Browsing by Author "Bastola, Ramchandra"
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Publication Bone Tuberculosis: Rare Condition Among Infants(Nepal Paediatric Society (JNPS), 2019) Bastola, Ramchandra; Adhikari, Neelam; Shrestha, Dhruba; Sigdel, Bhawana; Shrestha, Shree KrishnaAbstract: Bone tuberculosis in infancy has become rare these days. Here we report a case of 12 months old male infant who had presented with complaints of fever and skin rash for one month, along with protuberance of toe joint for 15 days. He was being treated with antibiotics, vitamin D and calcium without improvement. Further investigations led to mycobacterium positivity in bone biopsy. He was treated with anti-tubercular therapy and he responded to the treatment dramatically. So, though rare, it is important to consider bone tuberculosis when there are bony issues even in infancy, especially in endemic regions like ours.Publication Comparison of Oral Versus Normal and High-Dose Rectal Paracetamol in the Treatment of Fever in Children(Nepal Paediatric Society (JNPS), 2017) Bastola, Ramchandra; Shrestha, Shree Krishna; Bastola, Bhawana Sigdel; Shrestha, Dhurba; Sharma, YograjAbstract: Correction: On 13th June 2018 the author Yog Raj Sharma was changed to Yograj Sharma Introduction: Paracetamol is the most commonly used drug in paediatrics with the standard dose (15 mg/kg) of oral and rectal paracetamol preparations interchangeably is used to treat fever in children, assuming they have equal antipyretic effect. We did a study to compare the effectiveness of two different rectal doses of paracetamol: 15 mg/kg and 30 mg/kg to that of a standard oral dose of 15 mg/kg. Material and Methods: This is a prospective, interventional, randomized controlled study done in Western Regional Hospital, Nepal in which 192 children with fever aged six months to six years. Study duration was August 2015 to October 2015. The sample included 63 in the oral normal dose group (15mg/kg), 59 in normal dose rectal group (15mg/kg) and 70 in high dose (30mg/kg) rectal paracetamol group. Temperature was recorded before and after the administration of paracetamol at an interval of 30, 60, 120, and 180 minutes by using a digital thermometer. Results: Total of 59 patients received 15 mg/kg rectal Paracetamol (group A), 70 received 30 mg/kg rectal Paracetamol (group B), and 63 received 15 mg/kg oral Paracetamol (group C). Mean temperature before giving medication in Group A, B and C respectively were 101.7° F, 101.9° F and 101.5° F. At 30 min temperature was 100.8° F, 100.8° F and 100.66° F, while at 60 minutes temperature was 99.9° F, 99.7° F, and 99.7° F respectively for Group A,B and C. But at 120 and 180 minutes temperature decreased significantly who got rectal 30 mg/kg of paracetamol. Conclusions: Rectal paracetamol in a dose of 30mg/kg is more effective than oral paracetamol in a dose of 15 mg/kg. However oral paracetamol given in a dose of 15 mg/ kg is more effective than rectal paracetamol in a same dose.Publication Demographic Profile and Outcome of Pediatric Intensive Care Unit(Nepal Health Research Council, 2023) Bastola, Ramchandra; Shrestha, Shree krishna; Sigdel, Bhawana; Poudel, Drishti; Ghimire, Sunita; Ghimire, Amrita; Khadka, Khim Bahadur; Basnet, AnjaliAbstract Background: Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome. Methods: This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables. Results: The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). Conclusions: Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal. Keywords: Infants; Intensive care; Patients; PediatricPublication Emerging Antibiotic Resistance Pattern in a Neonatal Intensive Care Unit in Pokhara, Nepal(Nepal Health Research Council, 2025) Bastola, Ramchandra; Shrestha, Shree Krishna; Paudel, Rajan; Gurung, Laxmi; Sigdel, Bhawana; Neupane, Jamuna; Pradhan, Saugat; Basnet, Omkar; Subedi, NuwadattaBackground: Treating neonatal sepsis in Nepal remains difficult given the high rates of antimicrobial resistance. The objective of this study is to determine the antibiotic resistance pattern of culture-proven infections in neonates admitted to a neonatal intensive care unit. Methods: This cross-sectional prospective observational study was performed at the Neonatal Intensive Care Unit of Pokhara Academy of Health Sciences from 15th july 2022 to 15th july 2023. We included all neonates admitted with positive cultures grown from blood, cerebrospinal fluid, endotracheal tube, and pus. Demographic, clinical, and microbiologic data were collected from the medical record. We reviewed antimicrobial susceptibility testing of all isolates. Results: There were 51 culture-positive infections among 1327 neonates admitted, among which 23 cases from blood culture, 2 cases from cerebrospinal fluid, 14 cases from endotracheal tube samples, and 12 cases from pus samples. Gram-negative infections were predominant amounting to 35 (68.6%) including Pseudomonas in 12 (23.5%), and Acinetobacter species in 9 (17.6%) cases. Gram-positive infections were seen in 14 (27.4%) in which Methicillin-Resistant Staphylococcus aureus accounted for 6 (11.8%) cases. Yeast cells other than Candida albicans accounted for two (5.4%). For all Gram-negative isolates, resistance to Third-generation cephalosporin and aminoglycosides was reported in 75.0% (12 of 16 isolates tested) and 87.0% (24/31), respectively. Fluoroquinolone resistance was seen in 61% (8/13), resistance to penicillin was 59.3% (10/19), and resistance to carbapenem was in 100.0% (7/7) cases. Conclusions: There were high rates of antimicrobial resistance even with the reserved drugs among gram-negative pathogens. This alarms for the need for rationale prescribing of antimicrobials. Keywords: Antimicrobial resistance; bloodstream infection; meningitis, neonatal sepsis