Browsing by Author "Shrestha, Ashish Lal"
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Publication Diaphragmatic Hernia in a Preterm with Congenital Heart Defects with Successful Outcome: A Case Report(Nepal Medical Association, 2022) Manandhar, Sunil Raja; Shrestha, Ashish Lal; Shrestha, Sabina; Basnet, RydamAbstract Congenital diaphragmatic hernia is an anatomical defect of the diaphragm that is often associated with serious cardiopulmonary complications. It can also be associated with many other problems like multi systemic anomalies, chromosomal aneuploidy and prematurity. Of these, cardiac defects, liver herniation and prematurity seem to have a pivotal role in affecting the outcomes of repair. We hereby present a preterm newborn with such multiple defects repaired on 15th day of life and post operatively managed in a Neonatal Intensive Care Unit with a successful outcome. The key learning objective for our team in this case was to identify the steps taken that led to a successful management of a low birth weight preemie with multiple defects in a resource limited set up.Publication Hyponatremia among Postoperative Children Administered with Hypotonic Fluids in a Tertiary Care Hospital: A Descriptive Cross-sectional Study Authors(Nepal Medical Association, 2021) Shrestha, Ashish Lal; Jehangir, Susan; Thomas, Reju JosephAbstract: Introduction: Hypotonic solutions in postoperative children may cause hyponatremia. Considering humidity and temperatures in India, this study was conducted to find out the prevalence of hyponatremia among postoperative children who were administered with hypotonic solutions in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital. Ethical approval was taken from the institutional review board of Christian Medical College, Vellore, India (Reference number: 9177). Children aged less than 15 years undergoing elective surgery, requiring fasting for more than 12 hours post-operatively with normal preoperative electrolytes and renal functions were included. Hypotonic fluids were administered following existent protocol. Electrolytes were repeated immediate postoperatively and at 12-24 hours. Data was entered into and analyzed using the Statistical Package for the Social Sciences version 18.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 109 participants, hyponatremia in the postoperative period was seen in 53 (48.6%) (40.7-56.5 at 90% Confidence Interval) children. Hyponatremia was found in the immediate postoperative period in 10 (9.2%) children. All received Ringer Lactate as maintenance intra-operatively and none were severe enough to need correction. In the 12–24-hour sample, 43 (39.41%) had hyponatremia and none in severe category. Conclusions: Asymptomatic hyponatremia was noted in normal children planned for elective surgery. Among children managed with the existing institutional perioperative (hypotonic) fluid management protocol, subclinical postoperative hyponatremia within 12-24 hours of surgery was noted in a significant proportion, which was more in the hot and warm months in tropics. There are grounds for switching to isotonic fluids for perioperative management.Publication Pentalogy of Fallot with Anorectal Malformation: A Case Report(Nepal Medical Association, 2024) Maharjan, Sunil Raja; Kafle, Pankaj; Shrestha, Ashish Lal; Rai, DipendraAbstract Pentalogy of Fallot is a rare form of congenital cyanotic heart disease with a prevalence of 3/10,000 live births characterized by an association of Tetralogy of Fallot with Atrial Septal Defect. Pentalogy of Fallot with anorectal malformation is also a rare combination. Here we describe one of the rare case reports of a full-term, 38 weeks, female baby diagnosed with pentalogy of Fallot with imperforate anus and rectovaginal fistula at a tertiary care hospital. Pentalogy of Fallot combined with an imperforate anus and rectovaginal fistula is an exceptionally rare and complex congenital condition. The co- existence of these anomalies emphasizes the need for thorough prenatal and postnatal evaluation for early detection and management.