ABSTRACT
Introduction: Perinatal asphyxia is a common problem with the incidence varying from 0.5 – 2% of live births. It is an important cause of neonatal mortality and is a frequent cause for admission to neonatal intensive care units (NICU). The aims of this study were to find out the clinical and biochemical alterations in different stages of HIE. Materials and Methods: This was a prospective hospital based observational study performed during the period of February, 2010 to January, 2011. Results: Sixty inborn neonates satisfying the criteria for birth asphyxia requiring admission to pediatric wards and neonatal intensive care unit were studied. There were 13(21.7%) cases of mild hypoxemic ischemic encephalopathy (HIE), 27 (45%) moderate and 20 (33.3%) severe HIE. Seizures 41(68.3%), respiratory distress 32(53.3%) and shock 29(48.3%) were predominant manifestations observed. Meconium aspiration syndrome was found in 13.3% of neonates. Hypoglycemia 11(18.3%), hypocalcaemia 7(11.7%), hyponetremia 14 (23.3%) and hyperbilirubinemia 9(15%) were associated biochemical abnormalities. Twenty cases (33.3%) had acute renal failure and they belonged to moderate and severe stages of HIE. Seizures (P< 0.001), respiratory distress (P=0.015), shock (P<0.001) and serum creatinine (P=0.004) were found to be significant among different HIE stages. Conclusion: Neonates having birth asphyxia had HIE, seizures, respiratory distress, shock, hypoglycemia hypocalcaemia, hyponetremia, hyperbilirubinemia and acute renal failure mostly in moderate and severe stages
ABSTRACT
Non-compliance among leprosy patients has always been a problem in Nepal. Many researches on drug compliance has indicated that if a patient understands well about his /her disease and its treatment, he /she is more likely to be motivated to take the whole prescribed course of treatment properly. It is widely believed that the understanding and behavior of patients in relation to drug compliance are largely influenced by their socio-economic condition and level of knowledge. In order to determine the socio-economic characteristics of non-compliant leprosy patients and their level of knowledge of leprosy disease and treatment, a non-intervention study was carried-out in Dhanusha - a high prevalent district in Nepal bordering India. A total of 57 non-compliant leprosy cases were selected using systematic sampling method on the basis of available clinical records and an interview-schedule was used for data collection. The result shows that the majority of non-compliant cases were illiterate, laborers by occupation and from poor economic class family background (73.7%). Data revealed that majority did not understand the cause of the disease and were not aware of the duration of treatment. It was interesting to note that an overwhelming majority (94.7%) were having strong belief that the disappearance of sign/symptoms was the only meaning of the "cure of leprosy disease". In view of this, it is strongly recommended that the patient education and counseling, public/community awareness program should be improved and further strengthened. A socio-economic rehabilitation program with vocational/trade training to leprosy patients or their family members should be arranged to up-lift their socio-economic status.