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Introduction: Medical science is one of the most advance and modern technology over the course of time period with extensive research and scientific knowledge of human body and health care to make incredible changes enabling the population remain healthy with mere absence of disease or infirmity. Research is considered as one of the useful measures to track the scientific advancement of a country. Promoting research skills in undergraduate and post graduate medical students help to develop scientific advancement in medical field of a country. Aims: To assess knowledge, attitude, and perceived barriers among undergraduate and postgraduate medical students. Methods: An institutional based cross sectional analytical study covering total 224 undergraduate and postgraduate medical students of Nepalgunj Medical College was from January 2022 to April 2022. A pre tested, pre designed, sets of questionnaire were provided to all recruited participants after obtaining informed written consent. Then informations generated by the study were analyzed for scientific result by using descriptive analysis and independent T- test. Results: Male students were 135(60.3%) whereas female students were 89(39.7%) only. The mean knowledge score was 33.69 ± 3.8 and mean attitude score was 19.67 ± 2.34. The average 100(44.6%) had good knowledge and 118(52.7%) had positive attitude towards medical research. Most common perceived barrier was not having proper mentoring and research familiarity. Seventy Six(39.6%) undergraduate students had behavioral hesitation to participate in research while 21(65.6%) post graduate students showed social factor as one of the hesitancy to involve in research. Conclusion: Most of the participants had good knowledge regarding research and expressed positive attitude toward involvement in research activity. Some of barriers were lack of funds, awareness and research skills. This study would improve scientific knowledge and research skills for academicians and clinicians too.

The Severe Acute Respiratory Syndrome Coronavirus 2 causes COVID-19 infection. Vitamins C and D have been investigated for their effects on COVID-19 including the severity of it’s symptoms and complications. These vitamins may provide some benefits against the Severe Acute Respiratory Syndrome Coronavirus 2 as they modulate the immune system in addition to having anti-viral effects. This review will investigate the effects of vitamins C and D on COVID-19 infection to determine their benefits in the management of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2.

Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.

Introduction: Hypertensive disorders of pregnancy is one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.1 It is the leading cause of direct maternal death along with hemorrhage and infections. Approximately 70% of hypertensive disorders are due to gestational hypertension, preeclampsia and eclampsia whereas other 30% are due to preexisting or undiagnosed hypertension.2 Out of all the hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen to occur in 11% to 29% of patients.3 Thrombocytopenia occurs more commonly in patients with eclampsia (30%) compared to patients with both mild and severe forms of pre-eclampsia (15%-18%).4 Aims :To find out the severity of disease with platelet count in pregnancy induced hypertension. Methods: This is a hospital- based descriptive cross sectional study, conducted in the department of Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal, conducted over a period of one year from September 2018 to August 2019. Fifty pregnant women were enrolled in study after getting informed written consent and assessing for inclusion and exclusion criteria. Results: Incidence of Pre-eclampsia/eclampsia is 2.3% in this study. Majority of the women belong to age group 21-25(40%), followed by 15-20(38%) with mean age 23.18±5.45. 62% constituted primigravidas and 38% were multigravidas. 33 (66%) cases were at term (37-42 weeks of gestation), 11(22%) at 34-36 weeks of gestation and 6 (12%) were at 28-33 weeks of gestation with mean gestational age 36.38±3.17. Eclampsia cases were found more i.e. 48%, followed by pre-eclampsia 38% and Gestational hypertension 14%. Moderately low platelet count was seen in 11.76% of Gestational hypertension, 47% of pre-eclampsia and 41.17% of eclampsia and severely low platelet count in 21.4% pre-eclampsia and 64.70% of eclampsia. Conclusion: PIH continues to be a leading cause of Maternal and perinatal morbidity and Mortality. The disease accounts of 40,000 maternal deaths worldwide per year5. It is one of the common causes of iatrogenic preterm delivery. Etiology of Pre-eclampsia/Eclampsia is complex and not completely understood. A combination of abnormal Placentation and predisposing maternal factor contribute to widespread endothelial dysfunctions which lead to the syndrome of PIH. To date there has been no screening test that has been widely adopted in clinical practice. Platelet estimation method is reliable, rapid, cheaper, and simple lab method. Prognosis of diseases could be monitored by measuring platelet count and level of platelet count can predict the severity of PIH. Therefore assessment of platelet count has special place in management of PIH.

