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Introduction: Burn injuries are third commonest type of injury in Nepal and 61% of burn victims are children. This represents a significant morbidity and mortality burden for patients and families. This study was carried out to describe epidemiology, clinical pattern and therapeutic outcome of children with burn. Methods: It is a retrospective observational study of routinely collected data of children up to 14 years admitted to the Burns Ward at Kanti Children’s Hospital, Kathmandu, Nepal, from July 2016 to July 2019. Statistical analysis was done on the collected data. Results: Total 935 patients were admitted with an average of 311.7 per year, among which 63% were males and 83.0% were aged five years or under. Patients travelled from all over Nepal for treatment at this hospital. 50.6% of patients presented with fresh burns < 24 hours after injury. Scald burn was the commonest (82.6%). Children under five were more likely to have scald burns, whereas older children more likely to have flame or electric burns. Majority of cases (70%) were of mild burns < 10% TBSA and only 3.2% TBSA > 30%. 68.5% were managed conservatively and 18.4% required debridement and skin grafting. Mean length of stay was 15 days. Overall mortality was 1.0%. In children with > 30% burns mortality was 12.9%. Conclusions: Scald burn was the commonest while proportion of flame burn increases with age. Majority of burns occur in male under five years of age. Most cases presented with < 10% TBSA and were managed conservatively.

Background: The first wave of COVID 19 pandemic was among all age group with different presentations and outcome. This study done was to explore the social demographics, clinical characteristics, comorbidities and outcome of SARS-CoV-2 patients in Bagmati province. Methods: A retrospective study was done among the first wave of SARS-CoV-2 positive patients registered during the first wave in provincial Health Emergency Operation Center (PHEOC), Bagmati, Nepal. Data was collected from 14th April 2020 to 15th October 2020. Demographic and clinical characteristics, comorbidities, isolation centers and outcome of Bagmati province were analyzed and described. Results: Among the 58916 cases; 37045 (62.87%) were male 21871 (37.12%) were female, 4434 (7.52%) cases were below 18 years while 54482 (92.47%) were of older than 18 years. Median age was 36.56 years (IQR 1 day to 108 years). There were 1507 (2.55%) cases having co morbidities while 57409 (97.44%) did not have. There were 48734 (82.71%) asymptomatic cases and 10182 (17.28%) symptomatic. There were cases having fever 2665 (26.17%), loss of taste 2130 (20.91%), loss of smell 2097 (20.59%), cough 1330 (13.06%) and common cold 895 (8.79%) with involvement of respiratory system, gastroenterology and central nervous system. Home and intuitional isolated cases were 55227 (93.73%) and 3689 (6.26%) respectively. Four hundred eighty-seven (6.04%) had travel history within 15 days and 242 (0.41%) died. Conclusions: In the first wave of the COVID pandemic, most cases were asymptomatic while systemic involvement of CNS; respiratory, gastrointestinal symptoms were common presentation. Mostly patient remained in home isolation, few cases had co morbidity and had good outcome in total.

BackgroundAcute Respiratory Tract Infection (ARI) is one of the most common causes of mortality and morbidity worldwide. Every year millions of children suffer from viral Respiratory Tract Infections (RTIs) ranging from mild to severe illnesses. Human Metapneumovirus (HMPV) is among the most frequent viruses responsible for RTIs. However, HMPV infections and their severity among children have not been explored yet in Nepal. Therefore, the study aimed to determine the incidence of HMPV among children attending Kanti Children’s Hospital and assess the clinical characteristics of the infections as well as find out the co-infections.MethodsA hospital-based cross-sectional study was carried out from September 2018 to April 2019. A total of 105 throat swabs were collected from children clinically suspected of ARIs. The collected samples were tested for the presence of HMPV RNA by Multiplex Real-time PCR (RT-PCR) assay.ResultsThe incidence of HMPV in children in Kanti Children’s Hospital was found to be 13.3%. The HMPV was more prevalent in the age group less than three years (21.8%) which was found to be statistically significant (p - 0.038). Cough and fever were the most common clinical features present in all children infected with HMPV followed by rhinorrhea, sore throat, and wheezing. HMPV positive children were diagnosed with pneumonia (42.9%), bronchiolitis (28.5%), upper respiratory tract infections (14.3%) and asthma (14.3%). The incidence of HMPV was high in late winter (14.3%) followed by early spring (13.5%).ConclusionThis study provides the baseline information on HMPV and associated co-infection with other respiratory viruses for differential diagnosis and rational use of antibiotics in clinical management.

