) and lineage 4 (human), and none of them were found to have drug-resistant variants. The elephant-derived isolates were evolutionarily closely related to human-derived isolates previously described in Nepal, both in lineages 1 and 2, providing additional support for zooanthroponosis or bidirectional transmission between humans and elephants. The human-derived isolate clustered together with other published human isolates from Argentina, Russia and the United Kingdom in the lineage 4 clade. This complex multi-pathogen, multi-host system is challenging and highlights the need for a One Health approach to tuberculosis prevention and control at human-animal interface, particularly in regions where human tuberculosis is highly endemic.

Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention.

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.

Development and evaluation of transdermal delivery system of tranylcypromine for the treatment of depression.

Tranylcypromine (logP = 1.34, MW = 133.19 g/mol) is a monoamine oxidase inhibitor used in treating major depressive disorder and is available only as oral tablets. Transdermal delivery of tranylcypromine minimizes hepatic and gastrointestinal side effects associated with oral dosing and prevents systemic side effects improving patient compliance. A two-day suspension-based transdermal delivery method was developed in this study, and the delivery of tranylcypromine across dermatomed porcine ear skin was evaluated. Different penetration enhancers were screened, namely, isopropyl myristate, oleyl alcohol, oleic acid, and a combination of oleic acid and oleyl alcohol. Isopropyl myristate was chosen as the penetration enhancer, and suspension-based transdermal patches were formulated with acrylate and polyisobutylene pressure-sensitive adhesives by the solvent evaporation method. The release liner and backing membrane were chosen, and the drying time for each patch was optimized. The optimized patches were characterized for their adhesive properties, drying time, peel test, shear strength, and uniformity in drug content. In vitro permeation studies were performed on dermatomed porcine ear skin using vertical static Franz diffusion cells, and the receptor samples were collected at predetermined time points for 48 h. The samples were analyzed in a validated UPLC method. Acrylate-based suspension patch delivered a significantly higher amount of drug (712 ± 21.46 µg/cm2) as compared to passive delivery from drug dissolved in propylene glycol (461.49 ± 75.55 µg/cm2), reaching the two-day therapeutic target. However, the PIB-based suspension patch delivered 559.25 ± 12.37 µg/cm2 of tranylcypromine across the skin but did not reach the required target.

Clinicolaboratory Profile and Treatment Outcome Within Ninety Days After Discharge During Second Wave of Pediatric COVID-19.

BACKGROUND: The second wave of COVID-19 pandemic hit all age groups with different presentations and outcomes. This study aimed to explore the clinical characteristics, investigational findings, hospital outcomes along with a ninety days telephonic follow-up of COVID-19 infection in children. METHODS: A longitudinal descriptive study among COVID-19 RT-PCR positive hospital-admitted children was conducted during the second wave of the pandemic from 15 Mar 2021 to 15 Oct 2021 at Kanti Children's Hospital. Demographics, clinical characteristics, oxygen saturation, comorbidities, need of oxygen, need of ventilator, laboratory investigations, admission to intensive care unit, duration of hospital stay and patient's outcome (improved and discharged or death) were recorded. A follow up at ninety days from discharge was also done via telephonic call to inquire for any illness and hospital admission. RESULTS: Among the 156 admitted children, males and females were 54.5% and 45.5% with a median age of 15 months and Inter quartile range (IQR) of 63. Thirty-six (23.1%) were underweight and 31 (19.9%) had comorbidities. The most common presenting symptoms were fever 115 (73.7%), cough 50 (32.1%) and vomiting 38 (24.4%). The median (IQR) length of hospital stay was 15 (range of 11-20) days. Oxygen use was seen among 35 (22.4%) cases and 36 (23.1%) cases were admitted to the ICU. Ventilator was required for 7 (4.5%) cases. The number of deaths was 9 (5.8%) during hospital stay. After discharge from the hospital during the ninety days follow-up, 117 children had no health problems while 42 reported having some health problems and 5 died after discharge. CONCLUSIONS: In the second wave of the pandemic, only symptomatic children were admitted. Respiratory and gastrointestinal symptoms were common among the admitted cases. The majority of admitted cases had a good outcome and had no other health problems attributable to COVID-19 till ninety days of follow-up.

Understanding Mycobacterium tuberculosis complex in elephants through a One Health approach: a systematic review.

