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Study of Vitamin D Level in Paediatric Asthma at a Tertiary care Center
(Nepal Paediatric Society (JNPS), 2022) Kumar, Pankaj; Kumar, Rajesh; Singh, Pratap Bhanu
Abstract: Introduction: There are few studies that suggest low Vitamin D levels are associated with asthma. Present study was conducted to evaluate the association between vitamin D levels with asthma and its severity in children. Methods: This cross-sectional study included 70 children (35 asthmatic and 35 controls) aged between three to 12 yrs. CBC, AEC, IgE, spirometry, chest X-ray, and serum vitamin D levels were measured. Vitamin D levels were categorized according to guidelines of the American Academy of Paediatrics (2008) and compared between the two groups. The association between vitamin-D levels with asthma and its severity was studied. Results: The mean age of study group cases was 9.23 ± 2.62 yr. The male:female ratio in the study group was 2.5: 1. Cough and wheezing was the commonest manifestation (100%). Most of the patients had mild asthma (45.71%). Asthma was more common in the urban population (68.57%) and children belonging to lower socioeconomic status (51.43%). The markers of allergic disorders {Eosinophils, AEC and IgE} were elevated (all p-values ≤ 0.0001) in study group. Mean serum vitamin D levels in the study group and control group patients were 45.21 ± 28.52 nmol/L and 57.03 ± 40.01 nmol / L respectively. The mean levels of vitamin D in the study group were insufficient as per AAP criteria. Vitamin D levels were more deficient in severe asthma (26.19 ± 14.46 nmol/L).
Serum Homocysteine Levels in Indian Children on Valproate Monotherapy
(Nepal Paediatric Society (JNPS), 2022) Swaroop, Shikha; Mittal, Medha; Nair, Smita; Saini, Reetika; Bagla, Jyoti
Abstract: Introduction: Various research works have reported elevated serum homocysteine levels with the use of antiepileptic drugs. This may lead to an increased risk of atherosclerosis, a higher seizure frequency and may also cause cognitive decline. Methods: Twenty five children (Two to 12 years) on valproate monotherapy for more than one year and the same number of age and sex-matched healthy controls were enrolled. Venous blood samples were analyzed for serum homocysteine, vitamin B12 and folic acid levels. All biochemical parameters were compared between the groups. Results: The antiepileptic drug users had significantly lower serum homocysteine levels and higher B12 levels as compared to the controls. But serum folate levels were similar between the groups. No correlation of serum homocysteine levels was observed with either serum folate, B12 or valproate. Conclusions: The use of valproate monotherapy for epilepsy in the Indian paediatric population does not increase the risk of hyperhomocysteinemia.
Sensory Profile of Nepalese Children with or without Autism
(Nepal Paediatric Society (JNPS), 2022) Shrestha, Merina; Shrestha, Rena
Abstract: Introduction: Sensory Integration Dysfunction (SID) is common in children with Autism Spectrum Disorder. If SID is detected early and intervened, there is a decrease in autistic mannerisms and an improvement in the areas of sensory processing and regulation, social-emotional function, and fine motor skills. Thus, this study was conducted to compare the sensory profile of children with or without autism spectrum disorder (ASD) in Nepal. Methods: Thirty five parents of children with ASD and 43 parents of children without ASD (non ASD) completed Short Sensory Profile (SSP) questionnaire. Results: Definitive sensory issue was identified in 66% in ASD and 23% in non ASD group. Common sensory issues in ASD group were auditory filtering sensitivity (74.3%), movement sensitivity (37%), under responsiveness / seeks sensation (45.7%). In non ASD group, common sensory issue was under responsive/seek sensation. The internal consistencies between the sub-scales ranged from 0.70 to 0.83. Conclusions: Two third of the children with ASD have sensory issues. Identifying different sensory problems with SSP would be helpful for further management of children with ASD.
