Oral Zinc Supplementation for Reducing Mortality in Probable Neonatal Sepsis: A Double Blind Randomized Placebo Controlled Trial.

Objective: To study the role of Zinc in the treatment of neonatal sepsis. Design: Double blind, randomized, placebo controlled trial. Setting: Tertiary Care Hospital. Participants: 614 neonates with probable neonatal sepsis. Intervention: The drug group (n=307) received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in addition to antibiotic therapy and supportive care, till the final outcome (discharge/death). Outcome Measures: Decrease in mortality rates (primary outcome), duration of hospital stay and need of higher lines of antibiotic therapy (secondary outcomes) were tested. Results: Baseline characteristics of the two groups were similar. No statistically significant differences between drug and placebo group were found in mortality rate (9.77% vs 7.81 %; P=0.393), mean duration of hospital stay (142.85±69.41 hrs, vs. 147.99±73.13 hrs; P=0.841), and requirement of higher lines of antibiotic therapy (13.35% vs 12.05%, P=0.628) after supplementation. Conclusions: This study does not report decrease in mortality rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following zinc supplementation in neonatal sepsis.

Colonic Strictures after Necrotizing Enterocolitis in Infants: Case Series.

The fate of neonates with necrotizing enterocolitis is variable, with colonic strictures being one rare phenomenon after the insult. We describe here two infants with colonic strictures, which developed secondary to neonatal necrotizing enterocolitis. Infants recovered or in the process of recovery after it should be investigated for possibility of development of colonic strictures.

Childhood Intussusception: A Prospective Institutional Study at BPKIHS.

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. The present study deals with the presentation, management and outcome of children presenting with intussusception at the Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and Methods: Forty-seven children presenting at Department of Surgery, B. P. Koirala Institute of Health Sciences over a 5-year period were prospectively studied. Results: There were 27 (58.6%) males and 20 (41.4%) females, with male-to-female ratio of 1.4:1. The ages ranged from 2 months to 13 years, with a median age of 30 months. The mean duration of presentation was 10.7 ± 30.66 days (range 1-180 days). The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass was seen in 10 (21%) of the cases. Surgical exploration was done in 42 (89.3%) patients. The commonest lead point was non-specific hyperplastic lymph nodes, occurring in 22 (54.3%), followed by idiopathic variety (16.6%), Meckel’s diverticulum (9.5%), ileocaecal junction (7.1%), submucous lipoma (4.7%), Non- Hodgkin’s lymphoma (4.7%), appendix (2.3%) and a mucosal polyp (2.3%). Overall mortality rate was 6.3%. Conclusion: The presenting age group and the time of presentation are higher than other studies. The mortality rate of 6.3% is comparable to other studies in the developing world. Earlier presentation could have avoided surgery, with a higher possibility of cases being managed conservatively.

Glomerular Diseases in Children - A Review of 27 Cases Recorded at a Single Centre in Eastern Nepal.

Glomerular disease remains an important cause of renal disease in children. We retrospectively assessed the clinical features and histopathological diagnoses in kidney biopsy specimens in children (n=27). The medical records and histopathological diagnoses between 2003 and 2006 were reviewed. In each patient, clinical presentation, age at onset of disease, gender, presence of nephrotic range proteinuria, hematuria, hypertension and histopathological diagnoses were evaluated. SLE nephritis (n= 8) and membranoproliferative glomerulonephritis (MPGN) (n=8) were the most frequent glomerular diseases and nephrotic syndrome (n=21) was the frequent clinical manifestation.

Retinopathy of prematurity in a tertiary care hospital in eastern Nepal.

