Quote of the issue– Whenever a doctor cannot do good, he must be kept from doing harm- Hippocrates

From the President’s pen…..

HAPPY NEW YEAR 2070 B.S. Greetings from NEPAS! It's most encouraging to know that with

continuous efforts, we were able to come out with the second issue which has coincided with New Year

B.S. 2070. The issue has aroused lots of enthusiasm and the budding stars have done their best in con-

tributing to it. NEPAS itself has been alive and kicking with regular executive meetings, CMEs as well

as other relevant activities. Among several activities, one of the significant one has been the WHO con-

sultative meeting on measles and rubella immunization, organized in collaboration with IPA, APPA,

Federation of African Paediatric Association, involving about 150 delegates from 23 different countries.

Steps have been taken towards revival of Paediatric Association of SAARC(PAS), along with the decla-

ration of the venue, President as well as General Secretary. NEPAS has also set up a facebook account

page for easy accessibility for keeping abreast, sharing information among the members and the general

public as well. I hope that you would get the best out of it.

Once more, wishing all a very Happy New Year B.S. 2070.

Dr. Jyoti Ratna Dhakhwa

President NEPAS

I N S I D E T H I S

I S S U E :

Messages/Quiz of the issue 1

Welcome to new members 2

Fact of the issue/Quiz answer/

Know your terms 2

Recent events/Future events 3

Literature update from world of

pediatrics 4

Literature from Nepal/New reviews 5

Syndrome of the issue 6

Approach of the issue 7

NEPAS activities/Contact us 8

OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

Date Apr 1, 2013 Volume 1, Issue 2

Editorial

Happy New Year B.S. 2070 to all. We are more than pleased to launch the second issue of the newsletter

as a prelude to the New Year. The overwhelming response and support to the first issue has been the key

factors in pushing us forward with this issue. We are looking forward to your support in the future, along

with the suggestions, comments and feedbacks for enhancing the quality of the newsletter. We have added

the quiz of the issue and fact of the issue this time. We aim high for the newsletter, strive towards the

same and ultimately reach the zenith. Thank you all for the faith you have bestowed upon us. Once again,

Happy New Year B.S. 2070 and all the best for the year ahead.

Q U I Z O F T H E I S S U E

What is your diagnosis ?

Important clues- Abnormal skull shape / fused fingers and toes

W E L C O M E T O N E W M E M B E R S

A N S W E R T O T H E Q U I Z O F T H E I S S U E

P a g e 2 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

1. Dr. Yuba Nidhi Basaula 9841991043 basaulayuba@yahoo.com

2. Dr. Pankaj Ray 9841262610 pankajray2000@hotmail.com

3. Dr. Hari Bahadur Khadka 9843007565 harikhadka640@yahoo.com

4. Dr. Yog Raj Sharma 9841560227 dryogi100@hotmail.com

5. Dr. Sweta Kumari Gupta 9845508999 doctorsweta@gmail.com

6. Dr. Bikash Shrestha 9841233981 kalmaan@yahoo.com

7. Dr. Ram Hari Chapagain 9851046611 chapagainrh2007@gmail.com

APERT SYNDROME-Apert Syndrome is a rare form of syndromic craniosynostosis caused by muta-

tions in FGFR2 gene on chromosome 10q25-10q26 and is associated with premature fusion of sutures

and syndactyly of 2nd, 3rd and 4th fingers.

References-

1) Jones KL. Smith’s Recognizable Patterns of Human Malformations, 6th ed. Philadelphia: Saunders; 2006.

2) Kinsman SL, Johnston MV. Craniosynostosis. In: Kliegman RM, editor. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2007.

K N O W Y O U R T E R M S

MORO REFLEX AND STARTLE REFLEX

Moro reflex is a primitive reflex present in newborns, characterized by abduction and extension of the arms with

opening of the hands and followed by embracing of the arms when there is sudden movement of the neck. It is a

vestibular reflex which generally disappears by 3-4 months of age.

