Analysis of umbilical cord blood gas in term and near term asphyxiated newborn babies

Introductions: This study aims to determine the incidence of perinatal asphyxia in neonates with low Apgar and Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated babies. Methods: This was a cross sectional study from November 1, 2010 to July 30, 2011. Babies with Apgar score of less than seven at five minute were enrolled in the study. Blood was drawn from umbilical cord artery for blood gas analysis. Neonates were followed up in every six hours for at least 48 hours. Staging of HIE according to Sarnat staging was done in babies with Apgar score of <7 at five minutes within 24 hours of birth.  Results: Total of 2,425 live births, 56 (2.30%) were born with an Apgar of < 7 at five minute, six were excluded (due to set exclusion criteria) and remaining 50 were analysed. Thirty-four (68% of 50) of babies with low Apgar score had maternal risk factors – meconium stained liquor being the commonest risk factor. Majority (46%) had cord blood pH of >7.2, 40% had between 7.1 to 7.2, 12% between 7 to 7.1 and remaining 2% had pH < 7. HIE developed in 22% (11/50) of the asphyxiated babies. Conclusions: More than 1/3rd (46%) of babies with low Apgar had low cord blood pH, 1/4th (26%) had base excess, and 22% developed features of HIE. Cord blood pH were better predictors than Apgar in asphyxiated babies. Keywords: Apgar score, cord blood, hypoxic ischemic encephalopathy (HIE

DRUG UTILISATION STUDY OF STROKE AND OTHER PATIENTS ADMITTED TO GENERAL WARD OF NEUROLOGY UNIT AT QUATERNARY CARE PRIVATE HOSPITAL

Objective: To study the profile of the patient, the pattern of their illness and their drug use patterns attending to general ward of quaternary care hospital.Methods: Prospective observational study of 2 mo was performed at neurology unit of the quaternary care private hospital, India. Patients aged above 20 y with at least one neurological drug in prescription were included to observe their demographic profile, illness pattern and drug use. The data was analysed and summarised as frequency and percentage using microsoft excel and presented as tables.Results: Among 60 patient that were enrolled, more were males (N=33, 55%) than females (N=27, 45%) and within the age group of 60-70 y (N=22, 36.67%). The majority of patients were diagnosed with strokes (N= 48, 80%) where the cerebrovascular accident was most common (N=16, 26.66%). Males (N=29, 60.4%) were more prone to get stroke than females (N=19,39.6%). An average number of drugs per prescription was 5.7, the percentage of antibiotics, generic drugs and injections were 36.6%, 0.05% and 44.14% respectively. A total of 28 different drug classes with 61 different drugs was utilised. Fourteen drug classes had been accounted for 90% of drugs utilisation. Clopidegrol+Aspirin have frequently used the drug.Conclusion: Most people attending neurology unit were elderly. Stroke occupies 1st list for the burden. Average drugs for neurology visit remain high. Wide types of drug classes are utilised in neurological ward

Performance of black gram varieties to mungbean yellow mosaic disease at different sowing dates under spring and summer condition in western terai of Nepal

A field experiment was conducted at Grain Legumes Research Program (GLRP), Khajura, Banke, Nepal during spring and summer season 2019 to elucidate the effect of date of sowing and blackgram varieties on mungbean yellow mosaic disease severity and yield. The experiment was conducted in 2 factorial randomized complete block design with 3 replications. Factor A comprised date of sowing (S1= 5th April 2019, S2= 20th April 2019, S3= 5th May 2019, S4= 20th May 2019, S5= 25th July 2019, S6= 10th August 2019, S7= 25th August 2019 and S8= 10th September 2019) and factor B (Variety): V1= Khajura Mas 1 and V2= Rampur Mas. Disease severity was scored in 1-6 scale. Results revealed that mean values for days to disease appearance, disease score and grain yield in spring season sowing was 26 days, 3.72 and 635 kg/ha, whereas for summer season sowing was 14 days, 5.04 and 185 kg/ha.  Among the date of sowing, April 5th sown crop recorded minimum mean disease score (3.1) with highest yield (719 kg/ha). Whereas, September 10th sown crop recorded maximum mean disease score (5.1) with lowest yield (174 kg/ha). Black gram varieties showed significant response to mean disease score and yield at early sowing condition but when the sowing date was delayed, there was no significant response of varieties to mean disease score and yield. The contribution of regression (R2 =0.791) and (R2 = 0.655) for spring season and summer season indicate that 79% and 65% of the blackgram yield would be affected by disease for the respective season. Therefore, it is better to sow blackgram in early season to escape mungbean yellow mosaic disease and minimize yield loss

Effects of Variable Electrical Conductivity Levels in Hydroponic Nutrient Solutions on Morphological and Physiochemical Characteristics of Cucumber Plants in Advanced Greenhouse Cultivation

