Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa.

BACKGROUND: Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Maori); therefore, we cannot assume the effects of maltreatment are the same across the population. OBJECTIVE: Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Maori/non-Maori). PARTICIPANTS AND SETTING: Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Maori ethnic identity; 82.2 % (n = 883) were non-Maori. METHODS: CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Maori ethnicity. RESULTS: After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Maori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results. CONCLUSIONS: Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Maori childhood maltreatment outcomes.

The Risk of COVID-19 in People Having a Particular Set of Gene.

These risk factors of advancing age, male gender and co-existing health conditions like cancer, cardiovascular diseases, diabetes and obesity do not fully explain why some people have no or mild symptoms whereas others have severe symptoms. Genomewide association study (GWAS) identify a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure. They also found a higher risk among persons with blood group A and protective effect for blood group O than among patients with other blood groups. The particular haplotype in a region of chromosome 3 is contributed to modern humans by neandertals. Another Neanderthal haplotype on chromosome 12 is associated with a 22% reduction in relative risk of becoming severely ill with COVID-19. The ApoE e4e4 homozygous genotype was found to increase the risk of severe COVID-19. Change in angiotensin converting enzyme (ACE) 2 gene was also found to be associated with increased risk of COVID-19, cardiovascular and pulmonary conditions.

Respiratory Failure in a Neonate with Pierre Robin Syndrome -A Challenging Proposition.

Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent imageguided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.

Endometriosis of Groin Mimicking Neoplasm.

Endometriosis is principally a disease of women in active reproductive life. Although it is rare, foci of endometrial tissue may be seen in the bowel, the umbilicus, abdominal surgical scars and in the lungs. Inguinal endometriosis is challenging to the clinicians and pathologist and often diagnosed accidentally. We present a case of inguinal endometriosis mimicking neoplasm. A 40 year old woman presented with a swelling in the right inguinal region associated with cyclical pain. In view of presence of atypical cells in fine needle aspiration cytology, metastatic carcinoma was rendered as diagnosis. Histopathological examination revealed endometrial glands and stroma which was further confirmed by immunohistochemistry. Diagnosis of inguinal endometriosis is difficult and often challenging because of unusual site. The clinician must have high index of suspicion with any patient who has cyclical symptoms. A good history and physical examination can guide clinical diagnosis of endometriosis.

Incidence and Diagnosis of Ampullary Carcinoma in Dhulikhel Hospital, Kathmandu University Hospital.

Background Endoscopy from a suspected ampulla of vator may establish an early preoperative diagnosis of ampullary carcinoma. However, information regarding the diagnostic accuracy of this procedure is limited and variable. Objective To study the preoperative diagnostic accuracy of Endoscopic/ERCP appearance of ampullary tumors with that of endoscopic biopsy. Method Among patients who were performed endoscopy during a one year period; a suspicious ampulla of vator was seen in 44 cases. Endoscopic biopsy specimens were classified into four groups based on the degree of epithelial atypia: group 1 (no evidence of malignancy), group 2 (presence of dysplasia), group 3 (suspicious of malignancy) and group 4 (positive for malignancy). In each case comparison was made between the pre-endoscopic biopsy clinical diagnosis and endoscopic appearance. Result Endoscopic biopsy diagnosis of malignancy (group 4) were seen in 22 cases, Suspicious of malignancy (group 3) in 3 cases, dysplasia (group 2) in 9 cases and no evidence of malignancy (group 1) in 10 cases. Pre-endoscopic diagnostic accuracy of endoscopy/ ERCP was 50% compared to the diagnosis by biopsy. Conclusion Diagnostic accuracy of endoscopy/ERCP was 50% compared to the diagnosis by biopsy. A diagnosis of non malignancy in the forceps biopsy material does not rule out the presence of cancerous foci in ampullary neoplasms.

Prevalence and Clinical Manifestations of Helicobacter Pylori with Reference to Histopathological Diagnosis.

