Usefulness of Flexible Airway Endoscopy for the Diagnosis of Pulmonary Diseases in Children.

Background Flexible airway endoscopy is a highly valuable procedure for evaluating pediatric airway and pulmonary disorders. However, its use in our setup is limited. Objective The main objective of this study is to analyze indications for flexible airway endoscopy in our population, explore its diagnostic yield and highlight potential complications. Method Seventy flexible airway endoscopies performed in children at Nepal Medical College and Teaching Hospital from June, 2013 to May, 2015 were analyzed. Result Fifty six (80%) of airway endoscopy had a meaningful outcome. Diagnostic yield for individual indications ranged from 50 to 87.5%. Recurrent/persistent pneumonia was the most rewarding indication. Complications were minimal and easily reversible. Conclusion The overall diagnostic yield of flexible airway endoscopy in our study population was 80%. The procedure was safe with minimal complication. Hence, earlier intervention and utilization of bronchoscopy should be encouraged after a careful clinical consideration of patients who could potentially benefit from this procedure.

Identification of risk factors for cesarean delivery following induction of labour.

BACKGROUND: Induction of labor is one of the most common procedures in obstetrics. Induction has been found to both increase and decrease the risk of cesarean delivery. Various studies have found different factors in different studies. The purpose of this study is to increase our knowledge of factors that increase risk of cesarean delivery when labour is induced at term. METHODS: A prospective observational study was conducted from June 2006-July 2007 at an obstetric unit of Eastern Nepal. A total of 348 patients in a 1:1 ratio (vaginal delivered n1-174, cesarean delivered n2-174) were enrolled in the study after inclusion and exclusion criteria were met. Logistic regression analysis was done to assess the significant variables. RESULTS: Maternal age, height, parity, indication of induction, gestational period at induction, presence of meconium in amniotic fluid, hypertension were not significantly associated with increased risk of cesarean delivery. In an adjusted model only birth weight, prolonged latent and active phases of labour, Bishop's score ≤5 were significantly associated with increased risk of cesarean delivery. CONCLUSIONS: Bishop's score ≤5 at induction, obesity, three doses of misoprostol required for successful induction, use of oxytocin, prolonged latent phase, prolonged active phase, birth weight of neonate >4kg was significantly associated with increased risk of cesarean in unadjusted model but in an adjusted model only birth weight, prolonged latent and active phases of labour, Bishop's score ≤5 were significantly associated with increased risk of cesarean delivery.

Profile of neonates born to adolescent mothers at Nepal medical college teaching hospital.

Pregnancy in adolescence is often associated with maternal complications as well as preterm delivery, low birth weight babies and small for date babies. A retrospective study was carried out in 350 adolescent women who delivered child at Nepal Medical College Teaching Hospital (NMCTH), Attarkhel, Kathmandu from April 2005 to February 2009. Data were obtained from the case record register. Prevalence of pregnancy in adolescence was 11.1%. Majority of adolescent mother were aged between 17-19 years, belonging to Mongolian ethnicity, Hindu by belief and residing within Kathmandu Valley. More than 90.0% mothers were primigravida and 85.4% had complete antenatal check up (ANC). Normal vaginal delivery was the predominant mode of delivery (84.6%), followed by lower section caesarean section (LSCS) (14.0%) and instrumental delivery (1.1%). In newborn, male outnumbered female (59.7% versus 40.3%). A reasonable number of preterm (10.9%), low birth weight (12.3%), small for gestational age babies (7.4%) and neonates with birth asphyxia (10.3%) were noted. These newborns are often associated with high morbidity and mortality. Therefore, it is imperative to prevent teenage pregnancy by providing adequate access to health facilities and raising awareness about the sex and reproductive health amongst this population.

Clinical and bacteriological profile of urinary tract infection in children at Nepal Medical College Teaching Hospital.

