Browsing by Author "Basnet, Srijana"
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Publication Clinico-epidemiological Profile of Children with Diphtheria in Tertiary Care Hospital of Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Shrestha, Laxman; Bajracharya, LunaAbstract: Introduction: This study was conducted with the aim to describe the clinical presentation of diphtheria in children, relationship between clinical disease and immunization status, complications of the disease and adverse events due to anti diphtheria serum (ADS). Methods: All patients admitted at Tribhuvan University Teaching Hospital, Kathmandu from July 2016 to November 2018 with clinical diagnosis of diphtheria were included in this study. Results: There were total 12 children and age ranged from five to 15 years, out of which seven (58%) were males and five (42%) were females. All of them were immunized except one whose immunization status was unknown. All of them had tonsillopharyngeal diphtheria. Four patients (33%) also had nasal and five (42%) patients had additional laryngotracheal diphtheria. Seven patients had bull neck on presentation. Four patients had airway obstruction due to laryngotracheal diphtheria requiring tracheostomy. Throat swab for Corynebacterium Diphtheria by Albert stain and Gram stain were positive in 10 patients, and in nine, diagnosis was confirmed by culture. Six patients (50%) were given anti diphtheria serum (ADS) out of which four patients (66.66%) developed anaphylaxis. Myocarditis was the commonest complication seen in four patients (25%). All children with myocarditis developed complete heart block (CHB) and none of them survived. Conclusions: Tonsillopharyngeal diphtheria was the most common clinical presentation and myocarditis was highly fatal complication. This study emphasizes on the need for careful surveillance, early laboratory confirmation and careful administration of ADS in patients with clinical diagnosis of diphtheria.Publication Foetal and Neonatal Outcome in Pregnant Women with COVID-19(Nepal Paediatric Society (JNPS), 2020) Shrestha, Rupesh; Basnet, Srijana; Shrestha, LaxmanAbstract: Introduction: The pandemic caused by coronavirus disease 2019 has adversely affected the health of all individuals including pregnant women. The susceptibility of pregnant women and their foetuses to severe acute respiratory syndrome coronavirus 2 infection is not clearly known. The objective of this review is to summarise the available evidence on foetal and neonatal outcomes of pregnant women with confirmed coronavirus disease 2019. Methods: The review was conduced by searching the PubMed and MedRxiv databases for studies reporting outcome of pregnancy with confirmed coronavirus disease from December 2019 to April 2020 using combination of terms "pregnancy", "coronavirus disease 2019", "foetal outcome" and "neonatal outcome". Only peer reviewed articles reporting outcome of pregnancy with confirmed coronavirus disease 2019 were included in the review irrespective of language. Ongoing pregnancies, induced abortion, and pregnancies without outcome were excluded from analysis. Variables extracted and analysed included gestational age at delivery, mode of delivery, foetal and neonatal outcome. Results: In total, 21 studies consisting 230 pregnant women including three twin pregnancies were enrolled in the study. Fever and cough were the most common symptoms reported in pregnant women. One hundred and sixty-two (70.4%) pregnant women underwent cesarean section and there were 68 (29.6%) preterm deliveries. Eight babies tested positive out of 161 newborns that were tested for coronavirus infection. Among adverse outcomes reported, there were two miscarriages, two still births and only one neonatal death. Conclusions: Outcome of pregnancy with coronavirus disease 2019 in late trimester appears to be favourable. Occurrence of preterm delivery and cesarean section appear higher among infected pregnant women in comparison to general population. There was no conclusive evidence of vertical transmission.Publication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract: Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Kikuchi Fujimoto as an Initial Presentation of Systemic Lupus Erythromatosis(Nepal Paediatric Society (JNPS), 2021) Basnet, Srijana; Shrestha, Laxman; Shrestha, PrabinaAbstract: Kikuchi-Fujimoto Disease (KFD) is a rare benign, condition of necrotising histiocytic lymphadenitis. In this case report, we discuss a case of 10 year old male patient who presented with a fever, rash and generalised lymphadenopathy that was not attributable to the more common causes. Axillary lymph node biopsy confirmed the diagnosis of KFD. Treatment with prednisolone improved his symptoms but after six months he had recurrence of his symptoms. He was investigated again and finally met diagnostic criteria for SLE. This case report highlights importance of close follow up in a child with KFD.Publication Outcome of Improvised Bubble Continuous Positive Airway Pressure (bCPAP) in Respiratory Distress Syndrome (RDS) and Factors Associated with its Failure: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2023) Basnet, Srijana; Aryal, Surabhi; Poudel, Daman Raj; Shrestha, LaxmanAbstract: Introduction: Bubble CPAP (bCPAP) is the standard treatment for newborn with RDS but is challenged by availability of proper bCPAP delivery devices. The improvised bCPAP using modified nasal prong with expiratory limb immersed in water is commonly used to deliver pressurized air to the neonate’s lungs. The primary objective of the study was to evaluate effectiveness of improvised bCPAP in treating Respiratory distress syndrome (RDS) and to identify factors that may be associated with its failure. Methods: In this prospective observational study, all consecutively born preterm neonates delivered before 37 weeks of gestation, admitted to the neonatal intensive care unit (NICU) with diagnosis of RDS and needed bCPAP were included in the study. Early rescue surfactant was given according to NICU protocol of the hospital. Those neonates failed to improve despite treatment with Continuous Positive Airway Pressure (CPAP) and needed MV within 96 hours of life are considered as CPAP failure (CPAP-F). Results: 119 preterm newborn with mean gestational age was 31.95 ± 2.05 weeks and birth weight 1614.33 ± 454.32 gm were enrolled. bCPAP was successful in 22 (18.5%) preterm infants. The mean duration of Continuous Positive Airway Pressure (CPAP) was 61.21 ± 41.81 hours and NICU stay was 12.34 ± 8.12 days. Surfactant was given in 51 (42.9%) and mortality rate was 17 (14.29%). Multivariable logistic regression analysis showed gestational age less than 32 weeks 0.534 (95%CI: 0.340-0.839) and pneumothorax 22 (95%CI: 2.122 - 228.070) are independent risk factors associated with CPAP-F. Conclusions: Improvised bCPAP is effective in the management of respiratory distress syndrome (RDS). Pneumothorax and gestational age < 32 weeks are independent risk factor for its failure.Publication Refractory Cardiogenic Shock Secondary to Acute Myocarditis in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19: A Case Report(Nepal Medical Association, 2022) Karki, Susmin; Agrawal, Saurav; Rayamajhi, Aadesh; Yadav, Sushil Kumar; Basnet, SrijanaAbstract Children with Coronavirus disease 2019 infection usually have mild symptoms but rarely may present with a life-threatening condition called a multisystem inflammatory syndrome. We report a case of COVID-19-related multisystem inflammatory syndrome in an 8-year-old boy who presented with cardiogenic shock due to acute myocarditis with no features of Kawasaki disease. Cardiogenic shock was refractory to fluids and inotropes. Later, this case was successfully managed with hydrocortisone and intravenous immunoglobulin. Therefore, this case report highlights keeping a lookout for such atypical presentations and early referral to a higher center for timely intervention and aggressive therapy specifically directed against the underlying inflammatory process to ameliorate the outcomes.