Seed Rain in a Tropical Lowland Rainforest Fragment in Central Sri Lanka

Fragmentation of tropical rainforests can adversely affect seed dynamics due to the habitat loss, changed habitat configuration and altered species interactions. Halgolla Forest Reserve (HFR) is an isolated tropical lowland wet evergreen rainforest fragment, located in central province of Sri Lanka. Despite its small size, it harbors high biodiversity with many endemic species. However the biodiversity of HFR is highly threatened due to the agricultural expansion, illegal encroachments and logging. Thus, the study investigated the regeneration potential of the fragment by assessing seed rain dynamics in HFR. Comparisons were made for seed density and species diversity in seed rain of the forest edge (highly disturbed), riverine area (less disturbed) and forest interior (undisturbed) habitats for one year. Thirty plots of 10×10 m2 (ten plots each per habitat) were established using stratified random sampling at the forest edge, forest interior and riverine areas. Seed traps (1×1 m2) were placed in each plot and contents of traps were collected once in two weeks from November 2017 to November 2018. Seed morphotypes and abundance of species were recorded and diversity indices were calculated to make the comparisons between the three habitats. A total number of 28,714 seeds were recorded under 107 morphospecies in the seed rain. The seed density was higher in the forest edge (1,659.6 m-2year-1) than in the forest interior (533.1 m-2year-1) and the riverine habitat (678.8 m-2year-1). The differences in seed density between forest edge and interior habitats may be due to the altered seed dispersal patterns after fragmentation. Seed rain peaked at the end of dry season prior to the beginning of rainy season. The highest seed abundance was recorded by Ficus spp. in all three habitats. Species richness was more or less similar in all three habitats. Species diversity and evenness were lower in more disturbed forest edge than in forest interior and riverine habitats. HFR has a high regeneration potential probably due to being closer to other forest patches that can act as seed sources for HFR. However the influx of non-rainforest species through seed rain such as Coffea arabica L., Camellia sinensis (L.) Kuntze, Alstonia macrophylla Wall. ex G. Don and Swietenia macrophylla King from surrounding matrix is an evidence for habitat disturbance which indicate a threat to the regeneration of native species surviving in the forest fragment. Conservation of this forest fragment through enhanced awareness and community participation is vital to preserve this biodiversity refugium.Keywords: Seed rain, Tropical lowland rainforest fragment, Seed density, Species diversit

Bone Marrow Lymphocytes: can they be an alternative for Bone Marrow Lymphoblasts as early predictors of relapse and remission in Acute Lymphoblastic Leukemia at the post-Induction chemotherapy phase?

Background: Acute Lymphoblastic Leukemia (ALL) is a hematological malignancy that arises due to unusual proliferation of lymphoid precursor cells in bone marrow. Induction chemotherapy is vital for achieving complete remission in ALL, but accurately predicting relapse risk and identifying patients likely to sustain remission remains challenging. Conventionally, bone marrow lymphoblasts have been used as the gold standard for assessing treatment response and predicting relapse in ALL. However, emerging evidence suggests that bone marrow lymphocytes may serve as alternative predictive biomarkers. Aim: This study aims to review the utility of bone marrow lymphocytes as early predictors of relapse and remission in ALL during the post-induction chemotherapy phase. It will explore the advantages and limitations of assessing lymphocytes compared to lymphoblasts and discuss the potential mechanisms underlying their prognostic significance. Patients and Methods: Total of 105 newly diagnosed ALL patients; 75 with B ALL and 30 with T ALL was selected to the study. Laboratory investigations included Complete Blood Count (CBC) with the manual differential count analysis and obtaining bone marrow parameters from myelogram reports. The patients were followed until the end of the induction phase and, the laboratory parameters were taken. Correlation bivariate analysis, Paired sample t-Test was performed to establish the associations between peripheral blood parameters with the bone marrow parameters. Receiver operating characteristic (ROC) curve analysis was performed to establish cutoff values for peripheral blood parameters and the bone marrow lymphocytes with aiming to investigate bone marrow response. All the analysis was performed using Microsoft Excel 2013.12 SPSS version 26. Results: In B ALL at Day 8, Lymphocytes% in Bone Marrow (L%_BM) showed a significant strong negative correlation (r =-0.357, p<0.05) with NLR. ROC curve analysis showed cut off values for Lymphocytes; NLR =<0.400 indicates the presence of L%_BM >10% in B ALL. When considering T ALL D8, the ALC>=1756/mm3 suggests the presence of >10% L%_BM in D8. Conclusion: Our research demonstrated strong correlations to predict the Lymphoblasts% in Bone Marrow (BL%_BM) & L%_BM by using peripheral blood parameters which is straight forward and easily obtainable. Moreover, we were successfully able to set up cut off peripheral blood parameter values to monitor the response of the Lymphocytes of the bone marrow. Before implementing the results, further studies could be carried out by increasing the sample size for both B & T ALL with the accurate monitoring of the patients

