Journal of Nepal Paediatric Society <p>Official journal of the Nepal Paediatric Society (NEPAS). Articles available in full text. From Vol.30, the journal will be published three times a year.</p><p>Journal of Nepal Paediatric Society is included on <a href="" target="_blank">DOAJ</a> and <a title="Scimago" href=";tip=sid&amp;clean=0" target="_blank">Scimago</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>). Prevalence and Knowledge on Obesity Among School Going Adolescents of Kaski, Nepal <p><strong>Introduction: </strong>Childhood obesity has now been recognized as a global health problem because of its devastating consequences and prevalence at uncontrollable rate worldwide. The objective of this study was to determine prevalence of obesity and find out the knowledge on obesity among school going adolescents.</p> <p><strong>Material and Methods: </strong>This descriptive cross-sectional study was conducted among adolescents of two private schools of Kaski district. Altogether 120 adolescent students were selected using census method. Height and weight were measured with standard scale and BMI was calculated. Self-administered structured questionnaire was used to assess knowledge. Descriptive statistics and Chi-square test at 0.05 significance level was used to analyze data.</p> <p><strong>Results: </strong>The mean age of adolescents was 15.1 years and 50% of them were male. The prevalence of obesity among adolescents was 3.3%. Seventy five percent of the adolescents had knowledge regarding meaning of obesity and 59.2% had mentioned high calorie intake as a risk factor of obesity. Likewise, 52.5% adolescents stated Diabetes mellitus as consequence of obesity. Ninety eight percent mentioned regular exercise as a preventive measure of obesity. More than three fourth (78.3%) of the adolescents had inadequate knowledge regarding obesity. Male adolescents had significantly higher knowledge than female adolescents (<em>p</em>=0.00).</p> <p><strong>Conclusion: </strong>Even though very few adolescents had obesity, there were adolescents with overweight which were at more risk for getting obesity. Adolescents have inadequate knowledge regarding obesity.</p> Apsara Pandey Sony Sapkota ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 63 68 10.3126/jnps.v38i2.19917 Assessment of Hand Hygiene Knowledge among Residents and Nursing staffs at Nobel Medical College Teaching Hospital, Biratnagar <p><strong>Introduction</strong>: Hand hygiene is a very simple and cost-effective procedure to prevent cross-transmission of microorganisms. The compliance of residents and nursing staffs with hand hygiene guidelines seems to be vital in preventing disease transmission among patients. The objective of the study was to assess the knowledge of residents and nursing staffs with regard to hand hygiene.</p> <p><strong>Material and Methods: </strong>This was an institution based descriptive cross-sectional study conducted among 55 respondents (29 nursing staffs and 26 resident doctors) of department of paediatrics, Nobel Medical College in Biratnagar, Nepal. Knowledge was assessed using WHO hand hygiene questionnaire for health care workers. Chi square test was used to compare the percentage of correct responses between resident doctors and nursing staffs. A <em>p </em>value of &lt;0.05 was considered significant.</p> <p><strong>Results: </strong>Among 26 resident doctors and 29 nursing staffs who participated in the study, 30.7% of resident doctors and 55.1% of nursing staffs had received formal training in hand hygiene in the last three years. Only 9% of participants (5 out of 55) had good knowledge regarding hand hygiene.</p> <p><strong>Conclusions</strong>: The knowledge regarding hand hygiene is limited among the study population. The study recommends the need for emphasizing hand hygiene component in the preservice as well as in-service training programs of doctors and nurses. &nbsp;</p> Sunil Kumar Yadav Arun Giri ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 69 73 10.3126/jnps.v38i2.20547 Cognitive Function in Children with Epilepsy <p><strong>Introduction: </strong>Epilepsy is a worldwide and common child health problem. One of its complications is cognitive impairment that will impact on children’s cognitive development and quality of life. The objective of this study is to find out whether epilepsy affects cognitive function in children.</p> <p><strong>Material and Methods: </strong>This was a cross-sectional descriptive study using secondary data from medical records. We collected data from children with epilepsy from 2004 until 2014 that have been actively managed in the Growth and Development Clinic, Sardjito General Hospital, Yogyakarta, Indonesia. Cognitive function referred to low IQ score that was gained from patients’ data. We analyzed the data using Fischer’s exact and two-sample Kolmogorov-Smirnov test methods.