Medical Undergraduate Students’ Viewpoint on Online Learning During COVID-19 Pandemic
(Nepal Paediatric Society (JNPS), 2022) Rathoria, Ekansh; Rathoria, Richa; Singal, Umang; Singh, Asheesh Pratap; Bansal, Utkarsh; Agrawal, Prashant
Abstract: Introduction: The coronavirus pandemic constrained medical colleges to discontinue face-to-face learning activities and suddenly switch to an online learning model. Technology is making its way into medical education, also being advocated by the medical commission, though students’ perception is still poorly understood. This study aimed to investigate the medical students’ perspectives on online learning. Methods: It was a cross-sectional, questionnaire-based study to assess the demographics, merits, demerits, recommendations, and suggestions for online learning by medical undergraduates. A combination of multiplechoice, Likert scale-based, and open-ended questions was used. Results: The student-perceived merits of e-learning were flexibility in timings, convenience, self-directed learning approach, and prevention of pandemic spread. The demerits viewed were lack of personal interaction with teacher and batchmates, increased distractions, lack of high-speed internet, and less / no hands-on experience. The classroom teaching was the favoured teaching method (45.7%) and easy to comprehend (55.8%). The recommendations included: medical curriculum should not be completely e-learning based (84.1%), training for using online applications (51.4%), providing high-speed internet and apps with no time limit (83.7%), taking online tests (64.4%), student’s feedback (75%), and frequent online demonstrations and simulations (64.9%). Overall, 52.4% of students’ morale was positive towards e-learning. Students rated blended teaching as the preferred teaching method. Conclusions: Medical students still prefer face-to-face learning and opted for blended learning over complete e-learning. Appropriate steps like training faculties, providing high-speed internet, taking formative tests, giving online demonstrations, involving simulations, and student feedback can improve e-learning quality.
Knowledge, Attitude and Practice Regarding Menstrual Hygiene Among Girls of Government School
(Nepal Paediatric Society (JNPS), 2022) Shahi, Bibhooti; Singh, Shreejana; Joshi, Deepak Raj; Maharjan, Ajanta
Abstract: Introduction: Menstruation is a natural phenomenon unique to women and menstrual hygiene is fundamental to the wellbeing of women and girls. Menstruation is the process of periodic discharge from the female genital tract due to hormonal influence and takes place within the interval of 28 days. The objective of the study was to find out knowledge, attitude and practice regarding menstrual hygiene among adolescent girls of the Government school. Methods: A descriptive study was carried out among 100 adolescent girls attending selected schools of Birgunj, Nepal using pretested self-administered questionnaires. Proportional Stratified Sampling was used. During data collection privacy and confidentiality was ensured. The data were analyzed using SPSS version 16 through descriptive statistical methods and inferential statistical methods. Results: This study revealed that majority of the girls (32%) have good knowledge, 93% have good attitude and 23% girls have good practice. There was significant association (p < 0.05) between the level of practice and age of menarche but there was no any significant association (p < 0.05) between level of knowledge and attitude with selected variables regarding menstrual hygiene. Conclusions: This study concludes that though the majority of the girls have, good attitude, many have poor knowledge and practice about menstrual hygiene.
Knowledge and Attitude of Nurses on Implementation of Atraumatic Care among Hospitalized Children in Eastern Nepal: A Cross-sectional Study
(Nepal Paediatric Society (JNPS), 2022) Mahato, Pramila; Shrestha, Rit; Karn, Basant Kumar; Chaudhary, Amit Kumar; Singh, Rakesh
Abstract: Introduction: The modality and quality of care received during hospitalization affects a child’s response to their illness. Thus, any intervention delivered by healthcare providers including nurses must be based on principles of atraumatic care. This study aims to assess the knowledge and attitude of nurses in the implementation of atraumatic care among hospitalized children in a tertiary care center in Eastern Nepal. Methods: A descriptive cross-sectional study was conducted among 106 nurses in a tertiary hospital from 4th January to 1st February 2020. Ethical approval was received from the Institutional Review Committee. Sampling was done by total population enumeration method. Data was collected using a self-administered three-part questionnaire and analyzed using Statistical Package for the Social Sciences version 11.5 by utilizing descriptive statistics. Results: The mean knowledge and attitude of nurses towards implementation of atraumatic care among hospitalized children was found to be 14.90 ± 3.90 and 74.74 ± 7.5 respectively. Out of 106 nurses, 73 (68.90%) had adequate knowledge whereas 56 (52.80%) had favorable attitudes towards principles and implementation of atraumatic care, assessed using reliable scales. Variations due to socio-demographic and professional parameters were insignificant. Conclusions: The study shows that majority of the surveyed nurses had adequate knowledge of the principles of atraumatic care and a favorable attitude towards its application among hospitalized children. However, the measured attitude of nursing practitioners was relatively lower in terms of favorability.
