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Datura stramonium is a common plant found all over Nepal. It contains alkaloids like atropine, hyoscyamine and scopolamine which can produce severe anti-cholinergic effects upon intoxication. It is mostly consumed during Mahashivaratri as a means of recreation and sacred blessing from lord Shiva. We would like to present a case of accidental poisoning in children by consuming sacred food mixed with D. stramonium during Mahashivaratri. Careful history taking and physical examination is important for early diagnosis. Presence of eye witness and early presentation to hospital contributes to favorable outcome. It may be more beneficial if we become more cautious and follow safety measures while performing cultural rituals and celebrating festivals. Also, we need to be aware of the possible fatal complications of Datura poisoning.

Background: Acute glomerulonephritis is a common pediatric kidney disease which places a huge burden in developing countries. This study aimed to evaluate causes, clinical manifestations, laboratory findings and complications of acute glomerulonephritis in children presented to a tertiary care center of Nepal. Methods: This was a retrospective review of records of children admitted with acute glomerulonephritis at Chitwan Medical College from April 2018 to February 2021. Socio-demographic data, clinic-laboratory profile and outcomes were obtained from medical records and descriptive analysis was carried out. Results: Among 48 recruited children with acute glomerulonephritis, 60.4% were male and the mean age was 9.5 ± 3.7 years. Post infectious glomerulonephritis including post streptococcal glomerulonephritis (48%) was the main cause of acute glomerulonephritis. The major clinical features were edema (81.3%), hypertension (72.9%), dyspnea (29.2%) and hematuria (25%). ASO titer was positive in 45.8%. The complications noted were acute kidney injury (6.3%), hypertensive emergency (6.3%) and congestive cardiac failure (2.1%). Conclusions: Most of the patients were above 5 years of age and presented most commonly during autumn and summer season. The complications of acute glomerulonephritis were acute kidney injury, hypertensive emergency and congestive cardiac failure.

Caffey disease is a rare, self limiting condition which usually presents in early infancy. The clinical features include fever, irritability, inflammatory swelling of soft tissue due to acute inflammation of the periosteum and subperiosteal new bone formation. Possible differential diagnoses are osteomyelitis, hypervitaminosis A, scurvy, bone tumours, prolonged use of Prostaglandin E1 (PGE1) and child abuse. Although self-limiting, it can cause diagnostic dilemma leading to delayed diagnosis and unnecessary investigations. Here, we report a case of two month old male infant presenting with painful left scapular mass.

West syndrome is a genetically heterogeneous electro-clinical syndrome starting in early infancy. Short-term goal of therapy is spasm control and with standard hormonal or vigabatrin treatment, spasms can be controlled in 60 to 80% of patients in 2 weeks to 3 months period. Hormonal treatment with oral steroid is an alternative therapy to injectable adrenocorticotropin hormone, especially in low resource areas. Vigabatrin is preferred in tuberous sclerosis patients. Long-term aim of treatment is sustained remission of seizures and better neurodevelopmental outcome. About 50 to 70% of children are spasm free for prolonged duration, but epilepsy with multiple seizure types including Lennox–Gastaut syndrome is evident in 20 to 40% of children in long-term follow-up. Though hypsarrhythmia is helpful for the diagnosis, prognostic role of the resolution of electroencephalographic abnormalities is still uncertain. Seizures can be controlled in 40 to 60% of the patients, but only 12 to 40% children have normal neurodevelopmental outcome and a third of children are left with severe disabilities. Children with unknown etiology and normal development at spasm onset have better clinical outcome. Young age at onset, nonstandard therapy have less favorable outcome. Surgery is helpful for spasm control in patients with structural lesions and refractory spasms even in the absence of structural lesions.

