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Typhoid Fever among Admitted Pediatric Patients in a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Rauniyar, Gajendra Prasad; Bhattacharya, Shrawanti; Chapagain, Kumud; Shah, Gauri Shankar; Khanal, Basudha
Abstract: Introduction: Typhoid fever, an acute systemic febrile illness caused by Salmonella Typhi & Paratyphi, is an important public health problem in developing countries. It requires frequent observation regarding proper diagnostic protocol and treatment practices. The aim of the study is to find the prevalence of typhoid fever among admitted pediatric patients in a tertiary care center. Methods: This is a descriptive cross-sectional study conducted among the admitted patients of pediatric and adolescent medicine of a tertiary care center from August 2016 to May 2018 after obtaining ethical clearance (IRC/609/015). Convenience sampling was used and data was analyzed using the Statistical Package of Social version 11.5. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 7450 patients, 151 (2.03%) at 95% Confidence Interval (1.71-2.35) patients were diagnosed with enteric fever of which 85 (56.29%) were male and 66 (43.71%) were female. Common symptoms were fever 151 (100%), and abdominal pain 94 (62.25%). Azithromycin 54 (38.03%) was the most common antibiotic received before presenting to hospital and ceftriaxone 151 (100%) was prescribed to all the patients after admission. Two-third of the patients (96/151) was hospitalized for at least 6 days, with the longest hospital stay of 14 days and shortest of 3 days. Conclusions: Occurrence rate of Typhoid Fever was similar to other studies. Antibiotic susceptibility could not be well established; further surveillance on typhoid fever and the antimicrobial susceptibility pattern is recommended.
Primary Congenital Glaucoma among the Children Under 3 Years of Age in the Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Sitoula, Rakshya Panta; Gurung, Jamuna; Anwar, Afaque
Abstract: Introduction: Primary congenital glaucoma is a rare vision-threatening condition of children. Primary congenital glaucoma though a rare disease it is the most common cause of childhood glaucoma with potency to cause blindness. This study was undertaken to find the prevalence of the children with primary congenital glaucoma under 3 years of age in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted at a tertiary eye center in Nepal in children (≤ 3 years) presented in the outpatient department of a tertiary eye hospital between June 2017 and June 2020. The study was approved by the hospital review committee and adhered to the declaration of Helsinki. A convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated with frequency distribution. Data analysis was conducted using Statistical Package for the Social Sciences. Results: Out of total children under 3 years who presented to the outpatient department, 46 (0.31%) at 95% Confidence Interval (0.30-0.32) had primary congenital glaucoma. Among them, 30 children (65.2%) had bilateral involvement. Mean intraocular pressure was 42.40±8.15mm Hg. The mean age of initial presentation, horizontal corneal diameter, and axial length were 12.07±8.9 months, 12.95±1mm, and 23.89±1.7mm respectively. Consanguinity was observed in 12 (26%) children. Conclusions: From the study, we conclude that there was a low prevalence of primary congenital glaucoma among children under 3 years of age who presented to the outpatient department in a tertiary care hospital.
Anemia among Adolescent Girls Attending the Pediatric Outpatient Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Bhandari, Bikash; Kachapati, Anuja; Lamichhane, Kavita; Khadka, Gaurab
Abstract: Introduction: Adolescents are children aged 10-19 years. Nutrition influences the growth and development during infancy, childhood and adolescence. Adolescent girls are at higher risk of anemia and undernutrition. This research was aimed to find the prevalence of anemia among adolescent girls in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in the adolescent girls attending the pediatric outpatient department of a tertiary care centre from October 2020 to May 2021. After the ethical clearance from the institutional review committee, 380 adolescent girls were taken using a convenient sampling technique. Anthropometric measurements, social demography and blood for hemoglobin estimation were taken and documented in predesigned proforma. Data were analyzed with Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated. Results: Out of 380 adolescent girls, 230 (60.5%) at 95% Confidence Interval (55.56-65.41) were anemic with mean hemoglobin of 11.138±1.954 gm/dl. The mean age was 14.57±2.107 years. Conclusions: This study showed a higher prevalence of anemia than the national data. Proper education regarding personal and menstrual hygiene, weekly supplementation of iron in school, dietary habits and uplifting of economic status can prevent anemia in this population.
