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The gharial Gavialis gangeticus is a Critically Endangered crocodilian currently known from only 14 disjunct locations in Nepal and India. The protected stretch of the Babai River in Bardia National Park, Nepal, is home to one of the six subpopulations of gharials that have exhibited recent evidence of reproduction. However, there is limited information available on the gharial population in this region. We conducted surveys during the breeding, nesting and hatching seasons of gharials during 2020–2022 to study the gharial population in the Babai River in Bardia National Park. We located one breeding group of gharials in Soth Khola (2–3 individuals) and one in Dhanuse (5–6 individuals), and we observed pre-mating or mating behaviours in all 3 years. We identified potential nesting areas on sand banks of 19–175 m in length. During nesting seasons we found abundant signs of nesting only in Dhanuse, including entry and exit trails of female gharials to and from the water and trial nests. In 2020 and 2021 we did not find any signs of hatching, probably because of flooding. In 2022 we recorded two gharial nests, producing c. 60 hatchlings, in Dhanuse. Our findings indicate that the gharial population in the Babai River is probably nesting annually. We recommend various conservation actions for this gharial population.

Amniotic band syndrome (ABS) is a group of rare congenital abnormalities caused by wrapping of parts of the foetus by fibrous amniotic bands during intrauterine life. It can be seen in infants without any known genetic mutations. Band formation most frequently affects the distal segments, including the hand. Here, we report a case of a neonate who presented with multiple congenital abnormalities and clinical features that suggest the Amniotic Band Syndrome. It was delivered by a 17-year-old female patient at 28 weeks period of gestation, who had a medical abortion.

Cyclopia is the most extreme form of holoprosencephaly. It is characterized by the failure of the embryonic prosencephalon to properly divide the orbits of the eye into two cavities which results in babies with a single or partially divided eye in a single orbit. We report a case of a 28 years old primigravida who came for medical termination at 25 weeks of gestation and delivered a 600 grams dead female fetus with cyclopia, fetal proboscis, and neurocutaneous marker. Its incompatibility with life makes early diagnosis using ultrasonography and fetal magnetic resonance imaging essential in early management and essential counseling to parents.

Abstract Background Acute rhinosinusitis (ARS) refers to a group of disorders characterized by inflammation of the respiratory epithelium of the nose and paranasal sinuses lasting from 7 to 28 days. In the treatment of ARS in addition to an antibiotic, intranasal corticosteroids hasten the clearance of bacteria, decrease the frequency and severity of disease recurrence, and reduce the duration of infection. The purpose is to compare the efficacy of the combination of mometasone furoate nasal spray (MFNS) with amoxicillin and amoxicillin alone in the treatment of acute rhinosinusitis. A total of 120 patients (≥ 12 years) were randomized into 2 groups: group A (N: 60) receiving amoxicillin 500 mg thrice daily alone and group B (N: 60) receiving amoxicillin 500 mg thrice daily and MFNS 200 μg twice daily for 7 days. Patients were followed up after 7 days. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire was taken before and after. The total score of SNOT-22 was compared between the groups. Results There was a reduction in the mean total SNOT score in both groups from 21.32 ± 11.29 to 9.37 ± 6.55 in group A and from 26.68 ± 11.97 to 3.07 ± 3.46 in group B which were statistically significant (p < 0.001) in both groups. The posttreatment mean score with the amoxicillin group was 9.31 ± 6.55 and that of the amoxicillin and mometasone furoate group was 3.07 ± 3.46, and their mean difference was 6.3 ± 0.95. In comparison, MFNS with amoxicillin was significantly (p < 0.001) superior than amoxicillin alone. Conclusion Patients receiving amoxicillin alone or amoxillin with MFNS, both showed improvement of symptoms in ARS. However, amoxicillin with MFNS showed significantly higher improvement and relief of symptoms in ARS than amoxicillin alone.