</p> <p><strong>Results: </strong>Among 40 data samples, there were 19 patients (42.5%) with cognitive impairment (IQ &lt; 70) and 21 patients (57.5%) without cognitive impairment (IQ ≥ 70). There were twenty-five patients examined by the Stanford-Binet IQ test, which found 15 patients with cognitive impairment. In fifteen patients who were examined with the WISC test, we found more children with epilepsy without cognitive impairment (11 patients). Comorbidity with neuro-developmental disorder significantly affected cognitive impairment in children with epilepsy (<em>p </em>value = 0.034, 95% CI 1.08-21.76).</p> <p><strong>Conclusions: </strong>More children with epilepsy without cognitive impairment were found. Further studies are needed with larger number of samples utilizing a prospective study design to better determine the association of epilepsy in children and cognitive impairment. &nbsp;</p> Bayu Pratama Putra Agung Triono Dwi Susilawati ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 74 79 10.3126/jnps.v38i2.19386 Comparison of Oral Trichlophos and Intranasal Midazolam for Sedation in Minimally Invasive Paediatric Procedures (RAMT Study) <p><strong>Introduction: </strong>Uncooperative child does not allow completion of procedures, denying valuable data required for clinicians.</p> <p><strong>Material and Methods: </strong>An open labelled parallel group prospective randomized control study was conducted at zonal hospital Jorhat. We evaluated 200 children randomized into two groups using computer based randomization. Participants aged 3 months to 5 years (<em>n</em>=200) were randomized to receive 50 mg/kg Triclofos sodium orally or intranasal spray of midazolam 0.2 mg/kg.</p> <p><strong>Results: </strong>Adequate sedation (Ramsay reactivity score of 3 and 4) was obtained in 86% children in midazolam group as compared to 80% in triclofos group with p value of 0.138. Mean duration for onset of sedation was 20 min ± 5.4 min in Trichlophos group and 12 min ± 4.5 min with Intranasal Midazolam which was statistically significant with <em>p</em>-value of &lt;0.001. The mean duration of post procedural sedation was found to be 24.00 ± 9.21 min in midazolam group and 49.00 ± 16.99 min in triclofos group (<em>p</em>=&lt;0.001) which was statistically significant. No significant difference was seen for side effects frequency between the two drugs (15% in Triclofos, 10% in Midazolam group; <em>p</em>=0.285).</p> <p><strong>Conclusion: </strong>We conclude that intranasal midazolam is more effective than oral trichlophos with a comparable safety profile.</p> <p>CTRI Trial Number: /2017/08/009448. &nbsp;</p> Manoj Sharma Kamal K. Yenamandra Jitu Kalita Shaswat Dash Daljit Singh ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 80 83 10.3126/jnps.v38i2.19139 Comparison of the Single Breath Vital Capacity Technique with the Tidal Volume Technique <p><strong>Introduction: </strong>The single breath vital capacity (VC) induction and the tidal volume (TV) breathing induction are currently administered for inhalation of anaesthesia with sevoflurane in children. The aim of this study was to determine whether the vital capacity technique achieves more rapid induction of anaesthesia in children compared to the conventional tidal volume technique.</p> <p><strong>Material and Methods: </strong>Sixty ASA physical status 1 or 2 children aged between 5 and 15 years, scheduled to undergo elective urological, orthopaedic or visceral surgery under general anaesthesia using inhalational induction with sevoflurane were recruited and randomized to receive either vital capacity induction or tidal volume induction with 8% sevoflurane at 6L/min of O<sub>2</sub> followed by laryngeal mask airway insertion or endotracheal intubation with endotracheal tube. Time required for induction, hemodynamic changes, airway tolerance, side-effects, level of satisfaction using a visual analogue scale (0-100) and Smiley scale (0-10) were documented.</p> <p><strong>Results: </strong>Induction time was significantly shorter with the vital capacity induction technique than with the tidal volume breathing induction technique (43.8 ± 13.4 seconds vs 70.8 ± 16.4 seconds; P&lt;0.01). The time to central myosis, haemodynamic changes and respiratory events incidences were similar in both the group. Fewer complications occurred with vital capacity group. More than 94% of the children choose the single Breath Vital Capacity method of induction to the tidal volume technique.