Browsing by Author "Shrestha, Anil Kumar"
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Publication A Rare Case of Crigler-Najjar Syndrome Type 2(Nepal Health Research Council, 2025) Shrestha, Anil Kumar; Sherpa, Sangay Chultim; Karki, Asmita; Agrawal, Sumit; Paudel, Deepak RajCrigler–Najjar Syndrome Type 2 (CNS2) is a rare autosomal recessive disorder characterized by unconjugated hyperbilirubinemia due to partial deficiency of the enzyme uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1). We present a case of a 13-month-old male admitted to Kanti Children’s Hospital with persistent jaundice since birth. Diagnostic evaluation accompanied by gene sequencing confirmed CNS2 and the patient was effectively managed with orally administered phenobarbitone. CNS2 can be distinguished from other potential causes of unconjugated hyperbilirubinemia based on bilirubin concentration and the affected patient’s response to phenobarbitone. Genetic counselling is essential for the recognition and prevention of severe hyperbilirubinemia which, in the absence of timely medical intervention, may lead to neurotoxicity. Keywords: Case report; crigler-Najjar syndrome; genetic counseling; phenobarbitone; unconjugated hyperbilirubinemia.Publication Assessment of Bacterial Profile and Antimicrobial Susceptibility Pattern of Bacterial Isolates from Blood Culture in Tertiary Level Paediatric Hospital of Nepal(Nepal Paediatric Society (JNPS), 2023) Shrestha, Anil Kumar; Sharma, Nisha; Bhattrai, Pratiksha; Pokhrel, Nayanum; Bajracharya, Sohani; Sah, Umesh Prasad; Paudel, PrajwalAbstract: Introduction: Bloodstream infection is a major cause of morbidity and mortality which requires antibiotic treatment. Antimicrobial resistance is an emerging serious public health threat in both developed and developing countries. Children are more susceptible to infections requiring an appropriate choice of antibiotic based on blood culture. This study aims to investigate the bacteriological profile and antibiotic sensitivity pattern of blood culture isolates and compare the yield of bacterial growth between Brain Heart Infusion Broth (BHIB) or BD BACTEC culture media. Methods: A total of 12,795 blood samples were sent for bacteriological culture either for BHIB or BACTEC techniques, 10994 and 1801 samples respectively. Chi-square test was used for showing association between BACTEC and BHIB among isolates. Results: The findings showed that the BACTEC method detected more positive isolates than the BHIB method. The rate of isolation was found highest among children under five years. The most common pathogens isolated were Staphylococcus species (28.1%), Staphylococcus aureus (25.6%), Acinetobacter species (12%), Pseudomonas species (8.2%), Klebsiella species (6.6%), CONS (4.4%), Escherichia coli (4.4%), Salmonella Typhi (3.5%), Enterobacter species (3.2%) and Streptococcus species (0.3%). Conclusions: Staphylococcus aureus was the commonest isolate identified in the current study. BACTEC culture method detected the higher percentage of isolates than BHIB method.Publication Bacteriological Profile and Antibiotic Sensitivity Pattern of Neonatal Sepsis in Central Paediatric Referral Hospital in Nepal(Nepal Paediatric Society (JNPS), 2019) Bhattarai, Susan; Chapagain, Ram Hari; Mishra, Deepak; Shrestha, Anil Kumar; Shrestha, Sushan ManAbstract: Introduction: Neonatal sepsis is the most common cause of neonatal morbidity and mortality. The causative organisms of neonatal sepsis are changing and so do their antibiotic sensitivity pattern. So it is important to regularly monitor the change in bacteriological profile and their antimicrobial sensitivity pattern to help update the treatment guidelines of neonates. This study aimed to study the microbiological patterns of neonatal sepsis and their antibiotic susceptibility pattern in a tertiary care centre in Kathmandu. Methods: A prospective study was carried out among cases of neonatal sepsis admitted in Neonatal Intermediate Care Unit (NIMCU) of a tertiary care referral hospital from August 2015 to August 2016. Prospective data were collected with pretested and standardised proforma and analysed using SPSS version 20. Results: Out of 311 neonates admitted over a period of one year with diagnosis of neonatal sepsis, male:female ratio was 2.1:1. Among them 234 (75.2%) cases were of LONS and 77 (24.8%) were of EONS. Blood culture was positive in 47 neonates (15.1%). The organisms isolated included staphylococcus aureus (34.0%), klebsiella (32%), CONS (24%), escherechia coli (6%) and enterobacter (4%). In LOS, gram positive organisms staphylococcus and CONS were the commonest ones (61.4%). In EOS, gram negative organism klebsiella (65%) was more common. Most of staph aureus were susceptible to penicillins, amikacin and cefotaxime. Klebsiella was found to be resistant to penicillins, amikacin and cefotaxime. Conclusion: There is possible increasing incidence of gram positive septicemia in LONS and increasing emergence of resistance of kleibsella to the common antibiotics ampicillin, amikacin and cefotaxime.Publication Morbidity and Mortality Pattern of Patients Admitted into Paediatric Intensive Care Unit of Tertiary Level Hospital of Nepal(Nepal Paediatric Society (JNPS), 2020) Shrestha, Anil Kumar; Bhattarai, Susan; Paudel, Prajwal; Basel, Prem LalAbstract: Introduction: The paediatric intensive care unit (PICU) takes care of critically ill paediatric patients. Regular evaluation