Diagnostic Ability of Chest Ultrasound in Selective Paediatric Pneumonia Alternative to CT scan: A single-center Comparative Observational Study
(Nepal Paediatric Society (JNPS), 2022) Thareeb, Marwa Kareem; Zghair, Muna Abid Alghani; Hassan, Qays Ahmed
Abstract: Introduction: Chest CT is the gold standard method of the diagnostic evaluation of patients with pneumonia. Lung sonography has been lately explored as an alternative modality to decrease radiation hazards. This study aimed to evaluate the diagnostic ability of lung ultrasonography in detecting paediatric pneumonia at presentation and follow up and comparing findings with chest CT scan. Methods: A cross-sectional observational study was performed at a paediatric hospital from August 2019 to April 2021. We studied 106 children (ages from 45 days to 14 years) referred by the paediatrician with clinical data of pneumonia. All children underwent CT chest examination; 90 showed positive, while 16 showed no pneumonia. Ultrasonography was performed on all patients within 24 hours after CT examination. Results: We found that lung ultrasound showed 100% specificity, 82.2%, sensitivity in the diagnosis of paediatric pneumonia, accuracy was 84.9%, positive predictive value was 100% and negative predictive value was 50%. Their sensitivity and specificity are 100% in complicated pneumonia by parapneumonic effusion, empyema, and abscess formation. Conclusions: Chest ultrasound is a simple technique that can be performed in everyday practice, with high specificity and sensitivity compared to a chest CT scan in diagnosis and follow up of pneumonia in the pediatric age group.
A Case of Rare Choroidal Tumor, Choroidal Osteoma
(Kathmandu University, 2017) Shah, RK; Byanju, R
ABSTRACT Choroidal osteoma is a rare benign tumor of unknown etiology, commonly found in young asymptomatic females in their second or third decade of life. It typically appears as an orange-yellow to yellow-white lesion in juxtapapillary region which can extend over to involve macula. Lesion solely located in macular region is less common. Diagnosis is based on fundoscopic appearance and findings of ancillary tests like B scan ultrasonography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and computerized tomography (CT) scan. We report a case of unilateral macular choroidal osteoma in a fifteen-year-old girl with normal vision. KEY WORDS Benign tumor, Choroidal osteoma, Macula
Intussusception of Small Intestine as a Result of Inflammatory Fibroid Polyp Causing Small Bowel Obstruction in an Adult Patient
(Kathmandu University, 2017) Grover, AS; Kumar, M; Yadav, R; Sharma, A; Chowdhary, K; Zaman, M; Chowdhary, A; Bawa, A
ABSTRACT Intussusception is the telescoping of one segment of bowel into the adjacent segment. It is more commonly seen in children,however rarely encountered in adult patients. Proximal segment of bowel is called intussusceptum which is intussuscepted into the lumen of the adjacent distal segment known as intussuscipiens. There is always a lead point causing this disorder especially in adults. We presented a case of a 45 year old man who presented in emergency department of our institute with history and clinical features of acute intestinal obstruction since 10 days. Patient was resuscitated, investigated and taken for exploratory laparotomy under General anaesthesia. Segment of involved small gut was resected and well circumscribed polypoidal mass was found in intussuscepted bowel. Histopathological examination of the specimen revealed the features of inflammatory fibroid polyp. KEY WORDS Inflammatory fibroid polyp, Intussusception, Small bowel obstruction
Mesenteric Fibromatosis
(Kathmandu University, 2017) Radhakrishna, V; Patil, RS
ABSTRACT Mesenteric fibromatosis is a rare, locally invasive benign tumor arising from fibroblasts and fibrous tissue of mesentery. Their infiltrative nature can cause fatal visceral involvement. Most of the cases reported have an association with Gardner’s Syndrome, prolonged intake of estrogen, and previous trauma, but mesenteric fibromatosis can occur as a primary ailment without an underlying stimulant. A nineteen-year female presented with mass and pain abdomen diagnosed to have subserous fibroid but eventually turned out to be primary mesenteric fibromatosis. She underwent wide excision along with the resection of adjacent bowel. She is on follow-up with no evidence of recurrence. KEY WORDS Estradiol receptors, Fibromatosis, Mesenteric mass, Wide surgical excision