The aim of this study was to study the clinical and bacteriological profile of urinary tract infection (UTI) in children. This was a prospective study of 40 culture positive cases of UTI in children who attended pediatric outpatient department of Nepal Medical College Teaching Hospital. UTI was more common in female (65.0%) than in male (35.0%). Half were in the age group 1- 5 years. Fever was the most common presentation (65.0%) followed by abdominal pain (42.5%), decreased appetite (37.5%) and dysuria (37.5%). Escherichia coli was the most common (67.5%) bacterial isolate followed by Klebsiella sps (20.0%) and Proteus sps (10.0%). E. coli was 100 % sensitive to nitrofurantoin. E. coli was also highly sensitive to ofloxacin, cefotaxim and amikacin (94.0%). Klebsiella was 100 % sensitive to ciprofloxacin and amikacin. Greater degree of resistance was seen to ampicillin, cotrimoxazole and nalidixic acid.

Profile of acute lower respiratory tract infection in children under fourteen years of age at Nepal Medical College Teaching Hospital (NMCTH).

The purpose of this study was to find out the current pattern and prevalence of acute lower respiratory tract infections in children at Nepal Medical College Teaching Hospital in Katmandu, Nepal. A retrospective study was done in 73 children, admitted to the Pediatric ward over a period of one year from January 2010-December 2010. This study showed, 52.0% children below two years of age had acute lower respiratory tract infections, where 68.4% had pneumonia and 31.6% had acute bronchiolitis. The prevalence of infections was 58.9% in male children. The occurrence of infections was common in January and April month. Pneumonia was detected in 37.7% children with malnutrition. The most common presenting symptoms was fever observed in 90.4%, cough in 71.2% and fast breathing in 34.2% children. The WBC count was high in 47.9% children, out of which 43.8% had pneumonia and 4.1% had bronchiolitis. Increased neutrophil count in 36.9% and increased ESR in 50.7% seen in patients only with pneumonia. Chest x-ray showed, lobar pneumonia in 45.2% children where right middle zone was most commonly involved in 42.4% patients. Six (8.2%) children were diagnosed as pulmonary tuberculosis. The average duration of hospital stay was 6 days.

Clinical profile of tuberculosis in children.

Childhood tuberculosis is common in our community. The diagnosis in most cases is still based on clinical evidence alone. The present study was designed to study clinical profile, laboratory investigations and outcome of pediatric tuberculosis. A prospective study was conducted among the children admitted in Nepal Medical College from April 2007 to March 2011. The prevalence of tuberculosis was 1.5%. Pulmonary tuberculosis was common (53.7%) than extra pulmonary (46.3%) tuberculosis. BCG scar was present in 48.8%. History of tuberculosis contact was present in 36.6% and Mantoux test was positive in 39.0%. The most common symptoms were fever (75.6%), cough (63.4%) and weight loss (41.5%). Confirmed diagnosis was made (bacteriological or histological) only in 14.6%. This study supports the use of history and clinical features to diagnose childhood tuberculosis.

Neonatal status in Nepal Medical College Teaching Hospital.

The objective of this study was to know the state of newborns in Nepal Medical College Teaching Hospital. This was a retrospective study of newborns delivered in Nepal Medical College Teaching Hospital from mid April 2008 to mid April 2009. There were 793 births with male: female ratio being 1.08:1. Almost 90 % were term babies and 6.9% preterm. Low birth weight comprised of 9.1%. Seventy five babies were admitted in neonatal unit during that period. Neonatal sepsis (33.7%), neonatal hyperbilirubinemia (30.7%), prematurity (12.0%) were major cause of admission to neonatal unit. Mortality occurred in 3 of these babies and all of them were preterm babies with gestation 29-31 weeks. Therefore it is very important to upgrade our level II care neonatal unit to level III care to improve the neonatal care.

Overview of neonatal hyperbilirubinemia at Nepal Medical College Teaching Hospital.