Biometric authentication is a new technology that verifies an individual’ s identity via their unique physical or behavioural characteristics including Palm Vein or hand geometry. Despite its potential benefits and growing popularity in the public and private sectors, end-user adoption of the technology has been relatively slow. This study aims to investigate the major factors that influence Palm Vein biometric authentication devices through Technology Acceptance Model (TAM). In addition to the major TAM constructs, we postulate that the trust in the device, the users’ perception of risks involved, their perceived enjoyment during device utilization and their innovative nature to have a significant influence on their final adoption behaviour. Data was collected from 100 voluntary participants by offering them a chance to interact with a palm vein scanner connected to a coffee machine which was used for access authentication. The goodness-of-fit of the data to the model is validated and the proposed model and the hypotheses are evaluated using Structural Equation Modelling (SEM). The results confirm the influence of users’ risk perception, trust, and enjoyment factors on biometric technology adoption. Furthermore, this study shows that while risk perceptions and privacy concerns were found to be the primary hindrance to users’ intention to accept Palm Vein technology, building a sense of trust among its users and designing an endearing system has a substantial role in increasing their level of technology acceptance.

Fraser syndrome is a rare, autosomal recessive condition. It is characterized by cryptophthalmos, syndactyly, craniofacial dysmorphism, laryngeal and genitourinary malformations, and musculoskeletal anomalies. We report a case of a neonate who presented with multiple congenital abnormalities and clinical features suggestive of Fraser syndrome.

Abstract Foreign body ingestion should be considered as an important differential in a child with difficult asthma. We report an 11‐year‐old male child with foreign body aspiration who initially was diagnosed and treated as difficult asthma. Later on, he was diagnosed to have a foreign body in the right bronchus, which was successfully removed by flexible bronchoscopy.

Chinese Pangolins (Manis pentadactyla) are Critically Endangered and one of the most illegally traded mammals globally. We generated first COI sequences from five individuals of this species from Nepal. BLASTn search of our 600 bp sequences at GenBank showed pair-wise identity between 99.17% and 100% to M. pentadactyla. There were three haplotypes and a total of five variable sites among five M. pentadactyla sequences. Neighbor-joining tree revealed that all M. pentadactyla from Nepal clustered into same group further splitting into two sub-groups albeit with low bootstrap value, suggesting potential multiple geographic origins. The K2P distance was 0.3% within group and 0.7% between four sequences from Bhaktapur and Kavrepalanchok districts (Mape2, Mape3, Mape5 and Mape6) and museum sample (Mape10). This study has generated reference samples for M. pentadactyla from Nepal and will be helpful in understanding dynamics of illegal trade of this species and in successful identification of M. pentadactyla from Nepal even in the absence of intact specimens.

Background: Preterm births is one of the leading cause of perinatal mortality and morbidity. It causes long-term medical and financial burdens for affected children, their families, and the health care system of country. The objective of the study was to identify prevalence and outcome of preterm admissions attending a tertiary care centre in rural Nepal, Jumla. Methods: This retrospective study was carried out on 52 preterm births admitted at the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) of the Karnali Academy of Health Sciences (KAHS), Jumla from Magh 2076 to Poush 2077. This study was carried out from March 2021 to July 2021 for 5 months. Results: Preterm admissions constituted 19.4% of all admissions i.e 52 out of 268 cases at the NICU of KAHS. The mean birth weight and mean gestational age were 1730 ± 378 grams and 33.3 ± 2.13 weeks. Sepsis (34.62 %) was the most common cause for hospital admission followed by perinatal asphyxia (15.39%) and neonatal jaundice (13.47%). The most common risk factor of preterm delivery was PROM (28.8%) followed by hypertensive disorders of pregnancy (15.3%) and teenage pregancy (11.5%) in our study. Mortality was observed in 10 (19.2% ) cases. Conclusion: : Prematurity is still one of the main cause for admissions in intensive care unit. Identification of at risk pregnancy, early detection and treatment of medical diseases, improving pregnant womens' health care quality may decrease the rate of preterm birth.

