Browsing by Author "Basnet, S"
Now showing 1 - 20 of 22
Results Per Page
Sort Options
Publication Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal(Kathmandu University, 2022) Karmacharya, RM; Singh, AK; Vaidya, S; Tuladhar, SM; Devbhandari, M; Lama, B; Kharel, BB; Basnet, SABSTRACT Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases. KEY WORDS Lung Cancer, Smoker, ThoracotomyPublication Anthropometric Measurements in Different Ethnic groups of Nepalese New Borns(Nepal Paediatric Society (JNPS), 2012) Malla, K; Mall, T; Rao, S; Gauchan, S; Basnet, S; Koirala, DPAbstract: Introduction: There is a wide variation in normal birth weight, length and head circumference of newborns. The standards formulated by Western workers may not be very reliable to this part of world because of wide variations in normal range of length, weight and head circumference in different ethnic groups. This study aims to determine the anthropometric values – birth weight, length and head circumference in Term and Preterm newborns of different ethnic groups in this region of the country and to see if this can be used as a standard for taking the anthropometric measurements. Materials and Methods: A prospective study of 600 newborns born in Manipal Teaching Hospital, Pokhara from July 2009–June 2010. A detailed anthropometric measurement (weight, length, and head circumference) of all newborns was taken on 3rd day of life. Results: Six major Ethnic groups were noted Brahmin, Gurung, Dalit, Chettri, Magar and Newar. There were 54 % males and 46% females among which 18.16% were preterms, 20.66% small for gestation age, 81.50% term and 0.33% posterm. The mean weight, length and head circumference of term babies were 2.817±0.61 gms, 47.68±2.48 cm, 33.56±2.02 cm and for preterm babies it was 2.215± 0.41 gms, 46.36±2.39 cm, 32.23±2.03 cm respectively. There were 25% low birth weight (n=151, highest number in Brahmins-27%), 74.16% normal weight (n=445) and 0.66% over weight (n=4, all were gurungs) babies. In Term newborns weight, length and head circumference was noted to be highest in Gurungs (3.3004gms, 49.35cm, 34.72cm) and was statistically significant (p<0.000). Weight and length of Brahmins was lowest (2.578 gms, 45.49cm) and head circumference was lowest in Dalits (30.88cm, statistically significant<0.000). In case of preterms highest weight and length was seen in Magars (2.387gms, 47.90cm) but head circumference was highest in Gurungs (34.18cm) whereas weight was lowest in chettri (2.1609gms), length in Brahmin (44.61cm) and OFC in Dalits (29.92cm). These parameters were directly proportion with gestation age and was statistically significant (p<0.000). Conclusion: The present study highlights the mean weight, length and head circumference of term and preterm newborns in different ethnic groups and gestation age. These parameters were directly proportion to gestation age but were variable in different Ethnic groups. Therefore a study in larger population could give us a different standard for anthropometric measurements in Nepalese newborns.Publication Bardet Biedl Syndrome(Institute of Medicine, 2008) Basnet, S; Sharma, AKAbstract Bardet Biedl syndrome is a rare autosomal recessive condition characterized by central obesity, retinitis pigmentosa and postaxial polydactyly.Publication Bronchiectasis in a positive HIV child: a case report(Institute of Medicine, 2013) Shrestha, L; Basnet, S; Kanskar, PAbstract Human immunodeficiency virus (HIV) infection has a wide spectrum of pulmonary disease which usually complicates the clinical course. Non-cystic fibrosis bronchiectasis is more common in children with HIV infection than in general population. Bronchiectasis in children with HIV if not diagnosed early and managed aggressively can lead to irreversible destruction of bronchial wall and surrounded tissue leading to significant morbidity. This might decrease the benefit of the antiretroviral therapy (ARV) treatment on the long run.Publication Childhood chronic pancreatitis(Institute of Medicine, 2010) Basnet, S; Sharma, AKAbstract Chronic pancreatitis is one of the rare cause of abdominal pain in children. We report a seven year old boy with recurrent episodes of epigastric pain for one year which was ultimately diagnosed as chronic idiopathic pancreatitis, we discuss the evaluation and treatment of chronic pancreatitis.Publication Clinical profile and outcome of babies admitted to Neonatal