Journal of Nepal Paediatric Society <p>Journal of Nepal Paediatric Society is the official journal of Nepal Paediatric Society. It is a peer reviewed, open access, paediatric journal and follows the general principles of scientific publications. It is a paediatric journal which publishes articles related to all aspects of health care in neonates, children and adolescents.&nbsp;</p> <p>Journal of Nepal Paediatric Society is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Nepal Paediatric Society (NEPAS) en-US Journal of Nepal Paediatric Society 1990-7974 <p>Authors who publish with this journal agree to the following terms:</p><p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="CC-BY" href="" target="_blank">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p><p>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</p>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>). Anaemia In Preschool Children:its Correlation With Pica <p><strong>Introduction:</strong> According to the third National Family Health Survey, 79% of Indian children are anaemic. Pica is characterized by the persistent ingestion of non-nutritive substances such as plaster, charcoal, chalk, and earth for at least one month in a manner that is inappropriate for their developmental level. We investigated the correlation between pica behaviour and anaemia in preschool children.</p> <p><strong>Methods:</strong> In total, 103 children of ages six to 48 months attending the OPD were randomly included in this study for six months; they presented with clinical features of anaemia. Complete blood count and peripheral blood film examination were carried out. The children were assessed clinically for signs and symptoms of anaemia. History of ingestion of clay, sand, chalk, wall paints etc was asked from the parents.</p> <p><strong>Results:</strong> Most of the children (90.3%) had microcytic hypochromic anaemia with a mean haemoglobin value of 8.82 g / dl. The mean age was 18 months, and boys slightly outnumbered girls. In total, 57.3% of children had a positive history of pica, and all of them were found to be anaemic. However, no significant statistical correlation was observed between anaemia and history of pica.</p> <p><strong>Conclusions:</strong> All children with history of pica were anaemic and the most common type of anaemia was microcytic hypochromic. Although no significant statistical correlation was observed between and history of pica, it is very important for the clinicians to be cautious of this common condition and evaluate for anaemia</p> Sukhdeep Kaur Kunwar Pal Singh Copyright (c) 2022 DR. SUKHDEEP KAUR, DR.KUNWAR PAL SINGH 2022-11-27 2022-11-27 42 1 8 12 10.3126/jnps.v42i1.41453 Anxiety and Depression and their Predictors among School Adolescents of Kathmandu, Nepal <p><strong>Introduction:</strong> Adolescence is a vulnerable period in which different physical, psychological and behavioral changes occur contributing to mental health issues. Depression and anxiety occur more commonly than would be expected by chance in children and adolescents. Undetected and untreated mental disorders can impair one’s ability to perform at school or work place, cope with daily life activities and can lead to severe mental disorders and related consequences. The aim of this study was to assess the levels of anxiety and depression and their predictors among the adolescents of Kathmandu, Nepal. </p> <p><strong>Methods:</strong> A cross-sectional study was conducted in different higher secondary schools of Kathmandu. Cluster random sampling method was used to select 482 students of Grade XI and XII. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI)-II were used to assess the levels of anxiety and depression.</p> <p><strong>Results:</strong> Among 482 students, 230 (47.7%) were females and 252 (52.3%) were males with mean age of 17.25 (± 1.01) years. Majority (38.6%) had minimal anxiety and 11.6% had severe anxiety. On the other side, 45.9% had no depression and 16.4% had severe depression. Grade, sex, health problem, use of gadget and academic performance are found to be the predictors of anxiety, while, the predictors of depression are age, sex, health problem and academic performance.</p> <p><strong>Conclusions:</strong> Anxiety and depression are found prevalent among the adolescents, which need to be explored and addressed immediately through appropriate measures. Psychological counseling and support services should be available to vulnerable students.</p> Shanti Bajracharya Sujata Shakya Liza Nagarkoti Rita Kumari Ban Kalpana Regmi Copyright (c) 2022 Shanti Bajracharya, Associate Professor, Sujata Shakya, Liza Nagarkoti, Nursing Officer, Rita Kumari Ban, Associate Professor, Kalpana Regmi, Lecturer 2022-11-27 2022-11-27 42 1 13 21 10.3126/jnps.v42i1.38310 Clinico-epidemiological Profile of Children with Diphtheria in Tertiary Care Hospital of Nepal <p><strong>Introduction:</strong> This study was conducted with the aim to describe the clinical presentation of diphtheria in children, relationship between clinical disease and immunization status, complications of the disease and adverse events due to anti diphtheria serum (ADS).</p> <p><strong>Methods:</strong> All patients admitted at Tribhuvan University Teaching Hospital, Kathmandu from July 2016 to November 2018 with clinical diagnosis of diphtheria were included in this study.</p> <p><strong>Results:</strong> There were total 12 children and age ranged from five to 15 years, out of which seven (58%) were males and five (42%) were females. All of them were immunized except one whose immunization status was unknown. All of them had tonsillopharyngeal diphtheria. Four patients (33%) also had nasal and five (42%) patients had additional laryngotracheal diphtheria. Seven patients had bull neck on presentation. Four patients had airway obstruction due to laryngotracheal diphtheria requiring tracheostomy. Throat swab for Corynebacterium Diphtheria by Albert stain and Gram stain were positive in 10 patients, and in nine, diagnosis was confirmed by culture. Six patients (50%) were given anti diphtheria serum (ADS) out of which four patients (66.66%) developed anaphylaxis. Myocarditis was the commonest complication seen in four patients (25%). All children with myocarditis developed complete heart block (CHB) and none of them survived.</p> <p><strong>Conclusions:</strong> Tonsillopharyngeal diphtheria was the most common clinical presentation and myocarditis was highly fatal complication. This study emphasizes on the need for careful surveillance, early laboratory confirmation and careful administration of ADS in patients with clinical diagnosis of diphtheria.