NepMed Repository :: Browsing by Author "Baral, S"

Browsing by Author "Baral, S"

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A Fatal Presentation of Dermatomyositis
(Kathmandu University, 2012) Khatiwoda, P; Kayastha, SR; Khatiwada, P; Giri, A; Baral, S; Bista, D; Pant, P
ABSTRACT Dermatomyositis (DM) is an autoimmune disease that mainly affects the skin, muscle, and lung. The pathogenesis of skin inflammation in DM is not well understood. We present a 40-year-old male who presented with four months history of generalized skin lesion, pain and weakness. He had elevated transaminases with detectable muscle weakness. This case highlights the need to consider dermatomyositis with skin lesion and weakness; and the use of aggressive immunosuppressive therapies due to its associated vasculopathies. KEY WORDS Cutaneous lesions, dermatomyositis, idiopathic, myopathy, vasculitis
A Spatial Model of Socioeconomic and Demographic Determinants of Dengue Hemorrhagic Fever in Nepal
(Kathmandu University, 2025) Mahato, RK; Htike, KM; Yadav, A; Baral, S; Yadav, RK; Kafle, A; Sharma, V
ABSTRACT Background Dengue hemorrhagic fever (DHF) has re-emerged across the global South, particularly in tropical and subtropical urban areas, driven by environmental changes alongside local demographic and socioeconomic factors. Objective To investigate the spatial patterns and socioeconomic determinants of dengue fever in Nepal from 2020 to 2023. Method Using Geographic Information Systems (GIS), Gi* cluster analysis, and Local Moran’s I statistics, the study examined the relationship between socio-economic variables and dengue incidence across districts. Key factors analyzed included population density, urbanization, and night-time light (NTL) intensity. Result Bivariate Local Indicators of Spatial Association (LISA) analysis showed fluctuating correlations between dengue hemorrhagic fever incidence and factors such as population density, urbanization, and night-time light intensity. Moran’s I value for population density were -0.083 in 2020, -0.082 in 2021, 0.526 in 2022, and -0.020 in 2023. Similarly, for urbanization, Moran’s I values shifted from -0.103 in 2020 to -0.090 in 2021, 0.458 in 2022, and 0.007 in 2023. Night-time light intensity also demonstrated changing correlations, with Moran’s I values of -0.091 in 2020, -0.102 in 2021, 0.415 in 2022, and -0.068 in 2023. A notable shift from negative to positive correlations occurred between 2020 and 2022. In 2022, high-incidence dengue hemorrhagic fever clusters emerged in densely populated areas, while distinct spatial patterns were observed in 2020 and 2021. Conclusion Dengue hemorrhagic fever risk spatial models are useful tools for detecting high-risk locations and driving proactive public health initiatives. The study emphasized the importance of dynamic, targeted public health interventions based on spatial and socio-economic factors to effectively manage evolving dengue outbreak patterns. KEY WORDS Dengue, Gi* statistics, Local indicators of spatial association, Socio-economic status, Spatial analysis
Dialysis adequacy in ESRD patients on maintenance hemodialysis in a tertiary care center
(Institute of Medicine, 2017) Baral, S; Pant, V; Shah, DS
Abstract Introduction: Assessment of the hemodialysis adequacy is one of the key factors for measurement of quality of life in end stage renal disease since it can predict the outcome of this disease. In this study, we aimed to evaluate hemodialysis adequacy in Institute of Medicine, Kathmandu. This would provide a good background for effective future planning by healthcare authorities. Methods: This is a cross-section observational study done in Hemodialysis Unit, Tribhuvan university teaching hospital, Kathmandu, a tertiary level referral hospital in Nepal. Hemodialysis sessions of 50 patients on maintenance hemodialysis were evaluated after written consent Demographic data along with length of hemodialysis, reuse of hemodialyzer, hemodialysis sessions per week and hemodialyzer membrane type were recorded for each patient. Urea reduction ratio (URR) and single pool kT/v (spKt/v) were calculated to determine hemodialysis adequacy. Results: Bicarbonate-based solutions and low-flux membranes was used in all patients. Length of each hemodialysis sessions was 240 minutes. Thirty-nine (78%) patients were male and eleven (22%) patients were female. The mean spKt/V and URR were found to be (1.15 ±40.3) and (60.35 ±9.26%) respectively. A spKt/V more than 12 and urea reduction rate more than 65% were found in 42% and 34% of the end stage renal disease patients respectively. Conclusions: This study showed hemodialysis inadequacy in more than half of the patients. Adequacy of hemodialysis can be obtained by increasing its frequency, avoiding multiple use of dialyzer and increasing blood flow rate. Keywords: End stage renal disease, Urea Reduction Ratio, Single-pool Ki/V
Frequency and pattern of Skin Disorders in Adolescents in a School of Kathmandu
(Institute of Medicine, 2015) Shrestha, DP; Baral, S; Shrestha, R; Gupta, S; Bhattarai, S; Shrestha, S; Rosdahl, I
