Browsing by Author "Shrestha, M"
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Publication A Case of Precocious Puberty in a Setting with Limited Resources(Kathmandu University, 2011) Paudel, KP; Giri, S; Shrestha, PS; Shrestha, L; Thapa, SB; Shrestha, MABSTRACT Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma. KEY WORDS hypothalamic hamartoma, precociuos pubertyPublication An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis(Kathmandu University, 2010) Sharma, P; Neupane, S; Shrestha, M; Dwivedi, R; Paudel, KAbstract Background: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. Objective: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. Materials and methods: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. Result: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in five of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in five cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. Conclusion: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis. Key words: Muscular and soft tissue cysticercosis, ultrasound.Publication Bacterial Isolates and its Antibiotic Susceptibility Pattern in NICU(Kathmandu university, 2013) Shrestha, S; Shrestha, NC; Dongol Singh, S; Shrestha, RPB; Kayestha, S; Shrestha, M; Thakur, NKABSTRACT Background Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world. Objectives To determine the common bacterial isolates causing sepsis in neonatal intensive care unit and its antibiotic susceptibility pattern. Methods A one year discriptive prospective study was conducted in neonatal intensive care unit to analyse the results of blood culture and to look into the sensitivity of the commonly used antibiotics. Results The blood culture yield by conventional method was 44.13% with nosocomial sepsis accounting for 10.79%. 84.08% were culture proven early onset sepsis and 15.95% were late onset sepsis. Klebsiella infection was the commonest organism isolated in early, late and nosocomial sepsis but statistically not significant. Gram positive organisms were 39.36% in which Staphylococcus aureus was the leading microorganism followed by coagulase negative staphylococcus areus. Gram negative organisms were 60.64% amongst them Klebsiella was the most often encountered followed by Pseudomonas. The most common organism Klebsiella was 87.5% and 78.3% resistance to ampicillin and gentamycin respectively. Among gram negative isolates 87.5% and 77.2% were resistance to ampicillin and gentamycin respectively. Among gram positive isolates 58.5% and 31.5% resistance were noted to ampicillin and gentamycin respectively. Resistance to cefotaxim to gram negative and gram positive isolates were 87.34% and 59.35% respectively. Conclusion Klebsiella is most common organism which is almost resistance to first line antibiotics. Resistance to both gram negative and gram positive isolates among firstline antibiotics and even with cefotaxim is emerging and is a major concern in neonatal intensive care unit. KEY WORDS Antibiotic susceptibility, bacterial isolates, neonatesPublication Difficult Journey from Delivery to Discharge, Case of Congenital Diaphragmatic Hernia(Kathmandu University, 2014) Karmacharya, RM; Dangol, S; Shrestha, M; Koju, RABSTRACT We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient. KEY WORDS Bochdalek, congenital diaphragmatic hernia, hemithoraxPublication Morbidity pattern of children with asthma: A prospective study(Kathmandu University, 2006) Manandhar, K; Bajracharya, BL; Dhakal, S; Shrestha, MObjectives: To determine the morbidity pattern of asthma in children attending the paediatric asthma follow-up clinic. Materials and methods: Longitudinal prospective follow up of hundred and four patients, diagnosed as asthma, over a period of 2 years was done. Regular follow up by the same person during each visit and proper supervision of standard treatment along with parental education regarding the asthma, was done. Results: The mean age of children presenting with asthma was 6.7 years. Majority of children 49 (47.5%) were graded as mild persistent asthma. Fifty nine (56.7%) children were missing school more than 7 days per month. Family history was present in forty one percent of the children. Fifty seven (54.8%) children were taking significant amount of junk food and were undernourished. Significant reduction in school-missing days and Emergency Room visits was noted in these children during the follow up period. Conclusion: Awareness of disease is an important aspect of asthma management. Proper treatment and follow up with emotional support and education of the care taker, about the asthma, can reduce the morbidity pattern of asthma in children. Key words: Prospective study, longitudinal study, AsthmaPublication Occurrence of soil-transmitted helminths in women at the Himalayan region of Nepal(Kathmandu University, 2006) Kunwar, CB; Chapagain, RH; Subba, B; Shrestha, M; Jha, B; Subedi, J; Blangero, J; Williams-Blangero, S; Towne, BObjective: to find the occurrence pattern and prevalence of the soil transmitted helminths in women of child bearing age group. Methods and Materials: The study was conducted in Jiri , an area of Dolakha district at the altitude of 2100 meter from sea level. The faecal sample of 478 women of childbearing age (15 to 45 years) were taken randomly and examined for the ova of soil transmitted helianthus. Result: The occurrence pattern was 53.0%, 20.0% and 2.7% for Hookworms, Ascaries lumbricoids and Trichuris Trichuria respectively. Both Ascaries and Hookworm prevalence rates noticeably increased with increasing age, with the highest infection rate between the age of 36 - 45 years while trichuris infection reached the highest in women of 15-25 years of age. Conclusion: There is a high prevalence of hookworm and ascaries in women of childbearing age and necessary intervention is needed according to WHO guidelines. Key words: soil-transmitted helminth, stool sample, women, himalayanPublication Quality of care provided to newborns by nursing personnel at BP Koirala Institute of Health Sciences(Kathmandu University, 2009) Shrestha, M; Singh, R; Upreti, DAbstract Background: Birth is a major challenge for the newborn to negotiate successfully from intrauterine to extra uterine life. The first few hours since birth is the most crucial period in the life of an infant for further growth and development, which is largely determined by the quality of care that the newborn receives. Objective: The aim of this study is to assess the quality of care provided by nursing personnel to newborn in the labour room. Materials and methods: This study was conducted in BP Koirala Institute of Health Science. Cross sectional, non participatory observational research design was adopted for the study. Care provided by nursing personnel to 814 normal newborns was observed. Samples were chosen by non probability purposive sampling technique. Data was collected through observational method by trained nursing personnel, using 46 items pre-tested, validated and self developed observational checklist. Care provided to newborns was observed from birth to two hours and categorised as good, average and poor based on scores obtained. Data was entered and analysed using SPSS-10. Descriptive statistics- [Mean, percentage, frequencies and standard deviation] was used to describe the quality of care provided to the newborn babies. Results: Overall quality of care was good in 42.36%, average in 57.64% and none of them received poor care. Overall mean score for quality of care was 34.75/46 (75.54 %). Regarding subscales quality of care was good in majority of newborns in areas such as Preparation to receive the baby (76.1%), Initiation of breathing (100%), Maintaining thermoregulation (77.3%), Physical assessment (90.9%), and other aspects of care (95.2%). However the quality of care was poor in majority of newborns in establishment of breast feeding (58.23%) and average in prevention of infection (76.9%). Conclusion: Study findings highlight the need for focus in establishment of breast feeding and prevention of infection. Key words: Quality of care, newborns, nursing personnel, breast feeding, prevention of infection and assessment of newborn.Publication Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital(Kathmandu University, 2006) Shrestha, M; Manandhar, DS; Dhakal, S; Nepal, NIntroduction: Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. Aims and objectives: This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth’s classification and comparison made with earlier similar study. Results: Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth’s classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V. Discussion: The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths. Conclusion: Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND)