Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study

Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia. Key words: Birth asphyxia; HIE; Neonatal sepsisDOI: 10.3126/jnps.v30i3.3916J Nep Paedtr Soc 2010;30(3):141-146

Histiocytosis Syndromes of Childhood: A report of four cases

Histiocytosis Syndromes of Childhood (HSC) are a group of rare and diverse disorders characterized by aggressive proliferation or accumulation of cells of monocyte - macrophage system of bone marrow. The clinical spectrum of this syndrome is distinctly varied. The exact pathophysiology of HSC is yet to be determined; however, evidence suggests that one of the subtypes, Hemophagocytic Lymphohistiocytosis, is due to decreased Natural Killer cell activity, resulting in increased activation of other T cell subtypes and production of cytokines. We present four cases of HSC managed at our center between October 2008 & February 2010. Key words: Histiocytosis Syndromes of Childhood; Langerhan’s cell Histiocytosis (LCH); Hemophagocytic Lymphohistiocytosis (HLH); Macrophage Activation Syndrome (MAS). DOI: 10.3126/jnps.v30i3.3923J Nep Paedtr Soc 2010;30(3):171-174

Poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital

Objective: The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. Materials and methods: A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. Results: A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 ±14.85 years and 35.54±15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. Conclusion: The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning. Key words: poisoning; insecticides; organophosphorus DOI: 10.3126/kumj.v7i2.2711 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26,152-156

Estimation of Chlorinated Pesticide Residues in Animal and Vegetable Oils

A procedure for the determination of chlorinated pesticide residues in cottonseed oil, hydrogenated marine oil, seal oil, butter oil, and processed beef tallow is described. The oil is spread in the form of a thin film over a large surface area provided by Celite 545. The pesticides are extracted from the oil-coated Celite with 80% aqueous acetonitrile, partitioned into Skellysolve F, and cleaned up on a basic alumina (activity III) column. Gas chromatography with an electron capture detector is used for qualitative and quantitative estimations. The average recovery of six commonly used chlorinated pesticides (aldrin, dieldrin, heptachlor, heptachlor epoxide, lindane, and p,p'-DDT) at levels of 0.1 and 0.25 ppm ranged from 82 to 106%.

AN INTERACTION EFFECT OF NITROGEN STORAGE WITH SPECIFIC STRAINS IN THE HATCHABILITY OF TURKEY EGGS

Fertile turkey eggs, totalling 592 from two small strains over three bi-weekly hatch-storage periods in trial 1 and 666 from three large strains over one biweekly hatch-storage period in trial 2, were subdivided into two approximately equal groups and each group was subjected to either refrigerated storage or refrigerated storage plus nitrogen gas in a closed environment. Results indicated that the hatchability of eggs of specific strains was enhanced by storage in nitrogen gas. The enhancement in hatchability did not appear to be consistently related to the level of hatchability in a specific strain. The effect of nitrogen treatment in preserving embryonic viability was better in the second than in the first week of storage in one trial only. The interaction of nitrogen treatment with hatches in trial 1 suggested that the effect of nitrogen treatment may be most pronounced when other environmental factors deter embryonic viability.