Intensive Care Unit (NICU)(Institute of Medicine, 2011) Gauchan, E; Basnet, S; Koirala, DP; Rao, KSAbstract Introduction: Every year millions of babies are born and a large proportion of them are admitted to the neonatal ward for various indications. One of the Millennium Development Goals (MDG-4) is to reduce childhood mortality by two-thirds by 2015.This study was conducted to identify the general characteristics, disease spectrum and the commonest causes of morbidity and mortality in this group of babies. Methods: Prospective observational study of all infants admitted to neonatal intensive care unit, Manipal Teaching Hospital, Pokhara during November 2010 to April 2011. Results: 182 neonates were admitted during the period of study; 32.4% babies were inborn. 41.2 % babies were admitted directly from the emergency or outpatient department and 22.5 % were referred from district hospitals. Male: female ratio was 1.1:1. There were 67.5 % term babies and 31.3% preterm babies. 44.5% were admitted in the first 24 hours of life; commonest indications for admission were neonatal jaundice (24.7%); sepsis (21.4%) and perinatal asphyxia (19.2%). 76.9% babies were discharged after improvement, 6.5% left against medical advice and 1.62% were referred for surgical interventions and mortality was seen in 13.7%. Commonest cause for mortality was hyaline membrane disease (28%) and hypoxic ischaemic encephalopathy stage 3 (28%). Conclusion: Neonatal period is a very vulnerable period with a high risk of morbidity and mortality; most of which are preventable with good obstetric and subsequent neonatal care. Early anticipation and prompt management is very essential to reduce neonatal mortality. Keywords: admissions, neonates, NICU, outcomesPublication Clinico-epidemiological Profile of Children with Chronic Kidney Disease in Tertiary Care Referral Center in Nepal: Prospective observational study(Kathmandu University, 2022) Poudel, DR; Basnet, S; Shrestha, LPABSTRACT Background Chronic kidney disease in children has been increasing over the years and is associated with high degree of morbidity and mortality. The cost of treating children with chronic kidney disease is also substantial. Prevention of this disease is the only long term solution in our context. Till date, there is limited data on chronic kidney disease in Nepalese children. Objective To study the epidemiological, clinical and etiological profile of children with Chronic Kidney Disease from 2 to 16 years of age presenting for the first time in tertiary care hospital. Method This is the prospective observational study carried out at the tertiary care hospital over a period of 3 years. Children between 2-16 years who were first time diagnosed of chronic kidney disease and had estimated glomerular filtration rate < 60 ml/ min/1.73 m2 for last 3 months were enrolled. Result There were total of 124 patients, of whom 78 were male with male to female ratio of 5:3 with mean age of 11.8±2.2 years. Chronic glomerulonephritis (23%), reflux nephropathy (23%) and nephrolithiasis (16%) were the commonest etiological diagnosis. Rapidly progressive glomerulonephritis and systemic lupus erythematous accounted for 85% cases of chronic glomerulonephritis. Vesicoureteric reflux and posterior urethral valve accounted for 85% cases of reflux nephropathy. In 32%, the cause could not be determined. Swelling (45%) and dyspnea (20%) were the chief presenting complaints. Pallor were seen in all cases (100%) followed by hypertension in 68% and short stature in 64%. Majority (60%) of the patients with chronic kidney disease presented in the stage V. Conclusion Chronic glomerulonephritis and reflux nephropathy were the commonest etiologies of chronic kidney disease, majority of them following rapidly progressive glomerulonephritis, systemic lupus erythematosis, vesicoureteric reflux and posterior urethral valve. The commonest clinical features were swelling, dyspnea, pallor and hypertension. KEY WORDS Chronic kidney disease, Clinical profile, Epidemiological profile, ESRD, Etiology of CKD, Nepalese childrenPublication Current Understanding of Emergency Medicine and Knowledge, Practice, and Attitude toward Disaster Preparedness and Management among Healthcare Workers in Nepal(Kathmandu University, 2024) Shakya, YR; Patel, JN; Shrestha, R; Shrestha, SS; Dangal, R; Pradhan, B; Pandya, J; Basnet, SABSTRACT Background Disasters are serious disruptions to a