The second wave of COVID-19 pandemic hit all age groups with different presentations and outcomes. This study aimed to explore the clinical characteristics, investigational findings, hospital outcomes along with a ninety days telephonic follow-up of COVID-19 infection in children.A longitudinal descriptive study among COVID-19 RT-PCR positive hospital-admitted children was conducted during the second wave of the pandemic from 15 Mar 2021 to 15 Oct 2021 at Kanti Children's Hospital. Demographics, clinical characteristics, oxygen saturation, comorbidities, need of oxygen, need of ventilator, laboratory investigations, admission to intensive care unit, duration of hospital stay and patient's outcome (improved and discharged or death) were recorded. A follow up at ninety days from discharge was also done via telephonic call to inquire for any illness and hospital admission.Among the 156 admitted children, males and females were 54.5% and 45.5% with a median age of 15 months and Inter quartile range (IQR) of 63. Thirty-six (23.1%) were underweight and 31 (19.9%) had comorbidities. The most common presenting symptoms were fever 115 (73.7%), cough 50 (32.1%) and vomiting 38 (24.4%). The median (IQR) length of hospital stay was 15 (range of 11-20) days. Oxygen use was seen among 35 (22.4%) cases and 36 (23.1%) cases were admitted to the ICU. Ventilator was required for 7 (4.5%) cases. The number of deaths was 9 (5.8%) during hospital stay. After discharge from the hospital during the ninety days follow-up, 117 children had no health problems while 42 reported having some health problems and 5 died after discharge.In the second wave of the pandemic, only symptomatic children were admitted. Respiratory and gastrointestinal symptoms were common among the admitted cases. The majority of admitted cases had a good outcome and had no other health problems attributable to COVID-19 till ninety days of follow-up.

Introduction: Healthcare workers are always at the risk of exposure to different diseases like respiratory illness including COVID-19. Using appropriate face mask or respiratory protective equipment correctly can prevent transmission of diseases from and to healthcare workers while caring for patients. The study aimed to find out the practice regarding use of face masks during the COVID-19 pandemic in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital during June-July 2020 after receiving ethical approval from the review committee regarding practice of use of face masks. Convenience sampling method was used and a sample size of 162 was taken. Descriptive statistical analysis was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 162 participants, 123 (75.9%) knew the correct way of using the masks (72.5-79.3 at 95% Confidence Interval). Conclusions: In this study regarding practice of use of face masks, most of the healthcare workers knew the correct way of using masks and practised hygiene before and after using masks.

Introduction: Perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20 to 30 per thousand births. This study was carried out to review the different aspects of PMR and classifying them and identify the causes of perinatal and neonatal deaths and assessing the need for improvement in quality of pregnancy and newborn care. Methods: It was a retrospective study carried out in Bharatpur Hospital, Chitawan, Nepal. Data of all stillbirths from 22 weeks of pregnancy and neonatal deaths up to seven days of life was taken from monthly perinatal audit and annual mortality review. The data was taken from July 2017 to Jun 2019. All the perinatal deaths were then classified. Results: Over a two year period, there were total 25,977 births and total death was 369. Thus perinatal mortality rate was 12.3 per thousand births. Still births (fresh and macerated) contributed almost 82.4% of the perinatal deaths and neonatal death contributed 17.6% of total deaths. Deaths related to unexplained intrauterine fetal death (IUFD) showed an increasing trend and have increased by more than 20% in past two years from 39.1% to 60.8%. Deaths due to perinatal asphyxia, neonatal sepsis, respiratory distress syndrome and extreme prematurity were increased. Conclusions: PMR over the two years has shown increasing trend at our institute. There is need to improve antenatal, obstetric as well as intra-partum services to further reduce the still birth as well as deaths due to prematurity, RDS, neonatal sepsis and perinatal asphyxia.