There are two species of pangolins –Chinese (Manis pentadactyla) and Indian (M. crassicaudata) – in Nepal. Despite being one of the most illegally traded group of mammals in the world, there is scant information on pangolin trade in Nepal. We synthesized nation-wide information on pangolin seizures for 2015–2020 period to elucidate extent and network of illegal pangolin trade in Nepal. We recorded a total of 56 pangolin seizures in Nepal in 2015–2020 period. Pangolin scales were confiscated in all 56 seizures totaling to 154.12 kg along with confiscation of live and dead pangolins, and whole pangolin hide in some seizures. That amount of scales would have fetched up to $19,922 in local market and the price could reach up to $116,993 in an international black market. At least 209 pangolins could have been killed and illegally traded in Nepal between 2015 and 2020. Pangolin trade is widespread throughout Nepal with seizures recorded from almost a quarter of all 77 districts and almost third of 61 districts where pangolins are found. Most seizures occurred in country’s capital Kathmandu (n = 29). Additionally, we identified districts adjoining Kathmandu, and districts bordering Nepal-China and Nepal-India as major routes and points in pangolin trade network. A total of 95 people were involved in pangolin poaching that included local residents from 26 districts in Nepal. The pool of convicts was dominated by males and Nepali nationals between 20 and 30 years old. Most major ethnic groups in Nepal were involved in pangolin trade with the highest involvement of people from the Tamang ethnicity (36%). Presence of pangolins is reported from all 18 districts from where seizures were recorded and 26 districts from where convicts originated suggesting active involvement of locals in pangolin poaching and trafficking. We have generated baseline information on illegal pangolin trade in Nepal for 2015–2020. We expect that this information will be helpful to law enforcement agencies to curb existing pangolin trade in Nepal.

Abstract Herpes zoster generally occurs after the exposure of VZV following varicella. This case report emphasizes a rare case of HZ in an infant without prior history of varicella or its exposure in the baby, other siblings, and mother during or after the pregnancy.

Abstract Bardet‐Biedl Syndrome (BBS) is a rare autosomal recessive disorder with a wide spectrum of clinical manifestations like retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. We report a case of 14‐year‐old obese boy with poor scholastic performances, hypothyroidism, and poor vision diagnosed as BBS.

Introduction: Feeding intolerance is common among the preterm neonates and is associated with different comorbidities like respiratory depression, respiratory distress syndrome, apnea, hyperbilirubinaemia, and hypoxic ischaemic encephalopathy. Aim: To find the incidence of feeding intolerance in preterm neonates from 28-34 weeks of gestation along with the clinical signs and co-morbidities associated with feeding intolerance. Materials and Methods: A prospective observational hospital based study was conducted in Neonatal Intensive Care Unit (NICU) and postnatal ward of Universal College of Medical Sciences, a tertiary care hospital situated in western Nepal for 12 months (June 2018 to May 2019). All admitted preterm neonates between 28-34 weeks of gestation were included in the study and were followed-up for any neonatal morbidities along with feeding intolerance. Feeding intolerance was defined when the newborn had vomiting and/or abdominal distension and/or increased gastric residual volume with normal disruption of feeding process. Babies with feeding intolerance were subjected to final analysis for clinical signs and co-morbidities. Results: Out of 490 admitted preterm babies (28-34 weeks), 54 (11.02%) had feeding intolerance with 33 (61.1%) babies in the very low birth weight group. The mean birth weights of the total enrolled babies (n=490) and feed intolerant (n=54) babies were 1550 gm and 1418 gm, respectively. Different comorbidities associated with feeding intolerance were respiratory distress (25.9%), respiratory distress syndrome (22.2%), jaundice (16.7%), apnea (5.6%) and necrotising enterocolitis (3.7%). Among the total 37 preterm deaths, four babies were in the feeding intolerance group. Majority of all feed intolerant babies had vomiting 49 (90.7%) followed by gastric residue (57.4%), abdominal distension (55.6%), and reduced or absent bowel sounds (7.4%), respectively. The incidence of feeding intolerance was increased in babies fed with formula feed (p=0.46) and when feeding was started

