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Publication Congenital Genu Recurvatum(Nepal Paediatric Society (JNPS), 2014) Sharma, Deepak Kumar; Yadav, Jaivinder; Garg, Eva; Bajaj, HanishAbstract: NAPublication Prevalence of Double Nutrition Burden Among Adolescent Girls of Assam, Northeast India(Nepal Paediatric Society (JNPS), 2014) Sharma, Jyotismita; Mondal, Dr NitishAbstract: Introduction: Prevalence of the malnutrition is a very common phenomenon in the developing countries leads to high mortality, morbidity and long-lasting physiologic effects. The present study was conducted among adolescent populations residing in rural regions with an aim to determine the prevalence of double nutritional burden (e.g., thinness and overweight) in Karbi-Anglong district of Assam, Northeast India. Materials and Methods: The present cross-sectional study was conducted among 1228 heterogeneous groups of adolescent girls aged 10- 16 years residing in rural areas of Diphu, Karbi-Anglong, Assam is using simple random sampling method. The anthropometric measurement of height and weight were recorded using the standard procedure. The Body mass index (BMI=weight/height2, kg/m2) was calculated. Recently proposed, the BMI based age sex specific international references and cut-offs of Cole et al. was used to assess the prevalence of thinness and overweight. Results: The overall prevalence of overweight and thinness was found to be 8.13% and 19.14% respectively. The age specific prevalence of overweight and thinness was found to be higher among 11 years (12.00%) and 16 years (31.13%) respectively. Conclusion: The present study shows the magnitude of thinness is a still greater nutritional problem than overweight in rural adolescent girls in India. The results of the present study will be useful for the policy makers in their endeavour to formulate various developmental strategies and health care programmes of the population concern to combat the double burden of nutrition.Publication Percutaneous Endoscopic Gastrostomy in Children: Experience from Single Center of a Developing Country(Nepal Paediatric Society (JNPS), 2014) Kehar, Mohit; Wadhwa, Nishant; Upadhyay, SatyamAbstract: Introduction: Nutrition is of paramount importance for adequate growth and development of a child. Various routes of providing enteral nutrition to a paediatric patient are by nasogastric, nasojejeunal and gastrostomy which can be placed surgically or endoscopically. The objectives of this study were to review cases with percutaneous endoscopic gastrostomy (PEG) procedure and patient characteristics, indications, complications and outcome of PEG tube insertion in children at our center. Materials and Methods: This was a prospective study carried out in Sir Ganga Ram Hospital in New Delhi, India for a period of two years from August 2010 to August 2012. It included patients in whom PEG tube were placed during the study period and have had at least one year of post procedure follow up. Demograhic details, duration of procedure, complications, initial weight and height and then at 3 month, 6 months and 12 months of PEG tube placement were also recorded. Data between groups was compared using ANOVA and within groups across follow-ups was done using paired t-test. Results: Fourty six PEG insertions were performed during the study period, 26 twenty six conversions to BRT or Mickey button and ten PEG removals. The main indications for PEG insertion were Cerebral palsy with feeding difficulty (47.8 %). Erythema at the PEG insertion site was the most common complication (21%). There was significant improvement in the weight and height in all age group of patients at 3, 6 and 12 months post procedure with a p value <0.5. The average weight gain after 3, 6 and 12 months was 1.3 kg, 2.8 kg and 4.2 kg and the average height gain after 3, 6 and 12 months was 1.6 cm, 2.5 cm and 4.13 cm respectively. Conclusions: PEG is effective means for optimizing the nutritional goals of patients who are nutritionally debilitated with minimal complications.Publication Nutritional Status of Under-Five Children in Western Nepal(Nepal Paediatric Society (JNPS), 2014) Shrestha, BandanaAbstract: Introduction: Undernutrition is a major health problem in developing countries which may have adverse effects on growth and development of an individual. The objectives of this study were to assess the prevalence and grades of malnutrition in children below 60 months of age, attending outpatient department at Gandaki Medical College teaching hospital. Materials and Methods: A prospective study was conducted among 556 children below 60 months of age from August to December 2013. Weight and length/height were measured using standard technique and were plotted on WHO centiles curves and severity determined based on WHO classification. The prevalence of underweight, stunting and wasting were determined by anthropometry. Results: Based on WHO classification, out of 556 children, 20.2% were underweight, 34% were stunted and 15.1% were wasted respectively. Of them, severe underweight were 4.7%, severe stunted were 14.1% and severe wasted were 7.2% respectively. Conclusion: A high prevalence of undernutrition exists in under- five children attending a