Journal of Nepal Paediatric Society

Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador

David Israel Garrido Salazar — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.20193

Introduction: Anaemia and pneumonia are frequent diseases which affect children. However, these two conditions could coexist. The aim of this study is presenting the prevalence of anemia among Ecuadorian children diagnosed with pneumonia, hospitalized in a tertiary hospital.

Material and Methods: An observational and cross-sectional study conducted through a secondary source in that 80 children, between six months and 15 years of age were included. All the patients involved were admitted to the paediatric department presenting pneumonia. The medical evaluation included anthropometric measurements and complete blood count. Risk associations were evaluated using odds ratio.

Results: Anaemia was found in 21.25% of the whole group. Nonetheless, the children under three years of age were more affected by this condition (18.75%). Low mean corpuscular volume and high red cells distribution width were more frequent than anaemia itself; 38.75% and 28.75%, respectively. Additionally, the prevalence of anaemia in children under 36 months was higher than the patients with over three years, with a significant risk of anaemia in the first group (OR 13.04; CI 95% 11.48-14.61; p<0.05) and low haematocrit (OR 14.64; CI 95% 12.53-16.75; p<0.05). This was also seen in low mean corpuscular volume (OR 3.23; CI 95% 2.3-4.17; p<0.05), high red cells distribution width (OR 2.77; CI 95% 1.76-3.78; p<0.05), and mean corpuscular haemoglobin (OR 8.48; CI 95% 7.14-9.82; p<0.01).

Conclusions: Anaemia is a frequent condition in paediatric pneumonia, particularly during the first three years of life. Therefore, anaemia or nutritional deficiencies could be a risk factor for respiratory diseases.

Assessment of Hand Hygiene Knowledge among Residents and Nursing staffs at Nobel Medical College Teaching Hospital, Biratnagar

Sunil Kumar Yadav — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.20547

Introduction: Hand hygiene is a very simple and cost-effective procedure to prevent cross-transmission of microorganisms. The compliance of residents and nursing staffs with hand hygiene guidelines seems to be vital in preventing disease transmission among patients. The objective of the study was to assess the knowledge of residents and nursing staffs with regard to hand hygiene.

Material and Methods: This was an institution based descriptive cross-sectional study conducted among 55 respondents (29 nursing staffs and 26 resident doctors) of department of paediatrics, Nobel Medical College in Biratnagar, Nepal. Knowledge was assessed using WHO hand hygiene questionnaire for health care workers. Chi square test was used to compare the percentage of correct responses between resident doctors and nursing staffs. A p value of <0.05 was considered significant.

Results: Among 26 resident doctors and 29 nursing staffs who participated in the study, 30.7% of resident doctors and 55.1% of nursing staffs had received formal training in hand hygiene in the last three years. Only 9% of participants (5 out of 55) had good knowledge regarding hand hygiene.

Conclusions: The knowledge regarding hand hygiene is limited among the study population. The study recommends the need for emphasizing hand hygiene component in the preservice as well as in-service training programs of doctors and nurses.

Cognitive Function in Children with Epilepsy

Bayu Pratama Putra — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.19386

Introduction: Epilepsy is a worldwide and common child health problem. One of its complications is cognitive impairment that will impact on children’s cognitive development and quality of life. The objective of this study is to find out whether epilepsy affects cognitive function in children.

Material and Methods: This was a cross-sectional descriptive study using secondary data from medical records. We collected data from children with epilepsy from 2004 until 2014 that have been actively managed in the Growth and Development Clinic, Sardjito General Hospital, Yogyakarta, Indonesia. Cognitive function referred to low IQ score that was gained from patients’ data. We analyzed the data using Fischer’s exact and two-sample Kolmogorov-Smirnov test methods.

Results: Among 40 data samples, there were 19 patients (42.5%) with cognitive impairment (IQ < 70) and 21 patients (57.5%) without cognitive impairment (IQ ≥ 70). There were twenty-five patients examined by the Stanford-Binet IQ test, which found 15 patients with cognitive impairment. In fifteen patients who were examined with the WISC test, we found more children with epilepsy without cognitive impairment (11 patients). Comorbidity with neuro-developmental disorder significantly affected cognitive impairment in children with epilepsy (p value = 0.034, 95% CI 1.08-21.76).

Conclusions: More children with epilepsy without cognitive impairment were found. Further studies are needed with larger number of samples utilizing a prospective study design to better determine the association of epilepsy in children and cognitive impairment.

