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Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Chaudhary, Brajesh Raj; Malla, Kalpana Karmacharya; Poudel, Sajan; Jha, Brajesh Kumar
Abstract: Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. Methods: A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Results: Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Conclusions: Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.
Outcome of Laparoscopy in Infertile Couples attending a Teaching Hospital in Eastern Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Subedi, Shanti Sunuwar; Bhansakarya, Rakina; Shrestha, Prajmi; Sharma, Sajjan Kumar
Abstract: Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility. Methods: A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled. Results: Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas. Conclusion: Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.
Illness Perception Predicting Cardiovascular Health Behaviors among Patients with Ischemic Heart Disease in Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Gauro, Punam; Thaniwattananon, Ploenpit; Kritpracha, Charuwan
Abstract: Introduction: Cardiovascular health behaviors refer to the activities done by individuals to prevent recurrence, minimize risk factors, improve survival, reduce recurrent events, control cardiovascular disease, and help prevent further complications. Illness perception may determine these behaviors. This study is aimed to identify level of illness perception, cardiovascular health behaviors and illness perception predicting cardiovascular health behaviors among patients with ischemic heart disease. Methods: The study was a descriptive cross-sectional study. Altogether 114 samples were selected using convenience sampling technique. Data was collected by using pretested semi-structured questionnaire. The data were analyzed using descriptive statistics. Results: Illness perception was at moderate level (M= 148.05, SD= 12.86) which represented a moderate threatening perception. The score of cardiovascular health behaviors was at a high level (M=92.14, SD=10.72). Conclusions: The findings showed that illness perception can be a predictor of cardiovascular health behaviors.
Anatomical Position of Lower Third Molar in Relation to Mandibular Canal on Cone-Beam Computed Tomography Images in A Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Chaudhary, Bikash; Joshi, Ujjwal; Khanal, Pranaya; Sagtani, Alok; Dahal, Sirjana; Bhattarai, Niroj
Abstract: Introduction: The positional relationship between the mandibularcanal with impacted mandibular third molar is the main factor of inferior alveolar nerve injury. The purpose of this study wasto classify the anatomical three dimensional relationship between the proximity of impacted mandibular third molars to the inferior alveolar canal. Methods: The descriptive cross-sectional study was conducted inthe Department of Oral and Maxillofacial Surgery of a tertiary care hospital from July 2020 to August 2020 after obtaining ethical approval from the Institutional Review Committee (Reference number 2506202001). Cone-beam computed tomography images of 200 patientsâ€™ mandibular third molars were used. A convenient sampling method was used. Data were analyzed using Statistical package for the Social Sciences. Results: Mandibular canal relative to the roots of the mandibular third molar was observed on the apical side in 104 (52.0%) and 173 (86.5%) third molars had direct contact with the mandibular canal. About 36 (97.3%) lingually placed mandibular third molars had contact with the mandibular canal. Conclusions: The findings of the study conclude that most of the mandibular third molars situated lingually had a higher occurrence of mandibular nerve involvement. The anatomic structures of the mandibular third molar and the mandibular canal may be helpful to draw upon the adequate surgical plan to avoidor reduce nerve involvement.
A Study on the Clinical and Hormonal Profile of Polycystic Ovarian Syndrome Patients Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Vaidya, Achala; Yadav, Sweta; Vaidya, Anshu
Abstract: Introduction: Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age and has a considerable metabolic, reproductive, and cardiovascular consequences. This study was designed to provide an overview of the presentation of PCOS in the Nepalese population attending a tertiary care hospital, specifically the clinical presentation and hormonal profile. Methods: A descriptive cross-sectional study was conducted between September 14, 2019 to October 16, 2019 on patients presenting to a tertiary care hospital, after obtaining ethical clearance from Institutional Review Committee (Dated 03/09/2019) and informed consent from the patient or patient relatives. Data entry and analysis were done in Microsoft Excel 10. The data was statistically analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The study included 100 PCOS patients. The mean age of the patients was 24.9 Â± 4.52 years and the most common group was 26-34 years. The most common presenting symptom was menstrual irregularity which was seen in 86 (86%) of the patients, followed by weight gain in 55 (55%) of the patients. Thirty percent (30 in number) of the patients were overweight, while eleven (11%) of the patients had grade I obesity. Conclusions: PCOS has varying clinical manifestations, most commonly affecting the young women of reproductive age group. The commonest presenting complaint in the current study was menstrual abnormality. Majority of the patients had deranged hormonal profile which can lead to an increased risk of cardiovascular disease and type 2 DM. Thus, awareness regarding PCOS is important for early diagnosis and to prevent its sequalae to various complications.
