NepMed Repository :: Browsing by Author "Chapagain, Ram Hari"

Browsing by Author "Chapagain, Ram Hari"

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A Five Years Study of Occurrence and Associated Risk Factors for Birth Defects in a Tertiary Care Hospital in Central Nepal
(Nepal Paediatric Society (JNPS), 2019) Basaula, Yuba Nidhi; Paudel, Radha Kumari; Chapagain, Ram Hari
Abstract Introduction: Congenital anomalies account for 7.0% of neonatal deaths in Nepal. The present study was carried out to determine the overall rate of congenital malformations, incidence and prevalence in live births, still birth and incidence affecting various organ systems, at Bharatpur Hospital, Nepal. Methods: All the intramural deliveries between Jan 2015 to Dec 2019 were included in the study. All the newborns were looked for congenital malformations after birth within seven days. Antenatal ultrasonography findings were noted. 2D echocardiography was also used for all congenital heart diseases, along with routine X-ray chest. A total of 131 babies with congenital problem were studied and the information was recorded in WHO NBBD Proforma. Data were recorded in MS Excel and SPSS 16 version was used for analysis. Results: Out of the total 60160 deliveries, 131 (0.21% of total birth) were with congenital malformations, sex wise distribution was 65 (49.5%) females and 63 (48.7%) males and three (1.8%) were ambiguous. Oro-facial malformation (49, 37.4%) was the commonest form of malformation followed by the musculoskeletal system (31, 23.6 %), centre nervous system (31, 23.6%) and congenital malformations of genital organs (8, 6.0%). Conclusions: The incidence of congenital malformation in this study was 0.21%. Females were more common than males and oro-facial malformation was the commonest type of malformation. Lack of antenatal visit, lack of folic acid during pre-conception period and low socioeconomic status were the commonest risk factors. Author Biographies Yuba Nidhi Basaula, Bharatpur Hospital, Bharatpur, Chitwan, Nepal Department of Paediatrics Radha Kumari Paudel, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal Faculty of Nursing Ram Hari Chapagain, National Academy of Medical Sciences / Kanti Children’s Hospital, Kathmandu, Nepal Department of Paediatrics
Acceptance of New Respiratory Syncytial Virus Vaccine among Pregnant Women in Nepal for Future Routine Immunization: A Descriptive Crosssectional Study
(Nepal Medical Association, 2024) Adhikari, Santosh; Chapagain, Ram Hari; Maharjan, Jessica; Kunwar, Kshitij; Pudasaini, Sudip; Singh, Pramod; Gautam, Abhiyan; Bhattarai, Tribhuwan; Bhattarai, Srijana
Abstract Introduction: Children are at greatest risk for severe illness from Respiratory Syncytial Virus (RSV). The aim of the study was to find out the knowledge of RSV, practice and knowledge about vaccination during pregnancy and the willingness to accept vaccines against RSV during pregnancy in the future among mothers needs to be understood which would add up information for stakeholder and policy makers. Methods: A preformed Performa was used for face-to-face interview was conducted among 340 pregnant women who visited the Antenatal clinic from 15-Oct-2023 to 30-Nov-2023 in their second and third trimester. Socio-demographic characteristics, knowledge and the attitude concerning antenatal vaccination affecting the acceptance of RSV vaccine were evaluated from the interview. Results: The mean age was 28.4 years, with 310 (91.18%) already having at least one child. Six (1.76%) participants had previously heard about RSV, and 325 (95.59%) were aware of the problem caused by RSV after they were briefly explained about it in their local language. A total of 246 (72.35%) of the mothers expressed willingness to be vaccinated themselves rather than vaccinating their children if such an option existed. Only 2 (0.59%) participants were familiar with nasal vaccines, and only 18 (5.29%) believed in such vaccines being effective. Despite this, almost all participants 339 (99.71%) in the study demonstrated willingness to receive additional antenatal vaccines if approved for use in future. Conclusions: The study showed a limited understanding of RSV in children among pregnant women in Nepal. However, they are aware of the impact of bronchiolitis and expressed a strong willingness to undergo maternal vaccination against RSV.