community’s functioning that exceed its capacity to cope using its resources. Natural, man-made, technological hazards and other factors may cause disasters and influence a community’s exposure and vulnerability. Objective To assess the knowledge, practice, and attitude of healthcare workers in Nepal regarding disaster preparedness and management for emergencies. Method A retrospective study was conducted among healthcare workers in Nepal registered for the 1st World Academic Council of Emergency Medicine- Table-top Exercise and Communication in Disaster Medicine conference as participants or faculty. Information was collected using total enumeration sampling and a questionnaire developed from a literature review and the questionnaire was adapted from the Emergency Preparedness Information Questionnaire (EPIQ). Percentages, means, and medians were calculated for socio-demographic data, knowledge, practices, and attitudes toward emergency preparedness. A chi-square test assessed associations between socio-demographic characteristics, emergency procedures, and familiarity scores on the preparedness questionnaire. Result A total of 118 participants took part in the study, most with over six months of emergency department experience. There was a significant association between work experience and emergency procedure status ((ꭓ2=6.982, p=0.008), and between education level and familiarity with disaster management (ꭓ2=5.507, p=0.019). However, there was a low correlation (r=0.140, p=0.129) between emergency procedure status and disaster management familiarity. Conclusion Emergency preparedness is crucial for life-saving in disasters. The availability of emergency services and skills related to emergency preparedness and disaster management are crucial for saving lives in emergency conditions. The hospital should provide emergency preparedness and disaster management training to all healthcare workers. In addition, the hospital authority should perform disaster exercises/tabletop simulation exercises or drills periodically. KEY WORDS Attitude, Disaster management, Emergency preparedness, KnowledgePublication 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 First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt(Kathmandu University, 2020) Shrestha, AP; Bhushal, N; Shrestha, A; Tamrakar, D; Adhikari, P; Shrestha, P; Shrestha, A; Karmacharya, B; Basnet, S; Tamrakar, SR; Shrestha, R; Shrestha, RABSTRACT The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of “safety first” in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study. KEY WORDS Coronavirus, Emergency department, Personal protective equipment, Postpartum death, Real time polymerase chain reaction, ResuscitationPublication Infant Feeding Practices in Kaski District, Pokhara(Nepal Paediatric Society (JNPS), 2012) Basnet, S; Gauchan, E; Malla, K; Malla, T; Koirala, DP; Shah, R; Sedha, Y SedhaAbstract: Background: Children in developing countries are prone to infectious diseases due to insufficient and inappropriate feeding practices. Socio-demographic and socio-economic factors directly and indirectly play a role in influencing infant feeding practices. This study was conducted to assess the socio-demographic and economic factors associated with initiation of breastfeeding, complimentary feeding, and the various prelacteal feeds practiced in Kaski, Pokhara. Materials and Methods: In this prospective study, interviews were conducted to 500 mothers at Manipal Teaching Hospital who brought their child for treatment. The interviews were conducted in a questionnaire format relating to their demographic and financial statuses. Results: A total of 500 mothers were questioned, out of which 86.6% gave their child breastmilk as its first food. 47% initiated breastfeeding within half an hour of child’s birth. 