</p> Srijana Basnet Laxman Shrestha Luna Bajracharya Copyright (c) 2022 srijana basnet, Laxman shrestha, Luna Bajracharya 2022-11-27 2022-11-27 42 1 22 25 10.3126/jnps.v42i1.40546 Clinico-radiological Profile and Outcome of Children with Viral Pneumonia admitted to Paediatric Intensive Care Unit in the pre COVID 19 period <p><strong>Introduction:</strong> Viruses are common etiological agents of severe acute respiratory illness in under five children. Very few studies are available considering the profile of children with viral pneumonia admitted to paediatric intensive care unit (PICU) in our setting. Hence this study was done to describe the clinico- radiological profile and outcome of children diagnosed with viral pneumonia admitted to PICU.</p> <p><strong>Methods:</strong> This was a retrospective descriptive study done in the PICU of a tertiary care hospital in South India. The presenting clinical features, blood parameters, chest radiography findings, course during the hospital stay and outcome of children with viral pneumonia (RT- PCR Positive) admitted to PICU were studied.</p> <p><strong>Results:</strong> The aetiological profile of 28 children included - Influenza virus - 14 cases, Respiratory Syncytial Virus - 6 cases, Adeno virus - 4 cases, Human Boca virus - 2 cases, Human Rhino Virus - 1 case and Human metapneumo Virus - 1 case. Majority of children (50%) presented with severe respiratory distress. Predominant radiological picture included bilateral interstitial infiltrates followed by patchy alveolar consolidation. Eight children required mechanical ventilation. Complications included septic shock and MODS (n = 5), pneumothorax (n = 2), myocarditis (n = 2), pleural effusion (n = 1), ventilator associated pneumonia (n = 2) and pulmonary artery hypertension (n = 2). Mortality was observed in seven (25%) children. SpO2 / FiO2 ratio &lt; 300, shock at admission, neutrophil leucocyte ratio &gt; 2 and hypoalbuminemia were found to be significant predictors of mortality.</p> <p><strong>Conclusions:</strong> Malnutrition and iron deficiency analmia were the common risk factors. Patchy alveolar consolidation is also a common radiological finding along with interstitial infiltrates. Hypoalbuminemia was a common finding among non-survivors.</p> Shrikiran Aroor Suneel Mundkur Sandeep Kumar Copyright (c) 2022 Shrikiran Aroor, Suneel Mundkur, Sandeep Kumar 2022-11-27 2022-11-27 42 1 26 32 10.3126/jnps.v42i1.38454 Determinants of Mortality in Preterm Newborns Admitted in a Neonatal Intensive Care Unit: Findings from a Tertiary Level Maternity Hospital in Nepal <p><strong>Introduction:</strong> Prematurity is a major cause of admission in the NICU in most hospitals. Premature babies are likely to face complications. Understanding the factors contributing to preterm mortality is needed to identify interventions required to reduce neonatal mortality rate. This study aims to determine the causes of mortality in preterm babies.</p> <p><strong>Methods:</strong> A retrospective study was carried out in Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal. All the preterm babies admitted in the sick newborn units were included. Descriptive statistics were performed using frequency and percentage. The bivariate and multivariate analyses were performed to determine the causes of mortality in preterm.</p> <p><strong>Results:</strong> Total 205 (71.4%) admitted preterm babies had complications at the time of admission. LBW babies were three times more likely to have mortality among preterm admission (p – value &lt; 0.0001). Co-morbidities such as sepsis (p - value &lt; 0.05) and perinatal asphyxia (p – value &lt; 0.0001) were significantly associated with preterm mortality. The duration of stay among preterm babies was higher compared to term babies. The mortality rate was higher among preterm admission compared to term admission (60% vs 40%).</p> <p><strong>Conclusions:</strong> Preterm babies with LBW, neonatal sepsis and perinatal asphyxia are at greater risk of mortality. Improved antenatal and perinatal care, quality newborn care and appropriate infection prevention measures can help reduce preterm birth, prematurity related complications and mortality among these vulnerable group of newborns.</p> Shailendra Bir Karmacharya Kalpana Upadhyaya Subedi Sumit Agrawal Noora Pradhan Ritesh Barnwal Prajwal Paudel Copyright (c) 2022 Shailendra Bir Karmacharya, Kalpana Upadhyaya Subedi, Sumit Agrawal, Noora Pradhan, Ritesh Barnwal, Prajwal Paudel 2022-11-27 2022-11-27 42 1 33 38 10.3126/jnps.v42i1.39957 Early Onset Hypocalcaemia in Sick Newborns: A Prospective Observational Study <p><strong>Introduction:</strong> Calcium physiology is in transitional state after birth and may be deranged by various neonatal disorders leading to hypocalcaemia. Coexisting hypocalcaemia can further worsen underlying condition and increase mortality. This prospective observational study was done to study the incidence, clinical correlates and outcome of early onset hypocalcaemia in sick newborns.</p> <p><strong>Methods:</strong> A prospective observational study was done on 175 sick newborns. Ionized serum calcium levels were measured at six, 24, 48 and 72 hours of age by arterial blood gas analyzer. Maternal and neonatal characteristics, ionized calcium levels, clinical course and outcomes were recorded. Patient characteristics and neonatal morbidities were compared between hypercalcaemic group and normocalcaemic group by chi square test. Odds ratio was calculated to see correlation between hypocalcaemia with respiratory support and death.</p> <p><strong>Results:</strong> Early onset hypocalcaemia occurred in 101 of 175 (57.7%) sick newborns. Early onset hypocalcaemia was higher in preterm babies (59.7%) than term babies (54.1%). Meconium stained amniotic fluid, obstructed labour and MAS were significantly associated with early onset hypocalcaemia. Newborns with MAS and HIE had high incidence of hypocalcaemia in both term and preterm groups. Newborns with hypocalcaemia were more likely to receive mechanical ventilation (OR 2.84; CI 1.28-6.30; p value 0.01) and had higher mortality (OR 2.10; CI 1.02-4.33; p value 0.04).</p> <p><strong>Conclusions:</strong> Early onset hypocalcaemia is very common in sick newborns. Meconium aspiration syndrome was a significant risk factor for early onset hypocalcaemia. Early onset hypocalcaemia was associated with higher odds of receipt of mechanical ventilation and mortality</p> Rimjhim Sonowal Ashok Kumar Copyright (c) 2022 RIMJHIM SONOWAL, ASHOK KUMAR 2022-11-27 2022-11-27 42 1 39 44 10.3126/jnps.v42i1.39298 Efficacy of Hyoscine Butylbromide Versus Drotaverine in Relieving Acute Nonspecific Abdominal Pain in Children- A Non - Randomized Trial <p><strong>Introduction:</strong> Acute abdominal pain is a very common complaint for children presenting to the emergency department (ED). The purpose of this study was to compare efficacy of hyoscine and drotaverine for relieving acute nonspecific abdominal pain in children presenting to ED.