Introduction: Febrile seizure is the most common convulsive event in children younger than 60 months. Fever plays an important role in causing disturbances in fluid and electrolyte balance, also hyponatremia has been thought to enhance the susceptibility to seizures. The objective of this study is to find out the prevalence of febrile seizures among children admitted to the Department of Paediatrics of a tertiary care centre. Methods: A descriptive cross-sectional study among children admitted to the Department of Paediatrics was done at a tertiary care centre between December, 2020 to September, 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 077/078-098). A total of 1052 children were included in this study. A convenience sampling technique was used. Statistical Package for the Social Sciences version 25.0 was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 1052 children, the prevalence of febrile seizure was 100 (9.50%) (7.73-11.27 at 95% Confidence Interval). Among these 100 patients, 68 (68%) had simple febrile seizures while 32 (32%) had recurrent febrile seizures. Conclusions: The prevalence of febrile seizures was found to be higher than in other studies conducted in similar settings. This knowledge may be of practical value in advising parents or caregivers of the risk of a febrile seizure and its recurrence.

With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.

Vitamin K deficiency bleeding (VKDB) can manifest as intracranial hemorrhage (ICH) and is still prevalent in poor resource countries. Infants aged one to twelve months with the diagnosis of ICH from 1st July 2011 to 30th June 2016 were included. There were 16 cases of ICH attributed to vitamin K deficiency. Clinical presentations were anemia16 (100%), bulged fontanel 13(81.3%), seizures 10(62.5%), vomiting 8(50%) and fever 9(56.3%). Mean INR at admission was 8.575±7.267 and 1.868±0.838 after three doses of vitamin K administration. Sites of intracranial bleed were parenchymal 5(31.3%), subdural 4(25%), extradural 2(12.5%), ventricular 2(12.5%). In 3(18.8%) of cases bleeding was more extensive involving more than one site. Mortality was 4(25%) and 3(18.8%) had abnormal neurological findings at discharge. There is an urgent need for national policy for vitamin K prophylaxis at birth.

Background: Neonatal mortality rate of developing countries is declining over decades. In the recent years increasing number of preterm and high risk neonates have facilities for tertiary care treatment. The aim of the study was to assess the morbidities and outcome of neonatal intensive care admissions.Methods: It was a retrospective observational study carried out in neonatal intensive care unit of the Manipal Teaching Hospital, Pokhara, Nepal from January 2014 to December 2015. Neonatal details including place of delivery, birth weight, gestation, diagnosis at admission, hospital course and final outcome were recorded in predesigned proforma. Risk of mortality was calculated using odds ratio and 95% confidence interval. Results: There were total 1708 admission during study period and inborn as well as out born neonates were equally admitted. Neonatal hyperbilirubinemia (37.1%), neonatal sepsis 532 (31.2%), prematurity, 314 (18.4%) perinatal asphyxia 112 (6.6%), meconium aspiration syndrome 79 (4.6%) and intrauterine growth restriction 49 (2.8%) were main indications for hospitalization. A total of 1410 (82.6%) the patients were discharged after treatment, 167 (9.7) left against medical advice, 115 (6.7%) died in hospital and 16 (1%) cases were referred. Preterm neonates had twice the risk of mortality than term neonates (OR =2.1664). Birth weight < 2500 grams had three times more risk of neonatal mortality than normal birth weight (OR =3.0783).Conclusions: Neonatal hyperbilirubinemia, prematurity and neonatal sepsis were common morbidities inneonatal intensive care unit.

Under the sustainable Development Agenda 2030, WHO is supporting the countries for achieving the global hepatitis goals by formulating evidence-based policy and data for action, promoting partnerships and mobilizing resources, raising awareness, preventing transmission, and also improving the screening, care and treatment services. There is an urgent need for a national policy for active and passive hepatitis B immunization to sustain our low transmission status.Nepal J Epidemiol. 2017;7(3); 694-696

We report a case of Hurler syndrome in 10 years old boy diagnosed on the basis of classical clinical and radiological features. Early diagnosis, genetic counseling and regular follow up with recent modalities of treatment can decrease mortality significantly and the child may grow normally.J Nepal Paediatr Soc 2016;36(3):295-297