Introduction: COVID-19 has spread all around the world with huge toll of human lives and suffering since it evolved in China. Nepal had slow rise in morbidity due to COVID 19 in early days but has been gripped by the pandemic's exponential growth lately. This study was conducted with the aim to describe the clinical and epidemiological features of Nepali children in early phase of the pandemic. Methods: This was an observational study conducted at 11 COVID care centres designated by the Government of Nepal with availability of supervision by paediatricians between January and August 2020 in children under 18 years of age diagnosed with COVID 19. Data was collected based on definitions outlined in data collection resources available at WHO-ISARIC Global COVID-19 clinical resources platform and analysed. Results: One hundred and twenty one children diagnosed with COVID 19 who presented to the designated centres were enrolled. Majority of children (83.4%) were identified as a part of contact tracing, 28.1% had an identified contact to a person with COVID 19 prior to their diagnosis and 20.7% had another household member diagnosed with COVID 19. The mean age of admitted children was 8.8 years (SD 5.6 years) with the largest proportion being adolescents (40.5%). Male (58.7%) children were more commonly affected. There were 15 (12.4%) infants and 8 (6%) of them were under two months of age. Most children (87, 71.9%) were asymptomatic, 21 (22.3%) had mild symptoms and six (4.9%) had moderately severe symptoms. Fever (18.2%) was the most commonly reported symptom. All children were discharged after a median of 14 days of hospitalisation. Conclusions: Nepali children of all ages are affected by COVID 19 and present with asymptomatic or mildly symptomatic infection. Fever and respiratory symptoms are the most commonly reported symptoms. Most children do not develop complications. Continued surveillance in larger population of children as the pandemic unfolds will generate more stringent observations.

Introduction: Neonatal sepsis is the commonest cause of neonatal morbidity and mortality and remains a major public health problem especially in developing countries. It is one of the most common causes for admission to neonatal units. The objective of this study was to evaluate the cost of care of neonates admitted in Neonatal Intensive Care Unit. It also compared the cost of care of neonates with sepsis and those with non-sepsis along with the duration of hospital stay and its correlation. Method: A hospital based prospective cross-sectional observational study was carried out over a period of one year. All the neonates admitted at NICU and fulfilling the inclusion criteria formed the study population. Total cost was calculated as the summation of direct and indirect cost. Normally distributed data was analyzed using the Student’s t-test, non-normally distributed data using Mann-Whitney U test. P-value < 0.05 was taken to be statistically significant. Result: Direct cost comprises more than two third of the cost. The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The cost for the ones with sepsis was USD 226.30 (Range 172.19-291.34) and 174.02 (Range 99.67-221.96) in non-sepsis. The mean duration of stay in NICU of the ones having sepsis was 6.6 days and 4.4 days in non-sepsis. Conclusion: The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The duration of stay and the total cost of treatment with sepsis are higher than those with non-sepsis.

Introduction: Congenital anomalies account for 7.0% of neonatal deaths in Nepal. The present study was carried out to determine the overall rate of congenital malformations, incidence and prevalence in live births, still birth and incidence affecting various organ systems, at Bharatpur Hospital, Nepal. Methods: All the intramural deliveries between Jan 2015 to Dec 2019 were included in the study. All the newborns were looked for congenital malformations after birth within seven days. Antenatal ultrasonography findings were noted. 2D echocardiography was also used for all congenital heart diseases, along with routine X-ray chest. A total of 131 babies with congenital problem were studied and the information was recorded in WHO NBBD Proforma. Data were recorded in MS Excel and SPSS 16 version was used for analysis. Results: Out of the total 60160 deliveries, 131 (0.21% of total birth) were with congenital malformations, sex wise distribution was 65 (49.5%) females and 63 (48.7%) males and three (1.8%) were ambiguous. Oro-facial malformation (49, 37.4%) was the commonest form of malformation followed by the musculoskeletal system (31, 23.6 %), centre nervous system (31, 23.6%) and congenital malformations of genital organs (8, 6.0%). Conclusions: The incidence of congenital malformation in this study was 0.21%. Females were more common than males and oro-facial malformation was the commonest type of malformation. Lack of antenatal visit, lack of folic acid during pre-conception period and low socioeconomic status were the commonest risk factors.

Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality. Late onset sepsis (LOS) is associated with community environment or postnatal exposure to hospital environment. Its incidence is rising due to greater survival of preterm neonates and very low birth weight babies. Because of difference in local epidemiology and possible variation with time, regular monitoring and updates on pathogen and their antimicrobial sensitivity pattern is important for prevention and treatment. The objective of this study was to identify the common symptoms and signs and determine the common bacterial isolates and antibiotic susceptibility pattern of late onset neonatal sepsis. Methods: This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Kanti Children’s Hospital from July 2016 to June 2017. Results: Poor feeding (89.6%), fever/hypothermia (47.2%), excessive/ poor cry (40.8%) and irritability/lethargy (33.6) were the common symptoms. Staphylococcus aureus and Coagulase negative staphylococcus (CONS), the most predominant organisms, were isolated in 66.7% and 18.5% of culture positive cases respectively. Most of the isolated organisms showed sensitivity to cloxacillin (16/27), amikacin (15/27), ciprofloxacin (14/27), cefotaxime (11/27), cotrimaxazole (6/27) and amoxyclox (6/27). Conclusion: Poor feeding, fever/hypothermia, excessive/ poor cry and irritability/lethargy were the common symptoms. This study has indicated possible emergence of Staphylococcus aureus as the dominant cause of late onset neonatal sepsis. Cloxacillin, amikacin, ciprofloxacin and cefotaxime were more efficacious against the commonly isolated bacteria in late onset neonatal sepsis.

Introduction: Neonatal sepsis is the most common cause of neonatal morbidity and mortality. The causative organisms of neonatal sepsis are changing and so do their antibiotic sensitivity pattern. So it is important to regularly monitor the change in bacteriological profile and their antimicrobial sensitivity pattern to help update the treatment guidelines of neonates. This study aimed to study the microbiological patterns of neonatal sepsis and their antibiotic susceptibility pattern in a tertiary care centre in Kathmandu. Methods: A prospective study was carried out among cases of neonatal sepsis admitted in Neonatal Intermediate Care Unit (NIMCU) of a tertiary care referral hospital from August 2015 to August 2016. Prospective data were collected with pretested and standardised proforma and analysed using SPSS version 20. Results: Out of 311 neonates admitted over a period of one year with diagnosis of neonatal sepsis, male:female ratio was 2.1:1. Among them 234 (75.2%) cases were of LONS and 77 (24.8%) were of EONS. Blood culture was positive in 47 neonates (15.1%). The organisms isolated included staphylococcus aureus (34.0%), klebsiella (32%), CONS (24%), escherechia coli (6%) and enterobacter (4%). In LOS, gram positive organisms staphylococcus and CONS were the commonest ones (61.4%). In EOS, gram negative organism klebsiella (65%) was more common. Most of staph aureus were susceptible to penicillins, amikacin and cefotaxime. Klebsiella was found to be resistant to penicillins, amikacin and cefotaxime. Conclusion: There is possible increasing incidence of gram positive septicemia in LONS and increasing emergence of resistance of kleibsella to the common antibiotics ampicillin, amikacin and cefotaxime.

