bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional Status of Under-Five Children in Western Nepal
Authors: Shrestha Bandana 
Published: October 2014

Introduction: Undernutrition is a major health problem in developing countries which may have adverse effects on growth and development of an individual. The objectives of this study were to assess the prevalence and grades of malnutrition in children below 60 months of age, attending outpatient department at Gandaki Medical College teaching hospital.Materials and Methods: A prospective study was conducted among 556 children below 60 months of age from August to December 2013. Weight and length/height were measured using standard technique and were plotted on WHO centiles curves and severity determined based on WHO classification. The prevalence of underweight, stunting and wasting were determined by anthropometry.Results: Based on WHO classification, out of 556 children, 20.2% were underweight, 34% were stunted and 15.1% were wasted respectively. Of them, severe underweight were 4.7%, severe stunted were 14.1% and severe wasted were 7.2% respectively.Conclusion: A high prevalence of undernutrition exists in under- five children attending a tertiary hospital in a western region of Nepal.DOI: http://dx.doi.org/10.3126/jnps.v34i2.10566J Nepal Paediatr Soc 2014;34(2):119-124
Percutaneous Endoscopic Gastrostomy in Children: Experience from Single Center of a Developing Country
Authors: Kehar Mohit , Wadhwa Nishant , Upadhyay Satyam 
Published: October 2014

Introduction: Nutrition is of paramount importance for adequate growth and development of a child. Various routes of providing enteral nutrition to a paediatric patient are by nasogastric, nasojejeunal and gastrostomy which can be placed surgically or endoscopically. The objectives of this study were to review cases with percutaneous endoscopic gastrostomy (PEG) procedure and patient characteristics, indications, complications and outcome of PEG tube insertion in children at our center.Materials and Methods: This was a prospective study carried out in Sir Ganga Ram Hospital in New Delhi, India for a period of two years from August 2010 to August 2012. It included patients in whom PEG tube were placed during the study period and have had at least one year of post procedure follow up. Demograhic details, duration of procedure, complications, initial weight and height and then at 3 month, 6 months and 12 months of PEG tube placement were also recorded. Data between groups was compared using ANOVA and within groups across follow-ups was done using paired t-test.Results: Fourty six PEG insertions were performed during the study period, 26 twenty six conversions to BRT or Mickey button and ten PEG removals. The main indications for PEG insertion were Cerebral palsy with feeding difficulty (47.8 %). Erythema at the PEG insertion site was the most common complication (21%). There was significant improvement in the weight and height in all age group of patients at 3, 6 and 12 months post procedure with a p value <0.5. The average weight gain after 3, 6 and 12 months was 1.3 kg, 2.8 kg and 4.2 kg and the average height gain after 3, 6 and 12 months was 1.6 cm, 2.5 cm and 4.13 cm respectively.Conclusions: PEG is effective means for optimizing the nutritional goals of patients who are nutritionally debilitated with minimal complications. DOI: http://dx.doi.org/10.3126/jnps.v34i2.10960J Nepal Paediatr Soc 2014;34(2):125-131
Pneumopericardium
Authors: Pathak Meen Raj , Shakya Disuja 
Published: October 2014

Pneumopericardium may be defined as the presence of air within pericardial cavity which results due to spontaneous or iatrogenic cause. It is rare but life threatening entity, commonly caused by respiratory distress syndrome and vigorous resuscitation, in the paediatric population. Although, pneumopericardium is often asymptomatic, it may cause chest pain, dyspnoea and subcutaneous emphysema. The course of pneumopericardium is usually benign and self-limited. Treatment is crucial in tension pneumopericardium, a complication of pneumopericardium. Here, we report a case of pneumopericardium in a nine month old male child after vigorous resuscitation and intubation for respiratory distress syndrome. DOI: http://dx.doi.org/10.3126/jnps.v34i2.11152 J Nepal Paediatr Soc 2014;34(2):163-165
Left Lung Agenesis with Bicuspid Aortic Valve
Authors: Taran Shachi Jain , Kumar Ravindra , Lodha Manish 
Published: October 2014

Agenesis of the lung is an extremely rare congenital anomaly representing failure of development of the primitive lung bud. Here we are presenting a case of left lung agenesis with bicuspid aortic valve in a 17 year old girl who came with the complaints of backache only. The diagnosis was made on the basis of CECT and 2D Echocardiography. DOI: http://dx.doi.org/10.3126/jnps.v34i2.8792 J Nepal Paediatr Soc 2014;34(2):147-149
Morquio disease with CNS involvement: a rare association
Authors: Pal Shinabi , Dey Chandrashekhar , Ghosh Nilanjan , Roy Shabarna , Nayek Kaustav , Dasgupta Malay Kumar 
Published: October 2014

