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Neonatal Leukemoid Reaction: Correspondence
(Nepal Paediatric Society (JNPS), 2017) Mandal, Anirban; Sahi, Puneet Kaur
Abstract: To the Editor, We read with much interest the article by Bhatia et al., published in the recent issue of your journal [1] but at the same time would like to make the following comments, clarification to which would benefit the general readers of JNPS.
Tonsillectomy as Treatment for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome
(Nepal Paediatric Society (JNPS), 2017) Taniguchi, Kazuto; Sakai, Tatsuya; Ichiyama, Yasunobu; Yamamoto, Hirokazu; Uemichi, Kazuyasu
Abstract: Although the etiology of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome remain unclear, various treatments have been reported. We here describe two thought-provoking cases. Our experience suggests that tonsillectomy is effective against PFAPA syndrome, and can safely be performed in patients three years and older. We recommend that tonsillectomy be considered as early as possible in patients with PFAPA syndrome.
Pancreatic-Biliary Ascariasis in an Infant
(Nepal Paediatric Society (JNPS), 2017) Roy, Kakali; Das, Joydeep; Mukherjee, Devdeep; Kundu, Ritabrata
Abstract: Ascaris infestation that too causing biliary obstruction is very rare in infancy even in endemic area. Adult Ascaris diameter (3-6 mm) is more than the average diameter of CBD in paediatric population, which is 1.27 +/- 0.67 mm. We are reporting a baby of seven months who presented with conjugated hypebilirubinemia and pancreatitis due to Round Worm in CBD.
Methotrexate as a Suspected Trigger of Macrophage Activation Syndrome in Juvenile Idiopathic Arthritis
(Nepal Paediatric Society (JNPS), 2017) Roy, Soumya; Chakrabartty, Subroto
Abstract: A four year old girl with systemic onset juvenile idiopathic arthritis (SOJIA) developed macrophage activation syndrome (MAS) shortly after starting methotrexate. We observed methotrexate is a likely trigger of MAS in SOJIA. Possibly, there are only two case reports suggesting methotrexate triggered MAS. We reviewed the literature for possible mechanisms.
De Novo Robertsonian Translocation t(21; 21) in a Child with Down Syndrome
(Nepal Paediatric Society (JNPS), 2017) Israni, Anil Vasudev; Mandal, Anirban
Abstract: The phenotypic expression in DS is determined by the type of underlying cytogenetic abnormality. Almost 90-95% cases of DS are due to pure trisomy of the 21st chromosome; 6-7% is the result of mosaicism and in only 3-5% of cases it results from Robertsonian translocation (ROB). About 1/3rd cases of unbalanced Robertsonian translocation causing DS are inherited. We report a 1-year-old-boy with DS secondary to rea(21;21) ROB.
Congenital Diaphragmatic Hernia
(Nepal Paediatric Society (JNPS), 2017) Ogundare, Ezra Olatunde; Olatunya, Oladele Simeon; Ajite, Adebukola Abidemi; Oluwayemi, Isaac Oludare; Fatunla, Odunayo Adebukola; Omoniyi, Evelyn Omosede; Odiase, Oboite; Ige, Joshua Taye
Abstract: Congenital diaphragmatic hernia (CDH) refers to a diaphragmatic defect that allows herniation of some abdominal viscera into the thoracic cavity. We present a male neonate with CDH and bilateral cryptorchidism managed in our facility with limited expertise for cardiothoracic surgery. We highlight some of the challenges in the management.
A Rare Abdominal Tumour in a Paediatric Age Group: Pheochromocytoma
(Nepal Paediatric Society (JNPS), 2017) Sah, Rajesh Prasad; Sah, R.G.; Mahmood, Shaukat
Abstract: A 10 year boy presented with history of abdominal pain and palpitation. Abdominal ultrasound and CT oriented towards the diagnosis. After preoperative optimization, laparotomy with complete excision of an unusual pheochromocytoma tumour of about 8×10 cm adherent to liver and IVC performed. Histopathology confirmed the diagnosis without evidence of malignancy.
