PubMed | Centers for Disease Control and Prevention, University of Liverpool, BP Koirala Institute of Health science, Kanti Childrens Hospital and 3 more.
Type: Clinical Trial | Journal: PloS one | Year: 2015
Japanese encephalitis (JE) virus (JEV) is a mosquito-borne flavivirus found across Asia that is closely related to West Nile virus. There is no known antiviral treatment for any flavivirus. Results from in vitro studies and animal models suggest intravenous immunoglobulin (IVIG) containing virus-specific neutralizing antibody may be effective in improving outcome in viral encephalitis. IVIGs anti-inflammatory properties may also be beneficial.We performed a pilot feasibility randomized double-blind placebo-controlled trial of IVIG containing anti-JEV neutralizing antibody (ImmunoRel, 400mg/kg/day for 5 days) in children with suspected JE at two sites in Nepal; we also examined the effect on serum neutralizing antibody titre and cytokine profiles. 22 children were recruited, 13 of whom had confirmed JE; 11 received IVIG and 11 placebo, with no protocol violations. One child (IVIG group) died during treatment and two (placebo) subsequently following hospital discharge. Overall, there was no difference in outcome between treatment groups at discharge or follow up. Passive transfer of anti-JEV antibody was seen in JEV negative children. JEV positive children treated with IVIG had JEV-specific neutralizing antibody titres approximately 16 times higher than those treated with placebo (p=0.2), which was more than could be explained by passive transfer alone. IL-4 and IL-6 were higher in the IVIG group.A trial of IVIG for JE in Nepal is feasible. IVIG may augment the development of neutralizing antibodies in JEV positive patients. IVIG appears an appealing option for JE treatment that warrants further study.ClinicalTrials.gov NCT01856205.
Upreti S.R.,Child Health Division |
Janusz K.B.,Centers for Disease Control and Prevention |
Schluter W.W.,World Health Organization |
Bichha R.P.,Kanti Childrens Hospital |
And 8 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2013
Wider availability of the live, attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine has facilitated introduction or expansion of immunization programs in many countries. However, information on their impact is limited. In 2006, Nepal launched a JE immunization program, and by 2009, mass campaigns had been implemented in 23 districts. To describe the impact, we analyzed surveillance data from 2004 to 2009 on laboratory-confirmed JE and clinical acute encephalitis syndrome (AES) cases. The post-campaign JE incidence rate of 1.3 per 100,000 population was 72% lower than expected if no campaigns had occurred, and an estimated 891 JE cases were prevented. In addition, AES incidence was 58% lower, with an estimated 2,787 AES cases prevented, suggesting that three times as many disease cases may have been prevented than indicated by the laboratory-confirmed JE cases alone. These results provide useful information on preventable JE disease burden and the potential value of JE immunization programs. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.
Basnet S.,Tribhuvan University |
Shrestha P.S.,Tribhuvan University |
Sharma A.,Tribhuvan University |
Mathisen M.,University of Bergen |
And 9 more authors.
Pediatrics | Year: 2012
BACKGROUND AND OBJECTIVE: Diarrhea and pneumonia are the leading causes of illness and death in children <5 years of age. Zinc supplementation is effective for treatment of acute diarrhea and can prevent pneumonia. In this trial, we measured the efficacy of zinc when given to children hospitalized and treated with antibiotics for severe pneumonia. METHODS: We enrolled 610 children aged 2 to 35 months who presented with severe pneumonia defined by the World Health Organization as cough and/or difficult breathing combined with lower chest indrawing. All children received standard antibiotic treatment and were randomized to receive zinc (10 mg in 2- to 11-month-olds and 20 mg in older children) or placebo daily for up to 14 days. The primary outcome was time to cessation of severe pneumonia. RESULTS: Zinc recipients recovered marginally faster, but this difference was not statistically significant (hazard ratio = 1.10, 95% CI 0.94-1.30). Similarly, the risk of treatment failure was slightly but not significantly lower in those who received zinc (risk ratio = 0.88 95% CI 0.71-1.10). CONCLUSIONS: Adjunct treatment with zinc reduced the time to cessation of severe pneumonia and the risk of treatment failure only marginally, if at all, in hospitalized children. Copyright © 2012 by the American Academy of Pediatrics.
