Background Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. Methods A prospective observational study was carried out in children aged 1–16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. Results All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. Conclusions Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.

Background: Vitamin D is an essential prohormone for the normal skeletal and extraskeletal health. Vitamin D deficiency/ insufficiency is an unrecognized epidemic among children and adults worldwide. There are growing data from studies of young children and adolescents in other countries, but a limited information are available regarding the prevalence of this nutritional deficiency/insufficiency among the Nepalese children and adolescents. Thus this study was aimed to find out the prevalence of vitamin D deficiency/insufficiency among children and adolescents, who has attended in Chitwan Medical College (CMC). Methods: This was a retrospective hospital based study in children between 2 months and 19 years of age, conducted in CMC from April 2015 to December 2016. Results: Among 108 total studied, overall 74.1% (80) patients had 25(OH) D levels lower than 30 ng/ml with 27.8% having severe deficiency (< 10 ng/ml), 28.7% deficiency (10-19 ng/ml) and 17.6% insufficiency (20-29 ng/ml) category . The prevalence was found higher in females (95.2%), though the difference in prevalence between sexes was not statistically significant (P -value 0.243). Conclusion: Our study concluded that a high prevalence of low Vitamin D status (deficiency/insufficiency) found among the paediatric population (all paediatric age groups) indicates a need for further national level study to find out the actual prevalence of this nutritional deficiency, as well as the need for vitamin D supplementation to all children and adolescents.

Background: Acute glomerulonephritis is a common pediatric kidney disease which places a huge burden in developing countries. This study aimed to evaluate causes, clinical manifestations, laboratory findings and complications of acute glomerulonephritis in children presented to a tertiary care center of Nepal. Methods: This was a retrospective review of records of children admitted with acute glomerulonephritis at Chitwan Medical College from April 2018 to February 2021. Socio-demographic data, clinic-laboratory profile and outcomes were obtained from medical records and descriptive analysis was carried out. Results: Among 48 recruited children with acute glomerulonephritis, 60.4% were male and the mean age was 9.5 ± 3.7 years. Post infectious glomerulonephritis including post streptococcal glomerulonephritis (48%) was the main cause of acute glomerulonephritis. The major clinical features were edema (81.3%), hypertension (72.9%), dyspnea (29.2%) and hematuria (25%). ASO titer was positive in 45.8%. The complications noted were acute kidney injury (6.3%), hypertensive emergency (6.3%) and congestive cardiac failure (2.1%). Conclusions: Most of the patients were above 5 years of age and presented most commonly during autumn and summer season.  The complications of acute glomerulonephritis were acute kidney injury, hypertensive emergency and congestive cardiac failure.

Pulled elbow is a common condition but may not be recognized by most of the paediatric physician. The purpose of this study is to evaluate the common age, mechanism, site of pain, reduction maneuver and its efficacy among paediatric population. Among 40 patients, 31 patients meeting the inclusion criteria were included in this study. Simple analytical method was used to analyze the data due to small number of patients. Supination-flexion maneuver was used for reduction. Among 31, 15 (48.38%) were male and 16(51.61%) were female. The mean age was 3.12 years, mean arrival time was 13.03 hours. 32.25% of patients had history of pulling the child up and 41.93% of patient complained of pain around forearm. All patient underwent supination- flexion maneuver and was successful in first attempt, except one, that required second attempt. There were no recurrences. There should be a high index of suspicion among paediatricians, so that they can correctly diagnose and treat this condition satisfactorily.

Mechanical ventilation is a key therapeutic modality in treatment of sick neonates. Our hospital based retro­spective study conducted at Chitwan Medical College (CMC), Nepal over the duration of 2 years, from February 2015 to January 2017, with aims to study the clinical profile, indications, complications and outcome in terms of survival in mechanically ventilated neonates. Total of 119 mechanically ventilated neonates were included in the study. Along with admission and discharge register record, all the patient’s record files were retrieved from the medical record section, necessary details were entered in a predesigned proforma and statistical analysis was done using IBM SPSS 20 software. Out of 1306 total NICU admission, total 130 were mechanically ventilat­ed, among them only 119 (9.1%) were included in the study. Majority (71.4%) were male. More than half were Preterm (51.3%) and outborn (58%). Most common indication of mechanical ventilation was sepsis followed by Birth asphyxia (BA), respiratory distress syndrome/hyaline membrane disease (RDS/HMD) and Meconium Aspiration Syndrome (MAS). Overall survival was 45(37.8%). Among the indications during the study period, the best survival observed was in birth asphyxia. Shock and Disseminated intravascular coagulation (DIC) were the two most common complications encountered during the course of ventilation. Increasing birth weight, higher gestational age and Downes Score at intubation of 6 or < 6 was associated with a better outcome. Shock, multi organ dysfunctions (MODS), and ventilator associated pneumonia (VAP) were the statistically proven individual predictors of outcome.