86% gave Jaulo as the first complementary food to their children. About 26% of the mothers gave complementary feeding to their children before the recommended time of 6 months. Conclusion: Initiation of breastfeeding after life and complementary feeding practices overall has improved from previous studies. There is still need of making awareness campaigns and such in order to further improve this trend.Publication Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey(Kathmandu University, 2020) Basnet, S; Dahal, S; Tamrakar, D; Shakya, YR; Jacobson, C; Shrestha, J; Shrestha, SKABSTRACT Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers’ attitude and practices. KEY WORDS Awareness, COVID-19, Infectious diseasePublication Morbidity and mortality pattern of low birth weight babies(Institute of Medicine, 2008) Basnet, S; Adhikari, RK; Shrestha, PSAbstract Background: The Neonatal Unit, established in 1984 provides Level II care. The increase in preterm births from 25% to 42% with 21% of perinatal deaths related to immaturity and it’s consequences at birth prompted this study on low birth weight babies. Methods: A retrospective study was done for all babies admitted from 2058 to 2061B.S. Results: Of 1 327 babies, 29% were LBW with 62% being preterm. Increasing trends in babies < 1500gms and < 28 weeks at birth was noted. 70% were discharged, 10% referred (61% for advanced respiratory support) and 20% died. Respiratory distress and presumed sepsis were the most common reasons for admission as well as for deaths in LBW. Conclusion: The existing Neonatal Unit facilities have become inadequate to deal with the increased number, morbidity and mortality pattern of inborn LBW babies. The unit needs to be upgraded to Level III with provision for mechanical ventilation, early use of nasal CPAP and institution of effective infection control measures to improve survival of this high risk group. Keywords: Low birth weight, Neonatal unit, facilitiesPublication Morquio Syndrome in Two Siblings: A Case Report(Nepal Paediatric Society (JNPS), 2011) Malla, KK; Malla, T; Basnet, S; Rao, KS; Tiwari, PK; Ghosh, A; KC, NAbstract: Morquio syndrome is a rare inherited autosomal recessive disorder characterized by the accumulation of mucopolysaccharides (glycosaminoglycans) in various body tissues. It is rare cause of dwarfism. Many pediatricians therefore are unlikely to see this case hence may miss the diagnosis due to lack of experience. With this view we report two siblings with this dwarfism highlighting the classical clinical and radiological presentation.Publication Nephrotic syndrome in Nepalese children: clinical profile, histopathology and outcome in a tertiary care center of Nepal(Institute of Medicine, 2016) Basnet, S; Poudel, DR; Khanal, S; Thapa, NBAbstract Introduction: The demographic, clinical features, steroid response, histopathology and complications of all children diagnosed with nephrotic syndrome at Tribhuvan University Teaching Hospital over a 3-year period. Methods: A retrospective study was conducted among patients who were admitted in the Pediatrics ward of Tribhuvan University Teaching Hospital with the diagnosis of Nephrotic syndrome from April 2010 to April 2013. Results: During the study period from 2010 April to 2013 April, there were total of 80 patients admitted with the diagnosis of nephrotic syndrome. There was male preponderance with sex ratio 1.28:1. Mean age of patient at first episode was 8.51±4.33 years. Among the admitted patients, 48.8% (41) of children had single episode whereas steroid resistance was observed in 16.2% (13) of patients. Hematuria and hypertension were present in 21.2% (7) and 50% (40) of patients respectively. Renal dysfunction was present in 21.2% (17). Pneumonia was the most common complications 18.8% (15), followed by UTI 8.8%(7), spontaneous bacterial peritonitis 3.8% (3) and acute renal failure 7.5% (8). Two patients had multiple complications. Alternative therapies were used in 25% (20) of patients and cyclophosphamide was used most commonly as alternative therapy which was used in 17.4% (14). Most common histopathological diagnosis was FSGS 30.3% (10) followed by MPGN 15.5% (5), SLE nephropathy 15.5% (5) and IgA nephropathy 15.5% (5) Conclusion: The clinical course of childhood NS in Nepal is similar to the developed world. Differences at Presentation included older age and increased prevalence of microscopic hematuria, hypertension. Keywords: childhood, nephrotic syndrome, histology, outcomePublication Paragonimiasis: First autochthonous case report from Nepal(Institute of Medicine, 2016) Sah, R; Khadka, S; Sherchand, JB; Parajuli, K; Shah, NP; Mishra, SK; Sharma, S; Shrestha, L; Basnet, S; Tandukar, S; Bhandari, D; Yadav, SR; Kattel, HP; Pokhrel, BM; Rijal, BNA.Publication Postinfective Glomerulonephritis (PIGN) in Children Attending a Tertiary Care Centre in Nepal(Nepal Paediatric Society (JNPS), 2014) Poudel, DR; Basnet, S; Gami, FCAbstract: Introduction: Post infectious glomerulonephritis (PIGN) is one of the common paediatric