Browsing by Author "Amatya, Puja"
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Publication Clinical Characteristics and Outcome of Multisystem inflammatory syndrome in Children in a Tertiary Care Center, Nepal(Perinatal Society of Nepal (PESON), 2024) Amatya, Puja; Rajbhandari, Rateena; Tuladhar, Sucharita; Basnet, Sangita; Ojha, Anil Raj; Shrestha, ShrijanaAbstract: Introduction: Multisystem inflammatory syndrome in children (MIS-C) manifests a few weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is characterized by fever and multi-organ dysfunction. This disease has been increasingly reported from various countries since the outbreak of coronavirus in 2019. This study was done to determine the clinical characteristics and outcome of children with multisystem inflammatory syndrome in our settings. Methods: This was a retrospective study in children aged 1 month to 14 years fulfilling the World Health Organization case definition of MIS-C conducted between January 2020 and March 2022 in a tertiary care center, Nepal. The clinical characteristics, treatment and outcome parameters of these patients were reviewed and analyzed. Results: A total of 36 patients with MIS-C was reviewed, 20 (55.5%) were male with median age of 6 years (IQR 1.6-10). All children with MIS-C had fever while gastrointestinal symptoms were present in 24 (66.6%), cough in 15 (41.7%) and rash in 13 (36%). Twelve patients (33.3%) had cardiac symptoms of which 3 (8%) patients had dilated coronary arteries. Other presentations were Kawasaki disease like features (8), toxic shock syndrome (5), meningoencephalitis (3), subconjunctival hemorrhage (1), and pulmonary edema (1). Intravenous immunoglobulin was given in 18 (50%) patients, steroid in 23 (64%) and aspirin in 30 (83.3%) patients. All patients survived. Conclusion: The most common symptoms of multisystem inflammatory syndrome in children were fever, gastrointestinal symptoms, cough and rash. The overall outcome of patients even with severe disease was good.Publication Modified Sick Neonatal Score (MSNS) in Predicting the Outcome of Neonates in Tertiary Care Hospital(Nepal Paediatric Society (JNPS), 2023) Twanbasu, Sajal; Amatya, Puja; Shah, GaneshAbstract: Introduction: Neonatal disease severity scoring systems are widely used to predict severity of illness. Existing scoring systems contain variables like pH, PO2 / FiO2 ratio, and base excess, which are difficult to obtain in resource-limited settings. Modified sick neonatal score (MSNS) is based on eight clinical variables which are easy to calculate and are also accurate enough at the same time. This study was done to evaluate MSNS for predicting the outcome of neonates in our settings. Methods: This was prospective observational study done at neonatal intensive care unit (NICU) of tertiary care hospital in Nepal from February 2021 to January 2022. The parameters required for the score were recorded at admission. Total score was calculated and outcome was noted. Data collected was analyzed using SPSS Statistics for Windows, v21.0. Chi square test, Mann-Whitney U test and ROC analysis were used for statistical analysis. Results: Total of 195 neonates were discharged and 37 expired. The mean MSNS score among expired was 8.16 ± 1.625 and discharged was 10.99 ± 1.753. For a cutoff score of ≤ 10, sensitivity and specificity; Positive and negative predictive value were 89.2% and 60.5%; 30.7% and 98.3% respectively. The area under the curve (AUC) of MSNS was 0.875 (CI 95%; 0.817 - 0.934). Lower MSNS score was also associated with requirement of iontrope and ventilator support. Conclusions: MSNS can be used as an important clinical tool for predicting the severity of disease in neonates in resource limited settings.