Comparison of Oral Trichlophos and Intranasal Midazolam for Sedation in Minimally Invasive Paediatric Procedures (RAMT Study)

Manoj Sharma — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.19139

Introduction: Uncooperative child does not allow completion of procedures, denying valuable data required for clinicians.

Material and Methods: An open labelled parallel group prospective randomized control study was conducted at zonal hospital Jorhat. We evaluated 200 children randomized into two groups using computer based randomization. Participants aged 3 months to 5 years (n=200) were randomized to receive 50 mg/kg Triclofos sodium orally or intranasal spray of midazolam 0.2 mg/kg.

Results: Adequate sedation (Ramsay reactivity score of 3 and 4) was obtained in 86% children in midazolam group as compared to 80% in triclofos group with p value of 0.138. Mean duration for onset of sedation was 20 min ± 5.4 min in Trichlophos group and 12 min ± 4.5 min with Intranasal Midazolam which was statistically significant with p-value of <0.001. The mean duration of post procedural sedation was found to be 24.00 ± 9.21 min in midazolam group and 49.00 ± 16.99 min in triclofos group (p=<0.001) which was statistically significant. No significant difference was seen for side effects frequency between the two drugs (15% in Triclofos, 10% in Midazolam group; p=0.285).

Conclusion: We conclude that intranasal midazolam is more effective than oral trichlophos with a comparable safety profile.

Comparison of the Single Breath Vital Capacity Technique with the Tidal Volume Technique

Jeevan Singh — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.20145

Introduction: The single breath vital capacity (VC) induction and the tidal volume (TV) breathing induction are currently administered for inhalation of anaesthesia with sevoflurane in children. The aim of this study was to determine whether the vital capacity technique achieves more rapid induction of anaesthesia in children compared to the conventional tidal volume technique.

Material and Methods: Sixty ASA physical status 1 or 2 children aged between 5 and 15 years, scheduled to undergo elective urological, orthopaedic or visceral surgery under general anaesthesia using inhalational induction with sevoflurane were recruited and randomized to receive either vital capacity induction or tidal volume induction with 8% sevoflurane at 6L/min of O₂ followed by laryngeal mask airway insertion or endotracheal intubation with endotracheal tube. Time required for induction, hemodynamic changes, airway tolerance, side-effects, level of satisfaction using a visual analogue scale (0-100) and Smiley scale (0-10) were documented.

Results: Induction time was significantly shorter with the vital capacity induction technique than with the tidal volume breathing induction technique (43.8 ± 13.4 seconds vs 70.8 ± 16.4 seconds; P<0.01). The time to central myosis, haemodynamic changes and respiratory events incidences were similar in both the group. Fewer complications occurred with vital capacity group. More than 94% of the children choose the single Breath Vital Capacity method of induction to the tidal volume technique.

Conclusion: For inhalation induction of anaesthesia, the vital capacity induction was faster and produced less complication than that of tidal volume breathing technique.

End of Paediatric Posting Assessment of Medical Interns at a Teaching hospital from Coastal Karnataka

K.S. Sahana — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.19586

Introduction: Internship is very a critical period of a medical undergraduate education during which student evolves into a doctor. The objectives of this study were to assess the interns at the end of their paediatric postings.

Materials and Methods. Interns knowledge and skills were assessed at the end of their postings in the must know areas. Assessment was conducted by the trained faculty and interns were given the orientation about it. Method of assessment included OSCE, simulation based using standardized patients and computer-based model driven simulators. Feedback was given to the students immediately at the end of their exam

Results: Total 202 interns participated in the exam over the period of two years. New-borns assessment was done more frequently (22.7%) and interpretation of investigations was less frequently assessed (7.9%). Rest of other stations was assessed almost at the equal proportion. Highest score was observed in vaccines section (7.5) and lowest score was seen in procedures assessment (5.5).

Conclusion. Interns were found to be weaker in procedural, communication and clinical scenario judgement skills which will help us in planning future training of the Interns.

Knowledge, Attitude and Practice of Using ORS and Household Management of Childhood Diarrhoea

Naresh Chandra Acharya — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.19028

Introduction: Diarrhoea is defined as the passage of three or more loose stools per day. Diarrhoea is one of the leading causes of childhood mortality in India. The objectives of the study were to assess household Knowledge, Attitude and Practice for prevention of Diarrhoea in children through preformed questionnaires.

Material and Methods: Four hundred and sixty eight under five children were selected for study by Cluster sampling method. Background information, details of acute diarrhoea and treatment modalities were obtained from mother of the under five children. This was a hospital based study conducted at a tertiary care hospital, from 1^st May 2017 to 30^thDecember 2017.

