Browsing by Author "Agrawal, S"
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Publication Acute Primary Tuberculous Ulcer of Glans Penis(Kathmandu University, 2019) Pandey, D; Agrawal, S; Pokharel, SABSTRACT Acute primary tuberculous ulcer of glans penis is a rare entity even in the endemic region. We present a 55 year old male with multiple undermined ulcers for short duration of 4 weeks with raised erythrocyte sedimentation rate, negative Mantoux test and histopathology revealed a diagnosis of tuberculous ulcer which responded well to antitubercular therapy. KEY WORDS Acute primary tuberculous, Glans penis, Tuberculous ulcerPublication Alopecia Areata and Thyroid Dysfunction Association- A Study from Eastern Nepal(Kathmandu University, 2018) Marahatta, S; Agrawal, S; Mehata, KDABSTRACT Background Alopecia areata (AA) is one of the non-scarring alopecia. Its etiology has not been well established till date. The most convincing hypothesis is autoimmune process for its causation. Amongst all, most frequent association was found with thyroid disorder. Objective To study the association of thyroid dysfunction in patients with alopecia areata. Method All patients of alopecia areata attending dermatology outpatient department and currently not receiving any treatment for alopecia areata were enrolled in the study. Relevant history and examination findings were recorded in the preset pro-forma. All of them were subjected for thyroid function test by chemiluminescence microparticle immunoassay method. Then thyroid function test of cases was compared with that of equal number of age and sex matched healthy controls. Result A total of 75 patients were enrolled in both case and control groups. Mean age of case and control groups were 29.40±9.90 and 28.96±9.89 years respectively (P=0.786). Median Severity of Alopecia Tool score was 2.47 (IQR=0.96-5.79). Prevalence of thyroid disorder was significantly higher in alopecia areata group (17.3%) as compared to the control group (1.3%) (P=0.001). Likewise, in individuals with abnormal thyroid function, alopecia areata disease severity grade and median severity of alopecia tool (SALT) score was higher as compared to those with normal thyroid function. Conclusion We found a significant association between alopecia areata and thyroid dysfunction. Hence thyroid function evaluation must be considered in individuals with alopecia areata. However, further studies with larger sample size are recommended before its generalization. KEY WORDS Alopecia areata, Severity of alopecia tool score, Thyroid function testPublication Anesthetic Management of a Patient with Myasthenia Gravis for Meningioma Surgery - A Case Report(Kathmandu University, 2015) Srivastava, VK; Agrawal, S; Ahmed, M; Sharma, SABSTRACT Myasthenia gravis is a disease of great challenge to the anesthesiologist, because it affects the neuromuscular junction. Anesthetic management involves either muscle relaxant or non-muscle relaxant techniques. This case report documents the safe use of fentanyl, propofol and sevoflurane combination guided by bispectral index, without the use of muscle relaxants in a patient with myasthenia gravis who presented for meningioma surgery. KEY WORDS Fentanyl, myasthenia gravis, propofol, sevofluranePublication Clinico-epidemiological Profile of Rosacea at a Tertiary Care Hospital in Eastern Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Bhattarai, S; Agrawal, S; Rijal, ANA Keywords: Rosacea, epidemiology, aggravating factorsPublication Comparison of Oxidant-Antioxidant Status in Patients with Vitiligo and Healthy Population(Kathmandu University, 2014) Agrawal, S; Kumar, A; Dhali, TK; Majhi, SKABSTRACT Background Vitiligo is a well-recognized pigmentary disorder of the skin and /or mucous membrane characterized by circumscribed ivory or chalky white macules devoid of identifiable melanocytes. The pathogenesis of vitiligo is complex and still not well understood. According to autocytotoxic hypothesis, oxidative stress has been suggested to be the initial pathogenic event in melanocyte degeneration. The role of free radicals and oxidative damage in the pathophysiology of vitiligo has been documented in recent studies. Objective To evaluate the role of oxidative stress in patients with vitiligo and of healthy controls by measuring levels of the oxidant malondialdehyde (MDA) and antioxidants vitamin C and vitamin E in serum and catalase (CAT) in erythrocytes. Method A total of 80 clinically diagnosed