DOI: https://doi.org/10.3126/jnps.v38i2.20473 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. Keywords: Familial Chylomicronemia, lipemic plasma, triglyceride level, Lipemia retinalis

COVID-19 pandemic hit all age group with different presentations and outcome. This study aimed at exploring the clinical characteristics, investigational findings, hospital outcome along with 90 days follow up of COVID-19 infection in children.This was longitudinal descriptive study among hospital admitted children with COVID-19 RT-PCR positive during first wave of Pandemic with 90 days telephonic follow up. Demographic and clinical characteristics, comorbidities, SPO2, investigations, need of oxygen , PICU admission, need of ventilator, outcome (improved and discharged, death) and duration of hospital stay were recorded and 90 days telephonic follow up was performed for any illness and hospital admission.Out of 65 children admitted, male 44 (67.7%) and female 21 (32.3%), median age was 23 months ( IQR 6 days -14 years) with 52( 80.0%) without any comorbid conditions. The common signs were Fever 40(61.5%) vomiting 15 (23.1%) and Cough 11(16.9%).Thirteen (20.0%) children has platelets count less than 150000 and 16(24.6%) had C - reactive protein Positive .Mean duration of hospital stay 8 days (Range 1 -44 days), 20( 30.8% ) needed oxygen , 20(30.8%) needed Pediatric intensive care unit (PICU)admission and 6 (9.2%), needed ventilator. Forty seven (72.3%) recovered and discharged with death of 6.2% (n=4). Fifty six children (75.4%) has not experienced any problem after COVID -19 and only 2 children needed hospital admission in 90 days telephone follow up.In the first wave of the pandemic, Respiratory and Gastrointestinal symptoms were common presentation with few Severe and critical cases. Majority had good outcome. Majority has no other related illness till 90 days after discharge.

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age

Background: Frontline Health Care Workers are at risk of developing mental and psychological distress during Corona virus disease 2019 pandemic. This study aimed to assess level of stress, anxiety, depression and their associated factors among health care workers during Corona virus disease 2019 pandemic in Nepal.Methods: This is a web based cross-sectional survey conducted among 404 Health Care Workers during early phase of Corona virus disease 2019 pandemic. The participants were selected using convenience sampling technique and were invited to participate via various online networks. Depression, anxiety and stress were assessed using the Depression Anxiety Stress Scale-21 (DASS-21) and their associated factors were measured using structured questionnaires. Multivariable logistic regression was carried out to determine the associated factors.Results: The symptoms of stress, anxiety and depression among health care workers were found to be 28.9%, 35.6% and 17.0% respectively. Females were found to be 2 fold more likely to have anxiety and depression than male. Nurses were found to be two times more likely to have anxiety than doctors. Laboratory personnel were almost three folds more likely to have anxiety than doctors. Health care workers with insufficient/ no PPE were almost three fold more likely to have depression. health care workers working in high-risk areas had almost 2 fold higher odds of having depression.Conclusions: Health care workers experienced symptoms of stress, anxiety and depression in varied level of severity. This experience was higher among the nurses and laboratory workers than doctors. Pandemic preparedness assuring PPE and appropriate psychological interventions may be beneficial to promote mental health and well-being of health care workers.Keywords: Anxiety; associated factors; depression; health workers; stress

Background The RCPCH CPRR course was developed following the Lord Laming Inquiry (2003) after the death of Victoria Climbie in 2000. These Courses are run by ALSG (Advanced life supportgroup) in several centres and adopted abroad in some countries including Nepal. Aims To raise awareness of child abuse and neglect in Nepal. To encourage effective response including referrals to the appropriate agency. To support the development of a multi–agency response in the Nepalese context. Methods and Results In 2016, the first Nepalese course was conducted at Kanti Children Hospital, Kathmandu by the Visiting UK Paediatricians and Nurses led by Drs Neela Shabde & Chris Hobbs. A total of 35 doctors and nurses attended. Eleven candidates were identified as trainers.The 3rd and 4th day was jointly conducted by UK and Nepalese faculty. Similar courses were held in 2017, 2018 and 2019 with stake holder’s involvement of Nepal Paediatric Society, Swantrata Abhiyan Nepal, and some participation of Ministry of Health,Child Workersin Nepal ( CWIN), UNICEF & Police. Conclusions More than 100 doctors and nurses have been trained including a dedicated pool of trainers to take this forward. Two Paediatricians from Nepal have received training at AlderHey Children’s Hospital. So The Child May Live, UK and Health Exchange Nepal, UK have agreed to fund this project for further 3 years. There is a need for a coordination and joining up of services to develop pathways a for referral and management, involving Department of Social services and the health teams in hospitals. The multiagency response to the child protection training is a priority for developing child protection services in Nepal. Support from the UK team should be available during the training courses

