Browsing by Author "Agrawal, JP"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication Publication Spectrum of Cryptococcal Meningoencephalitis in Tertiary Hospital in Nepal(Institute of Medicine, 2018) Kharel, G; Karn, R; Rajbhandari, R; Ojha, R; Agrawal, JPAbstract Introduction: Cryptococcal meningoencephalitis is the most frequently encountered manifestation of cryptococcosis and prevalent throughout the globe. The majority of patient suffering from cryptococcosis is immunocompromised and AIDS account for most of the case. We aimed to determine the spectrum of cryptococcal meningoencephalitis at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective study was performed among all the patients (n=15) who were admitted with cryptococcal meningoencephalitis at TUTH over a period of one fiscal year July 2017 to June 2018. Data on patient’s demography, history, complaints, clinical findings, neuroimaging, cerebrospinal fluid (CSF) investigation, hospital medication information, complications, mortality and Left Against Medical Advise (LAMA) were extracted from patient medication records of the hospital. Descriptive statistics was performed using IBM-SPSS 20.0. Results: Of total 15 patients with Cryptococcal meningoencephalitis, majority (9, 60%) had HIV infection. The most common complaints were vomiting (12, 80%) and headache (11, 73%) and clinical findings showed meningeal irritation (8, 53%) and papilledema (4, 27%). Only two neuroimagings among all patients were abnormal. CSF investigation depicted high total cell count (>5cells/mm3), high protein (>45 mg/dl) and positive cryptococcal antibody in all patients while lymphocytic predominance and lower sugar levels (<3 mmol/dl) in 93% along with ADA of <10 U/L in 67%. Amphotericin-B (mean duration 17 days) and fluconazole antifungals were used in all the patients. Twenty seven percent patients died during hospital stay. Pancytopenia, hydrocephalus and hospital acquired pneumonia were observed in 7 percent of patient from each group and 13 percent of cases left against medical advice. Conclusion:Cryptococcal meningoencephalitis is common in People Living with HIV (PLHIV) and caused substantial mortality. Keywords: Cryptococcal Meningoencephilitis, HIV, immunocompromisedPublication The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige’s Syndrome(Kathmandu University, 2010) Bastola, P; Chaudhary, M; Agrawal, JP; Shah, DNABSTRACT Background Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. Objectives To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. Methods A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. Results A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 3.61 (+ Standard deviation 0.50, range 3-4), 3.21 (+Standard deviation 0.63, range 2-4) and 3.67 (+- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 4.3 (+ Standard deviation 1.6, range 2.0-6.5), 5.8 (+Standard deviation 1.4, range 3-8) and 4.5 (+ Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications. Conclusions The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige’s syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal. Key Words essential blepharospasm syndrome, hemifacial spasm, jankovic spasm grading, meige’s syndrome