Nepal: Kanti Childrens Hospital

Anshika Mishra

8-month-old

Anshika Mishra, an 8-month-old girl, was admitted to the Emergency Department with non-bilious vomiting for 4 days, as well as abdominal distension. She had also been passing stool containing blood and mucus for 3 days.

RMF Medical Officer Dr. Sanish provided the surgical consultation for the patient. A rectal examination revealed signs of intussusception, a type of intestinal obstruction, leading to a provisional diagnosis. All baseline laboratory investigations were sent, and an abdominal and pelvic ultrasound was done. The results of the ultrasound also suggested intussusception.

Anshika was admitted, and surgery was planned on that very day. Once a blood transfusion was arranged, the patient was shifted to the Operating Theatre, where an exploratory laparotomy (an investigative surgical procedure) was performed. An Ileoileocolic intussusception was found and manually reduced, and an appendectomy was also performed. All three surgeries went as planned and were performed successfully.

Anshika was then transferred to the Surgical ICU. Her postoperative days were uneventful, and once she started eating, she was transferred to the Surgical ward on the 5th postoperative day. She was soon discharged with oral medications. Anshika’s parents were glad to have their daughter treated at Kanti Children’s Hospital, happy about the successful operations which saved their child’s life, and grateful to all the hospital staff.

Kriti Maya Magar

1-year-old

Kriti Maya Magar, a 1-year-old girl, was admitted to the Medical ward with a diagnosis of global developmental delay (GDD) with left-sided hemiparesis, or weakness on one side of the body. She was well until one day prior to admission, when she developed a high-grade fever and abnormal body movements, including the rolling of her eyes and salivation during the febrile episode. As a result of her condition, Krita’s parents took her to the nearest hospital, and she was referred from there to Kanti Children’s Hospital.

After stabilizing the child in the Emergency Unit and keeping her under observation for 24 hours, hospital staff transferred Kriti to the Medical ward. RMF Nurse Rusa attended the case and also thoroughly answered questions for Kriti’s parents. At the time of admission to the Medical ward, Kriti was weak and required oxygen inhalation.

She was kept under close observation because she had a history of seizures. During hospitalization, Kriti had 3 more seizures, which were immediately managed by hospital staff. Her parents were continuously informed of and counseled on the condition of their child. When Kriti’s condition improved, she was discharged and advised to visit the neurologist for a thorough consultation and further treatment.

Jenisha Bhat

4-year-old

Jenisha Bhat, a 4-year-old girl, was admitted to the Medical ward. According to her caregiver, Jenisha was well until 8 days prior to admission, when she developed a fever (temperature not recorded) abdominal distension, and generalized swelling of the body.

RMF Nurse Rusa received the child during admission and noted that her condition was very poor. When her laboratory tests were done, Jenisha tested positive for scrub typhus, and her treatment was planned accordingly. The Department of Epidemiology was informed about the case, and records were kept. Jenisha’s parents were advised to maintain hygiene in the home in order to prevent rodents, which are the carriers of the ticks that transmit scrub typhus to humans.

Shriya Deula

11-year-old

Shriya Deula, an 11-year-old girl, was admitted to the Medical ward with a diagnosis of disseminated tuberculosis. According to her caregiver, Shriya was well until 1 month prior to admission, when she developed a cough, a sudden-onset fever that worsened at night, abdominal pain associated with decreased appetite, weight loss from 28 kg to 24 kg within a month, and vomiting.

Initially, Shriya was taken to local health facility, where some medications were prescribed, but her condition worsened. Shriya’s father then decided to bring her to Kanti Children’s Hospital. After receiving the child at Medical ward and obtaining her medical history, RMF Nurse Rusa suspected tuberculosis. Thus, she maintained all the necessary precautions and alerted the other nurses. Finally, Shriya’s AFB test results were positive, which confirmed her TB diagnosis. She was treated with antibiotics and antitubercular treatment (ATT). When her condition improved, she was discharged. Nurse Rusa counseled Shriya and her parents to strictly follow the ATT treatment instructions.

Laxman Joshi

6-year-old

Laxman Joshi, a 6-year-old boy from Dhangadhi, arrived at the Outpatient department (OPD) on October 20, 2018 with bilateral swelling of the calf muscles and difficulty standing properly after sitting. According to his father, Laxman’s calf muscles first began to show signs of bilateral swelling 2 years ago. The condition began suddenly and worsened progressively, but his biceps muscles were not affected.

The patient had no history of loss of consciousness, acute bacterial meningitis, or surgical intervention, and no similar family history on his maternal side. Basic laboratory tests were done, such as total blood count, inflammatory markers, ECHO, creatine phosphokinase (CPK) to check for Duchenne muscular dystrophy (DMD), and a brain and spin MRI. All reports were in the normal range except for the CPK, which was prominently high, confirming Laxman’s diagnosis of Duchenne muscular dystrophy, an incurable neuromuscular disorder which mainly affects males.

At the time of Laxman’s discharge, hospital staff recommended that the child receive the necessary immunizations, including meningitis, Pneumovax, Hib, and varicella. They also suggested physiotherapy and provided some multivitamins and calcium tablets. Laxman was advised to return for regular follow-ups. Finally, hospital staff discussed the possible outcomes of the disease with Laxman’s father.