</p> <p><strong>Conclusion: </strong>For inhalation induction of anaesthesia, the vital capacity induction was faster and produced less complication than that of tidal volume breathing technique. &nbsp;</p> Jeevan Singh Alex Tandukar Kalpana Kharbuja ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 84 89 10.3126/jnps.v38i2.20145 End of Paediatric Posting Assessment of Medical Interns at a Teaching hospital from Coastal Karnataka <p><strong>Introduction: </strong>Internship is very a critical period of a medical undergraduate education during which student evolves into a doctor. The objectives of this study were to assess the interns at the end of their paediatric postings.</p> <p><strong>Materials and Methods. </strong>Interns knowledge and skills were assessed at the end of their postings in the must know areas. Assessment was conducted by the trained faculty and interns were given the orientation about it. Method of assessment included OSCE, simulation based using standardized patients and computer-based model driven simulators. Feedback was given to the students immediately at the end of their exam</p> <p><strong>Results: </strong>Total 202 interns participated in the exam over the period of two years. New-borns assessment was done more frequently (22.7%) and interpretation of investigations was less frequently assessed (7.9%). Rest of other stations was assessed almost at the equal proportion. Highest score was observed in vaccines section (7.5) and lowest score was seen in procedures assessment (5.5).</p> <p><strong>Conclusion. </strong>Interns were found to be weaker in procedural, communication and clinical scenario judgement skills which will help us in planning future training of the Interns.</p> K.S. Sahana Ghulam Jeelani Qadiri Prakash R.M. Saldanha ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 90 93 10.3126/jnps.v38i2.19586 Knowledge, Attitude and Practice of Using ORS and Household Management of Childhood Diarrhoea <p><strong>Introduction: </strong>Diarrhoea is defined as the passage of three or more loose stools per day. Diarrhoea is one of the leading causes of childhood mortality in India. The objectives of the study were to assess household Knowledge, Attitude and Practice for prevention of Diarrhoea in children through preformed questionnaires.</p> <p><strong>Material and Methods</strong>: Four hundred and sixty eight under five children were selected for study by Cluster sampling method. Background information, details of acute diarrhoea and treatment modalities were obtained from mother of the under five children. This was a hospital based study conducted at a tertiary care hospital, from 1<sup>st</sup> May 2017 to 30<sup>th</sup> December 2017.</p> <p><strong>Results</strong>: About 70% of the moms were between the age assemble 25-32 years and the vast majority of them were housewives (72%). A greater part (&gt;66%) of the moms were having essential/auxiliary education. Learning with respect to different parts of the diarrhoea and ORS surprisingly extremely unacceptable. In the present examination it is seen that learning in regards to ORS in looseness of the bowels is more in educated mother than uneducated. Three sitting of Educational mediations realized huge enhancement of the middle scores of learning, state of mind and practice expanded from 9, 6, 3 to 19, 14, 8, individually,</p> <p><strong>Conclusion</strong>: The household knowledge regarding method of use and preparation of ORS for management of diarrhoea was observed to be lacking in this investigation. More estimates should be taken to enhance this learning and make moms mindful about the planning and utilization of ORS. &nbsp;</p> Naresh Chandra Acharya Dillip Kumar Dash Mamata Devi Mohanty Priyanka Agarwal Pratik Dey ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 94 101 10.3126/jnps.v38i2.19028 Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador <p><strong>Introduction: </strong>Anaemia and pneumonia are frequent diseases which affect children. However, these two conditions could coexist. The aim of this study is presenting the prevalence of anemia among Ecuadorian children diagnosed with pneumonia, hospitalized in a tertiary hospital.</p> <p><strong>Material and Methods: </strong>An observational and cross-sectional study conducted through a secondary source in that 80 children, between six months and 15 years of age were included. All the patients involved were admitted to the paediatric department presenting pneumonia. The medical evaluation included anthropometric measurements and complete blood count. Risk associations were evaluated using odds ratio.