IntroductionFernando De Ritis described the significance of the transaminase (AST/ALT) ratio in 1957, and since then it has been commonly used to screen liver diseases. The liver is sensitive to hemodynamic changes because it receives approximately one-quarter of total cardiac output. We aimed to investigate the AST/ALT ratio changes in patients with acute myocardial infarction without any history of liver diseases in the Chinese Han population.Material and methodsWe analyzed a total of 120 patients with acute myocardial infarction admitted to the cardiology department of Zhongnan Hospital of Wuhan University between January 2019 and June 2019. AST/ALT ratio of the first blood test was calculated for all patients.ResultsThe mean De Ritis ratio (AST/ALT) was higher in patients with ST-segment elevation myocardial infarction (STEMI) (3.2261 ±2.41379) than in non-ST-segment elevation myocardial infarction (NSTEMI) (2.2089 ±1.63177) patients. The difference was statistically significant (p = 0.002).ConclusionsAST/ALT ≥ 2.0 has a strong association with total coronary occlusion. We might rely on this test to predict coronary occlusion without age difference.

Background The frequent lockdown in Nepal during COVID-19 pandemic had brought various kinds of complexities such as stress among college students. This situation had created uncertainty of future academic career of undergraduate students in medical colleges. Some previously published literature showed gaming as a coping mechanism against stress. Objective To assess the gaming behavior of Medical college students during lockdown in COVID 19 pandemic. Method A cross-sectional study was conducted during lockdown period of July to August 2020. A total of 412 college students were enrolled. Online Google forms were shared to all the eligible students through email, viber and messenger with the help of class representative. Collected data were analyzed in SPSS version 20.0. Result The prevalence of gaming disorder was 8.5% among 260 internet gaming users. About 69.2% of the participants reported that their gaming behavior had increased due to stress of COVID-19 pandemic. Gender and spending more time online per day showed significant associations with greater scores on the internet gaming disorder. Conclusion During lockdown period of COVID-19 pandemic, the gaming behavior of medical college students has increased.

Introduction: Breastfeeding practices of women working at the hospital are likely to be modified by the facilities and support that they receive at the hospital. This study was done to evaluate the breast feeding practices and to analyse important factors that are associated with exclusive breast feeding till six months among women working at hospitals in Kathmandu, Nepal Methods: A total of 110 women, with a young child between the ages of six months and two years were recruited from two hospitals in Kathmandu. A predesigned structured, interviewer-administered questionnaire was used for data collection. Results: The mean age of the mothers was 29.85 ± 3.68 years. Ninety seven (88.2%) women were aware about initiation of breastfeeding within first hour of birth but only 64 (58.2%) women could practice it. Most women 100 (90.9%) were aware about exclusive breastfeeding but only 18 (16.3%) could practice exclusive breastfeeding till six months. Mean duration of exclusive breastfeeding was 2.86 ± 2.00 months and 20 (18.2%) mothers practiced mixed feeding since birth. The participants whose babies had prelacteal feeding had significantly shorter duration of mean exclusive breast feed {1.92 ± 2.18 (S.D)} compared to those who did not have prelacteal feed {3.33 ± 1.74 (S.D)} (p = 0.001). Those who delivered by normal vaginal delivery, initiated breastfeeding within first hour of delivery, expressed breast milk and got feeding breaks were associated with longer duration of mean exclusive breast feed. Conclusion: The breast feeding practices among working women at hospital is quite low compared to national statistics on IYCF. Breast milk expression and feeding breaks for lactating working women could improve feeding practices.

