Browsing by Author "Bhatta, NK"
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Publication Asthma symptomatics school children of Sonapur(Kathmandu University, 2007) Pokharel, PK; Pokharel, P; Bhatta, NK; Pandey, RM; Erkki, KAbstract Background: Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. Materials and methods: Two thousand school-going children from three schools of Sonapur VDC, Sunsari in the surrounding of industries were screened for the presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). Results: One hundred twenty children were identified with symptoms of bronchial asthma. For each child with asthma two age and sex matched non-asthmatic control were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were: passive smoking (OR 3.33, 95% CI 1.85-7.65), pets at home (OR 5.5, 95% CI 1.04-29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17- 13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant in statistical analysis. Conclusion: Thus, passive smoking, inadequate ventilation and domestic animals and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in these children. Key words: asthma; risk factors; passive smoking; domestic animals and pets; cross ventilation; childhood asthmaPublication Childhood Intussusception: A Prospective Institutional Study at BPKIHS(Nepal Paediatric Society (JNPS), 2011) Shakya, VC; Agrawal, CS; Sinha, AK; Bhatta, NK; Khaniya, S; Adhikary, SAbstract: Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. The present study deals with the presentation, management and outcome of children presenting with intussusception at the Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and Methods: Forty-seven children presenting at Department of Surgery, B. P. Koirala Institute of Health Sciences over a 5-year period were prospectively studied. Results: There were 27 (58.6%) males and 20 (41.4%) females, with male-to-female ratio of 1.4:1. The ages ranged from 2 months to 13 years, with a median age of 30 months. The mean duration of presentation was 10.7 ± 30.66 days (range 1-180 days). The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass was seen in 10 (21%) of the cases. Surgical exploration was done in 42 (89.3%) patients. The commonest lead point was non-specific hyperplastic lymph nodes, occurring in 22 (54.3%), followed by idiopathic variety (16.6%), Meckel's diverticulum (9.5%), ileocaecal junction (7.1%), submucous lipoma (4.7%), Non- Hodgkin's lymphoma (4.7%), appendix (2.3%) and a mucosal polyp (2.3%). Overall mortality rate was 6.3%. Conclusion: The presenting age group and the time of presentation are higher than other studies. The mortality rate of 6.3% is comparable to other studies in the developing world. Earlier presentation could have avoided surgery, with a higher possibility of cases being managed conservatively.Publication Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns(Nepal Paediatric Society (JNPS), 2007) Shrestha, P; Das, BK; Bhatta, NK; Jha, DK; Das, B; Setia, A; Tiwari, AAbstract: Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs.Publication Clinical Spectrum and Outcome of Empyema in Nepalese Children Authors(Nepal Paediatric Society (JNPS), 2008) Bhatta, NK; Singh, AP; Kalakheti, B; Khanal, B; Shrestha, P; Singh, RPublication Cytogenetic analysis of children with suspected genetic disorder(Kathmandu University, 2009) Shrestha, U; Bhattacharya, S; Bhatta, NK; Jha, CBAbstract Objectives: To analyze chromosomes in children with suspected genetic disorder and to categorize the chromosomal basis of genetic disorder Materials and methods: Thirty children were selected from the patients attending genetic clinic, Department of Pediatrics, B.P. Koirala Institute of Health Sciences presenting with dysmorphic feature, mental retardation, short stature, congenital malformations and ambiguous genitalia with age between 0-15 years. Cytogenetic analysis was carried using standard peripheral blood lymphocyte culture method and G-banding technique in Cytogenetic laboratory of Department of Anatomy, B.P. Koirala Institute of Health Sciences. Results: Chromosomal disorders were identified in 33.34% (10) of children. The most common chromosomal abnormality was Down syndrome (26.67%) followed by Turner syndrome (6.67%). Conclusion: The cytogenetic analysis of children with suspected chromosomal aberration is important to uncover the contribution of chromosomal disorder in genesis of dysmorphisms, mental retardation, short stature, sexual ambiguity and congenital malformation in children and prevent further potentially unpleasant investigation being undertaken. Key words: Chromosome, suspected genetic disorder, dysmorphic feature, mental retardation, short stature, congenital malformations, ambiguous genitaliaPublication Evaluation of Effectiveness of Neonatal Resuscitation Programme (NRP) Course Among Paediatric Residents of BPKIHS(Nepal Paediatric Society (JNPS), 2015) Yadav, SK; Bhatta, NK; Yadav, SP; Kanodia, P; Moktan, DAbstract: Introduction: Neonatal resuscitation is an essential skill for neonatal care providers, especially for junior doctors who are often the first persons to attend to a newborn in need of resuscitation. The Neonatal Resuscitation Programme (NRP) training course offers a comprehensive and systematic training programme that has been adopted in 130 countries worldwide. Reports from different countries attributed the improvements in neonatal mortality and morbidity over the past two decades partly