ABSTRACT : Neonatal hyperbilirubinaemia or jaundice is one of the commonest issues affecting neonates. It is observed in up to 60% of term infants and 80% of preterm infants .Phototherapy is one of the therapy methods for jaundice Hypocalcemia is one of the lesser known side effects, but is a significant complication induced by phototherapy. MATERIALS AND METHODS: This was a prospective cross sectional study , conducted between May 2020 and April 2021 at the Neonatal Intensive Care Unit and Special Newborn Care Unit of Karnali Academy of Health sciences (KAHS), Jumla. A total of 40 neonates with jaundice of either sex managed by phototherapy were enrolled in the study. Total serum bilirubin levels and serum calcium levels were checked before and after phototherapy. All the data were recorded in the preformed proforma and was analyzed using SPSS version 20. p value less than 0.05 was considered statistically significant. RESULTS: As per the study, the mean age of the neonates was 4.12±1.09 days and mean gestational age was 38.55 ± 2.34 weeks. The mean age at which jaundice was noticed in the neonates was 4.13 ± 1.4 days .Pre-phototherapy and post phototherapy level of total serum bilirubin was 14.53 mg/dl ± 2.91 mg/dl and 10.29 mg/dl ± 2.13 mg/dl respectively whereas serum calcium level before and after initiating phototherapy was 9.23 ± 1.11 mg/dl and 8.37 ± 0.69 mg/dl. respectively. 22.5% of jaundiced neonates receiving phototherapy developed hypocalcemia. CONCLUSION : Hypocalcemia is a common complication of phototherapy which is a commonly used modality of treatment for neonatal jaundice. Keywords: hyperbilirubinemia, hypocalcemia, phototherapy

Abstract Background Small for gestational age (SGA) is common among newborns in low‐income countries like Nepal and has higher immediate mortality and morbidities. Objectives To study the prevalence and prognostic factors of SGA babies in Western Nepal. Methods A cross‐sectional study (November 2016‐October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio‐demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. Results Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female‐SGA was greater in comparison to male‐SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. Conclusions SGA is common in Western Nepal and associated with several modifiable prognostic factors.

Background: Current scenario of novel coronavirus (COVID-19) pandemic pose challenge for effective utilization and accessibility of health services. Various interventions introduced countrywide to contain the disease can have an indirect impact on essential health services ; one of the core area being maternal and newborn health services. Hence, the present study was conducted to determine trend of institutional deliveries and their outcome before and during COVID-19 pandemic. Methods: This was a retrospective observational study carried out in Karnali Academy of Health Sciences (KAHS). Data on socio demographic characteristics, obstetrics and perinatal characteristics of cases who delivered over a period of a year from September 2019 till September 2020 was retrieved from maternal and neonatal records. Results: During the study period, among 740 women enrolled in the study, 418(56.4%) delivered prior to COVID-19 pandemic and 322(43.6%) during pandemic. Monthly trend of institutional deliveries showed a decline in number of deliveries and women receiving adequate antenatal care visits (ANC) during the pandemic. There was increase in incidence of adverse perinatal outcome during pandemic which consisted preterm births (7.3% before vs 9.6% during pandemic), increased neonatal admissions (9.5% before vs 20% during pandemic) and delivery of low birth weight babies (16.2% before vs 18% during pandemic). Neonatal mortality rate increased from 12.2 per 1000 live births before pandemic to 38 per 1000 live births during pandemic. Still birth rate increased from 26.3 per 1000 total births before pandemic to 43.4 per 1000 total births during pandemic . Conclusion: There was a decrease in antenatal care visits, institutional deliveries with increase in adverse perinatal outcome in our study. These findings call for adoption of effective policies that could be met within our resources for uninterrupted, easy accessibility and availability of maternal and neonatal health services during current pandemic scenario.

Abstract Background Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. Methods We examined the diagnoses of all children without trauma, admitted to Kanti Children’s Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7.8 magnitude Nepal earthquake on 25th April 2015. The admitted children were grouped based on direct effect of earthquake on their family (house damaged or family member injured or dead) and on whether their place of residence was located in an earthquake affected district. Most common diagnoses were identified and their distribution between the aforementioned groups analyzed to examine differences, if any, in disease occurrence or presentation. The fifteen weeks study duration was divided into three parts of five weeks each, to study trends in illness presentation. Variables were compared among various groups using appropriate statistical tests (p

BackgroundDespite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal.MethodsThis cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3-60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia.ResultsOut of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors.ConclusionTachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

