Stunting Among Under 5-Year-Olds in Nepal: Trends and Risk Factors

Maternal and Child Health Journal - Objectives Encouraging key parenting behaviors in early infancy may help decrease income-related developmental disparities. In this study we assessed whether a...     

Sonic hedgehog guides commissural axons along the longitudinal axis of the spinal cord

Dorsal commissural axons in the developing spinal cord cross the floor plate, then turn rostrally and grow along the longitudinal axis, close to the floor plate. We used a subtractive hybridization approach to identify guidance cues responsible for the rostral turn in chicken embryos. One of the candidates was the morphogen Sonic hedgehog (Shh). Silencing of the gene SHH (which encodes Shh) by in ovo RNAi during commissural axon navigation demonstrated a repulsive role in post-commissural axon guidance. This effect of Shh was not mediated by Patched (Ptc) and Smoothened (Smo), the receptors that mediate effects of Shh in morphogenesis and commissural axon growth toward the floor plate. Rather, functional in vivo studies showed that the repulsive effect of Shh on postcommissural axons was mediated by Hedgehog interacting protein (Hip).     

Out of Pocket Expenditure for Sick Newborn Care in Referral Hospitals of Nepal

Background

Almost all preventable neonatal deaths take place in low- and middle-income countries and affect the poorest who have the least access to high quality health services. Cost of health care is one of the factors preventing access to quality health services and universal health coverage. In Nepal, the majority of expenses related to newborn care are borne by the caregiver, regardless of socioeconomic status. We conducted a study to assess the out of pocket expenditure (OOPE) for sick newborn care in hospitals in Nepal.

Methods

This cross-sectional study of hospital care for newborns was conducted in 11 hospitals in Nepal and explored OOPE incurred by caregivers for sick newborn care. Data were collected from the caregivers of the sick newborn on the topics of cost of travel, accommodation, treatment (drugs, diagnosis) and documented on a sick newborn case record form.

Results

Data were collected from 814 caregivers. Cost of caregivers’ stay accounted for more than 40% of the OOPE for sick newborn care, followed by cost of travel, and the baby’s stay and treatment. The overall OOPE ranged from 13.6 to 226.1 US dollars (USD). The median OOPE was highest for preterm complications ($33.2 USD; CI 14.0–226.1), followed by hyperbilirubinemia ($31.9 USD; CI 14.0–60.7), respiratory distress syndrome ($26.9 USD; 15.3–121.5), neonatal sepsis ($ 25.8 USD; CI 13.6–139.8) and hypoxic ischemic encephalopathy ($23.4 USD; CI 13.6–97.7).

Discussion for practice

In Nepal, OOPE for sick newborn care in hospitals varied by neonatal morbidity and duration of stay. The largest proportion of OOPE were for accommodation and travel. Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals.

     

Sector analysis of 125I permanent prostate brachytherapy provides a rapid and effective method of evaluating and comparing pre- and post-implant dosimetry

PurposeTo evaluate a sector analysis program in the assessment and comparison of pre- and post-implant dosimetric parameters during the development of an ¹²⁵I permanent prostate brachytherapy service.Methods and MaterialsA total of 50 consecutive men being treated with permanent prostate brachytherapy had dose–volume analysis in 12 sectors of their pre-implant ultrasound (US_pre) and post-implant CT (CT_post) studies. Individual sectors were created by dividing prostate into three equal lengths, namely base, midgland, and apex. Each of these volumes was then divided into four axial sectors. Dosimetric parameters were compared in adjoining sectors within each study and between studies.ResultsThere were statistically significant differences between individual sectors on US_pre and CT_post volumes with CT_post higher than US_pre (p = 0.001). Statistically significant differences were found in corresponding sectors on US_pre and CT_post for all dosimetric parameters. The dosimetric parameters were significantly lower on CT_post in the anterior base and midgland (p = 0.001) and significantly higher at the posterior apex and midgland (p = 0.05). Dose homogeneity was demonstrated in adjoining sectors in all US_pre and most adjoining sectors on CT_post.ConclusionsSector analysis allows rapid assessment of US_pre and CT_post dosimetry. It offers a scientific method of identifying areas of increased and reduced dosing on CT_post when compared with US_pre, providing a learning tool to refine dosimetric analysis and highlight sectors where implant quality could be improved.     

Comparative evaluation of torasemide and furosemide on rats with streptozotocin-induced diabetic nephropathy

Nephropathy is one of the complications of diabetes mellitus in human and experimental animals. There are various pathological renal remodeling processes leading to diabetic nephropathy because of the chronic hyperglycemia during diabetes mellitus. Various reports suggest the involvement of oxidative stress, inflammation and fibrosis during this progression. As antihypertensive drugs are reported to provide renoprotection in various animal models and clinical studies, we have carried out this study to identify the effect of torasemide, a loop diuretic, against streptozotocin-induced diabetic nephropathy and compare with furosemide. Here we have performed the measurement of blood and urine parameters and renal protein expression levels for measuring the disease severity in streptozotocin-induced diabetic rats treated torasemide or furosemide and compared with the vehicle treated rats. Furosemide treatment significantly increased the urinary protein excretion when compared with the normal rats. Torasemide treatment has reduced the expression of mineralocorticoid receptor and oxidative stress marker p67phox levels with improved mRNA levels of heme oxygenase-1 in the kidneys. In addition, torasemide treated diabetic rats showed significantly reduced expression of renal fibrosis related proteins when compared with the vehicle treated diabetic rats. Although furosemide treatment has produced improvement, its effects are comparably less than that of torasemide. Thus with the present results, we can suggest that torasemide treatment can improve the diabetic kidney disease in this rat model and which is superior to furosemide against renal fibrotic remodeling.