cases of vitiligo and 80 control subjects were included in the study to assess the activity of MDA, vitamin C and vitamin E in serum and CAT in erythrocytes of patients and controls by using the spectrophotometric assay. Result There was statistically significant increase in the levels of MDA in patients with vitiligo compared to the control group (p<0.001). No significant difference was found in the levels of vitamin C (p=0.411) and vitamin E (p=0.771) between the patients with vitiligo and control group. The levels of CAT in the vitiligo patients were found to be significantly lower than those of controls (p<0.001). Conclusion Increased oxidative stress and decreased catalase have been observed in vitiligo patients and the data suggesting that the free radicals may be involved in the destruction of melanocytes or dysregulation of melanogenesis. KEY WORDS Antioxidants, oxidants, vitiligoPublication Cosmetic/Surgical Dermatology: Should it be an Integrated Part of Medical Dermatology?(Kathmandu University, 2016) Agrawal, SNAPublication Do Contacts have a Role in the Transmission of Leprosy?(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Rijal, A; Agrawal, S; Bhattarai, SNA Keywords: Contact, Transmission, LeprosyPublication Dyschromatosis Universalis Hereditaria(Kathmandu University, 2021) Bista, M; Agrawal, S; Agrawal, YABSTRACT Dyschromatosis universalis hereditaria (DUH) is a rare pigmentary genodermatosis usually inherited in autosomal dominant fashion characterized by multiple pinpoint to pea-sized hypo- and hyper-pigmented macules arranged in reticulate pattern that develops within the first few years of life. An 11 years old boy presented with multiple gradually progressive asymptomatic hypopigmented macules on hyperpigmented background on trunk, extremities and face since 2 years of age. Family history was absent. Punch biopsies revealed increased number of melanocytes in the epidermis with basal cell vacuolar alteration and pigmentary incontinence and perivascular infiltration by lymphocytes and melanophages in the dermis. We herein present a sporadic case of dyschromatosis universalis hereditaria. KEY WORDS Dyschromatosis universalis hereditaria, Reticulate pigmentationPublication Efficacy of Isotretinoin and Antihistamine versus Isotretinoin Alone in the Treatment of Moderate to Severe Acne: A Randomised Control Trial(Kathmandu University, 2019) Pandey, D; Agrawal, SABSTRACT Background Acne vulgaris has considerable impact on physical and psychological health. Isotretinoin is considered most effective drug available for acne therapy but with limited acceptance because of its adverse effects. Antihistamine inhibits inflammatory mediators, Propionibacterium acne induced itching, reduction of squalene and sebum in sebocyte, reduces anxiety and further lessens hormonal derangement and inhibits mast cell induced fibrosis and scars. Clinical relevance is lacking in the use of antihistamine in the treatment of acne and its potential efficacy needs to be clarified. Objective To evaluate the efficacy and safety of combining isotretinoin and antihistamine compare to isotretinoin alone in patients with moderate to severe acne at week 12. Method One hundred patients with moderate to severe acne were included in this randomised, controlled comparative study. Fifty patients were treated with isotretinoin and 50 patients were treated with additional antihistamine, levocetirizine and assessment was done at baseline, 4, 8 and 12 weeks of treatment. Result At week 12, compared to isotretinoin only group, combination of isotretinoin and levocetirizine group showed more statistically significant decrease in score of global acne grading system (51.0 vs. 38.5%) and acne lesion counts (non-inflammatory lesion: 63.2 vs. 44.5%; inflammatory lesions: 75.9 vs. 62.7%; total lesions: 66.07 vs. 48.7%; all p< 0.05). Flaring up of acne occurred less frequently and adverse effects were more tolerable in levocetirizine group. Conclusion Use of antihistamine with isotretinoin provides synergic effect while minimizing the side effect of isotretinoin and greater clearance of the lesion and scars. KEY WORDS Acne, Antihistamine, Isotretinoin, LevocetirizinePublication Efficacy of tazarotene cream plus clindamycin gel vs tretinoin cream plus clindamycin gel in treatment of mild to moderate acne vulgaris: a randomised trial(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Paudel, S; Agrawal, S; Dhali, TKNo Abstract:Publication Hirsutism