Hemoglobin status in children in the age group 6 to 60 months.

Objective of this study was to see the prevalence rate of anemia in children among the age of 6-60 months who attended paediatric out patient department of Kathmandu Medical College. 100 children aged 6-60 months were randomly selected for hemoglobin measurement and anthropometry. Detailed clinical examination including anthropometry was done. Hemoglobin was checked by Hemocue machine with prior consent from the attendant. Mean height, weight, and body mass index (BMI) were measured. Forty six percent of the study group population had hemoglobin <11 gm/dl, similar numbers of the children were in the various state of malnutrition. Twenty eight percent of the children came from outside of the valley residing in Kathmandu. Fifty percent were illiterate or had primary level education only. Poverty, high rate of illiteracy and lack of awareness on taking appropriate food were important factors related to such a high childhood anemia. Iron supplementation should be given to the children particularly in the age group of 6 months to 3 years.

A study of therapeutic effect of the growth of children with hypothyroidism.

OBJECTIVES: This study was done to see the therapeutic effect of the growth of children who was diagnosed as hypothyroidism. METHODS: Thirty-four children with primary hypothyroidism were included in this study. Height, weight and head circumference were measured at initial diagnosis and at every follow up visit. Thyroid function was done. The value was interpreted as abnormal if the range was above or below the normal (T3=70-200 u/L, T4=4-13 u/L, TSH=0.3-6 u/L). X-ray to see the bone age for the chronological age was performed. The value was interpreted as abnormal if the ossification center for the chronological age in inappropriate. Treatment was started with Eltroxine from the day of diagnosis. Dose was adjusted according to the response to the medicine. T3, T4 and TSH level was taken as the guideline to adjust the dose of the drug. X-ray was considered in the follow up where it was indicated. RESULT: Marked improvement in the anthropometry was seen in comparison to the initial assessment which was well correlated with the normalization of the TSH level and the x-ray of the bone. CONCLUSION: Serial follow up of these patients was necessary in order to assess the growth in height, weight and head circumference along with the repeated thyroid function to correlate the response of the drug.

Kala-azar (visceral Leishmaniasis) from Khotang.

Kala-azar is a chronic infection of reticuloendothelial system caused by flagellated protozoan, leishmania donovani injected into human host by the bite of the sand fly (phlebotomous) previously infected by biting and sucking the blood of a patient of leishmaniasis. It is characterized by irregular fever of long duration, large spleen and liver, anaemia, leucopenia and progressive emaciation. This article reports a case of a 10 year old girl from Khotang, a nonendemic zone for Kala-azar, who presented with long history of abdominal distension for 11 months, fever for 9 months, cough for a week and weight loss. Clinical examination revealed pallor, enlarged liver and huge splenomegaly. Investigations confirmed the diagnosis of kala-azar by the presence of L.D bodies in bone marrow smear. The patient is being treated with i.v Amphotericin B in Infectious Disease Hospital, Teku.

Clinical profile and antibiotics response in typhoid fever.

OBJECTIVE: The objective of this study is to evaluate the clinical profile and drug response in typhoid fever. METHODS: This is a retrospective analysis of paediatric patients suffering from typhoid fever who were admitted at Kathmandu Medical College Teaching Hospital, Sinamangal during the period of two years and nine months. RESULTS: Total numbers of 100 cases of typhoid were studied. Diagnosis of Typhoid fever was based on clinical features, Widal test and blood culture. The sensitivity pattern of drugs in blood culture was recorded. The mode of presentation, treatment history, laboratory investigations reports, antibiotics administered and response to therapy were recorded. CONCLUSION: Quinolone is still the highly sensitive drug and most widely used for Salmonella typhi. Because of the indiscriminate use of these drugs, resistant to ciprofloxacin has been quite high and the duration of the defeverscence period has also been prolonged. But Ofloxacin is still showed highly effective and widely used with good response.

Upper GI endoscopy in children- in an adult suite.

Although Upper GI endoscopy is commonly performed in adults, paediatric endoscopy is not available in many of our referral centres. The efficacy and safety of upper GI endoscopy in paediatric age group performed in adult suite of Kathmandu Medical College is reviewed. PATIENTS AND METHOD: A retrospective study of endoscopies performed on children aged up to 15 years in an adult endoscopy suite of Kathmandu medical college over last one year is presented. All cases were the referred cases from paediatric unit for various problems. RESULTS: Endoscopy in paediatric group comprises only 6% of total upper GI endoscopies performed during the same year. Sex ratio was almost equal. Most cases (87%) were performed under local anaesthetic and well tolerated by the patients. Recurrent abdominal pain (RAP) was the commonest indication and among them one third of cases had significant positive finding. CONCLUSION: Upper GI endoscopy is a useful diagnostic tool in children. Where specialized paediatric endoscopy units are not feasible i.e. developing countries, endoscopic services to children can be safely provided in adult endoscopy suite with or without sedation. Upper GI endoscopy is well tolerated by children even without sedation.