Startle reflex is a primitive reflex similar to Moro but is initiated by sudden loud noise or other stimulus, charac-

terized by flexion of the elbow and closing of the hands with less outward and inward movements of the arms.

References- 1) Illingworth RS. The Normal Child-Some Problems Of The Early Years And Their Treatment. 10th ed. Edinburgh: Churchill Livingstone; 2011.

2) Illingworth RS. The Development Of The Infant And Young Child-Normal And Abnormal. 9th ed. London: Churchill Livingstone; 2011.

F A C T O F T H E I S S U E

Immunization coverage among children aged 12-23 months in Nepal in 2011 AD is 87%.

Reference-

NDHS survey-Preliminary report 2011.

1. NEPAS members actively participated in the annual PEDICON 2013 held in Kolkata, India on 16-20

Jan, 2013.

2. NEPAS launched a facebook page account on 29 Jan, 2013.

3. NEPAS organized a CME on “Tobacco Use and Child Health” on 12 Feb, 2013 in Kanti Children’s

Hospital.

3. NEPAS coordinated WHO consultative meeting in collaboration with IPA in regards to MR vaccination

on 19-21 Feb, 2013 which was attended by 150 delegates from 23 different countries.

4. NEPAS organized a CME on “Management of Liver Failure in Children” at Kanti Children’s Hospital

on 4 Mar, 2013 which was chaired by Dr. Anupam Sibal from Apollo Hospitals, Delhi, India.

5. 1st International Paediatric Epilepsy Training courses were conducted at Kanti Children’s Hospital on 6

& 8 Mar, 2013 in conjunction with British Paediatric Neurology Association.

6. Official launching of Linezolid (Linosept) in Nepal was organized on 17 Mar, 2013.

7. Congratulations to NEPAS President Dr. Jyoti Ratna Dhakwa for being selected as Secretary General of

Paediatric Association of SAARC (PAS).

R E C E N T E V E N T S

F U T U R E E V E N T S

P a g e 3 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

1. NEPAS is organizing the following activities on 20 Apr, 2013 in regards to World Immunization

Week:-

a. Workshop on immunization

b. Health camp and talk programme at Samudayak Clinic at Nagbahal, Lalitpur

c. Write ups and talk programme about immunization on media

2. NEPAS is planning to celebrate annual NEPAS day on 15 Jun, 2013 by organizing the first NEPAS

annual scientific meeting.

3. NEPAS is working out for a certified training on Child Protection in collaboration with trainers

from United Kingdom.

5. The study on the impact of Hib vaccination is continuing in conjunction with Johns Hopkins Hospi-

tal, Baltimore, USA.

6. Paediatric Advanced Life Support course is being conducted at BPKIHS on 11 Apr, 2013 in collab-

oration with American Academy of Paediatrics and Indian Academy of Paediatrics.

P a g e 4 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

R E C E N T L I T E R A T U R E U P D A T E F R O M T H E W O R L D O F P A E D I A T R I C S

1. DownieL,ArmientoR,SubhiRetal.Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently

recommended antibiotics-systematic review and meta-analysis. Arch Dis Child. 2013 Feb;98(2):146-54.

2. Goudar SS, Somannavar MS, Clark R et al. Stillbirth and newborn mortality in India after helping babies breathe training. Pediat-

rics. 2013 Feb;131(2):e344-52.

3. Adams D, Dagenais S, Clifford T et al. Complementary and alternative medicine use by pediatric specialty outpatients. Pediatrics.

2013 Feb;131(2):225-32.

4. Pooni PA, Singh D, Bains HS et al. Parental stress in a paediatric intensive care unit in Punjab, India. J Paediatr Child Health. 2013

Mar;49(3):204-9.

5. CostelloJM,ClapperTC,WypijD. Minimiz-

ing complications associated with percutaneous central venous catheter placement in children: recent advances. Pediatr Crit Care

Med. 2013 Mar;14(3):273-83.