Management of Proximal Ureteric Stones: Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Ureterorenoscopic Lithotripsy (URSL)
(Kathmandu University, 2017) Joshi, HN; Shrestha, B; Karmacharya, RM; Makaju, S; Koju, R; Gyawali, D
ABSTRACT Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio. KEY WORDS Extracorporeal shock wave lithotripsy, Ureterorenoscopic lithotripsy, Ureteric stone
Prevalence and Correlates of Tobacco Use in a Suburban community of Nepal: Findings from the Dhulikhel Heart Study
(Kathmandu University, 2017) Karmacharya, B; Shrestha, A; Fitzpatrick, AL; Koju, R; Sotodehnia, N; Xu, DR
ABSTRACT Background Smoking and oral tobacco use are important risk factors for cancer and other chronic diseases. The distribution of tobacco consumption in Nepal varies across the population subgroups. There is little information on the correlates of tobacco use among suburban population in Nepal. Objective To estimate the prevalence of smoking and oral tobacco use; and determine the socio-demographic and other CVD risk factors associated with them in a suburban population of Dhulikhel, Nepal. Method This cross sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained from 1073 adults age 18 years and older using the questions based on the WHO STEPS survey questionnaire. Result More than a third (36%) of the men were current smokers and 12% reported regular use of oral tobacco. About 14% of the women were current smokers and only 0.5% reported to use oral tobacco regularly.In the multivariate analysis, sex, ethnicity, education, alcohol consumption and body mass index were significantly associated with tobacco use. Males were 2.6 times as likely as females to smoke (95%: 1.53-4.59; p<0.001). Brahmin/Chhetri were 2.8 times more likely to smoke compared to Newars (95% Ci: 1.53-5.18; p=0.001). Education reduced the odds of smoking; compared to those with no formal education, those with up to high school and those with a high school degree or higher were 0.50 (95% CI: 0.27-0.92; p=0.02 ) and 0.38 (95% CI: 0.16-0.91; p=0.03) percent less likely to smoke, respectively. Moderate drinkers were 8 times more likely (95% CI: .54 – 18.40; p<0.001) and high drinkers were 13 times (95% CI: 6.63 – 24.26; p<0.001) compared to non-drinkers. Regarding oral tobacco use males were 15 times as likely as females to use oral tobacco (95% CI: 4.1-58.8; p<0.001). Compared to Newars, Brahmin/Chhetri were 2.7 times as likely to use oral tobacco (95% CI: 1.08 – 6.66; p=0.03). Conclusion Although Nepal has made some progress in passing progressive laws for tobacco control, and national surveys have shown slight reduction on tobacco use, this is far from satisfactory to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to focus on socio-cultural, gender and behavioral aspects of tobacco use in addition to the epidemiological aspects. KEY WORDS Dhulikhel, Heart study, Sub-urban, Tobacco
Antibiotic Usage and its Culture Sensitivity Pattern in Urinary Tract Infections at Tertiary Hospital in Eastern Nepal
(Kathmandu University, 2017) Panday, DR; Amar, A; Subedi, A; Hussain, Md S; Gupta, M; Rauniar, GP
ABSTRACT Background The presence of microbial pathogen in the urinary tract is Urinary Tract Infection (UTI). In BP Koirala Institute of Health Sciences (BPKIHS), each year there are around 1000 cases of UTIs. Antibiotic is empirically started after sending culture/sensitivity (c/s) with intention to change antibiotic if c/s demands. Objective To see the antimicrobial prescribing pattern and c/s pattern of UTI inpatients of BPKIHS together with their socio-demographic and laboratory profile. Method It was a Record-Based Retrospective Descriptive Study of past one-year. All available inpatient-records from Medical-Record Section were extensively searched for the keyword “UTI” diagnosis. The relevant data were entered in Microsoft Excel-sheet and analyzed with IBM SPSS 21. Ethical clearance was obtained from the IRC before study. Result There were 86 cases from four different wards. There was slight