</p> <p><strong>Methods:</strong> Total of 52 children aged six years to 16 years were enrolled in a non-randomized trial at Paediatric ED of TUTH from Dec 2017 to June 2018, and randomly allocated to drotaverine or hyoscine groups; 26 in each group. Face pain score-revised tool was used to measure the efficacy of the drug. The primary outcome was to measure the reduction of face pain score (Self-reported) by at least 2 / 10 at 60 minutes after ingestion of study intervention. Other outcomes were requirement of rescue analgesia and adverse effects of drugs.</p> <p><strong>Results:</strong> A total of 20 (77%) in hyoscine and 21 (81%) in drotaverine group responded to oral medication at the end of 60 minutes of oral administration and the difference was not statistically significant (p=0.808). Vomiting was only adverse event present in five (19%) in drotaverine and two (8%) in hyoscine groups, respectively.</p> <p><strong> Conclusions:</strong> In this single center randomized controlled trial, both hyoscine and drotaverine were found to be equally efficacious for relieving acute non-specific abdominal pain in children.</p> Pradip Kumar Paudel Sudha Basnet Merina Shreshtha Copyright (c) 2022 Pradip Kumar Paudel Pradip Kumar Paudel 2022-11-27 2022-11-27 42 1 45 50 10.3126/jnps.v42i1.39773 Empyema Thoracis in children: A Five-Year Analysis from a Tertiary Care Center in Eastern Nepal <p><strong>Introduction:</strong> Complicated community-acquired pneumonia resulting in empyema thoracis remains the largest single cause of morbidity and mortality worldwide in children. This study was carried out to evaluate the clinical profile, associated complications and outcome of empyema thoracis in children.</p> <p><strong>Methods:</strong> A retrospective study was conducted in the Department of Paediatrics at a tertiary care center in Eastern Nepal. A total of 106 children were managed with the diagnosis of complicated pneumonia with effusion or empyema thoracis from March 2017 to February 2021 (Five years). Only those patients who had clinico-radiological evidence of pleural effusion or empyema thoracis and received treatment with or without intercostal chest tube drainage (ICD) as the initial procedure were enrolled in the study. Besides supportive treatments and antibiotics; streptokinase was instilled intrapleurally in all the patients for three days. Patients who did not respond underwent VATS / decortication.</p> <p><strong>Results:</strong> Majority of the children (60.19%) were below five years of age and were males (73.58%). Majority (55.67%) had a right-sided pleural effusion and fever was the predominant symptom (55.66%) at presentation. The pleural fluid culture was sterile in more than half (55.66%) of the patients with Staphylococcus aureus grown in 33.96%. The three most common complications were subcutaneous emphysema, thickened pleura, and pyo-pneumothorax. The success rate of medical management was 83.96% and the mortality was low (2.84%).</p> <p><strong>Conclusions:</strong> The success rate of conservative management with antimicrobial therapy, intercostal drainage and fibrinolytics in this study was high (83.96%) with no major adverse effects of fibrinolytic therapy in empyema thoracis.</p> Shyam Prasad Kafle Namu Koirala Eqtedar Ahmad Lalan Prasad Rauniyar Mukesh Bhatta Copyright (c) 2022 Shyam Prasad Kafle, Namu, Eqtedar Ahmad, Lalan Prasad Rauniyar, Mukesh Bhatta 2022-11-27 2022-11-27 42 1 51 56 10.3126/jnps.v42i1.41183 Extrauterine Growth Restriction among Very Low Birth Weight Neonate using Intergrowth 21st in a Neonatal Intensive Care Unit: A Retrospective Study <p><strong>Introduction:</strong> Extrauterine growth restriction (EUGR) is a universal problem but its prevalence using recent reference growth charts and morbidities associated with it are lacking. The study aims at estimating EUGR prevalence in very low birth weight (VLBW) neonates and its associated morbidities.</p> <p><strong>Methods:</strong> All VLBW neonates admitted to NICU between Jan 2018 to June 2019 were analysed. Neonatal anthropometries were recorded on Intergrowth 21<sup>st</sup> gender based postnatal growth chart. EUGR was defined by weight below 10th percentile at discharge. Demographic profile and neonatal morbidities were compared between EUGR and non-EUGR by using unpaired t test and Chi-square test. Regression was used for identification of the risk factors.</p> <p><strong>Results:</strong> Out of 148 VLBW neonates, 92 (62.1%) were male, 26 (17.56%) were below 1000 gm, 102 (68%) were EUGR at discharge. Mean (SD) birth weight and gestational age were 1202 (221) gms and 30.89 (2.77) wks respectively. Caesarean delivery, higher gestational age, lower birth weight, SGA at birth and prolonged duration to achieve full enteral feeding were significantly associated with EUGR (P &lt; 0.05). Sepsis was significantly associated with EUGR (36.28% vs. 17.4%; P 0.022). EUGR babies needed longer hospital duration (24.56% vs. 16.78%; P 0.005) with a higher mean PMA at discharge (38.07 wks vs. 35.11 wks; P &lt; 0.001). In regression model SGA at birth and delay in achieving full feeding were independent predictor of EUGR.</p> <p><strong> Conclusions:</strong> In VLBW neonate, prevalence of EUGR at discharge was 68%. Sepsis was significantly associated with EUGR. SGA and delay in achieving full feeding were independent predictors of EUGR.</p> Santosh Kumar Panda Bijay Kumar Meher Pravati Jena Deepti Damayanty Pradhan Subhadra Priyadarshini Copyright (c) 2022 Santosh Kumar Panda, Bijay Kumar Meher, Pravati Jena, Deepti Damayanty Pradhan, Subhadra Priyadarshini 2022-11-27 2022-11-27 42 1 57 62 10.3126/jnps.v42i1.41526 Glue Sniffing Among the Street Children Residing at Pokhara Metropolitan, Nepal: A Descriptive Cross-sectional Study <p><strong>Introduction:</strong> Glue sniffing usually refers to volatile substance abuse (VSA) for psychoactive effects. Street children are the children who live, work, and earn their livelihood through the streets of urban settlements. Street children are mostly attracted to substance abuse and more particularly towards volatile substances as they are cheap, easy to access and have psychoactive effects as alcohol intoxication. This study aimed to assess the general characteristics of street children of Pokhara Metropolitan, Nepal who are addicted to glue sniffing.