Background Pasteurellosis (Pasteurella infection) is one of the most common bacterial infections in rabbits on commercial farms and in laboratory facilities. Curative treatments using antibiotics are only partly efficient, with frequent relapses. Breeding rabbits for improved genetic resistance to pasteurellosis is a sustainable alternative approach. In this study, we infected 964 crossbred rabbits from six sire lines experimentally with Pasteurella multocida. After post-mortem examination and bacteriological analyses, abscess, bacteria, and resistance scores were derived for each rabbit based on the extent of lesions and bacterial dissemination in the body. This is the first study to use such an experimental design and response traits to measure resistance to pasteurellosis in a rabbit population. We investigated the genetic variation of these traits in order to identify potential selection criteria. We also estimated genetic correlations of resistance to pasteurellosis in the experimental population with traits that are under selection in the breeding populations (number of kits born alive and weaning weight). Results Heritability estimates for the novel response traits, abscess, bacteria, and resistance scores, ranged from 0.08 (± 0.05) to 0.16 (± 0.06). The resistance score showed very strong negative genetic correlation estimates with abscess (− 0.99 ± 0.05) and bacteria scores (− 0.98 ± 0.07). A very high positive genetic correlation of 0.99 ± 0.16 was estimated between abscess and bacteria scores. Estimates of genetic correlations of the resistance score with average daily gain traits for the first and second week after inoculation were 0.98 (± 0.06) and 0.70 (± 0.14), respectively. Estimates of genetic correlations of the disease-related traits with average daily gain pre-inoculation were favorable but with high standard errors. Estimates of genetic and phenotypic correlations of the disease-related traits with commercial selection traits were not significantly different from zero. Conclusions Disease response traits are heritable and are highly correlated with each other, but do not show any significant genetic correlations with commercial selection traits. Thus, the prevalence of pasteurellosis could be decreased by selecting more resistant rabbits on any one of the disease response traits with a limited impact on the selection traits, which would allow implementation of a breeding program to improve resistance to pasteurellosis in rabbits.

Introduction: Maxillofacial trauma is the most common problem seen by maxillofacial surgeons in Nepal. The causes of facial fractures are road traffic accidents (RTA), assaults, falls, gunshot wounds, domestic violence, sports and work injuries. Maxillofacial injury varies from soft tissue injury to facial bone fractures. This study was conducted to assess the burden of maxillofacial trauma in mid-western and far-western regions of Nepal. Material and Method: Patients with maxillofacial fractures admitted in dental ward of NGMCTH, Kohalpur, from April 2017 to April 2019 were included in the study. Patients having soft tissue injury without facial bone fractures and OPD cases were excluded from the study. Patient demographics, mechanism of injury, associated soft tissue injury, accompanying injuries to other parts of body and facial bone fractures were recorded. Patient were treated by open reduction internal fixation or lateral compression splint with circum-mandibular wiring or managed conservatively as necessary. Result: A total of 87 patients were included in the study. The age of patient ranged from 2 years to 67 years with a mean of 26.87 years. Most of the injuries occurred between the age group of 20-29 years with male: female ratio 5.2:1. The most frequent cause of facial bone fracture was RTA (51.7%) and the most frequently fractured facial bone was mandible. Contusion 54(49.5%) was the most common associated soft tissue injury. Head injury 20(52.6%) was the most common accompanying injury to other parts of body. The mean duration of hospital stay was 6.29. Conclusion: Male patient in their third decade mostly had mandible fracture due to road traffic accident. Head injury was the most common accompanying injury. Contusion was the most common type of associated soft tissue injury.