female preponderance (51.16%). Fifty-five (63.95%) cases were complicated. Fever (75.51%) was the most common symptom. Only 20% were tachycardic but 90% were tachypnic. Leucocytosis (59.26%), urine albumin within 30-100 mg/dl (33.85%) and >5 Urine WBC/hpf (80.26%) were seen. Ceftiaxone (53.16%) was the most commonly prescribed empirical antibiotic, followed by Cefixime (6.32%). Fourteen (16.27%) cases were culture positive. E. coli was the most (78.57%) common pathogen grown. In culture sensitivity study, Amikacin (42.85%) was the most sensitive antibiotic. Conclusion Eighty-six UTI inpatients were identified last year. Fever and Tachypnoea were very common. Leucocytosis, 1+ proteinuria and urine WBC>5/hpf were frequently seen. Ceftriaxone was the most common antibiotic prescribed. E. coli was the most common pathogen grown and Amikacin was the most sensitive antibiotic. KEY WORDS Antimicrobial, Inpatients, Urinary tract infection
Correlation of cord Blood pH with Nucleated RBC and Serum LDH in Neonates with Perinatal Asphyxia
(Nepal Paediatric Society (JNPS), 2022) S B, Chiranth; Avabratha, K. Shreedhara
Abstract: Introduction: Perinatal asphyxia is one of the leading causes of neonatal mortality in developing countries. No single indicator has good diagnostic efficacy for perinatal asphyxia and only a combination of various indices may help in diagnosis. This study aims at determining the utility of serum lactate dehydrogenase (LDH) and cord blood nucleated red blood cell (nRBC) count as surrogate markers to pH in perinatal asphyxia. Methods: It is an observational study done over a period of 18 months. All newborn babies fitting into inclusion criteria were enrolled into the study. After initial resuscitation, cord blood was sent for pH and nRBC analysis and serum LDH levels was estimated from first collected blood sample (within six hours). Data was collected on excel sheet, Pearson’s correlation coefficients and ROC curves were used to tabulate results. Results: Our study included 74 neonates with perinatal asphyxia. Mean pH was 6.99 (SD - 0.138). Mean nRBC count was 38 / 100 WBC (SD17.9) and mean LDH level was 1478 IU / L (SD - 429). Cord blood pH showed significant (p < 0.001) correlation with raising nRBC count and LDH levels ROC plot showed nRBC count (AUC: 0.7866) and Serum LDH (AUC: 0.8143) as very good predictors of severe acidosis in perinatal asphyxia. Conclusions: Cord blood nRBC count and serum LDH levels are significantly increased in perinatal asphyxia and correlate well with severity of acidosis. Nucleated RBC count and serum LDH can be used as surrogate markers to diagnose perinatal asphyxia.
Correlation between maternal weight gain and birth weight among term babies
(Nepal Paediatric Society (JNPS), 2022) Singh, Umesh; Acharya, Indira
Abstract: Introduction: Healthy and well-nourished mother is likely to give birth to a healthy normal child with adequate birth weight. We aimed to determine the correlation of gestational weight gain and newborn’s birth weight. Methods: We studied participant-level data for 295 pregnant women coming for delivery services between January 2018 and December 2020 at Shree Birendra Hospital, Chhauni, Kathmandu, Nepal. A retrospective data of pre-pregnancy body mass index, maternal weight gain during different trimesters of pregnancy were collected. The prevalence of small and large for gestational babies were compared with mother’s weight gain according to Institute of Medicine (IOM) guidelines. Pearson test was used to assess the correlation between gross maternal weight gain during pregnancy and birth weight. Results: Among 295 women, 12.2% underweight, 55.6% normal weight, 26.1% overweight and 6.1% were obese. The overall mean gestational weight gain (GWG) was 11.78 kg. Birth weight of the babies ranged from 1500 gm to 5100 gm with mean weight of 3148 gm. Majority of small for gestational age and large for gestational babies were seen among women below and above IOM guidelines respectively. Conclusions: Findings from this study suggest that maternal weight gain during pregnancy increases the birth weight. Across all BMI categories, insufficient GWG is associated with slightly increased risk of SGA, while relative risk of LGA is higher in excess GWG group.