World Health Organization's Vision 2020 program has recognized Retinopathy of Prematurity (ROP) as an important cause of childhood blindness in industrialized and developing countries. In the last few years, it has been identified in many under developed countries as well, as a result of improved neonatal intensive care. In Nepal, ROP screening is carried out in a few tertiary hospitals but there is no published data on this disease. The purpose of this study was to find out the incidence, severity and risk factors of ROP among infants screened in a tertiary care hospital in the Eastern Region of Nepal. A prospective cohort study was carried out in neonates with gestational age of 34 weeks or less and, or birth weight of 1700 gm or less born over the period of one year. Dilated fundus examination of all babies was done by indirect ophthalmoscopy between 2-4 weeks after birth and followed up till the retinal vascularization was complete. Classification of ROP was done according to international classification (ICROP). Maternal and neonatal risk factors were also noted. A total of 55 babies fulfilled the screening criteria. ROP was present in 25.45% (n=14) of the babies. Threshold disease was noted in 5.45% (n=3) of the babies screened. Low birth weight (p<0.01) and low gestational age (p<0.01) was significantly associated with the incidence of ROP. Oxygen supplementation (p=<0.01) was an independent risk factor. ROP screening should be performed in all preterm low birth weight infants where there is availability of good neonatal intensive care units. The examination should be intensified in those having risk factors like oxygen. Further studies in the other tertiary care hospitals in Nepal would help to establish the screening criteria for Nepalese infants.

Profile of renal diseases in Nepalese children.

AIM AND OBJECTIVES: To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal. MATERIALS AND METHODS: A retrospective chart review of all the patients admitted at the department of pediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis. RESULTS: A total number of 10,396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and hemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%). CONCLUSION: A substantial number of children are hospitalised with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal.

Clinical spectrum of patients presenting with bronchiectasis in Nepal: evidence of linkage between tuberculosis, tobacco smoking and toxic exposure to biomass smoke.

AIMS AND OBJECTIVES: The aim of the study was to describe the clinical spectrum of the patients presenting with bronchiectasis at the referral clinic for the respiratory diseases in eastern Nepal. An attempt would also be made to provide an overview of factors responsible for poor lung health in the community. MATERIALS AND METHODS: This is a retrospective observational study conducted at the Adult chest clinic of the department of internal medicine at the B.P Koirala Institute of Health Sciences (BPKIHS), Dharan Nepal. The medical records of all the consecutive patients presenting with the diagnosis of bronchiectasis in the adult chest clinic of department of medicine from January 2003 to December 2004 (two years) were reviewed for patient characteristics (age, gender, place of residence, occupation, smoking history, exposure to indoor air pollution due to use of biomass smoke, past and family history related to tuberculosis, and clinical characteristics such as clinical features and duration of symptoms. RESULTS: During the study period of two years, 100 patients presented with the diagnosis of bronchiectasis, 80 (80%) patients were smokers and 50 (50%) patients had history of significant exposure to indoor air pollution. Abnormal Chest X-ray was seen in 85(85%) patients. Post tubercular bronchiectasis was the most common etiological diagnosis Smoking status and exposure to indoor air pollution were important determinant for hospitalisation in patients with post tubercular bronchiectasis. CONCLUSIONS: In Nepal bronchiectasis remains one of the important chronic respiratory diseases, post tubercular variety being the commonest type. Tuberculosis, tobacco smoking and exposure to indoor air pollution contributes towards higher morbidity of this diseases.

Etiology and clinical profile of pediatric cataract in a tertiary care center of Eastern Nepal.