This study was done to assess the prevalence of neonatal jaundice, underlying risk factors and efficacy of phototherapy, which would be of value in identifying and implementing strategies to prevent morbidity and mortality from this condition. A retrospective study was carried out in 86 neonates admitted to neonatal intensive care unit at Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from May, 2005 to April 2008. All of the newborns who developed hyperbilirubinemia and required phototherapy and/or exchange blood transfusion (EBT) were included in this study. Case records were evaluated for details of maternal and babies birth history and clinical examinations. The initiation of phototherapy and/or EBT were done by using standard guidelines. Out of total of 820 NICU admissions, 86 (10.5%) had significant hyperbilirubinemia. Amongst them 59.3% were male and 40.7% female. Septicemia, prematurity and ABO incompatibility were observed in 33.7%, 23.2% and 13.9% cases respectively. Phototherapy was required in 95.5% and EBT in 4.6% cases. In our study, septicemia, prematurity and ABO incompatibility were found to be the most common risk factors of neonatal jaundice. The data showed, phototherapy as an effective procedure in management of neonatal hyperbilirubinemia.

Unsafe abortion: a tragic saga of maternal suffering.

INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8%) were of high grade. Most of them recovered but there were total 8 maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country.

Loading dose versus standard regimen of magnesium sulphate in eclampsia--a randomized trial.

Eclampsia is one of the leading causes of maternal mortality and morbidity around the world. Magnesium sulphate is used as primary agent in the treatment of seizure in eclampsia. Its dosage and frequent painful injection makes it a difficult drug for the patient. This study was carried out in one of the biggest referral centre of Nepal to study the suitability of different dosage schedule for our patient. A randomized controlled trial was carried out in the Obstetric Unit of BP Koirala Institute of Health Science (BPKIHS) over the span of 1.5 years. A total of 80 eclamptic women were randomized to receive either standard Pritchard Regimen (loading and maintenance) or Loading dose of magnesium sulphate. Both groups were evaluated for recurrence of seizures and outcomes. There were no recurrent seizures in standard regimen group. There were 2 patients with recurrent seizure in loading dose group. (p=0.184) Loading dose of magnesium sulphate is a good alternative for standard Pritchard regimen. It avoids multiple painful injections of magnesium Sulphate.

Perinatal mortality audit.

Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. A retrospective study of perinatal indices was conducted among 816 births delivered during the period of 1 year from April 2007 to March 2008 in Nepal Medical College. There were 11 still births and 11 early neonatal deaths. Breech presentation with stucked head and respiratory distress syndrome in preterm babies are the common causes for perinatal mortality. Within the Wigglesworth's classification; group 1, 3 and 4 are the common groups of perinatal death. The 76.5% of perinatal deaths and 100% of early neonatal deaths were low birth weight babies. Similarly 72.5% of perinatal death and 82% of early neonatal death were preterm babies. The perinatal mortality was 26.9/1000 births, comparable to other studies, but still emphasis should be given to upgrade the neonatal care. The efforts should be made for regular antenatal checkups and improvement of neonatal care.

Development and evaluation of the Kids Count Farm Safety Lesson.

The Kids Count Farm Safety Lesson was delivered to nearly 2,000 fifth-grade students in 15 rural schools in Hillsborough County, Florida. The lesson covered animal, machinery, water, and general safety topics applicable to farming in Florida. A staggered pretest-posttest study design was followed whereby five schools received a multiple-choice pretest and posttest and the remainder of the schools (N = 10) received the posttest only. Results of the study showed a significant increase in the mean number of correct answers on the posttests compared to the pretests. There was no significant difference in the mean number of correct answers of those students who received the pretest and those students who had not, eliminating a "pretest" effect. This study fills an important gap in the literature by evaluating a farm safety curriculum offered in the elementary school setting. It also included migrant schoolchildren in the study population. It is strongly recommended that agricultural safety information be included into the health education curriculum of these elementary schools.