Browsing by Author "Paudel, Prajwal"
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Publication Clinical Profile and Outcome of Mechanically Ventilated Neonates: Evidence from a Prospective Study(Perinatal Society of Nepal (PESON), 2023) Gupta, Neelam; Subedi, Kalpana; Vaidya, Swechhya; Karmacharya, Shailendra Bir; Paudel, Prajwal; Mishra, Megha; Tamrakar, Asia; Ligal, Grishma; Shrestha, Shuvechhcha; Thagunna, Sanjay Bikram; Sah, Pavan Kumar; Bhattarai, PratikshaAbstract: Introduction: Many sick neonates admitted to neonatal intensive care unit (NICU) require mechanical ventilation but it is associated with various complications and the outcome of neonates is unpredictable. This study aims to identify the indications for mechanical ventilation, complications, co-morbid conditions and outcome of those neonates in terms of survival. Materials and Methods: Retrospective observational study of all neonates who underwent mechanical ventilation from 1 January 2014 to 31 December 2014 in NICU, Tribhuvan University Teaching Hospital. Medical records of the patients were retrieved from hospital record section to collect the relevant data. Results: One-third of admitted neonates in NICU required mechanical ventilation (MV). Commonest indication was severe respiratory distress (70%) followed by perinatal asphyxia (12%) and recurrent apnea (8%). Disease pattern were sepsis (37.2%), RDS of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%) and congenital pneumonia (4%). Hospital acquired sepsis was a major complication occurring in 47% patients on mechanical ventilation. Survival rate among neonates on MV was 33%. Survival was better with increasing birth weight and gestational age. Survival was 100% in congenital pneumonia, 50% in perinatal asphyxia, 50% in recurrent apnea, 26% in sepsis, 20% in MAS and 0% in RDS of prematurity. Conclusion: Survival rate of neonates on mechanical ventilation in NICU was 33%. Sepsis was a major problem in NICU, which must be addressed to improve outcome. Keywords: Mechanical ventilation, RDS of prematurity, sepsisPublication Effect of COVID-19 Pandemic on Emergency Department Admissions and Outcome(Nepal Health Research Council, 2022) Tiwari, Jagannath; Paudel, Pramod; Adhikari, Sujan; Lamichhane, Sharmila; Basnet, Anjali; Subedi, Kirtipal; Bhattarai, Pratiksha; Paudel, PrajwalAbstract Background: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome. Methods: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020). Results: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively. Conclusions: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased. Keywords: Admission; Covid-19; emergency departmentPublication Effect of COVID-19 Pandemic on Emergency Department Admissions and Outcome(Nepal Health Research Council, 2022) Tiwari, Jagannath; Paudel, Pramod; Adhikari, Sujan; Lamichhane, Sharmila; Basnet, Anjali; Subedi, Kirtipal; Bhattarai, Pratiksha; Paudel, PrajwalAbstract Background: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome. Methods: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020). Results: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively. Conclusions: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased. Keywords: Admission; Covid-19; emergency departmentPublication Vitamin D Deficiency among Blood Transfusion-Dependent Beta Thalassemia Children Admitted to Tertiary Level Pediatric Hospital in Nepal: A Descriptive Cross-Sectional Study(Nepal Medical Association, 2024) Shrestha,Anil Kumar; Sherpa, Sangay Chultim; Gyawali, Bindu; Sharma, Manisha; Adhikari, Santosh; Shrestha, Suchitra; Bhattarai, Susan; Thapa, Sagar; Sharma, Devashish; Paudel, Prajwal; Gyawali, SushilAbstract Introduction: Children with beta thalassemia are on regular blood transfusions, which could result in iron deposition in the liver causing decreased synthesis of Vitamin D-25OH. There are limited publications on the association of Vitamin D deficiency with blood transfusion-dependent thalassemia in the Nepalese population. This study aims to determine the prevalence of Vitamin D deficiency among blood transfusion-dependent beta-thalassemia patients. Methods: This was a descriptive cross-sectional study conducted among beta-thalassemia major patients under 15 years of age, receiving regular blood transfusion, from July 17, 2022, to July 16, 2023, after attaining ethical approval from Ethical Review Committee, (reference number 155). Data were collected using convenience sampling, and descriptive analyses were performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) 2024. Results: A total of 127 blood transfusion-dependent beta-thalassemia major patients were included in the study, of whom 82 (64.56%) were female. Among these patients, 104 (81.88%) were aged between 5 and 14 year. Among 127, 41 (32.28%) had Vitamin D insufficiency, and 31 (24.40%) had Vitamin D deficiency. There were 12 (9.44%) underweight children. Conclusions: Vitamin D deficiency was seen in more than half of the children with blood transfusion dependent beta thalassemia major.