tertiary hospital in a western region of Nepal.Publication Neonatal Near Miss Cases of Different Health Facilities(Nepal Paediatric Society (JNPS), 2014) Manandhar, Sunil Raja; Manandhar, Dharma S; Adhikari, Dhruba; Shrestha, Jyoti Raj; Rai, Chandra; Rana, Hari; Paudel, MohanAbstract: Introduction: The near miss concept and the criterion-based clinical audit are proposed as useful approaches for obtaining such information in newborn health care. There is currently no Standard definition and criteria for neonatal near miss especially for the community level intervention. Thus, lifesaving interventions could be an entry point to initiate the development of the neonatal near-miss definition. Mother and Infants Research Activities and Health Right International (HRI) developed a new tool for assessing neonatal near miss cases based on the Community based newborn care package programme. This is a part of operational research programme on strengthening the health facilities of Electoral constituency No; 2 of Arghakhanchi district of Nepal. The objective of this study was to identify and analyze neonatal near miss cases at different health facilities of Electoral constituency No; 2 of Arghakhanchi district, Nepal. Materials and Methods: One day of training on identifying neonatal near miss cases was given by an expert at Arghakhanchi district hospital to the health facilities staff in two groups. Health facility staffs were trained on identifying neonatal near miss cases and completing the modified neonatal near miss case forms. Neonatal near miss cases were documented for nine months period. Results: There were a total of 28 cases of neonatal near miss reported from different health facilities. Among them, 90% babies were delivered at health facility and 72% babies were of normal birth weight. Low birth weight incidence is 21% among near miss cases. Neonatal near miss contributed possible severe bacterial infection/ severe infection 47%, birth asphyxia in 43% cases and very low birth weight 7%. Conclusions: Birth asphyxia and PSBI were the two most common causes of neonatal near miss in the health facilities of Arghakhanchi district. There is a need to improve the quality of neonatal care in health facilities to properly manage these neonatal near miss cases which were referred to higher centre.Publication Comparative Study of Diagnostic Markers in Neonatal Sepsis(Nepal Paediatric Society (JNPS), 2014) Sonawane, Vijay Baburao; Gaikwad, Sonali U; Kadam, Nitin N; Gavhane, JitendraAbstract: Introduction: Neonatal septicemia is one of the commonest causes of neonatal mortality and morbidity. The objectives of this study were intended for qualitative and quantitative analysis of diagnostic markers in neonatal sepsis. Materials and Methods: This is a hospital based study conducted over three years (Aug 2005 – Aug 2008). Hundred and sixty neonates, delivered in the hospital, having risk factors for neonatal sepsis, along with those coming to hospital with signs and symptoms of sepsis up to 28 days of life (as study group ) along with normal newborns admitted to the postnatal ward without high risk factors (control group) were enrolled for this study. Comparative study on various diagnostics markers such blood culture, CBC,CRP, IT ratio and Micro-ESR was carried out to know their sensitivity and specificity. Results: E.Coli was the most common organism responsible for sepsis. CRP was reported to be highly sensitive (84.21%), and CBC was highly specific (75.00%), IT ratio has sensitivity of 62.5% and specificity of 56.25% while Micro-ESR has shown sensitivity of 50.0% and specificity of 62.5%,Out of 160 cases, blood culture (BacTalert) showed growth in48 cases in study group while two cases in control group. Thus blood culture positivity was 60%. Conclusion: Blood culture is the gold standard for the diagnosis of septicemia. CRP is most sensitive while CBC is most specific marker in neonatal sepsis.Publication Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre(Nepal Paediatric Society (JNPS), 2014) Chaudhary, Shipra; Bhatta, Nisha Keshary; Khanal, Basudha; Bhandari, Rabin; Singh, Rupa RajbhandariAbstract: Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%. The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.Publication Clinical Profile of Acute Poisoning in Children at a Teaching Hospital in Lalitpur(Nepal Paediatric Society (JNPS), 2014) Dhakal, Ajaya Kumar; Shrestha, D; Shakya, A; Shah, SC; Shakya, HAbstract: Introduction: Acute poisonings are one of the common cause of emergency visits and hospital admissions and is potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the common age group in which the incidence of poisoning was high. Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from 2009 July to 2014 January. Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1days and mean age of poisoning was 7.8 years with a male(54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours. Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. Young children were most vulnerable for acute poisoning.Publication Breastfeeding Practices in Kathmandu(Nepal Paediatric Society (JNPS), 2014) Mathema, SmritiAbstract: Introduction: In spite of significant evidence on a number of important health benefits of breastfeeding, it has been seen that a vast number of infants in Nepal are not being breastfed appropriately based on standard recommendations. This study was conducted to evaluate the breastfeeding practices prevalent in Kathmandu. Materials and Methods: This was across-sectional survey carried out over a period of 24 months from January 2011 to December 2012 on a convenient sample of children aged 6 months to 23 months when they were brought for treatment to Kathmandu Medical College and Teaching Hospital. Breastfeeding was defined according to the recent WHO guidelines and mothers were interviewed as per a structured questionnaire. Results: There were 1250 children enrolled in the study, out of which almost all infants (99.7%, n=1246) received colostrum. Only 62.64% (n=783) babies received breast milk as their first food. Initiation of breastfeeding within one hour of delivery was done by 719 (57.5%) mothers. The median duration of exclusive breastfeeding was 3.8 months. Conclusion: This study reflects that majority of infants in Kathmandu are still not fed in accordance with breastfeeding recommendations and guidelines. More attention should be given to a proper community-based program including subsequent monitoring of its implementation as exclusive breastfeeding has been proved to be one of the most effective ways to improve infant survival.Publication Breastfeeding Practices as Observed in Those Attending a Teaching Hospital for Perinatal Care(Nepal Paediatric Society (JNPS), 2014) Anyanwu, Onyinye Uchenna; Ezeonu, Thecla Chinonyelum; Ezeanosike, Obumneme Beniah; Okike, Clifford OnuoraAbstract: Introduction: The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, especially in low-income and middle-income countries where the relevance for child survival is undisputed. Timely initiation of breastfeeding within one hour of birth, exclusive breastfeeding for six months with continued breastfeeding till 2years and beyond are important aspects of breast feeding for child survival. The objective of the study was to describe the practice and perception of breast feeding amongst mothers at the post natal wards of the Federal Teaching Hospital, Abakaliki. Materials and Methods: This study was a questionnaire based cross sectional view of breastfeeding practices of mothers who received perinatal care at the Federal Teaching Hospital Abakaliki, Ebonyi, South Eastern Nigeria. Results: 16.1% initiated breastfeeding within one hour, while others initiated later for reasons like poor lactation (19.6%); too tired (15.4%); felt dirty after delivery (5.3%) and caesarean section. Exclusive breastfeeding was not the intention of 30.8% for reasons like, too demanding(15.4%); cannot satisfy baby (38.6%); spouse and relations would not accept (26.5%); Work/School schedule would not permit (13.6%). Mode of delivery and socioeconomic class were significantly associated with time of initiation. Neither maternal age nor parity significantly influenced the overall practice of breastfeeding. Conclusion: Few mothers practice correct breastfeeding in this tertiary health institution suggesting that more work to improve the knowledge and attitudes of mothers is required starting from the antenatal period.Publication Blood Pressure Profile and Hypertension in Urban Adolescents: Need for Cognisance(Nepal Paediatric Society (JNPS), 2014) Faujdar, Dharmajeet Singh; Kunte, Renuka; Bhalwar, RajvirAbstract: Objective: To find the profile of blood pressure and the prevalence of hypertension in adolescents in an urban area. Methods: A cross sectional study was carried out in Adolescent students in the age group of 11-17 years, in a school in an urban area of Pune, belonging to upper socioeconomic group to measure their blood pressure and anthropometric parameters. Results: The mean SBP and DBP in both boys and girls were found to increase with increasing age and anthropometric measurements. The prevalence of hypertension was 12.23% in boys and 10.1% in girls and the prevalence of overweight as per BMI was 19.14% in boys and 18.62% in girls. The prevalence of hypertension observed in overweight children (36.1% in boys 30.8% in girls) was significantly (p<0.000) higher than normal weight children (6.5% in boys and 5.36% in girls). Among the anthropometric variables only weight & BMI had moderately strong correlation with SBP(r-0.559 &0.506). Conclusion: Hypertension is prevalent among adolescent population and overweight/obesity has been found to play a crucial role in predicting rise in BP in them. It is recommended bp monitoring be made mandatory part of school health services programme for early detection & instituting preventive measures.Publication Status Epilepticus Due to Organophosphate Poisoning in an Infant(Nepal Paediatric Society (JNPS), 2014) Parmar, PNAbstract: We report a case of a three months old female presented with status epilepticus who was diagnosed as organophosphate (OP) poisoning. She was from rural area with agricultural background. Typical clinical features and history of exposure to organophosphate compound were absent. The infant was successfully treated with atropine, pralidoxime and supportive management. Safety and efficacy data of