Browsing by Author "Singh, Rupa Rajbhandari"
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Publication Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis(Nepal Health Research Council, 2022) Siwakoti, Shraddha; Sah, Rinku; Singh, Rupa Rajbhandari; Khanal, BasudhaAbstract Background: Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. Methods: This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. Results: The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. Conclusions: The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed. Keywords: Bacteriological profile; incidence; MDR; neonatal sepsis; outcomePublication Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre(Nepal Paediatric Society (JNPS), 2014) Chaudhary, Shipra; Bhatta, Nisha Keshary; Khanal, Basudha; Bhandari, Rabin; Singh, Rupa RajbhandariAbstract: Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%. The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.Publication Nucleated Red Blood Cell in Cord Blood as a Marker of Perinatal Asphyxia(Nepal Paediatric Society (JNPS), 2015) Kanodia, Piush; Bhatta, Nisha Keshary; Singh, Rupa Rajbhandari; Shah, Gauri Shankar; Yadav, Shankar Prasad; Yadav, Sunil KumarAbstract: Introduction: Perinatal asphyxia is a common problem with the incidence varying from 0.5 –2% of live births. According to World Health Organization, approximately 4 million babies die each year before they reach the age of one month. The number of NRBC/100 WBC is variable but is rarely greater than 10 in normal neonates. This simple test can be helpful in the rapid assessment of perinatal asphyxia. Material and Methods: This prospective case-control study and there were 82 newborns in Case and 82 newborns in Controls comprising of asphyxiated and nonasphyxiated neonates, respectively, over a period of 12 months. Results: Out of the 82 neonates in case group, fifty nine (59) neonates were found to have NRBC level ≥10/100WBC, out of which 58 (70.7%) were cases and 1(1.2%) was a control. NRBCs count of ≥10/100WBC were seen more in the newborn who had low 5 min Apgar score and in the newborn with severe HIE, these association were statistically significant (P value <0.001). The cut-off NRBC value of ≥10/100WBC also found to have a sensitivity of 70.30% with a specificity of 98.78%. NRBC has a positive predictive value of 98.31% with a negative predictive value of 77.14%. Significance and sensitive area for ROC curve was 0.875. The ROC curve was calculated with cut-off NRBC value of ≥10/100WBC. Conclusions: NRBC counts can be very useful to differentiate HIE newborns from non-HIE newborns which will help in appropriate management and better outcome of these newborns.Publication Tuberculosis in Early Infancy: Rare in Today’s World(Nepal Paediatric Society (JNPS), 2018) Thakur, Jitendra; Rai, Rupa Rajbhandari; Singh, Rupa Rajbhandari; Ghosh, Sohini; Gyawali, PratyushAbstract: Tuberculosis in early infancy was not so common earlier also and has become rare these days. Since the disease is occasionally encountered, pediatricians should suspect tuberculosis in infants not responding to standard therapy. Here we report a case of three months old female who had presented with complaints of fever for two months, cough for one and half months and difficulty breathing for seven days and was being treated in line of bacterial pneumonia without improvement. She was found to be mycobacterium positive and was treated with anti-tubercular therapy leading to improvement and discharge. So, though rare, it is important to consider tuberculosis even in early infancy not responding to standard antibiotic therapy.