</p> <p><strong> Methods:</strong> A cross-sectional study was conducted among street children who were addicted to glue sniffing through the snowball sampling method in Pokhara Metropolitan, Nepal.</p> <p><strong> Results:</strong> All 88 children who were addicted to glue sniffing were males. Of the total children, 59 (67%) children started glue-sniffing at the age of five to ten years of age while nine (10.2%) children started sniffing even before they were five years old. Addiction to glue (n = 33, 37.5%), pleasure (n = 18, 20.5%)), coping with hunger (n = 14, 15.9%), and being a part of street children group (n = 13, 14.8%) were the major reasons to sniff glue for these children.</p> <p><strong>Conclusions:</strong> It has been observed that the majority of street children are at increased risk of getting involved in glue sniffing. It has resulted in different ill outcomes such as self-destruction and problematic behavior, fights and police arrest. There is a need to focus on the issue of glue sniffing among the street children to save and ensure the quality of life of these vulnerable children.</p> Anil Acharya Naveen Shrestha Shishir Paudel Copyright (c) 2022 Anil Acharya, Naveen Shrestha, Shishir Paudel 2022-11-27 2022-11-27 42 1 63 68 10.3126/jnps.v42i1.37768 Incidence and Risk Factors Association for Ventilator Associated Pneumonia in Neontal Intensive Care Unit <p><strong>Introduction:</strong> Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second commonest nosocomial infection in the neonatal intensive care unit (NICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate and risk factors of early and late ventilator associated pneumonia in NICU.</p> <p><strong>Methods:</strong> The study was conducted from December 2015 to November 2017 in which 40 neonates were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. Birth weight, gestation age, reintubation if needed and number of days of ventilation were noted. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP.</p> <p><strong>Results:</strong> Incidence of Early VAP was 12.5% and that of Late VAP was 87.5%. 93.95% neonates who were reintubated developed VAP. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Birth weight and gestation age were statistically insignificant factors in determining VAP.</p> <p><strong>Conclusions:</strong> Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Gestation age and birth weight have been identified as additional risk factors. Early diagnosis is necessary for appropriate treatment and decreased hospital stay.</p> Naresh Kumar Preeti Malhotra Amanjeet Kaur Bagga Gagandeep Kaur Copyright (c) 2022 Dr Naresh Sharma, Preeti Malhotra Kaur, Amanjeet Kaur Bagga, Gagandeep Kaur 2022-11-27 2022-11-27 42 1 69 73 10.3126/jnps.v42i1.38603 Kidney size in Children of Post-Weaning age: Does Nutrition have an Effect? <p><strong>Introduction:</strong> This study was undertaken to evaluate the effect of nutrition on kidney size and to determine the correlation between renal parameters and different anthropometric parameters.</p> <p><strong>Methods:</strong> This hospital-based descriptive observational study has been done in a tertiary care centre of Kolkata, West Bengal, India. Fifty malnourished children &amp; 50 healthy children (Controls) within the age group of six months to five years were included in the study. Anthropometric parameters (e.g. weight, height, mid-arm circumference, skinfold thickness etc.) were measured manually and bilateral kidney sizes were measured by ultrasound.</p> <p><strong>Results:</strong> Malnourished children had significantly lower weight, mid arm circumference, skinfold thickness, body mass index and body surface area [p &lt; 0.001], but the difference in height / length was not significant (p = 0.074). The length, width, depth and volume of both left and right kidneys and relative renal volume were significantly lower in the malnourished children (p &lt; 0.001). But, the same significance has not been found with kidney width, thickness or volume.</p> <p><strong>Conclusions:</strong> Malnutrition adversely affects kidney growth in children of post-weaning age.</p> Shatanik Sarkar Chaitali Patra Debasree Guha Malay Kumar Dasgupta Santanu Das Copyright (c) 2022 Shatanik Sarkar, Chaitali Patra, Debasree Guha, Malay Kumar Dasgupta, Santanu Das 2022-11-27 2022-11-27 42 1 80 86 10.3126/jnps.v42i1.37245 Knowledge and Perception Regarding Adolescent Sexual and Reproductive Health Services among Adolescents attending a Tertiary Level Hospital <p><strong>Introduction:</strong> Adolescence is the transitional phase of growth and development between childhood and adulthood with ages ranging from 10 to 19 years. Adolescent sexual and reproductive health (ASRH) services are the centers where adolescents can get access to their queries regarding health of both physical as well as psychological aspect. The objective of the study was to find out the knowledge and perception regarding ASRH services among adolescents attending a tertiary level hospital.</p> <p><strong> Methods:</strong> A descriptive study was carried out among 112 adolescents attending adolescent clinic using a pretested structured interview schedule. Non probability purposive sampling technique was used. The data were analyzed using SPSS version 16 through descriptive statistical method and Inferential statistical methods.</p> <p><strong>Results:</strong> The study revealed majority (58.0%) of respondents had moderate level of knowledge regarding ASRH (Mean value 68.89 ± 14.59 S. D). Respondent’s had high perception towards programmatic domain. Almost all (97.3%) of the respondents had positive perception towards ASRH services. There was no statistical significance between the level of knowledge and perception, level of knowledge and sociodemographic variables at 95% confidence level.</p> <p><strong>Conclusions:</strong> The study concludes that adolescents have moderate level of knowledge regarding ASRH. Adolescents have an overall positive perception towards the ASRH services but they have negative perception towards the facility of ASRH services in comparison to programmatic domain.</p> Shreejana Singh Saraswati Sharma Bimala Tandukar Pratibha Silwal Mohan Raj Sharma Copyright (c) 2022 Shreejana Singh, Professor Dr, Bimala Tandukar, Pratibha Silwal, Prof 2022-11-27 2022-11-27 42 1 87 91 10.3126/jnps.v42i1.42662 Maternal Smoking during Pregnancy and its Association with Low Birth Weight <p><strong>Introduction:</strong> Maternal smoking has been an important risk factor for low birth weight (LBW), preterm birth as well as small for gestational age. In this study, we try to analyze the association of maternal smoking during the different stages of pregnancy with outcome of birth weight.