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The Severe Acute Respiratory Syndrome Coronavirus 2 causes COVID-19 infection. Vitamins C and D have been investigated for their effects on COVID-19 including the severity of it’s symptoms and complications. These vitamins may provide some benefits against the Severe Acute Respiratory Syndrome Coronavirus 2 as they modulate the immune system in addition to having anti-viral effects. This review will investigate the effects of vitamins C and D on COVID-19 infection to determine their benefits in the management of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2.

Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.

Introduction: Hypertensive disorders of pregnancy is one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.1 It is the leading cause of direct maternal death along with hemorrhage and infections. Approximately 70% of hypertensive disorders are due to gestational hypertension, preeclampsia and eclampsia whereas other 30% are due to preexisting or undiagnosed hypertension.2 Out of all the hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen to occur in 11% to 29% of patients.3 Thrombocytopenia occurs more commonly in patients with eclampsia (30%) compared to patients with both mild and severe forms of pre-eclampsia (15%-18%).4 Aims :To find out the severity of disease with platelet count in pregnancy induced hypertension. Methods: This is a hospital- based descriptive cross sectional study, conducted in the department of Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal, conducted over a period of one year from September 2018 to August 2019. Fifty pregnant women were enrolled in study after getting informed written consent and assessing for inclusion and exclusion criteria. Results: Incidence of Pre-eclampsia/eclampsia is 2.3% in this study. Majority of the women belong to age group 21-25(40%), followed by 15-20(38%) with mean age 23.18±5.45. 62% constituted primigravidas and 38% were multigravidas. 33 (66%) cases were at term (37-42 weeks of gestation), 11(22%) at 34-36 weeks of gestation and 6 (12%) were at 28-33 weeks of gestation with mean gestational age 36.38±3.17. Eclampsia cases were found more i.e. 48%, followed by pre-eclampsia 38% and Gestational hypertension 14%. Moderately low platelet count was seen in 11.76% of Gestational hypertension, 47% of pre-eclampsia and 41.17% of eclampsia and severely low platelet count in 21.4% pre-eclampsia and 64.70% of eclampsia. Conclusion: PIH continues to be a leading cause of Maternal and perinatal morbidity and Mortality. The disease accounts of 40,000 maternal deaths worldwide per year5. It is one of the common causes of iatrogenic preterm delivery. Etiology of Pre-eclampsia/Eclampsia is complex and not completely understood. A combination of abnormal Placentation and predisposing maternal factor contribute to widespread endothelial dysfunctions which lead to the syndrome of PIH. To date there has been no screening test that has been widely adopted in clinical practice. Platelet estimation method is reliable, rapid, cheaper, and simple lab method. Prognosis of diseases could be monitored by measuring platelet count and level of platelet count can predict the severity of PIH. Therefore assessment of platelet count has special place in management of PIH.

IntroductionFernando De Ritis described the significance of the transaminase (AST/ALT) ratio in 1957, and since then it has been commonly used to screen liver diseases. The liver is sensitive to hemodynamic changes because it receives approximately one-quarter of total cardiac output. We aimed to investigate the AST/ALT ratio changes in patients with acute myocardial infarction without any history of liver diseases in the Chinese Han population.Material and methodsWe analyzed a total of 120 patients with acute myocardial infarction admitted to the cardiology department of Zhongnan Hospital of Wuhan University between January 2019 and June 2019. AST/ALT ratio of the first blood test was calculated for all patients.ResultsThe mean De Ritis ratio (AST/ALT) was higher in patients with ST-segment elevation myocardial infarction (STEMI) (3.2261 ±2.41379) than in non-ST-segment elevation myocardial infarction (NSTEMI) (2.2089 ±1.63177) patients. The difference was statistically significant (p = 0.002).ConclusionsAST/ALT ≥ 2.0 has a strong association with total coronary occlusion. We might rely on this test to predict coronary occlusion without age difference.

Background The frequent lockdown in Nepal during COVID-19 pandemic had brought various kinds of complexities such as stress among college students. This situation had created uncertainty of future academic career of undergraduate students in medical colleges. Some previously published literature showed gaming as a coping mechanism against stress. Objective To assess the gaming behavior of Medical college students during lockdown in COVID 19 pandemic. Method A cross-sectional study was conducted during lockdown period of July to August 2020. A total of 412 college students were enrolled. Online Google forms were shared to all the eligible students through email, viber and messenger with the help of class representative. Collected data were analyzed in SPSS version 20.0. Result The prevalence of gaming disorder was 8.5% among 260 internet gaming users. About 69.2% of the participants reported that their gaming behavior had increased due to stress of COVID-19 pandemic. Gender and spending more time online per day showed significant associations with greater scores on the internet gaming disorder. Conclusion During lockdown period of COVID-19 pandemic, the gaming behavior of medical college students has increased.

Introduction: Breastfeeding practices of women working at the hospital are likely to be modified by the facilities and support that they receive at the hospital. This study was done to evaluate the breast feeding practices and to analyse important factors that are associated with exclusive breast feeding till six months among women working at hospitals in Kathmandu, Nepal Methods: A total of 110 women, with a young child between the ages of six months and two years were recruited from two hospitals in Kathmandu. A predesigned structured, interviewer-administered questionnaire was used for data collection. Results: The mean age of the mothers was 29.85 ± 3.68 years. Ninety seven (88.2%) women were aware about initiation of breastfeeding within first hour of birth but only 64 (58.2%) women could practice it. Most women 100 (90.9%) were aware about exclusive breastfeeding but only 18 (16.3%) could practice exclusive breastfeeding till six months. Mean duration of exclusive breastfeeding was 2.86 ± 2.00 months and 20 (18.2%) mothers practiced mixed feeding since birth. The participants whose babies had prelacteal feeding had significantly shorter duration of mean exclusive breast feed {1.92 ± 2.18 (S.D)} compared to those who did not have prelacteal feed {3.33 ± 1.74 (S.D)} (p = 0.001). Those who delivered by normal vaginal delivery, initiated breastfeeding within first hour of delivery, expressed breast milk and got feeding breaks were associated with longer duration of mean exclusive breast feed. Conclusion: The breast feeding practices among working women at hospital is quite low compared to national statistics on IYCF. Breast milk expression and feeding breaks for lactating working women could improve feeding practices.