Background Biomass fuels are still in use for cooking by many households in resource poor countries such as Nepal and is a major source of household air pollution (HAP). Chronic exposure to HAP has been shown to be associated with shorter telomere length in adults. Objectives To measure the association between exposure related to household biomass fuel in infancy and leukocyte telomere length (LTL) at 18–23 months of age among 497 children from Bhaktapur, Nepal. Methods In a prospective cohort study design, we have collected information on household cooking fuel use and several clinical, anthropometric, demographic, and socioeconomic variables. We estimated the association between biomass fuel use and the relative LTL in multiple linear regression models. Results Most of the families (78%) reported liquified petroleum gas (LPG) as the primary cooking fuel, and 18.7% used biomass. The mean relative (SD) LTL was 1.03 (0.19). Children living in households using biomass fuel had on average 0.09 (95% CI: 0.05 to 0.13) units shorter LTL than children in households with no biomass fuel use. The observed association was unaltered after adjusting for relevant confounders. The association between LTL and biomass use was strongest among children from households with ≤2 rooms and without separate kitchen. Significance Exposure to biomass fuel use in early life might have consequences for longevity, and risk of chronic illnesses reflected in shortening of the telomeres. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings. Impact statements Biomass for cooking is a leading source of household air pollution in low and middle-income countries, contributing to many chronic diseases and premature deaths. Chronic exposure to biomass fuel through oxidative stress and inflammation has been associated with a shortening of the telomeres, a “biological marker” of longevity. This prospective cohort study describes the association between household biomass fuel use and leukocyte telomere length among 497 toddlers. Leukocyte telomere length was significantly shorter among children living in households with biomass fuel than in children from homes where mainly LPG was used for cooking. Clinical Trial registration Clinicaltrials.gov: NCT02272842, registered October 21, 2014, Universal Trial Number: U1111-1161-5187 (September 8, 2014)

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.

Background There are still many people in the world who prepare their meals on open fires or stoves using solid fuels from biomass, especially in low-and middle-income countries. Although biomass cooking fuels have been associated with adverse health impacts and diseases, the association with child linear growth remains unclear. Objectives In a cohort design, we aimed to describe the association between the use of biomass cooking fuels and linear growth in children aged 18–23 months living in the urban and peri-urban community of Bhaktapur, situated in the Kathmandu valley in Nepal. Methods Caretakers of 600 marginally stunted children aged 6–11 months were interviewed about their source of cooking fuel and other socio-demographic characteristics at enrolment into a randomized controlled trial. Children’s body length was measured when children were 18–23 months old. In linear regression models, we estimated the association between the use of biomass fuel and length-for-age Z-scores (LAZ), adjusted for relevant confounders. We repeated these analyses in pre-defined sub-groups and different percentiles of LAZ using quantile regression models. Results Among study participants, 101 (18%) used biomass as cooking fuel. The association between biomass fuel and LAZ was not statistically significant in the full sample (adjusted regression coefficient: –0.14, 95% CI: −0.28, 0.00). The association was stronger in some of the sub-groups and in the lower tail of the LAZ distribution (those who are stunted), but neither reached statistical significance. Discussion Children from households in poor, urban neighborhoods in Nepal which used biomass fuel for cooking were on average slightly shorter than other children, although the association only approached statistical significance. As this was an observational study, residual confounding cannot be excluded. Further studies are needed to confirm these associations, in particular those seen in certain sub-groups. publishedVersion

Leigh syndrome (LS) is a disorder of infancy and rarely late childhood. It presents with regression of mental and motor skills. Here, we present LS in an adolescent girl who presented with generalized dystonia and cognitive decline. Her infective, metabolic, endocrinal and autoimmune work up was normal. The neuroimaging showed progressive symmetric involvement of basal ganglia with focal intensity over bilateral lentiform nucleus and thalamic region. The cerebrospinal fluid (CSF) lactate level was elevated. Genetic test could not be performed; however the history of neuro-regression with extrapyramidal involvement with CSF and neuroimaging finding led to the diagnosis of Leigh’s syndrome.

