BackgroundThe World Health Organization (WHO) defines obesity as a 'global epidemic. Overweight and obese children are at higher risk for developing long-term chronic diseases like hypertension. With globalization bringing more lifestyle modifications, adolescents are exposed to multiple risk factors including obesity, diet, academic stress, lack of physical work apart from hereditary risk factors. Early diagnosis of obesity and hypertension is an important strategy in its control, effective treatment and prevention of complications. The aim of the study is to assess the prevalence of and the factors associated with childhood overweight/obesity among school children Material and Methods It is a school based cross sectional study done in schools of Biratnagar. School going children aged 6 to 16 years from 10 different schools of Biratnagar were taken as study population. Five were private schools and five were government schools. All the school going children aged 6 to 16 years were included in the study. Children with any chronic illness were excluded from the study. Results A total of 1900 students were included between age group of 6 to 16 years. The prevalence of overweight, obesity and hypertension were 2.9%, 1.8% and 6.1%. Conclusion Overweight, obesity was significantly associated with hypertension. Students studying in private schools and family income > Rs.10,000 were strongly associated with overweight, obesity and hypertension. Family history of hypertension was also associated with overweight/obesity.

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality. Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children. Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome. Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU. Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

INTRODUCTION: Diabetes Mellitus and blood groups are interrelated. The relationship between ABO blood groups and disease susceptibility has generated a concern. The identification of a positive relationship between DM and blood groups could indicate higher susceptibility to diabetes and a negative relationship could indicate protection from diabetes. Therefore, the objective of the study was designed to exemplify ABO blood groups in Patients with Diabetes Mellitus. MATERIALS AND METHODS: The study was conducted at Ram Janaki Hospital and Swastika Health Care Hospital, Janakpurdham from September 2017 to March 2018.The record of the patients from the medicine OPD in both the hospitals was identified and relevant data were extracted. The data was recorded from the reports of the patients with confirmed DM patients attending Medicine department. RESULTS: The majority of the 579 diabetic patients were in the 40-60 year old age group. The most predominant blood group was B (251; 43.4 %), followed by AB (137; 23.7 %), O (125; 21.5 %), and A (66; 11.4 %) respectively. In comparison to male diabetics, less than half (44.1%) of female diabetics had blood group B. (42.7%). Similarly, males (13.0 %) were found to have more blood group A than females (9.8%). In diabetic individuals, the relationship between blood group and age (p=0.652) and sex (p=0.659) was shown to be insignificant. The majority of the patients (94.3%) had Rh positive blood groups, whereas the other had Rh negative blood types (5.7%). There was no correlation between blood group Rh factor and age group (p=0.817) or as well as with sex (p=0.333) among diabetic patients. CONCLUSIONS: Diabetic patients were more likely to have blood type B, while diabetics were less likely to have blood group A. It implies that diabetes is linked to ABO blood types, and that those with Group-B are more likely to develop the condition. Blood group could be a risk factor, and knowing it can aid with disease evaluation and screening.

Introduction: Multiple organ dysfunction syndrome (MODS), characterized by a progressive physiologic dysfunction involving two or more organ systems after an acute threat to systemic homeostasis, is not a rare entity among patients admitted to the pediatric intensive care units. Despite recent advances made in the medical technology and newer treatment strategies, large numbers of deaths in the PICU are attributable to MODS. Objective: To describe the clinical profile of MODS among children admitted in PICU and to observe its associations and outcome. Methodology: A hospital based prospective observational study was conducted in PICU of Nobel medical college teaching hospital, Biratnagar, Nepal from June 2017- May 2018. Children aged 1 month to 14 years admitted in the PICU with various medical and surgical illnesses were included in the study. All variables defining MODS and the data showing the presence or absence of sepsis were collected within 1 hour of admission (day 0) and then every day until transfer or discharge from PICU or until patient's death. Results: Out of 150 admissions in the PICU, 103 fulfilled the inclusion criteria, and were enrolled in the study. A total of 53 patients (51%) developed MODS at some time during their stay at PICU and 88.7% of them had it at the time of admission. Of 103 cases under study, 26 died (mortality rate = 25.2%) and 92.3% of deaths were attributable to MODS. Children with neurological involvement had the highest risk of death [odds ratio (OR), 19.8; 95% confidence interval (95%CI), 4.37-90.30]. 75.5% of children with MODS had some sort of infection and 49% of them had sepsis. Conditions like SIRS, Sepsis, Severe sepsis, Septic shock and ARDS in the study patients were found significantly associated with MODS. Conclusion: A MODS is a common clinical entity among patients admitted to the PICU and are associated with significant mortality and morbidity. In children, MODS usually seem to develop early and in a simultaneous way. In developing countries like ours, morbidity and mortality associated with MODS in the PICUs is higher than that in the developed countries. Prevalence of sepsis in children with or without MODS is greater in the developing countries. Sepsis is further responsible for larger number of deaths in PICU.