Introduction: Maxillofacial trauma is the most common problem seen by maxillofacial surgeons in Nepal. The causes of facial fractures are road traffic accidents (RTA), assaults, falls, gunshot wounds, domestic violence, sports and work injuries. Maxillofacial injury varies from soft tissue injury to facial bone fractures. This study was conducted to assess the burden of maxillofacial trauma in mid-western and far-western regions of Nepal. Material and Method: Patients with maxillofacial fractures admitted in dental ward of NGMCTH, Kohalpur, from April 2017 to April 2019 were included in the study. Patients having soft tissue injury without facial bone fractures and OPD cases were excluded from the study. Patient demographics, mechanism of injury, associated soft tissue injury, accompanying injuries to other parts of body and facial bone fractures were recorded. Patient were treated by open reduction internal fixation or lateral compression splint with circum-mandibular wiring or managed conservatively as necessary. Result: A total of 87 patients were included in the study. The age of patient ranged from 2 years to 67 years with a mean of 26.87 years. Most of the injuries occurred between the age group of 20-29 years with male: female ratio 5.2:1. The most frequent cause of facial bone fracture was RTA (51.7%) and the most frequently fractured facial bone was mandible. Contusion 54(49.5%) was the most common associated soft tissue injury. Head injury 20(52.6%) was the most common accompanying injury to other parts of body. The mean duration of hospital stay was 6.29. Conclusion: Male patient in their third decade mostly had mandible fracture due to road traffic accident. Head injury was the most common accompanying injury. Contusion was the most common type of associated soft tissue injury.

Introduction: Mandible is frequently involved bone in facial fracture with angle fracture accounting for 27-30% of cases. Various methods and approaches have been tried for treatment of angle fracture. Objective: To correlate the different surgical approaches with its outcome postoperatively Methodology: A hospital based descriptive observational study was conducted in 30 patients admitted in DentalInpatient Department (IPD), from October 2016 to April 2019. ASA Ipatients having angle fracture of mandible either isolated or combined with other facial bones were included in the study. Different approaches were used for management of angle fracture of mandible. Patient characteristics were presented using frequency table and percentages. Result: The mean operative duration was lesser in transbuccal approach (111.25 minutes) compared to transbuccal (lower border) approach (120 minutes) and intraoral (122.5 minutes) in case of isolated angle fracture. Ease of surgical access was good in transbuccal approach 7 patients (70%) compared to intraoral approach 6 patients (42.86%). Occlusal discrepancies were more in transbuccal approach (50%) compared to intraoral approach (21.43%). Scar was barely visible in 2 patients (14.29%) out of 14 patients wheretransbuccal incision was made. Conclusion: We recommend intraoral surgical approach for favorable angle fracture. In unfavorable fractures we advise to place the first miniplate via intraoral approach, check for fracture stability intra-operatively and place second miniplate on lower bordervia transbuccal approach if unstable.

Leigh syndrome (LS) is a disorder of infancy and rarely late childhood. It presents with regression of mental and motor skills. Here, we present LS in an adolescent girl who presented with generalized dystonia and cognitive decline. Her infective, metabolic, endocrinal and autoimmune work up was normal. The neuroimaging showed progressive symmetric involvement of basal ganglia with focal intensity over bilateral lentiform nucleus and thalamic region. The cerebrospinal fluid (CSF) lactate level was elevated. Genetic test could not be performed; however the history of neuro-regression with extrapyramidal involvement with CSF and neuroimaging finding led to the diagnosis of Leigh’s syndrome.

Maternal depression has been associated with adverse child growth and development; less is known about its relation to children's diet. In a cross‐sectional study embedded at endline of a longitudinal community development intervention, mothers of 629 children (age 23–66 months) in rural Nepal responded to household and children's diet questionnaires and were screened for depression. Child anthropometry and development (Ages and Stages Questionnaire) were assessed. Regression models examined children's diet, growth and development, adjusting for household, child and maternal characteristics. The prevalence of maternal depression was 21%. Maternal depression was associated with 11% lower likelihood that the child consumed one additional food group [Poisson regression, adjusted relative risk (aRR) 0.89, 95% confidence intervals (95% CI 0.81, 0.99), p = 0.024] and 13% lower likelihood that the child consumed one additional animal source food (ASF) [aRR 0.87, (95% CI 0.76, 1.01), p = 0.061] compared with children of nondepressed mothers. However, maternal depression was not associated with either child anthropometry or development: these outcomes were strongly associated with better home child‐rearing quality. Stunting also related to child age and intervention group; child development related to mother's education and household wealth. This study suggests a correlation between maternal depression and child dietary diversity. This association could be due to unmeasured confounders, and therefore, further research is warranted. Understanding the relationship of depression to child outcomes—and the role of other potentially compensatory household factors—could help address some of the earliest, modifiable influences in a child's life and contribute to innovative approaches to improve child well‐being.