to the implementation of a systematic neonatal resuscitation training programme. The objective of this study was to evaluate the effectiveness of Neonatal Resuscitation Programme (NRP) in improving the knowledge of the paediatric resident doctors after completion of the course. Materials and Methods: This was a cross-sectional interventional study. The resident doctors who attended the NRP course were enrolled. The knowledge was evaluated by written 30-item questionnaire pre- and post- course score. Statistical analysis was done by descriptive statistics and paired t-test. p- value of <0.05 was taken as significant. Results: Data of 18 paediatric residents who attended the course were analyzed. There were four female and 14 male residents. Out of 18 residents, eight were from first year, seven were from second year and three were from third year. Their mean scores (out of 30) were 13.84 (SD 2.57) (pre-course) and 16.68 [(SD 3.15) (post-course) (p=0.001)]. Conclusions: NRP course produced a modest gain in residents’ knowledge on neonatal resuscitation at the end of their course. NRP training has the potential to substantially improve knowledge of neonatal resuscitation.Publication Glomerular Diseases in Children - A Review of 27 Cases Recorded at a Single Centre in Eastern Nepal(Nepal Paediatric Society (JNPS), 2009) Shrestha, P; Bhatta, NK; Tiwari, A; Singh, R; Kalakhetti, BK; Majhi, S; Paudel, P; Sinha, AAbstract: Glomerular disease remains an important cause of renal disease in children. We retrospectively assessed the clinical features and histopathological diagnoses in kidney biopsy specimens in children (n=27). The medical records and histopathological diagnoses between 2003 and 2006 were reviewed. In each patient, clinical presentation, age at onset of disease, gender, presence of nephrotic range proteinuria, hematuria, hypertension and histopathological diagnoses were evaluated. SLE nephritis (n=8) and membranoproliferative glomerulonephritis (MPGN) (n=8) were the most frequent glomerular diseases and nephrotic syndrome (n=21) was the frequent clinical manifestation.Publication Profile of renal diseases in Nepalese children(Kathmandu University, 2008) Bhatta, NK; Shrestha, P; Budathoki, S; Kalakheti, BK; Poudel, P; Sinha, A; Singh, RAbstract Aim and Objectives: To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal. Materials and Methods: A retrospective chart review of all the patients admitted at the department of paediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis. Results: A total number of 10396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and haemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%). Conclusion: A substantial number of children are hospitilsed with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal. Key words: Renal Disease, Children, Nephrotic Syndrome, Poststreptococcal Glomerulonepritis, Renal BiopsyPublication Randomized Control Trial of Kangaroo Mother Care in Low Birth Weight Babies at a Tertiary Level Hospital(Nepal Paediatric Society (JNPS), 2014) Acharya, N; Singh, RR; Bhatta, NK; Poudel, PAbstract: Introduction: This study was conducted to compare the effect of Kangaroo Mother Care (KMC) and conventional methods of care on weight gain, occurrence of hypothermia and apnea and duration of hospital stay among Low Birth Weight (LBW) babies. Materials and Methods: It was a randomized control trial conducted at a tertiary level hospital for a period of one year from June 2009 to May 2010. Total 126 stable LBW babies weighing less than 2000 gm and fulfilling inclusion criteria were included in the study. Neonates enrolled for the study were allocated to either KMC or control group using random number table. KMC group was subjected to Kangaroo mother care of at least six hours per day in not more than four sittings. In control group, babies were adequately clothed, covered and kept with their mother and if required were kept under radiant warmer. Recording of temperature in KMC group was done before, during and after KMC. In control group temperature was taken every 4 hours. Weighing of baby was done twice daily on electronic weighing scale. Results: Median daily weight gain (IQR) was 10 (6- 20) gm in KMC group as compared to 7 (0-10) gm in control group (p<0.001). Mean weight gain was 12.11±9.04 gm in KMC group as compared to 3.29±15.81 gm in control group (p<0.001). Incidence of hypothermia was more in control group (12.6%) as compared to KMC group (3.1%) (p=0.048). Duration of hospital stay was less in control group as compared to KMC group (p=0.015). Conclusion: LBW babies less than 2000 gm who receive KMC show better weight gain and have less incidence of hypothermia than those who do not receive KMC.Publication Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study(Kathmandu University, 2009) Kalakheti, BK; Singh, R; Bhatta, NK; Karki, A; Baral, NAbstract Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A’ and ‘B’ blood group babies of O ‘+ve’ mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O’ positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O’ positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O’ positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O’ Positive blood group and 23 (62%) were from group of babies having other than ‘O’ Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O’ Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve’ blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibility