BackgroundBirth asphyxia is defined as the presence of hypoxia, hypercapnia, and acidosis leading the newborn to systemic disturbances probably electrolyte disturbance also. Knowledge of these electrolyte disturbances is very valuable as it can be an important parameter affecting perinatal morbidity, mortality and ongoing management.MethodsSerum sodium, potassium and ionized calcium of asphyxiated term newborn were sent within one hour of birth as per the inclusion criteria. Statistical comparison of mean values of different electrolytes between different groups of perinatal asphyxia was performed by ANOVA test for parametric data and significant data were further analyzed using post hoc test. Bivariate analysis was done to determine the correlations between Apgar score at 5 min and serum electrolytes. Pearson test was used to calculate the correlation coefficient. Box plot was used to show the median and quartile between serum electrolytes and Apgar score at 5 min.ResultThe mean values of sodium for mild, moderate and severe asphyxia were 135.52, 130.7 and 127.15 meq/l respectively. The values of potassium for mild, moderate and severe asphyxia were 4.96, 5.93 and 6.78 meq/l respectively. Similarly, the mean values of ionized calcium for mild, moderate and severe asphyxia were 1.07, 1.12 and 0.99 mmol/l respectively. The values of sodium and potassium among different severity of asphyxia were significantly different (p-value< 0.001). Significant positive correlation was found between serum sodium and Apgar score at 5 min. Significant negative correlation was present between serum potassium and Apgar score at 5 min.ConclusionThe degree of hyponatremia and hyperkalemia was directly proportional to the severity of birth asphyxia. So these electrolyte disturbances should always be kept in mind while managing cases of perinatal asphyxia and should be managed accordingly.

Introduction: Neonatal mortality rate per thousand live births in Nepal is 24.2, and the majority of neonates die during the early neonatal period.Objective: To determine the knowledge, attitudes and practices of mothers regarding care of the newborn after delivery at a tertiary teaching hospital in Nepal. Method:A cross-sectional study employing both quantitative and qualitative study approaches was conducted in the Maternal and Child Health (MCH) unit of a tertiary hospital in East Nepal for a period of three months. Using a convenient sampling technique 65 postpartum mothers admitted in MCH unit were enrolled in the study. Structured interview questionnaires were used to collect data. Data was analysed using descriptive statistics by SPSS 20.Results: Sixty five mothers who delivered at the tertiary care centre were interviewed. Age of mothers ranged from 16 to 40 years, 63% were primipara and 18.4% were illiterate. Whilst 95% of mothers knew about immunisation, few had acquired knowledge regarding cord care, signs of illness in newborn and newborn feeding during antenatal checkups. Maternal knowledge about newborn danger signs was low. There are numerous unscientific and unhygienic health practices and social taboos in child rearing that makes the newborn extremely vulnerable. This study was conducted in order to determine the contemporary knowledge, attitude and practice of newborn rearing so as to intervene and educate caregivers in future for proper newborn care.

The authors present an illustrative technical note on microsurgical resection of ventrolateral completely ossified spinal meningiomas (OSMs) and a literature review of the surgical management of calcified spinal meningiomas or OSMs. These tumors are surgically demanding due to their solid consistency, especially when in a ventrolateral location with dislocation of the spinal cord. A challenging case with significant thoracic cord compression and displacement is described. Due to the firm consistency and the ventrolateral localization of the meningioma, a piecemeal resection was necessary. This could have resulted in a free-floating tumor remnant adherent to the spinal cord, impeding safe tumor resection. To avoid such a remnant, an anchoring burr hole was drilled at the border between the spinal cord and the adamantine tumor mass. Then, a microdissector was placed within the anchoring burr hole and the tumor was gently pulled laterally while drilling away the medial parts of the ossified tumor. This procedure was repeated until separation of the tumor from the spinal cord was possible and a gross-total resection (Simpson grade II) was manageable. Throughout the procedure, continuous intraoperative neurophysiological monitoring was performed.

Introduction: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. This study was done to determine the prevalence of tuberculosis in severe acute malnutrition (SAM) cases and to observe different presentations of SAM. Method: This prospective observational study was carried out in the Department of Paediatrics and Adolescent Medicine at a tertiary care center in Nepal for a duration of one year from December 2018 to November 2019. All cases of SAM meeting the inclusion criteria were evaluated with Mantoux test, chest X-ray, gastric aspirate / sputum analysis and gene-Xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data were entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data. Results: Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). Among TB cases, 40% were without any systemic complaints. Only 19.6% cases presented with nutritional complaint. Conclusions: This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (Pulmonary TB) in every case of SAM, irrespective of symptoms.

into clinical trials, and the development of targeted treatments was reported by the majority of participants. Challenges associated with genomic testing included difficulty comprehending genomic information during consultations, trouble explaining diagnosis to friends and family and dissatisfaction with length of time taken to receive test results. The need for genomic information to be simplified, specific and understandable was emphasised across all interviews. Families also expressed a desire for the provision of supplementary written and visual information and support resources to complement the information received during consultations. Participants identified the importance of developing rapport with healthcare providers, having a support network when undergoing testing and the need to provide assistance to navigate the health system. Conclusions: The study is ongoing but preliminary findings indicate that parents and families are likely to benefit from condition specific information resources and genetic counselling services beyond the renal clinic in order to optimise psycho-social adjustment during and after receiving genomic testing for kidney disease. 1. Vivante A, Hildebrandt F. Exploring the genetic basis of earlyonset chronic kidney disease.