Waldmann's disease, or primary intestinal lymphangiectasia, is an unusual cause of protein-losing enteropathy primarily characterized by lymphopenia, hypoalbuminemia, and hypogammaglobulinemia. However, variable clinical presentations result dilemmas in diagnosis and effective management. We present a toddler diagnosed with Waldmann's disease managed with a high-protein diet and medium-chain triglyceride supplementation.

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).

Introduction: Snake bite is a significant health issue globally. In Nepal, WHO has estimated more

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.

Waldmann’s disease / Primary intestinal lymphangiectasia, is an unusual cause of protein losing enteropathy primarily characterized by lymphopenia, hypoalbuminemia and hypogammaglobulinemia. However, variable clinical presentation results in diagnostic dilemma and effective management. We present a toddler diagnosed with Waldmann’s disease managed with high protein diet and medium chain triglycerides supplementation.