6. Moodley M. Clinical approach to syncope in children. Semin Pediatr Neurol. 2013 Mar;20(1):12-7.

7. Perry MS, Bailey L, Malik S et al. Clobazam for the treatment of intractable epilepsy in children. J Child Neurol. 2013 Jan;28(1):34-9

8. Siebert E, Spors B, Bohner G et al. Posterior reversible encephalopathy syndrome in children: Radiological and clinical findings-

A retrospectiveanalysis of a German tertiary care center. Eur J Paediatr Neurol. 2013 Mar;17(2):169-75.

9. Lo JC, Sinaiko A, Chandra M et al. Prehypertension and hypertension in community-based pediatric practice. Pediatrics. 2013 Feb;131

(2):e415-24.

10. Frank LH, Bradshaw E, Beekman R et al. Critical congenital heart disease screening using pulse oximetry. J Pediatr. 2013 Mar;162

(3):445-53

11. Henderson AJ, Shaheen SO. Acetaminophen and asthma. Paediatr Respir Rev. 2013 Mar;14(1):9-15.

12. Hoving MP, Brand PL. Causes of recurrent pneumonia in children in a general hospital. J Paediatr Child Health. 2013 Mar;49(3):E208-

12.

13. Osaretin OW, Uchechukwu ND, Osawaru O. Asthma management by medical practitioners: the situation in a developing country.

World J Pediatr. 2013 Feb;9(1):64-7.

14. Thibodeau BA, Metcalfe P, Koop P et al. Urinary incontinence and quality of life in children. J Pediatr Urol. 2013 Feb;9(1):78-83.

15. Caillaud C, Lacreuse I, Fothergill H et al. Observational, medical or surgical management of vesicoureteric reflux. Acta Paediatr. 2013

Mar;102(3):222-5.

16. Mišak Z, Hojsak I, Jadrešin O et al. Diagnosis of coeliac disease in children younger than 2 years. J Pediatr Gastroenterol Nutr. 2013

Feb;56(2):201-5.

17. Freedman SB, Geary DF. Bolus fluid therapy and sodium homeostasis in paediatric gastroenteritis. J Paediatr Child Health. 2013

Mar;49(3):215-22.

18. Irwin A, Sharland M. Measuring antibiotic prescribing in hospitalised children in resource-poor countries: A systematic review. J Pae-

diatr Child Health. 2013 Mar;49(3):185-92.

19. Goff I, Foster HE, Jandial S. Detecting joint disease in children-dispelling the myths. Arch Dis Child. 2013 Mar;98(3):168-9.

20. Vedi A, Cohn R. Oral versus intravenous antibiotics in treatment of paediatric febrile neutropenia. J Paediatr Child Health. 2013

Mar;49(3):170-8.

21. Bhakta N, Martiniuk AL, Gupta S et al. The cost effectiveness of treating paediatric cancer in low-income and middle-

income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi. Arch Dis

Child. 2013 Feb;98(2):155-60.

22. Powell LM, Nguyen BT. Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, bever-

age, and nutrient intake. JAMA Pediatr. 2013 Jan;167(1):14-20.

23. Wall CR, Grant CC, Jones I. Vitamin D status of exclusively breastfed infants aged 2-3 months. Arch Dis Child. 2013 Mar;98(3):176-

9.

24. Pohlman GD, Phillips JM, Wilcox DT. Simple method of paraphimosis reduction revisited: Point of technique and review of

the literature. J Pediatr Urol. 2013 Feb;9(1):104-7.

25. Gerson R, Rappaport N. Traumatic stress and posttraumatic stress disorder in youth: recent research findings on clinical impact, assess-

ment, and treatment. J Adolesc Health. 2013 Feb;52(2):137-43.