Bacteriological Profile of Urine in Patients with Different Types of Kidney Stones in a Tertiary Care Hospital: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2020) Ranjit, Srijana; Singh, Amit Kumar
Abstract: Introduction: The association of bacteriology in the pathogenesis of urolithiasis is a known and fact. The urinary tract stones being the most common problem that brings the patient to the surgical outpatient department; it is important to know the relation between the types of stone and the organism isolated from the urine for better management of the patient. The aim of this study was to find out the urine bacteriological profile of patients with kidney stones. Methods: This is a descriptive cross-sectional study done over 18 months in a tertiary care hospital in Nepal. Ethical clearance was taken from the Institutional Review Committee (No: 03/16). Preoperative urine cultures were done routinely in all the patients who agreed to take participate in the study. The biochemical stone analysis was done. Urinary microbial floras and stone composition were noted. Data entry and analysis was done using Statistical Package for the Social Sciences version 25.0. Results: Among 107 patients, kidney stones were more common in males and most of the patients were in their 2nd to 4th decade. Female patients 45 (42.05%) had more predilections towards the urinary tract infection. Among 15 (14.01%) positive cultures, Escherichia coli 10 (67%) was the most common organism isolated followed by Klebsiella; 4 (27%), and Pseudomonas; 1 (6%). Conclusions: Thus, we would like to state that Escherichia coli, though being a non-urease producing organism, is a major organism isolated in the preoperative culture of urine in a patient with kidney stones.
Prevalence of Aeroallergens in Allergic Rhinitis in a Tertiary Care Hospital
(Nepal Medical Association, 2020) Pokharel, Monika; Shrestha, Bikash Lal; Karn, Dharmendra; Dhakal, Ashish; K.C., Abha Kiran; Shrestha, Krishna Sundar; Shakya, Sushan
Abstract: Introduction: The prevalence of allergic rhinitis has increased significantly globally over the last two decades. Detection of sensitizing aeroallergens plays a crucial role in the diagnosis and management of this troublesome disease. This study aims to investigate the spectrum of aeroallergens sensitization in patients with allergic rhinitis in a tertiary care hospital. Methods: A descriptive cross-sectional study conducted in the Department of Otorhinolaryngology of our hospital between January 2016 to December 2019. Ethical approval was taken from the Institutional Review Committee (No: 210/19). Patients diagnosed with allergic rhinitis were enrolled using the convenience sampling technique. Data entry and analysis was done using IBM Statistical Package for Social Sciences version 20.0. Results: Among 170 patients, altogether 103 (60.6%) patients yielded positive responses on the skin prick test. The most prevalent aeroallergens were Lepidoglyphus 86 (50.60%), Dermatophagoides pteronyssinus 85 (50%), Dermatophagoides farina 82 (48.20%), Thyrophagus 50 (29.40%), Blomia 46 (27.10%), Acarus 43 (25.30%), cat dander 26 (15.30%), dog dander 24 (14.10%), cow and buffalo dander 20 (11.8%), ragweed 20 (11.8%), grass pollen 18 (10.60%) and mugwort 17 (10%). Conclusions: This study highlights that the frequency of aeroallergens based on skin prick test in patients presenting to a tertiary care hospital which showed the dominance of house dust mites, dog and cat hair, pollen, and grasses. Reduced exposure and training of patients about protection against these agents will possibly help in controlling the severity of allergic rhinitis in this region.
Prevalence of Acute Pediatric Burns in a Tertiary Care Hospital Authors
(Nepal Medical Association, 2020) Nakarmi, Kiran Kishor; Pathak, Bishnu Deep
Abstract: Introduction: Burn injury is an important cause of mortality and morbidity in children worldwide. Mortality is higher in developing countries than in developed ones. Most of them occur in predictable domestic settings and can be prevented. The objective of this study was to find out the prevalence of acute pediatric burns in a hospital setting. Methods: A descriptive cross-sectional study was conducted by reviewing the secondary data of burn cases admitted during the years 2016 AD to 2018 AD in a tertiary care hospital after taking ethical clearance from the Institutional Review Committee (IRC No. 016-2019). The sample size was calculated and systematic random sampling was done. Data analysis was done using Statistical Package for the Social Sciences, version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of acute pediatric burns at the hospital was found to be 101 (29.71%) (24.85-34.57 at 95% Confidence Interval). The majority of them were males 54 (53.47%) and toddlers 39 (38.61%). Scalding 54 (53.47%) was the main etiology. Most of the burn injuries occurred inside the house 76 (75.25%) and on November 11 (10.9%). The mortality rate was 11 (10.89%). Conclusions: The prevalence of acute pediatric burns in a hospital setting was lower than most other countries but mortality was higher. The majority of the burn injuries occurred inside the house. Therefore, special focus should be done on prevention at the household level. Adequate medical services for emergency management of childhood burns should be available in different parts of the country.
Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Ghartimagar, Dilasma; Ghosh, Arnab; Shrestha, Manish Kiran; Thapa, Sushma; Talwar, Om Prakash
Abstract: Introduction: Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions. Methods: A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used. Results: Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Graveâ€™s disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions. Conclusions: Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.
Prevalence of Valvular and Non-valvular Atrial Fibrillation and the Application of Antithrombotic Treatment in a Tertiary Care Hospital
(Nepal Medical Association, 2020) Dhungana, Sahadeb Prasad; Ghimire, Rinku
Abstract: Introduction: Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism. This study aims to provide information about the application of antithrombotic treatment based on risk stratification schemes for stroke in real-life clinical practices. Methods: This was a descriptive cross-sectional study in 260 patients admitted at the tertiary care hospital with a diagnosis of atrial fibrillation from January 2019 to February 2020 after approval from the Institutional Review Committee (ref. no. 207/2018). Convenient sampling was used. Predisposing conditions for atrial fibrillation, risk factors for stroke, and the use of antithrombotics were obtained based on the pre-structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Results: The prevalence of valvular and non-valvular atrial fibrillation was 125 (48.0%), and 135 (51.9%) respectively. Among patients with a non-valvular variant, 102 (75.5%) had a CHA2DS2VASC score of â‰¥ 2 who were eligible for oral anticoagulants, 13 (9.6 %) patients received it with a majority having sub-therapeutic international normalized ratio. Among patients with valvular type, only 47 (37.6%) patients were receiving oral anticoagulants and 20 (42.5%) patients achieved therapeutic international normalized ratio. Two hundred forty three (93.4%) patients had dilated left atrium (â‰¥40mm), 119 (45.9%) had hypertension and 27 (10.3%) had diabetes mellitus. Conclusions: Antithrombotics were markedly underused in patients with atrial fibrillation. There is a need for proper application of risk stratification schemes for stroke and appropriate use of antithrombotics to prevent thromboembolism.
Orthopaedics Practice in a Rural Hospital During the COVID-19 Pandemic: A Descriptive Cross-Sectional Study
(Nepal Medical Association, 2020) Rawal, Mangal; Kathayat, Tufan Singh; Rokaya, Poojan Kumar; Thakur, Abhishek Kumar; Mahat, Smritee; Acharya, Bishnu Dutta; Karki, Dhan Bahadur; Ojha, Sujata
Abstract: Introduction: The coronavirus disease 2019 pandemic is one of the biggest public health challenges that we have faced, and has had a significant impact on the delivery of essential healthcare worldwide. Trauma and orthopaedic surgery was one of the most severely affected specialties as all non-emergency surgical cases were cancelled. With the possibility of future peak of corona virus, knowing the impact of Covid on orthopaedics would enable us to manage trauma patient in an effective manner and will help us to resume normal schedule of the trauma care. Methods: This is a descriptive cross-sectional study. We studied the details of total number of patient at Orthopaedic and trauma outpatient, inpatient and operation theatre of Karnali Academy of Health Sciences from 14th March 2020 to 16 September 2020 as compared with the patient data from the same time period in 2019. Results: There were 2288 patients during the non-Covid period who visited to the orthopaedic outpatient in comparison to 1618 during Covid period. Only 5 implant removals were performed in comparison to 50 removals (90% reduction) in elective cases. But the number of surgical cases was almost similar (204 vs 207 respectively). Total number of hospital stay had significantly reduced in the non-COVID period (average 4 days vs 6 days). Conclusions: There is reduction in number of orthopaedic and trauma cases during COVID 19 with marked reduction in number of elective cases. Alternative methods of treatment like telemedicine and small scale health camps at peripheral districts should be conducted to treat non-urgent orthopaedic conditions during lockdown.