pralidoxime in infants are limited in literature and was found safe in our case.Publication Myiasis in Children: Fly Larval Infestation(Nepal Paediatric Society (JNPS), 2014) Meena, SS; Meena, DAbstract: Human myiasis is a parasitic infestation by fly larvae in poor hygienic or immunocompromised children’s. We present here two case of fly larval infestation including one scalp myiasis in six year old male street child and other one vulvar myiasis in 18 year old unmarried girl suffering from insulin dependent diabetes mellitus and psychiatric illness.Publication Greek Warrior Helmet Facies (Wolf-hirschhorn Syndrome)(Nepal Paediatric Society (JNPS), 2014) Biswas, P; Choudhury, R; Gayen, S; Guha, D; Roy, S; Dasgupta, MKAbstract: Wolf-Hirschhorn syndrome (WHS) is caused by a chromosomal deletion of the band 4p16.3 with characteristic craniofacial features -’Greek warrior helmet’5 facies (prominent glabella, hypertelorism, broad beaked nose and frontal bossing), high-arched eyebrows, protruding eyes, epicanthal folds, short philtrum, distinct mouth with downturned corners, micrognathia, dysplastic ears, preauricular tags. Till date there are very few case reports of Wolf-Hirschhorn syndrome.Here we report a case that had characteristic dysmorphic facies (Figure 1) ‘Greek warrior helmet’ and was diagnosed as a case of WHS. But presence of Meningo-encephalocele and lissencephaly is rarely reported in literature in association with Wolf-hirschhorn syndrome till date.Publication Anti-Tubercular Treatment of Tuberculous Meningitis Cause Paradoxical Multiple Neurotuberculoma(Nepal Paediatric Society (JNPS), 2014) Kumar, MK; Kumar, P; Singh, AAbstract: Tuberculosis is the most common cause of infectious disease related mortality worldwide. Paradoxical reactions to antituberculous treatment have created difficulties in the management of extrapulmonary tuberculosis, particularly central nervous system tuberculosis. We report a three years baby with tuberculous meningitis, who was treated outside with anti-tuberculous drugs without steroid one month back and presented in our emergency as status epilepticus. This case emphasizes the importance of addition of steroid along with anti-tubercular drugs in the treatment of central nervous system tuberculosis.Publication Acute Deterioration in Pleomorphic Xanthoastrocytoma in a Child(Nepal Paediatric Society (JNPS), 2014) YB Roka,; SR Pandey,; N RokaAbstract: Pleomorphic Xanthoastrocytoma (PXA) occur in less than 1 % of cases and usually present in the second decade. They present with seizures, focal deficits, intratumoral bleed and rarely with malignant transformation. The few cases that have been reported with acute deterioration in PXA have been secondary to intratumoral bleed. We present a case of PXA in a child that deteriorated secondary to high intracranial pressure which was managed successfully.Publication Text Book of Pediatric Gastroenterology Hepatology and Nutrition(Nepal Paediatric Society (JNPS), 2014) Neopane, A; Rimal, SAbstract: NAPublication Publication Silver-lining in the Time of Mayhem: The Role of Local Governments of Nepal During the COVID-19 Pandemic(Nepal Medical Association, 2020) Adhikari, Biplov; Budhathoki, Shyam SundarAbstract: The COVID-19 pandemic has not only affected health systems but also has had deep socio-economic effects. The lockdown enforced in Nepal, had people running out of means to make ends meet, the public in fear of an unknown disease, and challenges for leaders to deliver better. Local governments of Nepal, established under the federal system, have the closest ties to the community. They have powers entrusted by the constitution to enact laws according to the needs of the community. During the 83 days of lockdown, the local governments came through for their inhabitants by managing quarantines and isolation centers, taking care of diagnostics, providing food and rations, and arranging facilities to bring back their locals stranded in other cities. The local governments improved awareness and helped maintain the lockdown. These undertakings by the local governments of Nepal highlight the importance of a community-based approach to dealing with pandemics.Publication Parenting during the COVID-19 Pandemic(Nepal Medical Association, 2020) Karki, Utkarsh; Dhonju, Gunjan; Kunwar, Arun RajAbstract: Parenting is both an art and science of nurturing a child that comes very naturally to some. In today’s world, the fundamentals of parenting are getting challenged but it has been even more magnified during the coronavirus 2019 (COVID-19) pandemic. The mental health of children is bound to be affected by the stress related to COVID-19 owing to loss of usual routine, unpredictability, uncertainty. Various other social, economic, and environmental factors also threaten their mental well-being. Parents are the child’s first and longest-lasting context for development Positive parenting that involves sensitivity, responsivity, caring, communicating, and empowering would ensure positive developmental outcomes in children and adolescents. Positive parenting and self-care of parents would serve as a promotive and preventative intervention for child and adolescent mental health, especially during this crisis.