Adverse Events Following COVISHIELD and VERO CELL Vaccination Campaigns Against COVID-19
(Nepal Health Research Council, 2023) Adhikari, Santosh; Maharjan, Jessica; Bhattarai, Sushan; Kunwar, Kshitij; Agrawal, Sumit; Dangal, Raj Kumar; Chapagain, Ram Hari; Bista, Tek Bahadur; Bhattarai, Srijana
Abstract Background: Vaccination against COVID-19 for Nepalese was initiated in January 2021 for various age groups. People were anxious about receiving the vaccines and were concerned about the safety profile of the vaccine they received. In this study, we have tried to observe the Adverse Events Following Immunization of two different vaccines namely COVISHIELD (ChAdOx1 nCOV-19) and VERO CELL (CZ02 strain), used in different phases of vaccination by the government of Nepal. Methods: We conducted a cross-sectional study among people who received COVID-19 vaccines in this study using a self-administered questionnaire. Data was cleaned and then exported to IBM SPSS v.20 for analysis, Chi-square test was used to see the association between different variables and a p-value<0.05 was considered statistically significant. Results: Out of 303 respondents, all had received the first and 270 participants had received the second dose of the COVID-19 vaccine, among which, 133 (43.89%) reported at least one side effect after the first dose of vaccination while 58 (21.48%) had self-reported side effects after the second dose of vaccination. Seventeen percent of the respondents had COVID-19 infection within the past 3 months before receiving COVID-19 vaccine. Three percent of participants had re-infection with COVID-19 after receiving the first or the second dose of the COVID-19 vaccine. Among participants who experienced adverse events, 42% and 62.1% of participants experienced mild adverse events following the first dose and second dose of the vaccine, respectively. Conclusions: The adverse events following immunization for both vaccines after both doses of vaccination were quite low, with 43.89% of participants reporting side effects after the first dose and 21.48% of participants reporting side effects after the second dose. Adverse events were most frequently reported within 24 hours of vaccination and were mostly mild. There was no statistical significance of adverse events between both vaccines. Keywords: Adverse events following immunization (AEFI); COVID-19; COVISHIELD; VERO CELL. Author Biographies Santosh Adhikari, Kanti Children's Hospital, Kathmandu, Nepal Sushan Bhattarai, Kanti Children's Hospital, Kathmandu, Nepal Raj Kumar Dangal, Kathmandu University School of Medical Sciences, Dhulikhel hospital, Dhulikhel, Nepal Srijana Bhattarai, Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
Bacteriological Profile and Antibiotic Sensitivity Pattern of Neonatal Sepsis in Central Paediatric Referral Hospital in Nepal
(Nepal Paediatric Society (JNPS), 2019) Bhattarai, Susan; Chapagain, Ram Hari; Mishra, Deepak; Shrestha, Anil Kumar; Shrestha, Sushan Man
Abstract: Introduction: Neonatal sepsis is the most common cause of neonatal morbidity and mortality. The causative organisms of neonatal sepsis are changing and so do their antibiotic sensitivity pattern. So it is important to regularly monitor the change in bacteriological profile and their antimicrobial sensitivity pattern to help update the treatment guidelines of neonates. This study aimed to study the microbiological patterns of neonatal sepsis and their antibiotic susceptibility pattern in a tertiary care centre in Kathmandu. Methods: A prospective study was carried out among cases of neonatal sepsis admitted in Neonatal Intermediate Care Unit (NIMCU) of a tertiary care referral hospital from August 2015 to August 2016. Prospective data were collected with pretested and standardised proforma and analysed using SPSS version 20. Results: Out of 311 neonates admitted over a period of one year with diagnosis of neonatal sepsis, male:female ratio was 2.1:1. Among them 234 (75.2%) cases were of LONS and 77 (24.8%) were of EONS. Blood culture was positive in 47 neonates (15.1%). The organisms isolated included staphylococcus aureus (34.0%), klebsiella (32%), CONS (24%), escherechia coli (6%) and enterobacter (4%). In LOS, gram positive organisms staphylococcus and CONS were the commonest ones (61.4%). In EOS, gram negative organism klebsiella (65%) was more common. Most of staph aureus were susceptible to penicillins, amikacin and cefotaxime. Klebsiella was found to be resistant to penicillins, amikacin and cefotaxime. Conclusion: There is possible increasing incidence of gram positive septicemia in LONS and increasing emergence of resistance of kleibsella to the common antibiotics ampicillin, amikacin and cefotaxime.
Bruck Syndrome: A Rare Disorder in New-Born with Fractures and Contractures
(Nepal Paediatric Society (JNPS), 2017) Dhaubhadel, Suraj; Baniya, Bimala; Joshi, Hema; Chapagain, Ram Hari; Paudel, Krishna Prasad
Abstract: Bruck syndrome is a very rare autosomal recessive syndrome consisting of bone fragility and congenital joint contractures. It is considered as a combination of arthrogryposis multiplex congenita and osteogenesis imperfecta, while some consider it as the autosomal recessive variant of osteogenesis imperfecta. According to the genotype, it has been classified into types 1 and 2. To our knowledge, only about 28 patients of this syndrome have been reported so far worldwide with none been reported from Nepal. Here, we present a patient with generalized osteopenia, bilateral femur fracture and congenital joint contractures of distal extremities.
Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in National Immunization Program
(Nepal Health Research Council, 2023) Chapagain, Ram Hari; Adhikari, Santosh; Bhattarai, Tribhuwan; Basaula, Yubanidhi; Bhattarai, Srijana
Abstract Background: Enteric fever is a major public health problem in developing and under developed countries. Case fatality rate without treatment is 10-30% and with appropriate treatment is only 1-4%. Gold standard for diagnosis is isolation of Salmonella enterica from blood or bone marrow. Antibiotics resistance is skyrocketing with emergence of multidrug resistance S. typhi and extensively drug resistant S. typhi. Methods: The blood culture done in Kanti children hospital in last six years were taken from the data base and the culture positive cases were taken from which the salmonella species positive cases along with the drug sensitivity pattern were used in our study. Results: The culture positivity rate was 2.8% and 7.6% (n=136) among the culture positive cases were Salmonella species. Salmonella typhi (121; 88.9%) was the most frequently isolated species, followed by Salmonella paratyphi A (13; 9.5%) and Salmonella paratyphi B (2;1.4%). Children with age 5-10 years was the most affected age group for infection with Salmonella, 50.0% (n=68). Nalidixic acid is resistant in 89.9% Salmonella typhi; followed by ciprofloxacin (31.8%), ofloxacin (18.2%), ampicillin (9.6%), azithromycin (8.4%), chloramphenicol (8.2%), cotrimoxazole (5.4%), cefixime (4%), ceftriaxone (2.5%) and cefotaxime (0.0%). Cefixime, ceftriaxone, cefotaxime are 100% sensitive to Salmonella paratyphi, followed by cotrimoxazole (92.9%), ofloxacin (81.8%), chloramphenicol (75%), azithromycin (66.7%), ampicillin (60%), ciprofloxacin (50%) and Nalidixic acid (23.1%). Conclusions: Salmonella species culture isolatation are declining every year. Fluoroquinolones have more resistance than first line drugs of typhoid, azithromycin resistance is rising but 3rd generation cephalosporins are sensitive to Salmonella species. Keywords: Drug sensitivity; enteric fever; salmonella paratyphi; salmonella typhi; typhoid vaccine
Epidemiology, Clinical Pattern and Management Outcome of Paediatric Burn Injuries in Nepal
(Nepal Paediatric Society (JNPS), 2021) Thapa, Bijay; Chapagain, Ram Hari; Kayastha, Anju
Abstract: Introduction: Burn injuries are third commonest type of injury in Nepal and 61% of burn victims are children. This represents a significant morbidity and mortality burden for patients and families. This study was carried out to describe epidemiology, clinical pattern and therapeutic outcome of children with burn. Methods: It is a retrospective observational study of routinely collected data of children up to 14 years admitted to the Burns Ward at Kanti Children’s Hospital, Kathmandu, Nepal, from July 2016 to July 2019. Statistical analysis was done on the collected data. Results: Total 935 patients were admitted with an average of 311.7 per year, among which 63% were males and 83.0% were aged five years or under. Patients travelled from all over Nepal for treatment at this hospital. 50.6% of patients presented with fresh burns < 24 hours after injury. Scald burn was the commonest (82.6%). Children under five were more likely to have scald burns, whereas older children more likely to have flame or electric burns. Majority of cases (70%) were of mild burns < 10% TBSA and only 3.2% TBSA > 30%. 68.5% were managed conservatively and 18.4% required debridement and skin grafting. Mean length of stay was 15 days. Overall mortality was 1.0%. In children with > 30% burns mortality was 12.9%. Conclusions: Scald burn was the commonest while proportion of flame burn increases with age. Majority of burns occur in male under five years of age. Most cases presented with < 10% TBSA and were managed conservatively.
Familial Chylomicronaemia: A Neonate with Milky White Blood
(Nepal Paediatric Society (JNPS), 2018) Chaudhary, Nanda Kishwor; Chapagain, Ram Hari; Sipai, Sani; Chaudhary, Suryakant; Paudel, Krishan Prasad
Abstract: Familial Chylomicronaemia is a rare autosomal recessive disease of lipoprotein metabolism characterized by deficiency or absence of lipoprotein lipase (LPL) or its co-factor apoC-II which causes severe elevation of triglyceride and chylomicron resulting in lipaemic plasma, recurrent attacks of acute pancreatitis, eruptive xanthomas, hepato-splenomegaly and lipaemiaretinalis. We report a case of term female neonate with lipaemic plasma, lipemia retinalis, markedly elevated triglyceride level which is consistent with diagnosis of Familial Chylomicronaemia.