and Quality of Life of Women in Tertiary Care Center in Eastern Nepal(Kathmandu University, 2022) Maharjan, J; Agrawal, S; Marahatta, SABSTRACT Background Hirsutism is excess terminal hair growth in women at androgen-dependent sites of the body and it has great impact on psychological and social aspects of their lives, thus affecting their quality of life (QoL). Several studies assessing the quality of life in hirsute women could be found in world literature but none in Nepalese literature. So, this study was undertaken for the assessment of the impact of hirsutism on the quality of life in Nepalese women. Objective To assess the effect of hirsutism on quality of life of women in a tertiary center of Eastern Nepal and its association with various socio-demographic and clinical parameters. Method A cross-sectional questionnaire-based study was conducted in 49 participants aged 10 to 49 years at the Department of Dermatology, B.P. Koirala Institute of Health Sciences. Clinically diagnosed hirsute females with modified Ferriman-Gallwey (mF- G) score > 8, were enrolled and asked to fill Dermatology Life Quality Index (DLQI) questionnaire in the Nepalese version. Result More than 57.2% of the study population was of age 20 to 29 years with a mean of 27.76±8.08 years. The mean Dermatology Life Quality Index score was 7.78±4.95. The moderate effect was seen in the majority of participants (36.7%) with a predominant effect upon aspects of life like daily activities and symptoms and feelings. Participants with higher mF-G score (22.15±3.82) had a very large effect on their quality of life. Younger unmarried women with a school education and having a longer duration of hirsutism were found to have a higher effect upon their quality of life. However, the association was not statistically significant. Conclusion Hirsutism had affected the quality of life moderately with predominant effect upon aspects like daily activities and symptoms and feelings. No significant association was elicited between severity of hirsutism and its effect on quality of life from our study. KEY WORDS Hirsutism, Modified ferriman-gallwey score, Quality of lifePublication Impact of Patch Testing on Quality of Life in Patients with Hand Eczema: A Follow-up Study(Kathmandu University, 2013) Agrawal, S; Rijal, A; Bhattarai, SABSTRACT Background Patch testing has previously been shown to influence the quality of life, although a very few studies have shown if this is dependent on the result of the patch tests. Objective To assess the impact of patch testing on the quality of life (QOL) in patients with hand eczema (HE). Methods A total of 50 patients diagnosed of hand eczema at the time of patch testing, aged 16 years and above participated in this study. Detailed demographic information and diagnosis of hand eczema were collected on the day of the patch test. After six weeks, the patients were asked about the hand eczema, knowledge of their allergies and change in their life style to avoid the relevant allergens demonstrated on the patch test. Dermatology Life Quality Index (DLQI) was used to measure the QOL on both occasions. Results The patch test positivity was found in 68% of patients to one or more allergens. The sum score of DLQI at baseline was 12.16 ± 5.58 with median 12.0. HE had most impact on symptoms and feelings. Patients with both positive patch test (mean baseline= 11.94± 5.88; mean at six weeks=2.81± 2.01; P<0.001) and negative patch test (mean baseline=12.63± 5.03; mean at 6 weeks=5.4± 3.56; P=0.001) showed significant improvement in DLQI scores, however it was more improved in patients with positive patch test than in patients with negative patch test. Conclusions Hand eczema had an appreciable impact on the QOL. Patch testing had been beneficial to most patients in improving patient quality of life considerably. KEY WORDS Dermatology life quality index (DLQI), hand eczema, patch test, quality of life (QOL)Publication Leprosy after the Elimination: A BPKIHS experience(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Bhattarai, S; Agrawal, S; Rijal, A; Marahatta, SNo Abstract:Publication Methotrexate plus narrow band ultraviolet B (NBUVB) versus methotrexate alone in the treatment of moderate to severe plaque psoriasis: A randomized clinical trial(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2015) Khadka, Dhan Keshar; Agrawal, S; Dhali, T KAbstract: Introduction: Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives: To compare