Explore the vast range of titles available.

Background Infant neurodevelopment in the first years after birth is determined by multiple factors, including parental care and maternal mental wellbeing. In this study, we aim to assess the impact of persistent maternal depressive symptoms during the first 3 months postpartum on infant neurodevelopment at 6 months. Methods Using a longitudinal cohort design, 1253 mother-infant pairs were followed up at 7, 45, and 90 days to assess postpartum depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS); infants were followed up at 6 months to assess neuro-developmental status using the WHO’s Infant and Young Child Development (IYCD) tool. A generalized linear regression model was used to assess the association between persistent postpartum depressive symptoms and infant neurodevelopmental delay at 6 months. A generalized linear mixed model (GLMM) with a hospital as a random intercept was used to assess the persistent postpartum depressive symptoms with an IYCD score. Linear regression was used to compare the IYCD scores between exposure groups. Results In the study population, 7.5% of mothers had persistent depressive symptoms, and 7.5% of infants had neurodevelopmental delay. Infants born to mothers with persistent depressive symptoms had a higher proportion of neurodevelopmental delay than infants born to women without persistent symptoms (48.6% vs 5.1%; p  < 0.001). In the adjusted regression model, infants whose mothers had persistent depressive symptoms at 7, 45, and 90 days had a 5.21-fold increased risk of neurodevelopmental delay (aRR, 5.21; 95% CI, 3.17, 8.55). Mean scores in the motor domain (12.7 vs 15.2; p  < 0.001) and language domain (6.4 vs 8.5; p  < 0.001) were significant when a mother had persistent depression vs. no depression. Mean scores in the general behavioral domain (5.9 vs 10.4, p  < 0.001) and the socio-emotional domain (15.4 vs 17.7; p  < 0.001) were significantly different when a mother had persistent depression vs no persistent depression. Conclusions Our results suggest that 6-month-old infants are at higher risk for neurodevelopment delays if their mother reports persistent symptoms of depression from 7 to 90 days postpartum. The neurodevelopmental delay can be observed in all functional domains. Preventive intervention to reduce maternal postpartum depression may reduce the impact on infant developmental delay.

Background Sustainable Development Goal ( SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers ( p -value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 ( p -value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program ( p -value < 0.001) while the cost for medicine increased ( p -value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) ( p -value = 0.04) and neonatal sepsis ( p -value < 0.001) after the FNC program was implemented. Conclusions We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal. Trial registration ISRCTN- 30829654 , Registered on May 02, 2017.

Background The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. Methods A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. Result In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45 th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. Conclusion Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

Introduction and Importance: Dyke–Davidoff–Masson syndrome (DDMS) is a rare neurological condition characterized by focal or generalized drug‐resistant epilepsy, hemiparesis, face or body asymmetry with atrophy, and cognitive impairment in early childhood and adulthood. DDMS is generally diagnosed in the paediatric age group. Neuroimaging shows skull bone thickening with cerebral hemiatrophy and hyperpneumatization of sinuses. Case Presentation: Here is a case of a middle‐aged female presenting with a history of multiple episodes of seizure since childhood. MRI showed diffuse atrophy of the left cerebral hemisphere with hypertrophy of the contralateral hemisphere, hyperpneumatization of the left frontal sinus, and thickened calvaria, all characteristics of DDMS. Based on the history, clinical findings, and MRI reports, it was diagnosed as a case of DDMS. Discussion: DDMS can be due to injury to the brain, either intrauterine or during early childhood. The features can be confused with other conditions like Rasmussen encephalitis, hemiconvulsion‐hemiplegia‐epilepsy (HHE syndrome), Sturge–Weber syndrome, Silver–Russell syndrome, basal ganglia germinoma, Fishman syndrome, and linear nevus syndrome. Before making a diagnosis, a proper antenatal and postnatal history with early childhood presentations should be taken. Occupational therapy, physiotherapy, and seizure control improve the patient’s quality of life. Conclusion: Though DDMS is usually diagnosed during early childhood, a few missed cases lead to later findings in life, resulting in late medical consults and affecting an individual’s lifestyle. Management includes only symptomatic relief. Paediatricians, radiologists, neurologists, and gynaecologists need to be well‐informed about the case for its early diagnosis and management.