</p> <p><strong>Methods:</strong> This is a cross-sectional hospital-based study, which was undertaken comprising of 1240 singleton live born baby in a Tertiary Care Teaching Hospital, Nepal. The enrollment occurred between June 2012 and May 2016 (Four years) among mothers who smoked any time during the current pregnancy. Based on the amount of smoking, the mothers with cigarette smoking were divided into four groups which includes: preconception, the first trimester, second trimester and third trimester. The data analyses were performed using Logistic regression and 95% confidence interval along with p-value. A p-value &lt; 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> Of a total of 1240 singleton births, 328 (26.5%) were LBW. Among them, 149 (12.1%) of the mothers reported smoking during pregnancy. When compared with the nonsmoking groups, all the maternal smoking groups had higher incidences of LBW infants, especially when the mothers smoked &gt; 10 cigarettes / day and during any stage of conception.</p> <p><strong>Conclusions:</strong> Smoking during pregnancy is associated with an increased incidence of LBW among the infants. In addition, the newborns of mothers who smoked &gt;10 cigarettes / day were most susceptible to having LBW, irrespective of the stage of pregnancy during which the mothers smoked.</p> Manju Shrestha Anju Mandal Sweta Kumari Gupta Manish Baidya Copyright (c) 2022 Manju Shrestha, Anju Mandal, Sweta Kumari Gupta, Manish Baidya 2022-11-27 2022-11-27 42 1 92 96 10.3126/jnps.v42i1.37197 Outcome of Surfactant replacement therapy for respiratory distress syndrome in preterm babies <p><strong>Introduction:</strong> Surfactant is an important treatment modality in preterm babies with respiratory distress syndrome leading to decrease in mortality, morbidity and cost of treatment. Experiences on surfactant therapy in Nepal are scarce. This study was conceptualised to find the use and immediate outcome of surfactant therapy in preterm babies in a tertiary care hospital in Nepal.</p> <p><strong>Methods:</strong> A cross-sectional study was done in preterm babies who received surfactant over period of five years at neonatal / pediatric intensive care unit at Patan Hospital, Lalitpur, Nepal. After approval from Institutional review committee, information on gestational age, sex, birth weight, doses of dexamethasone, doses and time surfactant delivery, complications and immediate outcome was retrieved from the files. Comparison between early and late rescue group was done. Data was analysed using SPSS 16.</p> <p><strong>Results:</strong> Twelve babies (11.2%) needed a repeat dose of surfactant. Only 12 (11.2%) babies received early rescue surfactant. About 53 (49.5%) babies developed complications with hypotension being the most common seen in 38 (35.5%) babies. Complications were 75% and 46% in the early and late rescue group respectively (p - 0.22). The mortality was inversely proportional to the gestational age (p - 0.002) and birth weight (p &lt; 0.05). Mortality was 16% in both the groups but the deaths related to complications of surfactant was all in the late rescue group.</p> <p><strong>Conclusions:</strong> Complications were more in early rescue group and mortality was similar in both the groups, but mortality related to complications of surfactant was all in the late rescue group. Complications of surfactant therapy and mortality were inversely proportional to the gestational age and birth weight.</p> Prerana Kansakar Narottam Shrestha Alisha Prajapati Shiva Prasad Chalise Santosh Kumar Mishra Copyright (c) 2022 Prerana Kansakar 2022-11-27 2022-11-27 42 1 97 101 10.3126/jnps.v42i1.38218 Parental Satisfaction with Care and Support in Neonatal Care Units of Public Hospitals of Nepal <p><strong>Introduction:</strong> Parental satisfaction is one of the indicators of quality care. An understanding of the satisfying areas would help to identify and prioritize care and support areas for infants and parents. Therefore, this study was conducted to find out the parental satisfaction with care and support in neonatal care units (NCUs).</p> <p><strong>Methods:</strong> Cross-sectional descriptive study was conducted in NCUs of five selected public hospitals. The study was conducted among 305 parents of preterm infants (PTIs). After obtaining ethical approval, in-person interviews were conducted with parents using a satisfaction questionnaire. Both descriptive and inferential statistics were used for data analysis.</p> <p><strong>Results:</strong> Parents were moderately satisfied with care and support with a median score and interquartile range of 3.4 (3.1- 3.8). They were highly satisfied with the infant care and least satisfied with the attachment and care guidance support with median scores of 4.0 (3.5 - 4.0) and 3.1 (2.6 - 3.8) respectively. Parental satisfaction was significantly associated with parental age, gestational age at birth, and birth weight (P value &lt; 0.05).</p> <p><strong>Conclusions:</strong> Parents are moderately satisfied with the care and support received in the NCUs. Their satisfaction is lower with the support for attachment and care guidance. In addition to competent and affectionate care to PTIs, parental support for attachment, guidance, and involvement in care need to be considered by NCU personnel.</p> Tumla Shrestha Archana Pandey Bista Sarala Shrestha Copyright (c) 2022 Tumla Shrestha, Associate Professor, Dr., Professor, Dr. 2022-11-27 2022-11-27 42 1 102 107 10.3126/jnps.v42i1.42162 Prevalence of Tuberculosis in Severe Acute Malnutrition: A Prospective Observational Study <p><strong>Introduction:</strong> Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. This study was done to determine the prevalence of tuberculosis in severe acute malnutrition (SAM) cases and to observe different presentations of SAM.</p> <p><strong>Method:</strong> This prospective observational study was carried out in the Department of Paediatrics and Adolescent Medicine at a tertiary care center in Nepal for a duration of one year from December 2018 to November 2019. All cases of SAM meeting the inclusion criteria were evaluated with Mantoux test, chest X-ray, gastric aspirate / sputum analysis and gene-Xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data were entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data.