A ‘Missed’ Diagnosed Case of Christ-Siemens-Touraine Syndrome
(Nepal Paediatric Society (JNPS), 2017) Narayan, Shambhavi
Abstract: Christ-Siemens-Touraine syndrome also known as Anhidrotic ectodermal dysplasia, is a rare genetic disorder, occurring in 1-100,000 live male births. A two year old male child with classical signs and symptoms of the disease, affecting skin, hairs, nails and teeth, misdiagnosed initially as a case of seborrhic dermatitis, and later as tuberculosis, is described here. Treatment includes counselling the family, skin care, avoiding high ambient temperature, and prosthodontic measures. Diagnosis as early as possible, based mainly on clinical features can prevent mortality due to hyperpyrexia and respiratory infections. Beyond early childhood, life expectancy is normal to slightly reduced.
Ogbanje Phenomenon; Mothers Perception, and Childhood Morbidity MORBIDITY
(Nepal Paediatric Society (JNPS), 2017) Onyinye, U. Anyanwu; Chinonyelum, T. Eseonu; Obumneme, B. Ezeanosike; Okike, O. Cliford; Ibekwe, C. Roland
Abstract: Introduction: A cultural myth Ogbanje have existed among the Ibo people of Nigeria. These children may have morbidities that are manageable while some normal children may have to live with the stigma of being labelled such. The objective of this study was to assess mother’s perception of ogbanje phenomenon and morbidity in ogbanje children. Material and Methods: This was a Cross-sectional study amongst mothers having the concept of “Ogbanje” children who were clinically examined. SPSS version 20.0 was used for data analysis. Variables were compared with χ2. p<0.05 was accepted as significant. Results: A total of 64.8% believed in “Ogbanje”. Commonest presentation of “Ogbanje” was frequent illness (47.3%). Only 12(3.3%) would seek orthodox care for ogbanje children. Examined “ogbanje” children had sicklecell anaemia, structural anomalies, and diabetes. Four (9.5%; n=42) children were normal. Conclusion: Ogbanje myth still exists in the minds of mothers and affects health seeking behaviour. Ogbanje children may have manageable illness and sometimes may be normal.
Moyamoya Disease with Intraventricular Hemorrhage in a Child: A Case Report
(Institute of Medicine, 2025) Regmi, Nisha; Shrestha, Bibek; Karn, Vivek; Regmi, Pradeep Raj
ABSTRACT Moyamoya disease is a rare progressive cerebrovascular disorder in Nepal characterized by stenosis or occlusion of cerebral arteries with abnormal collateral vessels, and hemorrhagic presentation in children is extremely uncommon. We report an 8-year-old girl with intraventricular hemorrhage presenting with seizures, vomiting, and decreased consciousness. Imaging revealed characteristic angiographic features of Moyamoya disease. She was managed with external ventricular drainage and supportive treatment, achieving significant recovery. This case highlights the importance of considering Moyamoya disease in pediatric hemorrhagic stroke and underscores the need for early imaging and timely intervention. Keywords: Moyamoya Disease; intraventricular hemorrhage; pediatric stroke
Red Eye with Red Content in the Anterior Chamber: A Case Report of Buerger’s Disease
(Institute of Medicine, 2025) Sitaula, Ranju Kharel; Manandhar, Umang; Lama, Dichen Meghna
ABSTRACT Ocular involvement in Buerger’s disease is rare, with acute anterior uveitis (AAU) and hyphema being uncommon manifestations. We report a case of a 40-year-old male with Buerger’s disease presenting with AAU and hyphema. The patient presented with sudden onset redness and pain in the right eye for 3 days, with 1 mm hyphema and fibrin deposits. He had a history of peripheral vasculopathy and multiple amputations. Ocular exam revealed non-granulomatous acute anterior uveitis with hyphema. Vision and inflammation improved within 2 days of treatment. Hyphemic acute anterior uveitis can occur in Buerger’s disease, and early management is crucial to prevent progression. Keywords: Buerger’s disease; hyphema; red eye; uveitis
Experiences of Nurses during the COVID-19 Pandemic: A Qualitative Study from Nepal
(Institute of Medicine, 2025) Panta, Ganga; Sharma, Sharada