Introduction: Primary dysmenorrhea is one of the most common gynecological problems among adolescent females. It is defined as painful menses in women with normal pelvic anatomy, usually beginning during adolescence. This study aims to find out prevalence of self-medication practice in primary dysmenorrhea among medical and nursing undergraduate students. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital from November 2020 to March 2021 after taking ethical approval from the Institutional Review Committee. Convenient sampling technique was used. A total of 269 female medical and nursing students with complaints of dysmenorrhea were enrolled and the remedial methods used by them such as self-medication, medical advice and home remedies for dysmenorrhea were asked using an online questionnaire delivered to participants. Data analysis was done in the Statistical Package of Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Self-medication practice for dysmenorrhea was reported in 175 (65%) of students. The prevalence of mild or moderate pain was commonly present in age group 21-25 years. commonly used for self-medication was mefenamic acid 121 (48%), followed by ibuprofen 51 (20.3%) and paracetamol 41 (16.3%). Conclusions: Self- medication practice among medical and nursing undergraduate students is high despite awareness of adverse effects.

The demand for cobalamin (vitamin B12) and folate is increased during pregnancy, and deficiency during pregnancy may lead to complications and adverse outcomes. Yet, the status of these micronutrients is unknown in many populations. We assessed the concentration of cobalamin, folate and their functional biomarkers, total homocysteine (tHcy) and methylmalonic acid (MMA), in 561 pregnant women enrolled in a community-based randomised controlled trial in Bhaktapur, Nepal. Plasma concentrations of cobalamin, folate, tHcy and MMA were measured and a combined indicator of vitamin B12 status (3cB12) was calculated. We report mean or median concentrations and the prevalence of deficiency according to commonly used cut-offs, and assessed their association with indicators of socio-economic status, and maternal and dietary characteristics by linear regression. Among the women at gestational week less than 15, deficiencies of cobalamin and folate were seen in 24 and 1 %, respectively. Being a vegetarian was associated with lower plasma cobalamin, and a higher socio-economic status was associated with a better micronutrient status. We conclude that cobalamin deficiency defined by commonly used cut-offs was common in Nepalese women in early pregnancy. In contrast, folate deficiency was rare. As there is no consensus on cut-off points for vitamin B12 deficiency during pregnancy, future studies are needed to assess the potential functional consequences of these low values.

Babies who are exposed to high-risk factors during pregnancy, delivery, or immediately after birth are termed as high-risk babies. Preterm and birth-asphyxiated babies account for most of the high-risk babies, and these high-risk babies are at risk of adverse neurodevelopmental outcome. The adverse neurodevelopmental outcomes vary from mild motor and language delay to global delay, hearing and visual impairments, seizures and also long-term intellectual impairment, academic underachievement, and learning difficulties, thereby posing increased burden to family, society, and nation as well. Regular and close follow-up of any high-risk babies with early identification of any delay and early intervention with multidisciplinary approach will help to enhance the optimal development.

BACKGROUND One-carbon metabolism (OCM) refers to the transfer of methyl groups central to DNA methylation and histone modification. Insufficient access to methyl donors and B-vitamin cofactors affects epigenetic maintenance and stability, and when occurring in early life may impact future health and neurodevelopment. OBJECTIVE The objective of this study was to examine the relative associations between one-carbon metabolites in Nepalese mother-infant pairs and child cognition measured at 5 y of age. METHODS This is a cross-sectional study from Bhaktapur, Nepal, in a population at high risk of subclinical B-vitamin deficiencies and cumulative infection burden. Venous blood samples from 500 mother-infant pairs were collected when the infants were 2 to 12 mo old, and metabolite concentrations measured by microbiological assays and GC-tandem MS. We re-enrolled 321 of these children at 5 y and assessed cognition by the Ages and Stages Questionnaire, 3rd edition, and subtests from the Developmental Neuropsychological Assessment, 2nd edition (NEPSY-II). The associations of the independent metabolites or unobserved metabolic phenotypes (identified by latent class analysis) with the cognitive outcomes were estimated by seemingly unrelated regression. We explored direct and indirect relations between the OCM pathway and the cognitive outcomes using path analysis. RESULTS Infant cystathionine concentration was inversely associated with 4 cognitive outcomes (standardized βs ranging from -0.22 to -0.11, P values from

Introduction: There is an increase in the double burden of malnutrition globally, with a particular rise documented in Asia. In Nepal, undernutrition has been prevalent for decades. Today, however, the incidence of overweight and obesity (OWOB) in the country has increased substantially. There is a need to conduct local studies reporting on the concurrent burden of both underweight and OWOB across adult populations. This study addresses this need by describing the distribution of body mass index (BMI) in a defined population of adults living in the peri-urban community of Bhaktapur, Nepal. Material and methods: For this cross-sectional analysis, we used data that were available from 600 women and 445 men whose children were enrolled in an individually randomized, double-blind, placebo-controlled trial assessing the effect of daily vitamin B12 supplementation. Upon enrolment of their 6–11-month old children, mothers and fathers were interviewed about their socio-demographic details. In addition, their weight and height were measured by trained field workers. Each parent's BMI was calculated as the ratio of body weight (in kg) and height squared (in m), expressed as kg/m2, and categorized according to the WHO recommendation. We used linear and multinomial logistic regression models to assess associations between the BMI of the mothers and fathers, and their baseline characteristics. Results: The mean BMI was 23.7 kg/m2 for both the mothers and fathers with a standard deviation (SD) of 3.6 and 3.7, respectively. The proportion categorized as underweight, overweight, and obese was also similar in the two groups with around 5% being underweight, 30% being overweight and 5% being obese. Age was positively associated with BMI in both groups. Those categorized as daily wage earner had a lower mean BMI than those in other occupational groups. Conclusion: Our results contribute to documenting the burden of both under- and overnutrition in a selected group of young adults living in a peri-urban community in Nepal. As Nepal is undergoing an improvement in its economic situation, as well as a nutrition transition, it is important to provide sufficient information to enable timely action, and evidence-based decision-making to prevent a further increase in Nepal's growing double burden of malnutrition. publishedVersion

