National Institute of Child Health

본 연구는 빠알리 니까야에서 무아(anattā)와 윤회(saṃsāra)가 교차하는 텍스트를 대상으로, 붓다의 언어 전략을 체계적으로 분류하고 그 패턴을 제시한다. 기존 연구가 "무아인데 윤회는 어떻게 가능한가"라는 물음에 직접 답하려 했다면, 본 연구는 그 물음 자체를 붓다가 어떻게 다루었는지를 묻는다. 핵심 질문은 "답이 무엇인가"가 아니라 "어떤 질문 틀을 요구했는가"이다. 이를 위해 니까야 네 부(DN, MN, SN, AN)와 쿳다까 초기층에서 무아–윤회 교차 경전 86숫따(핵심 74 + 비핵심-A 6 + 비핵심-B 6; 255대화)를 선별하여 연구 자료체를 구성하였다. 질문 유형 7종(질문-행위주체, 질문-정체, 질문-실재, 질문-존속, 질문-기제, 질문-기타, 설시형)과 답변 유형 7종(답변-거부, 답변-무기, 답변-연기, 답변-중도, 답변-비유, 답변-교정, 답변-해명)으로 구성된 코드북을 설계하고, 7단계 결정트리에 따라 전수 코딩을 수행하였다. 코딩 규칙은 결론 도출 이전에 동결(규칙동결 1차·2차)하여, 결론에 유리하도록 규칙을 사후 조정하는 것을 구조적으로 차단하였다. 분석 결과, 세 가지 정량 지도를 산출하였다. 지도 1(질문 유형 × 답변 유형 교차표)은 붓다가 행위자 질문과 동일성 질문에 대해 질문 거부와 연기 전환을 지배적으로 사용하며, 메커니즘 질문에 대해서는 과정 해명으로 전환하는 패턴을 보여준다. 지도 2(표지 어구 동반 출현표)는 "no kallo pañho"(질문이 적절하지 않다), "na ca so na ca añño"(그도 아니고 다른 이도 아니다), 연기 공식이 높은 빈도로 동반 출현함을 확인한다. 지도 3(viññāṇa 용례군별 동사 결합 패턴)은 viññāṇa(식)의 용례를 문법적 표지, 연기 고리 내 위치, 결과 술어 연결이라는 세 기준으로 분할하여, 결생적 기능(어휘-재생), 존속적 기능(어휘-존속), 인식적 기능(어휘-인지) 등이 니까야 내부에서 이미 구분되고 있음을 보인다. 반례 판정에서는 다섯 유형의 충돌 텍스트(T1: 식의 윤회 주체화, T2: 업의 상속, T3: citta/mano/viññāṇa 교체, T4: pabhassara-citta, T5: 전생 회상)를 실질 긴장·표면 긴장·허위 긴장의 3유형으로 판정하고, 각 판정의 근거를 규칙 항목 번호로 추적 가능하게 기록하였다. 본 연구는 무아–윤회 문제에 단일한 해답을 제시하지 않는다. 대신, 연구 자료체 편입 규칙, 코드북과 결정트리, viññāṇa 기능 지도, 반례 판정표, 견고성 점검표라는 다섯 종의 산출물을 제공하며, 이 산출물은 후속 연구자가 그대로 가져다 재검증하거나 확장할 수 있는 연구 인프라로 기능한다. 주제어: 무아(anattā), 윤회(saṃsāra), 빠알리 니까야, 질문 구조, viññāṇa, 연기(paṭicca-samuppāda), 코드북, 결정트리

You can suffer without pain. Even on days free of distress, something keeps repeating—and the very wish to stop becomes part of the loop. This book examines the structure behind that repetition. Drawing on the early Buddhist discourses (Nikāyas), it reframes *dukkha* not as a feeling but as a structure. It traces how the five aggregates generate their own momentum, how comfort can become a prison, and how control persists without a controller. Then it asks: if you already understand the pattern, why can't you stop? This book offers no prescriptions. Instead, it examines the conditions under which mindful awareness does not become another cover, the path becomes an arrangement rather than a checklist, and a relationship becomes a mirror rather than a blade. It is not a book that gives answers. It is a book that leaves questions. Written for anyone who has already experienced a repetition they wanted to stop but could not. No background in Buddhism is required. The experience of repetition is enough.

