Indications of Fetal Echocardiography and Detection of Congenital Heart Disease Prenatally in Tertiary Care Hospital.

Background Congenital Heart Diseases are common childhood congenital anomalies encountered in developed and developing countries. Due to the improved prenatal diagnostic modalities, the diagnosis of cardiac disease is increasing in newborns. Fetal echocardiography is considered a good and accurate diagnostic method for congenital heart disease. Objective To study the common indications of fetal echocardiography and the detection of congenital heart disease in Dhulikhel Hospital, Kathmandu University Hospital. Method In this hospital-based, retrospective study, we reviewed medical records of 324 fetuses who were indicated for fetal echocardiography at Dhulikhel Hospital over 24 months period of time (September 1, 2017 to August 31, 2019). Result The mean age of pregnant women at presentation for fetal echocardiography was 30.7 ± 4.7 years. The mean gestational age at diagnosis was 28.9 ± 4.9 weeks. Among all the pregnant women, 208 (65%) presented during the second trimester and 112 (35%) presented during the third trimester. Maternal indications for fetal echocardiography were seen in48.12% cases, whereas fetal indications were seen in 42.81% cases. The most common indication was for maternal gestational diabetes (30.31%). Among the 324fetal echocardiography results, 65.43% cases had normal findings, echogenic intra-cardiac foci were seen in 18.82% and significant abnormal findings were seen in 15.74% of cases. Among all women having maternal indication for echocardiography, 34 (22.07%) fetus had some form of abnormal findings, whereas only 17 (12.40%) fetus with fetal indication showed abnormal findings (p < 0.05). Conclusion Indication of fetal echocardiography is increasing and can be a good diagnostic tool to improve prognosis and outcome of a newborn. It has become widely used in pediatric cardiology. Raising awareness is necessary regarding the importance of fetal echocardiography in the management and outcome of a newborn with cardiac anomalies.

Sydenham's Chorea as Presentation of Rheumatic Heart Disease.

Sydenham's chorea is the most common type of acquired chorea in childhood which is a major neurological manifestation of rheumatic fever. We describe a 13 years old girl who presented with weakness and purposeless involuntary movements of upper and lower limbs. The symptoms slightly affected the child's daily activities and had an unstable gait on walking which was aggravated during stress. Grade II ejection systolic murmur was noticed on cardiovascular examination. Echocardiography evaluation showed thickened aortic and mitral valve leaflets with mild to moderate degree of mitral regurgitation. Anti-streptolysin O titer was positive (≥200 IU/ml). CT scan of brain was normal. Subsequently child was diagnosed as Rheumatic heart disease with Sydenham's chorea and kept on regular Benzathine penicillin prophylaxis. Symptoms subsided spontaneously after 3 months without any further complications. Although decreasing, early diagnosis and management of Sydenham's chorea and Rheumatic heart disease are very crucial and should be considered with such presentation.

Bacterial isolates and its antibiotic susceptibility pattern in NICU.

BACKGROUND: Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world. OBJECTIVES: To determine the common bacterial isolates causing sepsis in neonatal intensive care unit and its antibiotic susceptibility pattern. METHODS: A one year discriptive prospective study was conducted in neonatal intensive care unit to analyse the results of blood culture and to look into the sensitivity of the commonly used antibiotics. RESULTS: The blood culture yield by conventional method was 44.13% with nosocomial sepsis accounting for 10.79%. 84.08% were culture proven early onset sepsis and 15.95% were late onset sepsis. Klebsiella infection was the commonest organism isolated in early, late and nosocomial sepsis but statistically not significant. Gram positive organisms were 39.36% in which Staphylococcus aureus was the leading microorganism followed by coagulase negative staphylococcus areus. Gram negative organisms were 60.64% amongst them Klebsiella was the most often encountered followed by Pseudomonas. The most common organism Klebsiella was 87.5% and 78.3% resistance to ampicillin and gentamycin respectively. Among gram negative isolates 87.5% and 77.2% were resistance to ampicillin and gentamycin respectively. Among gram positive isolates 58.5% and 31.5% resistance were noted to ampicillin and gentamycin respectively. Resistance to cefotaxim to gram negative and gram positive isolates were 87.34% and 59.35% respectively. CONCLUSION: Klebsiella is most common organism which is almost resistance to first line antibiotics. Resistance to both gram negative and gram positive isolates among firstline antibiotics and even with cefotaxim is emerging and is a major concern in neonatal intensive care unit.

