Journal of Nepal Paediatric Society

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https://imsear.searo.who.int/handle/123456789/146370

Editor in Chief: Dr Arun Neopane

ISSN 1990-7974 (Print) 1990-7982 (Online)

Language: English

Peer-reviewed open access journal indexed in Index Medicus

Website: https://www.nepjol.info/index.php/JNPS/index

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Now showing 1 - 20 of 211

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(2007-07) Vidhyashankar, C
Childhood Middle Ear Tuberculosis–A Rare Case Report.
(2007-07) Swain, P K; Mallik, S A; Thapalial, A
Tuberculosis rarely affects the middle ear cleft; the disease is a curiosity and not often considered in the differential diagnosis of otorrhea. The diagnosis is thus made too late, with resulting complications such as irreversible hearing loss and facial nerve paralysis. A case report with review of the literature is presented, emphasizing that tuberculosis should be considered in the differential diagnosis of chronic ear infection in children. In our case direct nosocomial spread of tuebrculous bacilli has been attributed.
Myelofibrosis in a Child with Tuberculosis: A Case Report.
(2007-07) Malla, K; Malla, T; Thaplial, A
Myelofibrosis (MF), or fibrosis of the bone marrow, is an uncommon condition in children. Fewer than 100 cases have been described in the medical literature. Most cases in children arise secondary to other disease processes. We present a case of Myelofibrosis in a 12-year-old girl. The purpose of reporting this case is that this child had a diagnostic dilemma and was sent home with poor prognosis but with proper diagnosis and treatment she improved and may have a complete cure, as the myelofibrosis was secondary to tuberculosis.
Langerhans Cell Histiocytosis - A Case Report.
(2007-07) Gurubacharya, S M; Gurubacharya, R L
Histiocytosis is a heterogenous group of disorders that are characterized by proliferation and activation of mononuclear phagocyte system. Langerhans Cell Histiocytosis (LCH) or Class I histiocytosis is a rare disorder of unknown etiology with proliferation of Langerhan cells which may infiltrate a single or multiple organs. This disease is more common in infants and children. It is usually sporadic but a familial pattern is known. The term embraces the whole clinical spectrum of the disorder from single bone lesions (eosinophilic granuloma) to an aggressive widespread multisystem disease in very sick child (Letterer-Siwe disease) with a wide variety of intermediate forms including the Hand-shuller Christian triad. The cause of LCH is not firmly established and most investigators in the field have long suspected that LCH is immunologic disorder either in its etiology or in its pathophysiology1,2. Recent evidence suggests that LCH is a clonal disorder rather than reactive disease3. LCH is classified according to sites of involvement into single system disease and multisystem disease4. Single system disease can be either unifocal or multifocal. Multisystem disease can be either without organ dysfunction or with organ dysfunction. Clinical course of LCH with single system disease is usually benign with high chance of survival5,6. However, its clinical course is often unpredictable and patients can experience spontaneous remission and exacerbations. Histiocytic diseases are currently classified by the writing group of the Histiocyte Society7 in the three classes, namely; Class I: Langerhans Cell Histiocytosis (LCH) Class II: Histiocytosis of mononuclear phagocytes other than Langerhans Cells Class III: Malignant Histiocytic disorders
Intussusception- A Case Report.
(2007-07) Gurubacharya, S M; Gurubacharya, R L
Intussusception, the invagination of a portion of the intestine into itself, is one of the emergencies in infancy and childhood. The etiology may be idiopathic or secondary to some pathology within the wall of the bowel. Most cases (90%) are idiopathic1,2 with no identifiable lesion acting as the lead point or pathological apex3 of the intussusceptum Children may present at any age but this occurs most commonly in the first year. The mode of presentation may vary depending upon the time of presentation. A case of intussusception confirmed with the help of an abdominal ultrasound in 10 month old infant who presented with only persistent vomiting but in the absence of classic features is reported with brief review of literature.
A Case of Acute Flaccid Paralysis: An Uncommon Presentation of a Common Disease.
(2007-07) Shrestha, S; Regmi, S K
A Study of Early Neonatal Deaths at Kathmandu Medical College Teaching Hospital.