BACKGROUND: Mycobacterium tuberculosis complex (MTC) that causes the chronic infectious disease- tuberculosis (TB), often presents with a complicated epidemiological pattern where the transmission chain may include humans, domestic animals and wildlife, including elephants. TB has been reported globally in both captive and wild elephants. The One Health approach might be the most effective way of understanding the shared MTC infection dynamics in captive and wild animals like Asian elephants. This systematic review accumulates evidence on occurrence, transmission pathways, and preventive measures of TB in elephants from a One Health perspective. RESULTS: The prevalence of TB reported in elephant populations ranges from 0 to 23.33% and high prevalence's are reported for elephants that are in close proximity to infected humans. The risk of elephant to human infection transmission increased significantly with exposure duration and contact with infected elephants. Some studies described the plausible TB transmission to captive elephants from other animals (wild and domestic), suggesting inter- and intra-species transmission. The results of this systematic review based on 27 relevant published works, suggest three overarching interrelated transmission pathways for M. tuberculosis infections in Asian elephants- i) humans and elephants, ii) other animals (wild or domestic) and elephants and iii) unclear sources of infection. CONCLUSIONS: The progress made with new TB diagnostic tools provides multiple methods to choose from. However, lack of harmonization of TB testing in elephants and their human contacts remains a challenge to prevent TB in those animals. Routine TB screening among elephants and caretakers by setting up an occupational health program for early diagnosis of infection through combined efforts of public health, veterinary medicine, and occupational health experts is suggested. This implies the need for a One Health approach to elephant TB control. This review reveals the need for more research on Mycobacterium tuberculosis complex transmission pathways at the human-animal interface.

Mapping interactions between the CRAC activation domain and CC1 regulating the activity of the ER Ca2+ sensor STIM1.

Stromal interaction molecule 1 (STIM1) is a widely expressed protein that functions as the endoplasmic reticulum (ER) Ca2+ sensor and activator of Orai1 channels. In resting cells with replete Ca2+ stores, an inhibitory clamp formed by the coiled-coil 1 (CC1) domain interacting with the CRAC-activation domain (CAD) of STIM1 helps keep STIM1 in a quiescent state. Following depletion of ER Ca2+ stores, the brake is released, allowing CAD to extend away from the ER membrane and enabling it to activate Orai1 channels. However, the molecular determinants of CC1-CAD interactions that enforce the inhibitory clamp are incompletely understood. Here, we performed Ala mutagenesis in conjunction with live-cell FRET analysis to examine residues in CC1 and CAD that regulate the inhibitory clamp. Our results indicate that in addition to previously identified hotspots in CC1⍺1 and CC3, several hydrophobic residues in CC2 and the apex region of CAD are critical for CC1-CAD interactions. Mutations in these residues loosen the CC1-CAD inhibitory clamp to release CAD from CC1 in cells with replete Ca2+ stores. By contrast, altering the hydrophobic residues L265 and L273 strengthens the clamp to prevent STIM1 activation. Inclusion of the inactivation domain of STIM1 helps stabilize CC1-CAD interaction in several mutants to prevent spontaneous STIM1 activation. In addition, R426C, a human disease-linked mutation in CC3, affects the clamp but also impairs Orai1 binding to inhibit CRAC channel activation. These results identify the CC2, apex, and inactivation domain regions of STIM1 as important determinants of STIM1 activation.

Minimum risk of intestinal parasitic infection to the visitors of Ghandruk, Kaski, Nepal: a pilot survey.

Ghandruk is one of the famous destinations of both international and domestic tourists situated in Kaski, Nepal. Travel-related diseases are an important aspect that one should consider before making a travel plan. Among diseases, zoonotically important ones make serious worries among visitors. In order to assess the existence of the zoonotically important parasitic disease in Ghandruk, a pilot survey was carried out by examining representative stool samples (n=51) of local residence, domestic animals, pet animals in Ghandruk. Samples were examined using direct smear as well as concentration methods. A questionnaire survey was conducted to see the associated risk factors among residents and their livestock of Ghandruk. None of the faecal samples from residents (n=14) found positive for any kind of intestinal parasites (IPs), while samples from most of the livestock: chicken (86%, 6/7), pigeons (75%, 3/4), cow (66%, 2/3), mule (60%, 3/5), and dog (60%, 3/5) showed heavy infection, except goat and buffalo indicated no infection. Eimeria spp., Ascardia spp. and cestodes spp. were the most prevalent IPs in livestock. Periodic deworming, walking outdoor with sandals/shoes, frequent use of soap and water for handwashing as reported by most of the residents (>80%) could be the main reason behind zero prevalence of IPs in them. The heavy infection among livestock may be incriminated to the contaminated vicinity and free-range livestock and poultry which were noticed in contact with river, sludge, and toilets during our field observation. Conclusively, it indicates that the residents of Ghandruk are conscious about their health, but have not paid satisfactory attention to the hygiene of their domestic animals including livestock, poultry and even pet. Though the observed parasites in livestock are of minimal zoonotic importance regarding safety of visitors, it is deemed necessary for at least to apply some preventive measures to mitigate the burden of parasites in their animals.