Comparision of clinical and laboratory parameters in culture proven and unproven early onset sepsis in NICU.

BACKGROUND: Early onset sepsis remains a major cause for neonatal morbidity and mortality. OBJECTIVES: The aim of this study was to describe and compare the clinical and laboratory characteristics of neonates in neonatal intensive care unit with culture positive and negative early onset sepsis and verify if there were any differences between the groups. METHODS: A one year comparative prospective study was conducted from January 2011 to January 2012 in neonatal intensive care unit (NICU), Dhulikhel Hospital, Kathmandu University Hospital (KUH). RESULTS: Out of 215 cases of suspected neonatal sepsis, 192 (89.30%) cases of early onset sepsis were admitted in neonatal intensive care unit. Out of which 82 cases (42.7%) had blood culture positive and 110( 57.3%) had culture negative but compatible with features of clinical sepsis. There were no cases of culture proven meningitis and urinary tract infections. The clinical characteristic did not show any statistical differences between the study groups except for seizure which was found to be high in culture positive cases (p= 0.041). The hospital stay in neonatal intensive care unit was significantly longer (p=0.02) in culture positive cases. As for the laboratory test there were no differences found between the two study groups except cases of meningitis was more in culture proven early onset sepsis (p=0.00). The overall mortality in early onset sepsis was 36.95%. The higher mortality of 64.7% was seen in culture positive cases but statistically not significant. CONCLUSION: Clinical manifestation and laboratory test were insufficient to distinguish between neonatal infection with blood culture positive and negative sepsis, hence both culture positive and negative cases should be treated promptly and equally.

Clinical and laboratory profile of children with eosinophilia at Dhulikhel hospital.

BACKGROUND: Eosinophilia in children is commonly caused by or parasitic, allergic and immunologic problems. OBJECTIVES: To study clinical and laboratory profile of patients with eosinophilia and to identify possible causes. METHOD: A prospective and descriptive study was conducted from January 2009- December 2011. All the cases of eosinophilia with symptoms and signs of single or multiple organ were included. The known cause of eosinophilia like allergy, asthma and drugs were excluded. RESULTS: During three years period, 84(2.41%) cases had eosinophilia with single or multiple organ involvement. 14.3%, 39.3% and 46.4% had mild, moderate and severe eosinophilia respectively, with cases of hypereosinophilia comprising 85.7%. Eosinophilia was seen predominantly in Tamang caste with overall age ranging from 1-14 years. Most common symptoms and signs were abdominal pain (67.9%) hepatomegaly (59.5%) respectively. Gastrointestinal system was most commonly involved organ followed by respiratory system. Nineteen percent had polyserositis involving pleural, pericardial effusion and ascites at presentation. Out of 84 patients only nine serum samples were able to be sent for parasitological analysis. Sixteen cases had identifiable and/ or possible causes. Serum sample for parasitological analysis revealed fascilosis, filariasis, strongylosis, stercoralis and toxocariasis. CONCLUSION: Eosinophilia is more common among Tamang population in our study. Most common symptoms and signs are abdominal pain and hepatomegaly respectively. Parasitic infection seems to be the most common cause however further study has to be done to reach final conclusion.

Simplification of an erythropoiesis model for design of anemia management protocols in end stage renal disease.

