Browsing by Author "Rai, Ganesh Kumar"
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Publication Bacteriological Analysis and Antibiotic Sensitivity Pattern of Blood Culture Isolates in Kanti Children Hospital(Nepal Paediatric Society (JNPS), 2010) Karki, Shubana; Rai, Ganesh Kumar; Manandhar, RekhaIntroduction: As antibiotic sensitivity pattern to common pathogen has been changing day by day, so it has been necessary to study about bacteriological analysis and antibiotic sensitivity pattern. Therefore, the purpose of this study was to analyze on data on bacteremia in children, the pathogen involved and sensitivity pattern. Objectives: The aim of this study was to determine the bacteriological profile and antibiotic sensitivity pattern of blood culture isolates from Kanti Children Hospital. Method: All blood culture reports (n=9856) during one year period (April 2007 to March 2008) included in the study were analyzed and the sensitivity pattern were recorded. In this retrospective study, we reviewed records of patients from Kanti Children Hospital from April 2007 to March 2008. Results: The positivity of blood culture was 4.2% (414/9856). Out of them, 269 (65%) were positive for Staphylococcus aures, 121(29.3%) E coli, 13(3.1%) Klebsiella pneumonia, 6(1.4%) Streptococcus pneumonia and 5(1.2%) Streptococcus viridence. Staphylococcus aureus was found most sensitive to Chloramphenicol (88.8%) followed by Amikacin (87.5%), Ofloxacin (76.5%), Ciprofloxacin (72%) and least sensitive to Ampicillin, Cloxacillin and Penicillin. E.coli was found most sensitive to Amikacin (74.7%) followed by Ofloxacin (69.9%), Ciprofloxacin (56.4%) and least sensitive to Cephalexin, Gentamycin and Ampicillin. Klebsiella pneumoniae was found most sensitive to Amikacin (91.7%) followed by Ofloxacin (87.5%), Chloramphenical (81.8%) and least sensitive to Cotrimoxazole and Gentamycin. It is 100% resistance to Ampicillin and Erythromycin. Streptococcus pneumoniae was most sensitive to Penicillin, Chloramphenical (100%) followed by Ampicillin and Erythromycin (83.3%) and least sensitive to Cotrimoxazole. Streptococcus viridence was most sensitive to Chloramphenical (100%) followed by Erythromycin (80%), Penicillin (75%) and least sensitive to Cotrimoxazole. Conclusion: This highlights the variable nature of antibiotic susceptibility patterns both in time and location around different geographical locations and within the same country as well. Therefore, it is advisable to continuously evaluate the sensitivity-resistance pattern of isolates so as to make a rational use of antibiotics.Publication Clinico-aetiological Profile of Congenital Hypothyroidism(Nepal Paediatric Society (JNPS), 2016) Karki, Subhana Thapa; Rai, Ganesh Kumar; Karki, Buddha Bdr; Gurung, RoshmaAbstract: Introduction: Thyroid hormone is critical for normal brain development in the early postnatal months. Biochemical diagnosis must be made soon after birth and effective treatment must be initiated promptly to prevent irreversible brain damage. Early diagnosis and adequate treatment from the first weeks of life result in normal linear growth and development. This study was conducted to find out the clinical features suggestive of congenital hypothyroidism and also its causation. Materials and Methods: This was a hospital based retrospective study of 40 congenital hypothyroid children conducted at endocrine unit of Kanti Children’s hospital from 2067 to 2072. All congenital hypothyroid children were reviewed in detail and frequency of signs/symptoms was calculated and also the possible causes were established using ultrasonography and scintigraphy. Results: Out of 40 congenital hypothyroid children 55% were male and 45% were female with M: F ratio of 1.23:1.Common age of presentation of congenital hypothyroidism was 6 to 12 months. The most frequent symptoms were decreased activity/ lethargy (78.9%) followed by stunted height (68.4%) and hypotonia (65.8%).Technetium thyroid scan was performed in 19 cases among which thyroid agenesis was the most common cause of congenital hypothyroidism (42.1%) followed by dyshormonogenesis (31.6%) and ectopic thyroid (26.3%). Conclusion: Early diagnosis of congenital hypothyroidism is possible in some children based on clinical features followed by biomedical investigation soon after birth.Publication Immunogenicity and Safety Profile of Typhoid Conjugate Vaccine (Vi-DT) Among Nepali Children(Nepal Health Research Council, 2025) Adhikari, Santosh; Rai, Ganesh Kumar; Chapagain, Ram Hari; Giri, Bishnu Rath; Joshi, Prakash; Shrestha, Nisha Jyoti; Manandhar, Bina Prajapati; Tamang, Suresh Man; Maharjan, Jessica; Thapaliya, Bibesh; Gupta, Birendra Prasad; Kim, Deok Ryun; Vemula, Sridhar; Sahastrabuddhe, Sushant; Saluja, TarunBackground: Typhoid fever remains a major concern in tropical countries. The availability of an effective vaccine could be an important inclusion to currently available interventions. We reported on our evaluation of the immunogenicity and safety of the typhoid conjugate vaccine (Vi-DT) among Nepali children. Methods: The study was an observer blinded, active controlled, randomized phase III clinical trial in children above 6 months and less than 18 years old. Three different lots of Vi-DT(Vi- Diptheria Toxoid); test vaccine and Vi-TT ( Vi-Tetanus Toxoid); comparator vaccines were administered to eligible children. Seroconversion was assessed with blood samples collected at baseline and 4 weeks after the vaccination. A rise of at least 4-fold vi-antibody titer from the baseline was used to indicate