Journal Issue: Volume: 31, No. 2 (2011)
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Issue Date
2011
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ISSN 1990-7974 eISSN 1990-7982
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Articles
A Scenario of Poisoning in Children in Manipal Teaching Hospital
(Nepal Paediatric Society (JNPS), 2011) Malla, Tejesh; Malla, Kalpana K; Rao, KS; Gauchan, Eva; Basnet, Sahisnuta; Koirala, DP
Abstract:
Objective: To see the pattern and prevalence of poisoning in children in Manipal Teaching Hospital, Pokhara. The cases were also considered in relevance to the age groups with various agents, the commonly observed clinical features in various poisonings and mortality.
Study design: Hospital based retrospective study.
Study period: 4 years (January 2006 – January 2010).
Study place: Department of Paediatric, Manipal Teaching Hospital, Pokhara.
Material and Methods: A detailed study of all the case files of the children admitted with various acute poisonings, where the causative agent was known, was done.
Results: A total number of 94 children (56 males & 38 females) were admitted with poisoning (1.79% of the total admissions) during that period. Maximum number of children were of the preschool age group i.e. < 5 years (64.89%). Organophosphorus Compounds (OPC) (27%) and Kerosene Oil (23%) were the two most frequent agents involved. The other agents included Snake bite (19%), Drugs/ Chemicals (16%), Dhatura (12%), and Mushroom poisoning (3%). The most common nature of poisoning noted was accidental (95%). The mortality rate observed was 6.38%.
Conclusion: OPC and Kerosene Oil poisoning were the two most common poisoning observed in this study comprising almost half the cases; accidental poisoning was the most common pattern noted and there was a male predominance. Early recognition and timely treatment can decrease the mortality.
Clinical and Biochemical Profile of Acute Liver Failure with Hepatic Encephalopathy in Children from Eastern Nepal
(Nepal Paediatric Society (JNPS), 2011) Shah, Gauri Shankar; Singh, Manoj Kumar; Shah, Dheeraj
Abstract:
Introduction: Hepatic encephalopathy is a potentially reversible neurophyschiatric abnormality in the setting of liver failure. Acute liver failure (ALF) is a potentially life-threatening disorder in children.
Objectives: The present study evaluated the clinical profile, outcome and factors influencing the outcome of children presenting with acute liver failure and hepatic encephalopathy presenting to a referral hospital of Eastern Nepal.
Methodology: Thirty children (17 males and 13 females) were admitted with this diagnosis during two year period.Prospective study.
Results: The most common cause of acute liver failure was mushroom poisoning seen in 30% of cases. Only 37% (11 out of 30) children survived, most of them in early stages (Stage I and II) of encephalopathy. Bleeding manifestations were significantly more common (P=0.002) in deaths as compared to survivors.
Conclusion: As liver failure is associated with high mortality rates especially in absence of facilities for liver transplantation, efforts should be directed in favor of implementing preventive measures such as vaccination and community education to prevent toxin ingestion.
Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal
(Nepal Paediatric Society (JNPS), 2011) Sharma, Krishna Sagar; Singh, Rupa; Shah, Gauri Shankar
Abstract:
Introduction. Guillain Barre Syndrome (GBS) is a post infectious polyneuropathy involving mainly motor but sometimes sensory and autonomic nerves. It is an acquired disease of the peripheral nerves that is characterized by rapidly progressing paralysis, areflexia and albumino-cytological dissociation in CSF.
Methodology: Prospective, descriptive, observational, hospital based study was carried out to find out the clinico-epidemiological features of GBS including existing treatment modalities and its outcome. All cases fulfilled the criteria for AFP (Acute flaccid Paralysis) surveillance was included. Cases were reviewed for full medical history and examinations. To confirm the diagnosis, necessary investigations were carried out and combined with clinical symptoms.
Results: Thirty patients were included in the study during study period. Among them 90% were diagnosed as GBS, 7.4% patients of GBS were associated with hypokalemic paralysis, 7.4% diagnosed as transverse myelitis and 3.7% diagnosed as idiopathic neuropathy. Different types of GBS were classified as AIDP (Acute inflammatory demyelinating polyneuropathy) 62.96%, AMAN (Acute motor axonal neuropathy) - 25.52%, AMASAN (Acute motor and sensory axonal neuropathy) - 3.3% and MFS (Miller fisher's syndrome) - 6.6% according to NCV result. Male female ratio is 1.7:1.0. There was 14.8% patients had relapse within 5 year. Associated diseases were URTI, pneumonia, sore throat and diarrhea. Facial Nerve palsy was commonest cranial nerve involvement.Sixty percentage of patients presented with sensory symptoms. There was transient bowel and bladder involvement in 20% of the cases. 69.2% patients became bed ridden at the nadir. There was albumin-cytological dissociation in 80% case. Majority of patients improved with supportive treatment alone, 19.5% patient required ventilator support among them 40% died. 7.4% of cases expired during treatment. Half of the patients fully recovered within 3 months.