Background Helicobacter pylori infection is on a steep decline in most of the developed countries; however, in developing countries like Nepal such steep decline is not seen. This may be due to failure of treatment regimens and emergence of drug resistance. Our previous study done in 2004/2005 showed 38% prevalence of Helicobacter pylori. The present study has been conducted to review the prevalence and clinical diagnosis of Helicobacter pylori with reference to histo-pathological diagnosis. Method This was retrospective study done at Dhulikhel Hospital, Kathmandu University Hospital over a period of 13 years from January 2006 to December 2018. Helicobacter pylori proven cases were retrospectively analyzed with clinical features and endoscopy findings. The clinical picture were categorized into antral gastritis, gastroduodenits, erosive duodenitis, acid peptic disease, reflux esophagitis, hiatal hernia, polyp, ulcer (gastric and duodenal), acute abdomen, upper gastrointestinal bleeding and malignancy. Result A total of 1624 upper gastrointestinal endoscopy biopsies were taken during the study period. Helicobacter pylori infection was seen in 618 (38.0%) cases out of 1624 cases. Helicobacter pylori were seen in 349 male and 269 female patients with male to female ratio of 1.29:1. Clinically, gastritis 210 (41.4%), acid peptic disease74 (42.7%), gastroduodenitis 46 (37.7%), reflux esophagitis 38 (52.7%), gastric ulcer 48 (28.4%), duodenal ulcer 34 (53.1%) and acute abdomen 50 (42.3%) cases were seen respectively. Conclusion Most commonly Helicobacter pylori cause chronic gastritis in our context. There is no significant change in prevalence of Helicobacter pylori infection as compared to our previous study (2004/05). This needs proper management of Helicobacter pylori infection to prevent serious complication such as gastric cancer in our part of the world.

The Diagnostic Accuracy of Frozen Section Compared to Permanent Section: Single Center Study.

Background Intra-operative consultation by frozen section is a procedure which plays a major role in the surgical management of patients with neoplastic and non neoplastic disease. Therefore it is critical to determine efficiency of frozen section performance periodically. Objective To evaluate the accuracy of frozen section tests at different anatomical sites by comparing the frozen section diagnosis with the histological diagnosis. Method We conducted a retrospective study in Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, and compared the results of 47 cases of frozen section with their final permanent section diagnosis during a period of January 2017 to December 2018. Result A total of 47 cases were studied on frozen section while no case was deferred for permanent paraffin section. The indication of frozen section was for presence/ typing of neoplasm in 38 cases (80.75%), clearance of margin in eight cases (17%) and diagnosis of Hirschsprung's disease in one case (2.1%). The overall accuracy of frozen section was 91.4% (43 cases) with 8.5% (four cases) discordant with the diagnosis, reported as false negative. None of the cases were reported as false positive. Sensitivity, specificity, positive predictive value and negative predictive value of frozen section in comparison with permanent section (as gold standard) were 85.18%, 100%, 100% and 83.33% respectively. Conclusion The accuracy of frozen section diagnosis at our institute was 91.4% which can be interpreted as comparable with most national and international studies. The overall error rate is 8.5% which is higher than previously published studies. Experience and training of the pathologist reduce the error rate.

DAS181 Treatment of Severe Parainfluenza Virus 3 Pneumonia in Allogeneic Hematopoietic Stem Cell Transplant Recipients Requiring Mechanical Ventilation.

Parainfluenza virus (PIV) may cause life-threatening pneumonia in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Currently, there are no proven effective therapies. We report the use of inhaled DAS181, a novel sialidase fusion protein, for treatment of PIV type 3 pneumonia in two allogeneic hematopoietic SCT recipients with respiratory failure.

Allogeneic stem cell transplantation for multiple myeloma: is there a future?

Despite remarkable progress in survival with the availability of novel agents, an overwhelming majority of patients with multiple myeloma (MM) relapse and the curability of MM remains limited. Genetically defined high-risk MM represents a subgroup with an aggressive disease course despite novel agents. Allogeneic hematopoietic cell transplantation (allo-SCT) is a potentially curative option in MM that has several advantages including a tumor-free graft, and the potential for sustained immune-mediated disease control. However, historically high treatment-related mortality (TRM) and conflicting reports from prospective studies in the United States and European Union have limited the utilization of this modality. Meanwhile, newer preparative regimens, planned maintenance strategies and improvements in supportive care have led to a decline in TRM and better survival in recent years. The allo-SCT platform also provides additional options of immunotherapy at relapse including donor lymphocyte infusions, immunomodulatory drug maintenance and withdrawal of immune suppression. In this article, we provide an in-depth review of literature for allo-SCT and other immunotherapy options, as well as the authors' approach to using allo-SCT in MM.

Assessing the performance characteristics and clinical forces in simulated shape memory bone staple surgical procedure: The significance of SMA material model.