the therapeutic efficacy of methotrexate plus NBUVB phototherapy combination vs. methotrexate in the treatment of moderate to severe chronic plaque psoriasis. Material and methods: Seventy-nine patients with chronic plaque-type psoriasis (body surface area involvement >2%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or methotrexate (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI75) Score or up to 12weeks, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of adverse effect, DLQI and relapse. Results: Of 79 patients, 69 completed the treatment period and follow-up. PASI 75 was achieved in 35/39(89%) patients in group A and 34/40(85%) patients in group B (P=0.052). The mean number of weeks (P = 0.031), the mean cumulative dose of NBUVB (8.2±3.5J/cm2)) and the mean number of phototherapy sessions (12±3)) required to achieve PASI 75 were less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow- up period (P = 0.68). Conclusion: Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with methotrexate monotherapy in the treatment for chronic plaque-type psoriasis. Keywords: DLQI, Methotrexate, NBUVB, PASI, PsoriasisPublication Postherpetic Trigeminal Trophic Syndrome: An under recognized condition(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Dhali, TK; Agrawal, SAbstract: NA Keywords: Postherpetic Trigeminal Trophic Syndrome, under recognized conditionPublication Quality of Life Among HIV Positive Individuals in Kathmandu Valley and Eastern Region of Nepal(Kathmandu University, 2012) Agrawal, H; Mourya, R; Shrestha, RK; Agrawal, SABSTRACT Background The alarming increase of HIV/AIDS, inability to afford highly active anti-retroviral therapy, disability and stigma associated with the disease, loss of productivity due to illness, and chronic nature of the disease has made HIV/AIDS one of the most important public health problems in developing countries. The Quality of life assessment is focused on humanistic element and intervention resulting from this result may lead to better overall patient well being. Objective The aim of our study was to assess and compare the quality of life among HIV positive individuals in Kathmandu Valley & Eastern region. Methods The study was conducted among 228 HIV positive individuals from Eastern Nepal and 213 from Kathmandu valley and they were compared with an equal number of age-sex matched controls from the community. The instrument used was the WHO QOL-BREF Nepali questionnaire. Results The HIV positive individuals had significantly lower (P<0.001) QOL scores than the controls in the overall QOL and all the domains of life: Physical, Psychological, Social and Environmental. HIV positive individuals from Kathmandu valley scored significantly better (P<0.001) scores in the Physical and Environmental domains when compared to HIV positive individuals from Eastern region. HIV positive females had a significantly higher (P<0.02) QOL scores for overall QOL and overall perception of health than the males. Conclusion These findings suggest that HIV positive individuals have a poorer quality of life than the general population in Kathmandu valley & Eastern region of Nepal and interventions could be targeted to improve this aspect of their health. KEY WORDS HIV/AIDS, QOL, NEPAL, WHO QOL-BREFPublication Socioeconomic and Nutritional Status of Children with Pyodermas(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Kharel, C; Pandey, S S; Agrawal, S; Bhattarai, MNA Keywords: Pyoderma, socio-economic status, nutritional factorPublication The Study of Prevalence of Helicobacter Pylori in Patients with Acne Rosacea(Kathmandu University, 2012) Bhattarai, S; Agrawal, S; Rijal, A; Majhi, S; Pradhan, B; Dhakal, SSABSTRACT Background Acne rosacea is an inflammatory disease affecting the central part of the face characterized by erythema, papules, papulo pustules and telangiectasias of unknown etiology. More recently numerous studies have described an association with Helicobacter pylori (Hp) and the extra gastric symptoms of cutaneous origin. Objectives To establish the prevalence of Helicobacter pylori (Hp) infection in the stomach in patients with rosacea based on standard Hp serological test. Methods All patients with the clinical staging of 2, 3 and 4 rosacea attending the Dermatology Out Patient Department from May 2009 – April 2010 were included in the study. Quantitative serological test using the SERION ELISA classic Helicobacter pylori IgG was done. Result A total of 26 patients