Browsing by Author "Sharma, PR"
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Publication Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal(Kathmandu University, 2010) Rijal, B; Tandukar, S; Adhikari, R; Tuladhar, NR; Sharma, PR; Pokharel, BM; Gami, FC; Shah, A; Sharma, A; Gauchan, P; Sherchand, JB; Burlakoti, T; Upreti, HC; Lalitha, MK; Thomas, K; Steinhoff, MAbstract Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal. Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal. Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed. Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F. Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal. Key words: Antimicrobial susceptibility, Streptococcus pneumoniae, Serotyping, NepalPublication Bacteriological study of upper respiratory tract infection in pediatric patients(Institute of Medicine, 2006) Shrestha, A; Sherchand, JB; Sharma, PR; Bhatta, DRAbstract Background: The study was conducted with aims to identify the causative bacterial agents of upper respiratory tract infection ( URTI ) among pediatric patients and to reveal the antibiotic susceptibility pattern of the major pathogen during November 2001 to October 2002. Methods: The throat swab samples from 192 children suspected of URTI were obtained from the outpatient department of Kanti Children’s Hospital and inoculated in the culture medium. The bacterial infection was confirmed only in 152 patients. The organisms isolated on medium were identified bytheir cultural, morphological and biochemical characteristics. Results: The infections were found to be due to S.pyogenes, S. aureus and S. pneumoniae. Most of the infections were due to S.pyogenes. The information obtained during sample collection showed that the high rate of infection was found to be in male patients, in infants and in urban children. Antibiotic susceptibility pattern for the isolated organisms revealed that Amoxycillin and Cephalexin, Erythromycin and Cephalexin were the most effective for S.pyogenes and S. aureus respectively whereas both Amoxycillin and Cephalexin were equally and the most effective for S. pneumoniae. The effective antibiotic for overall URTI was found to be Amoxycillin Conclusion: The study concluded that despite the existence of so many pathogens, and the susceptible antibiotics, Amoxycillin has been found to be the most effective against the pathogens causing URTI among pediatric population. Keywords: antibiotic, susceptible, resistant, acute respiratory infectionPublication Idiopathic lobular panniculitis (Weber Christian disease): A case report(Kathmandu University, 2006) Sharma, AK; Sharma, PRWeber Christian disease, an idiopathic relapsing febrile subcutaneous and visceral panniculitis is a rare disease in children. We report a case of Weber Christian disease for he first time from Kanti Children’s Hospital.Publication Ocular Manifestations of Meningitis in Children(Nepal Paediatric Society (JNPS), 2012) Chaudhary, M; Shah, DN; Sharma, PRAbstract: Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important.Publication Paediatric clinical teaching: comparison of two medical schools(Institute of Medicine, 2005) Sharma, PR; Bhattarai, P; Sharma, MAbstract Clinical paediatric teaching in undergraduate medical education is important to impart essential skills in communicating, diagnosing and formulating management plans for common childhood illness of the country so as to reduce existing high mortality and morbidity rates. Private medical colleges are facing challenges in paediatric teaching because of the unavailability of paediatric patients with different clinical signs; both the inpatient and outpatient paediatric attendance at their teaching hospitals is very discouraging at present. At the same time, they are plagued with inadequate investigative facilities. We conducted a study to evaluate some of the clinical skills in the students during their final examination. The study showed marked differences among students in some of the essential neonatal skills and other common paediatric problems. Statistically significant differences were found in the majority OSCE stations. The mean wrong answers in one medical school were 42.2% (Std D. 30.1 %) and the other school was 24.9% (Std. D 18.3 %). In one medical school the mean of signs that were rightly performed for the essential neonatal examination were 1.4% (Std. Dev. 1.1 %) and in other schools it was 10.4% (Std. Dev 6.1%). This shows that it is necessary to standardize pediatric teaching in the country’s medical schools.Publication Paediatric practice: an approach to a child with fever(Institute of Medicine, 2005) Sharma, PR; Bhattarai, P; Sharma, MAbstract Nearly seventy percent of all children between the ages of one week and two-years-of-age are brought to Kanti Children’s Hospital for some Type of febrile episode.And 50% of these visits are for temperatures greater than or equal to 39 degrees celsius. These children may have significant bacterial infection. In 35% of these childrenn there’s no definable source for the fever on clinical examination. So the child that don’t have identifiable sources could be either bacteremic, meningitis or could have a bone or joint infection in evolution. Simple clinical observation to differentiate a well looking infant from a toxic infant helps to differentiate children who needs admisson or out patient follow-up.Publication Publication The need of a Clinical Skills Learning Centre (CSLC) at Institute of Medicine(Institute of Medicine, 2005) Sharma, PRNA.