</p> <p><strong>Results:</strong> Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). Among TB cases, 40% were without any systemic complaints. Only 19.6% cases presented with nutritional complaint.</p> <p><strong>Conclusions:</strong> This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (Pulmonary TB) in every case of SAM, irrespective of symptoms.</p> Jitendra Thakur Ranjana Thakur Nisha Keshary Bhatta Shankar Prasad Yadav Basudha Khanal Narayan Raj Bhattarai Copyright (c) 2022 jitendra thakur, Dr., Dr., Dr., Dr., Dr. 2022-11-27 2022-11-27 42 1 108 111 10.3126/jnps.v42i1.39974 Relationship Between Gross Motor Function and Nutritional Status in Children with Cerebral Palsy attending a Tertiary Children’s Hospital of Nepal <p><strong>Introduction:</strong> Malnutrition is a common problem in children with cerebral palsy and their management outcome is not satisfactory unless we address their nutritional aspect. The present study aims to find the relationship between gross motor function and nutritional status in these children by comparing the proportion of stunting, wasting and under-weight between the various levels of gross motor function.</p> <p><strong>Methods:</strong> Our study was across- sectional study conducted on 82 cases of cerebral palsy between one to five years of age visiting Kanti Children’s Hospital, Kathmandu, Nepal from May 2017 to September 2018. Their level of gross motor function was ascertained by applying the Gross Motor Function Classification System (GMFCS) and anthropometry was done using standard methods. On the basis of their motor function, the children were divided into two categories: those with poorer motor function who had poor self-mobility even with assistance (GMFCS level 4 and 5) and those with better motor function who had self-mobility with various degrees of assistance (GMFCS level 1, 2 and 3). Wasting, stunting and under-weight were compared between the two categories and odds ratio with 95% confidence interval was estimated for malnutrition.</p> <p><strong>Results:</strong> The children belonging to poorer motor function were more likely to be underweight (Odds ratio 3.41; CI 1.36-8.52; p-value 0.008) and stunted (Odds ratio 3.9; CI 1.47-10.53; p-value 0.048) than those with better motor function.</p> <p><strong>Conclusions:</strong> Children with poorer motor function are more likely to develop malnutrition (Specially stunting) than those with better motor function indicating that chronic form of malnutrition is more common in these children.</p> Suraj Dhaubhadel Bina Prajapati Deepeshwara Nepal Copyright (c) 2022 Suraj Dhaubhadel, Bina Prajapati, Deepeshwara Nepal 2022-11-27 2022-11-27 42 1 112 118 10.3126/jnps.v42i1.38130 Retinopathy of Prematurity: Incidence, Risk Factors & Outcome in North Indian Rural and Semi-urban population <p><strong>Introduction:</strong> ROP is a challenge due to better premature survival. It has an increasing trend and is a preventable cause of vision loss. Its occurrence, severity and outcome in rural population is poorly studied.</p> <p><strong>Methods:</strong> Ahospital based prospective observational longitudinal study was conducted on babies born at a tertiary care centre. Babies with gestation &lt;32 weeks or birth weight &lt; 1500 g were screened for ROP. Preterm babies of &gt;32 weeks gestation with oxygen requirement, RDS, surfactant use, PDA, neonatal hyperbilirubinemia requiring phototherapy, septicemia, red cell transfusion due to anemia, need for inotropes were also included. Babies with ROP were assessed for severity as also need for intervention and were followed for12 months.</p> <p><strong>Results:</strong> Of the 211 neonates screened, 51 had ROP. Frequency was inversely related to both birth weight and gestational age with no gender difference. Oxygen therapy (p 0.001), RDS (p 0.005), mechanical ventilation (p0.003) and septicemia (p 0.005) were main risk factors. Neonatal hyperbilirubinemia requiring phototherapy was found to be protective (p 0.0005). 15.68% cases required laser photocoagulation. During follow up, ROP regressed in all patients.</p> <p><strong>Conclusions:</strong> Risk factors for ROP included oxygen usage, RDS, mechanical ventilation and septicemia. Blood products or inotropes use was not an independent factor. Neonatal hyperbilirubinemia was protective. When diagnosed early, outcome is good in ROP.</p> Kamal Parihar Pradeep Kumar Gupta Vandana Singh Sanjay Sharma Copyright (c) 2022 Kamal Parihar, PRADEEP GUPTA, Vandana Singh, Sanjay Sharma 2022-11-27 2022-11-27 42 1 119 123 10.3126/jnps.v42i1.39034 The Efficacy and Safety of Once Daily versus Twice Daily Dosing of Caffeine Citrate in Apnea of prematurity: a Randomised Control Trial <p><strong>Introduction:</strong> Caffeine citrate is widely used for prevention of apnea of prematurity and helps in successful extubation from mechanical ventilation. The optimum caffeine dose in preterm infants with apnea of prematurity has been extensively investigated with varied results. The objective of our study was to compare the efficacy and safety of once versus twice daily maintenance dose of caffeine citrate in premature infants with apnea.</p> <p><strong>Methods:</strong> In this study, preterm neonates with gestational age of 28 to 34 weeks, with evidence of apnea of prematurity were included. Both groups received a 20 mg / kg loading dose of caffeine citrate followed by a maintenance dose of 2.5 mg / kg every 12-hour-interval in group 1 and 5 mg / kg every 24-hour-interval in group 2, either orally or by intravenous infusion. Response to treatment, duration to achieve full feeds, possible adverse reactions were evaluated and compared among the two groups.</p> <p><strong>Results:</strong> Among two groups, group 1 had early reduction in number of apneic episodes on five consecutive days after loading dose, which was statistically significant. Time taken to establish full feeds following treatment initiation was lower in group 1 compared to group 2 (median: Two vs four days) which was statistically significant.</p> <p><strong>Conclusions:</strong> In this study, neonates who received twice daily maintenance dose of caffeine citrate had better outcomes in terms of early reduction in number of apneic episodes and early feed establishment when co</p> Farooq Syed Sandesh kini Abdul Majeed Copyright (c) 2022 Farooq Syed, Sandesh kini, Abdul Majeed 2022-11-27 2022-11-27 42 1 124 128 10.3126/jnps.v42i1.37173 Transcutaneous Bilirubin Measurement as a Predictor of Significant Neonatal Hyperbilirubinemia in Low Birth Weight Neonates <p><strong>Introduction:</strong> Early recognition of neonatal hyperbilirubinemia is essential to prevent bilirubin encephalopathy. Transcutaneous bilirubin (TCB) measurement is a simple and easy method to predict neonatal hyperbilirubinemia. We aimed to study the efficacy of TCB as a predictor of subsequent significant neonatal hyperbilirubinemia in low birth neonates and compared the forehead and sternal sites for TCB measurement.