(2007-07) Shrestha, M; Bajracharya, B L; Manandhar, D S
Introduction: Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section. Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH. Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births.
An Overview of Renal Diseases in Children in Pokhara.
(2007-07) Malla, T; Malla, K K; Thapalial, A; Sharma, M S
Objective: To determine the current pattern and prevalence of renal diseases in childhood in this region of Nepal. Material and Methods: A retrospective study of the renal diseases in children attending the Pediatric OPD and those hospitalised in Manipal Teaching Hospital, Pokhara was done over a period of 6 years (September 2000- September 2006). A detailed clinical and laboratory evaluation was performed at baseline. The children were managed according to disease diagnosed. These cases are under follow up and some have undergone surgical treatment. Results: 228 children (123 boys & 105girls) were diagnosed to have renal disease. Among them 39.5% had urinary tract infection (UTI), 30.7 % were suffering from acute glomerulonephritis (AGN), 17.5% were cases of nephrotic syndrome (NS) and 12 % had some other problems for example, 6.14% had genetic defects, 2.63% had renal Stone, 2.2% had pre-renal acute renal failure, unexplained recurrent hematuria in 1.3%. All the cases of UTI underwent through investigation and were treated accordingly. All cases of AGN are planned for follow up for 1½ yrs and among them 3 required biopsy till date. All cases of NS are under regular follow-ups and 2 have undergone biopsy. Renal stone was operated successfully. All cases of acute and chronic renal failures had required dialysis. Out of 5 (2.5%) chronic renal failures, 2 with end stage renal disease expired after repeated hemodialysis and three are still requiring dialysis. Among the obstructive uropathies, 43 % had renal stone, 36 % had posterior urethral valve and 21% VUR. Conclusion: It can be concluded that renal disease is not uncommon in children. It can be completely cured with proper and adequate treatment. Sometimes it has a bad prognosis when it reaches end stage renal disease. Early recognition, timely treatment and regular follow up are mandatory in management of children with renal diseases.
An Overview of Neonatal Admissions at College of Medical Sciences (COMS).
(2007-07) Gurubacharya, S M; Gurubacharya, R L
Objective: To know the profile of newborn admissions and its outcome and the factors associated with neonatal mortality. Methods: The study included both intramural and extramural cases of 180 newborn babies admitted in nursery over a period of 6 months from 01/08/06 to 31/01/07. The relevant data were recorded on a pre-designed proforma meticulously. Results: There were 180 newborn babies during the study period. The mean birth was 2.7 kg.. Majority, 77.8 %( 140) of the babies weighed equal to or more than 2.5 kg. Low birth weight (LBW) was seen in 22.2 %( 40) babies. There were 80 %( 144) full term babies and 20 %( 36) preterm babies. Majority of the mothers in the age group between 20-30 years had incomplete antenatal check- ups. There were 86 %( 155) normal vaginal deliveries, 4.5 %( 8) forceps deliveries and 9.5 %( 17) caesarean sections. Birth/perinatal asphyxia 39(22%), prematurity 36(20%) and neonatal septicemia 30(17%) comprised of leading admissions. There were 27deaths (15%) in total.13 (7%), 8(5%) and 6(3%) babies died of severe perinatal asphyxia, neonatal septicemia and prematurity respectively. Most of the deaths occurred during the first 72 hours. Conclusions: The mean birth weight is good. The major causes of neonatal death are birth/perinatal asphyxia, prematurity and neonatal septicemia. The factors influencing neonatal mortality are low and poor antenatal care, meconium stained liquor, delay in coming to the hospital, PROM, eclampsia. The study emphasises the importance of regular antenatal care, timely referral of pregnant women with complications to appropriate centers and conducting delivery in a clean environment for lowering neonatal mortality.
Role of Serum Alanine Aminotransferase Aspartate Aminotransferase and Alkaline Phosphatase in Early Detection of Protein Energy Malnutrition.
(2007-07) Karmacharya, K; Islam, M N
