JNGMC A Journal of Nepalgunj Medical College Vol. 18 No: 2 December 2020 Patrons: 1. Mr. Dinesh Shrestha, Chairman, LBEA 2. Dr. S. K. Kanodia, M.D., L.B.E.A. EDITORIAL BOARD Editor-in-Chief Prof. M.N. Marhatta Executive Editor Prof. Nanda Kumari Gurung Associate Editor Dr. Anup Sharma EDITORS EDITORIAL SECRETARIES Dr. R.C. Chaudhary Dr. Sumit Pandey Dr. Mohan Belbase Dr. Niraj Achary Dr. Dinesh Kumar Shrestha Dr. Binod Kumar Karna Dr. Haushila Prasad Pandey Mr. Gaurav Jung Shah Computer Layout: Mrs. Shikha Sharma Address for correspondence: Prof. M.N. Marhatta, Editor-in-chief, Journal of Nepalgunj Medical College, Kohalpur, Nepal. Tel No.: 081-540409 Fax No.: 00977-81-540409, E-Mail: [email protected] Vol. 18 No:2 December2020 CONTENTS ORIGINAL ARTICLES Phototherapy Induced Hypocalcaemia in Neonates with Jaundice 1-3 KC R, Kanodia P Kirschner’s Wires Fixation of Unstable Distal Radius Fractures in Children with the Kapandji Technique 4-8 Shrestha S, Shrestha DK, K.C D, Karki P, Yogi S Patterns and Severity of Alcohol Consumption in Patients with Alcoholic Liver Disease: A Cross-Sectional Study 9-12 Niroula N Maternal and Perinatal Outcome in Anemic Pregnancies 13-16 Sinha K, Adhikari H, Kushwaha A, Rimal G Prevalence of Depression among the Medical Students in Nepalgunj Medical College 17-21 Yadav BK, Shah GJ, Yadav R, Mahat R, Joshi A Hypoxic Ischemic Encephalopathy in Neonates with Birth Asphyxia - A Hospital Based Study 22-26 Adhikari J, Paudel D Hearing Status After Cartilage Augmented Type III Tympanoplasty: In Chronic Otitis Media Squamous Type 27-30 Verma LR, Paudel DR Role of Fine Needle Aspiration Cytology in Extrapulmonary Tuberculosis 31-34 Acharya S, Gupta S Prevalence and Etiology of Neonatal Jaundice in a Tertiary Care Hospital 35-38 Acharya N, Paneru CP A Comparative Study of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy For The Treatment of Lower Pole Kidney Stone of Size 10-20 mm 39-43 NM Shrestha Role of Alanine Aminotransferase in Determining the Biliary Etiology in Acute Pancreatitis 44-47 Bharti SV, Sharma A Ischemic Stroke and its Association with Risk Factors at Nepalgunj Medical College Teaching Hospital Kohalpur 48-50 BK SK, Baral S, Poudel N, Neupane H Correlation between Reflux Symptom Index and Reflux Finding Score in Laryngopharyngeal Reflux 51-54 Sharma A, Paudel DR A Study on Correlation Between Serum Cholinesterase Level and Clinical Severity Based on Pop Scale in Organophosphorus Poisoning 55-58 Shrestha A, Kidwai A, Shrestha R, KC S Efficacy of Oral Azithromycin versus Doxycycline in the Treatment of Acne Vulgaris 59-62 Arjel A, Pokhrel K, Sharma S Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur 63-67 Sharma N, BC D The Impact of Systemic Inflammatory Response Syndrome (SIRS) and Sepsis Training on Pediatric Nurses 68-71 Mathema S, Kayastha P, Sharma PR Prevalence of Periodontitis among the People with Diabetes Mellitus 72-74 Pant BN, Goit RK, Satyal B, Poudel A ORIGINAL ARTICLE Phototherapy Induced Hypocalcaemia in Neonates with Jaundice KC R1, Kanodia P1 ABSTRACT Introduction:Neonatal hyperbilirubinemia is seen mainly in the first week of life and in many of the cases it is only in physiological range which requires no intervention. Approximately 5-10% of them have clinically significant jaundice that requires phototherapy and even exchange transfusion. Phototherapy can produce various adverse effects; hypocalcaemia is one of the lesser known effects. So, estimation of calcium levels before and after phototherapy should be done in neonates with jaundice.Aims : The aim of this study is to determine hypocalcaemia, in neonates receiving phototherapy, by measuring serum calcium levels. Methods: This cross sectional study was conducted, from February 2020 to August 2020, on 50 neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur with unconjugated hyperbilirubinemia requiring phototherapy. Serum calcium levels were evaluated before and after phototherapy. Neonates were assessed for clinical features of hypocalcaemia i.e. jitteriness, irritability/ excitability and convulsions. Data were analyzed using SPSS version 25.P value <0.05 was taken as significant.Results: Frequency of hypocalcaemia after phototherapy was 26%. There was significant change in serum calcium levels before and after phototherapy (p<0.01). Among hypocalcaemic neonates, 56% were symptomatic; 38% developed jitteriness, 18% developed irritability / excitability and none of them developed convulsions. Conclusion: Neonates undergoing phototherapy are at increased risk for hypocalcaemia. Monitoring for hypocalcaemia and its complications should be considered. However, universal recommendation of calcium supplementation is yet to be established but seems