Effect of Auditory Interference on Visual Simple Reaction Time
(Kathmandu University, 2017) Gautam, Y; Bade, M
ABSTRACT Background Reaction time is the time between the application of the stimulus and the response. It is a physical skill based on human performance. Various factors like age, gender, distractions, personality, alcohol, etc. can affect the reaction time to a stimulus. Objective The objective was to determine whether auditory interference affects the visual simple reaction time or not. Method This is a quantitative, observational, cross-sectional study done at Kathmandu University School of Medical Sciences, Pre-Clinical Basic Science Block, Chaukot from April 2017 to June 2017. Total 120 participants who fulfilled the inclusion criteria and who were willing to participate in the study were included. Visual simple reaction time task was estimated alone without any interference followed by auditory interference using a software Deary Liewald reaction timer v3.10 in the laptop. The task was to press the spacebar as soon as the stimulus appeared in the screen of the laptop. Visual Reaction Time was recorded 20 times and the average of 20 recordings was given by the software itself which was later considered for statistical analysis. Then difference between the two values was reviewed using paired t-test since the data was normally distributed. Result The mean of visual simple reaction time for our study population was 298.93±37.12 milliseconds and the visual simple reaction time after auditory interference was 299.77±40.15 milliseconds. The difference between visual simple reaction time alone and after auditory interference was not significant (p=0.993). Conclusion This study shows that auditory interference doesn’t affect the simple visual reaction time; so the person can perform daily activities even if there is some kind of auditory interference at the same time. KEY WORDS Auditory interference, Reaction time, Visual simple reaction time
Clinical Profile and Outcome of Ventilated Children Admitted to Paediatrics Intensive Care Unit in a Tertiary Care Centr
(Nepal Paediatric Society (JNPS), 2022) Singh, Sandip Kumar; Khanal, Babita; Singh, Shivani
Abstract: Introduction: Mechanical Ventilation is an essential tool in paediatric critical care unit. Judicious use of ventilation when indicated, is essential along with very close clinical and hemodynamic monitoring, for successful outcome. As prolonged ventilation is associated with numerous adverse outcomes, we tried to find out common complications associated with invasive mechanical ventilation and its outcome. Methods: The study is an observational descriptive study conducted on mechanically ventilated children admitted to Paediatric Intensive Care Unit during 48 months period (November 2019 to October 2021). Demographic features included age, sex, reason for mechanical ventilation, duration of mechanical ventilation and any other comorbidities. Outcomes parameters included death in hospital, discharge from intensive care unit or shift to ward and left against medical advice (LAMA). Results: Among 1352 children admitted to PICU, 212 children (15.68%) required invasive mechanical ventilation. Common causes for mechanical ventilation were sepsis / MODS in 22.64% cases, followed by pulmonary (20.28%) and CNS infections 39 (18.39%). 166 (78.30%) children were extubated successfully, 24 (11.32%) children expired and 22 (10.37%) went on LAMA. Mortality rate of 14.18% was found in children, who were ventilated for > 72 hours, which was statistically significant. Conclusions: Ventilatory support is essential and lifesaving tool for critically ill children. Mortality rate was higher and statistically significant in children who were ventilated for > 72 hours.
