Background Enteric fever is very common infectious disease in developing countries like Nepal. Due to lack of resources diagnosis has to be clinical most of the time. Hence a proposal of clinical diagnostic criteria and validation of the same would be very useful. Objective To validate the proposed clinical diagnostic criterion including features characterized as major and minor criteria Methods This study was done in the department of medicine of Kathmandu Medical College Teaching hospital, from June 2009 to January 2012. A total of 114 patients presenting with fever were included in the study. After proposal of clinical diagnostic criteria for enteric fever, by a prior published study, all the fever patients were grouped according to criteria positive or negative. The most significant criteria were validated by calculating sensitivity and specificity along with positive and negative likelihood ratios with blood culture taken as gold standard. Results A total of 114 patients were enrolled. Total patients diagnosed as enteric was 47.3 %. Clinical diagnostic criterion B which included three major (headache, fever and relative bradycardia) and three minor criteria (abdominal pain, vomiting, diarrhea, splenomegaly and chills) was highly significant (p=<.0001) in diagnosing enteric fever and had a sensitivity of 72.2% ( 95% CI 58.1- 83.1) and specificity of 98.3% ( 95% CI 89.8-99-9). The positive likelihood ratio was 43.33 (95 % CI 6.16-304.77) and negative likelihood ratio as 0.28 (95% CI 0.18-0.43). Conclusion Clinical diagnostic criteria can be a very useful tool for diagnosis of enteric fever when culture facility is not available. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10986 Kathmandu Univ Med J 2012;10(4):8-11

Background: Enteric fever is a common public health problem in Nepal. The emerging fluoroquinolone resistance to Salmonella typhi is a major concern in every hospital and is a public health problem these days. Continuous antibiotic susceptibility patterns surveillance and standard treatment policies need to be established to control MDR typhoid. Objective: To detect the increasing pattern of fluoroquinolone resistant Salmonella typhi and to correlate its clinical response to third generation cephalosporins. Materials and Method: This is a cross-sectional prospective study conducted in the pediatric ward of Birendra Hospital, Kathmandu, from September 2009 to August 2010. Forty seven children aged between 3-14 years with the diagnosis of suspected, probable and confirmed cases of Enteric fever were enrolled in the study. Data was collected and statistical analysis was done using SPSS program. Result: Culture positive enteric fever was found in 21 cases (44.68%) and positive Widal test in 18 (38.29%). Among the culture positive cases, antibiotic sensitivity was highest for Ofloxacin (95.23%), followed by third generation Cephalosporins (Ceftriaxone, Cefixime) (90.47%). A significant number of isolates were resistant to Nalidixic acid (71.42%). All cases were successfully treated with parenteral antibiotics followed by oral third generation cephalosporins without any complications and/or mortality. Conclusion: There is an increasing trend to fluoroquinolone resistant Salmonella typhi. Third generation cephalosporin can be the appropriate antibiotic for treatment.of clinically suspected cases of Enteric fever and to minimize the risk of increasing emergence of MDR enteric fever including Nalidixic acid resistant Typhoid.(NARST).

BackgroundBody swelling in a child is a common symptom. Apart from systemic causes like renal, hepatic, and cardiac, rarely such a swelling may be caused by dermatologic conditions.Case presentationA child presented with swelling of the body which was subsequently diagnosed as scleredema, a rare and benign dermatologic condition. Scleredema can be confused with similar sounding terms like scleroderma and scleromyxedema.ConclusionsThe case is presented to highlight scleredema as a rare cause of body swelling in paediatrics and to differentiate it from similar sounding rare terms like scleroderma and scleromyxedema.

Background: Congenital heart diseases are recognized as public health concerns worldwide and Nepal is no exception. This study aims to study congenital heart disease in Nepal on grounds of burden, commonest type, common presentations, and associated noncardiac anomalies so that its spectrum can be known for prompt diagnosis and adoption of screening protocols.Methods: Relevant articles were searched in electronic databases using appropriate search terms and Boolean operators. Data were extracted in Excel and analyzed in Comprehensive Meta-Analysis Software. The proportion was used as an effect measure and a fixed or random-effect model was used as per the heterogeneity.Forest plots were used to give visual feedback.Results: A total of nine studies were included in the qualitative and quantitative synthesis after a rigorous screening of imported studies. The prevalence of congenital heart disease was 0.7% (Proportion: 0.007; CI: 0.001-0.035; I 2 : 99.263%). The burden of atrial septal defect was 32.1%, ventricular septal defect was 31.1%, patent ductus arteriosus was 12.6% and Tetralogy of Fallot was 7.3%.The most common presentations were respiratory tract infection (54.7%), developmental delay (49.8%), difficulty in breathing (44.5%), failure to thrive (17.1%), and cyanosis (15.9%). Conclusions:The prevalence of congenital heart disease in Nepal was 0.7% and the frequency of male patients was higher. The atrial septal defect was the commonest on the whole, while, Tetralogy of Fallot was the commonest among cyanotic variety. Respiratory tract infection was frequently seen at presentation and the most commonly associated noncardiac anomaly was the cleft palate.

Introduction: Pneumonia is the most common cause of mortality and morbidity in children in underdeveloped countries. e common bacterial agents are Streptococcus pneumonia followed by Haemophilus in uenzae type b. e only measure to treat bacterial pneumonia is the correct use of antibiotics along with oxygen in moderate to severe cases. e objectives of this study were to see the clinical features of community-acquired pneumonia and to observe the response to treatment with crystalline penicillin in hospitalized children. Methods: is study was a prospective study. e children aged between two months to 59 months with pneumonia were treated with intravenous crystalline penicillin. Response was observed by normalization of respiratory rate and absence of lower chest indrawing. Results: Out of 88 children treated, 79(89.8%) showed improvement in 48 hours. In children who had tachypnoea, 62.9% showed normalization in respiratory rate in the rst 24 hours and 37.1 percent in 48 hours of treatment. Similarly, among children with lower chest indrawing; 61.1% showed improvement in 24 hours and the remaining in 48 hours. In 24 hours of treatment 17.7% of children became afebrile and 46.8% in 48hours of treatment. Conclusion: e most common clinical features like cough, fever, tachypnoea and lower chest indrawing can be used to diagnose CAP where chest X-ray is not possible. e response to treatment with crystalline penicillin is very good and, thus, can be used as the rst line drug in the treatment of children with CAP.