Developmental delays affect between 150 and 200 million children

Background Vitamin B12 deficiency is common and affects cell division and differentiation, erythropoiesis, and the central nervous system. Several observational studies have demonstrated associations between biomarkers of vitamin B12 status with growth, neurodevelopment, and anemia. The objective of this study was to measure the effects of daily supplementation of vitamin B12 for 1 year on neurodevelopment, growth, and hemoglobin concentration in infants at risk of deficiency. Methods and findings This is a community-based, individually randomized, double-blind placebo-controlled trial conducted in low- to middle-income neighborhoods in Bhaktapur, Nepal. We enrolled 600 marginally stunted, 6- to 11-month-old infants between April 2015 and February 2017. Children were randomized in a 1:1 ratio to 2 μg of vitamin B12, corresponding to approximately 2 to 3 recommended daily allowances (RDAs) or a placebo daily for 12 months. Both groups were also given 15 other vitamins and minerals at around 1 RDA. The primary outcomes were neurodevelopment measured by the Bayley Scales of Infant and Toddler Development 3rd ed. (Bayley-III), attained growth, and hemoglobin concentration. Secondary outcomes included the metabolic response measured by plasma total homocysteine (tHcy) and methylmalonic acid (MMA). A total of 16 children (2.7%) in the vitamin B12 group and 10 children (1.7%) in the placebo group were lost to follow-up. Of note, 94% of the scheduled daily doses of vitamin B12 or placebo were reported to have been consumed (in part or completely). In this study, we observed that there were no effects of the intervention on the Bayley-III scores, growth, or hemoglobin concentration. Children in both groups grew on an average 12.5 cm (SD: 1.8), and the mean difference was 0.20 cm (95% confidence interval (CI): −0.23 to 0.63, P = 0.354). Furthermore, at the end of the study, the mean difference in hemoglobin concentration was 0.02 g/dL (95% CI: −1.33 to 1.37, P = 0.978), and the difference in the cognitive scaled scores was 0.16 (95% CI: −0.54 to 0.87, P = 0.648). The tHcy and MMA concentrations were 23% (95% CI: 17 to 30, P < 0.001) and 30% (95% CI: 15 to 46, P < 0.001) higher in the placebo group than in the vitamin B12 group, respectively. We observed 43 adverse events in 36 children, and these events were not associated with the intervention. In addition, 20 in the vitamin B12 group and 16 in the placebo group were hospitalized during the supplementation period. Important limitations of the study are that the strict inclusion criteria could limit the external validity and that the period of vitamin B12 supplementation might not have covered a critical window for infant growth or brain development. Conclusions In this study, we observed that vitamin B12 supplementation in young children at risk of vitamin B12 deficiency resulted in an improved metabolic response but did not affect neurodevelopment, growth, or hemoglobin concentration. Our results do not support widespread vitamin B12 supplementation in marginalized infants from low-income countries. Trial registration ClinicalTrials.gov NCT02272842 Universal Trial Number: U1111-1161-5187 (September 8, 2014) Trial Protocol: Original trial protocol: PMID: 28431557 (reference [18]; study protocols and plan of analysis included as Supporting information)., Tor A. Strand and colleagues measure the effects of daily supplementation of vitamin B12 for one year on neurodevelopment, growth, and hemoglobin concentration in infants at risk of deficiency., Author summary Why was this study done? Many marginalized children fail to reach their cognitive and growth potential. Subclinical vitamin B12 deficiency, which is poor vitamin B12 status without overt clinical symptoms, is common in this population in Nepal. Vitamin B12 deficiency in children is associated with anemia (low hemoglobin concentration), stunted growth, and poor neurodevelopment. What did the researchers do and find? In this population-based, double-blind, randomized controlled trial (RCT), we measured the effects of daily supplementation of vitamin B12 for 1 year in 600 infants. The primary outcomes were neurodevelopment, growth, and hemoglobin concentration. We targeted stunted infants as these children are at risk of vitamin B12 deficiency. Daily supplementation of vitamin B12 for a year resulted in a metabolic profile reflecting substantially improved B12 status (lower total homocysteine (tHcy) and methylmalonic acid (MMA) concentrations) but did not affect neurodevelopment, growth, or hemoglobin concentration. What do these findings mean? In spite of the improved metabolic profile following vitamin B12 supplementation, the findings do not support widespread vitamin B12 supplementation to improve short-term growth, neurodevelopment, or hemoglobin concentration in infants.

Background: Hypertensive disorder (HDP) during pregnancy is a group of conditions featuring with high blood pressure that may lead to feto-maternal morbidity and mortality, particularly in developing countries. Aims and Objectives: To assess relationship between risk factor of hypertensive disorder during pregnancy, their self care knowledge and practice to prevent and control hypertension. Materials And Method: A cross-sectional study of 93 registered, pregnant women belonging to reproductive ageth group, after 20th gestation age completed, who came for ANC checkup or admitted for hypertension management or prior to delivery in Nepalgunj medical college and teaching hospital under department of Obstetrics and Gynecology from 15th June to 15th December 2018. Blood pressure was measured for each women at booking or at subsequent visits. Urine test for protein albumin was performed if blood pressure was elevated. Data was entered and analysis was completed using SPSS package version 20. Results: The overall prevalence of hypertensive disorder during pregnancy was 2.85% among all deliveries. Pre-eclampsia accounted 36% of the cases followed by eclampsia 18%. Gestational hypertension was 21%, pregnancy induced hypertension was 20% and chronic hypertension was only 5% in study population. Conclusion: Knowledge and attitude regarding lack of exercise, low salt diet, obesity and lack of rest were poor contributory risk factors. It is recommended that all pregnant women must develop knowledge about associated risk factors and ensure the application of behavioral change practices to control and prevent hypertensive disorder during pregnancy.