Bruck syndrome is a very rare autosomal recessive syndrome consisting of bone fragility and congenital joint contractures. It is considered as a combination of arthrogryposis multiplex congenita and osteogenesis imperfecta, while some consider it as the autosomal recessive variant of osteogenesis imperfecta. According to the genotype, it has been classified into types 1 and 2. To our knowledge, only about 28 patients of this syndrome have been reported so far worldwide with none been reported from Nepal. Here, we present a patient with generalized osteopenia, bilateral femur fracture and congenital joint contractures of distal extremities.

Introduction: Congenital Heart Disease is the most common cause of major congenital anomalies accounting 28.0%, representing a major global health problem. Prevalence of Congenital Heart Disease is 1.3 per 1000 in school children of Nepal.Material and Methods: A cross sectional prospective study was carried out in the neonatal intermediate care unit of Kanti Children’s Hospital, Nepal from Jan 2016 until Dec 2016 to see the spectrum of CHD.Results: Out of admitted 831 neonates, 85 were found to have CHD with prevalence of 102.28 per 1000 admitted neonate. Respiratory distress was the commonest symptom (51.8%) followed by cyanosis (11.8%) and reluctant to feed (10.6%) at presentation. ASD was the commonest (87.1%) cases followed by PFO 23.5%, PDA 21.2%, Complex congenital heart disease 11.8% and TOF 1.2%. Cleft lip and Cleft Palate was found in 5.9%, Down’s syndrome 3.5% of cases, polydactyly and syndactyly was detected in 2.4% newborn with CHD. The mode of delivery was spontaneous in 71.8% followed by Elective LSCS were 14.1% and Emergency LSCS were 9.4%.Conclusions: Prevalence of CHD was the 102.28 per 1000 neonates admitted in NIMCU. Atrial Septal Defect was the commonest congenital heart diseases. Cleft lip and Down’s syndrome were the most extra cardiac anomaly associated with CHD. Respiratory distress was the commonest presentation of CHD for hospital admission.

Introduction: HIV in children is a public health problem in a developing country like Nepal. The aim of the study was to determine the clinical, nutritional and immunological profile of HIV +ve children enrolled in the ART clinic of Pokhara Academy of Health Sciences (PAHS).Materials and Method: This was a retrospective study of children enrolled in the ART clinic over a period of 10 years from July 2007 to June 2017. Clinical characters, Nutritional status and immunological status of children enrolled in the ART clinic were noted in the predesigned pro forma from the record of the clinic and review of the chart of the patients.Results: One hundred twelve children were enrolled in the Clinic during the study duration. Out of them 57 were males and 55 were females. All the children acquired infection through mother to child transmission. Majority of them from age group 1 to 5 years at the time of presentation. Forty-six percent were in the clinical stage III. The median CD4 count was 283.Fifty percent of the children were undernourished. Most of the children were started on AZT/3TC/NVP as first line ART.Conclusion: Although perinatal route was the most common route of transmission of HIV in children, diagnosis was late in the age group of 1-5 years and most of them were diagnosed in the advanced stage of HIV with Low CD4 count.