BACKGROUND: Both spacing and permanent birth control methods are the need of the hour. The popularity of male sterilization i.e. vasectomy is low compared to female sterilization (tubectomy). However, being safe, effective, cheap, and having less surgical complications no scalpel vasectomy (NSV) is emerging as good option. AIMS: To study the various demographic and behavioural factors of NSV acceptors. SETTING & DESIGN: This is institution based retrospective study conducted in Department of Obstetrics and Gynaecology, Medical College, Kolkata during the time period of 1st April ‘2009 to 31st March’ 2015. METHODS AND MATERIAL: The patients who accepted NSV for family planning were analysed with respect to their age, residence, occupation, literacy, number of issues and complications. STATISTICAL ANALYSIS: Data were represented as simple proportions or percentages and graphs by using micro soft excel. RESULTS: Out of 13, 048 sterilization operations, there were 3737(28.64%) vasectomies and 9311(71.36%) tubectomies. 67.08% of the couples selected sterilization for contraception. Tubectomies accounted for 2.5 times the vasectomies. The number of NSVs as a percentage of total sterilizations were 28.78% in 2009, rising to 36.96% in 2011 and gradually falling to 21.36% in 2015. Most of the clients (84%) were ≥30 years of age. In 2009-10, only educated (71%, primary education) accepted NSV. However, 74% were illiterate acceptors in 2014-15 and 83% were labourers. In last 2 years the trend is NSV after the 3rd child. CONCLUSION: NSV is emerging as a socially and culturally acceptable method of contraception in our society.

This editorial concludes that prevention is still better than cure, but instead of a mass Vitamin A supplementation in Nepal, we need a health promotion intervention aiming to increase the intake of relatively cheap vegetables and fruit (containing β carotene). In addition we need better surveillance and help to identify children with Vitamin A Deficiency and provide them with Vitamin A supplements. The primary focus should be on adopting sustainable food based approaches to combat vitamin A deficiency. In Public Health terms: rather than a blanket coverage of Vitamin A supplementation to whole population we should consider a targeted intervention aimed at those who need it most.

Introduction Neurocysticercosis is a common cause of seizure disorders in children of Western Nepal. The clinical presentation is variable. The incidence varies depending on the food habits and ethnicity of the population. The present study was undertaken with the objective of studying the mode of presentation, radiological findings and to determine the recent trend of the disease in children of Western Nepal. Methods Records from the Department of Pediatrics, Manipal Teaching Hospital, Pokhara, Nepal of children aged 0–17 years admitted from 2003 to 2015 and with the discharge diagnosis of seizure and neurocysticercosis (NCC) were reviewed. The diagnosis was primarily based on clinical features, neurological involvement and CT and MRI studies. Seizures due to other CNS pathologies were excluded. Patients with NCC were treated with Albendazole15mg/kg/day for 28 days with supportive treatments for seizures and raised intracranial pressure. Patients were followed up for one year after the completion of the treatment. Results There were 1355 cases of seizure disorders, out of which 229 (16.90%) were NCC. There were 99 (43.23%) in the age group 6–10 years followed by 91 (41.09%) in the age group of 11–15 years. Seizures were the most common presenting symptom in 88.65%, followed by raised ICP in 9.61%. Neuropsychiatric changes were noted in 38 cases (16.59%). CT scan findings revealed single lesion in 78.16% and multiple lesions in 21.83%. Poisson regression analysis showed statistically significant decline of year-wise incidence of NCC cases (p, Author summary Neurocysticercosis is a common parasitic infection of the central nervous system. It is caused by larval form of Taenia solium and it has been identified as a “Neglected Tropical Disease” endemic in south East Asia, including Nepal, by WHO. The clinical features in children are pleomorphic depending on the number, location and size of cysticerci. The parenchymatous lesions are presented as neurological symptoms like sudden onset seizures, encephalitis, raised intracranial pressure and neuropsychiatric symptoms. CT and MRI are the main diagnostic tools. Maximum incidence was found in school age children (6–15 years). Year wise review of percentage of NCC, revealed a declining trend from 20.83% in 2009 to 5.37% in 2014. The decline in the incidence of NCC noted in our study might be due to biannual deworming using Albendazole as a part of School Health and Nutrition Programme started by Ministry of Health Services, Nepal in 2008 and extended to all the districts of the country. In addition construction of household and school toilets to avoid open defecation, health education and hand washing facilities might have played a role. Large multicentre trials to evaluate role of biannual Albendazole to prevent cysticercosis is recommended.