Background: Intercondylar fracture of distal humerus are very difficult to manage. It needs proper anatomic reconstruction and rigid fixation. Aims and Objectives of study: Evaluation of outcome of dual bicolumnar 90-90 plating of AO type 13C fractures of distalhumerus in adult. Material and method: In a prospective hospital based study on 16 patients with a mean age of 33.37 years ± SD8.30, who presented with intercondylar fracture of distal hummers were studied between July 2015 to December 2017. All patients were graded according to AO classification. Out of 16 patients 5 were in 13C1, 6 were in 13C2 and 5 were in 13C3 subgroup. All patients underwent open reduction through Chevron olecranon osteotomy and fixation was done with dual plating in 90-90 fashioni.e.; 3.5 reconstruction plate posterior and 1/3 tubular plate from medial border. We used the Mayo elbow performance score system for evaluating our results. Results: The mean follow up period was 9.38 months. All fractures healed uneventfully. Two of five patients with 13C3 fractures and two of six patients with 13C2 fractures has flexion deformity of less than 30*. Average range of motion was 95*(range 60*-130*). The Mayo elbow performance score was excellent in 7, good in 7 and fair in 2 patients. Conclusion: Dual 90-90 plating technique through Chevron olecranon osteotomy is a good method for intercondylar reconstruction with rigid fixation like AO 13C fractures.

BACKGROUND: Many children worldwide have poor vitamin B12 status. The objective of this study was to estimate association between maternal and infant vitamin B12 status and long-term growth. METHODS: We randomly selected 500 Nepali mother-infant pairs and measured maternal intake and infant and maternal vitamin B12 status using plasma cobalamin, total plasma homocysteine, and methylmalonic acid concentrations. We revisited available children when they were 5 years old and measured growth. The associations between intake and maternal and infant markers of vitamin B12 and growth were estimated in multiple linear regression models adjusting for relevant confounders (n = 331). RESULTS: Maternal vitamin B12 intake and status and vitamin B12 status in infancy predicted linear growth at 5 years of age, but not during infancy. Each microgram increase in the vitamin B12 intake of the mother during infancy was associated with an increase in height of 0.4 (0.2, 0.6) height-for-age z-scores and 1.7 (0.7, 2.7) cm around the child's fifth birthday. CONCLUSION: Vitamin B12 status and intake in early life is an important determinant for linear growth at school age. Our findings should be verified in randomized, placebo controlled trials before translated into public health recommendations. We are grateful for the contributions of the field supervisor Chandrawati Chitrakar and data managers Pravin Rajbhandari and Uma Regmi, and the children and mothers for their invaluable contribution to the study. The present study was funded through grants from the Research Council of Norway (project no. 234495), from the GCRieber Funds, and the South-Eastern Norway Regional Health Authority (grant no. 2012090).

Introductions: Birth asphyxia is failure breathing causing severe consequences or death. This study aims to determine the incidence of perinatal asphyxia in neonates with low Apgar and Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated babies. Methods: This was a cross sectional study from November 1, 2010 to July 30, 2011. Babies with Apgar score of less than seven at five minute were enrolled in the study. Blood was drawn from umbilical cord artery for blood gas analysis. Neonates were followed up in every six hours for at least 48 hours. Staging of HIE according to Sarnat staging was done in babies with Apgar score of 7.2, 40% had between 7.1 to 7.2, 12% between 7 to 7.1 and remaining 2% had pH < 7. HIE developed in 22% (11/50) of the asphyxiated babies. Conclusions: More than 1/3rd (46%) of babies with low Apgar had low cord blood pH, 1/4th (26%) had base excess, and 22% developed features of HIE. Cord blood pH were better predictors than Apgar in asphyxiated babies.

Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age.Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study.Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.

Background Vitamin B12 deficiency is one of the most common micronutrient deficiencies and is associated with poor cognitive development and growth. Vitamin B12 is crucial for normal cell division and differentiation, and it is necessary for the development and myelination of the central nervous system. The aim of the present study is to measure the effect of daily supplementation of vitamin B12 on the neurodevelopment and growth of young children in Nepal. Methods/design We are conducting an individually randomized, double-blind, placebo-controlled trial with 600 marginally stunted children 6–11 months old (length for age less than −1 z-score). Children are randomized to receive a lipid-based paste containing vitamin B12 or placebo daily for 12 months. The main outcomes are changes in growth (z-scores) and in neurodevelopment measured by the Bayley Scales of Infant and Toddler Development, Third Edition, from baseline until the end of the study. Discussion If vitamin B12 supplementation benefits early child development and growth, this will have consequences for dietary recommendations for malnourished children worldwide. Trial registrations ClinicalTrials.gov Identifier: NCT02272842. Registered on 21 October 2014. Universal Trial Number: U1111-1161-5187. Registered on 8 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1937-0) contains supplementary material, which is available to authorized users.