Karki S.,Kanti Childrens Hospital |
Rai G.K.,Kanti Childrens Hospital |
Manandhar R.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2010
Introduction: As antibiotic sensitivity pattern to common pathogen has been changing day by day, so it has been necessary to study about bacteriological analysis and antibiotic sensitivity pattern. Therefore, the purpose of this study was to analyze on data on bacteremia in children, the pathogen involved and sensitivity pattern. Objectives: The aim of this study was to determine the bacteriological profile and antibiotic sensitivity pattern of blood culture isolates from Kanti Children Hospital. Method: All blood culture reports (n=9856) during one year period (April 2007 to March 2008) included in the study were analyzed and the sensitivity pattern were recorded. In this retrospective study, we reviewed records of patients from Kanti Children Hospital from April 2007 to March 2008. Results: The positivity of blood culture was 4.2% (414/9856). Out of them, 269 (65%) were positive for Staphylococcus aures, 121(29.3%) E coli, 13(3.1%) Klebsiella pneumonia, 6(1.4%) Streptococcus pneumonia and 5(1.2%) Streptococcus viridence. Staphylococcus aureus was found most sensitive to Chloramphenicol (88.8%) followed by Amikacin (87.5%), Ofloxacin (76.5%), Ciprofloxacin (72%) and least sensitive to Ampicillin, Cloxacillin and Penicillin. E.coli was found most sensitive to Amikacin (74.7%) followed by Ofloxacin (69.9%), Ciprofloxacin (56.4%) and least sensitive to Cephalexin, Gentamycin and Ampicillin. Klebsiella pneumoniae was found most sensitive to Amikacin (91.7%) followed by Ofloxacin (87.5%), Chloramphenical (81.8%) and least sensitive to Cotrimoxazole and Gentamycin. It is 100% resistance to Ampicillin and Erythromycin. Streptococcus pneumoniae was most sensitive to Penicillin, Chloramphenical (100%) followed by Ampicillin and Erythromycin (83.3%) and least sensitive to Cotrimoxazole. Streptococcus viridence was most sensitive to Chloramphenical (100%) followed by Erythromycin (80%), Penicillin (75%) and least sensitive to Cotrimoxazole. Conclusion: This highlights the variable nature of antibiotic susceptibility patterns both in time and location around different geographical locations and within the same country as well. Therefore, it is advisable to continuously evaluate the sensitivity-resistance pattern of isolates so as to make a rational use of antibiotics.
Sah K.P.,Kanti Childrens Hospital |
Shrestha P.N.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2014
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%.
Joshi B.B.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2013
Introduction: Recurrent abdominal pain (RAP) is one of the most common gastrointestinal complaints during childhood and most frequent presentation in paediatric clinics. RAP has been classified etiologically into two broad groups: organic and functional. Functional causes of RAP were reported to be present in 90% of cases in the past. Because of the new diagnostic tools and an improved knowledge, the prevalence of RAP has been now increasing. The current study was done to find out the etiology of RAP in Nepalese children. Materials and Methods: This was a prospective study conducted in Civil Services Hospital, Paediatric department from April 2010 to March 2011 in children aged between 4 and 15 years, attending the outpatient department. All the children with RAP, who fulfilled the Apley's criteria were included in this study. Results: Out of 47 children with RAP, organic causes were found in 41 children while non-organic causes, in 6 children. Parasitic infestation was the commonest organic cause of RAP, followed by idiopathic chronic constipation. Other causes were culture proven urinary tract infection, antral gastritis and H. pylori infection. Conclusion: Organic disorder is still the commoner cause of RAP in our part of the world. The key step in the management of RAP is to first investigate for the organic cause based on the symptoms.
Thapa B.,Kanti Childrens Hospital |
Pun M.S.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2014
We report a case of bladder prolapse through a patent urachus in a term male neonate with a large, red, tubular, mucosa lined mass inferior to the umbilical cord. A cystic mass communicating with fetal urinary bladder was detected in an antenatal ultrasound in a 26 years primigravida at 18 and 26 weeks gestation. The cyst disappeared at 35 weeks and a new solid mass was noted at the fetal abdominal wall. After birth a protruded mucosal mass inferior to the umbilical cord was noted. Urethral catherisation confirmed communication with bladder. On the second day of life excision of urachus, repair, reduction of bladder and reconstruction of abdominal wall was performed. The patient voided well and was discharged on ninth day without any complication.
