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Utility of Transcutaneous Bilirubinometer in Tertiary Care Hospital
(Nepal Paediatric Society (JNPS), 2017) Kumar, Vijay; Kahlon, Pardeep Singh; Singh, Palwinder; Singh, Kamail; Sharma, Anubha
Abstract: Introduction: Hyperbilirubinemia is one of the most vexing problems that may occur in 60% of term and 80% of preterm neonates. In order to reduce the risk of developing serious hyperbilirubinemia, it is vital to identify jaundiced infants who are in need of treatment as soon as possible. The objectives of this study were to find whether transcutaneous bilirubin (TcB) measurement correlates with total serum bilirubin (TSB) levels, measured with standard laboratory method and to analyse the effect of gestational age, birth weight and postnatal life on TcB and TSB. Material and Methods: A prospective study was conducted in the Department of Paediatrics, Government Medical College, Amritsar on 300 neonates with visible jaundice. These neonates were divided into various groups depending upon gestational age, birth weight and day of life. TcB readings were recorded at forehead and sternum and serum bilirubin level was measured within 30 minutes. Test of significance applied was unpaired T-test; mean value, p-value, standard deviation and Pearson's correlation coefficient 'r' were calculated. Results: Overall Mean value TcB at forehead was 15.32 with SD ± 2.75, mean TcB at sternum was 14.94 with SD ±2.51, mean value of TSB was 13.80 with SD ±2.15. Pearson’s correlation coefficient r was 0.895 for TcB forehead vs TSB, 0.903 for TcB sternum vs TSB and 0.966 between TcB forehead vs TcB sternum. Conclusion: TcB levels correlates well with the gold standard measurement of TSB. Gestational age, birth weight and day of life had no effect on TcB and TSB correlation. Transcutaneous bilirubinometer can thus be used to measure bilirubin level as a screening method for neonatal hyperbilirubinemia.
Serum Prolactin Level in Children with Febrile Seizure and Epileptic Seizure; Comparative Study
(Nepal Paediatric Society (JNPS), 2017) Mahendrappa, Kotyal B.; Sathya, S. Perumal; Suma, M.N.
Abstract: Introduction: Transient hyperprolactinaemia has been reported to follow unprovoked seizures, a finding proposed to be useful in the differential diagnosis of epilepsy. On this basis we conducted a study with an objective to compare the postictal serum prolactin level in children with febrile seizures (FS) and epileptic seizures (ES) to evaluate, whether serum prolactin (PL) could be used a predictor in the diagnosis of ES. Material and Methods: This was a prospective comparative study was conducted on 52 children (26 in febrile seizures group and 26 in epileptic seizure group) in the age group of six months to five years. Children with CNS infection, developmental delay, structural CNS defects or neurological abnormality, metabolic disorders and those on drugs, known to have altered serum prolactin level were excluded. Blood for estimation of serum prolactin was collected within 180 minutes of occurrence of seizure. Level of serum prolactin was quantitatively assayed by chemiluminescence method and the levels were considered high, if values were greater than 23 ng/ml, which is the upper limit of normal for all age groups and both sex. Results: The mean serum prolactin level in epileptic seizures group was 25 ng/ml and that of febrile seizures group was 10.72 ng/ml. High level of serum prolactin was noted in 17 children (77.2%) with GTCS and 3 children (75%) with CPS. None of the children with febrile seizures had significant raise in the level of serum prolactin. Conclusion: There is a significant rise in serum prolactin level in children with epileptic seizures compared to febrile seizures, if measured within 3 hours of occurrence of seizures. Thus, the post-ictal serum prolactin level can be used as an additional investigation to diagnose or predict epileptic seizures in children.
