Browsing by Author "Shrestha, LP"
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Publication Bacterial profile of Early versus Late onset neonatal sepsis and its antimicrobial susceptibility: A 1-year retrospective study in a tertiary level teaching hospital of Nepal(Institute of Medicine, 2017) Gurung, B; Shrestha, LPAbstract Introduction: Neonatal mortality accounts for 46% of all under-five deaths globally. The Neonatal Mortality Rate in Nepal (21/1,000 live births) still exceeds the global average. Infection remains one of the leading causes. South-Asian studies report different spectrum of pathogens in neonatal sepsis compared to Western literature, with concerns for emerging antimicrobial resistance. Local epidemiological data and periodic surveillance provides guidance to formulate antibiotic policy. This study was conducted to evaluate the organisms of neonatal sepsis and antimicrobial sensitivity pattern in a hospital setting. Methods: A retrospective study was conducted in Neonatal Intensive Care Unit, Tribhuvan University Teaching Hospital from April, 2016 – April, 2017. All neonates treated as neonatal sepsis were screened. Only the cases with positive blood culture were enrolled. Results: Out of 172 neonates with Probable sepsis, 36% cases were “Culture-proven sepsis”. Majority were preterm (56.45%), Low Birth Weight (59.67%) and male (64.5%). Around 30% were outborn babies which probably contributed to high (75.8%) cases of Late-onset Neonatal Sepsis (LoNS). Besides Coagulase-Negative-Staphylococcus, antimicrobial-susceptible, Gram-negative organisms dominates Early-onset Neonatal Sepsis (EoNS). There were 53.19% Multidrug resistant (MDR) organisms in LoNS– Klebsiella followed by Pseudomonas, accounting for 64.7% deaths. Excluding Methicillin Resistant Staphylococcus aureus (MRSA), all LoNS associated MDR isolates were susceptible to Colistin. Majority (90%) Non-MDR isolates in LoNS were susceptible to Amikacin and Piperacillin-Tazobactum or Meropenem combination. All MRSA isolates were susceptible to Vancomycin or Teicoplanin. Conclusion: Late onset neonatal sepsis remains the major burden. MDR isolates increase the challenge of newborn care with limited antimicrobial options and high mortality. Keywords: Antimicrobial susceptibility, Bacterial profile, Neonatal sepsisPublication Clinico-epidemiological Profile of Children with Chronic Kidney Disease in Tertiary Care Referral Center in Nepal: Prospective observational study(Kathmandu University, 2022) Poudel, DR; Basnet, S; Shrestha, LPABSTRACT Background Chronic kidney disease in children has been increasing over the years and is associated with high degree of morbidity and mortality. The cost of treating children with chronic kidney disease is also substantial. Prevention of this disease is the only long term solution in our context. Till date, there is limited data on chronic kidney disease in Nepalese children. Objective To study the epidemiological, clinical and etiological profile of children with Chronic Kidney Disease from 2 to 16 years of age presenting for the first time in tertiary care hospital. Method This is the prospective observational study carried out at the tertiary care hospital over a period of 3 years. Children between 2-16 years who were first time diagnosed of chronic kidney disease and had estimated glomerular filtration rate < 60 ml/ min/1.73 m2 for last 3 months were enrolled. Result There were total of 124 patients, of whom 78 were male with male to female ratio of 5:3 with mean age of 11.8±2.2 years. Chronic glomerulonephritis (23%), reflux nephropathy (23%) and nephrolithiasis (16%) were the commonest etiological diagnosis. Rapidly progressive glomerulonephritis and systemic lupus erythematous accounted for 85% cases of chronic glomerulonephritis. Vesicoureteric reflux and posterior urethral valve accounted for 85% cases of reflux nephropathy. In 32%, the cause could not be determined. Swelling (45%) and dyspnea (20%) were the chief presenting complaints. Pallor were seen in all cases (100%) followed by hypertension in 68% and short stature in 64%. Majority (60%) of the patients with chronic kidney disease presented in the stage V. Conclusion Chronic glomerulonephritis and reflux nephropathy were the commonest etiologies of chronic kidney disease, majority of them following rapidly progressive glomerulonephritis, systemic lupus erythematosis, vesicoureteric reflux and posterior urethral valve. The commonest clinical features were swelling, dyspnea, pallor and hypertension. KEY WORDS Chronic kidney disease, Clinical profile, Epidemiological profile, ESRD, Etiology of CKD, Nepalese children