Objective: Although Protein Energy Malnutrition (PEM) has been studied extensively; the best criteria for its detection in early stages have not been established. This study was carried out to observe the change in transaminases, alkaline phosphatase levels when compared with control and also to see their relationships with various grades of PEM. Then to see if certain biochemical parameters could be used to detect malnutrition in early stage. Methods: Cross sectional study between Jan 1999-Dec 2000,124 children from 5 months to 5 years were included in the study. Out of 124 children 98 (79%) were cases and 26 (21%) normal age matched healthy controls. Cases were divided into groups as per Gomez classification (Group1-Grade I PEM, 37;Group 2- Grade II PEM, 34; Group 3- Grade III PEM27; and Group 4 26 Healthy controls). Three serum enzymes, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Alkaline Phosphatase (ALP) was analyzed and for statistical analysis student’s “t” test was used. Results: The mean serum values +SD of ALT (Grade I PEM-41.40 +13.25,Grade II PEM-31.53+10.6,GradeIIIPEM-33.77+12.45,Control-23.11+8.73) and Aspartate aminotransferase (Grade I PEM-42.8+11.06,Grade II PEM 31.47+8.32,GradeIII PEM 35.00+10.86, Control-25.42+8.77) in patients with PEM were significantly (p<. 0.001) higher than controls. The degree of increase in serum values of these two enzymes was maximum in cases with Grade I PEM. The mean serum values of Alkaline phosphatase (Grade I PEM-403.40+100.76, Grade II PEM-294.23+50.40,Grade III PEM-221.26+94.09,Control-894.5+ 126.28) in cases of PEM were significantly lower than controls, lowering being maximum in PEM Grade III. Conclusion: It can be concluded that abnormalities in blood levels of these enzymes occur in any form of PEM and these are related to the severity of the disease. Hence this may be helpful in early diagnosis of PEM where clinical features are equivocal.
Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns.
(2007-07) Shrestha, P; Das, B K; Bhatta, N K; Jha, D K; Das, B; Setia, A; Tiwari, A
Neonatal infections currently cause about 1.6 million deaths annually in developing countries1. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs.
Efficacy of Albendazole and Short-Course Prednisolone Treatment in Children with One or Two Ring-Enhancing Lesions of Neurocysticercosis: A Randomized Controlled Trial.
(2007-07) Swain, P K; Thapalial, A; Das, R N; Dhaliwal, M S; Subedi, K
Context: Neurocysticercosis is a endemic disease in Nepal causing social and financial burden on society and developmental problem in children. Aims: To determine the efficacy of albendazole plus oral prednisolone in children with 1 or 2 ring-enhancing lesions (by CT) on resolution of lesions and recurrence of seizure. Setting and Design: Randomized controlled open trial. Methods and Materials: Children with 1 or 2 ring-enhancing lesions <20 mm in diameter on computed tomography scan, likely to have Neurocysticercosis, were assigned to treatment & control groups. Children assigned to the treatment group (n = 50) were given 2.0 mg/kg per day prednisolone orally for 5 days plus 15 mg/kg per day albendazole on third day for 28 days. Anti epileptic drugs were given to both groups {including Control group (n = 51)}. Statistical Analysis: The results were analysed with the use of Epi Info version 6.04 and Stata version;7 software. Results: The lesions resolved completely or partially in more children in the treated group compared with the control group (p = .04 & p = 0.03). The proportion of children who had seizures was significantly lower in the treated group compared with the control group at 6 months (10% versus 33%; p = .006) and 12 months (14% versus 38%; p = .003). Conclusion: Albendazole plus Prednisolone increased resolution of lesions on computed tomography scan and reduced the risk of subsequent recurrence of seizures among children with Neurocysticercosis.
Polio Eradication Efforts in Nepal.
(2007-07) Suvedi, B K
Nepal has made tremendous effort for polio eradication. The efforts are based on the global polio eradication strategies. Despite all the efforts as per the global strategies, wild poliovirus is still present in the country. The importance of water, hygiene and sanitation is stressed as an additional strategy in still persisting areas.
The Future of Paediatric Surgery in Nepal.
(2007-07) Thapa, N B
Distribution of Serotypes and Antimicrobial Resistance of Streptococcus Pneumoniae in a Children’s Hospital in Nepal.
(2008-07) Sherchand, J B; Joshi, A R; Gauchan, P; Amatya, J
Continuing medical Education for Paediatricians.
(2008-07) Adhikari, R K
Substitute for the Breast Milk (Sale, Distribution and Control) Act 2049.
(2008-01) Journal of Nepal Paediatric Society
Nepal Paediatric Society Guidelines for Childhood Immunization.
(2008-01) Journal of Nepal Paediatric Society
All About Medical Journals and Articles.
(2008-01) Vidya Shankar, C
Childhood Neurotic Traits.
(2008-01) Shakya, D N

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