Browsing by Author "Kafle, Prakash"
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Publication Pediatric Intensive Care Unit in a Developing Nation: Exploring Acute Neurological Illnesses and Their Clinical Course(Institute of Medicine, 2023) Khanal, Babita; Singh, Sandeep K; Mishra, Rajnish; Kafle, Prakash; Sharma, Mohan RABSTRACT Introduction: The burden of neurological illnesses is high in pediatric age group. Both primary neurological illnesses and neurological complication of systemic illness are commonly seen in pediatric intensive care unit (PICU). Neurological illness prolongs the length of PICU stay and also increases the mortality and morbidity.To assess the burden and describe the spectrum of acute neurological illness in a pediatric intensive care unit and analyze the early outcome. Methods: This was a prospective observational study conducted in Department of Pediatrics intensive care unit from January 2022 to December 2022. All children from 1 months to 16 years of age with neurological illness being admitted to PICU were included in the study. Basic demographic characters, diagnosis, treatment modalities and outcome were analyzed. Results: During study period, 237 (24.89%) were admitted to PICU with neurological illness. Mean age was 66 ± 42 months and 138 (58.22%) were male. Out of 237 children, 196 (82.70%) had primary neurological illness and 41 (17.30%) neurosurgical diagnosis. In primary neurological illness, 102 (52.10%) had primary CNS infection, followed by status epilepticus (21.52%), septic encephalopathy (11.70%), neuromuscular illness (8.16%), and metabolic encephalopathy (4.08%). In neurosurgical cases, 32 (78.04%) had Traumatic Brain Injury and 9 (22%) were shifted to PICU postoperatively. Mechanical ventilation was required in 156 (65.82%) and 88 (37.13%) required inotropic support. The mortality rate in neurological cases was 24 (10.12%) as compared to overall mortality rate of 6.8% in PICU. Conclusion: Neurological disorders are common in PICU and are associated with higher mortality rate. Primary central nervous system infection, severe traumatic brain injury and status epilepticus were common cause of PICU admission in our cohort. Keywords: Mortality; neurological illness; outcome; pediatric intensive care unitPublication Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors(Institute of Medicine, 2023) Kafle, Prakash; Rufus, Phelix; Paudyal, Nabin; Joshi, Narendra P; Khanal, Babita; Jonathan, Edmond; Bhandari, Binod R; Sharma, Mohan RABSTRACT Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes. Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed. Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes. Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery. Keywords: Brain tumor; preoperative KPS (Karnofsky performance status score); preoperative mRS (Modified Rankin scale score)