Results: About 70% of the moms were between the age assemble 25-32 years and the vast majority of them were housewives (72%). A greater part (>66%) of the moms were having essential/auxiliary education. Learning with respect to different parts of the diarrhoea and ORS surprisingly extremely unacceptable. In the present examination it is seen that learning in regards to ORS in looseness of the bowels is more in educated mother than uneducated. Three sitting of Educational mediations realized huge enhancement of the middle scores of learning, state of mind and practice expanded from 9, 6, 3 to 19, 14, 8, individually,

Conclusion: The household knowledge regarding method of use and preparation of ORS for management of diarrhoea was observed to be lacking in this investigation. More estimates should be taken to enhance this learning and make moms mindful about the planning and utilization of ORS.

Prevalence and Knowledge on Obesity Among School Going Adolescents of Kaski, Nepal

Apsara Pandey — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.19917

Introduction: Childhood obesity has now been recognized as a global health problem because of its devastating consequences and prevalence at uncontrollable rate worldwide. The objective of this study was to determine prevalence of obesity and find out the knowledge on obesity among school going adolescents.

Material and Methods: This descriptive cross-sectional study was conducted among adolescents of two private schools of Kaski district. Altogether 120 adolescent students were selected using census method. Height and weight were measured with standard scale and BMI was calculated. Self-administered structured questionnaire was used to assess knowledge. Descriptive statistics and Chi-square test at 0.05 significance level was used to analyze data.

Results: The mean age of adolescents was 15.1 years and 50% of them were male. The prevalence of obesity among adolescents was 3.3%. Seventy five percent of the adolescents had knowledge regarding meaning of obesity and 59.2% had mentioned high calorie intake as a risk factor of obesity. Likewise, 52.5% adolescents stated Diabetes mellitus as consequence of obesity. Ninety eight percent mentioned regular exercise as a preventive measure of obesity. More than three fourth (78.3%) of the adolescents had inadequate knowledge regarding obesity. Male adolescents had significantly higher knowledge than female adolescents (p=0.00).

Conclusion: Even though very few adolescents had obesity, there were adolescents with overweight which were at more risk for getting obesity. Adolescents have inadequate knowledge regarding obesity.

Child Adoption, Posttraumatic-Stress Disorder and the Role of a Paediatrician in the Adoption Process

Alphonsus Ndidi Onyiriuka — 2019-05-20

DOI: https://doi.org/10.3126/jnps.v38i2.20815

Child adoption represents a robust specialised child welfare service with the potential of meeting the needs and promoting the best interest of a child who have no permanent home or family to relate with. In addition, it provides succour for childless couples. Either way, there are socio-cultural challenges that need to be overcome. This paper reviews the objectives, types of adoption, circumstances in which adoption occurs, eligibility for adoption, and stress system biology/pathophysiology. Posttraumatic stress disorder in adopted children is discussed. The peculiarities and challenges of child adoption in Nigeria are highlighted. In addition, the role of a paediatrician in child adoption process is outlined. An extensive online search of the literature available in English was undertaken via electronic databases such as Nigerian Journals Online, African Journals Online, and Pubmed. Textbooks with chapters on child adoption as well as Newspapers with relevant articles on the subject were also consulted. Generally speaking, all adopted children have experienced some traumatic life event. Such an event, results in children’s brains initiating adaptive stressmediating neural systems. Basically, the paediatrician guides, advises, assists and supports all parties in the adoption triad.

Conclusion: The interest of each member of the adoption triad changes over time, making it necessary to design adoption process in a way that will provide protection and support for every triad member.

Cystic Fibrosis with Severe Anaemia and Hypoproteinaemia

Md Abu Bakkar Siddique — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.19196

The presentation of cystic fibrosis (CF) is dependent upon which organs are affected. Severe anaemia is reported to occur rarely in patients with CF. We are presenting a case of 2 months old infant admitted with anaemia, malnutrition, hypoproteinaemia and hypoalbuminaemia, without any pulmonary symptoms at the initial presentation. Abnormal sweat chlorides and low faecal elastase level confirmed the diagnosis of CF. Respiratory symptoms and signs developed later on further follow up.

Keywords: Cystic fibrosis, Severe anaemia, Hypoproteinaemia

Dilemma in the Management of Duchenne Muscular Dystrophy in a Resource Limited Settings

Ahmadu Baba Usman — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.19623

Duchene muscular dystrophy is an x-linked recessive genetic disorder which present with progressive muscle weakness in children. It is often complicated by child becoming wheelchair bound by age 12. This limitation on the child and lack of cure is a great burden on the child, family and the community. We present a case of an 11-year old boy who presented with a seven years history of progressive limb weakness. Examination revealed hyper-lordosis of the thora-columbar spine, hypertrophied calf muscles, weak lower limbs and waddling gait. Due to financial constraint, only histology was relied on for definitive diagnosis. He was counselled, placed on prednisolone and commenced physiotherapy. This case portrays the challenges associated with the management of a rare disease in resource constraint settings.