Cucumber (Cucumus sativus L.) is a fruit of the Cucurbitaceae family that is refreshing, low in calories, and offers various health benefits due to its rich nutritional profile. However, high-tech hydroponic greenhouse production of cucumber is nutrient-intensive and requires efficient management of electrical conductivity (EC) in the growing medium. In this study, three different EC levels (1.3, 2.6, and 3.6 dS/m) were applied to the nutrient medium of hydroponically grown Lebanese and Continental varieties of cucumber. The experiment did not have a significant impact on the number of fruits (p=0.744, p=0.163) or leaves per plant (p=0.252, p=0.377) at varying EC levels. However, in the Continental variety, pH (0.001***) and osmolality (0.005**) were significantly different among the three varied EC levels. High EC levels in the nutrient medium resulted in reduced TSS, pH, and osmolality of the fruit juice. Although the plants grown in low EC conditions produced almost the same number of fruits and leaves per plant as those grown in optimal EC conditions (2.6 dS/m), the physio-chemical attributes of the cucumbers were of inferior quality

Exploratory action research: experiences of Nepalese EFL teachers

The number of reports and publications about exploratory action research (EAR) has been increasing in recent years; however, there is still a dearth of studies that examine its effectiveness for improving teaching and learning. This study explores Nepalese EFL teachers’ perceptions of EAR, the ways they explored their classroom issues, and how they acted to improve their classroom practices through involvement in an online EAR training course for a year. The data collected from interviews and the teachers’ written reports show that these teachers found EAR to be an effective approach to explore their classroom puzzles or problems and develop informed, context-sensitive strategies to solve these. The findings of this study are relevant for teachers, teacher educators, and education policymakers in providing insights into the value of EAR for bringing about changes in teaching and learning situations

The feasibility of the Ages and Stages Questionnaire for the assessment of child development in a community setting in Nepal

Background: The Ages and Stages Questionnaire Third Edition (ASQ‐3) may be a feasible and cost‐effective tool to screen children's development in resource poor settings. We have assessed the feasibility of the ASQ‐3 “home procedure” when conducted by fieldworkers in a community‐based nutritional interventional trial on early child development in Nepal. Method: Six hundred children aged 6–11 months at risk of stunting were assessed by trained fieldworkers in their homes by the ASQ‐3. Three fieldworkers performed standardization exercises and were double scored with a gold standard during the study period. Intraclass correlations (ICCs) were calculated to measure the interrater agreement. The internal consistency was expressed by standardized Cronbach's alphas. The association between total ASQ score and gestation, low birth weight, and stunted children is presented to give an estimate of the construct validity of the tool. Result: Mean scores of the 600 Nepalese children were consistently lower than in the American norm sample. The ICCs from the standardization exercises were initially good to excellent but declined throughout the study period. The standardized alphas for the total score in the different age groups indicate good internal consistency but varied in the subscales. Children who were preterm, children with low birth weight, and children who were stunted scored substantially lower on the total ASQ score than those who were not. Conclusion: Although the ASQ‐3 “home procedure” is low at cost and easily accessible in a Nepalese context, the tool requires rigorous and stringent training to achieve acceptable interrater agreement. Further adjustment is required to achieve satisfactory internal consistency.acceptedVersio

The effect of infant vitamin B12 supplementation on neurodevelopment: A follow-up of a randomized placebo-controlled trial in Nepal.

The most critical period for brain development is before a child’s second birthday. Standardised tests measuring neurodevelopment are more reliable when administered after this period. Severe vitamin B12 deficiency affects brain development and function. In a randomised, double-blind, placebo-controlled trial in 600 Nepalese infants (6–11 months at enrolment), we found no effect of 2 µg vitamin B12 daily for a year on neurodevelopment. The primary objective of the current study was to measure the effect of the intervention on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) full scale intelligence quotient (FSIQ). We measured the effect on the Bayley Scales of Infant and Toddler Development 3rd edition at age 30–35 months (n 555). At age 42–47 months (n 533), we used the WPPSI-IV and subtests from the Neuropsychological Assessment, 2nd edition (NEPSY-II). We also used the FSIQ to estimate subgroup specific effects. The mean (SD) WPPSI-IV FSIQ in the vitamin B12 group was 84·4 (8·4) and 85·0 (8·6) in the placebo group (mean difference −0·5 (95 % CI -1·97, 0·94), P = 0·48). There were no effect of the vitamin B12 on any of the other neurodevelopmental outcomes and no beneficial effect in any of the subgroups. In conclusion, providing 2 µg of vitamin B12 for a year in infants at risk of vitamin B12 deficiency does not improve preschool cognitive function.publishedVersio

Determinants of Cognitive Development in the Early Life of Children in Bhaktapur, Nepal