This work is focused on the detailed computer simulation of the key stages involved in a shape memory alloy (SMA) osteosynthesis bone stapling procedure. To this end, a recently developed three-dimensional constitutive SMA material model was characterized from test data of three simple uniaxial-isothermal-tension experiments for powder metallurgically processed nickel-rich NiTi (PM/NiTi-P) material. The calibrated model was subsequently used under the complex, thermomechanical loading conditions involved in the surgical procedure using the body-temperature-activated PM/NiTi-P bone staple. Our aim here is to assess the immediate and post-surgical performance characteristics of the stapling operation using the material model. From this study: (1) it was found that adequate compressive forces were developed by the PM/NiTi-P bone staple, with the tendency of this force to even increase under sustained thermal loading due to the intrinsic "inverse relaxation phenomena" in the SMA material, (2) the simulation results correlated well with those from experimental measurements, (3) the body-temperature-activated PM/NiTi-P staple was proved to be clinically viable, providing a stable clamping force needed for speedy coaptation of the fractured bones, and (4) these realistic assessments crucially depend on the use of suitable and comprehensive SMA material models.

On the role of SMA modeling in simulating NiTinol self-expanding stenting surgeries to assess the performance characteristics of mechanical and thermal activation schemes.

The work is focused on a detailed simulation of the key stages involved in the NiTinol self-expanding stenting surgical procedure; i.e., crimping, deployment, SMA activation, as well as post-surgery steady-state cyclic behavior mimicking the systolic-to-diastolic pressure oscillations. To this end, a general multi-mechanism SMA model was utilized, whose calibration was completed using the test data from simple isothermal uniaxial tension experiments. The emphasis in the study was placed on the comparison of two alternative SMA activation protocols, in terms of both the immediate and long-term (post-surgery) performance characteristics. The first is 'hard' mechanical activation utilizing superelasticity, and the second is 'soft' thermal activation relying upon the combined one-way shape memory effect and constrained-recovery characteristics of the NiTinol material. The important findings are (1) the thermal activation protocol is far superior compared to the mechanical counterpart, from the point of view of lower magnitudes of the induced outward chronic forces, lesser developed stresses in the host tissue, as well as higher compression ratio with lesser crimping force for the same geometry of initial stent memory configuration, (2) the thermal activation protocol completely bypassed the complications of maintaining the high restraining force during deployment of the stent, and (3) there is no indication of any detrimental functional fatigue/degradation in the cured stenotic artery during cyclic pressure oscillations.

Mechanisms and consequences of bladder cell invasion by uropathogenic Escherichia coli.

Strains of uropathogenic Escherichia coli (UPEC) are the major cause of urinary tract infections worldwide. Multiple studies over the past decade have called into question the dogmatic view that UPEC strains act as strictly extracellular pathogens. Rather, bacterial expression of filamentous adhesive organelles known as type 1 pili and Afa/Dr fibrils enable UPEC to invade host epithelial cells within the urinary tract. Entry into bladder epithelial cells provides UPEC with a protected niche where the bacteria can persist quiescently for long periods, unperturbed by host defences and protected from many antibiotic treatments. Alternately, internalized UPEC can rapidly multiply, forming large intracellular inclusions that can contain several thousand bacteria. Initial work aimed at defining the host and bacterial factors that modulate the entry, intracellular trafficking, and eventual resurgence of UPEC suggests a high degree of host-pathogen crosstalk. Targeted disruption of these processes may provide a novel means to prevent and treat recurrent, relapsing and chronic infections within the urinary tract.

Evaluation of topical 0.03% flurbiprofen drops in the treatment of herpetic stromal keratitis.

PURPOSE: The management protocol for herpetic stromal keratitis (HSK) is still controversial. We have attempted to compare the relative efficacy of topical dexamethasone 0.01% and flurbiprofen 0.03% in combination with topical acyclovir 3% in HSK. METHODS: In this institutional, prospective, randomized, controlled, double-blind study, 45 clinically diagnosed cases of HSK were randomly distributed into three coded treatment groups--topical placebo, dexamethasone 0.01%, and flurbiprofen 0.03% each in tapering frequency and in combination with acyclovir 3% ointment five times per day for four weeks. Therapeutic response was assessed every third day for four weeks. Decoding of the treatment groups was done at the conclusion of the study and data analysed. RESULTS: Four-week success rate was 93.3% (14 of 15) in the dexamethasone-acyclovir treatment group, 66.7% (10 of 15) in the flurbiprofen-acyclovir treatment group and 20% (3 of 15) in the placebo-acyclovir treatment group. CONCLUSION: While dexamethasone in combination with acyclovir gives the best results in HSK with minimal side-effects, the role of topical flurbiprofen seems promising.