Browsing by Author "Mahaseth, C"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
Publication Accuracy of 7-8-9 Rule for Endotracheal Tube Placement in Nepalese Neonates(Nepal Paediatric Society (JNPS), 2011) Paudel, KP; Nepal, D; Mahaseth, CAbstract: Introduction: Neonatal intubation is done for cardiopulmonary resuscitation, hypoxemia, and hypercapnia, for surfactant therapy or for airway protection. When correctly placed, endotracheal tube (ETT) tip should be at mid tracheal position which is half way between the clavicles and the carina to prevent complications of ventilation. Objective: To assess the accuracy of 7-8-9 Rule in neonates at Kanti Children’s hospital. Methodology: Prospective observational study was conducted in neonates who required oral intubations from July 2009 to December 2009 at NICU of Kanti Children’s Hospital. The initial ETT depth of insertion was determined using admission weight in the 7-8-9 Rule calculation. This depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. Results: Mean gestation age of the 69 infants was 36.01 weeks (26 to 42 weeks) and weight was 2411 g( 900 g to 3800 g ). 7 (10.1%) neonates weighed 1000 g or less, 19 (27.5%) weighed between 1001 to 2000 g, 31 ( 44.9%) weighed between 2001 to 3000 g, 12(17.4%) weighed between 3001 to 4000 g. The accuracy of 7-8-9 rule in clinical setting with auscultation and Chest x-ray resulted in ETT depth 0.11 cm above midtracheal position. (-1.5 to 1.5 cm). Using this rule ET tube was placed 0.11 cm above the mid tracheal position. Conclusions: The 7-8-9 Rule appears to be an accurate clinical method for endotracheal tube placement in Nepalese neonates.Publication Latex Agglutination Test for Early Detection of Causative Organism in Acute Bacterial Meningitis(Nepal Paediatric Society (JNPS), 2013) Mishra, B; Mahaseth, C; Rayamajhi, AAbstract: Introduction: Acute bacterial meningitis is one of the leading causes of mortality and morbidity in children. Identification of the causative organism is crucial to its management and outcome. The objective of this study was to see the usefulness of latex agglutination test in the early diagnosis of acute bacterial meningitis. Materials and Methods: A hospital based prospective cross-sectional study was conducted at Kanti Children’s Hospital during December 2004 to August 2005. Cerebrospinal fluid from 150 consecutive clinically suspected cases of acute bacterial meningitis between the age group of 2 months to 14 years were analyzed. Bacterial culture and latex agglutination test was done on cerebrospinal fluid obtained from all 150 suspected cases of acute bacterial meningitis. Latex agglutination test was done using the BD DirectigenTM Meningitis Combo test kit (Becton, Dickinson and company, USA) for Streptococcus pneumoniae, group B Streptococcus, Escherichia coli, Neisseria meningitidis group A,C and Y/ W135, and Hemophilus influenzae type b. Data was analysed by using SPSS Version 11.5. Results: Of the 150 Cerebrospinal fluid samples analysed bacterial culture identified only 4 meningitis cases giving an isolation rate of 1.3% whereas latex agglutination test identified 29 cases giving an isolation rate of 19.3% from 150 samples. Streptococcus pneumoniae, Hemophilus influenzae type b and Group B Streptococcus were the most common causative organism. Conclusion: Latex agglutination test has a better yield, higher sensitivity, provides microbiological diagnosis earlier than the traditional cerebrospinal fluid culture and is easy to perform.Publication Molecular epidemiology of Rotavirus diarrhea among children in Nepal: Emergence of G12 and G9 strains(Institute of Medicine, 2013) Sherchand, JB; Tandukar, S; Sherchan, JB; Gurung, S; Dhakwa, JR; Bichha, RP; Mahaseth, CAbstract Introduction: Rotavirus is the leading cause of diarrhea and dehydration among infants in both developed and developing countries. The primary objective of this study was to find the magnitude of rotavirus disease burden and genotypic variations of rotavirus. Methodology: Questionnaires and stool samples were collected from 1003 enrolled children under 5 years of age attending tertiary care Children’s Hospital with acute watery diarrhea during January to December 2012. Rotavirus in stool samples was detected by Enzyme Immuno Assay (EIA) and strains detected from rotavirus positive samples were genotyped by Reverse-Transcription Polymerase Chain reaction (RT-PCR). Results: Among these, 356 (35.4%) cases were positive for rotavirus by EIA, among the positive cases, 344 samples underwent genotyping by RT-PCR. Rotavirus positive cases were predominant in children who were admitted to the hospital which was 37.8% (115 out of 336). Overall G12 was the most prevalent genotype (52.3%), followed by G1 (17.7%), G2 (10.17%) and G9 (8.1%). The P types identified were P[6] (55.23%), P[8] (20%), and P[4] (12.5%). Conclusion: The study reveals that rotavirus gastroenteritis accounted for more than one-third of all cases of acute diarrhea. Use of rotavirus vaccines may reduce of high burden of rotavirus diarrhea in children. Emergence of G12 and G9 strains proves the immediate need of vaccine in Nepal. Keywords: Molecular epidemiology, rotavirus, NepalPublication Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age(Nepal Paediatric Society (JNPS), 2011) Agrawal, K; Mahaseth, C; Rayamajhi, AAbstract: Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen.Publication Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis(Institute of Medicine, 2012) Shrestha, P N; Das, A; Rayamajhi, A; Mahaseth, CAbstract Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis. Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010. Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study. Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever. Keywords: dyspnea, endocarditis, rheumatic fever, rheumtic heart diseasePublication Spectrum of Biopsy Proven Glomerular Disease in Children at Kanti Children’s Hospital(Nepal Paediatric Society (JNPS), 2014) Khatun, N; Bista, KP; Mahaseth, CAbstract: Introduction: Glomerular disease is one of the most common forms of renal disease and can have many different clinical presentations. However there is variation in the prevalence in the type of glomerular disease according to geographical location and race of population. The aim of the study was to find the overall distribution pattern of glomerular disease based on renal biopsies. Material and Methods: The medical records of all children who underwent kidney biopsy (n=29) between January 2012-june 2014 were analyzed. In this retrospective study we review children from Kanti Children’s Hospital, Nephrology Department. Demographic data including age, sex and indication of kidney biopsy as well as complication of the procedures were recorded. Result: A total number of thirty one biopsies were done. Two children were excluded from the study due to inadequate tissue and artifacts defects in preservative. The remaining twenty nine biopsies were included in the study and analyzed. Renal disease was found nearly equal in both male and female (51.72% vs. 48.27%).Mean age was 10.95±3.30 years. Maximum number of biopsies (75.86%) was performed between 10- 15 years. The most common indication of the kidney biopsy was nephrotic syndrome (steroid resistant nephrotic syndrome and steroid dependent nephrotic syndrome, 31.02% followed by lupus nephritis 27.58%.The most common glomerular disease were focal segmental glomerulosclerosis and lupus nephritis both contribute 27.58%. Among lupus nephritis class III was found more common (44.44%) in children. IgA nephropathy was also contribute (17.24%) in all glomerular disease. Regarding the kidney biopsy complication gross hematuria was observed in 6.89% of children which was self-limited. Conclusion: FSGS and lupus nephritis is becoming the most common glomerular disease in children attending the Kanti Children Hospital. IgA nephropathy was also contribute the glomerular disease in the children.