Background

Background The integration of machine learning algorithms in decision support tools for physicians is gaining popularity. These tools can tackle the disparities in healthcare access as the technology can be implemented on smartphones. We present the first, large‐scale study on patients with skin of colour, in which the feasibility of a novel mobile health application (mHealth app) was investigated in actual clinical workflows. Objective To develop a mHealth app to diagnose 40 common skin diseases and test it in clinical settings. Methods A convolutional neural network‐based algorithm was trained with clinical images of 40 skin diseases. A smartphone app was generated and validated on 5014 patients, attending rural and urban outpatient dermatology departments in India. The results of this mHealth app were compared against the dermatologists’ diagnoses. Results The machine–learning model, in an in silico validation study, demonstrated an overall top‐1 accuracy of 76.93 ± 0.88% and mean area‐under‐curve of 0.95 ± 0.02 on a set of clinical images. In the clinical study, on patients with skin of colour, the app achieved an overall top‐1 accuracy of 75.07% (95% CI = 73.75–76.36), top‐3 accuracy of 89.62% (95% CI = 88.67–90.52) and mean area‐under‐curve of 0.90 ± 0.07. Conclusion This study underscores the utility of artificial intelligence‐driven smartphone applications as a point‐of‐care, clinical decision support tool for dermatological diagnosis for a wide spectrum of skin diseases in patients of the skin of colour.

Background: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved. Objectives:This study was conducted to analyze the spectrum of diseases and outcomes at a level two NICU at a tertiary care teaching hospital. Methods: A descriptive observational study conducted at the neonatal care unit in the Department of Paediatrics at KIST Medical College, Lalitpur, Nepal over one year from 14th of April 2013 to 13th April 2014. Data on age at admission, gender, gestational age, birth weight, initial presenting symptoms at admission, fi nal diagnosis and outcome were collected from in patient records at the hospital record section and analyzed using SPSS 17.0. Results: A total of 279 neonates were studied. The commonest causes of admission were infection (45.9%), followed by respiratory conditions (14.7%), neonatal jaundice (12.5%), perinatal asphyxia (9.3%) and prematurity/ small for gestational age (SGA) (6.5 %). Most of the admissions (62%) were during the fi rst 24 hours of life. The majorities, 89.2%, were term gestation and 10.8% were preterm. Most of the preterm babies were late preterms with gestational ages between 35-36 weeks (73% of preterms were late preterms). Total of four mortalities (1.4%) occurred, three of which were due to perinatal asphyxia and one was a Down's syndrome with overwhelming sepsis. Conclusion: In this study, infections followed by respiratory conditions were the leading causes of admission. Most of the admissions occurred during the fi rst 24 hours of life. This emphasizes the fact that attentiveness during the fi rst day of life, simple measure to prevent infection and early detection and treatment may go a long way in improving neonatal outcome.

BackgroundSystemic lupus erythematosus (SLE) is known to present with a wide variety of clinical manifestations. Lymphadenopathy is frequently observed in children with SLE and may occasionally be the presenting feature. SLE presenting with granulomatous changes in lymph node biopsy is rare. These features may also cause diagnostic confusion with other causes of granulomatous lymphadenopathy.Case presentationWe report 12 year-old female who presented with generalized lymphadenopathy associated with intermittent fever as well as weight loss for three years. She also had developed anasarca two years prior to presentation. On presentation, she had growth failure and delayed puberty. Lymph node biopsy revealed granulomatous features. She developed a malar rash, arthritis and positive ANA antibodies over the course of next two months and showed WHO class II lupus nephritis on renal biopsy, which confirmed the final diagnosis of SLE. She was started on oral prednisolone and hydroxychloroquine with which her clinical condition improved, and she is currently much better under regular follow up.ConclusionGeneralized lymphadenopathy may be the presenting feature of SLE and it may preceed the other symptoms of SLE by many years as illustrated by this patient. Granulomatous changes may rarely be seen in lupus lymphadenitis. Although uncommon, in children who present with generalized lymphadenopathy along with prolonged fever and constitutional symptoms, non-infectious causes like SLE should also be considered as a diagnostic possibility.

Hepatitis A virus infection is a common public health problem in developing countries primarily due to poor hygiene and sanitation. The clinical features of hepatitis A virus are mostly related to the derangement of liver function with occasional extrahepatic complications. Herein, a 2.5-year-old girl presented with abdominal pain and decreased appetite for 4 days, high-colored urine for 3 days, and yellowish discoloration of the eyes for 2 days. On presentation, there was icterus along with hepatomegaly and diminished breath sounds on the right side were noted 1 day after admission. Chest X-ray revealed right sided pleural effusion; however, ultrasonography of chest and abdomen displayed bilateral pleural effusion (right more than left) and minimal ascites with thickened gall bladder wall. Immunoglobulin M anti-hepatitis-A virus serology was positive. The pleural effusion in this child resolved spontaneously in 10 days. We report this case to highlight that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with features of acute hepatitis. However, other common causes of pleural effusion such as tuberculosis and parapneumonic effusions that may coexist with hepatitis, especially in developing world, need to be excluded.

IntroductionTuberculosis is a global health problem that mostly affects people in developing countries. Tuberculosis can occur in various organ systems and may present with diverse manifestations in the same system. Primary muscular tuberculosis is a very rare condition in both adults and children, and tuberculosis of various muscle groups presenting as intramuscular nodules is an even more uncommon presentation.Case presentationA 9-year-old Asian girl presented with multiple painless, gradually progressive swellings over different parts of her body for 3 months with no history of contact with tuberculosis. A physical examination was normal except for multiple swellings in her right forearm, a single swelling in her interscapular region and multiple swellings in her right calf. Ultrasonography of swellings revealed multiple nodules in the intramuscular layer. Excisional biopsies performed from two different sites revealed swellings in muscular layers and histopathology showed granulomatous inflammation with caseous necrosis consistent with tuberculosis. The child was started on antitubercular therapy after which the swellings resolved; she was kept on regular follow up.ConclusionsIntramuscular nodules in multiple muscular sites may be the presenting symptoms of tuberculosis of the muscles. Tuberculosis of skeletal muscles should be considered in a differential diagnosis when presented with single or multiple masses even when a chest X-ray is normal and there is no evidence of tubercular foci elsewhere in the body.

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Background: Sleep problems are common in children and various questionnaires have been devised to screen these problems. Brief Infant Sleep Questionnaire (BISQ) is one of the sleep screening tools which is simple, reliable and valid tool and is being used for screening of sleep problems in infants and toddlers in various countries. Objectives: The objective of this study was to translate English version of Brief Infant Sleep Questionnaire to Nepali language using a standard technique so that Nepali version could be used to screen sleep problems in Nepalese infants and toddlers. Methods: This article describes the process of translation of original BISQ questionnaire into Nepali language in a standard method. Four bilingual paediatricians translated English BISQ to Nepali language which was then tested among few parents for understanding, clarity and uniformity of expected response. A draft version was fi nalized after consensus of translators, two expert paediatricians and original author. This version was then translated back into English by two independent medical professionals and compared with original BISQ for content and meaning. The fi nal version of Nepali translation was approved after consensus agreement. Results: The translated Nepali BISQ was then tested among 15 parents who had a child below three years of age. These parents did not fi nd diffi culty in understanding and responses were uniform and as expected from the original questionnaire. Conclusion:The Nepali version of BISQ could be applicable as a screening tool to assess sleep in infants and toddlers in clinical setup as well as research studies.