Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Crosssectional Online Survey

Background COVID-19 is an infectious disease caused by a newly discovered coronavirus. The number of cases and dramatic loss of human life worldwide created psychological problems among general public, including health care workers. Objective To determine the burden of anxiety, depression, and functional impairment among health care workers in the early days of lockdown during the first wave of COVID-19 outbreak in Nepal. Method A hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur during the COVID-19 pandemic lockdown from April 3, 2020 to May 2, 2020 using an online questionnaire. The tools used were adopted from Nepali version of Hospital Anxiety and Depression scale (HADS) and Nepali version of WHO Disability Assessment Schedule (WHODAS 2.0). Result The mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants were equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p < 0.01) and depression (18.6% vs 9.3%, p=0.351). Clinical and nonclinical staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean functional impairment score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46), and 19.92 (95% CI: 15.28- 24.56), respectively. Conclusion Anxiety and depression during the first lockdown due to COVID-19 pandemic were highly prevalent in clinical and non-clinical employees. Besides controlling the outbreak, special consideration should be given to mental health.

Molecular study of 2019 dengue fever outbreaks in Nepal

BACKGROUND

Dengue cases have been continuously reported in Nepal, including some large outbreaks, since its first introduction in 2004. The disease is now expanding towards newer locations above 1400 m high, especially the country's capital city, Kathmandu. In 2019, >14,000 dengue cases including six deaths were reported. This study was aimed at the detection and molecular characterization of dengue virus (DENV) in dengue patients.

METHODS

A total of 451 patients were enrolled in this study. Demographic, clinical and laboratory information was collected from dengue patients. Dengue infection was confirmed by antibody/antigen detection assays followed by RT-PCR analysis.

RESULTS

The DENV patients showed fever, body ache, headache, myalgia, retro-orbital pain and arthralgia. The platelets were decreased, serum liver enzymes were increased and leucopenia was seen. Out of 195 patients, 111 (57.0%) were positive for DENV RNA by consensus PCR. We found DENV-2, 70 (63.1%) as the predominant serotype responsible for the 2019 outbreak, while DENV-3 was detected in two patients.

CONCLUSION

Our findings suggest that DENV-2 was the major serotype causing the 2019 massive outbreak in Nepal. This information will help in disease control programs to understand the molecular epidemiology and its changing trend.

Risk Factors and Clinical Profile of Preterm Deliveries at Dhulikhel Hospital, Kathmandu University Hospital

Background Preterm delivery is one of the major determinants of neonatal morbidity and mortality and has long term adverse health outcomes. Objective To study the risk factors of preterm deliveries and the clinical profile of preterm births presenting to a tertiary center in Kavre district. Method A hospital based prospective study was carried out in the Department of Pediatrics and Department of Obstetrics and Gynaecology, Dhulikhel Hospital, Kavre from 1st April 2016 to 31st October 2017. Result Study included 152 babies born premature and attending Dhulikhel Hospital. There were 5.26% babies less than 1000 grams and the least weight being 700 grams. Majority of the premature babies were male (57.24%). Most of the babies were in the gestational age of 28 to 32 weeks (60%). Steroids were given to 42.10% of the cases. Mode of delivery was vaginal route (60.53%) followed by cesearean section in 37.50%. Hyperbilirubinemia (53.29%), neonatal sepsis (46.05%) and respiratory distress syndrome (43.42%) were the commonest morbid conditions. Among the 152 cases, mortality was seen in 13.82%. The minimum weight to have survived was 900 grams. The most common modifiable risk factors responsible for preterm birth in mother were inadequate antenatal visits (29.60%), history of premature rupture of membranes (28.29%), history of urinary tract infection (21.05%) and weight less than 45 kg (14.47%). The non modifiable risk factors were mothers with blood group A (33.55%) and height of less than 145 cm (20.40%). Conclusion The modifiable risk factors such as inadequate antenatal visits, history of premature rupture of the membranes and urinary tract infection and under weighing mothers can be corrected by early interventions and preventive measures which will help in reducing perinatal morbidity and mortality.