</p> <p><strong>Results: </strong>Anaemia was found in 21.25% of the whole group. Nonetheless, the children under three years of age were more affected by this condition (18.75%). Low mean corpuscular volume and high red cells distribution width were more frequent than anaemia itself; 38.75% and 28.75%, respectively. Additionally, the prevalence of anaemia in children under 36 months was higher than the patients with over three years, with a significant risk of anaemia in the first group (OR 13.04; CI 95% 11.48-14.61; <em>p</em>&lt;0.05) and low haematocrit (OR 14.64; CI 95% 12.53-16.75; <em>p</em>&lt;0.05). This was also seen in low mean corpuscular volume (OR 3.23; CI 95% 2.3-4.17; <em>p</em>&lt;0.05), high red cells distribution width (OR 2.77; CI 95% 1.76-3.78; <em>p</em>&lt;0.05), and mean corpuscular haemoglobin (OR 8.48; CI 95% 7.14-9.82; <em>p</em>&lt;0.01)<strong>. </strong></p> <p><strong>Conclusions: </strong>Anaemia is a frequent condition in paediatric pneumonia, particularly during the first three years of life. Therefore, anaemia or nutritional deficiencies could be a risk factor for respiratory diseases. &nbsp;</p> David Israel Garrido Salazar Michelle Fuseau Santiago Moises Garrido Gina Vivas Miguel Gutiérrez ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 102 109 10.3126/jnps.v38i2.20193 Child Adoption, Posttraumatic-Stress Disorder and the Role of a Paediatrician in the Adoption Process <p>Child adoption represents a robust specialised child welfare service with the potential of meeting the needs and promoting the best interest of a child who have no permanent home or family to relate with. In addition, it provides succour for childless couples. Either way, there are socio-cultural challenges that need to be overcome. This paper reviews the objectives, types of adoption, circumstances in which adoption occurs, eligibility for adoption, and stress system biology/pathophysiology. Posttraumatic stress disorder in adopted children is discussed. The peculiarities and challenges of child adoption in Nigeria are highlighted. In addition, the role of a paediatrician in child adoption process is outlined. An extensive online search of the literature available in English was undertaken via electronic databases such as Nigerian Journals Online, African Journals Online, and Pubmed. Textbooks with chapters on child adoption as well as Newspapers with relevant articles on the subject were also consulted. Generally speaking, all adopted children have experienced some traumatic life event. Such an event, results in children’s brains initiating adaptive stressmediating neural systems. Basically, the paediatrician guides, advises, assists and supports all parties in the adoption triad.</p> <p><strong>Conclusion: </strong>The interest of each member of the adoption triad changes over time, making it necessary to design adoption process in a way that will provide protection and support for every triad member. &nbsp;</p> Alphonsus Ndidi Onyiriuka ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 110 117 10.3126/jnps.v38i2.20815 Cystic Fibrosis with Severe Anaemia and Hypoproteinaemia <p>The presentation of cystic fibrosis (CF) is dependent upon which organs are affected. Severe anaemia is reported to occur rarely in patients with CF. We are presenting a case of 2 months old infant admitted with anaemia, malnutrition, hypoproteinaemia and hypoalbuminaemia, without any pulmonary symptoms at the initial presentation. Abnormal sweat chlorides and low faecal elastase level confirmed the diagnosis of CF. Respiratory symptoms and signs developed later on further follow up.</p> Md Abu Bakkar Siddique Kalimuddin Khan Aparajita Bera Sudipta Ghorai Jasmine Mallik Suman Sarkar ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 118 121 10.3126/jnps.v38i2.19196 Dilemma in the Management of Duchenne Muscular Dystrophy in a Resource Limited Settings <p>Duchene muscular dystrophy is an x-linked recessive genetic disorder which present with progressive muscle weakness in children. It is often complicated by child becoming wheelchair bound by age 12. This limitation on the child and lack of cure is a great burden on the child, family and the community. We present a case of an 11-year old boy who presented with a seven years history of progressive limb weakness. Examination revealed hyper-lordosis of the thora-columbar spine, hypertrophied calf muscles, weak lower limbs and waddling gait. Due to financial constraint, only histology was relied on for definitive diagnosis. He was counselled, placed on prednisolone and commenced physiotherapy. This case portrays the challenges associated with the management of a rare disease in resource constraint settings.</p> Ahmadu Baba Usman Pembi Emmanuel Ovansa Emmanuel Onimisi Adewale O. Oyinloye Apollos Nachanuya Auwal M. Abubakar Haruna A. Nggada ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 122 124 10.3126/jnps.v38i2.19623 Eosinophilic Meningitis and Intracranial Haemorrhage: Can it be Neuro-Gnathostomiasis? <p class="Default">Peripheral eosinophilia is commonly encountered in our clinical practice. In this case report, we present a child who presented with hemorrhagic stroke and was finally diagnosed of eosinophilic meningitis. In this case report, we also propose probable etiologic agent.