Background: Children in low and middle income countries may have many risk factors for poor cognitive development, and are accordingly at a high risk of not reaching their developmental potential. Determinants for cognitive development in early life can be found among biological and socioeconomic factors, as well as in stimulation and learning opportunities. Objective: The present study aimed to identify determinants of cognitive, language and motor development in 6-11 months old Nepalese infants. Methods: Six hundred infants with a length-for-age z-score <-1 were assessed with the Bayley Scales of Infant and Toddler development, 3rd edition (Bayley-III). Information on socioeconomic factors, child and maternal demographics, clinical and biological factors, and the home environment were collected. In a manual stepwise variable selection procedure, we examined the association between selected biological, socioeconomic and stimulation and learning opportunity variables and the Bayley-III cognitive, language and motor development subscale scores in multiple linear regression models. Results: The length-for-age z-scores was positively associated with the cognitive composite score [standardized beta (ß): 0.22, p < 0.001] and the motor composite score [(ß): 0.14, p = 0.001]. Children born with low birth weight (<2500 g) scored significantly lower on all subscale scores. Diarrheal history was associated with poor language composite scores, and females had higher language composite scores than boys [(ß): 0.11, p = 0.015]. Children who had been hospitalized during the first month of life had also lower cognitive and motor composite scores than those who had not been hospitalized. Parental reports of physical punishment and lack of spontaneous vocalization were associated with poor cognitive and language composite scores, respectively. The statistical models with the various subscale scores as dependent variables explained between 8 to 16 percent of the variability in the cognitive developmental outcomes. Conclusion: Our findings reveal important determinants for developmental scores in infancy, and underline the role of biological risk factors faced by marginalized children in low and middle income countries such as in Nepal. Copyright © 2019 Ranjitkar, Hysing, Kvestad, Shrestha, Ulak, Shilpakar, Sintakala, Chandyo, Shrestha and Strand.publishedVersio

Genetic variability, heritability and genetic advance in Lentil (Lens culinaris Medik.)

The present study was carried out to study the variation, broad-sense heritability, and genetic advance, correlation among traits for growth, yield, and its attributing traits in lentil genotypes. Sixty lentil genotypes were evaluated in augmented design in 2020 at Khajura, Banke. The results indicated that the genotypes were significantly different for days to flowering, days to maturity, 500 seed weight and grain yield kg/ha. The phenotypic coefficient of variation (PCV) was greater than the genotypic coefficient of variance (GCV) for all traits. The 500 seed weight showed the highest PCV (22%) and GCV (21%) whereas days to maturity showed the lowest PCV (5.5%) and GCV (3.2%). The highest value (90%) of heritability (broad sense) was in and lowest (3%) in pods per plant. Genetic Advance Mean 40% was the highest for seed weight but lowest at 1.2% in pods per plant. Grain yield showed a positive and significant correlation in genotypic level with days to maturity (r = 0.7**), plant height (r = 1.66*), pods per plant (r = 1.15**) and seed weight (r = 0.56*). Path analysis found that the seed weight had the most impact on grain yield followed by pod per plant. Thus, selection for yield in lentils through these characteristics would be effective in the varietal developmental program. &nbsp

Effect of an improved biomass stove on acute lower respiratory infections in young children in rural Nepal: a cluster-randomised, step-wedge trial

Background Acute lower respiratory infections (ALRI) are an important cause of death in young children in low income countries. High concentrations of fine particulate matter (PM2.5) indoors caused by open burning of biomass are associated with risk of ALRI. However, improved biomass stoves reduce emissions and might reduce the incidence of lower respiratory illness. A cluster-randomised, step-wedge, community-based trial was conducted to estimate the eff ect that a change from open burning of biomass to improved biomass stoves could have on rates of ALRI in children younger than 36 months in a rural area of southern Nepal. Methods Households were enrolled in Sarlahi district that had at least one child aged younger than 36 months or a married woman aged 15–30 years. Respiratory morbidity data were collected for 6 months prior to the introduction of improved biomass stoves between March, 2010, and December, 2010. Mothers were asked about respiratory signs and symptoms (cough, difficult or rapid breathing, wheeze, ear discharge, fever) in their participating children in the past 7 days during weekly visits from local study staff. A 12-month stepped-wedge introduction of an improved biomass stove with chimney to participating households followed the 6-month run-in period (Envirofit Corp. Colorado Springs, CO, USA). Weekly morbidity assessments continued during the step-wedge period (from January, 2011, to February, 2012) and for 6 months after stove introduction (from March, 2012, to December, 2012). Children were discharged at age 36 months. The primary outcome was ALRI, defined as a maternal report of 2 or more consecutive days of fast or difficult breathing accompanied by fever. Episodes were separated by a minimum of 7 symptom-free days. An environmental assessment was done in households once before and once after the improved stove was installed. The trial is registered at clinicaltrials.gov (NCT00786877). Findings 5254 children from 3376 households were enrolled either at baseline or during the trial period. Mean 20-h kitchen concentration of PM2.5 was reduced from 1386 μg/m3 to 930 μg/m3 There was a strong secular decline in the incidence of ALRI over the period of the study. The intervention was associated with a 13% decline in the incidence of ALRI but the strength of evidence was weak (0·87, 95% CI 0·67–1·13). There were statistically significant reductions in persistent cough (0·91, 0·85–0·97), wheeze (0·87, 0·78–0·97) and burn injury (0·68, 0·48–0·95) but not for fever, severe ALRI, or ear discharge. Interpretation There was weak evidence for a modest decline in the incidence of ALRI. Post-installation PM2.5 concentrations remained well above current indoor air standards of 25 μg/m3 . Better performing biomass stoves or cleaner fuels such as liquid petroleum gas or ethanol are needed to reduce concentrations enough to estimate the impact on ALRI incidence