Hemiconvulsion-Hemiplegia-Epilepsy Syndrome in a Girl Presented with Complex Partial Seizures

The mechanisms underlying the Hemiconvulsion-Hemiplegia-Epilepsy syndrome remains unclear. The current proposed pathogenic mechanism is a neuronal injury induced by venous thrombosis and/or hypoxia. Children develop hemispheric brain atrophy with contralateral hemiplegia, epilepsy, and a variable degree of cognitive deficit. We report a 33 months old female child a case of hemiconvulsion-hemiplegia-epilepsy syndrome with right hemisphere unilateral brain edema and left sided hemiplegia and aphasia who presented with left upper extremities complex partial seizures with generalization to tonic clonic seizures and developed status epilepticus that posed diagnostic and therapeutic challenges. Progressive atrophy of the right cerebral hemisphere was noted after 3 months of follow up. Hemiconvulsion-Hemiplegia-Epilepsy syndrome should be suspected in a child with unilateral cerebral hemisphere brain edema and hemiplegia with cognitive deficit following status epilepticus to provide patients and families with an accurate prognosis regarding the subsequent development of epilepsy.

Clinical Profile and Electroencephalogram Findings in Children with Seizure Presenting to Dhulikhel Hospital

Background Seizure disorder is the most common childhood neurologic condition and a major public health concern. Identification of the underlying seizure etiology helps to identify appropriate treatment options and the prognosis for the child. Objective This study was conducted to investigate the clinical profile, causes and electroencephalogram findings in children with seizure presenting to a tertiary center in Kavre district. Method This was a hospital based prospective study carried out in the Department of Pediatrics, Dhulikhel Hospital, Kavre from 1st April 2015 to 31st March 2016. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and outcome. Result Study included 120 (age 1 month to 16 years) children attending Dhulikhel Hospital. Majority of the patients were male (60.84%). Age at first seizure was less than 5 years in 75.83% of children. Seizure was generalized in 62.50%, focal in 31.67% and unclassified in 5.83%. Common causes of seizure were - Primary generalized epilepsy (26.66%), neurocysticercosis (10%) and hypoxic injury (6.6%) which was diagnosed in the perinatal period. Febrile seizure (26.66%) was the most common cause of seizure in children between 6 months to 5 years of age. Neurological examination, electroencephalography and Computed Tomography were abnormal in 71.66%, 68.92% and 58.14% cases respectively. Seizure was controlled by monotherapy in 69.16% cases and was resistant in 7.50% of the cases. Conclusion Primary generalized epilepsy and febrile seizure were the most common causes of seizures in children attending Dhulikhel Hospital. Electroencephalogram findings help to know the pattern of neuronal activity. Response to monotherapy was good and valproic acid was the most commonly used drug.

A Prospective Study on Exchange Transfusion in Neonatal Unconjugated Hyperbilirubinemia--in a Tertiary Care Hospital, Nepal

BACKGROUND

An exchange transfusion involves replacing patient's blood with donor blood in order to remove abnormal blood components and circulating toxins while maintaining adequate circulating blood volume.

OBJECTIVE

To observe the incidence, causes of jaundice requiring Exchange and any adverse event of exchange transfusion in newborns with unconjugated hyperbilirubinemia.

METHOD

Prospective study undertaken at Neonatal Intensive Care Unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal from March 2014 to April 2015. For both mothers and neonates blood group and Rh typing and for all newborns pre and post exchange complete blood count with peripheral smear, serum bilirubin, hemoglobin, calcium, potassium, random blood sugar, C-reactive protein and blood culture and where ever required Direct Coombs test, reticulocyte count, G6PD activity and thyroid function test were done. The incidence, indications, positive outcome, complications and mortality were noted.

RESULT

Out of 481 cases of unconjugated hyperbilirubinemia 29 (6%) required exchange transfusion. 55.2% Pathological Jaundice [13.8% ABO incompatibility, sepsis and hypothyroidism was commonest causes] and 44.8% exaggerated physiological jaundice [27.6% with no underlying pathology, 10.3% preterms 3.4% cephalhematoma] required exchange transfusion. Post transfusion, bilirubin level decreased significantly (p < 0.001). The commonest adverse events noted were anemia (89.7% / p < 0.018), hyperglycemia(51.7% / p < 0.001), hypocalcaemia (48.3% / p < 0.001)), sepsis(10.3%), hypernatremia (13.8%), hyperkalaemia, bradycardia, apnea and feed intolerance (6.9%). None of them had kernicterus and there was no mortalities.