Hypothermia for encephalopathy in low and middle-income countries (HELIX): Study protocol for a randomised controlled trial

BACKGROUND: Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries and is used as standard therapy in these settings. However, the safety and efficacy of cooling therapy in low- and middle-income countries (LMICs), where 99% of the disease burden occurs, remains unclear. We will examine whether whole body cooling reduces death or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs. METHODS: We will randomly allocate 408 term or near-term babies (aged ≤ 6 h) with moderate or severe neonatal encephalopathy admitted to public sector neonatal units in LMIC countries (India, Bangladesh or Sri Lanka), to either usual care alone or whole-body cooling with usual care. Babies allocated to the cooling arm will have core body temperature maintained at 33.5 °C using a servo-controlled cooling device for 72 h, followed by re-warming at 0.5 °C per hour. All babies will have detailed infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our primary endpoint is death or moderate or severe disability at the age of 18 months. DISCUSSION: Upon completion, HELIX will be the largest cooling trial in neonatal encephalopathy and will provide a definitive answer regarding the safety and efficacy of cooling therapy for neonatal encephalopathy in LMICs. The trial will also provide important data about the influence of co-existent perinatal infection on the efficacy of hypothermic neuroprotection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02387385. Registered on 27 February 2015

Pathogen-Specific Neurocognitive Outcomes in Tropical Childhood Encephalitis

Background: Childhood encephalitis causes long-term neurocognitive disability, which may lead to secondary disabilities such as poor academic achievement and social isolation. This is particularly problematic in resource limited, tropical countries, where the burden of vector-borne viral encephalitis is substantial, yet the resources for identifying the myriad of pathogens involved and characterizing the resulting neurocognitive sequelae are limited. To our knowledge, comprehensive assessments of neurocognitive function following tropical childhood encephalitis have not been performed. We hypothesize that the risk of neurocognitive sequelae is pathogen-specific, and that the use of portable, on-site metagenomic Next Generation Sequencing of CSF in Sri Lankan children with encephalitis will increase diagnostic yield. When coupled with comprehensive neurocognitive evaluations, a more nuanced understanding of pathogen-specific sequelae may emerge. Methods: We will utilize the portable Oxfore nanopore next generation sequencing device at 3 sites in Sri Lanka (Academic Medical Centers in Kandy, Colombo and Galle, 2000 pediatric beds total). CSF will be analyzed for each case of encephalitis, along with cell-based diagnostic platforms for auto-immune encephalitis. Each child will undergo serial neurocognitive evaluations with both the CANTAB (Cambridge Neuropsychological Test Automated Battery) and a novel neurocognitive assessment tool developed for use in Sri Lankan children. These neurocognitive assessments will be repeated in age and gender matched controls. Anticipated Results: We anticipate that this approach will provide a more nuanced understanding of tropical childhood encephalitis, help risk-stratify children following infection and provide evidence for targeted neurocognitive and neuropsychological therapy. Next Steps: We have 35 CSF isolates from Sri Lankan children with febrile encephalitis of unknown etiology which will be sequenced this Spring. A Sri-Lankan specific neurocognitive assessment tool has been developed and is being pilot-tested. This summer, pilot-testing using the CANTAB will be undertaken in a cohort of 20 Sri Lankan children with encephalitis and 130 otherwise healthy children

Effectiveness of an Awareness Program on Lunch Sheets Pollution: A Case study at Faculty of Applied Sciences, University of Sri Jayewardenepura

The research was based on irregular disposal practices among the FAS students and giving knowledge about alternatives instead of non-degradable lunch sheets. Among all years of students, including from 1st year to 4th year, 62 students were randomly selected from different combinations and data was collected by sharing a Google form. The collected data was based on the type of lunch sheets used (biodegradable/non-biodegradable); the way of discarding the used lunch sheets; knowledge of the decomposition period of non-biodegradable lunch sheets; awareness of alternatives and lunch sheets ban in Sri Lanka; knowledge of environmental and health impact; and their interest in biodegradable lunch sheets. A poster was shared with information on the environmental and health impacts of non-degradable lunch sheets and the alternatives that can be used to reduce the usage of lunch sheets. After the awareness program, the resurvey was conducted by sharing the Google form among the 62 students who had joined the survey to identify how their behavior had changed. Among 62 students, 93.2% of students used separate bins as a disposal method early and after the awareness program, it was upgraded to 96.7%. At the same time, 11.9% of students disposed of their lunch packaging by burning it, and it was reduced to 3.3%. Before the awareness program, only 27.1% of students knew the decomposing period (10-20 years). After the awareness program, 95% of students selected the correct answer. In the beginning, only 52.5% of students knew about the ban on non-degradable lunch sheets in Sri Lanka. According to the results of resurvey, their awareness about banning lunch sheets increased to 95%. In addition, the students were more knowledgeable than before about the impacts of lunch sheets on the environment and animals after the awareness program. As a result of the resurvey, the awareness of reusable food packaging has improved by up to 98.3%. Furthermore, results showed that 91.7% of students preferred to buy biodegradable packaging materials that are five times more expensive than currently used non-degradable lunch sheets. However, reducing the production cost of biodegradable packaging materials requires further research and investigations. In conclusion, after this study, students were made aware of lunch sheet pollution, environmental impact, and alternatives for lunch sheets. Further investigation into this research will be carried out based on other faculties belonging to the University of Sri Jayewardenepura.  Keywords: Lunch sheet, Pollution, Non-degradable, Environmental effects&nbsp

