Browsing by Author "Joshi, Prakash"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Publication Application of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes(Nepal Health Research Council, 2023) Joshi, Prakash; Agrawal, Sumit; Ghimire, Jagat Jeevan; Shrestha, Pun Narayan; Najala Khatun,; Banjara, Megha RajAbstract Background: Children admitted in a pediatric intensive care unit have a high risk of mortality. Pediatric risk of mortality III score in first 24 hours of admission has increasingly been used to predict mortality. The objective of this study was to evaluate the validity of Pediatric risk of mortality score in prediction of mortality among the patient admitted in pediatric intensive care unit. Methods: This prospective observational study was conducted at pediatric intensive care unit of a government pediatric hospital from January to June 2021. Patients between 1 month to 14 years of age and meeting the inclusion criteria were enrolled. Pediatric risk of mortality III score was calculated within 24 hours of admission. Patients were followed up for outcome measure as survivors and non survivors. Chi square test and logistic regression analysis were used to find the association of predictors and the score. Results: The mean Pediatric risk of mortality III score was lower in survivors than in non-survivors (4.67 ± 3.8 versus 14.10 ± 6.07; p<0.001). Those requiring inotropic and ventilator support have significantly higher mortality [49.4 versus 0.6 (p<0.001) and 81.8 versus 1.5 (p<0.001) respectively]. Minimum systolic blood pressure, abnormal pupillary reflex, increased blood urea nitrogen and decreased platelet were the significant (p<0.001) risk factors. The area under the Receiver Operating Characteristic curve was 0.916±0.024 (p<0.001) and goodness-of-fit test showed no significant difference between observed and expected mortalities (p=0.186). Conclusions: The Pediatric risk of mortality score constitutes a useful prognostic tool in predicting the mortality. Key words: Mortality; pediatrics; pediatric intensive care unit; risk score,Publication Chronic Diarrhoea: A Rare Presentation Of Vitamin B12 Deficiency Anemia In Children(Nepal Paediatric Society (JNPS), 2021) Shrestha, Pun Narayan; Khanal, Bipin; Joshi, PrakashAbstract Vitamin B12 deficiency in children often under reported and usually presents with nonspecific manifestations like neuropsychiatric symptoms, anaemia, glossitis and chronic diarrhoea. Vegetarianism, minimal intake of animal products, poverty and malnutrition may lead to vitamin B12 deficiency. Laboratory reports often show pancytopenia, megaloblasts in bone marrow and low serum cynocobalamine. Injectable vitamin B12 is the treatment of choice. We would like to highlight this case report in view of vitamin B12 deficiency presenting as diarrhoea.Publication 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, TarunBackground: 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-DTPublication Study of Morbidity and Mortality Pattern of Children Admitted in Paediatric Intensive Care Unit of Tertiary Care Children’s Hospital(Nepal Paediatric Society (JNPS), 2020) Joshi, Prakash; Agrawal, Sumit; Sah, Umesh PrasadAbstract: Introduction: Intensive care is predominantly concerned with the management of patients with acute life threatening conditions in a specialised unit. The objective of this study was to describe the morbidity and mortality patterns as well as outcome of patients admitted in the Paediatric Intensive Care Unit (PICU) of a tertiary care government paediatric hospital in Nepal. Methods: A cross-sectional study of 652 children admitted to the PICU of Kanti Children’s Hospital was undertaken from 1st January 2018 to 31st December 2018. The data were retrieved retrospectively from the record files of PICU regarding patient’s age, sex, inhabitant, admitting and final diagnosis, length of stay in the ICU and final outcome. Data were entered into MS Excel and analysed using Pearson’s Chi Square Test. Results: Among 652 admitted children between 1 month to 14 years of age, 397 (61%) were males and 255 (39%) females with male to female ratio 1.55:1. Majority 352 (54%) of them were in the age group of one month to 12 months of age. Pneumonia (216, 33.1%) was the major disease seen followed by septicemia (123, 18.9%), bronchiolitis (44, 6.7%), Other infectious diseases (38, 5.8%) and so on. Out of total admission, 484 (74.23%) cases improved, 46 (7.05%) left against medical advice (LAMA) and 120 cases died with mortality rate of 18.46%. More than half of the deaths (n = 87/120, 72.5%) were due to infections (Septicemia, acute gastroenteritis, pneumonia and meningitis and other infectious diseases). Conclusions: Pneumonia with respiratory distress was the major cause of PICU admission while fatality was highest for acute leukemia. Therefore it seems justifiable to improve primary and secondary health care facilities for timely and reliable delivery of current standardised therapeutic practice as well as to increase ICU facilities in those areas.