Seed Rain in a Tropical Lowland Rainforest Fragment in Central Sri Lanka

Fragmentation of tropical rainforests can adversely affect seed dynamics due to the habitat loss, changed habitat configuration and altered species interactions. Halgolla Forest Reserve (HFR) is an isolated tropical lowland wet evergreen rainforest fragment, located in central province of Sri Lanka. Despite its small size, it harbors high biodiversity with many endemic species. However the biodiversity of HFR is highly threatened due to the agricultural expansion, illegal encroachments and logging. Thus, the study investigated the regeneration potential of the fragment by assessing seed rain dynamics in HFR. Comparisons were made for seed density and species diversity in seed rain of the forest edge (highly disturbed), riverine area (less disturbed) and forest interior (undisturbed) habitats for one year. Thirty plots of 10×10 m2 (ten plots each per habitat) were established using stratified random sampling at the forest edge, forest interior and riverine areas. Seed traps (1×1 m2) were placed in each plot and contents of traps were collected once in two weeks from November 2017 to November 2018. Seed morphotypes and abundance of species were recorded and diversity indices were calculated to make the comparisons between the three habitats. A total number of 28,714 seeds were recorded under 107 morphospecies in the seed rain. The seed density was higher in the forest edge (1,659.6 m-2year-1) than in the forest interior (533.1 m-2year-1) and the riverine habitat (678.8 m-2year-1). The differences in seed density between forest edge and interior habitats may be due to the altered seed dispersal patterns after fragmentation. Seed rain peaked at the end of dry season prior to the beginning of rainy season. The highest seed abundance was recorded by Ficus spp. in all three habitats. Species richness was more or less similar in all three habitats. Species diversity and evenness were lower in more disturbed forest edge than in forest interior and riverine habitats. HFR has a high regeneration potential probably due to being closer to other forest patches that can act as seed sources for HFR. However the influx of non-rainforest species through seed rain such as Coffea arabica L., Camellia sinensis (L.) Kuntze, Alstonia macrophylla Wall. ex G. Don and Swietenia macrophylla King from surrounding matrix is an evidence for habitat disturbance which indicate a threat to the regeneration of native species surviving in the forest fragment. Conservation of this forest fragment through enhanced awareness and community participation is vital to preserve this biodiversity refugium.Keywords: Seed rain, Tropical lowland rainforest fragment, Seed density, Species diversit

Teleneurology based management of infantile spasms during COVID-19 pandemic: A consensus report by the south Asia allied west syndrome research group

With telehealth services rescuing patients with chronic neurological disorders during the COVID-19 pandemic, there is a need for simplified teleneurology protocols for neurological disorders in children. Infantile spasms is an epileptic encephalopathy where treatment lag is a significant predictor of outcome. It is one such condition where telemedicine can make a remarkable difference when in-person consultations are delayed or are not possible. However, the adverse effect profile of the first-line therapeutic options, the need for frequent follow-up, underdeveloped telemedicine services, lack of a rational protocol, poor awareness about infantile spasms, a lesser level of parental understanding, and scarcity of pediatric neurologists are the major hurdles in developing countries. This paper provides a teleneurology based approach for the management of infantile spasms in developing countries during the COVID-19 pandemic. The cornerstones of this approach include the fundamental principles of management of infantile spasms, decentralization of patient care to local health providers, efforts for improving sensitivity and specificity of diagnosis, early initiation of first-line therapeutic options, and constant motivation of parents and local health providers to be vigilant for therapeutic response, adverse effects of therapy, and infections

Management practices for west syndrome in south Asia: A survey study and meta-analysis