Hypocalcemia in Elderly Population in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Thapa, Sangita; Rayamajhi, Rabindra Jang
Abstract: Introduction: As the medical facilities are improving, the life expectancy is increasing which has led to rapid rise in elderly population. The epidemiology of many diseases in elderly has been modified, including calcium imbalance. This study aims to know the prevalence of hypocalcemia in elderly population visiting a tertiary care center of Kathmandu. Methods: A descriptive cross-sectional study was conducted in a tertiary care center of Kathmandu from March to July 2020 after obtaining ethical clearance (Ref: 2003202007). Total 402 participants at or above 60 years of age groups visiting outpatient departments were included in the study by convenience sampling method excluding those under vitamin D and calcium supplements. Serum total calcium level was measured using standard routine method and corrected with albumin. The serum calcium value less than 8 mg/dl was considered as hypocalcemia in accordance with the reference range of our laboratory. Data analysis for calculation of frequency and proportion was done in Statistical Package of Social Sciences. Results: The prevalence of hypocalcaemia in elderly was found to be 97 (24.1%). Out of 286 participants of age group 60-74 years, hypocalcemia was seen in 75 (26.2%) and among 116 participants of age group >74 years, 22 (19%) were hypocalcemic. Among 181 male participants, 44 (24.3%) had hypocalcemia and out of 221 female participants, 53 (24%) had hypocalcemia. Conclusions: The finding of present study suggests that hypocalcemia is common among elderly which can be life threatening. Therefore, regular monitoring of serum calcium is recommended for this age group.
Vitamin D Deficiency among Patients Visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2020) Poudel, Nimesh; Dhakal, Subodh Sagar; Sukhupayo, Renu; Karki, Dambar Bahadur
Abstract: Introduction: Vitamin D deficiency is a common condition prevalent among both developed and developing countries where it is seen mostly in females. It has been linked to various skeletal and non-skeletal diseases. This study was done to find out the prevalence of Vitamin D deficiency and clinical features of deficient patients attending the outpatient department of a tertiary care hospital. Methods: This descriptive cross-sectional study was done among the patients attending the outpatient department of a tertiary care hospital in Kathmandu, Nepal. The study was conducted from May 2019 to July 2019. The ethical approval was taken from the Institutional Review Committee (ref no. 310520113). Convenient sampling was done. The collected data was entered in Microsoft Excel and was analyzed in the Statistical Package for the Social Sciences (SPSS) version 26. Results: Out of 481 participants, the prevalence of vitamin D deficiency was 335 (69.6%). Severe vitamin D deficiency was seen in 78 (16.2%) and insufficient vitamin D in 77 (16%) of the patients. The mean serum vitamin D concentration by gender was 22.38Â±17.07 ng/ml in males and 18.89Â±15.25 ng/ml in females. A total of 263 (54.6%) females and 72 (14.97%) males had vitamin D deficiency. The most common symptoms found in vitamin D deficiency patients were fatigue 187(55.8%), muscle cramps 131(39.1%), generalized myalgia 125(37.31%), bone and joint pain 111(33.13%) Conclusions: Vitamin D deficiency was prevalent especially in females and elderly people. Fatigability was present in more than half of the vitamin D deficient patients.
Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients
(Nepal Medical Association, 2020) Shrestha, Shristi; Joshi, Smita; Bhandari, Sajana
Abstract: Introduction: Topical corticosteroids misuse has become one of the burning issues in many countries across the globe. They are known to cause a myriad of adverse effects which include local effects commonly and systemic effects rarely. In dermatology practice, one of the common problems we see these days are steroid-induced and steroid aggravated dermatoses. So, this study was done to find the prevalence of misuse of topical corticosteroid among dermatology outpatients. Methods: A descriptive cross-sectional study was done in the outpatient department of dermatology at atertiary care hospital for 18 months. Ethical clearance was obtained from the Institutional Review Committee of NMCTH (Reference no. 029-076/077). Convenient sampling was done. Statistical Package for the Social Sciences (SPSS) version 16 was used to tabulate the data and analyze the results. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 19464 patients, 614 (3.15%) (2.91%-3.39% at 95% Confidence Interval) gave a history of applying steroid containing creams. Among them, 220 (35.8%) belonged to the age group 21-30 years. Dermatophytoses were the skin disease where TCS was most commonly misused followed by melasma in 425 (69.2%) and 115 (18.7%) respectively. Beclomethasone was the steroid preparation that was misused in the maximum number of patients in 271 (44.1%). Some form of adverse effects was seen in 554 (88.6%) patients. Conclusions: Non-prescription sale of topical corticosteroids is the major cause of topical corticosteroids abuse in Nepal. Creating awareness among the prescribers as well as the patients is the current need.