Background: Analysis of cerebrospinal fluid is gold standard for diagnosis of meningitis. There is considerable difficulty in interpreting laboratory finding after prior antibiotic therapy. This study was conducted to evaluate the effect of intravenous antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. Methods: A hospital based retrospective study carried out using the data retrieved from the medical record department of Manipal Teaching Hospital Pokhara, Nepal; from 1st July 2006 to 31st July 2011. Clinical findings and relevant investigations were entered in a predesigned proforma. Patients were divided in two different groups as bacterial meningitis with and without prior intravenous antibiotic therapy. Various laboratory parameters including CSF were compared between these two groups using the statistical software, SPSS version 18.0. Results: A total of 114 children were included in this study among which 49(43%) children had received intravenous antibiotics before lumbar puncture. Mean CSF WBC count was(267.6± 211 vs. 208.1±125.3.3) and protein level (114.1±65.9 vs. 98.3±37.7mg/dl) in untreated vs. pretreated groups respectively. Neutrophil percentage was decreased (57.1±28.1vs.72.9±18.9) with higher CSF sugar level (43.3±11.8 vs. 51.2±13.2) after prior antibiotics therapy (p

Background: Snake bite is a widely distributed and neglected condition with a significant mortality. Medically significant snakes are: Elapidae, which are mainly neurotoxic and Viperidae, which are hemotoxic. Most studies on snake bites are done in Terai belt of Nepal and this is a first study of its kind in children in western region of Nepal. Methods: This was a 7 year retrospective study in Pediatric unit of Manipal Teaching Hospital, Pokhara, Nepal. Relevant data from all cases of snake bite in children up to 18 years of age was collected in a structured proforma and analyzed. Results: Among the 39 cases of Snake bites; it was more in boys (M: F=1.16:1), from rural areas (62%) and was more common during monsoon (64%). The commonest site of bite was foot (64%). Snakes were identifiable in only 23% of the cases. Local swelling (77%) and pain (74%) were common clinical features. Coagulation profile was deranged in 80% of the patients, hematuria was observed in 13% patients and 15% patients had thrombocytopenia. Most of the snakes were hemotoxic (77%) and only 1 case (2.5%) was neurotoxic. Only 44% of the patients received polyvalent anti-snake venom and blood products were required in 51% of the patients. Most patients improved (75%) and the case fatality rate was 2.5%. Conclusion: Most snakes found in mountainous region of Nepal are hemotoxic and lead to deranged coagulation profile. Mortality is low in hemotoxic as compared to neurotoxic envenomations. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 119-124 DOI: http://dx.doi.org/10.3126/njms.v2i2.8954

Introduction: Diarrhoea is an undesirable side effect when treating common infections in children with antibiotics. Though studies have shown the effectiveness of probiotics in preventing antibiotic associated diarrhoea, and there is no documented research in Nepal regarding this issue. Aim: The objective of this study was to observe the efficacy of probiotics for the prevention of antibiotic associated diarrhoea when co-administered with an oral antibiotic in children with respiratory tract infections who attended the outpatient department in Manipal Teaching Hospital, Pokhara, Nepal. Materials and Methods: A prospective interventional study was conducted from January 2016 to October 2016 in which 174 children attending the outpatient department in Manipal Teaching Hospital, Pokhara, Nepal and requiring antibiotics for respiratory tract infection were enrolled using convenient sampling method. Eighty-seven of the subjects received standard antibiotic treatment with amoxicillin and clavulanate (control group) and another 87 children received the same antibiotic which was prescribed along with probiotics (probiotic group). Result: Out of the 174 eligible children enrolled in the study, diarrhoea occurred in 11/87 (12.6%) of the patients in the control group and in 1/87 (1.1%) patient in the probiotic group {relative risk, 12.45, 95% CI(1.57,98.67)}. The co-administration of probiotic with amoxicillin and clavulanate significantly decreased the incidence of diarrhoea in the probiotic group (p= 0.003). Conclusion: Co-administration of probiotics in children receiving oral amoxicillin and clavulanic acid reduces the risk of diarrhoea.