Use of Intravitreal Bevacizumab Injection among Patients Undergoing Surgical Retinal Interventions at Tertiary Eye Hospital: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Shrestha, Arjun; Suwal, Rinkal; Shrestha, Rajan; Suwal, Barsha; Khadka, Deepak
Abstract: Introduction: Intravitreal Bevacizumab injection has now become a routine procedure for retina specialists throughout the world. Easy availability of this monoclonal antibody molecule even in Nepal has brought a revolution in the management of various retinal diseases. This study aims to find out the prevalence of the use of intravitreal Bevacizumab for retinal diseases at the tertiary eye hospital. Methods: This descriptive cross-sectional study was carried out in the retina department at a tertiary care hospital from January 2017 to December 2019 after obtaining ethical clearance from Nepal Health Research Council (Ref: 125/2020P). The sample size was calculated and the study enrolled all patients who received intravitreal Bevacizumab for retinal diseases using convenience sampling technique. Data were analyzed using Statistical Package for Social Science Version 21. Point estimate at 95% Confidence Interval was calculated, along with frequency and percentage for binary data. Results: Out of 959 total surgical retinal interventions done 296 (30.86%) at 95% Confidence Interval (27.93-33.78) patients received intravitreal Bevacizumab. Out of total intravitreal Bevacizumab injections, 143 (36.7%) injections were given to retinal vein occlusions patients, 127 (32.6%) injections were given to diabetic retinopathy patients and 66 (17%) injections was given to age-related macular degeneration patients. Males 176 (59.5%) outnumbered the females 120 (40.5%) in receiving intravitreal Bevacizumab. Mean baseline Logarithm of the Minimal Angle of Resolution visual acuity, 1.1, improved to, 0.75, after 3 months of intravitreal Bevacizumab. Conclusions: Intravitreal Bevacizumab was one of the commonest retinal interventions used. Retinal vein occlusion, diabetic retinopathy, and age-related macular degeneration were the commonest retinal diseases needing intravitreal Bevacizumab.
Meropenem Resistance among Acinetobacter Positive Clinical Samples in a Tertiary Care Centre in Nepal: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Sharma, Nisha; Thapa, Bibechan; Acharya, Ashirbad; Raghubanshi, Bijendra Raj
Abstract: Introduction: Antimicrobial-resistant Acinetobacter species are implicated in a variety of infections including nosocomial bacteraemia, secondary meningitis, and urinary tract infections. Carbapenem including meropenem-resistant Acinetobacter is recognized as one of the most difficult antimicrobial resistant gram-negative bacilli to control and treat. It was classified as an urgent threat by Centers for Disease Control and Prevention in 2019 Antibiotic Resistance Threats Report. This study was carried out to determine the prevalence of meropenem resistance among acinetobacter positive clinical samples in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in microbiology department of Clinical Laboratory Services among Acinetobacter positive clinical samples of a tertiary care center in Nepal. The culture and sensitivity reports of various clinical samples from April 2018 to April 2020 which were positive for Acinetobacter species were taken from hospital records section. Convenience sampling was done. Meropenem-resistant Acinetobacter samples were studied. Ethical approval was received from Institutional Review Committee (Ref No. 076/77/40). Analysis of data was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval calculated with ferquency. Results: Out of 121 Acinetobacter isolates, prevalence of meropenem-resistant Acinetobacter was reported in 93 (76.9%) at 95% Confidence Interval (69.39-84.40). Among the meropenem-resistant Acinetobacter samples, most of the samples were collected from the sputum 70 (75.2%) followed by blood 8 (8.6%). Conclusions: High prevalence of meropenem-resistant Acinetobacter species in our hospital setting is alarming. In addition, there is emergence of resistance against even the last resort drugs which is creating a treatment crisis.