Introduction: Mandible is frequently involved bone in facial fracture with angle fracture accounting for 27-30% of cases. Various methods and approaches have been tried for treatment of angle fracture. Objective: To correlate the different surgical approaches with its outcome postoperatively Methodology: A hospital based descriptive observational study was conducted in 30 patients admitted in DentalInpatient Department (IPD), from October 2016 to April 2019. ASA Ipatients having angle fracture of mandible either isolated or combined with other facial bones were included in the study. Different approaches were used for management of angle fracture of mandible. Patient characteristics were presented using frequency table and percentages. Result: The mean operative duration was lesser in transbuccal approach (111.25 minutes) compared to transbuccal (lower border) approach (120 minutes) and intraoral (122.5 minutes) in case of isolated angle fracture. Ease of surgical access was good in transbuccal approach 7 patients (70%) compared to intraoral approach 6 patients (42.86%). Occlusal discrepancies were more in transbuccal approach (50%) compared to intraoral approach (21.43%). Scar was barely visible in 2 patients (14.29%) out of 14 patients wheretransbuccal incision was made. Conclusion: We recommend intraoral surgical approach for favorable angle fracture. In unfavorable fractures we advise to place the first miniplate via intraoral approach, check for fracture stability intra-operatively and place second miniplate on lower bordervia transbuccal approach if unstable.

Background: Various aspects of socio-demographic conditions effect individual’s life at the time of an old age which ultimately make their life vulnerable and dependent on other people. Old age home is one of the important place for those elderly people whose spouse are not alive, have nuclear family background and no one at home to take care of them. Aims and objectives: To study socio-demographic profile, disease morbidity and factors effecting elderly people to live in an old age homes. Material and method: A community based cross sectional qualitative study was conducted among geriatric age group 65 and above, without any physical and mental severity, and living in old age homes in community field area of department of community medicine of Nepalganj medical college from 14th April2019 to 16th September 2019.The total sample size was 84. Results: Majority of female occupants (63.1%) belonged to age group 65 to 75 years old. Half of them were illiterate and their spouses were not alive (71.4%). Family member’s migration (63.1%) and nuclear family (67.9%) were the contributory factors for living in old age homes. Conclusion: The result of the study showed that there is need of geriatric social services and health facilities for making elderly people financially and emotionally strong.

Background Biomass fuel use for cooking is widespread in low to middle income countries. Studies on the association between biomass fuel use and cognitive abilities in children are limited. Objective To examine the association between biomass fuel use for cooking and cognitive abilities in Nepalese children at 4 years of age. Methods In a cohort design we have information on biomass fuel use in the households of 533 children in infancy and cognitive abilities when they were 4 years old from a community-based sample. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and the NEPSY-II. We examined the associations between biomass fuel use and scores on the WPPSI-IV Full-Scale IQ (FSIQ) (primary outcome), and WPPSI index and NEPSY-II subtest scores in multiple linear regression models. The associations were also examined in predefined subgroups. Results Ninety-nine (18.6%) of the families used biomass fuel for cooking. Children in these families had lower mean FSIQ than children in families with no biomass use (83.3 (95%CI 81.7, 85.0) vs. 85.3 (95%CI 84.5, 86.0)), with a mean difference of −2.2 (95%CI -3.9, −0.5) adjusting for demographics and socio-economic status. The association between biomass fuel use and cognitive abilities was strongest in subgroups of children from households with more than three rooms, with separate kitchen and bedroom, and with higher wealth-score. These interactions were significant for number of rooms in the home (p = 0.04), if the household had separate bedroom and kitchen (p = 0.05), and for the wealth-score (p = 0.03). Conclusion Biomass fuel use for cooking in Nepalese families was associated with lower overall cognitive abilities at 4 years. Uncertainties include exposure misclassification and unmeasured confounding. The associations between biomass fuel use and neurodevelopment in children needs further investigation with more precise measurements of the exposure. publishedVersion