Keywords: Duchene Muscular dystrophy, Nigeria, Children

Eosinophilic Meningitis and Intracranial Haemorrhage: Can it be Neuro-Gnathostomiasis?

Srijana Basnet — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.19211

Peripheral eosinophilia is commonly encountered in our clinical practice. In this case report, we present a child who presented with hemorrhagic stroke and was finally diagnosed of eosinophilic meningitis. In this case report, we also propose probable etiologic agent.

Keywords: eosinophilic meningitis, intracranial hemorrhage, parasite

Familial Chylomicronaemia: A Neonate with Milky White Blood

Nanda Kishwor Chaudhary — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.20473

Familial Chylomicronaemia is a rare autosomal recessive disease of lipoprotein metabolism characterized by deficiency or absence of lipoprotein lipase (LPL) or its co-factor apoC-II which causes severe elevation of triglyceride and chylomicron resulting in lipaemic plasma, recurrent attacks of acute pancreatitis, eruptive xanthomas, hepato-splenomegaly and lipaemiaretinalis. We report a case of term female neonate with lipaemic plasma, lipemia retinalis, markedly elevated triglyceride level which is consistent with diagnosis of Familial Chylomicronaemia.

Keywords: Familial Chylomicronemia, lipemic plasma, triglyceride level, Lipemia retinalis

Mermaid Syndrome

Md Abu Bakkar Siddique — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.18802

We report a case of sirenomelia baby (Mermaid syndrome) born to a twenty three years old female at 37 weeks of gestation. Sirenomelia is characterized by fusion of the lower limbs with absent kidneys, absent external genitalia and other gastrointestinal defects. It results from the failure of normal vascular supply from the lower aorta in vitro, maternal Diabetes mellitus has been associated with caudal regression syndrome and sirenomelia.

Keywords: Mermaid syndrome, Sirenomelia, Caudal regression

Necrotizing Pneumonia In Infant: Rare Complication of Community Acquired Pneumonia

Suman Bikram Adhikari — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.21327

Necrotizing pneumonia, rare complication of Community-acquired bacterial pneumonia (CABP), bear its own morbidity and mortality. Even though CABP generally respond well to the antibiotic treatment, but complications like empyema, necrotizing pneumonia with pneumatocoel formation (cavitary necrosis) supervene in mainly immune-compromised patient. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. Some cases may required surgical intervention like tube thoracotomy or open thoracotomy. A case is presented of an infant that developed necrotizing pneumonia with pneumatocoel formation during treatment of bacterial pneumonia. Tube thoracotomy was performed due to conservative treatment failure.

Keywords: Necrotizing pneumonia, antibiotic, tube thoracostomy

Takayasu’s Arteritis: Rare Cause of Hypertension in Children

Reshma Dhakal Lamichhane — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.20551

Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta, its major branches and pulmonary arteries. Diagnosis of TA during childhood remains challenging due to the non-specific symptoms. We report a six years age boy with unresolved hypertension who was later diagnosed as childhood TA. Oral corticosteroid was started 2mg/kg/day. TA is rare in children; Childhood TA must be considered in children who present with, hypertension and increased acute phase reactants.

Keywords: children, Takayasu’s arteritis,Steroids

Tuberculosis in Early Infancy: Rare in Today’s World

Jitendra Thakur

DOI: https://doi.org/10.3126/jnps.v38i2.19329 Tuberculosis in early infancy was not so common earlier also and has become rare these days. Since the disease is occasionally encountered, pediatricians should suspect tuberculosis in infants not responding to standard therapy. Here we report a case of three months old female who had presented with complaints of fever for two months, cough for one and half months and difficulty breathing for seven days and was being treated in line of bacterial pneumonia without improvement. She was found to be mycobacterium positive and was treated with anti-tubercular therapy leading to improvement and discharge. So, though rare, it is important to consider tuberculosis even in early infancy not responding to standard antibiotic therapy. Keywords: Tuberculosis, infant, diagnosis

Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia: Correspondence

Nagendra Chaudhary — 2019-05-23

DOI: https://doi.org/10.3126/jnps.v38i2.21755

Not present

Keywords: Pneumonia; clinical diagnosis