One year follow up study of term babies born at Kathmandu medical college teaching hospital.

OBJECTIVE: To study the mean, standard deviation and centiles for anthropometry and haemoglobin in healthy term infants followed up to 12 months of age. DESIGN: Cohort study. SETTINGS: Kathmandu Medical College Teaching Hospital (KMCTH) in Kathmandu. SUBJECT: Consecutive healthy term newborns Method: 100 consecutive healthy term newborns were enrolled at birth.19 babies were lost in follow up. So, 81(45 male, 36 female) healthy, full term infants were followed up from birth to 12 months of age. Anthropometry (weight, length, and head circumference) and haemoglobin were measured at birth, 6 weeks, 6 months, 9 months and 12 months of age. Haemoglobin was estimated by Hemocue microcuvette method. The data so obtained was subjected to statistical analysis by using SPSS computer package. MAIN OUTCOMES: Mean, centile and standard deviation score values for weight (Kgs), infant length (cms), head circumference (cms) and haemoglobin (gm/dl) at birth, 6 weeks, 6 months, 9 months and 12 months of age. RESULTS: Out of 100 babies enrolled, data presented here is for the remaining 81 babies. Among 81 babies, 76 were appropriate for gestational age (AGA) and 3 were small for gestation (SFD). The mean, standard deviation and percentile values are presented for anthropometry (weight, length and head circumference) and haemoglobin at birth, 6 weeks, 6 months, 9 months and 12 months of age. The mean birth weight was 3.05 kg (SD 0.41). The mean infant length and head circumference at birth were 49 cm (2.28) and 33.8 cm (SD1.4) respectively. The mean haemoglobin at birth was 15.7 gm/dl (SD 2.29). At 12 months of age mean weight, length, head circumference and haemoglobin were 9 kg (SD 0.81), 73.5 cm (SD 2.9), 45 cm (SD 1.2 ) and 11.1 gm/dl (SD 1.41) respectively. Almost 50% of the babies at 6 weeks, 9 months and 12 months of age were found to be anaemic (Hb < 11 gm/dl). Among the babies, 49% were exclusively breast fed for 6 months of age. Other feeding practices seen were, mothers breast feed with water supplementation (25%), mothers breast feeding with formula feed (16%) and formula feeding only (5%). National and international comparisons of anthropometry and haemoglobin data are shown in table.

One year audit of perinatal mortality at Kathmandu Medical College Hospital.

INTRODUCTION: Perinatal mortality is a sensitive indicator of the quality of service provided to pregnant women and their new borns. Regular audit of perinatal mortality will help in finding out preventive factors and thus helps in reducing perinatal mortality rate in an institution. OBJECTIVE: This study was carried out to determine perinatal mortality rate (PMR) and the factors associated with it at KMCTH in the one year period (Bhadra 2059-Shrawan 2060) MATERIALS AND METHODS: This is a retrospective study of entire still births and early neonatal deaths that occurred at KMCTH during the one year period (Bhadra 2059-Shrawan 2060). The study was done by collecting the data of all stillbirths and early neonatal deaths from record books of the Special Care Baby Unit, Labour Room and operation theatre. RESULTS: Out of 563 total births in the one year study period, 17 were still births (SB) and 10 were early neonatal death (ENND). Out of 17 SB, 7 were of < 1 kg and out of 10 ENND, 3 were of < 1 kg. Thus, perinatal mortality rate during the study period was 30.7 and extended perinatal mortality rate was 47.9 per 1000 births. Perinatal deaths were mostly due to extreme prematurity, birth asphyxia, septicemia and congenital anomalies. According to Wiggleworths classification, 18.5% of perinatal deaths were in Group I, 14.8% in Group II, 22.3% in Group III, 40.7% in Group IV and 3.7% in Group V. Intrapartum asphyxia was the commonest cause of perinatal deaths, but majority of these babies were of low birth weight. Prevention of preterm births, better care during intrapartum period, more intensive care of very low birth weight and preterm babies would help in reducing the present high perinatal mortality.

Case of Schizencephaly: a case report.

Schizencephaly is a rare developmental disorder of neuronal migration, characterized by early focal destruction of the germinal matrix and surrounding brain before the cerebral hemispheres are fully formed at 1-5 months of gestation .The lesion is most likely related to multiple aetiologies including genetic, toxic, metabolic, vascular or infectious agents. This case is reported due to its rarity. The prevalence of schizencephaly is very uncommon internationally.