Factors affecting willingness to participate in vaccine clinical trials in an underdeveloped country: perspective from Nepal.

Due to the inherent complex nature of clinical trials, individual's willingness to participate and hence, enrollment in a clinical trial maybe challenging. When it comes to vaccine clinical trial in children, informed consent needs to be secured from the parents or legally acceptable representatives (LARs). Some of the factors which contribute to hesitancy in taking part in clinical trials are based on the level of education, living standards, part of the world they live, associated burden of disease, fear of different procedures in clinical trial, side effects, limited understanding, limited time, and mistrust with Investigational product. This study included 201 parents/LARs, who approached Kanti Children Hospital site in Kathmandu with the interest to get their children enrolled in a vaccine clinical trial with objectives of describing the reasons for agreeing or disagreeing to participate in the vaccine clinical trial, factors affecting decision making, and finding the major concerns of parents/LARs. The acceptance for the study vaccine was 136 (67.7%) whereas denial was 65 (32.3%). This study showed that age, education level, family structure, advice from family and friends, and medical guidance play important roles in willingness of parents to get their child enrolled in the trial. If a proper counseling is done, fear of blood sampling is not a big factor which is contrary to the belief among clinical researchers. Safety of vaccine, frequency of injections, and cost of vaccine were the main concerns of the parents, which need to be addressed extensively while planning for any clinical trial in children.

Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy under General Anaesthesia in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Postoperative nausea and vomiting are frequent complications after laparoscopic cholecystectomy. Several risk factors have been associated with postoperative nausea and vomiting. This study aimed to find out the prevalence of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anaesthesia in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted among the patients undergoing laparoscopic cholecystectomy under general anaesthesia at a tertiary care centre from 1 July 2021 to 30 April 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 050-077/078). Convenience sampling was done. All the patients received antiemetic prophylaxis with ondansetron. The general anaesthetic technique was standardised in all the patients. They were followed up 24 hours after surgery for an episode of nausea and vomiting. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 200 patients, postoperative nausea and vomiting were seen in 28 (14%) (9.19-18.81, 95% Confidence Interval). Among them, 7 (25%) of the patients experienced post-operative vomiting as well. CONCLUSIONS: The prevalence of postoperative nausea and vomiting among patients undergoing laparoscopic cholecystectomy in our study was lower when compared to other studies conducted in similar settings.

Conventional versus Modified Tarso-frontalis Suspension Surgery using Targeted Lid Crease for Simple Congenital Blepharoptosis with Poor Levator Action.

INTRODUCTION: The routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis with poor levator action is cosmetically less rewarding due to either an absence or asymmetry of the postoperative eyelid crease. The objective of this study was to assess the eyelid crease quality after a modified open method of tarso-frontalis suspension surgery compared to the closed method. MATERIALS AND METHODS: This was a retrospective comparative study reviewing the case sheets of all the patients undergoing unilateral tarso-frontalis suspension surgery with silicon rod employing Fox pentagon design from September 2017 to February 2019 at Mechi Eye Hospital, Jhapa, Nepal. A review of 40 case sheets of congenital lid ptosis with poor levator function(<4mm) aged 9 years or more was done. Tarso-frontalis suspension surgery, modified with a mini blepharoplasty incision, direct attachment of silicon rod to tarsus, completion of pentagon design with supra-brow incisions, and skin-orbicularis-tarsus-orbicularis-skin suture (open method) was done in 20 cases whereas other 20 cases underwent surgery with supraciliary stab incisions (closed method). RESULTS: The mean age of the patients was 21.1+5.9 years (range 9-30 years). The ptosis amount ranged from 3-10mm. At the 6th postoperative month, most of the cases had good ptosis correction (90% open group, 85% closed group, p=0.74). However, cosmetic outcomes were better in the open group compared to the closed group: 100% symmetrical eyelid crease compared to 40% (p<0.001) and 90% acceptance rate for eyelid contour compared to 70% (p=0.23). CONCLUSION: Predictable, targeted, and symmetrical lid crease can be obtained using the modified open method of tarso-frontalis suspension surgery.

Orai1 Channels Are Essential for Amplification of Glutamate-Evoked Ca2+ Signals in Dendritic Spines to Regulate Working and Associative Memory.

Store-operated Orai1 calcium channels function as highly Ca2+-selective ion channels and are broadly expressed in many tissues including the central nervous system, but their contributions to cognitive processing are largely unknown. Here, we report that many measures of synaptic, cellular, and behavioral models of learning are markedly attenuated in mice lacking Orai1 in forebrain excitatory neurons. Results with focal glutamate uncaging in hippocampal neurons support an essential role of Orai1 channels in amplifying NMDA-receptor-induced dendritic Ca2+ transients that drive activity-dependent spine morphogenesis and long-term potentiation at Schaffer collateral-CA1 synapses. Consistent with these signaling roles, mice lacking Orai1 in pyramidal neurons (but not interneurons) exhibit striking deficits in working and associative memory tasks. These findings identify Orai1 channels as essential regulators of dendritic spine Ca2+ signaling, synaptic plasticity, and cognition.

Temporary Membrane Permeabilization via the Pore-Forming Toxin Lysenin.

Pore-forming toxins are alluring tools for delivering biologically-active, impermeable cargoes to intracellular environments by introducing large conductance pathways into cell membranes. However, the lack of regulation often leads to the dissipation of electrical and chemical gradients, which might significantly affect the viability of cells under scrutiny. To mitigate these problems, we explored the use of lysenin channels to reversibly control the barrier function of natural and artificial lipid membrane systems by controlling the lysenin's transport properties. We employed artificial membranes and electrophysiology measurements in order to identify the influence of labels and media on the lysenin channel's conductance. Two cell culture models: Jurkat cells in suspension and adherent ATDC5 cells were utilized to demonstrate that lysenin channels may provide temporary cytosol access to membrane non-permeant propidium iodide and phalloidin. Permeability and cell viability were assessed by fluorescence spectroscopy and microscopy. Membrane resealing by chitosan or specific media addition proved to be an effective way of maintaining cellular viability. In addition, we loaded non-permeant dyes into liposomes via lysenin channels by controlling their conducting state with multivalent metal cations. The improved control over membrane permeability might prove fruitful for a large variety of biological or biomedical applications that require only temporary, non-destructive access to the inner environment enclosed by natural and artificial membranes.

Prevalence and factors associated with depression among higher secondary school adolescents of Pokhara Metropolitan, Nepal: a cross-sectional study.

OBJECTIVE: This study examined the prevalence and factors associated with depression among adolescents attending higher secondary schools in the Pokhara Metropolitan City of Nepal. DESIGN: A cross-sectional study design was adopted. SETTING: Four randomly selected higher secondary schools of Pokhara Metropolitan, Nepal. PARTICIPANTS: 312 randomly sampled higher secondary school students. METHODS: The Center for Epidemiologic Studies Depression Scale was used to assess the level of depression among students. The data collected through a self-administered questionnaire were analysed using descriptive statistical methods such as frequency and percentage. χ2 test and unadjusted OR (UOR) were calculated to assess the statistical relationship between depression and various variables at 95% CI, with level of significance at p<0.05. RESULTS: The study found a high prevalence of depression among high school students, with more than two-fifths (44.2%) of students having depression. Furthermore, almost a quarter (25.3%) of the students were noted to have mild depression and 18.9% of the students expressed major depression. Students who had low perceived social support (UOR: 3.604; 95% CI 2.088 to 6.220), did not share their problems with anyone (UOR: 1.931; 95% CI 1.228 to 3.038) and had low self-esteem (UOR: 5.282; 95% CI 2.994 to 9.319) were at higher odds of being depressed. CONCLUSION: A high prevalence of depression was observed among high school students. It was also observed that students' level of perceived social support, self-esteem and help-seeking behaviour are somehow related to their mental well-being. Hence, improving social support and self-esteem may alleviate depression and mental distress among these adolescents.

Association of parental methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in couples with unexplained recurrent pregnancy loss.

OBJECTIVE: The aim of this study was to identify the association of parental MTHFR C677T gene polymorphism in couples with and without RPL history. RESULTS: During the study, 21.4% (15/70) of Ala222Val polymorphism was observed among RPL couples while no polymorphism was seen among normal, healthy couples. Our study did not find any association between MTHFR C677T polymorphism and gender (p > 0.05), gestational period (p > 0.05), geographical region (p > 0.05) and menstrual history (p > 0.05). However, significant association was seen between MTHFR C677T polymorphism and number of losses (p < 0.05), concluding that the risk of the polymorphism increased with the increase in number of losses. Significant variation in the MTHFR C677T genotype with number of losses among RPL couples were seen but not with other study variables.