Immunogenicity and Safety Profile of Typhoid Conjugate Vaccine (Vi-DT) Among Nepali Children
(Nepal Health Research Council, 2025) Adhikari, Santosh; Rai, Ganesh Kumar; Chapagain, Ram Hari; Giri, Bishnu Rath; Joshi, Prakash; Shrestha, Nisha Jyoti; Manandhar, Bina Prajapati; Tamang, Suresh Man; Maharjan, Jessica; Thapaliya, Bibesh; Gupta, Birendra Prasad; Kim, Deok Ryun; Vemula, Sridhar; Sahastrabuddhe, Sushant; Saluja, Tarun
Background: Typhoid fever remains a major concern in tropical countries. The availability of an effective vaccine could be an important inclusion to currently available interventions. We reported on our evaluation of the immunogenicity and safety of the typhoid conjugate vaccine (Vi-DT) among Nepali children. Methods: The study was an observer blinded, active controlled, randomized phase III clinical trial in children above 6 months and less than 18 years old. Three different lots of Vi-DT(Vi- Diptheria Toxoid); test vaccine and Vi-TT ( Vi-Tetanus Toxoid); comparator vaccines were administered to eligible children. Seroconversion was assessed with blood samples collected at baseline and 4 weeks after the vaccination. A rise of at least 4-fold vi-antibody titer from the baseline was used to indicate positive seroconversion. Data on solicited and unsolicited adverse events were collected. Results: Four hundred and eighty-eight children participated in the study. Seroconversion rate was 98.61% and 98.36% among participants who received Vi-DT and Vi-TT vaccines respectively. One immediate adverse event was observed only for Vi-DT group. One hundred forty-two and 66 solicited AEs within 7 days were observed with test and comparator vaccine respectively. Unsolicited AEs within 28 days were 125 for test vaccine compared and 77 for the comparator vaccine. Two SAEs were reported which were Not- related to study vaccine. Conclusions: The overall seroconversion in Vi DT vaccine was non inferior to the comparator vaccine and the safety profile of the vaccine was good without any life-threatening events. Keywords: Immunogenicity; Nepal; safety profile; typhoid conjugate vaccine; Vi-DT
Risk Factors and Clinico-laboratory Characteristics of Scrub Typhus in Children Admitted to a Tertiary Pediatric Hospital of Nepal
(Nepal Health Research Council, 2024) Chapagain, Ram Hari; Adhikari, Santosh; Bista, Bihungum; Bhattarai, Tribhuwan; Thapa, Prabhat
Backgrounds: Scrub Typhus is a re-emerging illness with considerable morbidity and mortality and affected children have nonspecific sign symptoms. This study was conducted to find out the risk factors, clinical characteristics and laboratory profile and treatment outcome of scrub typhus among the children admitted in tertiary level pediatric hospital for febrile illness. Methods: A case control study was conducted among hospitalized children with acute febrile illness in a government pediatric referral hospital of central Nepal for two years (2021 to Sept 2023), who were tested using Scrub Typhus Antibody Rapid Test Kit. Results: We recruited 137 participants, comprising 68 cases of scrub typhus and 69 controls who had fever as a presenting complain, tested negative for scrub typhus and are matched with case in terms of age, gender, place of residence, and most importantly devoid of chronic health issues like leukemia, solid tumor, tuberculosis or kala-azar. Almost all cases i.e. 98.5% (n=67) had fever which is followed by abdominal pain 19.1% (n=13), headache 11.8%(n=8), vomiting 10.3%(n=7) and abdominal distension 8.8%(n=6). Hepatomegaly was commonest finding among scrub typhus positive cases comprising 50% (n=34) followed by lymphadenopathy 29.4% (n=20), splenomegaly 27.9% (n=19), eschar 17.6% (n=12) and rashes 10.3% (n=7). Cases having thrombocytopenia and leukocytosis were 51.5% (n=35) and 32.3% (n=22) respectively. Among scrub typhus cases, 17.6% (n=12) needed pediatric intensive care, 20.6% (n=14) had some sort of complications (i.e., meningitis, acute kidney injury, septic shock, acute respiratory distress syndrome), 46.3% (n=31) became afebrile within 24 hours of therapy, 29.8% (n=20) needed 48 hours to become afebrile. There were about 80% cases with the habit of taking naps on the ground. Those who reside other than cemented houses were with an increased risk factor of about 72%. Those who were not having good beds were at an increased risk factor of almost 100%. There were 62% of cases with bushes near their home and about 100% cases where they store animal fodder in their home. There were 63% who have any sort of animal in their bedroom. Conclusions: Engaging in agricultural work like working on fields, planting and livestock, working with bare hands/ feet, and having naps on the ground and living in houses made of mud dung and wood are the risk factors for the scrub factor. Fever, lymphadenopathy, hepatomegaly, splenomegaly are the common signs and symptoms and thrombocytopenia and increased levels of creatinine are the significant laboratory finding of scrub typhus in children. Keywords: Children; clinico-laboratory; Nepal; risk factor; scrub typhus.