Evidence of the relationship between breastfeeding and maternal mental health is mixed and complex, with some studies suggesting breastfeeding may lower the risk for postpartum depressive symptoms, while others report no clear or consistent effects. Given these inconsistencies, we aim to assess the association between the timing of initiation of breastfeeding and postpartum depressive symptoms 90 days after birth in Nepal. This longitudinal multi-centric cohort study included 898 mother-infant pairs in 9 district hospitals of Nepal. Data was collected on timing of initiation of breastfeeding, sociodemographic variables and depressive symptoms assessed through the Edinburg Postnatal Depression Scale. A Directed Acyclic Graph was constructed and multiple logistic regression, generalized mixed linear regression model and Generalized Estimating Equations (GEE) were used to assess the association of timing of breastfeeding with postpartum depressive symptoms. At the 90th day postpartum, 31.4% of women reported depressive symptoms. Compared to women who had immediate breastfeeding, those who had no immediate breastfeeding had 3.47 higher odds of depressive symptoms (cOR: 3.47; 95% CI; 2.40, 5.01). After adjusting for confounding and mediating factors, the odds of depressive symptoms were 2.81 times higher among women who did not immediately breastfeed (aOR, 2.81; 95% CI; 1.76, 4.50). Using GEE modeling, there was a positive association between delayed breastfeeding and postpartum depression at 7 days (β coefficient, 0.583,  = 0.001) and at 45 days (β coefficient, 0.551,  = 0.003). Using the generalized linear mixed model, the prediction to postpartum depression score increased with delay in breastfeeding. This study highlights that the delayed initiation of breastfeeding is associated with higher odds of symptoms for postpartum depression among various groups of women, especially among women from disadvantageous groups and women with no education in Nepal. Improving support to women for early initiation of breastfeeding could help reduce postpartum depression.

Objective: We aim to correlate the prevalence of symptoms of the lateral medullary syndrome (LMS) based on radiological classification.Methods: A five-year record of 41 patients diagnosed with LMS and admitted to a tertiary care center in Nepal was reviewed. We used chi-square tests to compare symptoms between rostral and caudal groups and different horizontal subtypes.Results: The subtype prevalence in the horizontal classification of LMS was large (31.7%), lateral (22%), dorsal (19.5%), typical (14.6%), and ventral (12.2%). The most common symptoms in the typical subtype of the horizontal classification were: pain/temperature loss in the contralateral body (7.3%) and dysphagia (7.3%); in the ventral subtype, swaying on the Romberg test (12.2%), dysarthria (9.8%) and dizziness (9.8%); in the dorsal subtype, headache (12.2%) and vomiting (12.2%). Whereas headache (22.2%) and lateropulsion on standing (14.6%), swaying on the Romberg test (14.6%), nausea/vomiting (14.6%) were common in the large subtype, and nausea/vomiting (19.5%) and headache (17.1%) in the lateral subtypes. Whereas, in rostrocaudal classification, the rostral subtype (61%) was more common than the caudal subtype (31%). There was no significant variation in symptoms based on the rostrocaudal classification of LMS.Conclusion: The common clinical manifestations are different for different radiological subtypes of LMS. Further comprehensive studies are essential to understand the prevalence of symptoms in different radiological subtypes and the clinical-radiologic correlation in LMS.

This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation. This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal. This is a cross-sectional survey. Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1-5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis. The median age of 21 mothers who completed the survey was 25 years (range 18-37). Among them, 11 mothers (52.4%) completed their bachelor's or master's level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant's care during resuscitation. There was no statistical difference in mothers' acceptability of MALA system, when stratified by mothers' age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers' education level (up to higher secondary level vs. bachelor's level or higher), mothers with Bachelor's degree or higher more strongly felt that they were comfortable with the infant's care being video recorded (p = 0.026) and someone using a tablet when observing the infant's care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 14.3%) (p = 0.024). The novel technology using video and audio recordings for newborn resuscitation was accepted by mothers in this study. Its application has the potential to improve resuscitation quality in low-and-middle income settings, given proper informed consent and data protection measures are in place.

BackgroundStimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.MethodsThis is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.ResultsAmong non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, p<0.0001). The use of bag-and-mask ventilation was lower among those who were stimulated with the cord intact than those who were stimulated with cord clamped (18.0% vs 32.4%, p<0.0001). The proportion of neonates with Apgar Score ≤3 at 1 min was lower with the cord intact than with cord clamped (7.6% vs 11.5%, p=0.001). In multivariate analysis, neonates with intact cord had 84% increased odds of spontaneous breathing (adjusted OR, 1.84; 95% CI: 1.48 to 2.29) compared with those with cord clamped.ConclusionsStimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.

Periodontal treatment aims at reduction of infection and inflammation. Linezolid is a synthetic antibacterial agent of a new class of antibiotics, the oxazolidinones, which has clinical utility in the treatment of infections caused by aerobic and anaerobic bacteria susceptible organisms methicillin and vancomycin-resistant in the treatment of periodontitis. Diclofenac sodium is anti-inflammatory agent and in-situ gel containing Linezolid and Diclofenac sodium in this study may have a potential additive effect. Hence, there is broad scope for research in local application of antimicrobial and anti-inflammatory combination drug (s) in periodontitis. Linezolid and Diclofenac sodium. In-situ gel containing Linezolid in combination with Diclofenac sodium was prepared using combination of carbopol-HPMC and carbopol-NaCMC. The prepared in-situ gel formulation showed satisfactory results for in-vitro gelling capacity, rheology, and other physical properties. In-vitro drug release profile was dependent up on the concentration of polymer, i.e. drug release was decreased with increase in polymer concentration and vice versa. The formulations of batches LDCF1, LDCF2, LDCF3, LDSF1, LD SF2 and LDSF3 failed to extend the drug release up to 12 hours. Thus, the formulation of batches LDCF4 and LDSF4 containing carbopol: HPMC and carbopol: NaCMC in 1:2 ratios were considered as optimum formulation on the basis of optimum viscosity, gelation time, gelation temperature, gelling capacity, and their capacity to extend the in-vitro drug release up to 12 hours. Hence, prepared formulations showed sustain drug release behaviour.

The aim of the present study was to prepare and evaluate sustained release cubogel formulation of Timolol maleate and Dorzolamide HCl, as a potential formulation for the treatment of glaucoma. Various batches of Timolol maleate and Dorzolamide HCl loaded cubosomes were prepared by top down technique using Glyceryl monooleate as stabilizer and Poloxamer 407 as surfactant. Cubogel formulations were prepared by mixing optimized batch of cubosome and in-situ gelling system. In-situ gelling system was prepared by using varying concentration of gellan gum, carbopol 940p and chitosan. The formulated cubogel formulations were then evaluated for physical isotonicity, viscosity, in-vitro drug release, in-vitrocorneal permeation, mucoadhesive behaviour, drug content, sterility test, ocular irritation, intra ocular pressure measurement and ocular pharmacokinetics studies. Visual inspection showed that cubosomal dispersion was milky white liquid in appearance. The average particle size of Timolol maleate cubosome and Dorzolamide HCl cubosome was found in the range of 24.32-191.60 nm and 24.48-202.40 nm, respectively. The zeta potential value was found in the range of -24.92 mV to -34.70 mV and -15.4 to -24.1 mV for Timolol maleate cubosome and Dorzolamide HCl cubosome respectively. Entrapment efficiency was increased when glycerol was added to the cubosomal dispersion. Drug loaded cubogel formulations were found to be nonirritant, sterile, isotonic and stable in nature. Ocular pharmacokinetics studies revealed that the relative bioavailability of Timolol maleate cubogel and Dorzolamide HCl cubogel was 1.65-fold and 1.27-fold higher, respectively compared to marketed formulation. The obtained results confirmed that the developed cubogel can be considered as an efficient drug delivery candidate for glaucoma therapy