Cervical Intraepithelial Lesions in Women with Persistent Inflammatory Smear on Pap Smear: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Shrestha, Junu; Magar, Dilasma Gharti; Pandey, Chandani
Abstract: Introduction: Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear. Methods: This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid’s colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy. Conclusions: The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.
Breast Arterial Calcifications on Mammography among Patients Attending the Radiology Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Jha, Anamika; Sah, Anugya; Joshi, Birendra Raj; Lohani, Benu
Abstract: Introduction: Breast arterial calcifications are common mammographic findings which are associated with coronary artery disease. The aim of this study was to find the prevalence of breast arterial calcifications in women presenting for mammography in a tertiary care centre. Methods: This descriptive cross-sectional study was performed in the Department of Radiology, in a tertiary care hospital after taking ethical clearance, Reference number 352(6-11)E-2, 077/078, data was collected from Syngovia database from March-June 2021 which included 1614 mammograms. Convenience sampling was done and mammograms evaluated for presence of vascular or non-vascular calcification. Further, vascular calcification was graded. Data was entered in Statistical Package for Social Sciences version 25. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated. Results: The prevalence of breast arterial calcification was 188 (11.6%) at 95% Confidence Interval (10.03-13.2). The mean age of women included in this study was 48.42±9.55 years with the largest number of patients in the age group 40-49 years, 682 (42.3%), and least in the age group 80-89 years, 3 (0.2%). All patients in the age group 80-89 years, 3 (100%) had vascular calcifications followed by 70-79 years group, 22 (57.5%) and none in patients younger than 30 years. Conclusions: We found an increase in the number and grade of vascular calcifications in breasts with the patient's age. When present breast arterial calcifications must be mentioned in mammogram report. Identification of such calcifications on mammogram should prompt further screening for atherosclerotic disease.
Cesarean Section Among all Deliveries in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Tamrakar, Renuka; Sapkota, Sachin; Sitaula, Deekshanta; Thapa, Rohit; Pokharel, Bandana; Acharya, Suchita; Parajuli, Aakriti
Abstract: Introduction: Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. Conclusions: The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.
Anaemia among Patients of Heart Failure in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Bhandari, Abhishek; Shah, Prashant; Pandey, Naveen Kumar; Nepal, Richa; Sherchand, Ojaswee
Abstract: Introduction: Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Results: Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia. Conclusions: Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.
Early Clinical Exposure in Preclinical Years of Medical School
(Nepal Medical Association, 2021) Basukala, Anisha; Chaudhary, Kabita
Abstract: Medical science is one of the sectors which has faced rapid advancement in the past few years. But sadly, medical schools are still following the traditional curriculum where a wide gap between the pre-clinical and clinical phases prevails. Early clinical exposure is known to act as a bridge to this gap. It contributes to the overall development of naive medical students enhancing their communication skills, clinical skills, teamwork, empathy development, and motivation towards selfdirected learning and hence making them more competent for clinical years. So, as it reinforces the conventional didactic teaching-learning method it becomes a much-needed part for the students in preclinical years.
Radical Cystectomy for Intradiverticular Bladder Carcinoma: A Case Report
(Nepal Medical Association, 2021) Sah, Anil Kumar; Maharjan, Bipin; Adhikari, Mahesh Bahadur; Rana, Reena; Basnet, Sunila; Panta, Rajesh; Aryal, Gopi
Abstract: Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.
Sandifer Syndrome: A Case Report
(Nepal Medical Association, 2021) Shrestha, Abhigan Babu; Rijal, Prateet; Sapkota, Unnat Hamal; Pokharel, Pashupati; Shrestha, Sajina
Abstract: Sandifer syndrome is an extra oesophageal manifestation of gastrointestinal reflux disease that usually presents with torticollis and dystonia (often mimicking epilepsy). Here, we describe a case of a four and a half years old child with convulsion, neck contortion, and irritability. Gastrointestinal reflux disease was suspected on the earlier visit of the patient based on the presenting symptom of vomiting and cough. Electroencephalogram revealed normal findings. A barium meal radiograph was performed which was insignificant for gastrointestinal reflux disease and hiatal hernia. Complete blood count showed results suggestive of iron deficiency anaemia, while the rest of the biochemical parameters and the infection screening were normal. The case was confirmed by a medication trial for gastrointestinal reflux disease. This syndrome is often misdiagnosed as infantile seizure and musculoskeletal disorder. So, physicians need to have a sound knowledge of Sandifer Syndrome while assessing a child presenting with convulsion and torticollis.