Thapa B.,Kanti Childrens Hospital |
Pun M.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2014
Introduction: Despite hundreds of repair techniques for hypospadias, the introduction of tubularized incised plate urethroplasty (TIP) by Warren T. Snodgrass has become popular because of good functional and cosmetic outcome. The objective of this study was to share our experience of Snodgrass tubularized incised plate (TIP) urethroplasty for the repair of distal and mid-penile hypospadias. Materials and Methods: This prospective study was carried out for a period of 24 months. It included 46 male patients with the mean age of 4.1 years (18 months to 10 years). Proximal hypospadias and those distal with moderate to severe chordee were excluded. All cases underwent TIP urethroplasty as described by Snodgrass and the neourethra was covered by single or double layer of dorsal prepucial layer. The results were analyzed on the basis of duration of surgery, types of postoperative complications like urethrocutaneous fistula, meatal stenosis and wound dehiscence. Functional results assessed with ease of voiding, force and direction of urinary stream and cosmetic with external look of penis. Results: The overall complication rate requiring surgical intervention was 8 (17.3%). Mean duration of surgery was 66 minutes (60-80 minutes). Urethrocutaneous fistula occurred in 5 (10.8%), meatal stenosis in 1 (2.1%) and wound dehiscence in 2 (4.3%) patient. The cosmetic appearance was excellent in all patients involved in this study except 2 cases of wound dehiscence. All of them had vertically oriented slit like meatus with straight urinary stream. Conclusion: Tubularized incised plate urethroplasty gives good functional and excellent cosmetic results with low rate of complications in distal and mid-penile hypospadias.
Joshi B.G.,Civil Service Hospital |
Keyal K.,Civil Service Hospital |
Pandey R.,Civil Service Hospital |
Shrestha B.M.,Kanti Childrens Hospital
Journal of Nepal Paediatric Society | Year: 2011
Introduction: Enteric fever is a systemic infection caused by the bacteria, Salmonella enterica serovar Typhi (S.typhi) and Salmonella enterica serovara Paratyphi (S. paratyphi A, B and C). Most of the burden of the disease is limited to the developing world and the disease still has the issues like wide spectrum of clinical presentation and multidrug resistance. Objectives: This study was done to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive enteric fever. Methods: A prospective cross-sectional study was conducted in Civil Service Hospital from February 2010 to January 2011 in the paediatric population in the age group of 2 to 14 years. Children with Salmonella species isolated in blood culture were included in the study. Results: Out of the 40 children with culture positive enteric fever, male to female ratio was 1.3: 1 with common age group between 11-14 years. S typhi was isolated in 25 cases while S. paratyphi in 15 cases. Clinical features of S. typhi and S. paratyphi were indistinguishable. Both S.typhi and S. paratyphi were found to be 100% sensitive to drugs like Ceftriaxone, Cefotaxime, Cefixime and Chloramphenicol. Sensitivity to Ofloxacin was 100% in S. paratyphi and 92% in S.typhi. Similarly sensitivity of Azithromycin was 92% and 93% for S.typhi and S. paratyphi respectively. Conclusion: Salmonella serotype is still 100% sensitive to third generation cephalosporin. Some percentage of resistance is seen with Ofloxacin in S. typhi and with Azithromycin in both S.typhi and S. paratyphi.
PubMed | National Academy of Medical science and Kanti Childrens Hospital
Type: Journal Article | Journal: Journal of Nepal Health Research Council | Year: 2016
Sepsis is one of the leading causes of neonatal morbidity and mortality. Because of difference in local epidemiology and possible variation with time, regular monitoring and updates on pathogen and their antimicrobial sensitivity pattern is important for prevention and treatment.A retrospective descriptive study was carried out among cases of neonatal sepsis admitted in neonatal intermediate care unit of Kanti Childrens hospital from August 2014 to August 2015. The data was collected from medical records of neonatal intermediate care unit and microbiology department and analyzed using SPSS version 20.There were 644 admissions, among which 210 (32%)were suspected of having neonatal sepsis. Thirty(14%) of the suspected cases had positive blood culture. Proportions of late and early onset were 25 (83.3%) and 5(17.7%) respectively.In blood culture Staphylococcus aureus was the most common organism(80%),followed by Coagulase negative Staphylococcus (6.66%), Acinetobacter (6.66%), Enterobacter species(3.33%) and Morgonellamorgoni (3.33.5%).Gram positive organisms were isolated in all cases of early onset sepsis and in 84% of late onset sepsis. Most of the isolated organisms showed sensitivity to amikacin, cloxacillin, ciprofloxacin and vancomycin.This study has indicated possible emergence of Staphylococcus aureus as the dominant cause of neonatal sepsis. Cloxacillin, amikacin, ciprofloxacin have high proportion of efficacy against the commonly isolated bacteria in neonatal sepsis.