Introduction: Perinatal mortality rate is a sensitive indicator of the quality of obstetric and pediatric health services. It also helps us to evaluate the efficiency of health care provided by a particular hospital. The aim of this study was to evaluate the cause of perinatal death in a tertiary care medical centre, which may help to reduce the incidence of perinatal death and improve the quality of care. Methods: The two-year retrospective study of perinatal deaths was done at Karnali Academy of Health Sciences (KAHS), Jumla from March 2017 to April 2019. Data was collected from monthly perinatal audit and annual mortality reviews. Registers in the maternity ward, sick Neonate Care Unit, and files of dead newborns kept in the record section of the hospital were studied and reviewed. Results: A total of 1354 deliveries were conducted in the 24 months period at KAHS with a perinatal mortality rate of 36.08 per 1000 total birth and early neonatal death rate of 12.8 per 1000 live birth. The Perinatal mortality was higher in low birth weight and premature baby. The cause of stillbirth and early Neonatal death were identified. Most of the early neonatal death was due to Prematurity (41.17%) followed by Birth Asphyxia and Neonatal Sepsis. Conclusion: Prematurity and its related complication were the most common cause of early neonatal death followed by birth Asphyxia and Neonatal Sepsis. There is a need to improve antenatal, early identification of high-risk pregnancy as well as Neonatal Intensive Care Unit (NICU) to further reduce deaths due to prematurity and birth asphyxia. Keywords: Perinatal Mortality Rate; Early Neonatal Mortality Rate; Rural Areas; Jumla DOI: http://doi.org/10.3126/jkahs.v2i2.25178

Introduction: Nepal is a low socioeconomic country and adolescent pregnancy can have a deleterious effect on the mother, child and the community. The aim of this study was to know the incidence of teenage pregnancy and its outcomes in the mid-western region of Nepal Method: This was a retrospective study conducted in Karnali Academy of Health Science, Jumla, Nepal. Data were collected from the hospital records from October 2017 to September 2018. Result: The incidence of teenage pregnancy was 22.6% among total deliveries. Most of them were Primigravida (84.9%). Majority of them were 18 years of age (47.5%). Caesarean section accounted for 10.8%. In perinatal outcome, the incidence of preterm birth was 15.1%, and extremely low birth weight was 2.2%, very low birth weight was 1.4% and low birth weight was 12.2%. Maternal complication accounted for 33.09%. Conclusion: The study concluded that the incidence of teenage pregnancy is considerably high and it is associated with an increases risk of an adverse outcome to both mother and newborn. Therefore, education and awareness can be helpful in reducing adolescent pregnancy and its adverse outcomes. Keyword: Adolescent pregnancy, teenage pregnancy, Karnali Academy of Health Science, Jumla, Nepal, Intrauterine Fetal Death, World Health Organization (WHO) DOI: http://doi.org/10.3126/jkahs.v2i2.25169

Abstract A rare phenomenon, natal teeth are observed in infants at birth .The incidence of this anomaly has been approximately 1:1000 to 1:6000 live births. Presence of natal tooth may lead to numerous complications. Natal teeth can interfere with breastfeeding and, if excessively mobile, may be swallowed or aspirated during nursing. In this article, a case report is presented where a natal tooth was present in the mandibular incisor region. Due to the possibility of aspiration because of the presence of mobility and also as the teeth are causing discomfort to the mother during breast feeding, the teeth was extracted under topical anaesthesia and the healing was found to be satisfactory. Key words: Natal teeth, Neonatal teeth, Complication

BackgroundScrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children.MethodsA prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA.ResultsAll cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%.ConclusionsScrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.

