Browsing by Author "Neopane, AK"
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Publication Isolation and Intensive Care (ICU) Service, Surge Capacity and Pandemic Training in Government Designated COVID-19 Clinics and Hospitals of Nepal(Kathmandu University, 2022) Bhattarai, S; Neopane, AK; Shrestha, B; Dangol, SR; Shrestha, SKD; Dutta, A; Adhikari, G; Dahal, SABSTRACT Background The coronavirus pandemic preparedness and response activities began in Nepal after the detection of the first case on 24 January 2020. Highest daily case record in June 2020 was 671, but it reached above 5,000 in October 2020. Objective This study assessed preparedness and response status of government designated COVID-19 clinics and various level hospitals. Method A web-based survey was conducted among government designated COVID-19 clinics and Level hospitals in June 2020. The Medical Operations Division of the COVID-19 Crisis Management Center (CCMC) retained contact list of focal person in each facility for regular updates. Forty-nine out of 125 clinics and all level hospitals (five Level-1, 12 Level-2, three Level-3) provided responses. Result There were 25 or less isolation beds in the majority of COVID-19 clinics (83.7%) and Level-1 hospitals (60%), whereas the majority of Level-2 (92%) and Level-3 hospitals (67%) had arranged >25 beds. Only five clinics, one Level-1 hospital, six Level-2 and two Level-3 hospitals had a surge capacity of additional 20 or more isolation beds. Only one-fourth of the designated health facilities had arranged separate isolation facility for vulnerable population. Majority of the designated clinics and Level-1 hospitals had five or less functional ICU beds and functional ventilators. Very few Level-2 hospitals had > 10 ICU beds and > 10 ventilators. Healthcare workers in the majority of facilities were trained on donning/doffing, hand washing, swab collection, and healthcare waste management, but, a very few received formal training on patient transport, dead body management, epidemic drill, and critical care. Conclusion This study revealed insufficient preparation in COVID-19 facilities during the initial phase of pandemic. The findings were utilized by the government stakeholders at central, provincial and local levels for scaling up surge capacity and improving health services at the time of case surge. As the pandemic itself is a dynamic process, periodic assessments are needed to gauze preparedness and response during different phases of disease outbreak. KEY WORDS COVID-19, Crisis Management Center (CCMC), Outbreak, PandemicPublication Salmonella Typhi Infections and Effect of Fluroquinolones and Third Generation Cephalosporins in Clinical Outcome(Nepal Paediatric Society (JNPS), 2011) Singh, UK; Neopane, AK; Thapa, M; Aryal, N; Agrawal, KAbstract Background: Enteric fever is a common public health problem in Nepal. The emerging fluoroquinolone resistance to Salmonella typhi is a major concern in every hospital and is a public health problem these days. Continuous antibiotic susceptibility patterns surveillance and standard treatment policies need to be established to control MDR typhoid. Objective: To detect the increasing pattern of fluoroquinolone resistant Salmonella typhi and to correlate its clinical response to third generation cephalosporins. Materials and Method: This is a cross- sectional prospective study conducted in the pediatric ward of Birendra Hospital, Kathmandu, from September 2009 to August 2010. Forty seven children aged between 3-14 years with the diagnosis of suspected, probable and confirmed cases of Enteric fever were enrolled in the study. Data was collected and statistical analysis was done using SPSS program. Result: Culture positive enteric fever was found in 21 cases (44.68%) and positive Widal test in 18 (38.29%). Among the culture positive cases, antibiotic sensitivity was highest for Ofloxacin (95.23%), followed by third generation Cephalosporins (Ceftriaxone, Cefixime) (90.47%). A significant number of isolates were resistant to Nalidixic acid (71.42%). All cases were successfully treated with parenteral antibiotics followed by oral third generation cephalosporins without any complications and/or mortality. Conclusion: There is an increasing trend to fluoroquinolone resistant Salmonella typhi. Third generation cephalosporin can be the appropriate antibiotic for treatment.of clinically suspected cases of Enteric fever and to minimize the risk of increasing emergence of MDR enteric fever including Nalidixic acid resistant Typhoid.(NARST).