Post Endoscopic Retrograde Cholangiography Bilateral Loss of vision: A Case Report Authors
(Nepal Medical Association, 2021) Pun, Ashis; Sah, Kamlesh Kumar; Shah, Sunil Kumar; Bastola, Ramjee
Abstract: Endoscopic retrograde cholangiopancreatography is an invasive endoscopic procedure done more often for therapeutic rather than diagnostic purposes. There are various complications of this procedure like pancreatitis, cholangitis, hemorrhage, perforation and other rare adverse events. In this case report, we discuss a case of a 40 years female who was referred to our center for endoscopic retrograde cholangiography. After the procedure she complained of bilateral loss of vision which was an unknown complication to us. But after looking back to literature we found two such case reports attributed to isolated bilateral lateral geniculate body infarct.
Human Ocular Thelaziasis: A Case Report
(Nepal Medical Association, 2021) Pal, Anjila; Atreya, Alok; Maharjan, Nabina; Mahat, Monika; Bom, Rabin
Abstract: Thelaziasis is a zoonotic disease which affects the eye of domestic and wild carnivores caused by the nematode Thelazia. It is transmitted to humans by secretophagous arthropod-borne zoophilic nonbiting flies of the family Drosophilidae. Human thelaziasis is rare and occurs in poor socio-economic families of the rural locations where people live in close proximity with animals. A one and halfyear-old was presented to the outpatient ophthalmology clinic after her mother noticed a whitish, thread-like worm in her right eye. A total of four worms were mechanically removed from her right eye. All the collected worms were gravid female nematodes of Thelazia species. The present case of human ocular thelaziasis from Palpa, Nepal is presented for its rarity.
Subretinal Cysticercosis in a Challenging Case: A Case Report
(Nepal Medical Association, 2021) Shrestha, Ruchi; Shah, Ritesh Kumar; Joshi, Purushotam
Abstract: Ocular cysticercosis occurs rarely and may involve various parts of the eye including subretinal space. We report a case of a 42 years-old female with diminution of vision in the right eye for one month and no vision in the left eye for 10 years. Best corrected visual acuity in the right eye was 5/60. Fundus examination showed whitish round elevated cystic mass temporal to the macula. It was confirmed as a subretinal cyst by Brightness scan and Magnetic Resonance Imaging. The subretinal cyst was removed in toto by pars plana vitrectomy followed by histopathological examination of the cyst which confirmed the diagnosis of cysticercosis. This case report highlights the importance of early diagnosis of subretinal cysticercosis which could threaten the vision in a one-eyed patient. Pars plana vitrectomy could be an effective method for subretinal cyst removal in toto even in a challenging case.
Ewing's Sarcoma of Rib in a Four Year Old: A Case Report
(Nepal Medical Association, 2021) Kunwar, Saru; Sharma, Nisha; Giri, Bishnu Rath; BC, Bom; Shrestha, Anil Kumar
Abstract: Although rare, the Ewing’s sarcoma family of tumors represents the second most common primary bone malignancy that typically occurs in adolescents and young adults aged 10-25 years, presenting with localized pain and swelling of a long bone. We report a case of Ewing’s sarcoma of rib in a four years old child that presented with acute onset of fever, cough, shortness of breath and was initially treated as pneumonia. Although the patient did not belong to typical demography and the symptoms were suggestive of infective pathology, careful scrutiny of the radiographic findings led to further investigations and diagnosis of Ewing’s sarcoma of rib after correlating computerized tomography scan findings with immunohistochemistry reports.