ABSTRACT Introduction: Identification of the nurses’ experiences with regards to their personal, work and social situation, and timely addressed of their concern is crucial for the betterment of the health care. The objective of this study was to explore the experiences of nurses during the COVID-19 pandemic. Methods: Qualitative design with a descriptive phenomenological approach was adopted for the study. Twenty nurses, who were working as front-liners during the COVID-19 pandemic in Tribhuvan University Teaching Hospital having at least six months experience in the COVID unit, were selected for an In-depth interview by adhering to interview guidelines. Colaizzi’s analysis method was used to analyze the data. Lincoln and Guba’s criteria were used for study rigor. Results: The study identified the three main themes, which are chaotic environment, stigma and discrimination, and fear and anxiety. Nurses experienced a huge workload, terrible deaths due to the unavailability of oxygen, beds, ICU, and ventilators. They also experienced fear and anxiety of transmission of COVID-19 to their family members, including hesitation to disclose the working area and positive status as well as restrictions in gathering due to fear of discrimination. They realized that adequate support from their family and public appreciation helped them to gain self-esteem and recognition. Conclusion: Nurses experienced a turmoil environment, a huge loss of life of people due to a lack of resources during the pandemic. Fear of transmission and social discrimination during the COVID-19 pandemic were other aspects affecting the nurses' daily lives. Thus, the adequate preparation of the health facilities to combat with such pandemic situations, including social awareness programs for the support of nurses, are crucial. Keywords: COVID-19; anxiety; chaotic environment; discrimination; fear; pandemic; stigma
Prevalence of Variants of Mandibular Second Premolar in Medical Students: A Descriptive Cross-sectional Study
(Institute of Medicine, 2025) Mehta, Prem Kumar; Shrestha, Kabir; Nepal, Prashuv; Singh, Archana Kumari; Dahal, Samarika; Khapung, Anju; Baral, Radha
ABSTRACT Introduction: The mandibular premolars have shown diversity in cusp morphology, although they are included under the bicuspid. This has been useful in anthropology and forensic odontology as supporting evidence. This study aimed to determine the prevalence of different types of mandibular second premolars among medical students. Methods: A descriptive cross-sectional study was conducted among 255 medical students after obtaining ethical approval. The number of cusps and the groove pattern present on the mandibular second premolar were examined and recorded using a sterile mouth mirror and explorer. The data was entered in a Microsoft Excel sheet and analyzed by the Statistical Package for Social Sciences (SPSS) version 27.0. Results; The prevalence of the two-cusp variant 319 (62.5%) was more than the three-cusp variant 191 (37.5%). The most common groove type was H type 198 (38.8%), followed by Y type 191 (37.5%) and U type 121(23.7%). The present study showed that the Y-shaped groove pattern was more common in the right premolar 40% (102), and the H-shaped groove pattern was more common on the left side 42.4% (108). The study showed that two cusp-type premolars are more common on the right and left sides of both genders. This study also revealed that two cusp variants are more common than other variants in different ethnic groups examined on both sides. Conclusion: The most prevalent variant of the mandibular second premolar was the two-cusps type. H-shaped grooves were most common, followed by Y and U-shaped grooves. H-shaped grooves were more prevalent compared to other types in both males and females. Keywords: Anthropology; bicuspids; cross-sectional studies; prevalence
Prevalence of Bilateral Vocal Fold Palsy in Cases with Perinatal Hypoxia
(Institute of Medicine, 2025) Gyawali, Bigyan Raj; Dutta, Heempali; Neupane, Yogesh; Pokhrel, Sishir; Guragain, Rajendra; Shrestha, Laxman; Basnet, Srijana; Balakrishnan, Karthik; Sidel, Douglas