Approach to Sample Collection, Transport and Processing of Suspected or Confirmed COVID-19 Patients for Biochemistry Investigations
(Nepal Medical Association, 2020) Niraula, Apeksha; Gelal, Basanta; Lamsal, Madhab
Abstract: During this global pandemic period of COVID-19, the health care system is the most affected area. Health care workers including clinicians, laboratory professionals, and other allied health workers pose a high threat for acquiring and transmission the disease. Apart from the diagnosis of disease by the RT-PCR, other laboratory investigations are equally essential in disease prognosis and monitoring. This biosafety guidance is intended to provide and insight to the clinicians, nurses, and laboratory professionals in handling the blood and other body fluid samples for biochemical investigations concerning the proper methods of sample collection, transport, processing, and disposal. Every day, the laboratory receives samples of the patient with confirmed and suspected cases of COVID-19 patients. This poses a high threat of contamination to the health professionals and thus, a proper risk assessment and standard precautions protocol must be followed to ensure safety, minimize the risk of contamination and disease transmission.
Spectrum of Biopsy Proven Glomerular Disease in Children at Kanti Children’s Hospital
(Nepal Paediatric Society (JNPS), 2014) Khatun, N; Bista, KP; Mahaseth, C
Abstract: Introduction: Glomerular disease is one of the most common forms of renal disease and can have many different clinical presentations. However there is variation in the prevalence in the type of glomerular disease according to geographical location and race of population. The aim of the study was to find the overall distribution pattern of glomerular disease based on renal biopsies. Material and Methods: The medical records of all children who underwent kidney biopsy (n=29) between January 2012-june 2014 were analyzed. In this retrospective study we review children from Kanti Children’s Hospital, Nephrology Department. Demographic data including age, sex and indication of kidney biopsy as well as complication of the procedures were recorded. Result: A total number of thirty one biopsies were done. Two children were excluded from the study due to inadequate tissue and artifacts defects in preservative. The remaining twenty nine biopsies were included in the study and analyzed. Renal disease was found nearly equal in both male and female (51.72% vs. 48.27%).Mean age was 10.95±3.30 years. Maximum number of biopsies (75.86%) was performed between 10- 15 years. The most common indication of the kidney biopsy was nephrotic syndrome (steroid resistant nephrotic syndrome and steroid dependent nephrotic syndrome, 31.02% followed by lupus nephritis 27.58%.The most common glomerular disease were focal segmental glomerulosclerosis and lupus nephritis both contribute 27.58%. Among lupus nephritis class III was found more common (44.44%) in children. IgA nephropathy was also contribute (17.24%) in all glomerular disease. Regarding the kidney biopsy complication gross hematuria was observed in 6.89% of children which was self-limited. Conclusion: FSGS and lupus nephritis is becoming the most common glomerular disease in children attending the Kanti Children Hospital. IgA nephropathy was also contribute the glomerular disease in the children.
Postinfective Glomerulonephritis (PIGN) in Children Attending a Tertiary Care Centre in Nepal
(Nepal Paediatric Society (JNPS), 2014) Poudel, DR; Basnet, S; Gami, FC
Abstract: Introduction: Post infectious glomerulonephritis (PIGN) is one of the common paediatric kidney disease in developing countries. This study was undertaken to describe the common clinical features, biochemical findings and complications in children with PIGN. Materials and Methods: This was a retrospective descriptive study in which 30 patients admitted with a diagnosis of PIGN at Tribhuvan University Teaching Hospital (TUTH) in a six month period (July 2014 to Dec 2014) were included. Hospital medical records were reviewed for the data collection. Results: Out of 30 patients, 24 (80%) were between 5 to 15 years of age (mean age of 11.5±3.3) with male to female ratio of 2.3:1. Pedal oedema and hypertension were the clinical features seen in 29 (97%) and 28 (93%) patients respectively. Hypocomplementemia was found in 29 (97%) patients. Recent past history of sore throat seen in 10 (33%) patients and skin lesions in 12 (40%). The complications noted were congestive cardiac failure in 5 (17%) patients, rapidly proliferative glomerulonephritis in 3 (10%) and encephalopathy in 1(3%). Conclusion: The most important clinical and biochemical profile observed in nepalese children with PIGN are the hypertension, pedal edema and hypocomplementemia.