Background Earthquakes impact child health in many ways. Diseases occurring immediately following an earthquake have been studied in field based hospitals but studies on the inpatient disease pattern among children without trauma in a permanent hospital setup is lacking. Methods We examined the diagnoses of all children without trauma, admitted to Kanti Children’s Hospital, Kathmandu for fifteen-week duration (from 4th week to end of the 18th week) following the 7.8 magnitude Nepal earthquake on 25th April 2015. The admitted children were grouped based on direct effect of earthquake on their family (house damaged or family member injured or dead) and on whether their place of residence was located in an earthquake affected district. Most common diagnoses were identified and their distribution between the aforementioned groups analyzed to examine differences, if any, in disease occurrence or presentation. The fifteen weeks study duration was divided into three parts of five weeks each, to study trends in illness presentation. Variables were compared among various groups using appropriate statistical tests (p

DOI: https://doi.org/10.3126/jnps.v38i2.20551 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. Keywords: children, Takayasu’s arteritis,Steroids

Introduction: Scrub typhus is an acute febrile illness endemic to tsutsugamushi triangle including Nepal. The WHO identifies scrub typhus as a re-emerging disease in South-East Asia. Scrub typhus can have varied manifestations in children. We aimed to study clinicolaboratory profile and therapeutic outcomes of serologically confirmed scrub typhus in children. Methods: A retrospective study was conducted at Kanti Children’s Hospital, Nepal after obtaining ethical clearance from Institutional Review Committee, and reviewing the medical records of serologically diagnosed scrub typhus admitted to the hospital between August 2016 and January 2018. Relevant data were entered in and analyzed using SPSS 20.0. Results: Children from 9 districts of Nepal severely affected by the 2015 earthquake were admitted; mostly from Dhading (14.5%) and Gorkha (9.7%) districts. All 62 children included in the study had a fever; whereas pain abdomen, vomiting, cough, headache, and generalized body swelling were present in 25.8%, 21.0% 24.2%, 14.5%, and 14.5% cases respectively. Hepatomegaly, splenomegaly, hepatosplenomegaly, lymphadenopathy, and rashes were found in 53.2%, 38.7%, 32.2%, 17.7% and 9.7% cases respectively. Thrombocytopenia and hyponatremia were seen in 72.6% and 28.6% cases respectively. The combination of hepatosplenomegaly and thrombocytopenia was seen in 29.0%. Azithromycin was used as first-line treatment in 56 (90.3%) children while other children were treated with doxycycline and chloramphenicol. Seven (11.3%) children required PICU admission. The mean duration of hospital stay for all children was 6.95 ( ± 2.68) days while it was 9.00 ( ± 3.51) days for children requiring PICU admission. Conclusions: Scrub typhus should be considered in children with an acute febrile illness with hepatosplenomegaly and thrombocytopenia. Azithromycin is the drug of choice. Some children may need intensive care.

Background: Most of the febrile infants

Background An estimated 2.7 of the 5.9 million deaths in children under 5 years of age occur in the neonatal period. Severe infections contribute to almost a quarter of these deaths. Mortality due to severe infections in developing country settings is substantial despite antibiotic therapy. Effective interventions that can be added to standard therapy for severe infections are required to reduce case fatality. Methods/Design This is a double-blind randomized placebo-controlled parallel group superiority trial to investigate the effect of zinc administered orally as an adjunct to standard therapy to infants aged 3 days up to 2 months (59 days) hospitalized with clinical severe infection, that will be undertaken in seven hospitals in Delhi, India and Kathmandu, Nepal. In a 1:1 ratio, we will randomly assign young infants to receive 10 mg of elemental zinc or placebo orally in addition to the standard therapy for a total of 14 days. The primary outcomes hospital case fatality, which is death due to any cause and at any time after enrolment while hospitalized for the illness episode, and extended case fatality, which encompasses the period until 12 weeks after enrolment. Discussion A previous study showed a beneficial effect of zinc in reducing the risk of treatment failure, as well as a non-significant effect on case fatality. This study was not powered to detect an effect on case fatality, which this current study is. If the results are consistent with this earlier trial, we would have provided strong evidence for recommending zinc as an adjunct to standard therapy for clinical severe infection in young infants. Trial registration Universal Trial Number: U1111-1187-6479, Clinical Trials Registry – India: CTRI/2017/02/007966 : Registered on February 27, 2017.