Introduction: Scrub typhus is an acute undifferentiated febrile illness with varied nonspecific manifestations. It dramatically responds to appropriate antibiotic if started earlier in the course of disease leading to significant reduction in morbidities and mortalities. Objective: To describe the clinical profile, treatment and prognosis of scrub typhus in children. Patients and Methods: Serologically confirmed children with scrub typhus admitted to Tribhuvan University Teaching Hospital (TUTH) over a period of 3 years (April 15, 2015, to April 14, 2018) were retrospectively analyzed for clinical manifestations, investigations, complications and treatment outcomes. Findings: A total of 84 children (39 boys, 45 girls) were found to have serologically confirmed scrub typhus. Apart from fever which was invariably present in all children, the most common symptoms were that of respiratory system such as shortness of breath, gastrointestinal system which were vomiting and abdomen pain followed by headache. On physical examination, the most frequent clinical signs were hepatosplenomegaly, edema, eschar and lymphadenopathy. Hepatitis, myocarditis and meningitis were the most common complications. Most patients had the shortest defervescence of less than 48 hours with oral doxycycline (64.7%) followed by intravenous chloramphenicol (56.7%). The overall mortality rate was 4.8%, all due to multiorgan dysfunction. Conclusion: In a country like Nepal, scrub typhus should be suspected in any child who presents with fever associated with shortness of breath, abdomen pain, vomiting, headache and clinical findings suggestive of multisystem involvement such as hepatitis, myocarditis or meningitis. Early empirical medical management based on high clinical suspicion while waiting for definitive serological report with oral doxycycline or intravenous chloramphenicol may prevent complications of scrub typhus thereby reducing mortality.
Abstract:Nepal Earthquakes 2015 April and may caused huge loss of lives and properties in the country. Several traditional buildings and monuments in the Kathmandu Valley were literally collapsed to the ground, completely changing the built form of several traditional towns such as Bungamati, Khokana, and Lubhu. In this regards, traditional town Sankhu is also not in an exception. According to the field survey, 90% of traditional houses were severely damaged in Sankhu. In this respect, this study was focused on rebuilding of Sankhu, preserving its traditional form and analyzing it from economic perspective. The study was based on household survey and the respondents were selected as per their availability and willingness to participate in the research process. The traditional building construction technology is rich in terms of resilience against earthquakes, if it is well maintained. Maintenance and repair of building elements of traditional building is relatively simple, without affecting the building structure and other building elements, as compared to RCC structure. Sankhu is economically struggling town and, it is very important to rebuild the town in traditional style to bring back its original identity for its prosperity in trade and tourism. It is an opportunity to bring some of the lost glory of the past and its outstanding building and monuments.
Acknowledgements:We would like to thank all the staffs of NICU who counseled parents for the follow up in high-risk clinic at schedules time. We would also like to thank staffs from high-risk clinic who helped during assessment.We are very grateful towards all parents who made sure to visit us at scheduled date for AbstractIntroduction: With increasing survival of high risk babies,
Short stature in children is a very common condition that requires timely investigations and management. Although there has been dramatic reduction in stunted growth in children below the age of 5 years during the last two decades in Nepal, the process of systemic screening and evaluation followed by timely treatment can still be made better. Awareness programs for short stature such as at the time of birth of baby and use of social media for its dissemination in public can enhance short stature screening programs in schools, local ward clinics and other child health welfare programs as immunization. Children with suspected short stature can then further be referred to higher health centers as per need for investigations and management. Data generated may then be later used to develop algorithms and plan strategies to incorporate height well being in child healthcare policies. An integrated approach is necessary for maximum benefit.
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