of the outcomes of patients admitted to PICU is important to assess the effectiveness of various interventions. This study aimed to find the morbidity and mortality pattern of patients admitted to PICU of tertiary level Paediatric hospital of Nepal. Methods: We conducted a retrospective, cross sectional observational study using the records of all the patients admitted to PICU of a tertiary level hospital from January 2017 to August 2017. We collected data on age, sex, geographical distribution, duration of PICU stay and the morbidity and mortality outcomes. Outcome is classified as transfer to ward, leave against medical advice (LAMA) and death. Data were analysed descriptively using SPSS version 23. Results: Out of 358 patients admitted to PICU, the mean age was 1.83 years. Majority were infants (54.5%) with male:female ratio of 1.8:1. The major causes of PICU admission were respiratory disease (27.7%) followed by CNS disease (19.6%) and infections (17.3%). The average length of stay was 6.27 days. Overall mortality was 22.7%. Conclusion: Respiratory infections were the primary cause of PICU admission and overall mortality rate was high at 22.7%. However, mortality rate was even worse for patients with multi-system involvement. We need prospective studies to examine the underlying reasons for mortality among patients with multi-system involvement.Publication Sociodemographic and Clinical Profiles of Patients Admitted in Tertiary Level Pediatric Hospital of Nepal: An Observational Study(Nepal Medical Association, 2025) Shrestha, Anil Kumar; Adhikari, Santosh; Gyawali, Sushil; Basnet, Bal Mukunda; Maharjan, Sobi Lal; Karmacharya, Pujash; Paudel, Deepak RajAbstract Introduction: Child health is crucial in low and middle-income countries. Pediatric healthcare in tertiary-level hospitals addresses complex medical conditions. This study aimed to describe the sociodemographic and clinical profiles of pediatric patients admitted to Kanti Children’s Hospital in Nepal. Methods: An observational cross-section study was conducted including all the inpatients under 15 years of age. The data were collected from the hospital medical record section from July 17, 2023 to July 15, 2024, after the ethical approval from Institutional Review Review Committee, (Reference number 2168). The statistical analysis included descriptive statistics to assess demographic characteristics, case types, admission patterns, and outcomes using Microsoft Excel and Statistical Package for Social Sciences (SPSS) 2024. Results: A total of 9682 pediatric cases were included, of which 6389 (65.99%) of the patients were male, with 3305 (34.13%) being aged 1 to 5 years. Among the admitted patietns 2194 (22.66%) had respiratory cause and 1520 (15.70%) had infectious disease. Mortallity rate was 203 (2.09%) and it was 82 (12.06%) in pediatric intensive care unit and 48(10.62%) in neonatal intensive care unit. Conclusions: Respiratory and infectious diseases were the most common cause of admission in pediatric settings with a higher prevalence in younger children. The majority of cases were residing outside the capital city. This study highlighted higher mortality rates in critical care units.Publication Utilization and Effectiveness of Free Newborn Care Service Package in Inpatient Care of Sick Newborns –A Time For its Revision to Ensure Sustainability: Evidences From a Tertiary Level Public Hospital in Nepal(Nepal Paediatric Society (JNPS), 2021) Paudel, Prajwal; Subedi, Kalpana Upadhyaya; Karmacharya, Shailendra Bir; Shrestha, Sarita; Shrestha, Anil Kumar; Subedi, Pratikshya; Sah, Sunil Kumar; Mishra, Megha; Tamrakar, Asia; Khati, Nisha; Singh, Astha; Subedi, Kirtipal; Sunny, Avinash K; Mishra, Sangeeta KaushalAbstract: Introduction: Free Newborn Care (FNC) service has been implemented to address the financial barriers to access sick newborn care in Nepal. This study was designed to evaluate the effectiveness of FNC package in terms of its adequacy to support a facility financially and the factors to be considered for reimbursement schemes in the FNC guideline. Methods: This is a cross sectional retrospective study where 2907 newborns who received FNC service from 2019 Mar 15 to 2021 Jan 14 over 20 months were included. Descriptive statistics using frequency and percentages were used to describe the package received. Pearson’s Chi squared test was used to determine if the various factors receiving different newborn packages were statistically significant or not. Results: Amount reimbursed by FNC package for 20 months fell short by NRs 1355541. Majority of preterm (58%), LBW (52.3%) and MAS (55.3%) received package C. Babies who received package C with single morbidity was 576 (37.3%) with two to three morbidities was 380 (48.7%) and with more than three morbidities was 301 (70.2%). Those newborns who stayed for four to seven days, majority 654 (53.4%) received package B, whereas those who stayed for eight to 14 days, 15 - 21 days and > 21 days, the majority 490 (38.4%), 66 (5.2%), 32 (2.5%) received package C respectively. There was an association between receiving package C mortality among cases (P < 0.001). Conclusions: Inpatient quality newborn care can save lives of many vulnerable newborns. FNC service has provided opportune context in care of sick newborns with promising results. However, revising the reimbursing schemes by focusing on length of stay, mortality and disease severity can better strengthen sick newborn care.