ABSTRACT Introduction: There is a notable gap concerning the potential impact of perinatal hypoxia on laryngeal innervation and its role as a causative factor for bilateral vocal fold palsy (BVFP) in children. This study aims to assess the prevalence of BVFP in cases with perinatal hypoxia. Methods: This cross-sectional study took place at the Department of Ear, Nose, and Throat (ENT) and the Department of Pediatrics of Institute of Medicine, Kathmandu, Nepal. Institutional Review Board approval was obtained. From November 2019 to March 2023, all children under 2 years of age with documented perinatal hypoxia were included. Exclusion criteria comprised cases without parental consent, identification of another identifiable cause of BVFP, or the child being on oxygen support during examination, preventing laryngoscopy. Additionally, a retrospective cohort analysis included all BVFP patients at the department between January 2013 and November 2019 to validate our findings. Results: The study included 21 cases, and none of those with perinatal hypoxia exhibited BVFP. Furthermore, the retrospective cohort of BVFP cases presenting at our department did not reveal a significant history of perinatal hypoxia. Conclusion: Our study did not yield compelling evidence linking perinatal hypoxia with BVFP however, considering the constraints of our study, insights from existing literature and absence of prior research in this area, the hypothesis of perinatal hypoxia's impact on laryngeal innervation merits further, more comprehensive research in this area. Keywords: Hypoxic injury; perinatal hypoxia; vocal fold palsy
Physical Status and Psychosocial Wellbeing of Child Domestic Workers in Selected Wards of Pokhara
(Institute of Medicine, 2025) Banstola, Ratna Shila; Paudel, Usha Kiran; Shrestha, Romina
ABSTRACT Introduction: Child domestic workers (CDWs) face unique physical and psychosocial challenges; however, research on these issues is limited. This study assesses the nutritional status, physical health, and psychosocial problems among CDWs in selected wards of Pokhara. Methods: A cross-sectional study was conducted among 125 CDWs using a snowball sampling. Data were collected via semi-structured interviews and physiological measurements. Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (Chi-square test) at a 5% significance level were used. Odds ratios were calculated at a 95% confidence interval. Data analysis was performed using SPSS version 16. Results: Among the CDWs, 50.9% reported inadequate fulfilment of basic needs; 50.4% exhibited stunted stature, 35.2% had low weight for age, and 16.8% were underweight based on BMI. Male CDWs (p = 0.001, OR = 4.929) and those obtaining less than seven hours of sleep per night (p = 0.003, OR = 5.77) demonstrated significantly greater odds of being underweight. Health problems were reported by 47.2%, while 50.9% had sustained work-related injuries. Older CDWs (p = 0.011, OR = 2.679) were significantly more likely to report health problems. Psychosocial problems were observed in 25.6% of the CDWs and were significantly associated with working over eight hours daily (p = 0.036, OR = 2.450), inadequate fulfilment of basic needs (p = 0.002, OR = 3.868), and dissatisfaction with work (p = 0.003, OR = 3.471). Conclusion: Poor nutrition among child domestic workers was associated with inadequate sleep and male sex; health and psychosocial problems correlated with older age, long hours, unmet needs, and dissatisfaction, warranting further longitudinal research. Keywords: BMI; child domestic workers; child labor; nutritional status; psychosocial problems
Influence of Ureteric Orifice Configuration on Effective Insertion of Ureteral Access Sheath during Flexible Ureteroscopy
(Institute of Medicine, 2025) Jha, Amit Kumar; Luitel, Bhojraj; Chapagain, Suman; Poudyal, Sujeet; Pradhan, Manish Man; Chalise, Pawan Raj
ABSTRACT Introduction: Retrograde Intrarenal surgeries are facilitated by the use of ureteral access sheaths (UAS) but it is not always possible to insert the sheath on the first attempt. The aim of the study was to determine the possible predictive factors enabling insertion of UAS during flexible ureteroscopy (fURS). Methods: All consecutive patients undergoing fURS/RIRS who were not pre-stented were studied and data collected. The study parameters were the demographics of the patients, characteristics of the stones, and perioperative data, including the ureteric orifice (UO) configuration over introductory guidewire. Multivariate logistic regression analysis was used to detect the possible predictors of successful UAS insertion. Results: In total, 78 patients who underwent primary fURS were included, with a mean age of 38.9±14.68 years and a male: female ratio of 2.25:1 with an average stone burden of 11.4 mm. There