Maternal depression has been associated with adverse child growth and development; less is known about its relation to children's diet. In a cross‐sectional study embedded at endline of a longitudinal community development intervention, mothers of 629 children (age 23–66 months) in rural Nepal responded to household and children's diet questionnaires and were screened for depression. Child anthropometry and development (Ages and Stages Questionnaire) were assessed. Regression models examined children's diet, growth and development, adjusting for household, child and maternal characteristics. The prevalence of maternal depression was 21%. Maternal depression was associated with 11% lower likelihood that the child consumed one additional food group [Poisson regression, adjusted relative risk (aRR) 0.89, 95% confidence intervals (95% CI 0.81, 0.99), p = 0.024] and 13% lower likelihood that the child consumed one additional animal source food (ASF) [aRR 0.87, (95% CI 0.76, 1.01), p = 0.061] compared with children of nondepressed mothers. However, maternal depression was not associated with either child anthropometry or development: these outcomes were strongly associated with better home child‐rearing quality. Stunting also related to child age and intervention group; child development related to mother's education and household wealth. This study suggests a correlation between maternal depression and child dietary diversity. This association could be due to unmeasured confounders, and therefore, further research is warranted. Understanding the relationship of depression to child outcomes—and the role of other potentially compensatory household factors—could help address some of the earliest, modifiable influences in a child's life and contribute to innovative approaches to improve child well‐being.

Introduction: Primary dysmenorrhea is one of the most common gynecological problems among adolescent females. It is defined as painful menses in women with normal pelvic anatomy, usually beginning during adolescence. This study aims to find out prevalence of self-medication practice in primary dysmenorrhea among medical and nursing undergraduate students. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital from November 2020 to March 2021 after taking ethical approval from the Institutional Review Committee. Convenient sampling technique was used. A total of 269 female medical and nursing students with complaints of dysmenorrhea were enrolled and the remedial methods used by them such as self-medication, medical advice and home remedies for dysmenorrhea were asked using an online questionnaire delivered to participants. Data analysis was done in the Statistical Package of Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Self-medication practice for dysmenorrhea was reported in 175 (65%) of students. The prevalence of mild or moderate pain was commonly present in age group 21-25 years. commonly used for self-medication was mefenamic acid 121 (48%), followed by ibuprofen 51 (20.3%) and paracetamol 41 (16.3%). Conclusions: Self- medication practice among medical and nursing undergraduate students is high despite awareness of adverse effects.

Background Vitamin B12 deficiency is common worldwide and has been associated with poor sleep. The effect of vitamin B12 supplementation on sleep in infants is not known. Aims To measure the effect of daily supplementation of vitamin B12 for one year on sleep in infants at risk of deficiency. Methods This was an individually randomized double-blind placebo-controlled trial in 600 infants in low-to middle-income neighborhoods in Bhaktapur, Nepal of daily supplementation of vitamin B12 for one year. Infants were included if they were 6–11 month year-old and with a length-for-age less than one z-score. Sleep was a predefined, secondary outcome, and was measured by actigraphy including sleep duration at night and total sleep duration (day and night), sleep onset latency (SOL), and wake after sleep onset (WASO). The effect of vitamin B12 on sleep was additionally assessed in predefined subgroups defined by stunting, underweight, vitamin B12 status, low birthweight, anemia and exclusive breastfeeding for 3 months. Results There was no effect of vitamin B12 supplementation on sleep duration at night, total sleep duration, or WASO. There was a small significant negative effect for SOL. None of the included subgroup analyses revealed effect modification on any of the sleep outcomes. Conclusion Overall, vitamin B12 supplementation did not have an effect on sleep in infants or for high-risk subgroups, with the exception of a small negative effect for SOL. The present study does not support vitamin B12 supplementation to improve sleep in infants. publishedVersion

The demand for cobalamin (vitamin B12) and folate is increased during pregnancy, and deficiency during pregnancy may lead to complications and adverse outcomes. Yet, the status of these micronutrients is unknown in many populations. We assessed the concentration of cobalamin, folate and their functional biomarkers, total homocysteine (tHcy) and methylmalonic acid (MMA), in 561 pregnant women enrolled in a community-based randomised controlled trial in Bhaktapur, Nepal. Plasma concentrations of cobalamin, folate, tHcy and MMA were measured and a combined indicator of vitamin B12 status (3cB12) was calculated. We report mean or median concentrations and the prevalence of deficiency according to commonly used cut-offs, and assessed their association with indicators of socio-economic status, and maternal and dietary characteristics by linear regression. Among the women at gestational week less than 15, deficiencies of cobalamin and folate were seen in 24 and 1 %, respectively. Being a vegetarian was associated with lower plasma cobalamin, and a higher socio-economic status was associated with a better micronutrient status. We conclude that cobalamin deficiency defined by commonly used cut-offs was common in Nepalese women in early pregnancy. In contrast, folate deficiency was rare. As there is no consensus on cut-off points for vitamin B12 deficiency during pregnancy, future studies are needed to assess the potential functional consequences of these low values.