Poverty adversely affects child development through multiple pathways in low- and middle-income countries. Relationships between diet and child development are poorly understood. In this study, we aimed to explore these associations in a longitudinal cohort of 305 children in rural Nepal (baseline mean age 14 months), evaluating dietary diversity and the consumption of specific food groups at three timepoints over 1.5 years. Child development was assessed using the Ages and Stages questionnaire-version 3 (ASQ-3). Associations between the number of days that children consumed minimum dietary diversity (MDD) (&ge, 4/8 items) and specific food groups over time (range 0&ndash, 3) and total and subscale ASQ scores at age 23&ndash, 38 months were estimated using multiple linear and logistic regression, dichotomizing scores at the lowest quartile. After adjusting for confounders, each additional day of consuming MDD was associated with a 35% reduction in the odds of low total ASQ score [OR 0.65, 95% CI (0.46, 0.92)]. The consumption of animal source foods [OR 0.64, (0.46, 0.89)], and vegetables/fruits [OR 0.60, (0.41, 0.90), but not processed foods [OR 0.99, (0.62, 1.59)] was associated with lower odds of low total development. Vegetables, fruits and animal source foods may be important for child development in this setting.

Background: Many young children in developing countries do not reach their developmental potential. Traditional methods for assessing developmental outcome are time consuming, thus, physiological measures that can contribute to the prediction of developmental outcomes in high risk groups have been suggested. Vagally mediated heart rate variability (vmHRV) is considered a neurophysiological or peripheral proxy for prefrontal and executive functioning and might serve as a supplement for traditional measurements of developmental status and as a potential useful risk indicator. Aim: In the present study, we wanted to describe the vmHRV in Nepalese infants and relate it to the Bayley Scales of infant and toddler development, 3. edition (Bayley-III) subscales. Methods: 600 Nepalese infants were included in the study. At 6–11 and 17–24 months, we measured neurodevelopmental and socio-emotional outcomes by the Bayley-III. Inter-beat intervals were recorded at two measurement points when the children were 17–24 months. Results: There was a high intraclass correlation between HRV indices generated from the two measurement points. No significant associations between vmHRV and Bayley-III sub scales were found at any time. Conclusion: This study is the first to describe vmHRV in healthy infants and the relationship between Bayley-III scores. Our results suggest that vmHRV is not associated with measures of general development in infancy. publishedVersion

Background: The Ages and Stages Questionnaire Third Edition (ASQ-3) may be a feasible and cost-effective tool to screen children's development in resource poor settings. We have assessed the feasibility of the ASQ-3 "home procedure" when conducted by fieldworkers in a community-based nutritional interventional trial on early child development in Nepal. Method: Six hundred children aged 6-11 months at risk of stunting were assessed by trained fieldworkers in their homes by the ASQ-3. Three fieldworkers performed standardization exercises and were double scored with a gold standard during the study period. Intraclass correlations (ICCs) were calculated to measure the interrater agreement. The internal consistency was expressed by standardized Cronbach's alphas. The association between total ASQ score and gestation, low birth weight, and stunted children is presented to give an estimate of the construct validity of the tool. Result: Mean scores of the 600 Nepalese children were consistently lower than in the American norm sample. The ICCs from the standardization exercises were initially good to excellent but declined throughout the study period. The standardized alphas for the total score in the different age groups indicate good internal consistency but varied in the subscales. Children who were preterm, children with low birth weight, and children who were stunted scored substantially lower on the total ASQ score than those who were not. Conclusion: Although the ASQ-3 "home procedure" is low at cost and easily accessible in a Nepalese context, the tool requires rigorous and stringent training to achieve acceptable interrater agreement. Further adjustment is required to achieve satisfactory internal consistency. GC Rieber Funds Thrasher Research Fund. Grant Number: 11512

Objective The objective of this study was to determine the diagnostic validity of digital chest auscultation to improve the differentiation of chest sounds associated with pneumonia in children. Methods This is a prospective case–control study at two hospitals in Nepal. Cases had World Health Organization-defined pneumonia and were classified as radiologically confirmed or nonconfirmed based on radiographic findings. Controls had no respiratory complaints. The presence of crepitations in recorded lung sounds defined pneumonia. Radiologically confirmed pneumonia was the reference standard. Results Sensitivity and specificity of digital auscultation were 56% (95% confidence interval [CI], 40–70%) and 73% (95% CI, 70–76%), respectively. Conclusion Digital auscultation in conjunction with standardized grading of digital lung sounds has the potential to improve the specificity of pneumonia diagnosis, but further development of objective interpretation of lung sounds is needed.

There is a National strategy of infant and young child feeding which includes exclusively breastfeeding till six months timely start of complementary feeding and continuing breastfeeding till two years and beyond. However very few of us are aware of Breast Milk Substitute Act (BMS) in the country. Here we have tried to summarize the Act which would help us to be aware of our law and protect and promote breastfeeding. BMS Act 2049 was published by Government of Nepal in 2049. This Act focuses mainly to control the sale and distribution of Breast Milk Substitute (BMS). BMS means an edible product that is sold and distributed to partially or fully substitute the Breast Milk. In Nepal this Act covers till one year of age. After the formation of Act in 2049 there has not been any amendment. With increased marketing policies for BMS and low awareness about the law its high time the Act is revised amended and more awareness programs to be initiated. The main objective of this Act is to patronize and promote breastfeeding. For the implementation of the Act government has appointed Breast Feeding Protection and Promotion Committee (BPPC) which is chaired by the Secretary of Health Ministry. Ministry of Health with consultation with BPPC can give permission to publicize the information and educational materials about infant food. The Act has clear guidelines for manufacturers and distributors along with health care professionals as well. (Excerpt)