were enrolled in the study with the age ranging from 26- 82 years. There were 14 males and 12 females and the male: female ratio was 1.6:1. Three (11.53%) patients presented with Grade IV rosacea, a severe clinical presentation and symptoms suggestive of acid peptic diseases were found in 14/26 (53.8%) patients. A positive serology to H. pylori was found in 17/26 (65.4%) of patients. A statistically significant correlation was found when association of H.pylori positivity in patients of rosacea compared with the seropositivity in controls. However correlation in the seropositivity was not found amongst the patients having gastritis and rosacea. Conclusion There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease . KEY WORDS H.pylori, rosaceaPublication Treatment of Infrabony Defects by Open Flap Debridement with or without Diode Laser(Kathmandu University, 2022) Agrawal, S; Pradhan, SABSTRACT Background Periodontitis is the common oral condition which affects the periodontium of the teeth that leads to destruction of periodontal ligaments and alveolar bone. Open flap debridement is the surgical procedure which provides access and visibility of the site, application of laser as an adjunct has various advantanges. Objective To compare clinical outcomes after open flap debridement with or without diode laser. Method Patients aged 25-45 years diagnosed with infrabony defect ≥ 5 mm visiting Department of Dental Surgery, Bir Hospital. Control group sites were treated with open flap debridement alone, whereas test-groups were treated with Open flap debridement with diode laser. Various parameters like Plaque index, Gingival index, Pocket depth and Clinical attachment level were assessed and compared between groups at baseline, 3 and 6 months. Result The mean plaque and gingival scores improved in both the control and test groups at 3 and 6 months follow up as compared to baseline and was statistically non- significant between two groups. Open flap debridement with or without diode laser in the treatment of periodontal intrabony defects did not produce significant reduction in pocket depth and gain in clinical attachment level. Conclusion There was no significant differences in the clinical parameters were seen in the surgical flap debridement of infrabony pocket with and without diode laser. Diode laser can be used safely as an adjunct. However, long-term, multicentric, histologic and microbial studies are required. KEY WORDS Attachment loss, Diode laser, Gingival recession, Periodontitis, Periodontal pocketPublication Understanding Of Nepalese Patients With Vitiligo About Their Disease(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Agrawal, S; Kumar, A; Shyngwa, PMAbstract: Introduction: Vitiligo, a pigmentary disorder, may influence considerably patients’ health-related quality of life (QoL) and psychological wellbeing. Previous reports indicated that the patients' illness understandings influence adherence behaviors and actions in various chronic dermatological conditions. Objectives: To know the understanding of Nepalese patients with vitiligo about their disease by using illness perception questionnaire and also to investigate the potential factors that might influence it. Material and Methods: The illness perception questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 154 patients with vitiligo of 13 years or more age attending the dermatology OPD. Results: A total of 146 patients completed the questionnaire. The belief about the causes of vitiligo was considered as “germs or virus” by 64.4% patients while half of the patients believed that vitiligo was due to “chance or fate”. Vitiligo was considered to be a serious condition (83.6%) and have had serious consequences on their life (63%). Approximately half of the patients believed that their disease had serious economic and financial consequences more so in female patients and in those with generalized disease. Although 43.8% patients believed that their illness was likely to be permanent rather than temporary, 75% patients believed that vitiligo would improve with the time and their treatments were effective (75.3%). However, females felt that there were very little that could be done to improve their vitiligo. Conclusion: The knowledge about vitiligo is unsatisfactory and needs accessible, accurate, community based education about the natural history of vitiligo and the effectiveness of treatment. Keywords: Illness perception questionnaire, Vitiligo