Many end stage renal disease (ESRD) patients suffer from anemia due to insufficient endogenous production of erythropoietin (EPO). The discovery of recombinant human EPO (rHuEPO) over 30 years ago has shifted the treatment of anemia for patients on dialysis from blood transfusions to rHuEPO therapy. Many anemia management protocols (AMPs) used by clinicians comprise a set of experience-based rules for weekly-to-monthly titration of rHuEPO doses based on hemoglobin (Hgb) measurements. In order to facilitate the design of an AMP based on formal control design methods, we present a physiologically-relevant erythropoiesis model, and show that its nonlinear dynamics can be approximated using a static nonlinearity, a step that greatly simplifies AMP design. We demonstrate applicability of our results using clinical data.

Outcome of preterm babies and associated risk factors in a hospital.

INTRODUCTION: Preterm birth is a major problem associated with maximum perinatal mortality and morbidity in developed and developing countries. The aim of this study is to identify risk factors associated with preterm birth and to study morbidities and mortality. METHODS: A descriptive retrospective study was conducted on 164 cases of preterm babies admitted to Neonatal Intensive Care Unit from January, 2007 to December, 2009 RESULTS: Incidence of preterm birth was 19.5%. Mean birth weight was 1670 +/- 370 grams and mean gestational age was 30.02 +/- 0.37 weeks. Common risk factor associated with preterm birth were inadequate antenatal checkup (52%), maternal age <20 years (34.7%), ante partum hemorrhage (23.4%) and pregnancy induced hypertension (13.1%). Common morbidities were clinical sepsis (66.7%), hyperbilirubinemia (58.8%), birth asphyxia (26.8%) and hyaline membrane disease (23.5%). Overall survival was 79.4% with minimum age of survival of 880 grams. The mortality rate in extremely low birth rate and very low birth rate was 80% and 39.5% respectively. The common causes of death were hyaline membrane disease (64.5%), sepsis (58.06%) and necrotizing enterocolitis (25.8%). CONCLUSIONS: The main risk factors for preterm delivery were inadequate antenatal check up, maternal age <20 years, antepartum hemorrhage and pregnancy induced hypertension. The most common morbidity was clinical sepsis followed by hyperbilirubinemia. Common causes of death were hyaline membrane disease and sepsis.

The genome of the thermoacidophilic red microalga Galdieria sulphuraria encodes a small family of secreted class III peroxidases that might be involved in cell wall modification.

We report the identification of a small family of secreted class III plant peroxidases (Prx) from the genome of the unicellular thermoacidophilic red alga Galdieria sulphuraria (Cyanidiaceae). Apart from two class I ascorbate peroxidases and one cytochrome c peroxidase, the red algal genome encodes four class III plant peroxidases, thus complementing the short list of algal cell wall peroxidases (Passardi et al. in Genomics 89:567-579, 2007). We have characterized the family gene structure, analyzed the extracellular space and cell wall fraction of G. sulphuraria for the presence of peroxidase activity and used shotgun proteomics to identify candidate extracellular peroxidases. For a detailed enzymatic characterization, we have purified a secreted peroxidase (GsPrx04) from the cell-free medium using hydrophobic interaction chromatography. The enzyme proved heat and acid-stable and exhibited an apparent molecular mass of 40 kDa. Comparative genomics between endolithically growing G. sulphuraria and a close relative, the obligatory aquatic, cell wall-less Cyanidioschyzon merolae, revealed that class III peroxidases only occur in the terrestrial microalga, thus supporting the key function of these enzymes in the process of land colonization.

Effective models for medical and health response coordination: summary and action plan.

INTRODUCTION: To effectively respond to this relatively new, complex mandate, it is essential to find effective models of coordination to ensure that medical and health services can meet the standards now expected in a disaster situation. This theme explored various models, noting both the strengths that can be built on and the weaknesses that still need to be overcome. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 1 and Theme 4 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) preplanning (predisaster goals), (2) information collection (assessment), (3) communication (materials and methods); and (4) response centres and personnel. There exists a need for institutionalization of processes for learning from experiences obtained from disasters. DISCUSSION: Action plans presented include: (1) creation of an information and data clearinghouse on disaster management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) action on lessons learned from evidence-based research and practical experience. CONCLUSIONS: There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

Control of epidemic group A meningococcal meningitis in Nepal.

During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.