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Pleural effusion fluid with ?10% eosinophils may be seen in 5-16% of exudative pleural effusions. Its association with helminthic infestation is reported in the literature. This patient with left-sided eosinophilic pleural effusion was a referred case from another hospital and treated initially as parapneumonic. With inadequate response to antibiotics and a markedly high IgE level praziquantel was started. This resulted in rapid disappearance of symptoms, decrease in the eosinophil count, and radiological improvement. After exclusion of parapneumonic, tuberculosis, autoimmune disease, and malignancy, a trial of antihelminthics should be considered an option. This may spare unnecessary investigations.

Refractory status epilepticus, with persistence of seizures despite initial intravenous benzodiazepine and one secondline intravenous antiepileptic drug occurs in nine percent to 44% of the patients with status epilepticus. Aggressive treatment is needed to control such seizures with drug refractoriness. A case of a 2-year-old boy treated with intravenous levetiracetam with cessation of seizures, averting the need for general anesthesia is reported. Option of using levetiracetam in refractory status epilepticus is suggested.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal.Knowledge about its etiology and frequency helps in its evaluation and management. The presentstudy was undertaken to find out the causes and their frequency of pain abdomen in Nepalichildren. Children with pain abdomen presenting at the emergency room and pediatric outpatientdepartment of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 wereclinically evaluated and investigated to find out the causes and frequency of their pain abdomen. Theoutcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completedinvestigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only.91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic(9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related tosurgical conditions, which needed operative management. Secondary or extra-abdominal causeswere found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic(11) were predominant causes. Our study showed that the causes of pain abdomen in children werepredominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, includingfunctional and emotional causes were infrequent. Small percentage needing surgical managementformed a diagnostic challenge.Key words: abdomen, children, gastroenteritis, pain

Background: The His Majesty's Government/Japan International Cooperation Agency Primary Health Care Project began in April 1993 in collaboration with the Saitama Prefectural Government, for the purpose of improving the health status of the people in model districts of the Kingdom of Nepal. Growth monitoring is one of the basic methods that defines the health and nutritional status of children. Methods: Anthropometric indices were measured in 759 children in the Bhaktapur district. We used the World Health Organization prototype growth chart and national growth standard for Japanese children (1990) to analyze the growth data. Results: We found that the average bodyweight growth curve of children up to 4 months of age followed the 50th percentile reference curve. For children of5–12 months of age, there was a delay in bodyweight gain and the growth curve reached the 3rd percentile curve. For children more than 1 year old, the growth curve moved below the third percentile curve. Catch-up growth did not occur before the children reached 5 years of age. The main causes of catch-up growth being hampered were chronic undernutrition and inadequate nutritional balance. Conclusions: As this was the first opportunity to evaluate infant growth in this district, the first important consequence of the results was to analyze the causes of growth faltering and failure-to-thrive in Nepalese children. Even more important, was the need to give appropriate counseling on improving feeding and other health-related practices, and the most important consequence of all was to instruct Nepalese health workers that utilizing the growth charts is an integral part of health care.