NepMed is a Nepal MEDLINE(Medical Literature Analysis and Retrieval System Online) by Nepal Health Research Council(NHRC). It includes bibliographic information for articles from academic biomedical journals covering medicine, dentistry, nursing, pharmacy, dentistry veterinary medicine, and allied health sciences.
Recent Submissions
Neonatal Screening for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in Eastern India
(Nepal Paediatric Society (JNPS), 2021) Mukherjee, Sweta; Mallige, Ashish; Chowdhry, Anupama; Devgan, Amit; Singh, Brajesh; Mukherjee, Bhasker; Shaw, Subhash Chandra
Abstract:
Introduction: The overall magnitude of the frequency of G6PD deficiency ranges between 0 to 10 percent in the Indian population. This prospective study was planned to estimate the prevalence of G6PD deficiency in newborn population born in a tertiary care centre in Eastern India.
Methods: This prospective observational study was undertaken among all consecutively delivered neonates born in a tertiary care teaching hospital of Eastern India, between Apr 2016 and Oct 2017. Prematurity less than 32 weeks and perinatal asphyxia requiring extensive resuscitation were excluded from the study. Umbilical cord blood samples were collected in a EDTA containers, drawn from the placental side of the umbilical cord incised while severing it at the time of birth. The G6PD levels were estimated quantitatively based on ultraviolet (UV) method by quantitative sphectrophotometric assay using ILab 650 fully automated analyzer. All babies wherein the cord blood G6PD levels was less than 6.95 mU/g of Hb was taken as deficient.
Results: Mean (SD) of G6PD at birth was 12.56 (3.45) mU/g of Hb. Out of 1037 neonates, five were found to be G6PD deficient. There was increased incidence of neonatal jaundice requiring phototherapy in G6 PD deficient neonates, and it was statistically significant.
Conclusion: The prevalence of G6PD deficiency was 0.48% in term and late preterm neonates as assessed quantitatively in cord blood
Hyperchloremic Metabolic Acidosis in Diabetic Ketoacidosis – Boon or Bane in Paediatrics? Prospective Cohort Study
(Nepal Paediatric Society (JNPS), 2021) Patil, Anusha Kalagoud; Vishwanath, B
Abstract:
Introduction: Patients with DKA generally present with a high anion gap metabolic acidosis (AG > 16) due to the presence of ketones but may also develop a narrow anion gap metabolic acidosis related to hyperchloremia. This study attempts to determine the incidence of hyperchloremic metabolic acidosis (before starting IV fluids) in children with DKA and to evaluate the impact of hyperchloremic metabolic acidosis on acute kidney injury and cerebral edema and inturn on mortality and duration of PICU stay.
Methods: This was a prospective study conducted in the Department of Paediatrics, VIMS, Bellary between May 2016 to December 2017 and a total of 32 patients with DKA were enrolled in the study. Along with routine investigations, ABG and serum chloride levels were measured at the time of admission for categorization into normochloremic (high anion-gap) metabolic acidosis and hyperchloremic (normal anion-gap) metabolic acidosis. Incidence of hyperchloremic metabolic acidosis and its impact on the development of acute kidney injury and cerebral edema was taken as the primary outcome of the study. Mortality rate and duration of PICU stay were taken as a secondary outcome.
Results: Hyperchloremic metabolic acidosis was observed in 18.8% of the study group. Acute kidney injury was seen in 38.4% of children who had normochloremic metabolic acidosis and in 83.3% of children with hyperchloremia. About 50% patients developed cerebral edema in the hyperchloremia group and only 3.8% developed cerebral edema in normochloremic group. These differences were statistically significant. Mortality rate in normochloremic and hyperchloremic metabolic acidosis was 3.8% and 50% respectively.
Conclusions: Hyperchloremia at presentation in DKA is a risk factor for increased mortality. This fact should be born in mind while treating patients aggressively with chloride-containing fluids. Simple investigations like ABG and serum chloride levels can direct careful management of DKA and appropriate selection of IV fluids.
Gallbladder Wall Thickness to Predict Severe Dengue in Children
(Nepal Paediatric Society (JNPS), 2021) Prashanth, S N; Jagwani, Harshita; Das, Sudha Kiran; Kumar, Jagadish; Murthy, Srinivasa
Abstract:
Introduction: Significant increase in plasma leakage is characteristic of severe dengue. This results in collection of fluid in serous cavities. Gall bladder wall thickening (GBWT) often precedes the development of pleural effusion and ascites. Early detection of plasma leakage and management is shown to reduce mortality in dengue illness. Ultrasonography is a point of care investigation to identify GBWT. The aim of this study was to determine the cut-off value of GBWT to predict severe dengue in the early phase of the illness.
Methods: This was a prospective study done on 310 children with dengue illness. Abdomen and chest ultrasound was done in all these children between third and sixth day of illness. GBWT of more than 3.5 mm was taken as a thickened gall bladder wall. Maximum severity of the illness was considered for categorising the severity of dengue.
Results: Out of 310 children, 160 (51.6%) were categorized as dengue fever, 91 (29.4%) as dengue with warning signs and 59 (19%) as severe dengue. The incidence of thickened gall bladder wall was 27.5% in DF (Dengue fever), 68% in DF with warning signs and 96.6% in severe dengue. The odds of finding thickened gall bladder wall in severe dengue are 3.5 times that of dengue fever. GBWT increases as the severity of the illness increases. GBWT of 5 mm has sensitivity of 93.7% and specificity of 70% to predict progress to severe dengue. There was a fair correlation of 46% between thickened gall bladder wall and thrombocytopenia. Gall bladder wall thickness of 2.5 mm had sensitivity of 86.3% and specificity of 80% for ascites. GBWT of 3.5 mm had a sensitivity of 77.6% and specificity of 85% for pleural effusion.
Conclusions: GBWT assessment by ultrasonography in early phase of illness can be used as a point of care modality to predict severe dengue. The sensitivity and specificity to predict the progression to severe dengue is 93.7% & 70% respectively for the cut-off value of five mm of GBWT.