kidney disease in developing countries. This study was undertaken to describe the common clinical features, biochemical findings and complications in children with PIGN. Materials and Methods: This was a retrospective descriptive study in which 30 patients admitted with a diagnosis of PIGN at Tribhuvan University Teaching Hospital (TUTH) in a six month period (July 2014 to Dec 2014) were included. Hospital medical records were reviewed for the data collection. Results: Out of 30 patients, 24 (80%) were between 5 to 15 years of age (mean age of 11.5±3.3) with male to female ratio of 2.3:1. Pedal oedema and hypertension were the clinical features seen in 29 (97%) and 28 (93%) patients respectively. Hypocomplementemia was found in 29 (97%) patients. Recent past history of sore throat seen in 10 (33%) patients and skin lesions in 12 (40%). The complications noted were congestive cardiac failure in 5 (17%) patients, rapidly proliferative glomerulonephritis in 3 (10%) and encephalopathy in 1(3%). Conclusion: The most important clinical and biochemical profile observed in nepalese children with PIGN are the hypertension, pedal edema and hypocomplementemia.Publication Sonographic Assessment of the Normal Dimensions of Liver, Spleen, and Kidney in Healthy Children at Tertiary Care Hospital(Kathmandu University, 2015) Thapa, NB; Shah, S; Pradhan, A; Rijal, K; Pradhan, A; Basnet, SABSTRACT Background Ultrasonography is one of the most common imaging modality to measure dimensions of visceral organs in children. However, the normal limit of size of visceral organs according to age and body habitus has not been specified in the standard textbooks. This might result in under detection of organomegaly in pediatrics population. Objective The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy children. Method This is prospective cross-sectional, hospital-based study done at Tertiary-care teaching hospital. Participants included 272 pediatric subjects (152 male and 120 female) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were one month to 15 year (180 months) old. All measured organs were sonographically normal. Relationships of the dimensions of these organs with sex, age, body weight and height were investigated. Limits of normal dimensions of these organs were defined. Result Normal length of liver, kidneys and spleen were obtained sonographically for 272 children (152 male [55.9%] and 120 female [44.1%]) in the age group from 1 months to 15 (180 months) years. The mean age was 45.78 months (SD, 44.73). The measured dimensions of all these organs showed highest correlation with height and age so the descriptive analysis of the organ dimensions (mean, minimum, and maximum values, SD and 5th and 95th percentiles) were expressed in 10 age groups along with height range of the included children. The mean length of right kidney was shorter than the left kidney length, and the difference was statistically significant (p = 0.001). Conclusion This study provides practical and comprehensive guide to the normal visceral organ dimension in pediatric population. The normal range limit of the liver, spleen, and kidney determined in this study could be used as a reference in daily practice in local radiology clinics. KEY WORDS Children, kidneys, liver, spleen, ultrasonographyPublication Sydenham’s Chorea with Silent Cardiac Lesions, Mimicking Encephalitis in a 13 Year Old Girl(Kathmandu University, 2021) Shakya, KN; Bhatta, A; Yadav, A; Gautam, U; Basnet, SABSTRACT Sydenham’s chorea is an uncommon neurological manifestation of rheumatic fever and has many and varied differential diagnosis. It may mimic encephalitis when presents as an isolated feature even when silent cardiac lesions are present. Early diagnosis, treatment and penicillin prophylaxis prevents recurrence and progression of cardiac lesions. Prompt symptomatic relief and alleviation of distress is obtained with therapeutic intervention. A case of rheumatic chorea with silent cardiac valve lesions which mimicked herpes simplex encephalitis with choreoathetosis, in a 13 year old girl is presented along with review of literature. KEY WORDS Chorea, Encephalitis, Rheumatic fever, Silent carditisPublication Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review(Nepal Paediatric Society (JNPS), 2012) Shrestha, M; Shrestha, L; Basnet, S; Shrestha, PSAbstract: Introduction: The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia.