Mental Health of Mothers with Malnourished Children in Nepal: A Prospective Observational Study.

BACKGROUND: Maternal mental health may influence the nutritional status of their children. It was intended to assess the mental health status of the mothers of children admitted to a nutrition rehabilitation center. We specifically explored the relationship between maternal mental health and malnutrition of the child; to observe any change of maternal depressive/anxiety symptoms and weight gain in the child following admission. METHODS: In a prospective observational study, malnutrition of children was assessed based on weight for height z scores using the WHO Anthro-Survey-Analyser. We evaluated anxiety using the Generalized Anxiety Disorder Scale (GAD-7) and depression by Patient Health Questionnaire (PHQ-9). Demographic and clinical variables were collected. RESULTS: The degree of malnutrition of the children at admission and discharge was: mild (3.6% v 31.7%), moderate (37.7% v 26.3%), severe (58.7% v 8.4%), and no malnutrition (0.0% v 33.5%) (p<0.001). At admission, 12% of mothers had anxiety, depression, or both, which decreased to 3.0% at the time of discharge. There was no difference in malnutrition scores among children of mothers with or without anxiety/depression at admission or discharge, except that children of depressed mothers continued to have significantly greater levels of malnutrition at discharge compared with the mothers without depression. Maternal anxiety or depression was not associated with the severity of malnutrition. CONCLUSIONS: A proportion of mothers of children with malnutrition had clinical anxiety and depression; and maternal mental health concerns, especially depression may influence the nutrition of children. It is imperative to explore maternal mental health routinely for malnourished children.

Trends in Surgical Management of Esophageal Cancer.

BACKGROUND: Management of esophageal cancer has changed to a combined modality approach over the past two decades due to poor outcome. Recently, multimodal treatment has become the standard practice. The aim of this study was to evaluate the changing trends in management and outcomes of esophagectomy over 15 years from a single center in Nepal. METHODS: Patients with squamous cell carcinoma and adenocarcinoma of esophagus/ gastroesophageal junction who underwent surgery between 2001-2018 were analyzed. Patients were grouped into three successive 5-year periods. RESULTS: 547 patients underwent esophagectomy during 2001-2018. There was increased trend of neoadjuvant treatment from 9-13% to 52% (p<.001) and minimally invasive surgery (MIS) from 0% to 80% (p<.001). 30-day mortality decreased from 8% to 1% (p=.01). The 5-overall survival was 24% which increased from 17% to 27% (p=.003). CONCLUSIONS: Long term outcome has improved over last 15 years with decreasing mortality which appears to be due to incorporation of MIS and neoadjuvant treatment.

Evaluation and comparison of bond strength to 10% carbamide peroxide bleached enamel following the application of 10% and 25% sodium ascorbate and alpha-tocopherol solutions: An in vitro study.

AIM: To evaluate and compare composite bond strength to carbamide peroxide bleached enamel following the application of 10% and 25% sodium ascorbate and alpha-tocopherol solutions. MATERIALS AND METHODS: Sixty premolars were divided into six groups. Groups I and VI served as unbleached and bleached controls respectively. Groups II, III, IV and V served as the experimental groups and were subjected to 10% carbamide peroxide bleaching followed by 10 min application of 10% and 25% sodium ascorbate and 10% and 25% alpha-tocopherol solutions, respectively. Following composite bonding, shear bond strength was determined and the results were analyzed using ANOVA and Tukey highest significant difference test. RESULTS: Only Group IV showed significantly lower bond strength when compared to Group I (unbleached control). When compared to Group VI (bleached control), except Group IV, groups II, III and V showed significantly higher bond strength. However, there was no statistically significant difference between the experimental groups corresponding to 10% and 25% and similar concentrations of sodium ascorbate and alpha-tocopherol solutions. CONCLUSION: Following 10% carbamide peroxide bleaching, except 10% alpha tocopherol, 10 min application of 10% and 25% sodium ascorbate and 25% alpha-tocopherol solutions significantly improves the shear bond strength of composite resin to enamel.