Depression Among Chronic Kidney Diseases Patients Receiving Hemodialysis

Background: Chronic Kidney Disease (CKD) is a progressive irreversible loss of renal function over a period of months or years. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintains life. Hemodialysis is used for patients who require short term dialysis (days to weeks) and for patients with advanced CKD and End Stage renal Disease (ESRD) who require long term or permanent renal replacement therapy. Hemodialysis significantly and adversely affects the lives of patients, both physically and psychologically. Depression is the most common psychological condition among patients with ESRD. Depression in dialysis patients not only effect mortality, but increased rate of hospitalizations and dialysis withdrawal is also very common.  Methods: A descriptive exploratory research design was carried out to identify the depression level of chronic kidney disease patients receiving Hemodialysis in Western Regional Hospital, Pokhara using Beck Depression Inventory among forty six patients.  Results: The study findings revealed that majority of the patients (84.8%) has various degree of depression i.e. mild (21.7%), moderate (30.8%) and severe (32.6%). Only fifteen percent of patient has no depression. There was no statistical association between the level of depression and socio-demographic variables. It can be concluded that the prevalence of depression is high among patients receiving Hemodialysis. Conclusion: The prevalence of depression is high among patients receiving Hemodialysis. It is effective to provide mental health services to the CKD patients receiving Hemodialysis which help them better psychologically adaptation to their disease and improve their quality of life

On-farm Diversity Assessment and Evaluation of Finger Millet Genotypes in the Mid Hills of Nepal

The objective of the study is to assess the phenotypic diversity among the finger millet genotypes and evaluate overall performance for the recommendation of genotypes to the farming community of mid hills of Nepal. The overall performance of 8 candidate genotypes selected  from diversity block of 46 varieties in 2015, were assessed in randomized complete block design (RCBD) with three replicates under on-farm conditions in Lamjung district during 2016. Highly significant (p?0.01) variability among the selected 8 genotypes for agro-morphological traits viz., plant height, number of fingers per head, grain yield, 1000 grain weight, straw yield, days to heading and maturity was revealed. Strong inter-correlation among grain yield, plant height, time to flowering and straw yield was detected. The traits viz., plant height, grain yield, straw yield, days to heading and days to maturity were the most important traits contributing to the overall variability and thus, provide options for selection

Child Trafficking and Associated Factors in Earthquake Affected Area of Nepal

Background: Recruitment, transportation, transfers, harboring, and/or receipt kidnapping of under 18 yrs child for the purpose of slavery, forced labor and exploitation is Child Trafficking. To assess the knowledge about child trafficking and factors associated with child trafficking in Gorkha district of Nepal Methods: Cross sectional study conducted to determine the knowledge and factors related to child trafficking in Gorkha district. Two urban municipalities selected purposively and other three rural municipalities were randomly selected.  Out of 160,772 households, total 300 households for survey was calculated by using Yamane formula (n) = N/ (1+Ne2). Wards of the municipalities were Primary Sampling Unit. Based on Population Proportionate Sampling technique; required number of households of each Wards was identified.  In Wards, households for survey were selected by using simple random method.  Head of the selected household were the respondent for household survey. Ten Key Informant Interviews were done with policemen, teachers, social workers, community leaders, stakeholders and six Focus Group Discussions were done with Youths (15-25 yrs), Parents and Social worker/teacher/community leader groups. Results: Remarkable proportions of respondents have correct knowledge about the child trafficking. Near relatives, unknown person, pears group, parents/family members and neighbor were common traffickers. During and after disaster is the most vulnerable time/event for child trafficking. False marriage, assuring lucrative job, asking for adoption and proposing good education were tricks of traffickers for child trafficking.  Homeless children, children travelling without parents, socially isolated children, children travelling at night, unprotected girl child like orphan, separated from family or without parent are most vulnerable for child Trafficking. Conclusions: Family, social groups, government officials and stakeholders should jointly initiate for anti child trafficking movement. School teacher and management committee should also take initiation to make fully aware to school going children about different dimension/aspect of Child Right and Child Trafficking

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Critical sets in orthogonal arrays with 7 and 9 levels

To date very few results are known on the critical sets for a set of Mutually Orthogonal Latin Squares(MOLS). In this paper, we consider Orthogonal Array OA(n2,k+2,n,2) constructed from k mutually orthogonal cyclic latin squares of order n and obtain bounds on the possible sizes of the minimal critical sets. In particular, for n = 7 we exhibit a critical set, thereby improving the bound reported in Keedwell (1997). The problem is also addressed for n = 9 and a critical set is also presented

Agro-morphological diversity of Nepalese naked barley landraces

Abstract Background Naked barley is a traditional, climate-resilient and highly nutritious crop of the high mountains of Nepal. Knowledge of agro-morphological diversity among the naked barely genotypes is fundamental for their efficient utilization in plant breeding schemes and effective conservation programs. The primary objective of this study is phenotypic characterization and diversity assessment of naked barley landraces in Nepal for pre-breeding purposes. Methodology Data on quantitative and qualitative traits of 25 naked barley landraces from diversity blocks established across the four mountainous locations of Nepal (Humla, Jumla, Dolakha and Lamjung) were subjected to calculation of descriptive statistics and multivariate analysis (UPGMA cluster analysis/principal component analysis). Frequency distribution of various categories of qualitative traits and Shannon–Weaver diversity indices were computed. Results The UPGMA cluster analysis using both quantitative and qualitative traits individually categorized the 25 naked barley landraces in five clusters in each case with no distinct regional grouping patterns in such a way that the landraces from same or adjacent regions of origin and collection amassed in different clusters. NGRC04894, Lamjung Local, NGRC02306, NPGR1579, NGRC02327 and NPGR1579 exhibited morphoagronomical superiority and potentiality for utilization as genitors in crop improvement programs. Principal component analysis revealed the quantitative traits, viz. grain yield, plant height and earliness, and qualitative traits, viz. grain color, overall phenotypic performance, lemma awn/hood and lemma awn barbs, to be the principal discriminatory characteristics of the Nepalese naked barley landrace collection. The Shannon–Weaver diversity index (H′) ranged from 0.32 to 0.99 with a mean value of 0.73, inferring tremendous diversity in the collection for the qualitative traits. Conclusion The marked diversity observed among the Nepalese naked barley landraces could be utilized in crop improvement for various traits. The information generated complements the robust breeding program of competitive, stable and climate-resilient varieties of end users’ preferences in different mountainous agro-ecologies and also bolsters the employment of innovative and proven participatory plant breeding approach using diversity kits and informal research and development kits to expand and promote the varietal choice options for expeditious benefits to the farmers in the high mountains, considering that only one naked barley variety, viz. Solu Uwa, has been released in Nepal to date