Browsing by Author "Chaudhary, Shipra"
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Publication Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre(Nepal Paediatric Society (JNPS), 2014) Chaudhary, Shipra; Bhatta, Nisha Keshary; Khanal, Basudha; Bhandari, Rabin; Singh, Rupa RajbhandariAbstract: Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%. The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.Publication Hyperthyroidism in Down’s Syndrome – A Rare Association(Nepal Paediatric Society (JNPS), 2022) Shrestha, Manju; Agrawal, Jyoti; Rai, Basant; Chaudhary, ShipraAbstract: Trisomy 21 is the most common chromosomal abnormality in paediatric population, and the most common cause of intellectual disability. The most common endocrine disease in these population is hypothyroidism. Hyperthyroidism is rare in patients with Down syndrome, but is likely to be underestimated. Hyperthyroidism treatment strategy is highly important for an undisturbed and balanced development of the children.The objective of this case report is to highlight the importance of hyperthyroidism in Down syndrome which is the rare presentation, to best of our knowledge.Publication Incidence and Outcome of Acute Kidney Injury in Hospitalised Children(Nepal Paediatric Society (JNPS), 2021) Paudel, Rajan; Shah, Gauri Shankar; Chaudhary, Shipra; Dharel, Dinesh; Timilsina, AnuradhaAbstract: Introduction: Acute kidney injury (AKI) is common in hospitalised children with adverse short and long term outcomes. Detection of the incidence, etiological profile and outcome of AKI is important for starting preventive and therapeutic modalities. This study aimed to determine the incidence, etiology and short term outcome of AKI at a tertiary centre in Eastern Nepal. Methods: A prospective observational study was conducted in children from two months to 14 years of age admitted in paediatric wards and paediatric intensive care unit (PICU) of a tertiary centre of Eastern Nepal. AKI was defined according to pRIFLE criteria. Results: From May 2015 to March 2016, 942 patients enrolled in Paediatric wards and PICU were evaluated. The overall incidence of AKI was found to be 5.9% and 18.23% in patients admitted in PICU. AKI was commonest among cases having infectious etiology compromising 73.2% (n = 41), 17.85% (n = 10) due to primary renal disease, 5.35% (n = 3) secondary to congenital heart disease, and 3.57% due to other causes. Among AKI patients, 55.4% (n = 31) required inotropic support, 33.9% (n = 19) required mechanical ventilation while 5.36% (n = 3) underwent dialysis. Out of 56 AKI patients 71.4% (n = 40) had improved clinical outcome and 28.6% (n = 16) expired. Patient with AKI had significant longer duration of hospital stay as compared to non AKI (Seven days vs. three days, p < 0.001). Mortality was high among AKI patients on injury and failure stage (p = 0.003) and those requiring mechanical ventilation and inotropic support (p < 0.001). Conclusions: The incidence of AKI was found to be high in paediatric patients. Presence of AKI increased the duration of hospital stay and mortality in hospitalised children often requiring mechanical ventilation and inotropic support.Publication Prevalence and Associated Factors of Malnutrition in Under Five Children in Eastern Nepal: A Hospital Based Study(Nepal Paediatric Society (JNPS), 2023) Shrestha, Manju; Rai, Basant; Agrawal, Jyoti; Chaudhary, Shipra; Shrestha, Kala; Singh, Rupa Raj BhandariAbstract: Introduction: Malnutrition among children remains one of the most important causes of morbidity and mortality in the developing countries like Nepal. Multiple interrelated determinants are involved in causing malnutrition that needs to be catered. This study aims to assess the prevalence and associated factors of malnutrition among under-five children in eastern Nepal. Methods: This is a hospital-based correctional study. The enrolment occurred between Jan 2018 and Dec 2019 among children who visited nutrition clinic in our hospital. The data analyses were performed using Logistic regression and 95% confidence interval along with p-value. A p-value < 0.05 was considered statistically significant. Results: A total of 310 children were analyzed for malnutrition. Among them, the prevalence of underweight, stunting and wasting was 34.10, 32.45, 17.54 % respectively. Among them, majority of the mother belonged to young age group between 18- 25 years, 216 (69.68%) were females and 120 (38.71%) and Majority of malnutrition fell in the age group of 12 – 23 months. Mother’s age, mother’s education, family size, economic status, child’s age and sex, exclusive breast, ethnicity, mother’s occupation and total family size were found to be significantly associated with malnutrition. Conclusions: This study highlights serious concern of malnutrition among under five years old children in eastern part of Nepal. Multiple hierarchically interrelated determinants associated with child, mother and the social environmental factors were found significant in malnutrition among the children.