Morquio syndrome is a rare type of mucopolysaccharidosis. Our patient presented with uncontrolled seizures and gross skeletal deformity. He was suspected to be suffering from mucopolysaccharidosis based on his disease presentation but the diagnosis could be made as Morquio syndrome on the basis of the presence of keratan sulphate in the urine. DOI: http://dx.doi.org/10.3126/jnps.v34i2.9298 J Nepal Paediatr Soc 2014;34(2):157-159
Miller Dieker Syndrome as a Cause of Refractory Seizures
Authors: Pati Sananda , De Sangita , Nag Sankha Subhra , Nayek Kaustav 
Published: October 2014

Miller-Dieker syndrome is a genetic deletion syndrome characterized by neuronal migration disorder lissencephaly where the exterior of the brain is abnormally smooth with fewer folds and grooves and characteristic facial dysmorphism. A one year old boy born presented to our emergency with severe respiratory distress and recurrent convulsions. A diagnosis of Miller Diecker syndrome was made consistent with typical clinical features and investigations. The child was managed symptomatically, however the seizures remained refractory and the child succumbed on day three of admission. Diagnosis of rare diseases like this is necessary not only for management but also for predicting recurrence in the family and genetic counselling. Key words: Miller Dieker syndrome; Lissencephaly; Refractory Seizures DOI: http://dx.doi.org/10.3126/jnps.v34i2.9408J Nepal Paediatr Soc 2014;34(2):154-156
Ataxia Telangiectasia: Case Report from a Rural Hospital in Nepal and Current Management Recommendation
Authors: George Susan Mary , Mathews MC 
Published: October 2014

It is important though challenging to make accurate diagnosis of neurodegenerative conditions in children and initiate the right treatment. A 14 years old boy presented with deterioration in speech, mobility and performance of daily activities and frequent chest infections over four years. Aided ataxic gait, dysarthria, stooped posture, generalised hypotonia and weakness and ocular telangiectasia were noted. We present a case of Ataxia telangiectasia from a rural hospital in Nepal. DOI: http://dx.doi.org/10.3126/jnps.v34i2.9694 J Nepal Paediatr Soc 2014;34(2):138-140
Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre
Authors: Chaudhary Shipra , Keshary Bhatta Nisha , Khanal Basudha , Bhandari Rabin , Rajbhandari Singh Rupa 
Published: October 2014

Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%. The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.doi: http://dx.doi.org/10.3126/jnps.v34i2.9794J Nepal Paediatr Soc 2014;34(2):104-110
Congenital Genu Recurvatum
Authors: Sharma Deepak Kumar , Yadav Jaivinder , Garg Eva , Bajaj Hanish 
Published: October 2014

No abstract available DOI: http://dx.doi.org/10.3126/jnps.v34i2.9890 J Nepal Paediatr Soc 2014;34(2):168-169
Anemia in pregnancy and its associated factors: A study from Eastern Nepal
Authors: Maskey Manisha , Jha N , Poudel SI , Yadav D 
Published: October 2014

Background Anemia in pregnancy is responsible for many adverse effects on maternal and fetal outcome. It is the commonest hematological disorder accompanying pregnancy. Prevalence of anemia among pregnant women is fairly high worldwide, especially in developing countries. A research finding published by World Health organization revels that the prevalence of anemia among pregnant women in developing countries averages 56% (ranging between 35 to 100%). Though Nepal has decreasing trend of prevalence of anemia, it is still high (42% in 2006). Identifying the associated factors which are responsible for the development of anemia during pregnancy would be of great help in mitigating the burden to some extent. Ojective of the study was to find out the pattern of anemia and associated risk factors for anemia during pregnancy. Materials and Methods A cross-sectional study was conducted in VDC named Hansposa. Door to door survey was carried out to collect data using pre-designed questionnaires. Ante-natal check-ups were provided with analysis of hemoglobin levels, in every individual of study population, using conventional Shali's method. Chi-square test was applied, where applicable. Results Altogether 249 pregnant women were included in the study. The proportion of anemia was found to be 46.6%, the cases of mild anemia, and moderate anemia were 51.0% and 49.0% respectively. Risk factors includes: history of complications during previous pregnancy (P<0.001), education (P<0.05), age at marriage (P=0.028), low socio-economic status (P<0.001), gravidity and parity (P<0.01), poor knowledge about anemia (P<0.001), abnormal body mass index (P<0.001) and smoking (P=0.05). Conclusion This study indicates that the prevalence of anemia during pregnancy bears a resemblance to national value. Major associated risk factors include: history of complications during previous pregnancy, low knowledge about anemia in pregnant women, women with low body mass index, age at marriage, socio-economic status, gravidity and parity, and smoking. Most importantly, the lack of commitment in female education plays vital role in its existence.DOI: http://dx.doi.org/10.3126/nje.v4i4.11358 Nepal Journal of Epidemiology 2014; 4(4):386-92
Urolithiasis in male patients: A pilot study on the ethnic differences and clinical profile
Authors: Sreedharan Jayadevan , John LJ , Freeg HAM Aly , Muttappallymyalil J 
Published: October 2014