Objectives: Considering the dearth of literature on West syndrome (WS) from South Asian countries, this study aimed to evaluate the management practices in South Asia by an online survey and meta-analysis.Methods: An online questionnaire was sent to 223 pediatric neurologists/pediatricians in India, Pakistan, Myanmar, Sri Lanka, Bhutan, Nepal, and Bangladesh. Their responses were evaluated and supplemented by a meta-analysis.Results: Of 125 responses received (response rate: 56%), around 60% of responders observed male preponderance and an approximate lead-time-to-treatment (LTTT) of 4-12 weeks. The commonest etiology observed was a static structural insult (88.6% of responders). Most commonly used first-line drug (country-wise) was as follows: India-adrenocorticotropin hormone (ACTH, 50%); Pakistan-oral steroids (45.5%); Myanmar, Sri Lanka, and Nepal-oral steroids (94.4%); Bangladesh-ACTH (2/2); Bhutan-vigabatrin (3/5). ACTH and vigabatrin are not available in Myanmar and Nepal. The most commonly used regime for ACTH was maximal-dose-at-initiation-regime in India, Sri Lanka, and Bangladesh and gradually escalating-regime in Pakistan. Maximum dose of prednisolone was variable-most common response from India: 3-4 mg/kg/d; Pakistan, Bhutan, and Bangladesh: 2 mg/kg/d; Sri Lanka, Nepal, and Myanmar: 5-8 mg/kg/d or 60 mg/d. The total duration of hormonal therapy (including tapering) ranged from 4 to 12 weeks (67/91). Most responders considered cessation of spasms for four weeks as complete response (54/111) and advised electroencephalography (EEG; 104/123) to check for hypsarrhythmia resolution. Difficult access to pediatric EEG in Bhutan and Nepal is concerning. More than 95% of responders felt a need for more awareness. The meta-analysis supported the preponderance of male gender (68%; confidence interval [CI]: 64%-73%), structural etiology(80%; CI 73%-86%), longer LTTT (2.4 months; CI 2.1-2.6 months), and low response rate to hormonal therapy(18% and 28% for ACTH and oral steroids respectively) in WS in South Asia.Significance: This study highlights the practices and challenges in the management of WS in South Asia. These include a preponderance of male gender and structural etiology, a longer LTTT, difficult access to pediatric EEG, nonavailability of ACTH and vigabatrin in some countries, and low effectiveness of hormonal therapy in this region

Epilepsy after perinatal stroke with different vascular subtypes

Objective: With an incidence up to 63/100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence and predictive factors of epilepsy, and to describe the course of epilepsy of children with perinatal stroke with different vascular subtypes. Methods: Patients were retrieved from Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into five perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. Results: Final study group included 73 children with perinatal stroke (39 boys). With median follow-up time 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative post-stroke epilepsy risk according to Kaplan-Meier estimator was 40.8% (95%CI: 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS had more often severe epilepsy syndromes. Cortical lesions (OR 19.7; 95%CI 2.9–133), involvement of thalamus (OR 9.8; 95%CI: 1.8–53.5) and temporal lobe (OR 8.3; 95%CI: 1.8–39.6) were independently associated with post-stroke epilepsy. Significance: The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time. This article is protected by copyright. All rights reserved.Peer reviewe

Hypothermia for encephalopathy in low and middle-income countries (HELIX): Study protocol for a randomised controlled trial

BACKGROUND: Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries and is used as standard therapy in these settings. However, the safety and efficacy of cooling therapy in low- and middle-income countries (LMICs), where 99% of the disease burden occurs, remains unclear. We will examine whether whole body cooling reduces death or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs. METHODS: We will randomly allocate 408 term or near-term babies (aged ≤ 6 h) with moderate or severe neonatal encephalopathy admitted to public sector neonatal units in LMIC countries (India, Bangladesh or Sri Lanka), to either usual care alone or whole-body cooling with usual care. Babies allocated to the cooling arm will have core body temperature maintained at 33.5 °C using a servo-controlled cooling device for 72 h, followed by re-warming at 0.5 °C per hour. All babies will have detailed infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our primary endpoint is death or moderate or severe disability at the age of 18 months. DISCUSSION: Upon completion, HELIX will be the largest cooling trial in neonatal encephalopathy and will provide a definitive answer regarding the safety and efficacy of cooling therapy for neonatal encephalopathy in LMICs. The trial will also provide important data about the influence of co-existent perinatal infection on the efficacy of hypothermic neuroprotection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02387385. Registered on 27 February 2015

Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh

Background: Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. Methods: We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18–22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. Findings: We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87–1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. Interpretation: Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. Funding: National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. Translations: For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section

Gillespie syndrome in a South Asian child:a case report with confirmation of a heterozygous mutation of the ITPR1 gene and review of the clinical and molecular features

Abstract Background Gillespie syndrome is a rare, congenital, neurological disorder characterized by the association of partial bilateral aniridia, non-progressive cerebellar ataxia and intellectual disability. Homozygous and heterozygous pathogenic variants of the ITPR1 gene encoding an inositol 1, 4, 5- triphosphate- responsive calcium channel have been identified in 13 patients recently. There have been 22 cases reported in the literature by 2016, mostly from the western hemisphere with none reported from Sri Lanka. Case presentation A 10-year-old girl born to healthy non-consanguineous parents with delayed development is described. She started walking unaided by 9 years with a significantly unsteady gait and her speech was similarly delayed. Physical examination revealed multiple cerebellar signs. Slit lamp examination of eyes revealed bilateral partial aniridia. Magnetic resonance imaging of brain at the age of 10 years revealed cerebellar (mainly vermian) hypoplasia. Genetic testing confirmed the clinical suspicion and demonstrated a heterozygous pathogenic variant c.7786_7788delAAG p.(Lys2596del) in the ITPR1 gene. Conclusion The report of this child with molecular confirmation of Gillespie syndrome highlights the need for careful evaluation of ophthalmological and neurological features in patients that enables correct clinical diagnosis. The availability of genetic testing enables more accurate counseling of the parents and patients regarding recurrence risks to other family members

EpiNet as a way of involving more physicians and patients in epilepsy research: validation study and accreditation process

Objective EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator‐led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet‐First trials. Methods Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet‐First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false‐positive errors and could make only one error regarding seizure classification. Results Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet‐First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. Significance We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet‐accredited and to participate in these investigator‐led clinical trials

Design of a garbage compacting tractor trailer hydraulic system

The most common motorized vehicle used for garbage transportation in Sri Lanka is the tractor with an open trailer. Garbage is transported in an open system causing unpleasantness, pollution, bad smell, poor hygiene and over spillage. The objective of the proposed design is to improve the capacity of garbage handled by the open tractor-trailer per each transport cycle and to improvise a closed system for waste transport to improve hygienic standards. The proposed design is one in which an existing tractor-trailer is modified to a rear loading trailer. While loading, the garbage will be compacted using a hydraulic system to overcome the low productivity. A hydraulic pump, solenoid valves, hydraulic cylinders and an electrical system are used for this construction. Apart from this, the trailer body is modified into a closed body. The measured value of solid waste currently handled per single load which is approximately 1000 kg, will be improved to about 2000 kg per load. The closed system will minimise the environmental pollution present in the existing system. These modifications to the existing tractor trailer would help to improve the present standards of , solid waste management at a relatively low cost. The cost of installation of the hydraulic system and constructing a closed body IS approximately seven hundred thousand rupees.The most common motorized vehicle used for garbage transportation in Sri Lanka is the tractor with an open trailer. Garbage is transported in an open system causing unpleasantness, pollution, bad smell, poor hygiene and over spillage. The objective of the proposed design is to improve the capacity of garbage handled by the open tractor-trailer per each transport cycle and to improvise a closed system for waste transport to improve hygienic standards. The proposed design is one in which an existing tractor-trailer is modified to a rear loading trailer. While loading, the garbage will be compacted using a hydraulic system to overcome the low productivity. A hydraulic pump, solenoid valves, hydraulic cylinders and an electrical system are used for this construction. Apart from this, the trailer body is modified into a closed body. The measured value of solid waste currently handled per single load which is approximately 1000 kg, will be improved to about 2000 kg per load. The closed system will minimise the environmental pollution present in the existing system. These modifications to the existing tractor trailer would help to improve the present standards of , solid waste management at a relatively low cost. The cost of installation of the hydraulic system and constructing a closed body IS approximately seven hundred thousand rupees