was successful primary insertion of UAS in 47(60.26%) patients. Out of them, 44 of the patients had rounded configuration of the ureteric orifice with a successful primary insertion of UAS in 17 (38%) patients whereas 30 (88%) patients had successful insertion in those with tented configuration of the ureteric orifice over a guidewire with a significant p value (<0.001). In multivariate regression analysis, a tent-shaped UO after guidewire insertion was the only significant predictor (OR:13.70 95% CI:3.76-50.10 with p-value<0.0001) for primary successful UAS insertion into virgin ureters. Conclusion: Patients with tent-shaped UOs after insertion of a guidewire were more likely to have an UAS insertion on the first attempt in a virgin ureter. Keywords: Flexible ureteroscopy; ureteric access sheath; ureteric orifice configuration; virgin ureters
Prognostic Value of Serum Glucose Level in Septic Children in PICU
(Institute of Medicine, 2025) Poudel, Bulu Wagley; Devkota, Ascol; Rimal, Sabin; Gaire, Manisha; Karki, Samikshya; Rayamajhi, Ajit
ABSTRACT Introduction: Pediatric sepsis is a major cause of morbidity and mortality. Abnormal blood glucose is linked with higher mortality, increased requirement for mechanical ventilation and inotropic support. This study is aimed to determine the prognostic value of serum glucose level in sepsis children in PICU. Methods: This retrospective study was performed in the Pediatric Intensive Care Unit (PICU) of Kanti Children’s Hospital with diagnosis of Sepsis from April 2024 to September 2024 with age ranging from 1 month to 14 years. The data was collected from the record section. The outcome of sepsis in the form of discharge or death during the hospital stay, length of hospital stay, use of ionotropic support, mechanical ventilation and blood sugar level were tabulated and the data analysis was done by SPSS version 21. Results: Among 53 patients enrolled, 21 were male and 22 were female with male to female ratio of 1.4. The median age of the patient is 2.5±4.46 years. The median length of hospital stay was 7± 5days. There was no statistical significance in the length of PICU stay, use of ionotropic support and septic shock in patients with abnormal blood glucose. However, it was significantly associated with mortality (p value 0.009) and use of mechanical ventilator (p value 0.09). Conclusion: Our study highlights that abnormal blood glucose level in pediatric sepsis is significantly associated with increased mortality and a greater need for mechanical ventilation. However, no significant relationship was observed between abnormal blood glucose, length of PICU stay and ionotropic support. Keywords: Pediatric; hypoglycemia; prognosis; sepsis
Assessment of Adequacy of Analgesics in Post-Operative Orthopedic In-patients using Visual Analogue Scale
(Institute of Medicine, 2025) Gupta, Mayuri; Aryal, Sushant; Shrestha, Amrit
ABSTRACT Introduction: Adequate post-operative pain management in orthopedic patients is essential for optimizing recovery and reducing complications. This study aimed to evaluate the adequacy of analgesic use among post-operative orthopaedic inpatients using the visual analogue scale (VAS). Methods: An observational cross-sectional study was conducted on 240 post-operative orthopedic in-patients at Patan Hospital, Lalitpur, Nepal. Analgesic administration patterns were analysed, and pain intensity was assessed at 6 hours and the next morning at 10 am post-operative using VAS score. SPSS 16 was used to evaluate analgesic adequacy and its association with age, gender, surgery type, and anatomical site. Results: The majority of patients were male 134 (55.8%) with a mean age of 41.03 ± 16.60 years. The most frequently used analgesics were Pethidine 67 (27.92%) and ketorolac 64 (26.67%). The mean VAS score decreased from 6.43 at 6 hours post-operatively to 4.96 the next morning in major surgeries (p <0.001), and similar statistically significant reductions were observed in other surgical categories and anatomical sites, including spine and pelvis. VAS scores showed a significant reduction in pain across all sites and surgical types, particularly in spine and pelvic surgeries. Major surgeries had higher initial VAS scores, which improved significantly by the next day (p < 0.001). Conclusion: Analgesic use in this setting was effective in pain reduction observed among post-operative orthopedic in-patients. These results indicate that timely and appropriate analgesic administration effectively controls post-operative pain in orthopedic in-patients and highlight the importance of protocol-based pain management strategies tailored to surgical invasiveness. Keywords: Analgesics; orthopedic surgery; pain management; post-operative pain; visual analogue scale (VAS)