BACKGROUND One-carbon metabolism (OCM) refers to the transfer of methyl groups central to DNA methylation and histone modification. Insufficient access to methyl donors and B-vitamin cofactors affects epigenetic maintenance and stability, and when occurring in early life may impact future health and neurodevelopment. OBJECTIVE The objective of this study was to examine the relative associations between one-carbon metabolites in Nepalese mother-infant pairs and child cognition measured at 5 y of age. METHODS This is a cross-sectional study from Bhaktapur, Nepal, in a population at high risk of subclinical B-vitamin deficiencies and cumulative infection burden. Venous blood samples from 500 mother-infant pairs were collected when the infants were 2 to 12 mo old, and metabolite concentrations measured by microbiological assays and GC-tandem MS. We re-enrolled 321 of these children at 5 y and assessed cognition by the Ages and Stages Questionnaire, 3rd edition, and subtests from the Developmental Neuropsychological Assessment, 2nd edition (NEPSY-II). The associations of the independent metabolites or unobserved metabolic phenotypes (identified by latent class analysis) with the cognitive outcomes were estimated by seemingly unrelated regression. We explored direct and indirect relations between the OCM pathway and the cognitive outcomes using path analysis. RESULTS Infant cystathionine concentration was inversely associated with 4 cognitive outcomes (standardized βs ranging from -0.22 to -0.11, P values from

Introduction: There is an increase in the double burden of malnutrition globally, with a particular rise documented in Asia. In Nepal, undernutrition has been prevalent for decades. Today, however, the incidence of overweight and obesity (OWOB) in the country has increased substantially. There is a need to conduct local studies reporting on the concurrent burden of both underweight and OWOB across adult populations. This study addresses this need by describing the distribution of body mass index (BMI) in a defined population of adults living in the peri-urban community of Bhaktapur, Nepal. Material and methods: For this cross-sectional analysis, we used data that were available from 600 women and 445 men whose children were enrolled in an individually randomized, double-blind, placebo-controlled trial assessing the effect of daily vitamin B12 supplementation. Upon enrolment of their 6–11-month old children, mothers and fathers were interviewed about their socio-demographic details. In addition, their weight and height were measured by trained field workers. Each parent's BMI was calculated as the ratio of body weight (in kg) and height squared (in m), expressed as kg/m2, and categorized according to the WHO recommendation. We used linear and multinomial logistic regression models to assess associations between the BMI of the mothers and fathers, and their baseline characteristics. Results: The mean BMI was 23.7 kg/m2 for both the mothers and fathers with a standard deviation (SD) of 3.6 and 3.7, respectively. The proportion categorized as underweight, overweight, and obese was also similar in the two groups with around 5% being underweight, 30% being overweight and 5% being obese. Age was positively associated with BMI in both groups. Those categorized as daily wage earner had a lower mean BMI than those in other occupational groups. Conclusion: Our results contribute to documenting the burden of both under- and overnutrition in a selected group of young adults living in a peri-urban community in Nepal. As Nepal is undergoing an improvement in its economic situation, as well as a nutrition transition, it is important to provide sufficient information to enable timely action, and evidence-based decision-making to prevent a further increase in Nepal's growing double burden of malnutrition. publishedVersion

