Browsing by Author "Shrestha, PN"
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Publication Acute Lymphoblastic Leukemia: Fourteen Years Experience of a Single Institution(Nepal Paediatric Society (JNPS), 2014) Sah, KP; Shrestha, PNAbstract: Introduction: Leukemia commonly known as blood cancer is the most common malignant neoplasm in childhood accounting for about 41 % of all malignancies that occur in children younger than 15 year of age. The objectives of this study were to find out the clinico-laboratory features and survival of children with acute lymphoblastic leukemia (ALL) during fourteen years in pediatric oncology unit of a tertiary care hospital. Materials and Methods: This was a retrospective study conducted at Kanti Children’s Hospital (KCH) from March 1998 to March 2012. Bone marrow aspiration showing ≥25 % blast cells was the criteria for diagnosis of ALL. Results: Out of 755 childhood cancers reported in this hospital during study period, total number of Acute leukemia patients were 375 (49.7%). Among acute leukemia, patients with ALL were 300, which was 80.0 % among all leukemias and 39.7% of all cases of cancers. Among cases of ALL, L1, L2 and L3 constituted 163 (54.3%), 131 (43.7%) and 6 (2%) respectively. The age of the children with acute leukemia ranged from six months to fourteen years, with a mean age of 7.3 years. The majority of children (61.7 %) with ALL fell into the age group of 2-9 years. Males: Female ratio was (M:F=1.3:1 ). The most common presenting features in ALL were fever (89.2 %), followed by splenomegaly (89.1%), hepatomegaly (69.2%) and lymphadenopathy (58.4 %). Among all patients, remission rate was 28.3% at ≥ 5 years, 17.7% were on maintenance, 30.3% abandoned treatment and 23.7 % died. Conclusion: This study showed that the patients on remission at ≥ 5 years in this centre were 28.3%.Publication Emperical Oral Antibiotic Therapy for Children with Low Risk Febrile Neutropenia during Cancer Chemotherapy(Nepal Paediatric Society (JNPS), 2009) Shrestha, PN; Sah, K; Rana, RAbstract: Introduction: In patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods: We conducted a prospective hospital based study to the patients who had fever and neutropenia during caner chemotherapy. Only low risk patients i.e. neutropenia of less than seven days, ANC >250/cmm, without any signs of shock were included in the study. All the patients were hospitalized and given oral antibiotics Ofloxacin and Amoxy-Clav and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results: A total of 54 cases were enrolled in the study. Out of 54 patients two patients were lost, 8 needed IV antibiotics for different reasons and 44 patients (81%) improved well with oral antibiotics only. Conclusion: In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics.Publication Guillain-Barré Syndrome in Nepalese Children(Institute of Medicine, 2008) Bhattarai, P; Shrestha, PNAbstract Background: Guillain-Barré Syndrome (GBS) is a group of autoimmune syndromes consisting ofdemyelinating and acute axonal degenerating forms of the disease. This study gives the profile of 30patients who were admitted with the diagnosis of GBS in a pediatric hospital. Methods and material: We reviewed the admitted case notes of children admitted with the diagnosisof GB syndrome from January 2005 to December 2007. The data were analyzed to find out thedemographic features, preceding illness, clinical features and CSF findings. Result: The age ranged from 3.6 years to 14 years. The mean (SD) age was 4.9 (9.7) years. The mostcommon symptoms were inability to walk after awaking in the morning.The median evolving time from the onset of illness to nadir was 12 days. The CSF protein concentrationranged from 60 to <100mg% and the CSF cell counts were less than 10/cmm in 23 patients and 11-19in 7 patients. Conclusion: We could not find any previous study done in such a large paediatric population of thiscountry. Our results show the similarity in pattern of age distribution, preceding events, and cellprotein dissociation similar to that of other studies. Keywords: Guillain-Barré Syndrome, diagnostic criteria, children, clinical profile, hospitalPublication Pleural Effusion in Children: How often do we suspect Tubercular origin?(Nepal Paediatric Society (JNPS), 2010) Shrestha, PN; Rayamajhi, AAbstract: Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs.Publication Wilm’s Tumor: Ten Year Experience at Kanti Children’s Hospital(Nepal Paediatric Society (JNPS), 2010) Sah, Kailash Prasad; Rai, Ganesh Kumar; Shrestha, PN; Shrestha, AmitAbstract: Introduction: Wilm's tumor is the second most common abdominal tumor in children. It arises from the kidney. The survival of children with Wilm's tumor has improved over the past 25 years. Objectives: To study the clinical presentation of Wilm’s tumor and evaluate the ten year survival. Materials and Methods: A retrospective hospital based study was conducted at Kanti Children's Hospital from March 1998 to February 2008. A total of 60 histopathologically diagnosed children below 14 yr of age were included in the study. Results: About 2/3rd (66.5%) presented with abdominal swelling followed by abdominal pain (16.5%) and fever (13.5%). A few children manifested with red colored urine (3.5%). The age of children ranged from one month to 13 years with the mean age of 36 months. Males were affected more than the females (M:F=3:1). Most affected age group was 2 to 5 yrs (41.5%) followed by 1 to 2 yrs (25.0%). Most of the cases were in stage III (36.5%) followed by stage II (33.5%). SIOP protocol was used to treat these children and overall 10 year survival rate was 50.0%. One fifth (20%) of the cases died, 16.5% relapsed and 13.5% lost to follow up. Conclusion: Despite severe resource limitations, paediatric oncology unit at Kanti Children’s Hospital has been successfully treating Wilm's tumor with the success rate of 50.0%.