Browsing by Author "Basnet, Sangita"
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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 Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal(Nepal Paediatric Society (JNPS), 2021) Basnet, Sangita; Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Bajracharya, Binod Lal; Shrestha, Anil; Shrestha, Sudeep; Rajchal, Pramila; Kafle, Raju; Shrestha, Devendra; Puri, Sangeeta; Bhatta, Anwesh; Pathak, Om Krishna; Shrestha, ShrijanaAbstract: Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.Publication Nepal Paediatric Society Guideline for use of Antibiotics in Critically ill Children in the Pediatric Intensive Care Unit(Nepal Paediatric Society (JNPS), 2021) Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Shrestha, Shrijana; Sharma, Yograj; Pathak, Santosh; Pokharel, Prakash Jyoti; Shrestha, Nipun; Pokhrel, Santosh; Dongol, Srijana; Raya, Ganendra Bhakta; Ghimire, Amrit; Koirala, Janak; Basnet, SangitaAbstract: Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care UnitPublication Nepal Pediatric Society Guidelines for the Safe Transport of Critically Ill Children in Nepal(Nepal Paediatric Society (JNPS), 2021) Amatya, Puja; Shrestha, Dhruba; Joshi, Suchita; Sharma, Arun; Shrestha, Shrijana; Basnet, SangitaAbstract: Transport of critically ill children is associated with increased risk of morbidity and mortality in developing countries due to the lack of adequate resources and skilled personnel. Transport of the sick child remains a major challenge in Nepal as well. The main objective of this article is to describe the importance of safe transport, and be a resource and guide for health care personnel during inter-facility transport of sick children in Nepal. This guideline is based on consensus statement of Nepal Pediatric Critical Care Working Group (NPCCWG) under the aegis of the Nepal Pediatric Society (NEPAS). It includes different components of transport, namely essential equipment, patient preparation, communications, medications, and transport checklist, that are required during transport of sick children, taking into consideration the current resources available in our health care facilities.