Risk and Triggering Factors Associated with Bronchial Asthma Among School-Going Children in an Urban City of Coastal Karnataka
(Nepal Paediatric Society (JNPS), 2017) Kamath, Sowmini P.; Shrishakumar, Shrividya; Jain, Animesh; Ramakrishna, Anand; Baliga, Shantharam B
Abstract: Introduction: Asthma is common in childhood and is a major public health issue. The objectives of this study were to identify risk and triggering factors associated with asthma among school children. Material and Methods: A prospective cross sectional study was conducted among 6-15 years old children, over two months in two private schools at Mangalore city. Trigger factors were assessed as per asthma trigger inventory (ATI). Responses were graded from 0-5 score based on ‘never’,’ rarely’, ‘sometimes’, ‘most of the time’ and ‘always’. A predesigned questionnaire suiting the city environment was prepared and used to assess the risk and triggering factors. Analysis was done using SPSS version 16. Results: Asthma and allergic rhinitis in parents (34.1%,40.7%), smoking at home(24.2%), exclusive breast feeding absence (27.5%),early weaning(24.2%), living in a flat (37.4%) and pets at home(37.4%) were risk factors noted. As per ATI, it was found that ‘having a cold’ was the most frequently selected trigger at 94.5% (47.3% ‘sometimes’, 2.2% ‘always’), followed by ‘running’ at 79.1% (27.5% ‘sometimes’, 13.2% ‘always’), and ‘house dust’ at 69.2% (31.9% ‘sometimes’, 6.6% ‘always’). The highest mean was for infections, (2.228, SD=0.546), followed by physical exercise (2.167, SD=0.331). Animal allergens had lowest mean (1.527, SD=0.104), followed by psychological triggers at second lowest (1.579, SD=0.181). However none of the risk and trigger factors had statistical significance with asthma. Conclusion: Avoiding exposure to probable triggers and identifying risk factors would aid in planning effective strategic measures with better quality of life.
Parental Perceptions Influencing the Utilization of Early Intervention Services in Children with Developmental Delay
(Nepal Paediatric Society (JNPS), 2017) Chauhan, Sandhya; Prasad, Prem Lochan; Rai, Preeti Lata; Khurana, Bhawana
Abstract: Introduction: Early intervention services play a pivotal role in the management of children with developmental delays but the utilization of these is quite low. This study aims to explore the influence of parental perceptions on the utilization of these services. Material and Methods: This is a hospital based qualitative study of 31 parents having children with developmental delay in 2 or more domains who presented for the first time for diagnostic evaluation. A semi-structured questionnaire was used in the interviews, exploring various aspects of parental perceptions regarding the child’s disability and the services required for them. Results: Apart from factors like educational and socioeconomic status of parents, accessibility of the services there are other factors involved at the level of parents which influence their readiness and motivation to utilize a service, viz understanding of the total spectrum of a child’s disability by parents and how well their child care needs are fulfilled. Conclusion: The parents’ long term motivation for utilizing the services depends upon how well their idea of a futuristic goal for their child is being addressed.
Neurodevelopmental Outcome of High Risk Babies at One Year of Age Born in a Tertiary Centre
(Nepal Paediatric Society (JNPS), 2017) Shrestha, Merina; Bajracharya, Luna; Shrestha, Laxman
Abstract: Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age. Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study. Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.
Neonatal Outcome in Early and Late Gestational Diabetes Mellitus
(Nepal Paediatric Society (JNPS), 2017) Misra, Saheli; Das, Niloy Kumar
Abstract: Introduction: Gestational diabetes mellitus in pregnancy is quite common and the prevalence is higher in ethnic communities. This study aims to look at neonatal complications and NICU admissions occurring in early and late onset gestational diabetes for better monitoring and management of neonatal complications. Material and Methods: This is a prospective observational study in a neonatal intensive care unit of a tertiary hospital in Kolkata over a year. Neonates born to mothers with gestational diabetes were admitted for observation in NICU. Their demographics and complications were noted. Maternal details were collected from maternal records. Results: Gestational diabetes was noted in 45.8% in early pregnancy. 33.3% mothers were managed with insulin. 75% delivered by Ceasarean section. Preterm delivery noted in 23.6%. Complication were 60.60% in early onset gestational diabetes which was significantly greater (p<0.05). Hyperbilirubinaemia and hypoglycaemia were the commonest complication. Macrosomia and congenital complications were seen in early onset GDM. Conclusion: Strict monitoring and intervention is necessary in early gestational diabetes to prevent neonatal complications.
Inguinal Exploration for the Management of Impalpable Undescended Testes
(Nepal Paediatric Society (JNPS), 2017) Thapa, Bijay; Pun, Madhusudan
Abstract: Introduction: The primary goal of surgical intervention with an impalpable testis is to locate and reposition the gonad. There has been much debate in the management of impalpable undescended testes. Many centres still advocate the role of open inguinal exploration in impalpable testes. Materials and methods: This retrospective study included 35 male patients. The clinical notes were reviewed for details of age at operation, side, location and condition of testes intraoperatively and the type of operation performed. Standard approach of inguinal explorations was performed under general anaesthesia. Follow up in first week and after 3 months was done. Results: 25(71.42%) impalpable testes were in left side, 9(25.71%) were on right side and 1(2.85%) was bilateral. At exploration 17(47.22%) were intracanalicular, nine (25%) were intraabdominal with seven low and two high,49(11.11%) were scrotal and six (16.66%) were absent, seven (41.17%) canalicular testes underwent orchidopexy and 10(58.22%) underwent gonadectomy for atrophied testes. Seven (77.77%) low abdominal testes were brought down to scrotum and two (22.22%) high abdominal were brought down to lower inguinal area as a first stage surgery. All 4(100%) scrotal testes were atrophied and gonadectomy performed. Six patients were diagnosed anorchia, 14 (87.5%) of impalpable testes that underwent orchidopexy were in a follow up with excellent results. One high first stage orchidopexy and another canalicular testes were found to have atrophied who did orchidectomy in follow-up. Conclusion: Inguinal exploration is a safe, reliable and successful surgical procedure for the management of impalpable testes including intraabdominal testes without procedure related complications.
Factors Affecting Drug Compliance in Paediatric Asthma
(Nepal Paediatric Society (JNPS), 2017) Singh, Rajesh Kumar; Thapar, Rajeev Kumar; Gupta, Rakesh Kumar; YV, Abhijit
Abstract: Introduction: Childhood asthma is an immensely important chronic disease in children with increasing prevalence worldwide. Inhaled corticosteroids and bronchodilators are the key drugs in asthma therapy. Material and Methods: Compliance of childhood asthma was assessed at a tertiary care centre to find out the percentage of compliant Vs noncompliant patients and the reasons for the latter. If the patient had attended at least nine visits (> 75%) the previous year he was labelled compliant and those with less than six visits (<50%) were put in the non-complaint group. Results: Of the 374 patients attending the asthma clinic, 60 were randomly selected for the study of which 53 finally participated. In this study the compliance was 47% and gender predilection did not affect compliance. The distance a patient had to commute to reach the hospital and the mother’s education did not have any influence on the compliance. Older asthmatics exhibited better compliance in our study. Conclusion: Forty percent of our patients were compliant to regular use of prescribed medicine. Older age of the patients and care giver`s awareness about asthma were the two factors which are statistically significant in compliance with drug therapy in asthma. Gender of the patient, academic qualification and distance from the hospital did not have a significant effect on compliance.
Effect of Helminth Infestationin Children Infected with Human Immunodeficiency Virus (HIV)
(Nepal Paediatric Society (JNPS), 2017) Orji, Maria-Lauretta Chito; Onyire, Nnamdi Benson; Ibe, Bede C.; Ibekwe, Roland
Abstract: Introduction: Infection by human immunodeficiency virus results in immune destruction, while studies among the Ethiopian immigrants in Israel showed that chronic helminthiasis induces immune dysregulation. With destruction of CD4+ cell and consequently progression to AIDS, the host may be more susceptible to invading organisms such as helminths. This study was aimed at determining the effect of immune state on the prevalence and intensity of helminth infection in HIV infected children in two hospitals in Abakaliki. Material and Methods: It was a cross sectional study that involved consecutive recruitment of 84 confirmed HIV infected children attending the ART clinic. Stool analysis for subjects was done, using the Kato-Katz technique. Blood sample for estimation of CD4 cell count was carried outusing flow cytometer from the HIV positive subjects. Results: A total of 84 subjects were recruited during the study period, majority were males (58.3%). Male to female ratio was 1.4:1. The age range of participants was 2-17 years, while mean age of subjects infected with helminthiasis was 6.10± 3.34 year. A significant number of subjects in advanced and severe immunological stages had helminthiasis (χ2 =12.49, p=0.001). There was however no significant relationship between intensity of helminthiasis and immunologic stages of subjects. Conclusion: The study suggests that immunodeficiency state may increase the susceptibility of helminth infection in HIV infected children. Hence children with HIV/AIDS may benefit from routine testing and/or de-worming of helminth infection.
Clinical Features, Laboratory Findings and Complications of Scrub Typhus in South Indian Children
(Nepal Paediatric Society (JNPS), 2017) Gopalakrisna, Manjunath Vaddambal; Suryaprakash, Hedda; Kumar, G. Shankarappa Vijay; Kumar, Kalenahalli Jagadish; Murthy, Doreswamy Srinivasa
Abstract: Introduction: Scrub typhus clinical features are non-specific and resemble other tropical infections like malaria, dengue and typhoid fever. Therefore appropriate gold standard laboratory tests are necessary to confirm the diagnosis of scrub typhus. Aim of this study was to determine the incidence, clinical features, laboratory data and complications of scrub typhus in South Indian Children. Materials and Methods: Children with fever of more than seven days who were tested negative for common tropical infections were subjected to IgM-IFA for scrub typhus. Results: Out of 857 children, 74 were eligible for IFA test. Out of these, 27(3.1%) tested positive for scrub typhus. Clinical features included hepatomegaly (96.3%), generalized lymphadenopathy (81.5%), splenomegaly (81.5%), hypotension (59.3%), rash (14.8%), eschar (7.4%), thrombocytopenia (66.7%), elevation of SGOT (85.2%) and SGPT (81.5%). Complications include hepatitis (14.8%), pneumonia (14.8%), myocarditis (14.8%) meningoencephalitis (3.7%) and MODS (3.7%). Conclusion: Scrub typhus should be considered in the differential diagnosis of a febrile child having hepatosplenomegaly, lymphadenopathy, liver dysfunction and thrombocytopenia.
Internship Experience: A Transition from Academic World to Health Care Workplace Authors
(Nepal Medical Association, 2022) Bhandari, Rupa; Basnet, Krity; Bhatta, Krishna
Abstract: Internship is the training period during MBBS in which medical students will be able to learn methods/modalities to administer actual practice of medical and health care based on the knowledge gainded in their medical school. The students will get short-term supervised professional learning experience in different departments of medical and surgical specialities and have opportunity to develop professional networks within their intended career field. Internship gets your foot in the door of the real-world health care practice environment from the theoretical learning. Gaining knowledge and skills by reflecting on mistakes in practical scenario will boosts confidence and refine the practice later on. An internship can be a powerful medium for personal and professional growth as it allows the sense of responsibility towards the patients, their family and the organisation. It is indeed a great opportunity to have a hands-on learning experience prior to graduation of medical school.
Coping up with Stress as a Medical Student
(Nepal Medical Association, 2022) Acharya, Jiya; Sahani, Shambhu
Abstract: Psychological stress is one of the most common problems faced by medical students in their day to day life. There are a variety of manifestations of stress and these manifestations can directly or indirectly hamper the performance of a medical student. Knowing proper measures to manage stress as well as time can help medical students live their life in a more practical way. Practising mindfulness, mental health awareness and seeking help from experts can be beneficial in coping with stress as a medical student.