Abstract Introduction: Skin disorders are one of the major causes of morbidity in Nepal. The objectives of this study are to determine the relative frequency and pattern of skin disorders in a cohort of adolescents 9-18 years of age. Methods: The study was conducted in a residential school of Kathmandu. A detailed information about the study was given to the student members of a school club and they in turn, informed all the other students of the dermatologic health camp, which was conducted subsequently. All students appearing at the camp were examined by a dermatologist and information regarding age, gender, school grade and diagnosis were recorded in a pre-validated format. Results: In the school there were a total of 950 students (627 m, 323 f). Of them 242 (116 m, 126 f) had skin disorder with a point prevalence of 25.5%. Female students had significantly higher prevalence (29%) than male (18.5%). The most common skin disorders were acne, eczemas and urticaria, and the 10 most frequent diagnoses comprised 87% of all skin conditions. Conclusion: This study demonstrates that 1/4 of the students had one or more identifiable skin disorders. Despite the wide range of dermatoses, only a few of them accounted for a major proportion of the skin disorders. This study provides data for targeting health care programs for prevention and treatment of skin disorders in this age group. Keywords: skin disorrders, adolscents, frequency, patttern
Langerhans Cell Histiocytosis, presenting as Central Diabetes Insipidus and Pneumothorax a Case Report
(Institute of Medicine, 2017) Pant, V; Shrestha, A; Baral, S; Bhattarai, B; Bhatta, U
Abstract Langerhans cell histiocytosis (LCH) is a proliferative disorder where pathologic Langerhans cell accumulate in a various organ. We report a case of 28 years’ male who was admitted in medical ward for initial evaluation of pneumothorax and increased thirst. Laboratory workup revealed central diabetes insipidus. After careful examination, a skin lesion was found from which biopsy and immunophenotyping was performed that lead to the diagnosis of Langerhans cell histiocytosis with multisystem involvement. Patient was managed as per LCH protocol and intranasal desmopressin was prescribed for Diabetes Insipidus. Keywords: Langerhans cell histiocytosis (LCH), Diabetes Insipidus, Pneumothorax
Leflunomide Induced DRESS Syndrome: A Case Report
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Parajuli, S; Chaudhary, D; Pandey, S; Baral, S; Pokhrel, D B
NA Keywords: Leflunomide, Dress syndrome
Mobile teledermatology for Dermatological Care in Rural Nepal: Dermatology training of medical officers at primary health care centers
(Institute of Medicine, 2017) Shrestha, DP; Baral, S; Shahi, PV; Rosdahl, L
Abstract Introduction: Skin diseases are common in Nepal but dermatologists are very few, and there is no adequate training for Medical officers to diagnose and treat common skin diseases. We developed a training program based on Mobile teledermatology and evaluated its effectiveness. Methods: Five medical officers from 3 primary health care centers of Kavre District were trained in their respective working centers. They did 12 days of mobile teledermatology sessions in which they saw minimum of 60 common skin diseases in direct supervision of a dermatologist. Medical officers were involved in all aspect of patient care from history taking, examination of skin lesions, writing down the prescription to counseling and follow up. The effectiveness of training was evaluated by, difference in skin disease knowledge before and after the training, ability to diagnose and treat common skin diseases independently at the end of the training and feedback from the trainees. Results: Altogether 337 skin diseases were seen by 5 medical officers. There was significant difference between the skin disease knowledge before and after the training (p-value 0.009). At the end of the session they were able to diagnose independently 87% (80%-95%) of common skin diseases. All of them strongly agreed that this is the effective way of training Conclusions: Mobile teledermatology is the feasible and effective method of dermatology training to the medical officers at primary health care centres in remote areas, while providing skin care to the villagers at the same time. Keywords: Mobile teledermatology, dermatology training, medical officers, rural Nepal
Unilateral Pheochromocytoma in Von Hippel-Lindau Syndrome Revealed by a Hemangioblastoma
(Kathmandu University, 2024) KC, S; Poudyal, H; Baral, S
ABSTRACT Von Hippel–Lindau (VHL) syndrome is characterized by the occurrence of both benign and malignant tumors, with typical manifestations such as cerebellar hemangioblastoma, Renal cell carcinoma (RCC) and pheochromocytomas.1 Additional tumors that may be associated include pancreatic cysts; neuroendocrine tumours; epididymal cysts and endolymphatic sac tumors.1 This case report details a 29-year-old male who arrived at the Emergency Department (ED) with a one-month history of headaches accompanied by dizziness and vomiting. A Computed Tomography (CT) scan of the head followed by Magnetic Resonance Imaging (MRI) suggested cerebellar hemangioblastoma. Further workup showed multiple tumors, including unilateral pheochromocytoma and pancreatic cysts, which aligned with a diagnosis of von Hippel-Lindau (VHL) syndrome. Notably, the patient’s catecholamine and vanillylmandelic acid (VMA) levels were within normal limits. The patient underwent surgical intervention for the cerebellar hemangioblastoma, and the postoperative recovery was uneventful. This case is noteworthy due to its characteristic findings and the rarity of the condition. KEY WORDS Hemangioblastoma, Pheochromocytoma, Von Hippel-Lindau syndrome

Browsing by Author "Baral, S"

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