Background Ethnicity play a role in the occurrence of urinary stones, probably related to climatic, environmental and dietary factors in ethnic groups. The association between ethnicity, age, clinical profile, stone size with type of ureteric stones among males with urolithiasis was studied. Materials and Methods Male patients (>18 years) with lower ureteral stones size <10mm attending outpatient department of Urology, at a private hospital, Ajman over a period of one year were included. Ethics approval was obtained from Institutional Ethics Committee. Data was retrieved from the case records which included socio-demographic variables (age, ethnicity), clinical profile (ureteric colic, duration of pain, other complaints), and laboratory investigations (type of stone, stone size). Descriptive and inferential statistics were performed with SPSS-20 and p values <0.05 considered significant. Results 185 male patients were included. Mean age was 41.5 (7.3) years, range (22-71) years. Out of the total, 81 (43.8%) patients were Asians, 81(43.8%) Arabs and 23 (12.4%) were of other ethnicity. Most patients (95.1%) presented with ureteric pain. 49 (26.5%) had family history of stone disease where calcium oxalate monohydrate and uric acid stones were common, with majority being first degree relation. Data on stone type was available for 90 patients; of which, 21 were calcium oxalate monohydrate, 33-calcium oxalate dehydrate, 24-uric acid and remaining 12 other form of stones. Average age for different types of stone was 38.3, 41.6, 39.4 and 42.8 years for calcium oxalate monohydrate, calcium oxalate dehydrate, uric acid and other types respectively. Conclusion Uric acid stones were more prevalent among Asians and calcium oxalate-dehydrate stones among Arabs. Future studies can be conducted among multiethnic population focusing on dietary pattern and stone analysis.DOI: http://dx.doi.org/10.3126/nje.v4i4.11359 Nepal Journal of Epidemiology 2014; 4(4):393-98
Effect of Age, Sex and Pregnancy on Levels of Urinary Inhibitors of mineralization in Human Beings
Authors: Kakkar Monica , Kakkar R , Lal AK , Singla SK 
Published: October 2014

Background: Based upon the differences observed in the level of urinary inhibitors between adult normal subjects of both sexes and kidney stone patients of identical sex, it has been postulated that urinary inhibitors play an important role in the control of pathological mineralization. Review of literature revealed that corresponding studies on the level of urinary inhibitors in children of both sexes and during various stages of pregnancy are not available. These studies, so important to investigate the role of inhibitors in physiological mineralization, formed the objective of the present study. Materials and Methods: Homogenous system of In vitro mineralization was employed to study not only the extend of mineralization and the effect of various urine samples obtained from normal subjects of both sexes and pregnant females at various trimesters of pregnancy on extend of mineralization but also to quantify the level of the inhibitors. Results: Using in vitro system of mineralization (precipitation of Ca2+ or HPO4 2- ions as mineral phase), it has been shown that in contrast to the adult human beings, in children of less than 13 years of age no significant differences exists in the level of the urinary inhibitors between males and females children provided experimental support to the epidemiological studies on the occurrence of the renal calculosis problem in both sexes of children and adult human beings. The findings that the level of the urinary inhibitors of mineralization in both sexes of children is as high as present in adult females and that a highly significant decrease in their levels occurs during the 3rd trimester of pregnancy strongly suggests that hormones may be playing an important role in regulating their levels. Conclusion: Inhibitors of mineralization excreted in urine of normal healthy subjects of both sexes of Children (<13 years), adults (>20 years), kidney stone patients at these ages, non pregnant and pregnant females (during various trimesters of pregnancy) have been postulated to play an important role in the control of both physiological and pathological mineralization.DOI: http://dx.doi.org/10.3126/nje.v4i4.11360 Nepal Journal of Epidemiology 2014; 4(4):399-404
Accessing research literature: A mixed-method study of academics in Higher Education Institutions in Nepal
Authors: Simkhada Padam , Van Teijlingen E , Devkota B , Pathak SR , Sathian B 
Published: October 2014