Background. Neurocysticercosis (NCC), a common cause of seizures in children from low and middle income countries (LMICs), if not diagnosed and treated early enough may lead to considerable morbidity and mortality. There is a lack of data on the prevalence of NCC and its clinical characteristics among those with seizure in South-Western Nepal. Aims and Objectives. To study the prevalence and clinical characteristics of NCC in children with seizures. Material and Methods. All children admitted to Universal College of Medical Sciences, a tertiary hospital in South-Western Nepal with seizures during 2014–16, were tested for NCC. NCC was diagnosed by neuroimaging [computerized tomography (CT) scan or magnetic resonance imaging (MRI)]. We used logistic regression to test the association between NCC with participants’ characteristics and clinical symptoms. Results. Among 4962 in-patient children, 168 (104 boys and 64 girls) had seizures (138 with generalized tonic clonic seizures (GTCS) and 30 with focal seizures). 43% of children with seizures had CT scan confirmed NCC. The prevalence of NCC in the oldest children (13–16 years) was significantly greater (57.1% versus 15.6%) compared to the youngest (0–4 years) one (p

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal. Methods: This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves. Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length. Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.

Seizures are one of the common causes for hospital admissions in children with significant mortality and morbidity. This study was conducted to study the prevalence and clinicodemographic profile of children with seizures in a tertiary care hospital of western Nepal. This prospective cross-sectional study conducted over a period of 2 years included all admitted children (2 months–16 years) with seizures. Among 4962 admitted children, seizures were present in 3.4% (n=168) of children, with male preponderance. 138 (82.1%) children had generalized tonic-clonic seizures (GTCS) and 30 (17.9%) children had partial seizures. GTCS were more common than partial seizures in both sexes (male = 82.7%; female = 81.2%) and age groups. There was no statistical significance in the distribution of seizures (GTCS and partial seizures) with sexes (P=0.813) and age groups (P=0.955). Mean ages of children having GTCS and partial seizures were 8.2±4.6 years and 8.2±4.2 years, respectively. Loss of consciousness (55.4%), fever (39.9%), vomiting (35.1%), and headache (16.1%) were common complaints in seizure patients. Significant number of GTCS cases had fever (P=0.041) and neurocysticercosis (n=72; 43%) was the most common etiology in seizure patients. Idiopathic epilepsy (38 (22.6%)), meningoencephalitis (26 (15.5%)), and febrile convulsions (14 (8.33%)) were other leading disorders in children with seizures.

Sclerema neonatorum is a form of panniculitides characterized by diffuse hardening of subcutaneous tissue with minimal inflammation. It usually affects ill and preterm neonates. Prognosis is usually poor in many cases despite aggressive management. Various treatment modalities (antibiotics, intravenous immunoglobulin, steroids, and exchange transfusion) have been explained in literature. Steroids due to its easy availability and low cost can prove to be lifesaving in such cases, especially in resource poor countries. Here, we report a case of sclerema neonatorum in a one-week preterm baby treated successfully with parenteral steroids and antibiotics.

Goldenhar syndrome (GS), a rare condition, occurring due to defect in development of first and second branchial arches, is characterized by a combination of various anomalies involving face, eyes, ears, vertebrae, heart, and lungs. The etiology of GS is not fully known, although various hypotheses have been proposed along with its genetic association and many other causes. Facial asymmetry and hypoplasia of the mandible are characteristic features of GS along with microtia and preauricular appendages and pits. Dextrocardia or pulmonary hypoplasia in GS has previously been reported separately. We report a 7-year-old female child of GS with combination of anomalies, dextrocardia, and pulmonary hypoplasia, which is a rare association.

The Chinese pangolin Manis pentadactyla is categorized as Critically Endangered on the IUCN Red List but little is known about its status in Nepal. Although indirect sign surveys have reported its presence in several community forests in Kavrepalanchok district, no photographic or video evidence has previously been documented. We used camera traps to investigate the occurrence of pangolins in 20 community forests in Panauti Municipality in Kavrepalanchok. A total of 75 0.01 km2 plots were surveyed using camera traps during September 2022–February 2023, with a total survey effort of 803 trap-days. The cameras recorded a total of 16 individual video footage events of Chinese pangolins in six of the community forests. This is the first camera-trap evidence of the species' presence in these forest patches, and in Kavrepalanchok district. The pangolins displayed behaviours such as sniffing, gathering plant material and digging, between 18.00 and 1.00. The camera-trap records provide more accurate species identification and reliable information than indirect sign surveys, indicating camera traps are a useful surveying tool for rare, nocturnal and elusive pangolins.