Integrated Electronic Health Record System in a Tertiary Care Centre: A Single Centre Implementation Experience
(Nepal Medical Association, 2022) Agrawal, Pawan Kumar Bajaj; Giri, Baburam; Gupta, Priyanka; Khatri, Rohit; Devkota, Shreya
Abstract: An integrated electronic health record system is a common platform for efficient and active interaction of four major subsystems namely the medical record system, laboratory system, picture archiving and communication system and enterprise resource planning system. Barriers like knowledge and attitude of computer usage, time consumption, information technology workforce, electricity, cost of technology and devices, data safety and security deter institutions from implementation. However, implementation of this system is inevitable with its inherent advantages of efficient storage and timely retrieval, comparison of lab and imaging data over time, cash billing, institutional resource planning and finally ease of processing insurance claims as the Government of Nepal is looking forward to financing public health sector through the national health insurance system. Many hospitals struggle to implement and maintain integrated electronic health records. We aimed to discuss the steps undertaken to integrate this system in a district hospital setting with the inherent challenges and the subsequent impact.
Aspiration of a Row of Artificial Dentures in an Adult: A Case Report
(Nepal Medical Association, 2022) Dulal, Malati; Tripathi, Prashant; Shrestha, Amit; Acharya, Kunjan; Niroula, Sailesh
Abstract: Clinical findings of foreign body aspiration, generally, are subtle. Scrutinous clinical suspicion is always recommended. Here, we present a rare case of an adult male, who under the influence of alcohol had aspirated a row of his artificial denture without his conscience of where his denture got missing and presented to our outpatient department with non-specific symptoms. With clinical examination and advanced diagnostics, he was successfully managed with rigid bronchoscopy. With the advancement in diagnostic techniques and our widened knowledge of the condition, utmost early detection has been possible and our case report reinforces the need for a low threshold for foreign body aspiration suspicion, especially in adults with dentures, and the use of rigid bronchoscopy as a plausible tool for the prompt management of the aspiration.
Surgical Removal of a Long-Standing Impacted Firearm in Neck: A Case Report
(Nepal Medical Association, 2022) Adhikari, Arun; Mahoto, Nain Bahadur; Khatri, Bijay
Abstract: The gunshot neck injury is an emergency and must be addressed immediately. However, as our case report, a long-standing retained foreign body (firearm) in the deep neck is rare. Surgical removal of a long-standing foreign body is challenging for the operating surgeon. A 36-year-old male with a history of a firearm injury to the neck dating 16 years back with complaints of recent onset of pain was evaluated. A computed tomography scan of the neck showed a metallic foreign body located in close proximity to the right common carotid artery. Neck exploration was performed under general anaesthesia, and the foreign body was removed without complications. The patient has recovered following the intervention and has resumed his normal activities. The use of methylene blue helps to locate the foreign body during surgery. However, the choice of intervention for a stable patient with a penetrating neck injury remains based on cases.
Mucinous Carcinoma of the Skin: A Case Report
(Nepal Medical Association, 2022) Jhunjhunwala, Adarsh Kumar; Magar, Dilasma Gharti; Upreti, Dipesh; Thapa, Niku; Ghosh, Arnab; Thapa, Sushma; Regmi, Sudeep; Timilsina, Bishowdeep
Abstract: Primary mucinous carcinoma of the skin is a rare malignant neoplasm showing predilection to the periorbital region. These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma. In this case report, we have put forth the findings of a 70-year-old male who presented with a slow-growing periorbital swelling and was subsequently diagnosed with mucinous adenocarcinoma. An extensive workup in search of another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of primary mucinous adenocarcinoma of the skin was rendered.