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Epilepsy is considered to be present when 2 or more unprovoked seizures occur in a time frame of longer than 24 hours. Objectives: To determine the knowledge, attitude, and practice of parents of children with epilepsy. Methods: This descriptive cross-sectional study was conducted at the Outpatient Department of Pediatric Neurology, National Institute of Child Health, Karachi, Pakistan, from January to June 2025. A total of 262 parents of children aged 1–12 years with epilepsy for ≥6 months were enrolled through non-probability consecutive sampling. A structured 15-item KAP questionnaire (7 knowledge, 5 attitudes, 3 practice) was developed, validated by experts, pilot tested on 20 parents, and showed good reliability (Cronbach’s alpha 0.81). Scores ≥12/15 were classified as good KAP. Analysis was performed using SPSS version 26.0, with chi-square applied post-stratification, taking p<0.05 as significant. Results: In 262 parents, the mean age was 34.6 ± 7.8 years; 117 (44.7%) were fathers, and 145 (55.3%) were mothers. Good knowledge was noted in 209 (79.8%), favorable attitude in 142 (54.2%), and good practice in 122 (46.6%). Overall, a good KAP was observed in 138 (52.7%). Good KAP was associated with urban residence (p=0.006), higher education (p<0.001), and healthcare professionals as information source (p=0.002), but not with gender, age, or income. Conclusions: Most parents had adequate knowledge about epilepsy, while attitudes and practices were comparatively less satisfactory. Better knowledge, attitude, and practice were observed among parents with higher education, those living in urban areas, and those who received information from healthcare professionals.

Objective: To determine the frequency of thyroid disorders among children with obesity attending public sector hospital of Karachi, Pakistan. Study Design: Descriptive, Cross-sectional. Setting: Departments of Emergency and Outpatient, National Institute of Child Health (NICH), Karachi, Pakistan. Period: March 2024 to August 2024. Methods: A total of 193 children aged 5–16 years of either gender with obesity (BMI-for-age ≥95th percentile by WHO standards) were enrolled using non-probability consecutive sampling. Sociodemographic and clinical data were recorded. Fasting blood samples were analyzed for TSH, T3, and T4. Thyroid dysfunction was classified using standard TSH and FT3 and FT4 thresholds. Data were analyzed with SPSS using t-tests and Chi-square, considering p<0.05 significant. Results: Of the 193 obese children, the mean age was 11.1 ± 2.8 years, and 105 (54.4%) were boys. There were 135 (69.9%) children who were resided in urban areas, while 124 (64.2%) children had class 1 obesity, and 69 (35.8%) had severe obesity. The mean BMI z-score was 2.56±0.46. Thyroid dysfunction was detected in 35 children (18.1%). Severe obesity was significantly more common among those with thyroid dysfunction (45.7% vs 33.5%, p=0.011). Conclusion: Thyroid dysfunction was frequently observed in obese children, with the highest risk among those with severe obesity.

Primary immunodeficiencies are genetic disorders that impair immune function, increasing the risk of infections, autoimmune diseases and cancer. Patients with severe viral infections are often not thoroughly evaluated for immunodeficiencies. This case presents a young infant with human parvovirus B-19 meningitis and persistent lymphocytopenia, whose immunophenotyping revealed low absolute counts of T, B and natural killer cells, leading to a diagnosis of underlying immunodeficiency. This case underscores the necessity for vigilant diagnosis when standard presentation is complicated by recurrent illness or risk factors, highlighting the 'Think Zebra' analogy in paediatric practice.

CKD affects approximately 850million people worldwide and is a leading cause of mortality. Podocytes, cells in the kidney are terminally differentiated and incapable of division in vivo making the establishment of primary cultures particularly challenging. The ability of cells to proliferate and avoid senescence is closely linked to telomere length. However, cellular senescence ensues when telomere length becomes critically shortened. We present the successful rejuvenation of a human SIX2-positive renal progenitor cell line derived from the urine of a 30-year-old West African male (UM30-OSN). To achieve partial reprogramming, plasmids expressing the Yamanaka factors OCT4, SOX2, NANOG, c-Myc, and KLF4 were employed. UM30-OSN expresses the pluripotency-associated marker SSEA4, renal stem cell markers such as SIX2, CD133 and CD24, determined by immunofluorescence, FACS and qPCR. Expression analysis revealed downregulation of senescence markers p21 and p53 and upregulation of proliferation-associated genes PCNA, KI67 and TERT, confirming rejuvenation. Upon podocyte differentiation, UM30-OSN cells expressed podocyte-specific markers NPHS1, NPHS2, SYNPO and CD2AP. Comparative transcriptome analyses revealed a correlation co-efficiency (R2 = 0.88) with the immortal podocyte line AB 8/13. To highlight the value of UM30-OSN in modeling APOL1-mediated kidney disease with an APOL1 (G1/G0) genotype, we examined how Interferon-γ (IFN-γ) affects UM30-OSN-derived podocytes and assessed whether the JAK1/JAK2 inhibitor Baricitinib can counteract IFN-γ-induced cellular responses. IFN-γ stimulation resulting in increased phosphorylation of STAT1, activation of APOL1, upregulation of pro-inflammatory and fibrotic markers such as, IL-6, TGF-β, Vimentin, Fibronectin, and morphological changes indicative of cell stress. Pre-treatment with Baricitinib effectively inhibited STAT1 phosphorylation, reduced expression of pro-inflammatory and fibrosis-associated genes, and preserved podocyte morphology. Given their robust proliferation capacity, UM30-OSN cells represent a valuable additional model for investigating kidney-associated diseases such the contribution of APOL1 high-risk variants to kidney injury and fibrosis.