Effect of Posture on Post Lumbar Puncture Headache after Spinal Anesthesia: A Prospective Randomized Study
(Kathmandu University, 2017) KC, HB; Pahari, T
ABSTRACT Background Headache after lumbar puncture has long been attributed to early mobilization, and hence prophylactic bed rest had been standard protocol to prevent spinal headache after lumbar puncture. However, trend has been changing towards early mobilization to no need of bed rest at all after lumbar puncture. Objective To study the influence of posture in the incidence of post lumbar puncture headache in patients undergoing spinal anesthesia. Method In a prospective randomized study, patients undergoing various surgical procedures under spinal anesthesia from February 2013 to January 2014 were included. They were randomly allocated into two groups; group A, no restriction of position and group B, 24 hours bed rest after spinal anesthesia. Two groups were compared with regards to spinal anesthesia complications such as headache, backache, urinary retention, nausea and vomiting. Result Total of 112 patients, 58 in group A and 54 in group B, were enrolled in the study. The mean age was 40.13±17.4 years and male: female ratio was 2.5:1. Post spinal headache was observed in 13(22.4%) patients in group A and 13 (24.0%) patients in group B which was statistically not significant (p=0.755). Similarly, there was no significant difference of headache score, and the incidence of other complications like backache, nausea, vomiting and urinary retention between two groups. Conclusion There is no significant influence in the incidence of post lumbar puncture headache by early mobilization after spinal anesthesia. Hence, prophylactic bed rest following spinal anesthesia is of no benefit. KEY WORDS Post lumbar puncture headache, Posture, Spinal anesthesia
Awareness and Perceptions of Medical Students towards Health Care Ethics - A Study from Nepal
(Kathmandu University, 2017) Nepal, S; Atreya, A; Kanchan, T
ABSTRACT Background Medical practitioners are the men of science who treat patients based on their knowledge and skill. Unethical and immoral conduct in the practice of medicine pertains to human right issues and litigation. Objective The present study is conducted to understand the perceptions and awareness of the moral and ethical responsibilities of future medical doctors in Nepalese scenario. Method This cross sectional study was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal who were administered a pre-tested, semi-structured questionnaire relating to various aspects of health care ethics. A total of 202 students (116 girls and 86 boys) voluntarily participated in the study. Based upon the criteria whether a student had attended forensic medicine lecture the study participants were thus divided into two groups Group I and Group II. The responses of the participants were obtained on a 5 point Likert scale and analyzed. Result The study observed that the overall awareness on issues regarding consent was proportionately higher than for issues dealing with patient’s right to treatment. The awareness levels were similar among the students of both groups for most of the issues with exception of a few issues where awareness levels were higher among the Group II students when compared to the Group I students. Conclusion This present study attempts to present the assessment of students on issues relating to ethics and moral reasoning. The present study also emphasizes on the importance of ethics in the practice of medicine. KEY WORDS Awareness, Health care ethics, Medical students
Bee Honey as a Safer Alternative for Routine Formalin Fixation
(Kathmandu University, 2017) Srii, R; Peter, CD; Haragannavar, VC; Shashidara, R; Sridhara, SU; Srivatsava, S
ABSTRACT Background Formaldehyde (10% buffered formalin) is still in use as the gold standard fixative in the field of biology however, as reported by Occupational Safety and Health Administration (OSHA) the use of formalin causes health hazards due to its toxicity. Hence, we considered to substitute formalin with natural Bee-Honey to achieve a formalin free laboratory for preservation of the biological specimens. Objective To assess the efficacy of honey as a fixative agent for the preservation of the tissue specimens and to study their cellular and structural characteristics by using routine stains, special stains and Immunohistochemistry (IHC) and compare its effectiveness with the currently, universally accepted formalin fixation. Method Our study contained sample size of 10 tissue specimens. All samples were fixed in two different solutions one in honey and other in conventionally used formalin solution for 24 hrs in room temperature and then were routinely processed, sectioned and stained using routine, special stains and with immuno-histochemical markers. The slides were viewed by two independent examiners and the entire procedure was blind folded. Result We obtained good comparable results with bee honey for Hematoxylin and Eosin, special stains including immunohistochemistry when compared to formalin fixed tissues. Conclusion Based on the observations of this study, it can be suggested that natural bee honey could be a safer alternative to formalin as a fixative, considering the health hazards of formalin. KEY WORDS Fixation, Formalin, Honey

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