Minimal Change Disease in an Adult: A Case Report
(Nepal Medical Association, 2022) Neupane, Shashank; Pudasaini, Prasamsa; Sharma, Anupam; Sharma, Shriya; Adhikari, Aakriti; Roka, Kumar
Abstract: Minimal change disease is an important cause of nephrotic syndrome in children, however, few cases are seen among adults. There is very little literature regarding the occurrence of minimal change disease in adults. We reported a case of a 63-year-old male who presented with the complaint of swelling around the eyes mostly during the morning for 18 days and frothing of urine for 7 days. On examination, the patient was ill-looking and had edema around the eyes and over the ankles. After preliminary investigations, renal biopsy was performed and electron microscopy revealed diffuse effacement of foot processes of visceral epithelial cells suggesting minimal change disease (podocytopathy). The patient has been treated with tablet prednisolone 60 mg per oral once daily, tablet ramipril 2.5 mg per oral once daily, and tablet torsemide 20 mg per oral twice daily. Hence, minimal change disease should also be considered as a differential diagnosis in adults presenting with the features of nephrotic syndrome.
Takayasu Arteritis Masquerading as Shoulder Pain: A Case Report
(Nepal Medical Association, 2022) Poudel, Prabhat; Oli, Paras; Ojha, Prashant; Yadav, Radhay Shyam; Poudel, Binaya Raj
Abstract: Takayasu arteritis is a rare progressive chronic granular inflammation of the vessels that mainly affects the aorta and its branches. It is widely distributed in the world population and mainly involves young Asian women, manifesting as a systemic illness with myriads of cardiovascular signs and symptoms. The current case focuses on a young girl who had shoulder pain and weakness as the only manifestation of underlying Takayasu arteritis. Early clinical identification of the disease and control with disease-modifying anti-rheumatic drugs could improve the outcome and prevent devastating sequelae.
Left-sided Appendicitis with Intestinal Non-rotation: A Case Report Authors
(Nepal Medical Association, 2022) Bhattarai, Ashish Mohan; Devkota, Yogendra; Bhattarai, Ayush Mohan
Abstract: Appendicitis rarely presents with an left lower abdominal pain especially when the intestine is non-rotated or malrotated. Its diagnosis becomes quite troublesome to clinicians and delays prompt intervention. Non-rotation is the most common type of intestinal malrotation. Here, we present a case of a 40-year-old female with previously undiagnosed intestinal non-rotation with left lower abdominal pain and features of localised peritonitis. Abdominal ultrasonography and multidetector computerised tomography showed left-sided appendicitis with intestinal non-rotation. Diagnostic laparoscopy followed by explorative laparotomy and appendectomy was performed. Clinicians and surgeons are usually trained to diagnose and operate on right-sided appendix, thus, diagnosing and promptly intervening on left-sided appendicitis is quite challenging. Left-sided appendicitis must be kept in mind if a patient presents with left lower abdominal pain. Timely radiological scans like ultrasonography and computerised tomography scans help in prompt diagnosis in these cases.
Mean Canal-body Ratio among Specimens of Dried Lumbar Vertebrae in the Department of Anatomy of a Medical College: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Shrestha, Iju
Abstract: Introduction: Lumbar spinal canal stenosis is assumed to be one of the chief causative factors for low back pain. The measurement of lumbar canal and body dimensions has thus become an important tool for the diagnosis and treatment of spinal stenosis. This study aims to find out the mean canal-body ratio among specimens of dried lumbar vertebrae in a medical college. Methods: A descriptive cross-sectional study was done in a medical college from May, 2021 to July, 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: 0502202103) and whole sampling was done. Seventy-three intact dried lumbar vertebrae were studied for the dimensions of the body and canal in transverse and anteroposterior planes. The findings were recorded and the canal body ratio was calculated using the transverse diameters of the spinal canal and vertebral body. The data obtained were computed and analysed using Microsoft Excel 2013. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data. Results: The mean canal-body ratio was observed to be 0.53±0.032. The vertebral canal-body ratio was observed to be 0.58 in L1 followed by 0.53 in L2, 0.51 in L3, 0.49 in L4 and 0.53 in L5. Conclusions: The mean canal-body ratio observed in the present study was comparable to studies done in similar settings.

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