R E C E N T L I T E R A T U R E F R O M N E P A L I N T H E W O R L D O F P A E D I A T R I C S

P a g e 5 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

N E W R E V I E W O V E R V I E W

1. Pandey S, Lin Y. Tobacco Use Among Married Women in Nepal: The Role of Women's Empowerment. Matern Child Health

J. 2013 Apr;17(3):530-8.

2. Sah RP, Paudel N, Shrestha JB. Marfan's syndrome: a refractive challenge for optometrists. Clin Exp Optom. 2013 Mar 4.

3. Upreti SR, Janusz KB, Schluter WW et al. Estimation of the Impact of a Japanese Encephalitis Immunization Program with

Live, Attenuated SA 14-14-2 Vaccine in Nepal. Am J Trop Med Hyg. 2013 Mar;88(3):464-468.

4. Bhatta DN. Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children

in Kathmandu, Nepal. BMC Pregnancy Childbirth. 2013 Jan 16;13:14.

5. Shrestha S, Timila D, Karki U et al. Clinical profile of children with moderate-to-severe eosinophilia presenting to a tertiary

hospital in Nepal. Trop Doct. 2012 Oct;42(4):232-4.

6. Ansari S, Sherchand JB, Parajuli K et al. Bacterial etiology of acute diarrhea in children under five years of age. J Nepal Health

Res Counc. 2012 Sep;10(22):218-23.

7. Shrestha S, Karki U. Indications of admission and outcome in a newly established neonatal intensive care unit in a developing

country (Nepal). Nepal Med Coll J. 2012 Mar;14(1):64-7.

8. Paudel R, Pradhan B, Wagle RR et al. Risk factors for stunting among children: a community based case control study in Nepal.

Kathmandu Univ Med J (KUMJ). 2012 Jul;10(39):18-24.

1. Oh W. Fluid and electrolyte management of very low birth weight infants. Pediatr Neonatol. 2012 Dec;53(6):329-33.

2. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013 Mar;14(1):29-

36

3. Slaughter LA, Patel AD, Slaughter JL. Pharmacological treatment of neonatal seizures: a systematic review. J Child Neurol.

2013 Mar;28(3):351-64.

4. Larru B, Zaoutis TE. Newer antifungal agents. Curr Opin Pediatr. 2013 Feb;25(1):110-5.

5. Kirkham FJ. Guidelines for the management of encephalitis in children. Dev Med Child Neurol. 2013 Feb;55(2):107-10.

6. Ionita CM, Acsadi G. Management of juvenile myasthenia gravis. Pediatr Neurol. 2013 Feb;48(2):95-104.

7. de Almeida Torres RS, Fedalto LE, de Almeida Torres RF, Steer AC, Smeesters PR. Group A streptococ-

cus meningitis in children. Pediatr Infect Dis J. 2013 Feb;32(2):110-4.

8. Rao PS. Consensus on timing of intervention for common congenital heart diseases: part I - acyanotic heart defects. Indian J

Pediatr. 2013 Jan;80(1):32-8.

9. Patria MF, Esposito S. Recurrent lower respiratory tract infections in children: a practical approach to diagnosis. Paediatr Respir

Rev. 2013 Mar;14(1):53-60.

10. Srinath AI, Lowe ME. Pediatric pancreatitis. Pediatr Rev. 2013 Feb;34(2):79-90.

11. Dominguez SR, Anderson MS. Advances in the treatment of Kawasaki disease. Curr Opin Pediatr. 2013 Feb;25(1):103-9.

12. Oberoi S, Suthar R, Bansal D, Marwaha RK. Febrile neutropenia: outline of management. Indian J Pediatr. 2013 Feb;80(2):138-

43.

13. Rajendran A, Bansal D, Marwaha RK et al. Tumor lysis syndrome. Indian J Pediatr. 2013 Jan;80(1):50-4.

14. Crawford J. Childhood brain tumors. Pediatr Rev. 2013 Feb;34(2):63-78.

15. Tchaconas A, Adesman A. Autism spectrum disorders: a pediatric overview and update. Curr Opin Pediatr. 2013 Feb;25(1):130-

44.