positive seroconversion. Data on solicited and unsolicited adverse events were collected. Results: Four hundred and eighty-eight children participated in the study. Seroconversion rate was 98.61% and 98.36% among participants who received Vi-DT and Vi-TT vaccines respectively. One immediate adverse event was observed only for Vi-DT group. One hundred forty-two and 66 solicited AEs within 7 days were observed with test and comparator vaccine respectively. Unsolicited AEs within 28 days were 125 for test vaccine compared and 77 for the comparator vaccine. Two SAEs were reported which were Not- related to study vaccine. Conclusions: The overall seroconversion in Vi DT vaccine was non inferior to the comparator vaccine and the safety profile of the vaccine was good without any life-threatening events. Keywords: Immunogenicity; Nepal; safety profile; typhoid conjugate vaccine; Vi-DTPublication Is Antimicrobial Resistance Pattern of Enteric Fever Changing in Kathmandu Valley?(Nepal Paediatric Society (JNPS), 2012) Rai, Ganesh Kumar; Karki, Subhana; Prajapati, BinaAbstract: Introduction: Enteric fever is a public health problem in developing countries including Nepal. Antimicrobial sensitivity pattern of Salmonella sp causing enteric fever is changing over time and also differs according to geographical location. Periodic surveillance of antimicrobial resistance of Salmonella sp is mandatory for management of enteric fever rationally. The objective of this study was to analyze the resistance pattern of Salmonella sp to commonly used antimicrobials. Materials and Methods: This was a retrospective study undertaken reviewing the records of blood isolates of Salmonella sp over one year period at Kanti Children’s Hospital, Nepal. Antimicrobial sensitivity testing was done following Kirby Bauer’s disk diffusion technique using Muller Hinton agar. Results: Salmonella typhi was found to be 100% resistance to ampicillin and resistance to nalidixic acid and ciprofloxacin was also high. The resistance to chloramphenicol and ofloxacin was low. No resistance was found to amoxicillin, ceftriaxone, cefotaxime and amikacin. However, among the sensitive isolates of Salmonella typhi intermediate sensitivity to ceftriaxone and ceftazidime was reported to be high. Among the isolates of S paratyphi A, the resistance to nalidixic acid was 100% followed by 75% to ciprofloxacin. No resistance was found to chloramphenicol, ceftriaxone, cefixime, amikacin and low resistance to amoxicillin and ofloxacin. Among the sensitive isolates of S paratyphi A, majority of them were only moderately sensitive to cefotaxime and ceftazidime and about 1/3 of the organisms had only intermediate sensitivity to ceftriaxone. Conclusiion: Commonly used parenteral third generation cephalosporins, first line drugs like chloramphenicol and amoxicillin and ofloxacin among fluoroquinolones were found to be effective in vitro in treating enteric fever. However, Salmonella typhi was found to be highly resistant to the most frequently used drugs like ciprofloxacin and cefixime and Salmonella paratyphi A to ciprofloxacin. A comparative chart of antimicrobial sensitivity of enteric fever in children over 10 year period from different hospitals of Kathmandu valley is also presented in the study.Publication Metachromatic Leucodystrophy: A Case Report(Nepal Paediatric Society (JNPS), 2011) Karki, Subhana; Rai, Ganesh Kumar; Kafle, RajuAbstract: Metachromatic leukodystrophy (MLD) is an autosomal recessive neurodegenerative disorder characterized by deficient activity of the enzyme arylsulfatase-A. Deficiency of this enzyme results in intralysosomal storage of sphingolipid cerebroside 3-sulfates (sulfatides), which are abundant in myelin and neurons. A pathological hallmark of MLD is demyelination and neurodegeneration, causing various and ultimately lethal neurological symptoms. Its frequency is estimated to be 1/40,000 live births. The disease encompasses three clinical subtypes: late infantile (40% of the patients with MLD), juvenile (40%), and adult (20%).Publication Wilm’s Tumor: Ten Year Experience at Kanti Children’s Hospital(Nepal Paediatric Society (JNPS), 2010) Sah, Kailash Prasad; Rai, Ganesh Kumar; Shrestha, PN; Shrestha, AmitAbstract: Introduction: Wilm's tumor is the second most common abdominal tumor in children. It arises from the kidney. The survival of children with Wilm's tumor has improved over the past 25 years. Objectives: To study the clinical presentation of Wilm’s tumor and evaluate the ten year survival. Materials and Methods: A retrospective hospital based study was conducted at Kanti Children's Hospital from March 1998 to February 2008. A total of 60 histopathologically diagnosed children below 14 yr of age were included in the study. Results: About 2/3rd (66.5%) presented with abdominal swelling followed by abdominal pain (16.5%) and fever (13.5%). A few children manifested with red colored urine (3.5%). The age of children ranged from one month to 13 years with the mean age of 36 months. Males were affected more than the females (M:F=3:1). Most affected age group was 2 to 5 yrs (41.5%) followed by 1 to 2 yrs (25.0%). Most of the cases were in stage III (36.5%) followed by stage II (33.5%). SIOP protocol was used to treat these children and overall 10 year survival rate was 50.0%. One fifth (20%) of the cases died, 16.5% relapsed and 13.5% lost to follow up. Conclusion: Despite severe resource limitations, paediatric oncology unit at Kanti Children’s Hospital has been successfully treating Wilm's tumor with the success rate of 50.0%.