Browsing by Author "Ghimire, Amrit"
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Publication Nepal Paediatric Society Guideline for use of Antibiotics in Critically ill Children in the Pediatric Intensive Care Unit(Nepal Paediatric Society (JNPS), 2021) Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Shrestha, Shrijana; Sharma, Yograj; Pathak, Santosh; Pokharel, Prakash Jyoti; Shrestha, Nipun; Pokhrel, Santosh; Dongol, Srijana; Raya, Ganendra Bhakta; Ghimire, Amrit; Koirala, Janak; Basnet, SangitaAbstract: Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care UnitPublication Practice Pattern Survey for Paediatric Asthma in Nepal (SPAN)(Nepalese Respiratory Society, 2024) Ghimire, Amrit; Mukhopadhyay, Aniruddha; Gaur, Vaibhav; Gogtay, JaideepAbstract: Background: In Nepal, asthma is one of the most prevalent diseases affecting children and is a leading contributor to childhood morbidity. Objectives: We evaluated the current perceptions and experiences of pediatricians in Nepal regarding the diagnosis and management of pediatric asthma. Methods: A questionnaire-supported, observation-based, cross-sectional survey was conducted digitally among paediatricians from Nepal who routinely manage patients ≤12 years of age with asthma. A total of 121 paediatricians from different practice settings participated in the survey. Results: Of patients who visit paediatricians, 31.6% were under 5 years and 26.6% were between 5 and 12 years of age. 90.08% of paediatricians found an increasing trend in asthma cases in the last 5 years in Nepal. 64.46% of paediatricians agreed that dust and dust mites were the most common triggers. Diagnosis based solely on history and physical examination was used by 54.54% of paediatricians. 49.59% of paediatricians prioritized getting back to the normal routine as the criterion for achieving asthma control. 43% of paediatricians prescribed oral bronchodilators, 31.4% oral steroids, 54.5% only short-acting beta2-agonist (SABA), 66.1% combination of inhaled corticosteroids and long-acting beta2-agonist (ICS/LABA), 96.7% ICS/SABA, 46% only ICS, and 66.1% nebulization therapy to their patients with asthma. Nine out of 10 paediatricians agreed that an average of 34.01% of their patients were on add-on montelukast with inhalation therapy. Pressurized metered dose inhaler (pMDI) + spacer + facemask with bronchodilators was suggested by 63.63% of paediatricians to manage asthma attacks at home. The average adherence to inhalation therapy was 47.02%. During the first interaction, most paediatricians spent at least 15 minutes educating patients/parents about the disease and its treatment. 67.77% of paediatricians or their paramedics checked patients’ inhalation techniques on every visit. Most paediatricians considered tear-off pads about asthma (46.3%) and videos on asthma for patients (31.4%) as the best tools that can increase patient awareness of asthma and inhalation therapy. Conclusion: Only half of the participating paediatricians in Nepal follow the Global Initiative for Asthma (GINA) strategy reports to diagnose and manage their patients with asthma. pMDI + spacer with or without a face mask was the most preferred device. Patient education and awareness were critical, and most paediatricians educated their patients regularly.