16. Lombel RM, Gipson DS, Hodson EM. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatr

Nephrol. 2013 Mar;28(3):415-26.

17. Lombel RM, Hodson EM, Gipson DS. Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDI-

GO. Pediatr Nephrol. 2013 Mar;28(3):409-14.

18. Dodwell ER. Osteomyelitis and septic arthritis in children: current concepts. Curr Opin Pediatr. 2013 Feb;25(1):58-63.

19. Branchford BR, Monahan PE, Di Paola J. New developments in the treatment of pediatric hemophilia and bleeding disorders.

Curr Opin Pediatr. 2013 Feb;25(1):23-30.

20. Sethuraman G, Ramesh V. Cutaneous tuberculosis in children. Pediatr Dermatol. 2013 Jan-Feb;30(1):7-16.

P a g e 6 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

S Y N D R O M E O F T H E I S S U E

Introduction-A genetic disorder which is the commonest inherited cause of mental retardation.

Synonyms-Martin X syndrome / Martin Bell syndrome / Escalante syndrome

Incidence-1 in 4000 males and 1 in 8000 females.

Etiology– Caused by inheritable unstable DNA in FMR1 gene in X chromosome.

X linked dominant with variable expressivity and penetrance.

Features-

Facial-Narrow and elongated face/high forehead/strabismus

high arched palate/prominent lower jaw/large protruding ears

Body-Macroorchidism/hyperextensible joints/flat feet

Language-Echolalia/talkative/language limitation

Behaviour-Hyperactivity/impulsivity/chaotic/learning problems

Cognition-Mental retardation/intellectual and cognition problems

Investigation-

Differential diagnosis-Myotonic dystrophy/SMA type I/Down’s syndrome

Management-Early diagnosis/behavioral therapy/complications management

Prognosis-Relatively normal life span

Genetic counseling-Males pass the expansion to the daughters only/females pass the expansion in

50% cases/transmission among each generation is increased- “Sherman paradox”

References-

1) Maria Descartes, Andrew j Carroll. Cytogenetics. In: Kliegman RM, editor. Nelson Textbook of Pediatrics. 18th ed. Phila-

delphia: Saunders; 2007.

2) Garber KB, Visootsak J, Warren ST . Fragile X syndrome. Eur J Hum Genet. 2008 Jun;16(6):666-72.

3) http://healthlineinfo.com/wp-content/uploads/2012/10/Fragile_x_syndrom.png

4) http://mindletters.com/2012/10/10/dear-dr-fragile-x-syndrome/

FRAGILE X SYNDROME

P a g e 7 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

A P P R O A C H O F T H E I S S U E

APPROACH TO A CHILD PRESENTING WITH ALTERED MENTAL STATUS

Reference-RK Lehman, J Mink. Altered mental status. Clin Ped Emerg Med. 2008 (9):68-75.

N E P A S A C T I V I T I E S 2 0 1 3

P a g e 8 OFFICIAL NEWSLETTER OF NEPAL PAEDIATRIC SOCIETY

Editorial Advisors: Dr. Jyoti Ratna Dhakhwa & Dr. Arun Neopane

Editors– 1) Dr. Bikash Shrestha,

Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal.

Email- kalmaan@yahoo.com Mobile No- 9841233981

2) Dr. Krishna Poudel,

Department of Paediatrics, Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal.

Email-kpkalyan@gmail.com Mobile No-9841393287

3) Dr. Mahesh Shrestha,

Department of Paediatrics, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.

Email-sthamahesh@hotmail.com Mobile No-9841276027

Office- NEPAS newsletter section, NEPAS office, Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal.

Email-nepas2010@gmail.com Tel-01-4412648

CME on tobacco use and child health

Members and trainers in IPET course attended by paediatricians and nurses

C O N T A C T U S

NEPAS members at PEDICON 2013 at Kolkata

WHO consultative meeting in collaboration with IPA in regards to MR vaccination