</p> <p><strong>Methods:</strong> A prospective study was conducted from August to October 2018 at a teaching hospital in South India including term and late preterm neonates weighing &lt; 2.5 kg. The TCB values were obtained from the forehead (TCB-FH) and sternum (TCB-S) by a non-Invasive Bilirubin Analyser. The average of TCB (TCB- AV) was determined for each baby with TCB-FH and TCB –S values. Neonates were followed up subsequently till discharge for the development of significant hyperbilirubinemia. Receiver operating characteristic (ROC) curve was generated and the best cut-off value for 24-hour TCB as a predictor of significant hyperbilirubinemia was established.</p> <p><strong>Results:</strong> The study included 88 neonates, of which 39 (44.3%) were late preterm and 49 (55.7%) term small for gestation age. Mean values of TCB –AV 6.25 ± 1.58, TCB – FH 6.24 ± 1.57391, and TCB – S 6.27 ± 1.56 were noted. The cut off value for TCB – AV was found to be 6.85 as a predictor for subsequent neonatal hyperbilirubinemia. TCB – AV was a better predictor than TCB - FH or TCB – S.</p> <p><strong>Conclusions:</strong> TCB measurement is an easy and reliable predictor for subsequent significant hyperbilirubinemia in low birth weight neonates. The average of TCB forehead and sternum was a better predictor of significant hyperbilirubinemia.</p> Suchetha S Rao Karthik Chellaganapathy Nutan Kamath Copyright (c) 2022 Suchetha S Rao, Dr, Karthik Chellaganapathy, Mr, Nutan Kamath, Dr 2022-11-27 2022-11-27 42 1 129 133 10.3126/jnps.v42i1.38236 Utility of Sequential Organ Failure Assessment Score in Prognosticating sick Children in Paediatric Intensive care Unit <p><strong>Introduction:</strong> There are number of scoring systems to assess the morbidity and mortality of sick children in intensive care unit. Out of these scoring systems our study was designed to look for the utility of Sequential Organ Failure Assessment (SOFA) score which is less time consuming and simple to apply as a predictor of mortality in sick children admitted in Paediatric Intensive Care Unit (PICU).</p> <p><strong>Methods:</strong> This was a prospective observational study done in PICU of Universal College of Medical Sciences, Bhairahawa, Nepal. Recruited patients were all critically sick children above one year who stayed in hospital above 72 hours and underwent all necessary evaluation, and were followed up until they were discharged or deceased. Initial SOFA score was calculated within 24 hours of admission (SOFA T0) and again calculated after 72 hours (SOFA T72). Delta SOFA score was calculated as the change in SOFA scores over 72 hours (SOFA T0 - SOFA T72). The primary outcome was in-hospital mortality.</p> <p><strong>Results:</strong> When compared to outcome, the non survivors had high mean initial SOFA (T0) 11.51 ± ences ec ing 3.001 (P &lt; 0.001), mean SOFA after 72 hours (T72) was 15.51 ± 4.026 (P &lt; 0.001) and mean delta SOFA (T0-T72) was 4.58 ± 2.59 (P = 0.166) as compared to survivors. Delta SOFA was not significantly associated with outcome (P = 0.166). The initial SOFA score T0 &gt; / = 11 predicted a mortality of 70.90% and SOFA T72 score of &gt;/=15 predicted a mortality of 81.60% but delta sofa &gt;/= 4 predicts a mortality of only 43.60%. Area under receiver operating characteristic (ROC) curve for SOFA TO was 0.769, for SOFA T72 was 0.890 and for delta SOFA was 0.604 and thus, showing excellent discriminative power for SOFA 72 for predicting mortality.</p> <p><strong>Conclusions:</strong> The SOFA score demonstrated fair to good accuracy for predicting mortality when applied to sick children &gt; 1 year admitted in PICU. Our study showed both initial SOFA T0 and SOFA at 72 hours predict mortality with good accuracy but SOFA at 72 hours is a better predictor of mortality as compared to initial and delta SOFA scores.</p> Raju Kafle Shah Sanjeev Gupta Binod Kumar Copyright (c) 2022 Raju Kafle 2022-11-27 2022-11-27 42 1 134 139 10.3126/jnps.v42i1.41178 Hyperbaric Oxygen Therapy : A new Evolving Future Perspective for Management of Mucormycosis and COVID 19 in Children in Developing Countries <p>The SARS COVID-19 virus has arisen as a major hazard to mankind, posing harm to the whole world population. During the second COVID wave, mucormycosis has emerged as one of the deadliest and most devastating illnesses. Mucormycosis is strongly associated with diabetes, prolonged use of steroids, prolonged hospitalisation and immunocompromised states. Children have also been affected by this badly. Hyperbaric oxygen therapy is a non-invasive, cost-effective and painless therapy where 100% oxygen is given to patients under high atmospheric pressure in small tents or chambers. It helps in tissue regeneration and angiogenesis. Hyperbaric oxygen has proved to be effective in the treatment of oculo-rhino-cerebral mucormycosis. Various studies have proved its role in the management of mucormycosis and acute respiratory distress syndrome associated with COVID-19 infection. The advantages of hyperbaric oxygen are same in children as in adults with minimum side effects. Hyperbaric oxygen therapy can be one of the good adjunctive therapies in the management of mucormycosis. It is found to be safe in the treatment of COVID-19 infection, but data is still limited on its use and further studies are needed. This article is all about its use, its efficacy, and future perspectives in the management of mucormycosis and COVID-19 in view of the arrival of the third COVID wave in developing countries like India.</p> Mahaveer Lakra Amar Taksande Bhavana Lakhkar Sachin Damke Ashwini Lakra Copyright (c) 2022 Mahaveer Lakra, Amar Taksande, Bhavana Lakhkar, Sachin Damke, Ashwini Lakra 2022-11-27 2022-11-27 42 1 1 7 10.3126/jnps.v42i1.42443 Role of Sildenafil in Severe COVID-19 Pneumonia in Infancy - A Case Series <p>SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Though pulmonary arterial hypertension (PAH) has been described in as a sequela of COVID pneumonia in adults, only a coincidental association between pre-existing PAH and SARS-CoV-2 infection in children has been reported. To our knowledge, severe COVID pneumoniacausing PAH in children, especially in infancy has not been reported yet. With the meteoric spread of the pandemic and rapid development of newer mutated variants, the timely discovery of new drugs is near impossible. The idea of repurposing existing drugs to treat COVID-19 is an attractive strategy, especially if they are already approved (for other indications) and have wellestablished safety profiles. Sildenafil specifically targets pulmonary vasodilation, endothelial function, and vascular remodelling. It hence has emerged as an effective first - line oral therapeutic agent for patients with symptomatic PAH in all age groups. We present a case series of four cases where Sildenafil has been repurposed for the treatment of PAH associated with severe COVID-19 pneumonia in infancy.