Background Long chain polyunsaturated fatty acids (LCPUFA) especially docosahexaenoic acid (DHA) and arachidonic acid (AA) are crucial for normal brain development in utero and in early infancy. Data on fatty acid status and cognitive development in infants and children from low-income countries are scarce. Methods We examined the association between the DHA and AA status in infancy (n = 320) and developmental status and cognitive functioning five years later. At five years of age, we measured development by the Ages and Stages Questionnaire 3rd. ed. (ASQ-3) and cognitive functioning by subtests from the neuropsychological test battery NEPSY II. In addition, infant fatty acid composition in red blood cells (RBC) was analyzed. In multiple linear and logistic regression models, we estimated the associations between DHA and AA status in infancy and scores on the ASQ-3 and the NEPSY II subtests. Results There were no notable associations between infant AA and DHA status, and the scores on the ASQ-3 and the NEPSY II subtests five years later. It should be noted that we found better than expected concentrations of erythrocyte DHA and AA among the infants, and the ASQ scores were left-skewed, which limited the ability to identify associations. Conclusion DHA and AA status in infancy is seemingly not related to neurodevelopment measured 5 years later in this peri-urban population from Nepal.

Cobalamin and folate are crucial micronutrients during infancy and they are required for growth and cognitive development. Due to the monotonous and predominantly vegetarian-based complementary feeding and poor maternal micronutrient status, infants from low- and middle-income countries are susceptible to cobalamin deficiency. However, data on plasma cobalamin and folate and the functional markers methylmalonic acid and total homocysteine from breastfed infants in Nepal are still needed. We collected plasma samples from 316 6–11-month-old breastfed infants with a length-for-age of less than minus one z-score and analyzed blood for plasma folate, cobalamin, methylmalonic acid and total homocysteine concentrations. Cobalamin deficiency (plasma cobalamin 10 µmol/L) and methylmalonic acid (>0.28 µmol/L) indicating functional cobalamin deficiency were found among 53% and 75% of the infants, respectively. Based on a combined indicator of cobalamin status, 58% were found to have low cobalamin status. However, folate deficiency (

Introductions: In most children aged 1-36 months, the cause of a febrile illness is a self limiting viral infection. It is very difficult to distinguish these from serious bacterial infection. Objective of this study is to assess the efficacy of the Yale Observation Scale (YOS) to detect serious bacterial infection in febrile children aged 1-36 months. Methods: YOS scores were assigned as a part of a cross- sectional study in 100 children presenting in Tribhuvan University teaching hospital with fever to divide the child into well- looking if YOS ≤10 or ill- looking if YOS >10. Then the history, examination and necessary investigation was performed to come to a diagnosis of non- serious illness and serious bacterial infection. Results: Serious bacterial infection was found in 33(33%) of the patients. The sensitivity, specificity, positive and negative predictive values for a YOS score greater than 10 to detect serious bacterial infection were 45.45%, 88.05%%, 65.21% and 76.62%, respectively. Conclusions: A YOS ≤10 predicts non-serious illness while a YOS>10 does not necessarily indicate serious bacterial infection and should undergo further evaluation to confirm serious bacterial infection. Keywords: febrile children, serious bacterial infection, yale observation scale

INTRODUCTION: Vitamin B12 is crucial for normal cell division and differentiation, and necessary for the development and myelination of the central nervous system. Pregnant mothers in resource poor settings are at risk for poor vitamin B12 status. Poor vitamin B12 status in infancy is linked to poor growth and neurodevelopment. Brain development starts from conception, and pregnancy is a period of rapid growth and development for the brain. METHODS AND ANALYSIS: The study is an individually randomised double-blind placebo controlled trial in 800 pregnant Nepalese women randomised in a 1:1 ratio. A daily dose of 50 µg of vitamin B12 or placebo is given to women from early pregnancy, not later than week 15, until 6 months after birth. Weekly visits are conducted in order to record compliance, growth and morbidity. The primary outcomes are scores on the cognitive, language and motor subscales of the Bayley Scales of Infant and Toddler Development, Third Edition, measured at 6 and 12 months of age, and growth (length and weight) measured at 6 and 12 months of age. ETHICS AND DISSEMINATION: National Health and Research Council, Nepal (NHRC 253/2016) and Regional Committee for Medical and Health Research Ethics of Western Norway (2016/1620/REK vest) have approved the study. Investigators who have contributed to the conceptualising, conducting, as well as being involved in the data analyses and manuscript writing will be eligible for authorship and be responsible to share outcomes with different stakeholders through publications and workshops. The results from this study may support new dietary guidelines for Nepalese and possibly South Asian pregnant women that can lead to improved pregnancy outcomes, neurodevelopment and cognitive functioning in children. TRIAL REGISTRATION NUMBER: Universal Trial Number: U1111-1183-4093. TRIAL REGISTRATION: clinicaltrials.gov: NCT03071666. Protocol date: version 1.2, 1 June 2017. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. KEYWORDS: Cobalamin; Nepal; Pregnancy; Supplementation Funding This study has been granted funding from the Centre of Excellence Scheme and the University of Bergen (UiB), Norway to the Centre for Intervention Science in Maternal and Child Health (CISMAC; project number 223269).

Introduction : The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia. J. Nepal Paediatr. Soc. 32(2) 2012 150-153 doi: http://dx.doi.org/10.3126/jnps.v32i2.6898

Introduction : Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates. Materials and Methods : A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO 2 ) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure. Results : The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant ( p = 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR ( p = 0.0001) and decrease in SpO 2 ( p = 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP ( p = 0.0001). Conclusion : Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates. J. Nepal Paediatr. Soc. 32(2) 2012 99-104 doi: http://dx.doi.org/10.3126/jnps.v32i2.5477

Awareness and knowledge about autism is almost non-existent in Nepal. Children who eventually get the diagnosis often miss their opportunity for early intervention. The current study shows that medical help was seeked at mean age of 27.9 + 14.5 months and most of them were for delayed language and the first preference for parents were pediatricians. The mean age of diagnosis of autism was 55.6 months. The time length between help seeking to diagnosis was 29.4 months with longest time lag of 13 years. Delay in recognition of symptoms, delay in health seeking and lack of awareness even in treating physicians might be the reason for advanced age at diagnosis of autism in Nepal.