Hereditary spherocytosis.

Hereditary spherocytosis is a congenital haemolytic anaemia due to defect in spectrin-a RBC membrane protein and is transmitted as autosomal dominant. Due to this defect there is presence of characteristic spherical cell in peripheral blood smear and osmotic fragility is increased. Haemolytic anaemia, reticulocytosis, jaundice and splenomegaly are present. This article reports a case of a 9 year old boy who presented with a history of prolonged jaundice since the age of 4 years and recurrent pain in the right upper quadrant of abdomen. Clinical examination revealed jaundice, enlarged liver and marked splenomegaly. Investigations confirmed the diagnosis of hereditary spherocytosis by the presence of spherocytes in blood smear, raised reticulocytes and increased osmotic fragility. The patient was subjected to splenectomy after vaccination against coccobacillus and was discharged after proper advice and on post splenectomy antibiotic prophylaxis.

Efficacy and tolerability of Ketotifen in Nepalese asthmatic children: a clinical study.

OBJECTIVE: To assess the efficacy of Ketotifen in asthmatic children and to record its adverse effects, if any. DESIGN: Prospective clinical trial. SETTING: Pediatric asthma follow up clinic of a teaching hospital. PARTICIPANTS: 23 asthmatic children between 3 and 15 years; 100% completed the trial on full protocol. INTERVENTIONS: Ketotifen 1mg (adjusted according to body weight, 50 mcg/kg/dose) orally twice daily for 9 months. MAIN OUTCOME MEASURES: Primary outcome: Decrease in frequency of asthmatic attacks and severity of exacerbations with improvements in peak expiratory flow rates (PEFR). Other measures included decrease in bronchodilator requirement, steroid doses and parental perception regarding patient quality of life. RESULTS: 34.78% children were symptom free by the end of 2nd 3 months and 65.21% had no further attack by the end of 3rd 3 months of Ketotifen prophylaxis. Those children with activity and sleep 'affected' (8.69%) and 'may be affected' (30.43%) together improved to 'may be affected' group (21.73%) by the end of 2nd 3 months and further reduced to 8.69% by the conclusion of 3rd 3 months. The duration of exacerbations was reduced in the remaining cases. Variability of PEFR decreased from 26.08% to 8.69% of children after the 3rd 3 months of Ketotifen prophylaxis. No significant adverse effect of therapy was observed during the study. CONCLUSION: Oral Ketotifen is effective and well tolerated for use in prophylactic treatment of bronchial asthma in children.

A case report of Gilbert Syndrome.

Gilbert syndrome is benign, often familial condition characterized by recurrent but asymptomatic mild unconjugated hyperbilirubinemia in the absence of haemolysis or underlying liver disease. If, it becomes apparent, it is not until adolescence and then usually in association with stress such as intercurrent illness, fasting or strenuous exercise. Virtually all patients have decreased level of UDP-Glucuronosyltransferase, but there also is evidence for a defect in hepatic uptake of bilirubin as well. This case is reported due to its rarity. The prevalence of Gilbert syndrome in U.S is 3-7% of the population.

Epilepsy in children: an epidemiological study at Kathmandu Medical College Teaching Hospital Kathmandu.

OBJECTIVES: To analyze the relative frequencies of various epileptic seizures and to study the age at onset of different seizure types in Nepalese children. DESIGN: Prospective study. SETTING: Hospital outpatient based in Kathmandu, Nepal, between November 2001 to October 2002. PARTICIPANTS: 50 children diagnosed as epilepsy excluding neonatal and febrile seizures. Main outcome measure: Diagnosis and classification of cases according to the International Classification of Epilepsy of the International League Against Epilepsy [ILAE] and number of patients in each category with various ages at first seizure. RESULT: Generalized seizures (78%) were 3.54 times commoner than partial seizures (22%). Most frequent seizure types were generalized tonic clonic (36%), tonic (16%), complex partial (14%), atonic (12%) and absence (10%). Generalized clonic, simple partial and partial with secondary generalization, each had less than 5% frequencies. In 40% cases the first seizure occurred when aged between 2-5 years. In partial seizures the peak age at onset was observed below 6 years while primary generalized seizure was more frequently seen in age group 2-10 years. CONCLUSION: More paediatric patients with primary generalized seizures (78%) were observed than with partial seizures (22%). In this age group, the most frequent seizure type was generalized tonic clonic (36%) with the peak frequency of age at onset of seizures in 2-5 years.