Silent Myocardial Infarction and Acute Multiorgan Failure in a COVID-19 Patient: A Case Report
(Nepal Medical Association, 2021) Baral, Nischit; Montalbano, Andrea; Khan, Ashiya; Qureshi, Mehak; Luitel, Pankaj
Abstract: Silent myocardial infarction or unrecognized myocardial infarction has increased prevalence in elderly population with increased cardiovascular risk factors. However, its prevalence in COVID-19 patients is not well-known. A 77-year-old Caucasian male with COVID-19 pneumonia, presented with silent ST-segment elevation myocardial infarction, diabetic ketoacidosis and multiorgan failure. He underwent cardiac catheterization and drug eluting stent placement in the ostial right coronary artery with safety protocol. He was discharged to extended-care-facility in stable condition. This is a first case report of silent ST-segment elevation myocardial infarction in a patient presenting with COVID-19. In patients with COVID-19, acute myocardial infarction should be ruled out even when asymptomatic, especially in older patients. Prompt intervention using safety protocol is life-saving.
Major Spinal Surgery Between Two Documented COVID-19 Infections in an Elderly Female: A Case Report Authors
(Nepal Medical Association, 2021) Sharma, Bishruti; Paudyal, Nabin; Rajbhandari, Binod; Pradhanang, Amit; Dwa, Nikita; Pradhan, Ajay; Sharma, Mohan Raj
Abstract: Documented re-infection of COVID-19 is uncommon and doing a major spinal surgery in an elderly patient right after the recovery from the first event is itself a major undertaking. Re-infection after successful surgery points to the possibility of COVID-19 infection being a post-surgical complication. Here, we report a case of a 72-years-old elderly female who had presented to us with features of COVID-19 infection confirmed by reverse transcription polymerase chain reaction assay and unstable spinal fracture who underwent a pedicle screw fixation for the fracture of the third and fourth thoracic vertebrae after two consecutive negative serology assays. A month after discharge from the hospital, she presented with severe symptoms of COVID-19 again confirmed by two consecutive polymerase chain reaction assays. She was managed conservatively and was discharged without significant respiratory and neurological complications. We described this case in detail in addition to reviewing the pertinent literature.
Occipital Encephalocele with Multiple Birth Defects: A Case Report
(Nepal Medical Association, 2021) Pyakhurel, Bikash; Lamichhane, Anita; Bhandari, Bikash; Oli, Navachandra; Lamichhane, Somraj
Abstract: A full-term female baby presented at 24 hours of life at the emergency department with occipital encephalocele, bilateral cleft lip, and cleft palate. She was born to a second gravida mother with no consanguinity between the parents. On examination, encephalocele was 10centimeters x 7centimeters in size with bilateral cleft lip and palate. It presents the opportunity for healthcare professionals to learn about a group of congenital neurological disorders in the content of a rare case presentation and highlights the importance of ultrasonography in the antenatal period for the detection of neural tube defects in the early stage for proper counselling and management. A compulsory prenatal diagnosis of the suspected family should be done by the intervention of the public sector of any country so that we can prevent and avoid abnormal birth.
Complication of Early Application of One and a Half Hip Spica for Femoral Shaft Fractures in Children below Six Years in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Rokaya, Poojan Kumar; Rawal, Mangal; Kathayat, Tufan Singh; Thakur, Abhishek Kumar; Lama, Monika; Maharjan, Ramu
Abstract: Introduction: Hip spica with or without prior traction has become a standard treatment for closed isolated femoral shaft fracture in children below six years. The time of hip spica application is not uniform in the existing literature. The aim of this study is to find out the prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years in a tertiary care hospital. Methods: A descriptive cross-sectional study was done among 42 children who were managed with early hip spica application (within 72 hours) for femoral shaft fracture from January 2015 to December 2020 after receiving ethical clearance from Institutional Review Committee. Convenient sampling technique was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Complication was seen in nine (21.4%) (95% Confidence Interval= 9.02-33.84) patients. Skin breakdown from local pressure had the highest prevalence in our study which was documented in three (7.14%) patients who resolved with conservative treatment. Conclusions: The prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years was similar to other studies done in similar setting.

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