Clinical profile of type 1 diabetes mellitus among children in eastern part of Nepal

Background: The objective of this study is to determine the clinical profile of Type 1 diabetes mellitus (T1DM) among children.Methods: Descriptive cross sectional study was conducted at B.P. Koirala institute of Health Sciences (BPKIHS), Dharan, Nepal, the eastern part of Nepal. A total of 42 diabetic children of less than 20 years old diagnosed with T1DM were included in the study. Data were collected via semi-structured interviews and medical records of patients attending diabetic clinic at the time of follow up.Results: The mean age at diagnosis of disease was 11.1'4.9 years. Polyuria 33 (78.6%) was found to be the commonest symptom followed by polydipsia 27 (64.3%), weight loss 23 (54.8%) and polyphagia 13 (30.9%). The mean duration of symptoms before diagnosis was 14.3'9.7 days. DKA was present in 25 (59.5%) children at the time of diagnosis. Mean Glycosylated hemoglobin (HbA1c) value was 10.6'2.7. Obesity was observed in 9 (21.4%) children. Nine (21.4%) children had family history of diabetes. In most of the cases, primary caregiver was mother, among them only 24 (57.2%) had formal education. Almost half of the caregivers were using FRIO, an insulin cooling case, for insulin storage.Conclusions: Polyuria was the most common presenting symptom followed by polydipsia, weight loss and polyphagia. Moreover, most of the children had landed up in diabetic keto-acidosis (DKA) at the time of diagnosis. Therefore, community awareness programs should be emphasized among parents and primary health care workers especially in rural areas regarding T1DM for early recognition and prompt treatment.

Assessment of control of bronchial asthma in children using Childhood Asthma Control Test.

Background. The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines. Objective. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV1). Methods. This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained. Results. Significant positive correlations were found between C-ACT score and FEV1 at enrollment (r=0.772) (p<0.001), three months (r=0.815) (p<0.001) and at six months follow-up (r=0.908) (p<0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of >19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. Conclusion. C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.

Systemic lupus erythematosus in childhood--a review of 11 patients at a single center in eastern Nepal.

We retrospectively evaluated the clinico-laboratory features of 11 children and adolescents with Systemic Lupus Erythematosus between the period of 2001 and 2006. All of them (100.0%) had renal involvement at the first visit in the hospital. Female to male ratio was 10:1. Skin and or mucosal involvement (90.9%), periorbital puffiness and or pedal edema (81.8%), fever (72.7%), hypertension (72.7%), and reticuloendothelial involvement (72.7%), were the commonest presentations. All patients had anemia (8.6 +/- 1.5 gm/dl), raised ESR (46.7 +/- 9.4 mm in first hour), proteinuria, and in disease activity as evident by raised ESR and positive anti-dsDNA antibody at the first visit. The mean duration of disease was 7.6 months and the average duration of disease activity was 63.18 days. Renal biopsy was performed in 8 patients: class IV lupus nephritis in 4 patients (50.0%), class II in 2 patients (25.0%), class III and V in patient (12.5%) each. Nephrotic range proteinuria and hypertension was observed in all patients of class IV and V of lupus nephritis. Class II and III lupus nephritis patients' were normotensive and had non-nephrotic range proteinuria. Three out of 11 patients (27.2%) expired. The commonest primary determinant of mortality was uncontrolled disease activity in 2 patients (66.6%). The third one had infection and developed disseminated intravascular coagulation. The mean duration of disease activity in patients who died (mean 30 days) was statistically lower than the survival group (75.6 days) (p < 0.01). Renal involvement during first visit and mortality could be attributed by late referrals and diagnosis at hospital.

Fulminant hepatic failure complicating visceral leishmaniasis in an apparently immunocompetent child.

Fulminant hepatic failure (FHF) is an unusual complication of visceralleishmaniasis (VL). Here, we present a 1.5-yr-old girl with VL developing rapidly progressive fatal FHF. In absence of established guidelines, additional use of immunomodulatory therapies has been discussed in reference to available information.

Knowledge, attitude and practices of mothers regarding home management of acute diarrhoea in Sunsari, Nepal.

In Nepal, 45,000 children less than five years age die due to diarrhoea annually. Home management of diarrhoea is the hallmark of control of diarrhoeal diseases program in Nepal, which also aims to increase the correct use of Oral Rehydration Solution (ORS) by mothers, so mothers play a great role in the reducing the morbidity and mortality of children. The aim of the study was to assess knowledge, attitude and practices of the mother regarding home management of acute diarrhea in their children. The list of 330 children on Plan 'A' treatment was prepared at 11 peripheral health institutions of Sunsari district. Their identification data were recorded by health workers. The mothers were interviewed by the same health worker at the time of home visit after 24 hrs to know the improvement in the child and also preparation and use of ORS. Majority (97.6%) of the mother had information about ORS and also its usefulness in the management of dehydration due to diarrhea. Fifty percent mothers could make ORS properly and gave ORS to their children ideally (after each stool). The correct preparation and ideal use of ORS have not reached in proper way to the mothers of Sunsari district. Use of ORS definitely lowers the mortality due to dehydration, an effect that can clearly be seen in the short term. Intervention such as increasing women's literacy, improving basic sanitation and health care services, and raising the general nutritional status of the population can only be expected to decrease the diarrhoeal diseases morbidity and mortality in long term.

Sodium stibogluconate and polymorphic ventricular tachycardia.

Numerous antimicrobials including pentavalent antimonials are implicated in causing prolong QT-interval and ventricular tachycardia. Torsades de pointes is rarely documented with use of sodium stibogluconate. Here is described a 12-yr-old girl with visceral leishmaniasis, who developed syncopal attacks, prolong QT-interval, polymorphic ventricular tachycardia and torsades de pointes after completing a course of Stibogluconate (20 mg/kg/day for 30 days). Prolong lidocaine infusion and cardioversion were life saving.

Unusual presentation of an iatrogenic esophageal perforation in a newborn.

Spontaneous rupture of esophagus (Boerhaave's Syndrome) in neonates is a rare occurrence. However iatrogenic perforation of the esophagus is not that uncommon, especially in a premature. The presentation of esophageal perforation is rather stereotyped. In the present case however patient presented with unusual features.