Teleneurology based management of infantile spasms during COVID-19 pandemic: A consensus report by the south Asia allied west syndrome research group

With telehealth services rescuing patients with chronic neurological disorders during the COVID-19 pandemic, there is a need for simplified teleneurology protocols for neurological disorders in children. Infantile spasms is an epileptic encephalopathy where treatment lag is a significant predictor of outcome. It is one such condition where telemedicine can make a remarkable difference when in-person consultations are delayed or are not possible. However, the adverse effect profile of the first-line therapeutic options, the need for frequent follow-up, underdeveloped telemedicine services, lack of a rational protocol, poor awareness about infantile spasms, a lesser level of parental understanding, and scarcity of pediatric neurologists are the major hurdles in developing countries. This paper provides a teleneurology based approach for the management of infantile spasms in developing countries during the COVID-19 pandemic. The cornerstones of this approach include the fundamental principles of management of infantile spasms, decentralization of patient care to local health providers, efforts for improving sensitivity and specificity of diagnosis, early initiation of first-line therapeutic options, and constant motivation of parents and local health providers to be vigilant for therapeutic response, adverse effects of therapy, and infections

Management practices for west syndrome in south Asia: A survey study and meta-analysis

Objectives: Considering the dearth of literature on West syndrome (WS) from South Asian countries, this study aimed to evaluate the management practices in South Asia by an online survey and meta-analysis.Methods: An online questionnaire was sent to 223 pediatric neurologists/pediatricians in India, Pakistan, Myanmar, Sri Lanka, Bhutan, Nepal, and Bangladesh. Their responses were evaluated and supplemented by a meta-analysis.Results: Of 125 responses received (response rate: 56%), around 60% of responders observed male preponderance and an approximate lead-time-to-treatment (LTTT) of 4-12 weeks. The commonest etiology observed was a static structural insult (88.6% of responders). Most commonly used first-line drug (country-wise) was as follows: India-adrenocorticotropin hormone (ACTH, 50%); Pakistan-oral steroids (45.5%); Myanmar, Sri Lanka, and Nepal-oral steroids (94.4%); Bangladesh-ACTH (2/2); Bhutan-vigabatrin (3/5). ACTH and vigabatrin are not available in Myanmar and Nepal. The most commonly used regime for ACTH was maximal-dose-at-initiation-regime in India, Sri Lanka, and Bangladesh and gradually escalating-regime in Pakistan. Maximum dose of prednisolone was variable-most common response from India: 3-4 mg/kg/d; Pakistan, Bhutan, and Bangladesh: 2 mg/kg/d; Sri Lanka, Nepal, and Myanmar: 5-8 mg/kg/d or 60 mg/d. The total duration of hormonal therapy (including tapering) ranged from 4 to 12 weeks (67/91). Most responders considered cessation of spasms for four weeks as complete response (54/111) and advised electroencephalography (EEG; 104/123) to check for hypsarrhythmia resolution. Difficult access to pediatric EEG in Bhutan and Nepal is concerning. More than 95% of responders felt a need for more awareness. The meta-analysis supported the preponderance of male gender (68%; confidence interval [CI]: 64%-73%), structural etiology(80%; CI 73%-86%), longer LTTT (2.4 months; CI 2.1-2.6 months), and low response rate to hormonal therapy(18% and 28% for ACTH and oral steroids respectively) in WS in South Asia.Significance: This study highlights the practices and challenges in the management of WS in South Asia. These include a preponderance of male gender and structural etiology, a longer LTTT, difficult access to pediatric EEG, nonavailability of ACTH and vigabatrin in some countries, and low effectiveness of hormonal therapy in this region

Epilepsy after perinatal stroke with different vascular subtypes

Objective: With an incidence up to 63/100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence and predictive factors of epilepsy, and to describe the course of epilepsy of children with perinatal stroke with different vascular subtypes. Methods: Patients were retrieved from Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into five perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. Results: Final study group included 73 children with perinatal stroke (39 boys). With median follow-up time 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative post-stroke epilepsy risk according to Kaplan-Meier estimator was 40.8% (95%CI: 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS had more often severe epilepsy syndromes. Cortical lesions (OR 19.7; 95%CI 2.9–133), involvement of thalamus (OR 9.8; 95%CI: 1.8–53.5) and temporal lobe (OR 8.3; 95%CI: 1.8–39.6) were independently associated with post-stroke epilepsy. Significance: The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time. This article is protected by copyright. All rights reserved.Peer reviewe