Perinatal asphyxia with hypoxic ischemic encephalopathy (HIE) causes significant mortality and morbidity in developing countries. There is limited information about long term neurodevelopmental outcome of infants with neonatal encephalopathy.Term infants with the diagnosis of perinatal asphyxia were followed up in neurodevelopmental clinics of Manipal Teaching hospital, Nepal. Study design was prospective mixed longitudinal study. Prematurity, major congenital malformations, other intracranial pathology, birth weight2500g and chromosomal abnormalities were excluded. After consent and enrollment their detailed perinatal history, Apgar score, resuscitation measures and outcome parameters were recorded on a predesigned proforma. Developmental assessment was done with Denver Developmental Screening Tool 2nd edition (DDST 2) at the age of 3months, 6months, 9months, 1year, 18months and 2years.Total 187 assessments done in the age group of 3months to 2years among HIE stage 2 patients. Impaired hearing and vision was noted in 5.3% while language delay was observed in 19.2% of infants. Abnormal tone and deep tendon reflexes were noted in 46.2% infants at 3months. Abnormal tone and reflexes were noted only in 18.8% and 9.4% respectively at the age of 2years. Overall, gross motor delay was noted in 55(29.4%) of patient, 34(18.2%) showed fine motor delay and 17.1% social delay. Seizures were persistent in 15.6% patients at 2years age.Infants affected with HIE have delay in all sectors of developmental milestones. Motor abnormalities are common and tend to improve with advancing age.

Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA Syndrome) is a rare congenital anomaly. It mostly presents with severe dysmenorrhea and a palpable mass due to unilateral hematocolpos. Sometime it presents in unusual way with prolonged vaginal bleeding and profuse vaginal discharge. We report a case of an 18-year-old married female with OHVIRA syndrome presenting late with symptoms of recurrent pyocolpos following dilatation and evacuation for midtrimester miscarriage that was diagnosed on the basis of MRI and managed by vaginal septotomy.

Tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is a rare congenital anomaly. Most of the children are treated for episodes of pneumonia prior to definitive diagnosis. A 5 months infant presented with recurrent pneumonia and diagnosis of H type TEF was made with contrast esophagram.DOI: http://dx.doi.org/10.3126/jnps.v34i1.8517 J Nepal Paediatr Soc 2014;34(1):71-73

There are many anesthetic hazards of major operations, some of which may be fatal and others may leave the patient with terminal disability. Unintentional intra-arterial (IA) injection of medications can lead to clinically important sequelae, including paresthesias, severe pain, motor dysfunction, compartment syndrome, gangrene, and limb loss. Incidences of these complications have been reported to be 1 in 3,440 to 1 in 56,000 [1]. We are reporting one such uncommon postoperative complication that occurred following cesarean section together with a discussion on the means of its early diagnosis and prevention.

Is N-acetylcysteine a better Insulin Sensitizer than Metformin in Polycystic Ovarian Syndrome? The primary objective of this study was to examine the effect of NAC on IR by HOMA-IR compared to that of MET in PCOS patients. The secondary objectives were to study their effects on other parameters: BMI, waist circumference, fasting blood glucose, fasting insulin, serum testosterone and clinical improvement of hyperandrogenic features.

Objective To study the difference in causes of maternal deaths at two tertiary centers one being rural and the other urban.

Background Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups presenting to tertiary center in Western Nepal. Methods This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Manipal Teaching Hospital, Pokhara from 1st July 2007 to 31st July 2011.Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results A total of 551 patients were admitted for seizures with 338 (61.3%) males and 213 (38.7%) females. Among these patients, 295 (53.5%) presented with fever and 317 (57.5%) of children were less than 5 years of age. Generalized tonic-clonic seizures were the most common seizure type (69.9%). Seizure disorder (33.4%), febrile seizures (30.7%), CNS infections and neurocysticercosis were common etiologies. Abnormal brain images were noted in 111 (45.9%) of 242 patients and most common abnormality was neurocysticercosis 66 (59.5%). Conclusion CNS infections and febrile convulsions were common causes of seizures in febrile children. Neuroimaging should be advised in all afebrile children for the diagnosis of neurocysticercosis. Children diagnosed as seizure disorder require long term follow up studies including neurophysiologic studies.