Browsing by Author "Ansari, I"
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Publication Culture Proven Bacterial Meningitis in Children: Agents, Clinical Profile and Outcome(Kathmandu Unversity, 2011) Ansari, I; Pokhrel, YABSTRACT Background Meningitis is a serious infection. Little is known about the bacterial agents and their antibacterial sensitivity in Nepalese children. Objectives To study bacteriological agents, clinical profile and immediate outcome in patients admitted to children’s ward of Patan Hospital with meningitis. Methods Prospective observational study conducted in paediatric ward of Patan Hospital. All the children admitted to the ward, with the diagnosis of culture proven bacterial meningitis’ on discharge were eligible. Results Out of 7,751 children, 296 (3.8%) had meningitis. This was a group ranging from neonates to adolescents aged 18 years. Only 13 (4.4%) of cerebrospinal fluid samples taken from them yielded positive culture reports. The organisms were pneumococcus (6), Haemophilus influenza ‘b’ (3), β-hemolytic Streptococcus (1), α-hemolytic Streptococcus (1), N. meningitides (1) and Pseudomonas (1). Whereas Haemophilus influenza ‘b’ was isolated from young infants, pneumococci were found in the young as well as the old. Fever, vomiting, high leukocyte count with left shift were all commonly present. All but one had cerebrospinal fluid pleocytosis. Low sugar and high protein was found in most specimens. Neuroimaging was done in six children of which three were abnormal (all young infants and pneumococci cases). Ceftriaxone was given to all but one child. Everybody recovered but three had complications – profound hearing loss and cortical atrophy with subdural collection in pneumococcal and septic arthritis with persistence of fever in Haemophilus influenzae ‘b’ meningitis. Conclusion The present study corroborates most of the epidemiological and clinical features of acute bacterial meningitis and sheds light on the causative agents of bacterial meningitis in Nepalese children. KEY WORDS antibiotics, CSF, meningitis, pneumococcusPublication Establishment of Paediatric and Neonatal Intensive Care Units at Patan Hospital, Kathmandu: Critical Determinants and Future Challenges(Nepal Paediatric Society (JNPS), 2011) Adhikari, N; Avila, ML; Kache, S; Grover, T; Ansari, I; Basnet, SAbstract: Introduction: Although preventive medicine and primary care are priorities in developing countries, they must be supported by appropriate care of sick and extremely sick children in the medical facilities. Lack of resources and absence of skilled physicians and nurses may lead to poor outcomes in critically ill patients. Intensive care of newborns and children is thought to be very expensive with a low cost-benefit ratio. This presentation discusses the critical factors that facilitated the establishment of PICU and NICU in an urban public hospital in Nepal, where a good standard of Level 2 care was already provided. Aims and objectives: A cooperative model of creation and transfer of technology from the West to a resource-poor country was envisaged. PICU and NICU with six beds each were established. Design and setting: The Nick Simons Foundation, USA provided financial support for design, building and furnishing of a new Mother and Child Wing at Patan Hospital. A generous grant of $300,000 again by the Nick Simons Foundation helped equip the units. Donated equipments also included procedures, medication and storage carts. Methodology: A total of 22 volunteers, 21 from USA and one from Netherlands, were recruited to complete the three months of training. An extensive curriculum was prepared. The trainer team had monthly teleconferences and regular communications with the Chief of Paediatric Services and Nursing Director of Patan Hospital via e-mails and telephone. Responsibilities of volunteers and the host hospital were identified. Results: After 3 years of preparation, the project started in June 2009. All day lectures on topics in critical care, mock case scenarios, practical equipment training and simulated procedures led to the graduation of 60 nurses. Twenty five physicians were trained for three months. The expert team worked with the locals in preparing the units, arranging furniture and equipment, stocking carts, making inventory and preparing protocols. A protocol handbook was developed on topics such as mechanical ventilation, sedation, admission/discharge criteria, procedures and management of different disease states. Various charts such as nurse observation charts, notes by residents, procedure hand offs at change of shifts were designed and printed. Infection control practices and methods of sterilizing non disposable articles were identified and protocols written. At the end of three months the units were functioning with trained local manpower and reasonable modern equipment. Conclusion: Developing nations may not have enough resources to establish much needed critical care facilities. Developed countries can help by funding basic infrastructure and providing expertise in order to transfer knowledge and technology. Involvement in planning from the beginning and training at the host site is a preferred model of transfer of technology.Publication Publication Pattern of Pediatric Poisoning and Accident in Patan Hospital(Kathmandu University, 2012) Chhetri, UD; Ansari, I; Shrestha, SABSTRACT Background Kerosene, drugs, pesticides are chemicals used in home and farms. But because of parents’ or caretakers’ negligence; accidents and poisoning in children may take life of a child. Objective To study the common causes and outcome of pediatric accident and poisoning cases admitted in Patan Hospital. Method A prospective (2068-69) and retrospective (2066-67) studies of pediatric accident and poisoning cases admitted in Patan Hospital (2066-chaitra 2069) were done. Result Out of 44 registered cases total 35 cases were collected in last 4 years. Twenty one in prospective and 14 in retrospective study. Male female ratio was 1.2:1. Most vulnerable age group was 1-5 years (21) and 11-15 yrs (8). Most common poison was pesticide (11), kerosene (9) and drugs (7). Twenty percent were suicidal, 3% were homicidal and rest was accidental. Suicidal poisoning was common in 11-14 years. Accidental poisoning was: taking kerosene from mineral water bottle for water. Small children took drugs and pesticides due its easy availability or careless storing. Five common accidents were near drowning (2), hot water scald, hanging and fall from height. Outcome was 2 expired; 1 Organo-phosphorous and 1 food poisoning. Mortality was 6%. One hanging survived as vegetation. Conclusion Accident and poisoning are preventable. We need to make our home and surrounding poison and accident proof. Small children should never be left unattended. Drugs, pesticides, hot things, and sharp instruments should be kept out of reach of children and in child proof container in separate places. Pesticide should not be sold to children. KEY WORDS Paediatric, poisoning, accidentPublication Perinatal Mortality in Patan Hospital(Nepal Health Research Council, 2003) Adhkari, N; Ansari, IPublication Sex Preferences Among Mothers Delivering at Patan Hospital(Kathmandu University, 2011) Chhetri, UD; Ansari, I; Bhandary, S; Adhikari, NABSTRACT Background High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries. It is reflected in sex ratio Objective To determine reasons for the preferences for different sex; to find out whether there is altered sex ratio at birth and to find out whether female feticide are common among women who had abortion. Method It is a prospective study. Women who had previous history of abortion and had delivered at Patan Hospital in the year 2066 were interviewed as per questionnaires. Results Among 560 women with total live births of 965, (462 male and 503 female) during their life time the overall sex ratio was 92 male per 100 female birth; total abortions were 663. Preferences for male were 10%, female 15.4% and either was for 74%. The reason for male preference was to continue family lineage, to bring honor, old age security, and performing funeral rites while the reasons for daughter preferences were that they understand mother’s pain, help in household work. The sex ratio of the babies born during the study period was 113 male per 100 female births. The Sex ratio at birth from 1st to 6th deliveries was 61, 79, 101, 210, 286 and 1100 male per 100 female birth respectively. Prenatal sex selection was 8% (by USG) but none had sex selected abortion. Conclusion Sex ratio of those delivered during the study period was skewed (136 boys per 100 girls) towards male. There was shift in SRB in 4th and subsequent pregnancies in favor of boys. As the male sex ratio increased the number of induced abortion decreased in subsequent pregnancies. KEY WORDS Feticide, Induced abortion, Sex preferences, Sex ratio