CONCLUSION

Exchange transfusion is an effective procedure to decrease bilirubin levels but is associated with many complications. Hypothyroidism was one of the commonest cause of jaundice requiring Exchange transfusion.

Pattern of Cardiac Diseases in Children Attended at Dhulikhel Hospital, Nepal

Background Congenital Heart Disease and Rheumatic Heart Disease are the most common childhood cardiac disease encountered in developing countries. Objective To study the pattern and the prevalence of cardiac diseases, its age wise distribution and to determine their risk factors for mortality in children presented to Dhulikhel Hospital, Kathmandu University Hospital. Method A study of cardiac diseases in children, since birth to 16 years of age attending the department of pediatrics in Dhulikhel Hospital, Kathmandu University Hospital was done over a period of 30 months (Jan 2014 to June 2016). The pattern of disease was studied. Detailed clinical examination of all cases was done followed by the necessary relevant investigations including electrocardiography, chest x-ray, echocardiography and supportive laboratory investigations. Result In this study period, 218 pediatric cardiac cases were encountered, among which 144 cases (66.05%) were Congenital Heart Disease, 57 cases (26.14%) were Rheumatic Heart Disease, 14 cases (6.42%) were Pericardial Disease and 3 cases (1.37%) were classified as Dilated Cardiomyopathy. Majority of Congenital Heart Disease were of isolated Ventricular Septal Defect (25%) and isolated Atrial Septal Defect (20.13%) followed by Patent Ductus Arteriosus (9.02%), Tetralogy of Fallot (6.94%) and Complex Congenital Heart Disease (6.25%). All of the Rheumatic Heart Disease primarily involved the Mitral Valve; however combined Aortic Valve involvement was seen in 26.31% of cases. All the 14 cases of pericardial disease presented with pericardial effusion and two cases presented with constrictive pericarditis. All the cases of pericardial disease were investigated to be of tubercular in origin. Conclusion Septal defects are the most common Congenital Heart Disease encountered in children. Although the prevalence of Rheumatic Heart Disease is decreasing worldwide, it is still a big burden in our community. Tubercular pericardial effusion is still not uncommon and should be suspected with a child presenting with pericardial effusion. Increased level of cardiac care and corrective surgeries are needed for children with cardiac disease in Dhulikhel Hospital, Kathmandu University Hospital.

Stress Induced Gastric Ulcers: Presenting as Massive Rectal Bleeding in a Newborn

Severe gastrointestinal bleeding in newborn period is a serious but uncommon phenomenon that has a broad differential diagnosis. Primary duodenal ulcers are rare in children but stress induced ulceration in stomach occurs more often in neonatal period due to birth asphyxia, prolonged labour, cesarean deliveries, instrumentations, respiratory distress syndrome and sepsis. These present as acute onset of gastrointestinal bleeding commonly as altered gastric aspirate, hematemesis or malena. We report a case of a neonate with stress induced gastric bleeding following birth asphyxia who presented with massive gastrointestinal bleed manifesting as hematemesis and massive rectal bleeding. Resuscitation with multiple blood transfusion and parenteral use of ranitidine controlled the bleeding. Stress induced gastric ulcers should be suspected in a neonate presenting with massive gastrointestinal bleeding after difficult delivery and birth asphyxia.

Modifiable demographic factors that differentiate bronchiolitis from pneumonia in Nepalese children less than two years - a hospital based study

BACKGROUND

Bronchiolitis and pneumonia is an important cause of mortality and morbidity in children. Various risk factors make these children more prone for this illness. There is limited data on the risk factors from this part of the world. Moreover there is a significant clinical overlap between bronchiolitis and pneumonia thus necessitating the need for evaluating their demographic difference.

OBJECTIVE

To evaluate the modifiable demographic risk factors for bronchiolitis and pneumonia in children less than 2 years.

METHOD

A prospective, comparative hospital based study undertaken during March 2012- March 2013 in Manipal Teaching Hospital, Pokhara. Altogether 200 cases of bronchiolitis and 200 cases of pneumonia, in the age group of 2 to 24 months, were randomly selected for comparison of risk factors as per a predesigned proforma. A 'p' value of < 0.05 was considered statistically significant. Data was analyzed by using SPPS version 16.