</p> Jayant Kumar Muduli Meenakshi Mitra Asish Banerjee Arnab Paul Copyright (c) 2022 Jayant Kumar Muduli, Meenakshi Mitra, Asish Banerjee, Arnab Paul 2022-11-27 2022-11-27 42 1 140 143 10.3126/jnps.v42i1.41095 Acetaminophen induced Stevens Johnson syndrome - Toxic Epidermal Necrolysis Overlap Syndrome: A rare Adverse Reaction <p>Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are hyper sensitive life - threatening rare dermatological reactions. In SJS - TEN overlap syndrome, the extent and severity of epidermal detachment is 10- 30%. Drugs like sulfonamides, nonsteroidal anti- inflammatory agents, antibiotics and anticonvulsants are the commonest precipitants. Here, we present a rare case of SJS - TEN overlap syndrome in a previously normal 11 years old girl after acetaminophen intake for fever. This case report is intended to make paediatricians aware that the adverse reaction like SJS - TEN overlap syndrome can develop with a drug like acetaminophen which is supposed to be the safest antipyretic in paediatrics.</p> Saiprasad Onkareshwar Kavthekar K. Amith Anil Bapurao Kurane Yoganand J Phulari Copyright (c) 2022 kavthekar, Amith k, ravikiran, Yoganand J Phulari 2022-11-27 2022-11-27 42 1 144 146 10.3126/jnps.v42i1.39225 A Neonate with Retroperitoneal Mature Cystic Teratoma – A Case Report <p>Retroperitoneal teratoma is a rare occurrence in neonates. They are usually asymptomatic and the only finding may be abdominal distension. We report an unusual case of a large retroperitoneal teratoma in a neonate who presented with abdominal distension. Imaging done showed a cystic lesion with calcifications, internal septations and fat dense areas. It was successfully managed by surgical excision, findings of which were consistent with that of a mature cystic teratoma. Despite being rare, we must consider retroperitoneal teratomas as a differential diagnosis of an abdominal mass in a newborn. Early detection and complete surgical excision may be life-saving.</p> Jayateertha Joshi Owais Ahmed Mushtaq Sayashi Roy Suchetha S Rao Copyright (c) 2022 Jayateertha Joshi, Owais Ahmed Mushtaq, Sayashi Roy, Suchetha S Rao 2022-11-27 2022-11-27 42 1 147 150 10.3126/jnps.v42i1.38113 Back Pain in Atypical Immediate Hypersensitivity Caused by Exposure to Dust Mites and Molds: A Case Report <p>Immediate hypersensitivity to inhaled allergens is common in children. Although wheezing and urticaria are well known in immediate hypersensitivity, back pain is unknown. A nine year old boy with a history of asthma presented with back pain, but not wheezing or urticaria, while wiping the floor. The immuno-capsulated hydrophilic carrier polymer (ImmunoCAP) test revealed that dust mites and molds were the specific antigens causing the immediate hypersensitivity. Therefore, back pain can appear in immediate hypersensitivity. The ImmunoCAP test is useful for determining the allergens in atypical immediate hypersensitivity. Risk factors can be hidden in daily cleaning.</p> Kazuto Taniguchi Kazutaka Mizuta Kazuyasu Uemichi Copyright (c) 2022 Kazuto Taniguchi, Kazutaka Mizuta, Kazuyasu Uemichi 2022-11-27 2022-11-27 42 1 151 153 10.3126/jnps.v42i1.38141 Chylolymphatic Cyst - Presenting as Acute Intestinal Obstruction – A Case Report <p>Chylolymphatic cyst is one of the rare variants of mesenteric cysts. These cysts are present within mesentery and contain chylous or lymphatic fluid. Chylolymphatic cysts are rare in paediatric age group. We present a case of a four years old boy who presented with features of acute intestinal obstruction. CECT abdomen revealed a hypodense cystic mass in the peritoneal cavity. Exploratory laparotomy of the abdomen revealed a solitary cyst measuring 10.7 cm x 9.4 cm x 10.5 cm which was adherent to the loops of small intestine and right kidney. Complete excision of cyst along with resection of the adjacent gut and end to end anastomosis was done. Histopathology of the excised cyst was suggestive of chylolymphatic cyst. It has been highlighted that chylolymphatic cyst can be a rare cause of intestinal obstruction in children.</p> Sunita Arora Taranjeet Kaur Harwinder Singh Rana Copyright (c) 2022 Taranjeet Kaur 2022-11-27 2022-11-27 42 1 154 156 10.3126/jnps.v42i1.38679 Isolated Pleural Effusion- An Interesting Case Report of Foreign Body Aspiration-A Case Report <p>Foreign body (FB) aspiration is a serious medical problem that can mimic other respiratory conditions. Isolated pleural effusion is a rare presentation of FB aspiration. We report herein a six years old boy presenting with fever and cough without history of choking and respiratory distress and X-ray chest suggestive of pleural effusion. Although, the child was initially misdiagnosed as pneumonia with sympneumonic effusion, the diagnosis was established only once he coughed out a piece of foreign body. The present case highlights that FB aspiration, even though rare, should be considered as one of the differential diagnosis of pleural effusion.</p> Ashish Gupta Deepa Shreyas Ramya Nayak Copyright (c) 2022 Ashish Gupta 2022-11-27 2022-11-27 42 1 157 159 10.3126/jnps.v42i1.39003 Lumbosacral Edema as an Unusual Presentation of Henoch-Schönlein purpura: A Case Report and Literature Review <p>Henoch- Schönlein purpura (HSP) is the most common vasculitis of childhood. Subcutaneous edema in the extremities is a common finding of HSP, whereas lumbosacral edema is a rare presentation. We report a case of HSP in a six year old boy who visited the emergency department for acute - onset back pain with gait problems. An extensive radiologic workup was performed, but the patient was finally diagnosed with HSP based on knee and ankle edema with a few purpura. We described the clinical, imaging findings, and treatment of the current case and review the literature regarding this rare presentation of HSP.</p> Jung Sook Yeom Ji-Hyun Seo Hee-Shang Youn Copyright (c) 2022 Jung Sook Yeom, Ji-Hyun Seo, Hee-Shang Youn 2022-11-27 2022-11-27 42 1 160 163 10.3126/jnps.v42i1.39409