Depression, Anxiety, and Stress among Vitiligo Patients and Healthy Controls at A Tertiary Hospital: A Comparative Cross-Sectional Study
(Institute of Medicine, 2025) Mishra, Vilok; Khadka, Anupa; Tulachan, Pratikchya; Parajuli, Sudip
ABSTRACT Introduction: Vitiligo is often associated with stigma, leading to emotional distress and increased vulnerability to mental health disorders such as depression, anxiety, and stress. This study aimed to compare the levels of these psychological issues between vitiligo patients and healthy controls, while also examining the impact of socio-demographic and clinical factors. Methods: This hospital-based cross-sectional study included 42 vitiligo patients and 42 healthy controls. The Vitiligo Area Scoring Index (VASI) was used to assess the severity of vitiligo, and the Depression Anxiety Stress Scale (DASS-21), comprising three subscales: Depression (DASS-D), Anxiety (DASS-A), and Stress (DASS-S), was used to evaluate depression, anxiety, and stress. Descriptive statistics and non-parametric tests were used for data analysis. Results: Among vitiligo patients, 50% (n=21) exhibited depressive symptoms [median DASS-D score 9 (IQR 1.5-18.0)], compared to 19% (n=8) of controls. Anxiety symptoms were present in 54.8% (n=23) of the vitiligo group [median DASS-A score 8 (IQR 2.0-16.5)], compared to 21.4% (n=9) of controls. Stress was reported in 31% (n=13) of the vitiligo group [median DASS-S score 11 (IQR 2.0-16.5)], compared to 7.1% (n=3) in controls. Significant differences were found in depression, anxiety, and stress between the two groups (p = 0.005, p = 0.003, p = 0.02). A negative correlation between vitiligo duration and anxiety/stress was observed (p=0.03, p=0.01). Positive correlations existed among the DASS-D, DASS-A, and DASS-S scores. Conclusion: Patients with vitiligo were more susceptible to psychological distress, including symptoms of depression, anxiety, and stress, and experienced these issues at significantly higher rates compared to healthy controls. Keywords: Anxiety; depression; stress; vitiligo seeking
Ten-Years Cardiovascular Disease Risk Assessment among Health Camp Attendees
(Institute of Medicine, 2025) Khatri, Pratima; Sayami, Jamuna Tamrakar; Regmi, Bhawana
ABSTRACT Introduction: Cardiovascular disease burden has been increasing globally. The risk was greater in low-middle-income countries than in developed countries. The objective of the study was to assess the ten years CVD risk among the health camp attendees. Methods: Physiometric measurement of the 159 participants was used as data. The major variables were height, weight, systolic blood pressure, gender, and smoking. WHO non-laboratory-based CVD risk chart was used to analyze data. Results: The mean age (SD) of the participants was 45.64 (±13.97) ranging from 19 to 82 years. The majority of participants (99, 62.3%) were female, Brahmin/Chhetri (93, 58.5%), and 20 (12.6%) were smokers. The mean systolic BP (SD) was 121.84 (±19.3) mmHg ranging from 90 to 200, among this 62.9% of participants had less than 120 mmHg. Similarly, the mean body mass index (SD) was 25.3 (±5.1) ranging from 16.6 to 38.8, out of this 42.8% had a body mass index of 20-24. Regarding the ten years CVD risk of participants, the majority (76.1%) had very low CVD risk followed by 14.5% low risk, and 9.4% had a moderate risk. There was no high and very high CVD risk found among participants. Ten year CVD risk had strong positive relation (r=0.795) with age and a moderated positive relation (r= 0.519) with systolic BP at 0.01 level of significance. Conclusion: CVD risk was lower among the participants who were female, non-smoker, systolic BP <140, and normal body mass index. Therefore, priority should be given to those who are smoker and abnormal SBP and BMI. Keywords: Cardiovascular disease; health camp attendees; non-laboratory risk chart; risk assessment

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