Nutritional Status of Children Seeking Medical Treatment in a Rural Hospital in Ilam District, Nepal
(Nepal Paediatric Society (JNPS), 2014) Paneru, C; George, SM
Abstract: Introduction: Childhood malnutrition is a leading cause of mortality and morbidity in children under five years in Nepal. There is evidence to show that childhood malnutrition varies from region to region, within Nepal. But there is no data available about nutritional status of children in the 75 districts in Nepal. The aim of this study was to evaluate the nutritional status of children less than five years of age in Ilam district. Material and Methods: We analysed the anthropometric data for the children of Ilam district who visited Dr. Megh Bahadur Parajuli Community Hospital in Ilam district. Results: Our data showed that 15.7% of girls and 21.2% of boys under-five years suffered from moderate malnutrition. Severe malnutrition was present in 6.7% of girls and 9.6% of boys. Stunting was seen in 32.6% girls and 30.16% boys. Moderate stunting was present in 19.6% of girls and 19% of boys; while severe stunting was present in 11% of the boys and 13% of the girls. Conclusion: Our data shows that stunting among under-fives in Ilam is less as compared to that reported for Nepal, but underweight is comparable to the national data. However, a systematic study needs to be carried out in Ilam before drawing firm conclusions.
Neonatal Sepsis: A Profile of a Changing Spectrum
(Nepal Paediatric Society (JNPS), 2014) Venkatnarayan, K; Bej, PK; Thapar, RK
Abstract: Introduction: The clinical features of neonatal sepsis are protean and are based on variety of clinical, demographic and laboratory profile of suspected cases. Objectives: To describe the aforementioned profiles in neonates presenting with clinically suspected sepsis based on pre-defined clinical criteria. Material and Methods: Design: Cross-Sectional Study; Setting: Level-2 NICU, Tertiary Care Hospital; Duration: Jan 2011 to Jul 2012. Subjects: 50 consecutive neonates presenting with any of the predefined clinical criteria were assessed for presence of maternal risk factors and studied with respect to: Gestational age, sepsis screen, clinical profile and antibiotic sensitivity of the organisms cultured. Results: Out of the fifty neonates, 38 (76%) were early onset sepsis. The sepsis screen showed an overall sensitivity of 73%, specificity of 54%; with a positive predictive value of 41% and a negative predictive value of 83%. The most common organism cultured was Staphylococcus aureus followed by E Coli, Pseudomonas, Coagulase Negative Staphylococcus and Group B Streptococcus. Ampicillin and Amikacin fared better than Cefotaxime and Gentamicin for Gram positive and Gram negative organisms, respectively. Overall, 37 babies responded to first line antibiotics and 11 required a change of antibiotics. One required addition of inotropes and two of the neonates died. Conclusion: A clinical diagnosis of sepsis based on predefined clinical criteria along with maternal risk factors, over- treated 27 babies (71%) with EONS and 8 babies (66.6%) with LONS. However, such a clinical diagnosis was supported by a septic screen almost twice as frequently (50% Vs 26.3%) in LONS. Staphylococcus aureus was the most common organism isolated.
Knowledge and Practice of Mother regarding Exclusive Breastfeeding having Infant at a Tertiary Level Hospital, Kathmandu
(Nepal Paediatric Society (JNPS), 2014) Adhikari, TM
Abstract: Introduction: Promotion of exclusive breastfeeding is a cost effective intervention to reduce infant mortality in developing countries. The objective of this study was to identify knowledge and practice of mothers regarding exclusive breastfeeding. Material and Methods: This was a descriptive exploratory study carried out in the immunization clinic of tertiary level hospital in Kathmandu. A total of 323 mothers who came for immunization of six months to one year were selected as the sample for the study by using non-probability purposive sampling technique. Semi - structured interview questionnaire was used to collect the data both on knowledge and practice of exclusive breastfeeding, from 13th July to 8th September 2014. Results: Study findings revealed that 84.5 % of the respondents were aware of the correct meaning of exclusive breastfeeding and 49.5 % of the respondents practiced exclusively breastfeeding to their children up to 6 months. There was statistically significant association of respondent’s level of knowledge regarding exclusive breast feeding with their educational status (p = 0.034, OR = 1.7, 95% CI = 1.03-2.66) and type of delivery (p = 0.005, OR = 1.9, 95% CI = 1.2-3). Likewise, a significant association was seen between respondent’s level of practice regarding EBF and type of delivery (p = 0.005, OR = 1.9, 95% CI = 1.2-3). Conclusion: Study concludes that only about half of the mothers tended to have adequate knowledge regarding exclusive breast feeding. However, practice of exclusive breastfeeding for up to six months tended to be low so there should be efforts on encouraging and counseling for exclusive breast-feeding up to six months in hospital, community and immunization clinic.

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