Conclusion: GBS is the commonest cause of AFP, AIDP being commonest subtype in our setting. We have to improve our existing treatment facilities and extend to different centers to detect and treat GBS. Most of the patients improve with supportive treatment alone. Ventilator support indicates grave prognosis.
Key words: GBS (Gullein Barre Syndrome); AFP (Acute flaccid Paralysis); AIDP (Acute inflammatory demyelinating polyneuropathy; AMAN (Acute motor axonal neuropathy); AMASAN (Acute motor and sensory axonal neuropathy); MFS (Miller fisher's syndrome).
Knowledge and Management Practices of Paediatricians about Autism Spectrum Disorder in Kathmandu, Nepal
(Nepal Paediatric Society (JNPS), 2011) Khatri, Goma Kumari; Onta, Sharad Raj; Tiwari, Suresh; Choulagai, BP
Abstract:
Introduction: Autism Spectrum Disorder is increasing day by day around the world. Recent finding of CDC shows that this problem occurs 1 in 110 populations. This problem is such a disorder, which not only affects to the individuals but also the families, society and nation as a whole if not managed properly.
Aim: The aim of this study was to assess the knowledge and management practices of Paediatricians about Autism Spectrum Disorder.
Methods: The study design was descriptive and cross sectional. A census was used to select the study unit and self-administered questionnaire was used to collect data.
Results: Out of 54 Paediatricians, 64.8 percent had inadequet knowledge and 59.3 percent had inadequet practice related to Autism Spectrum Disorder. Majority of them (79.6%) knew that Autism Spectrum Disorder is a Developmental Disorder but they (24.1%) also mentioned it to be mental retardation and 13 percent thought that it as a form of psychosis. Most of Paediatricians, (72.2%) knew that Autism Spectrum Disorder could be due to genetic reason. However, a significant number of respondents 22.2 percent also believed that Autism Spectrum Disorder could occur due to the neglect of children. Almost fifty percent of Paediatricians had rarely handled the Autistic child and a majority of the Paediatricians, (90.7%) found it difficult to diagnose this disease.
Conclusion: Most of the Paediatricians in Nepal have inadequet knowledge and practice related to Autism Spectrum Disorder. Although some of the practice was good, they also had misconceptions as to managing the children with Autistic disorders. Most of the Paediatricians need to improve their knowledge and practice related to Autism Spectrum Disorder.
Nosocomial Citrobacter Infection in Neonatal Intensive Care Unit in a Hospital of Nepal
(Nepal Paediatric Society (JNPS), 2011) Khadka, Sanu Bhai; Thapa, Badri; Mahat, Kishori
Abstract:
Introduction: Neonatal Citrobacter infection is either acquired horizontally or vertically as a nosocomial infection. The source of nosocomial Citrobacter is either hands of medical staff or the innate objects.
Objective: The aim of this study was to study nosocomial Citrobacter infection in neonates admitted in Neonatal Intensive Care Unit (NICU) and trace the source of infection.
Methods: The study was conducted in NICU in a hospital in Kathmandu, Nepal during a period of January to March 2010. Specimens were collected from neonates, hands of medical staff and innate objects and were processed using a standard microbiological method.
Results: The prevalence of neonatal nosocomial infection was 32.6% (29/89). Citrobacter spp. was isolated in 11 neonates admitted in NICU with the prevalence rate of 37.9% (11/29) among other pathogens. Umbilical cord infection was most common (n=8). These isolates were grouped into five antibiotypes (I, 4; II, 3; III, 2; IV, I; V, 1). All of these isolates were multi-drug resistant showing susceptibility towards quinolones. The isolate of Citrobacter spp. was also recovered from a nasal prong which was grouped with 4 other clinical strains.
Conclusion: Multi-drug resistant nosocomial Citrobacter spp. was inflicting neonates in NICU and the source of this pathogen was traced to nasal prong. Nosocomial Citrobacter infection is a common problem of neonates in NICU. This will lead to increase neonatal mortality if infection prevention and control practices are not initiated.