Cataract is one of the leading causes of blindness in children. There are very few studies from Nepal on pediatric cataract. The present study is an attempt to get information on clinical profile and etiology of cataract in pediatric age group with an emphasis on preventable factors. A hospital based cross sectional study was carried out in a tertiary referral hospital in Eastern region of Nepal. After obtaining detail history, all children upto 14 years of age with cataract underwent examination under slit lamp or the operating microscope. Cataract is broadly classified into traumatic and non-traumatic groups. TORCH test for rubella, random blood sugar, urine reducing substance, chromosomal analysis were done in children with non-traumatic cataract Out of 172 children 34 (88%) had non-traumatic and 65 (12%) traumatic cataract. The mean age was 5.63 +/- 3.59 years and 7.39 +/- 3.94 years in non-traumatic group and traumatic group respectively. 8 (9.82%) patients with non-traumatic cataract were below the age of one year. Among non-traumatic cataract, 42 (37.50%) had hereditary, 9 (8.03%) had systemic syndromes, 5 (4.46%) had cataract due to maternal infection, 3 (2.67%) had metabolic disorder. While 11 (9.82%) cataract were associated with other ocular dysmorphology, cause was not ascertained in 31 (idiopathic). 11 (9.82%) had complicated cataract. 24.1% (n=27) of children with bilateral cataract had nystagmus at the time of presentation to hospital. In traumatic group, play related injuries were more common than household injuries. A very few children were below one year of age at the time of presentation to hospital. Establishing pediatric vision screening program in the primary health posts, genetic counseling, maternal immunization, health education to school children and use of safety glasses are some important measures that could prevent cataract blindness in our children.

Knowledge about human genetics among school students of eastern Nepal.

School students from 10 to 19 years of age are adolescents. Adolescent girls are usually exposed to consequences of early marriage, pregnancy and increased responsibility. Genetic disorders are important issues to persons of the reproductive age group. History-taking and screening-tests could uncover risk factors that require diagnostic testing during pregnancy. Therefore, the present survey was conducted among 707 school students (55.6% males, 44.4% females) to find out their knowledge about human genetics. Data were collected as written responses to a close-ended questionnaire. The knowledge of students about human genetic was found to be poor. The majority of students was not aware of the prevalence of genetic disorders in the community. Many students (75%) felt that genetic laboratory facilities and counseling services are necessary in this country. More than half of the students did not know the name of a hospital where genetic laboratory services are available. The study indicates that there is a need to introduce the basics of human genetics in the school curriculum and to implement strategies for awareness programs about genetic disorders and their early detection for possible intervention.

Asthma symptomatics school children of Sonapur.

BACKGROUND: Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. MATERIALS AND METHODS: Two thousand school-going children from three schools of Sonapur VDC, Sunsari in the surrounding of industries were screened for the presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). RESULTS: One hundred twenty children were identified with symptoms of bronchial asthma. For each child with asthma two age and sex matched non-asthmatic control were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were: passive smoking (OR 3.33, 95% CI 1.85-7.65), pets at home (OR 5.5, 95% CI 1.04-29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17-13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant in statistical analysis. CONCLUSION: Thus, passive smoking, inadequate ventilation and domestic animals and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in these children.

Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns.

Neonatal infections currently cause about 1.6 million deaths annually in developing countries1. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs.

Roundworm infestation presenting as acute abdomen in four cases--sonographic diagnosis.

Infestation with Ascaris lumbricoides (roundworm) is very common in the tropics and subtropics. Patients with ascariasis can be asymptomatic or may present with different clinical features in the form of simple nausea, decreased appetite, abdominal pain or more severe bowel obstruction, perforation, intussusception, biliary colic etc. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms and also evaluating response to treatment (1, 2, and 3). Here we present four cases of roundworm infestation presenting with acute abdomen in the emergency department, which were diagnosed by USG and further imaging features of ascariasis on USG is described.

Air travel and supplemental oxygen therapy in patients with cardiopulmonary diseases.

Air travel has become more popular in modern society and increasing number of patients with cardiopulmonary diseases are travelling by air. Although it represents a safe form of transportation, it leads to significant stress to an individual and its certain inherent risks may cause or promote hypoxia in patients with cardiopulmonary diseases. Clinicians will have to deal with situations where they will be asked to assess the fitness to travel and need for supplemental oxygen during flight. Once in a while the clinician may be required to help a co-passenger in distress during air travel. Predicting requirement of supplemental oxygen during commercial air flight requires knowledge of physiology of commercial air flight and available prediction equations. With modern pressurized aircrafts most of the patients with cardiopulmonary diseases would be able travel by air safely.