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Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP) readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV) catheterization using Seldinger's technique. In group A, central venous catheterization was done under electrocardiography (ECG) guidance. In group B, the catheter was inserted blindly using Peres' formula of “height (in cm)/10”. The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.

DOI: http://dx.doi.org/10.3126/njog.v5i1.5055 NJOG 2010 Jul-Aug; 5(1): 17-20

BACKGROUND: Diarrhoea is a major health problem among children. It remains a major cause of childhood morbidity and mortality worldwide, with particularly high morbidity in children younger than 5 years of age. The objective of this study is to determine the frequency and associated risk factors of viral diarrhoea in children less than 5 years of age at Dhulikhel Hospital, Kathmandu University Hospital, Nepal and also to study the clinical presentation and the common causes of acute childhood diarrhoea.METHODS: This is a hospital based, prospective, non-interventional study conducted in Dhulikhel hospital. A total of 100 cases attending Dhulikhel hospital between 1st December 2011 to 31st March 2012, presented with acute onset of diarrhoea were enrolled in the study. During the study period the parents were asked to respond to questionnaires regarding their family size, educational status and knowledge of Oral Rehydration Solution (ORS), their water source and sanitation, personal hygiene and food habit. The children were examined, assessed for dehydration and anthropometry was also taken. The fresh stool specimens were analysed in the hospital laboratory in order to look for the common pathogens. All the statistical analysis was done using both descriptive and inferential (chi-squared test) statistics with the help of SPSS 20 software.RESULTS: Out of 100 children studied 69% were males and 31% females. Majority of the study population were below 24 months of age (77%). Majority were classified as no dehydration (75%) as per WHO guidelines for assessment of dehydration. The main source of drinking water in the family was tap water (65%), 44% didn’t used any method for water purification and 26% had no habits of hand washing in the family, 89% of the mothers had a good knowledge of ORS.  Majority had no history of fever (64%). 37% of cases needed hospital admission among which 7 cases needed PICU care. Test was positive for Rotavirus in significant number of cases (66%) followed by Adenovirus (13%).CONCLUSIONS: Incidence of Acute diarrhoea is highest below 24 months of age. As the age increases the incidence decreases. Lack of safe drinking water, poor sanitation and poor living conditions are associated risk factors for childhood diarrhoea. Viral diarrhoea is still the most common cause of childhood diarrhoea. Most children are not dehydrated and can be managed using ORS at home or in primary health care centres. We expect that results of the study would be useful initiation of vaccine requirements in a developing country like Nepal.

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A combination of rough topography, steep slopes, active tectonic and seismic process and intense impact of monsoon rain has made the fragile environment of Nepal vulnerable to a variety of natural hazards. Most frequent hazards are floods, landslides, epidemics, fires, earthquake and other hydro-meteorological disasters, causing heavy loss of human lives as well as economic loss including housing and infrastructures (MDRIP, 2009). Hence, hazard assessments are the need of the hour. They help district and regional decision makers, policy makers and development agencies prepare disaster risk reduction plans. The chosen study area was Banepa and Panauti municipality. Separate hazard assessments have been performed for four hazards, namely, earthquake, flood, landslide and industrial hazards.Earthquake hazard zone maps have been made following the Probabilistic Seismic Hazard Assessment (PSHA) approach for 500 year return period to produce seismic intensity distribution maps in the form of Modified Mercalli Intensity (MMI) maps using Trifunac and Brady formula. Flood inundation maps have been made using HEC-RAS and HEC-GeoRAS extension for ArcGIS for return periods of 2, 10 and 500 of Chandeswori and Punyamata rivers. Landslide hazard susceptibility map has been made using the Stability Index Mapping (SINMAP) extension for ArcGIS that uses an infinite-slope equation accurate for debris flows. Industrial hazard maps that depict the vicinity that falls within various ranges of danger in the event of different industrial hazards like fire, Vapor Cloud Explosion (VCE) and Boiling Liquid Expanding Vapor Explosion (BLEVE) have been prepared as well. Finally, a composite multi hazard map has been prepared by combining all the four hazards.Nepalese Journal on Geoinformatics -13, 2014, Page: 25-31

Background Retinal haemorrhage in new-born is a clinically common neonatal fundus condition. Although, it usually does not affect the development of visual function, entities like macular haemorrhages may lead to amblyopia causing deterioration of visual function. Such scenario leads to downgrade in quality of life of the affected child. Objective To explore the underlying clinical factors associated with retinal haemorrhage in term new-borns. Method A cross sectional study was conducted involving 136 term neonates admitted in the neonatal intensive care unit of Dhulikhel Hospital. Fundus examination was performed within 2 weeks of delivery. Retinal haemorrhage was graded according to their location in three retinal zones. Result Out of 136 cases examined, 44 (32.35%) of the cases had one of the eyes with retinal haemorrhage. Where grade 1 retinal haemorrhage was accounted in majority of the cases. Birth weight, gestational age, mode of delivery, poor Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) Score in 1 and 5 minutes, birth asphyxia, neonatal sepsis and heavy work in antenatal period had statistically significant correlation with occurrence of retinal haemorrhage. Conclusion Our results suggest that spontaneous vaginal delivery, larger birth weight, higher gestational age, birth asphyxia, low Appearance, Pulse, Grimace, Activity, and Respiration score, are risk factors for occurrence of neonatal retinal haemorrhage. It is recommended that in neonates with above high-risk factors should undergo targeted fundus screening for early identification and needful interventions.

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