Cyclopia is a rare and lethal congenital anomaly of the forebrain system, resulting from incomplete cleavage of prosencephalon into right and left hemispheres occurring between the 18th and the 28th day of gestation. Approximately 1.05 in 100,000 births are identified as infants with cyclopia, including stillbirths. Many teratogenic factors are identified as the causative factors for this anomaly which include irregular cholesterol biosynthesis, radiation exposure, viruses, alcohol intake and maternal diabetes. Many authors also suggest genetic etiology of this illness. We report a case of 35 year old lady G7P6L5 with previous history of normal vaginal delivery who presented to us in second stage of labor. She delivered a male baby with a large head, a median single eye and absent nose with intact mouth. The baby died soon after the birth. This case is presented because of its rarity. Early ultrasound diagnostics and proper management of this anomaly must be emphasized most strongly to prevent complication associated with this condition.

Background: Bronchiolitis is an acute, highly communicable lower respiratory tract infection. A variety of agents ranging from nebulised racemic epinephrine, salbutamol and routinely available levoepinephrine have been tried. The Present study was aimed at comparing the effectiveness of adrenaline and salbutamol in acute bronchiolitis in children aged 2 months to 2 years. Materials and Methods: The Present study was conducted at Nobel medical College Teaching Hospital over the period of one year from Feb 2018 to Jan 2019. Two different cohorts were identified in which clinically diagnosed cases and were grouped into Group A and Group B to receive the different drugs as per the study protocol. Respiratory Distress Assessment Instrument (RDAI) Scores was used for clinical assessment. Results: The age of the patients ranged from 2 months to 24 months with a median of 8 months. The males constituting about 57.42% of the study population of 155 patients. On comparing the prenebulisation variables with 10 and 30 minutes post nebulisation values, it was found that Both adrenaline and salbutamol caused overall significant improvement in RR (p-value <0.00001 in both groups) except in the age group of 19-24 months. Adrenaline was seen to be superior to salbutamol in decreasing the RR (p<0.0001) except for children in the age group of 19-24months. Adrenaline also caused greater rise in heart rate in comparison to salbutamol in all age groups. Conclusion: This study concludes that Adrenaline was seen to be superior to salbutamol in decreasing the RR and RDAI, although it showed variance with age.

It's quite difficult to diagnose the meniscus tear by clinical examination even the experienced orthopaedic surgeon, so this review has shortly focused on clinical examination and its treatment. How to overcome missed diagnosis of meniscus tear in clinical setting? This review article highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in Magnetic resonance imaging (MRI) and Arthroscopy. Although partial, subtotal and total meniscectomy is the choice for different types of meniscal tears, there are certain criteria to be meet for undergoing surgical treatment. The most common criteria for meniscal repair include: 1) A vertical longitudinal tear more than 1 cm in length located within vascular zone, 2) A tear which is unstable and displaceable into the joint, 3) An active informed and cooperative patient but younger than 40 years old, 4) A stable knee or wound stabilized with a ligamentous reconstruction. Chronically deformed or degenerative menisci are bottom-out candidates for repair. Most investigators report that only 10% to 15% of meniscal tears can be repaired and that most such repairs are done in association with an anterior cruciate ligament reconstruction. However, this article presents a review of the clinical relevant anatomic, function, repair and healing mechanism, description of the meniscus attachment as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus attachments.

Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country. Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile. Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests. Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases. Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.