We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient.Kathmandu University Medical Journal Vol.12(2) 2014: 149-150

Background Autism is a global phenomenon. Epidemiological studies estimate that 1–2% of children worldwide lie on the autism spectrum,1 with approximately 52 million individuals with autism across the globe. These estimates are largely driven, however, by prevalence estimates from high-income countries (HIC). Virtually no data exist, however, on the prevalence of autism in low-income countries (LIC) and none in a LIC rural setting. Aims Methods The Autism Quotient-10 (AQ-10) is a well-validated brief questionnaire of the 10 statements most strongly predictive of a diagnosis of autism in a UK population of children (sensitivity: 95%; specificity: 97%).2 We translated the AQ-10 – adolescent version in discussion with UK and Nepali paediatricians and clinical psychologists. The translated version was further developed and tested for acceptability in 3 focus groups of parents (n = 25). It was then piloted as a questionnaire with 136 families, following which minor edits were made only and additional fieldworker training provided. We conducted face-to-face interviews with 3984 parents from a cohort of 10–13 year-old children recruited from a 10-year follow-up study of a trial of women’s participatory groups.3 These families live in Makwanpur, a rural district of Nepal. Results Eleven out of 3984 children scored greater than 6 out of 10, indicative of autistic symptomatology. If the AQ-10 screening tool is as sensitive and specific in the Nepali population as it is in the UK, this would give an estimated true prevalence of 3 in 1000 (95% confidence interval 2 to 5 in 1000).4 Conclusion This is the first study to estimate prevalence of autism in a rural LIC setting. Prevalence estimates were lower than those in HIC. Future research is required to validate this tool through in-depth comprehensive assessments of high-scoring children. This preliminary estimate, combined with complementary research showing the lack of awareness of autism by Nepali professionals and parents, stresses the need to develop services to support families and children with atypical development in rural LIC settings.

Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6353 Kathmandu Univ Med J 2011;9(4):315-7

Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section. Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH. Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births Key words: Early neonatal death (ENND), neonatal mortality doi:10.3126/jnps.v27i2.1584 J. Nepal Paediatr. Soc. Vol 27(2), p.79-82

Introduction: Nasal Continuous Positive Airway Pressure (CPAP) in newborn babies with respiratory distress reduces requirement for mechanical ventilation thereby decreasing referral to higher centre. In our neonatal unit prior to the use of this intervention, morbidity and mortality associated with respiratory distress was significant which has decreased after we started CPAP in Kartik 2065 (October 2008) including a decrease in referrals to higher centre for ventilator support.The objective of this study was to evaluate the outcome of bubbling CPAP in newborn babies who had respiratory distress. Methods: Observational study done in neonatal unit of TUTH over a period of 3 months i.e from Kartik to Poush 2065 B.S (mid of October to mid of January,2008) Results: 127 neonates were admitted, of whom 15 babies with respiratory distress (11.8% of total admissions) received CPAP. 11 babies improved, while 4 babies died. Among those attending follow up (8 babies) none had any features of chronic lung disease. Conclusion: In resource poor settings where level II neonatal care is already exists; CPAP can be easily applied for newborn babies with respiratory distress with promising results and it helps to decrease neonatal morbidity and mortality. Key words: CPAP, neonatal mortality, respitatory Distress. DOI: 10.3126/jnps.v30i1.2465 Journal of Nepal Paediatric Society Vol.30(1) 2010 64-68

Objective: To assess risk factors and outcome in the early neonatal period of babies who were asphyxiated at birth. Methodology: This was a retrospective study conducted at Tribhuvan University Teaching Hospital (TUTH) over a period of one year from 15th Feb 2007 to 14th Feb 2008. All the term babies who had Apgar score of less than < 6 at 1 minute of birth were included. Detailed maternal risk factors during pregnancy and labor were analyzed. The newborn babies who required admission in neonatal unit were again analyzed for development of hypoxic ischemic encephalopathy (HIE) and their outcome. Results: During the study period, out of 3594 term babies, 327 babies (9%) were asphyxiated. Of the total asphyxiated babies, 85% and 15% had moderate and severe asphyxia, respectively, at 1 minute of birth. Out of these asphyxiated babies, 51% and 7% had intrapartum and maternal risk factors, respectively. Intrapartum risk factors like meconium stained liquor, non-vertex presentation, and fetal heart rate abnormalities accounted for 4 fold risk of asphyxia. Of these babies, 26% required admission in nursery and 29% developed hypoxic ischemic encephalopathy. Among the admitted babies 6% expired, 2% left against medical advice and rest were discharged. Conclusion: Early identification and close monitoring of high risk mothers studies with maintaining partograph during labor will help to reduce neonatal asphyxia. Key words: Asphyxiated babies doi:10.3126/jnps.v29i1.1592 J. Nepal Paediatr. Soc. Vol.29(1) p.3-5

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple type seizures, slowness of intellectual growth, and a specific EEG disturbance. Children affected might previously have infantile spasms or underlying brain disorder but etiology can be idiopathic. LGS seizures are often treatment resistant and the long term prognosis is poor. Key words: epilepsy, intellectual growth DOI: 10.3126/jnps.v30i1.2461Journal of Nepal Paediatric Society Vol.30(1) 2010 50-52