reasonable. Keywords: Hypocalcaemia, Jaundice, Neonates, Phototherapy Authors: 1. Dr. Rajesh KC 2. Dr. Piush Kanodia 1Department of Pediatrics, Nepalgunj Medical College & Teaching Hospital, Kohalpur, Banke. Address for Correspondence: Dr. Rajesh K.C. Lecturer Department of Pediatrics Nepalgunj Medical College & Teaching Hospital Kohalpur, Banke E-mail: [email protected] INTRODUCTION Neonatal hypocalcaemia is defined as total serum calcium Jaundice is a common cause of morbidity encountered in concentration < 7 mg/dl or ionized calcium concentration < 4mg/ neonates, mainly in the first week of life. It is an utmost dl. Ionized calcium is crucial for many biochemical processes, concern for physicians and source of anxiety for parents.1 including blood coagulation, neuromuscular excitability, 7 Jaundice in newborns occurs when the level of bilirubin rises and cellular enzymatic activities. The overall prevalence more than 5-6 mg/dl. It is observed in 60% of term and 80% of hypocalcaemia in neonates receiving phototherapy was 1 of preterm neonates.2 In majority of cases, it is benign and no 8.7% in full-term newborns. In another investigation, 90% intervention is required. Approximately 5-10% of them have of the preterm and 75% of term neonates experienced 8 clinically significant jaundice that requires treatment.3 High hypocalcaemia after phototherapy. Hypocalcaemia can cause bilirubin level may be toxic to the developing central nervous serious manifestations like convulsions, apnea, laryngospasm, 9 system and may elicit neurological impairment.4 Phototherapy irritability, and jitteriness. Hence, phototherapy-induced is one of the modalities for management of hyperbilirubinemia hypocalcaemia can be a significant problem. This study was in neonates which is convenient and readily available.5 undertaken to determine hypocalcaemia, in neonates receiving Phototherapy may lead to various complications including phototherapy, by measuring serum calcium levels. skin rashes, diarrhea, hyperthermia, dehydration, retinal METHODS degeneration, bronze baby syndrome especially in cholestatic jaundice, opening of patent ductus arteriosus in low birth The cross sectional study was carried out in the Neonatal weight neonates and hypocalcemia.6 Intensive Care Unit (NICU) of the Department of Pediatrics, JNGMC Vol. 18 No. 2 December 2020 1 KC R : Phototherapy Induced Hypocalcaemia in Neonates with Jaundice Nepalgunj Medical College, Kohalpur from February 2020 Before Phototherapy After Phototherapy p- value to August 2020. Ethical clearance was obtained from the Total serum (n=50) (n=50) calcium level Mean SD Mean SD institutional Review Committee, Nepalgunj Medical College (mg/dl) <0.01 and Teaching Hospital. Study included 50 neonates who were 9.1 2.3 8.9 3.8 admitted for phototherapy. Selection of cases was done by Table II: Change in serum calcium level with phototherapy. convenient sampling method. Neonates were divided in two In the present study, there was a significant decrease in serum groups- preterm and term. Informed consent was taken from calcium levels after phototherapy (p<0.01). The mean values their parents/guardians. Complete history and thorough of serum calcium before and after phototherapy were 9.1±2.3 physical examination was carried out in all the cases. Serum mg/dl and 8.9±3.8 mg/dl respectively (Table II). Of the 50 calcium was measured at initiation of phototherapy and neonates in the study, 13(26%) showed hypocalcaemia after 24 hours after completion of phototherapy. Neonates with phototherapy; among those 13 neonates, 56% developed jaundice requiring exchange transfusion, birth asphyxia, sepsis, hypocalcaemia symptoms; 18% developed irritability/ and conjugated hyperbilirubinemia, infants of diabetic mother excitability, 38% developed jitteriness and none of them and with congenital anomalies were excluded from the study. developed convulsions. Requirement of phototherapy was decided based on American DISCUSSION Academy of Pediatrics (AAP) Guidelines and according to birth Neonatal jaundice is a frequent cause of morbidity in weight in preterm neonates.10 The neonates were clinically newborns worldwide and significant cause of hospitalization, assessed for features of hypocalcaemia i.e. jitteriness, mainly in the first week.1 Efficacy of phototherapy in treatment irritability/excitability and convulsions, as well as other of hyperbilirubinemia in newborns has been well established. complications like rashes, loose stool, fever and dehydration. The efforts made around the globe recognize it as a potential Hypocalcaemia in the neonates was managed with intravenous complication with variable results, some showing severe calcium supplementation. hypocalcemia.7