</p> Srijana Basnet Laxman Shrestha Daman Raj Poudel ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 125 127 10.3126/jnps.v38i2.19211 Familial Chylomicronaemia: A Neonate with Milky White Blood <p>Familial Chylomicronaemia is a rare autosomal recessive disease of lipoprotein metabolism characterized by deficiency or absence of lipoprotein lipase (LPL) or its co-factor apoC-II which causes severe elevation of triglyceride and chylomicron resulting in lipaemic plasma, recurrent attacks of acute pancreatitis, eruptive xanthomas, hepato-splenomegaly and lipaemiaretinalis. We report a case of term female neonate with lipaemic plasma, lipemia retinalis, markedly elevated triglyceride level which is consistent with diagnosis of Familial Chylomicronaemia.</p> <p>Keywords: Familial Chylomicronemia, lipemic plasma, triglyceride level, Lipemia retinalis</p> Nanda Kishwor Chaudhary Ram Hari Chapagain Sani Sipai Suryakant Chaudhary Krishan Prasad Paudel ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 128 131 10.3126/jnps.v38i2.20473 Mermaid Syndrome <p>We report a case of sirenomelia baby (Mermaid syndrome) born to a twenty three years old female at 37 weeks of gestation. Sirenomelia is characterized by fusion of the lower limbs with absent kidneys, absent external genitalia and other gastrointestinal defects. It results from the failure of normal vascular supply from the lower aorta in vitro, maternal Diabetes mellitus has been associated with caudal regression syndrome and sirenomelia.</p> <p><em>&nbsp;</em></p> Md Abu Bakkar Siddique Sudip Saha Kallol Bose Sudipta Ghorai Kalimuddin Khan ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 132 134 10.3126/jnps.v38i2.18802 Necrotizing Pneumonia In Infant: Rare Complication of Community Acquired Pneumonia <p>Necrotizing pneumonia, rare complication of Community-acquired bacterial pneumonia (CABP), bear its own morbidity and mortality. Even though CABP generally respond well to the antibiotic treatment, but complications like empyema, necrotizing pneumonia with pneumatocoel formation (cavitary necrosis) supervene in mainly immune-compromised patient. Although cavitary necrosis is manifested as a severe disease, most children show complete recovery even without surgical treatment and have normal chest radiographs at long term. Some cases may required surgical intervention like tube thoracotomy or open thoracotomy. A case is presented of an infant that developed necrotizing pneumonia with pneumatocoel formation during treatment of bacterial pneumonia. Tube thoracotomy was performed due to conservative treatment failure.</p> Suman Bikram Adhikari Ramananda Prasad Chaudhary ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 135 139 10.3126/jnps.v38i2.21327 Takayasu’s Arteritis: Rare Cause of Hypertension in Children <p>Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta, its major branches and pulmonary arteries. Diagnosis of TA during childhood remains challenging due to the non-specific symptoms. We report a six years age boy with unresolved hypertension who was later diagnosed as childhood TA. Oral corticosteroid was started 2mg/kg/day. TA is rare in children; Childhood TA must be considered in children who present with, hypertension and increased acute phase reactants.</p> Reshma Dhakal Lamichhane Ram Hari Chapagain ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 140 142 10.3126/jnps.v38i2.20551 Tuberculosis in Early Infancy: Rare in Today’s World <p>Tuberculosis in early infancy was not so common earlier also and has become rare these days. Since the disease is occasionally encountered, pediatricians should suspect tuberculosis in infants not responding to standard therapy. Here we report a case of three months old female who had presented with complaints of fever for two months, cough for one and half months and difficulty breathing for seven days and was being treated in line of bacterial pneumonia without improvement. She was found to be mycobacterium positive and was treated with anti-tubercular therapy leading to improvement and discharge. So, though rare, it is important to consider tuberculosis even in early infancy not responding to standard antibiotic therapy.</p> Jitendra Thakur Basant Rai Rupa Rajbhandari Singh Sohini Ghosh Pratyush Gyawali ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 143 145 10.3126/jnps.v38i2.19329 Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia: Correspondence <p>Not present</p> Nagendra Chaudhary Sandeep Shrestha ##submission.copyrightStatement## 2019-01-11 2019-01-11 38 2 146 147 10.3126/jnps.v38i2.21755