Browsing by Author "Malla, Kalpana Karmacharya"
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Publication Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome(Nepal Health Research Council, 2023) Bhandari, Isha; Malla, Kalpana Karmacharya; Chaudhary, Brajesh Raj; Ghimire, PukarAbstract Background: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome. Methods: This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied. Results: Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them. Conclusions: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios. Keywords: Meconium; meconium aspiration syndrome; newbornPublication Scrub Typhus among Febrile Children in a Tertiary Care Center of Central Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Bhandari, Isha; Malla, Kalpana Karmacharya; Ghimire, Pukar; Bhandari, BibekAbstract: Introduction: Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi, obligate intracellular bacteria, transmitted by chigger mites. Scrub typhus is an emerging febrile illness with clinical suspicion being the only key to diagnosis. This study was conducted to find out the prevalence of Scrub typhus among febrile children in a tertiary care center of central Nepal. Methods: A descriptive cross-sectional study was conducted from January 2018 to December 2019 in the pediatric inpatients of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee of Institute (Reference number 2020-105). Convenient sampling method was used. Data was analyzed using Statistical Packages for the Social Science version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 1024 febrile patients, prevalence of scrub typhus among febrile children was 55 (5.37%) (3.66-7.08 at 90% Confidence Interval). Of 55 patients, mean age was 9.2 years with 52 (94.6%) of cases diagnosed between July to November. Among 55 patients, other symptoms were vomiting 33 (60%), headache 22 (40%), abdominal pain 19 (34.5%), cough 15 (27.3%), nausea (25.5%), seizure 11 (20 %), and dyspnea 6 (10.9%). Major clinical signs was lymphadenopathy 29 (52.7%). Major complication noted was meningitis 11 (20%). Conclusions: The prevalence of scrub typhus is considerably high during July to November so it should be considered as a differential diagnosis of fever particularly in this period.Publication Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2020) Chaudhary, Brajesh Raj; Malla, Kalpana Karmacharya; Poudel, Sajan; Jha, Brajesh KumarAbstract: Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. Methods: A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Results: Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Conclusions: Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.Publication Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Pokhrel, Ram Prasad; Bhurtel, Radha; Malla, Kalpana Karmacharya; Shah, Love KumarAbstract: Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.Publication Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Pokhrel, Ram Prasad; Bhurtel, Radha; Malla, Kalpana Karmacharya; Shah, Love KumarAbstract: Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.