RESULT

The significant risk factors for bronchiolitis were age <6 months (p<0.001), prematurity (p<0.001),male(P<0.04), younger maternal age (p<0.009), poor maternal knowledge (p<0.013), air pollution and lack of ventilation (p<0.001), exposure to cooking fuel - kerosene (p<0.007), firewood (p<0.001) , tobacco smoke (p<0.001), overcrowding (0.008), winter season (p<0.015), domestic pets (p<0.003), low birth weight (p<003), use of animal milk (p<0.001).The significant risk factors for pneumonia were age 13 months- 24 months, maternal age 26- 35 yrs (p<0.009), female (p< 0.04), malnutrition, lack of Vitamin A supplementation and immunization (p<0.001).

CONCLUSION

Most of the risk factors for bronchiolitis and pneumonia identified in this study were modifiable; hence could be prevented to decrease the burden of both the diseases.

Sydenham's Chorea as Presentation of Rheumatic Heart Disease

Sydenham's chorea is the most common type of acquired chorea in childhood which is a major neurological manifestation of rheumatic fever. We describe a 13 years old girl who presented with weakness and purposeless involuntary movements of upper and lower limbs. The symptoms slightly affected the child's daily activities and had an unstable gait on walking which was aggravated during stress. Grade II ejection systolic murmur was noticed on cardiovascular examination. Echocardiography evaluation showed thickened aortic and mitral valve leaflets with mild to moderate degree of mitral regurgitation. Anti-streptolysin O titer was positive (≥200 IU/ml). CT scan of brain was normal. Subsequently child was diagnosed as Rheumatic heart disease with Sydenham's chorea and kept on regular Benzathine penicillin prophylaxis. Symptoms subsided spontaneously after 3 months without any further complications. Although decreasing, early diagnosis and management of Sydenham's chorea and Rheumatic heart disease are very crucial and should be considered with such presentation.

Recurrent pneumonia-H type Tracheoesophageal fistula, diagnostic dilemma

Tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is a rare congenital anomaly.  Most of the children are treated for episodes of pneumonia prior to definitive diagnosis.  A 5 months infant presented with recurrent pneumonia and diagnosis of H type TEF was made with contrast esophagram.DOI: http://dx.doi.org/10.3126/jnps.v34i1.8517   J Nepal Paediatr Soc 2014;34(1):71-73

Clinical Profile and Outcome of Childhood Tuberculosis at Dhulikhel Hospital

The corrected PDF for this article was loaded on 07/02/2011.Background: Children contribute a significant proportion of the tuberculosis (TB) burden in Nepal and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary TB (EPTB) is challenging.Objectives: The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis. Methods: A prospective analysis of 60 cases of TB children within three years period was conducted at Pediatric Department, Dhulikhel Hospital and followed up till child completely recovered.Results: In the present study 60 children had clinical and lab evidence of tuberculosis and received anti tubercular therapy. Extra pulmonary tuberculosis was common (78.3%) than pulmonary tuberculosis (21.6%). BCG scar was absent in eight (13.33%) and absent BCG vaccination was significantly associated with disseminated TB (p<0.05). The most frequently seen symptoms were fever (65 %), cough (46.67 %) and abdominal distension (36.67%). Hepatomegaly (45%), ascites (33.33%), lymphadenopathy (23.33 %) and splenomegaly (11.67 %), and are common signs. Malnutrition seen in (33.3%) with more malnourished children with disseminated TB than in other diagnosis (p<0.001). Mantoux test was positive in (48.3%). Isolation of AFB was possible only in (8.33%). Among 60 cases (60%) were recovered completely with the primary regimen, (5%) recovered with extending the duration of primary regimen to three more months. (25%) failed to follow up, while (6.67%) died.Conclusion: EPTB is common than pulmonary TB. Among 60 cases 36 (60%) recovered completely with the primary regimen, three cases (5%) recovered with extending the duration with primary regimen. Fifteen cases (25%) failed to follow up, while four cases (6.67%) died.Key words: Children; Tuberculosis; Diagnosis; Outcome DOI: 10.3126/jnps.v31i1.4160J Nep Paedtr Soc 2010;31(1):11-16