Background: Research in Higher Education (HE), particularly in health and medical sciences plays a crucial role, not only in enhancing knowledge and skills of students and academics, but also in helping to develop managers and policy makers who rely on evidence-based planning and programming. This paper reports university teacher’s knowledge and practices in accessing to electronic research-based evidences in health and medical sciences in Nepal. Material and Methods: This was mixed-methods study comprising a self-administered questionnaire completed by HE teachers and informant key interviews with authorities of HE institutions. A total of 15 out of the total 40 institutions offering HE above Bachelors level on health-related subjects were included for the study. Results: The response rate was 68%; 244 out of 360 HE teachers completed self-administered questionnaire. The respondents comprised nurses (36%), followed by doctors (23%), public health practitioners (18%), dentists (17%) and pharmacists (12%). Most of the HE teachers reported that they have computer skills and possess their own computer. Two-thirds (66%) of the HE teachers had work email and almost all (93%) have a personal email ID. All institutions had a computer lab and/or library. Almost all teachers had internet access at work but the internet was reportedly slow. Each institution had a librarian to support to the students and staff but only a third of teachers sought their help. Many do not know what kind of support librarians can provide. Less than half of the staff had accessed electronic research materials. This proportion varied between HE institutions ranging from 13 to 83%. HINARI and PubMed were the mostly used research databases. Less than half of respondents (48%) had published research papers in peer-reviewed journals, and only 19% published a paper based on a systematic review. Female HE teachers were less likely to publish (32%) than males (68%). More readers and professors had published (75%) than instructors/assistant lecturers (30%) and lecturers (45%). Conclusions: Accessing electronic research literature provides an opportunity to gathering up-to-date research-based information that should be core to all health curricula. We call upon curriculum developers and university authorities in Nepal to revise health curricula and help build electronic searching skills among staff and students. DOI: http://dx.doi.org/10.3126/nje.v4i4.11375 Nepal Journal of Epidemiology 2014; 4(4):405-14
Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study
Authors: Bjellvi Johan , Flink Roland , Rydenhag Bertil , Malmgren Kristina 
Published: October 2014

OBJECT
Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series.

METHODS
The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months).

RESULTS
A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09–1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years.

CONCLUSIONS
This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.
Intraoperative stereotactic injection of Indigo Carmine dye to mark ill-defined tumor margins: a prospective Phase I–II study
Authors: Margetis Konstantinos , Rajappa Prajwal , Tsiouris Apostolos John , Greenfield Jeffrey P. , Schwartz Theodore H. 
Published: October 2014

OBJECT
A critical goal in neurosurgical oncology is maximizing the extent of tumor resection while minimizing the risk to normal white matter tracts. Frameless stereotaxy and white matter mapping are indispensable tools in this effort, but deep tumor margins may not be accurately defined because of the “brain shift” at the end of the operation. The authors investigated the safety and efficacy of a technique for marking the deep margins of intraaxial tumors with stereotactic injection of Indigo Carmine dye.

METHODS
Investigational New Drug study approval for a prospective study in adult patients with gliomas was obtained from the FDA (Investigational New Drug no. 112680). At surgery, 1–3 stereotactic injections of 0.01 ml of Indigo Carmine dye were performed through the initial bur holes into the deep tumor margins before elevation of the bone flap. White light microscopic resection was conducted in standard fashion by using frameless stereotactic navigation until the injected margins were identified. The resection of the injected tumor margins and the extent of resection of the whole tumor volume were determined by using postoperative volumetric MRI.

RESULTS
In total 17 injections were performed in 10 enrolled patients (6 male, 4 female), whose mean age was 49 years. For all patients, the injection points were identified intraoperatively and tumor was resected at these points. The staining pattern was reproducible; it was a sphere of stained tissue approximately 5 mm in diameter. A halo of stained tissue and a backflow of dye through the needle tract were also noted, but these were clearly distinct from the staining pattern of the injection point, which was vividly colored and demarcated. Postoperative MR images verified the resection of all injection points. The mean extent of resection of the tumor as a whole was 97.1%. For 1 patient, a brain abscess developed on postoperative Day 16 and needed additional surgical treatment.

CONCLUSIONS
Stereotactic injection of Indigo Carmine dye can be used to demarcate multiple deep tumor margins, which can be readily identified intraoperatively by using standard white light microscopy. This technique may enhance the accuracy of frameless stereotactic navigation and increase the extent of resection of intraaxial tumors.