Preterm Birth, Exasperation to the South Asian Countries.

When a child is born before 37 weeks or 259 days of pregnancy, it is termed as preterm birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing preterm births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth.

Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum.

Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2 , mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2 ), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum.

Paediatric Stroke: A Rare Presentation of Iron Deficiency Anemia in a Four Year Old Child.

Paediatric stroke is an uncommon syndrome with even lesser annual incidence rates of arterial ischemic stroke in infants and children. In children the diagnosis of stroke is frequently delayed or missed. This is due to subtle and nonspecific clinical presentations, a complicated differential diagnosis and a lack of awareness by physicians and also delay in the seeking of medical attention as in our case. We report you a rare case of a four year old child from remote Nepal who presented to our Out Patient Department after a long gap of around four months after the sudden onset of loss of consciousness and decreased movement of right limbs who after detailed history examination and lab investigations and imaging revealed ischemic stroke due to iron deficiency anemia.

Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate.

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia. Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

Retroperitoneal schwannoma: a rare presentation.

The Schwannoma is nerve sheath tumor originating from Schwann cell of peripheral nerve and is commonly found in head,neck and flexor surface of extremities. Only few cases have been reported to be found in retroperitoneum. Here, we describe a 21 year old female lady who presented to our centre with lump and pain in right iliac fossa and was found to have Schwannoma by CT scan and Fine needle aspiration cytology. She underwent laparotomy and excision of tumor and was confirmed to have Schwannoma on histopathological examination.

Universal health coverage in a regional Nepali hospital: who is exempted from payment?

This study assessed the characteristics of beneficiaries of a government-led policy of exemption for payment being provided in a regional hospital in Nepal. In January and February 2012, 9547 patients sought services at the out-patient clinic, the majority (83%) of whom were from the same district although this was a referral hospital for 15 districts. Only 10.8% received exemption from payment; 66% of the individuals aged >60 years and eligible for exemption were missed. These shortcomings highlight intrinsic weaknesses in the current implementing mechanisms for payment exemption, which may not be providing financial protection. This hampers efforts towards achieving universal health coverage.

Cette étude a évalué les caractéristiques des bénéficiaires d'une politique d'exemption de paiement menée par le Gouvernement du Népal dans un hôpital régional. Pendant les mois de janvier et février 2012, 9547 patients ont bénéficié des services de la polyclinique externe ; la majorité d'entre eux (83%) provenaient du même district en dépit du fait que l'hôpital régional servait d'hôpital de référence pour 15 districts. Seuls 10,8% des patients ont bénéficié de l'exception de paiement. Celle-ci n'a pas été attribuée à 66% des individus âgés de >60 ans et éligibles pour cette exemption. Ces déficiences témoignent de la faiblesse intrinsèque des mécanismes actuels de mise en œuvre de l'exemption de payement, ce qui pourrait entraîner l'absence d'apport d'une protection financière et entraver les efforts visant à réaliser la couverture universelle de santé.

En el presente estudio se evaluaron las características de los beneficiarios de una política gubernamental de exoneración del pago en un hospital regional de Nepal. Entre enero y febrero del 2012, 9547 pacientes recurrieron a los servicios de un dispensario clínico; la mayoría de las personas (83%) provenía de un mismo distrito, aunque el hospital de referencia atiende a la población de 15 distritos. Solo 10,8% se beneficiaron de la exención de pago; 66% de las personas > 60 años que cumplían con los requisitos de adjudicación no recibieron la ayuda. Estas fallas indican debilidades intrínsecas en los mecanismos vigentes de aplicación de la medida de exoneración de pago, con lo cual tal vez no se ofrece la protección económica adecuada y se obstaculizan las iniciativas encaminadas a lograr la cobertura universal de salud.

Late presentations of congenital diaphragmatic hernia.

The occurrence of congenital diaphragmatic hernia in adults is rare and misleading even to experienced clinicians. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal and respiratory symptoms mimicking other diseases. Hence high index of suspicion is required. When a diagnosis is established, it must be promptly treated surgically in order to avoid complications such as strangulation or bowel perforation. We present two cases of diaphragmatic hernia which were being managed as pulmonary pathologies.

Abstruse diagnosis of obturator hernia--a case series.

The diagnosis of obturator hernia is one of suspicion as it is almost never seen and rarely palpated. The incidence is less than 1% of all hernias worldwide. Five cases of obturator hernias are reported where the diagnosis of obturator hernia were overlooked.

Gender variations in the prevalence of parasitic infections and the level of awareness in adolescents in rural Nepal.

The study was conducted in rural school adolescent children to investigate the awareness and its association in parasitic infections in boys and girls. Of the 182 children examined 119 (65.3%) were male and 63 (34.6%) were female, age ranged 12-20 years with median age 15 years. Out of 182 stool samples examined 73 (40%) were found to be positive for parasites in which two or more parasites were found in 10 stool samples. Giardia lamblia 33 (18.1%) was the predominant parasite followed by hook worm 27 (14.8%) Entamoeba histolytica 13 (7.1%), Ascaris lumbricoides 05 (2.7%), Hyminolepis nana 02 (2.2%) and Trichuris trichiuria 01 (0.5%). Thirty-one (49.2%) in 63 females and 40 (33.6%) of the 119 males were positive for parasitic infections. The prevalence of worm infection was significantly higher in female children than male (p < or = 0.05). In contrast to the high parasitic prevalence rate in females they possessed significantly higher levels of awareness about parasitic infections. Out of 119 males 99 (83.2%) and 61 (96.8%) of the 63 females (p < or = 0.05) knew that worms suck food from host body. Similarly, 62.2% of males and 96.85 of females (p < or = 0.05) knew that parasites suck blood from human body. More study should be carried out to find out the gender difference in parasitic infection and level of exposure to risk factors.