Developmental delays affect between 150 and 200 million children

Background: Hypertensive disorder (HDP) during pregnancy is a group of conditions featuring with high blood pressure that may lead to feto-maternal morbidity and mortality, particularly in developing countries. Aims and Objectives: To assess relationship between risk factor of hypertensive disorder during pregnancy, their self care knowledge and practice to prevent and control hypertension. Materials And Method: A cross-sectional study of 93 registered, pregnant women belonging to reproductive ageth group, after 20th gestation age completed, who came for ANC checkup or admitted for hypertension management or prior to delivery in Nepalgunj medical college and teaching hospital under department of Obstetrics and Gynecology from 15th June to 15th December 2018. Blood pressure was measured for each women at booking or at subsequent visits. Urine test for protein albumin was performed if blood pressure was elevated. Data was entered and analysis was completed using SPSS package version 20. Results: The overall prevalence of hypertensive disorder during pregnancy was 2.85% among all deliveries. Pre-eclampsia accounted 36% of the cases followed by eclampsia 18%. Gestational hypertension was 21%, pregnancy induced hypertension was 20% and chronic hypertension was only 5% in study population. Conclusion: Knowledge and attitude regarding lack of exercise, low salt diet, obesity and lack of rest were poor contributory risk factors. It is recommended that all pregnant women must develop knowledge about associated risk factors and ensure the application of behavioral change practices to control and prevent hypertensive disorder during pregnancy.

Background: Intercondylar fracture of distal humerus are very difficult to manage. It needs proper anatomic reconstruction and rigid fixation. Aims and Objectives of study: Evaluation of outcome of dual bicolumnar 90-90 plating of AO type 13C fractures of distalhumerus in adult. Material and method: In a prospective hospital based study on 16 patients with a mean age of 33.37 years ± SD8.30, who presented with intercondylar fracture of distal hummers were studied between July 2015 to December 2017. All patients were graded according to AO classification. Out of 16 patients 5 were in 13C1, 6 were in 13C2 and 5 were in 13C3 subgroup. All patients underwent open reduction through Chevron olecranon osteotomy and fixation was done with dual plating in 90-90 fashioni.e.; 3.5 reconstruction plate posterior and 1/3 tubular plate from medial border. We used the Mayo elbow performance score system for evaluating our results. Results: The mean follow up period was 9.38 months. All fractures healed uneventfully. Two of five patients with 13C3 fractures and two of six patients with 13C2 fractures has flexion deformity of less than 30*. Average range of motion was 95*(range 60*-130*). The Mayo elbow performance score was excellent in 7, good in 7 and fair in 2 patients. Conclusion: Dual 90-90 plating technique through Chevron olecranon osteotomy is a good method for intercondylar reconstruction with rigid fixation like AO 13C fractures.

BACKGROUND: Many children worldwide have poor vitamin B12 status. The objective of this study was to estimate association between maternal and infant vitamin B12 status and long-term growth. METHODS: We randomly selected 500 Nepali mother-infant pairs and measured maternal intake and infant and maternal vitamin B12 status using plasma cobalamin, total plasma homocysteine, and methylmalonic acid concentrations. We revisited available children when they were 5 years old and measured growth. The associations between intake and maternal and infant markers of vitamin B12 and growth were estimated in multiple linear regression models adjusting for relevant confounders (n = 331). RESULTS: Maternal vitamin B12 intake and status and vitamin B12 status in infancy predicted linear growth at 5 years of age, but not during infancy. Each microgram increase in the vitamin B12 intake of the mother during infancy was associated with an increase in height of 0.4 (0.2, 0.6) height-for-age z-scores and 1.7 (0.7, 2.7) cm around the child's fifth birthday. CONCLUSION: Vitamin B12 status and intake in early life is an important determinant for linear growth at school age. Our findings should be verified in randomized, placebo controlled trials before translated into public health recommendations. We are grateful for the contributions of the field supervisor Chandrawati Chitrakar and data managers Pravin Rajbhandari and Uma Regmi, and the children and mothers for their invaluable contribution to the study. The present study was funded through grants from the Research Council of Norway (project no. 234495), from the GCRieber Funds, and the South-Eastern Norway Regional Health Authority (grant no. 2012090).