Spectrum of Congenital Heart Disease in Neonates Admitted in an Intermediate Care Unit of a Tertiary Level Hospital
(Nepal Paediatric Society (JNPS), 2017) Chapagain, Ram Hari; Shrestha, Needa; Kayastha, Madhusudhan; Shakya, Sheelendra; Adhikari, Kimat; Shrestha, Sushan Man
Abstract: Introduction: Congenital Heart Disease is the most common cause of major congenital anomalies accounting 28.0%, representing a major global health problem. Prevalence of Congenital Heart Disease is 1.3 per 1000 in school children of Nepal. Material and Methods: A cross sectional prospective study was carried out in the neonatal intermediate care unit of Kanti Children’s Hospital, Nepal from Jan 2016 until Dec 2016 to see the spectrum of CHD. Results: Out of admitted 831 neonates, 85 were found to have CHD with prevalence of 102.28 per 1000 admitted neonate. Respiratory distress was the commonest symptom (51.8%) followed by cyanosis (11.8%) and reluctant to feed (10.6%) at presentation. ASD was the commonest (87.1%) cases followed by PFO 23.5%, PDA 21.2%, Complex congenital heart disease 11.8% and TOF 1.2%. Cleft lip and Cleft Palate was found in 5.9%, Down’s syndrome 3.5% of cases, polydactyly and syndactyly was detected in 2.4% newborn with CHD. The mode of delivery was spontaneous in 71.8% followed by Elective LSCS were 14.1% and Emergency LSCS were 9.4%. Conclusions: Prevalence of CHD was the 102.28 per 1000 neonates admitted in NIMCU. Atrial Septal Defect was the commonest congenital heart diseases. Cleft lip and Down’s syndrome were the most extra cardiac anomaly associated with CHD. Respiratory distress was the commonest presentation of CHD for hospital admission.
Takayasu’s Arteritis: Rare Cause of Hypertension in Children
(Nepal Paediatric Society (JNPS), 2018) Lamichhane, Reshma Dhakal; Chapagain, Ram Hari
Abstract: Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta, its major branches and pulmonary arteries. Diagnosis of TA during childhood remains challenging due to the non-specific symptoms. We report a six years age boy with unresolved hypertension who was later diagnosed as childhood TA. Oral corticosteroid was started 2mg/kg/day. TA is rare in children; Childhood TA must be considered in children who present with, hypertension and increased acute phase reactants.
The Economic burden of Neonatal Intensive Care Unit Admission at a Community Hospital of Central Nepal
(Nepal Paediatric Society (JNPS), 2020) Sharma, Samana; Chapagain, Ram Hari; Pathak, Om Krishna; Gupta, Arun; Rai, Kavi Raj; Karn, Shruti; Sah, Sandeep Kumar
Abstract: Introduction: Neonatal sepsis is the commonest cause of neonatal morbidity and mortality and remains a major public health problem especially in developing countries. It is one of the most common causes for admission to neonatal units. The objective of this study was to evaluate the cost of care of neonates admitted in Neonatal Intensive Care Unit. It also compared the cost of care of neonates with sepsis and those with non-sepsis along with the duration of hospital stay and its correlation. Method: A hospital based prospective cross-sectional observational study was carried out over a period of one year. All the neonates admitted at NICU and fulfilling the inclusion criteria formed the study population. Total cost was calculated as the summation of direct and indirect cost. Normally distributed data was analyzed using the Student’s t-test, non-normally distributed data using Mann-Whitney U test. P-value < 0.05 was taken to be statistically significant. Result: Direct cost comprises more than two third of the cost. The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The cost for the ones with sepsis was USD 226.30 (Range 172.19-291.34) and 174.02 (Range 99.67-221.96) in non-sepsis. The mean duration of stay in NICU of the ones having sepsis was 6.6 days and 4.4 days in non-sepsis. Conclusion: The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The duration of stay and the total cost of treatment with sepsis are higher than those with non-sepsis.

Browsing by Author "Chapagain, Ram Hari"

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