Climate change and river health of the Marshyangdi Watershed, Nepal: An assessment using integrated approach.

Climate change alters the river flow regimes causing significant changes in the structure and function of an aquatic ecosystem, ultimately affecting river health. This study applied a customized framework consisting of 1-index, 4-components, 6-indicators, and 43-metrics, to assess river health for two seasons and future periods, in the Marshyangdi Watershed, Nepal. Hydrological, water quality, biological and physical conditions were assessed using simulated results from a hydrological model, physiochemical analysis of water samples, macroinvertebrates assemblages analysis, and physical habitat condition assessment, respectively. Climate change impact on river health was assessed based on projected climate (precipitation and temperature) based on regional climate models under representative concentration pathways (RCP) 4.5 and 8.5 scenarios until the mid-century. Results showed moderate river health condition in both the seasons and it's deterioration for future scenarios and periods. It reveals the need to formulate appropriate measures for the conservation of the river health.

Underweight full-term Indian neonates show differences in umbilical cord blood leukocyte phenotype: a cross-sectional study.

BACKGROUND: While infections are a major cause of neonatal mortality in India even in full-term neonates, this is an especial problem in the large proportion (~20%) of neonates born underweight (or small-for-gestational-age; SGA). One potential contributory factor for this susceptibility is the possibility that immune system maturation may be affected along with intrauterine growth retardation. METHODS: In order to examine the possibility that differences in immune status may underlie the susceptibility of SGA neonates to infections, we enumerated the frequencies and concentrations of 22 leukocyte subset populations as well as IgM and IgA levels in umbilical cord blood from full-term SGA neonates and compared them with values from normal-weight (or appropriate-for-gestational-age; AGA) full-term neonates. We eliminated most SGA-associated risk factors in the exclusion criteria so as to ensure that AGA-SGA differences, if any, would be more likely to be associated with the underweight status itself. RESULTS: An analysis of 502 such samples, including 50 from SGA neonates, showed that SGA neonates have significantly fewer plasmacytoid dendritic cells (pDCs), a higher myeloid DC (mDC) to pDC ratio, more natural killer (NK) cells, and higher IgM levels in cord blood in comparison with AGA neonates. Other differences were also observed such as tendencies to lower CD4:CD8 ratios and greater prominence of inflammatory monocytes, mDCs and neutrophils, but while some of them had substantial differences, they did not quite reach the standard level of statistical significance. CONCLUSIONS: These differences in cellular lineages of the immune system possibly reflect stress responses in utero associated with growth restriction. Increased susceptibility to infections may thus be linked to complex immune system dysregulation rather than simply retarded immune system maturation.

Pancreas divisum: an uncommon cause of acute pancreatitis.

Pancreas divisum is the most common congenital anomaly of the pancreas and has been reported to be an infrequent cause of acute and recurrent pancreatitis. The authors herein report a 4-year-old child with acute pancreatitis associated with pancreas divisum. Coexistent ascariasis initially suggested a diagnosis of pancreatic ascariasis.

Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit.

OBJECTIVE: To study the profile and outcome of children admitted to a tertiary level pediatric intensive care unit (PICU) in India. METHODS: Prospective study of patient demographics, PRISM III scores, diagnoses, treatment, morbidity and mortality of all PICU admissions. RESULTS: 948 children were admitted to the PICU. Mean age was 41.48 months. Male to female ratio was 2.95:1. Mean PRISM III score on admission was 18.50. Diagnoses included respiratory (19.7%), cardiac (9.7%), neurological (17.9%), infectious (12.5%), trauma (11.7%), other surgical (8.8%).196 children (20.68%) required mechanical ventilation. Average duration of ventilation was 6.39 days. 27 children (30.7 children /1000 admissions) had acute respiratory distress syndrome. Gross mortality was 6.7% (59 patients). PRISMIII adjusted mortality was directly proportional to PRISMIII scores. 49.5% of nonsurvivors had multiorgan failure. Average length of PICU stay was 4.52 +/- 2.6 days. Complications commonly encountered were atelectasis (6.37%), accidental extubation (2%), and pneumothorax (0.9%). Incidence of nosocomial infections was 16.86%. CONCLUSION: Our data appears to be similar with regards to PRISMIII scores and adjusted mortality, length of the PICU stay, and duration of ventilation, to previously published western data. Multiorgan failure remains a major cause of death. As expected, Dengue and malaria were common. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. Clearly more studies are required to assess the overall outcomes of critically ill children in India.