Anxiety during COVID -19 among School Going Adolescents of Six Private Schools in Kathmandu Valley: A Descriptive Cross-sectional Study.

INTRODUCTION: Psychological health problems are common in adolescent and young adults. The psychological well-being is greatly influenced by stressful environment and the coping mechanism of an individual. The 2019 Coronavirus disease has caused unprecedented morbidity and mortality worldwide owing to its high infectivity and mortality. In addition to these physical manifestations, psychological impact has also been substantial. This study is a descriptive cross-sectional study done to find out the prevalence of anxiety disorder and its severity during the COVID-19 pandemic in school going adolescents of Kathmandu valley. METHODS: A descriptive cross-sectional study was carried out among adolescents from August 15 to September 30, 2020. Two private schools from each district in the Kathmandu valley i.e. Kathmandu, Lalitpur and Bhaktapur were included in the study using convenient sampling. Ethical clearance was obtained from Institutional Review Committee (reference no: 1208202007). All data were inserted on Microsoft Excel 2016 and analysed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 358 students, 165 (46.1%) at 95% Confidence Interval (40.8-51.2) were found to have anxiety. Out of these patients, 115 (69.7%) had mild, 39 (23.6%) had moderate and 11 (6.7%) had severe anxiety. The mean age was 16.17±1.57 years. CONCLUSIONS: This study shows that a remarkably higher number of children had symptoms of anxiety disorder. Majority of the children with anxiety had mild form. The study further highlights the need of emotional support to adolescent children during the current ongoing pandemic.

Macrophage Activation Syndrome secondary to Systemic Juvenile Idiopathic Arthritis: A Case Report.

Macrophage activation syndrome is a rare but a life threatening condition commonly associated with Systemic Juvenile Idiopathic Arthritis. Its clinical presentation includes fever, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia and impaired liver enzymes. The symptoms are alarming yet non-specific and often lead to a delayed diagnosis. A 12 year male presented with a history of intermittent fever and was started on antibiotics but failed to respond after several days of hospital stay. After a series of investigations to rule out multiple diagnoses he was diagnosed as a case of Macrophage Activation Syndrome secondary to Systemic onset Juvenile Arthritis and was treated with steroids.

Sleep Pattern and Problems in Young Children Visiting Outpatient Department of a Tertiary Level Hospital in Kathmandu, Nepal.

BACKGROUND: Sleep is an important parameter of a child's growth and development. The pattern and duration of sleep varies with age. Sleep problems are a common occurrence during childhood days, and these problems that establish in childhood are presumed to continue later in life. Many times, parental concerns regarding their child's sleep problems like difficulty in putting to sleep, frequent night time awakening, and waking up early are overlooked during their visits to the hospital. OBJECTIVE: The aim of this study was to find out the sleep patterns and problems of children aged six to thirty-six months. Methodology. A cross-sectional study was conducted at the pediatric outpatient department of Kathmandu Medical College Teaching Hospital from October, 2019 till March, 2020. Two hundred and forty-nine respondents were chosen purposively and were given questionnaires to be filled out. Research instrument was a standard, Nepali version of a structured questionnaire called Brief Infant Sleep Questionnaire (BISQ) which contained questions related to sleep parameters and sleep problems existing among young children of 6-36 months. Mean, standard deviation, frequencies, and Kruskal Wallis test were used for statistical analysis. RESULTS: The mean duration of total sleep was 12.12 ± 2.00 hours, while that of night sleep was 9.22 ± 1.19 hours and mean daytime nap was 2.90 ± 1.66 hours. Most of the children (96%) coslept with their parents, and 55% of the children had feeding as a bedtime ritual. Overall, 19.6% of the children had sleep problems as identified by BISQ although only 5.6% of the parents perceived that their children had it. CONCLUSIONS: Sleep problems were present among young Nepalese children included in our study, and sleep assessment should be a part of every health checkup for children.

Intestinal Obstruction of Congenital Origin: A Case Report.

Congenital bands are rare causes of intestinal obstruction and often leads to diagnostic challenges. Diagnostic delays in cases of mechanical obstruction might lead to irreversible bowel ischemia and perforation. Presently described is a case of an 18 month young child with severe vomiting developed for one day. The child was initially thought to have acute viral enteritis and treated accordingly. Due to the severity, an X-Ray and computed tomography scan were sent which pointed towards the possibility of having congenital bands. He was treated operatively. The child was kept under observation for eleven days and was discharged. Although rare, intestinal obstruction due to congenital bands must be considered when treating a child with severe vomiting. Keywords: case reports, congenital abnormalities, intestinal obstruction, vomiting.

Posterior Reversible Encephalopathy Syndrome in a Patient with Post Streptococcal Glomerulonephritis: A Case Report.

Posterior reversible encephalopathy syndrome is a clinical-radiological syndrome neurological disorder with varied symptoms which include headache, visual field defects, seizures, altered consciousness. It is a rare complication of post-streptococcal glomerulonephritis and results in life-threatening manifestations if not managed on time. Although reversible by definition, complications like status epilepticus, intracranial hemorrhage, and ischemic infarction may lead to mortality and morbidity. We report a case of a 9-year-old female patient with posterior reversible encephalopathy syndrome who presented with multiple episodes of seizures and bilateral painless loss of vision for 1 day. Due to her severity, a computed tomography scan was sent which revealed a hypodense lesion in the brain. She was admitted to the pediatric intensive care unit and managed with supportive care for 6 days where she died on the 6th day. Vital signs are simple but important and if overlooked can lead to a series of complicated events.