Browsing by Author "Bhusal, Mohan"
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Publication Clinical Profile and Endoscopic Management in Patients with Choledocholithiasis(Nepal Health Research Council, 2024) Lamsal, Manoj; Jha, Anurag; Kafle, Brindeswari; Hamal, Rabin; Sherpa, Tshering Wangdi; Kafle, Pradip Kumar; Bhattarai, Tulsi Ram; Bhusal, Mohan; Koirala, Dinesh; Pathak, RahulBackground: Common bile duct stones is a common medical problem that are usually seen in association with gallstone disease. Endoscopic management of Common bile duct stones involves doing Endoscopic retrograde cholangiography for bile duct clearance which is the primary therapeutic modality of choice. This prospective study was done to identify the clinical characteristics and outcome of patients presenting with Common bile duct stones undergoing Endoscopic retrograde cholangiography. Methods: A prospective observational study was conducted on all patients undergoing Endoscopic retrograde cholangiography in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of diagnosed or suspected choledocholithiasis from April 2023 to March 2024. Patient demographics, clinical characteristics, Endoscopic retrograde cholangiography findings and post procedure outcome data were collected and analysed. Results: A total of 110 patients (61.8% male and 38.2% female) were included in the final analysis. Successful clearance of Common bile duct was obtained in 76.4% patients with overall adverse events of 18% related to the procedure. Among patients undergoing the procedure, 16.4% couldn’t be managed with Endoscopic retrograde cholangiography and were referred for surgical management. Conclusions: Endoscopic management in form of Endoscopic retrograde cholangiography is a safe and effective method to manage patients with Common bile duct stones. Keywords: Common bile duct calculi; endoscopic sphincterotomy; ERCP.Publication Clinico-epidemiological Profile and Photoprotective Behaviour among Patients with Photodermatosis: A Hospital-based Cross-sectional Study(Institute of Medicine, Tribhuvan University, 2025) Bhusal, Mohan; Dhungana, Sanjay; Rana, Arnija; Shrestha, Shristi; Thapa, Deeptara Pathak; Piya, SmritiAbstract: Introduction Photodermatoses (PD) encompass a spectrum of skin conditions induced or exacerbated by sunlight. There is limited data on their clinico-epidemiological profile in Nepal. This study aimed to assess the prevalence and study the clinic-epidemiological profile and photoprotective behaviour among patients with photodermatoses. Methods This hospital-based descriptive cross-sectional study was conducted between September 2023 to August 2024 in the outpatient department of dermatology of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee. The number of patients diagnosed with PD were determined using Sukraa Hospital Information Management System software, V1.2.24.5 for the calculation of prevalence. Non-probability convenience sampling was used. A total of 69 patients clinically diagnosed with photodermatoses were included in study. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences (SPSS) version 16. Results Prevalence of photodermatitis was 2.24% (338/15116). Polymorphic light eruption was the most common diagnosis 48 (69.57%), followed by photo-contact dermatitis. The prevalence was higher among females 41 (59.42%), with a mean age of 37.21±18.18 years. Most patients were in the 21–30 years age group. The neck 28 (28.28%) and face 20 (20.20%) were the most commonly affected sites, and papules were the predominant lesion morphology 41(42.27%). Only 15 (21.74%) used photoprotective measures, of which sunscreen was the most common 10 (66.67%). Conclusion Polymorphic light eruption was the most common type of photodermatosis, particularly among females and younger individuals. There was a notably low use of photoprotective measures among patients with PD, particularly sunscreen usage.Publication Efficacy and Safety of Intralesional Immunotherapy with Tuberculin Purified Protein Derivative among Cutaneous Wart Patients(Nepal Health Research Council, 2022) Shrestha, Sanju Babu; Bhusal, Mohan; Jwarchan, Jayanti; Gautam, Sujan; Shrestha, Prashanna RajAbstract Background: Cutaneous warts are common skin problems caused by Human Papilloma Virus. Conventional therapies are mostly ablative and limited by recurrences and side effects. Immunotherapy using bacterial, fungal, and viral antigens is an emerging and safer technique to treat warts at local and distant sites. The objective of this study was to measure the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative among cutaneous wart patients in the dermatology department of a tertiary care centre. Methods: A cross sectional, time series design, was conducted between October 2019 and September 2020 among 77 patients of cutaneous warts attending Dermatology out-patient department using convenience sampling. Percentage response was evaluated for patients treated with tuberculin purified protein derivative for eight weeks at an interval of two weeks into complete response (100% clearance), partial response (50-99% clearance), no response (0-49% clearance). Side effects were also recorded. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Results: Out of 77 patients, complete response (100%) was seen in 53.2% patients, partial response (50-99%) in 14.3% and no response (0-49%) was seen in 32.5%. Side effects noted were pain and erythema (19.50%), blisters (2.60%) and flu like symptoms (1.30%). Conclusions: Intralesional PPD is an effective and safer therapeutic option for the treatment of cutaneous warts. Keywords: Immunotherapy; intralesional injections; purified protein derivative of tuberculin; warts Author Biographies Jayanti Jwarchan, Gandaki Medical College Lecturer, Department of Dermatology Sujan Gautam, Kathmandu Medical College Resident, Department of Dermatology Prashanna Raj Shrestha, Kathmandu Medical College Lecturer, Department of DermatologyPublication Efficacy of Lactulose and Polyethylene Glycol in the Treatment of Hepatic Encephalopathy(Nepal Health Research Council, 2025) Pathak, Rahul; Lamsal, Manoj; Bhusal, MohanBackground: Hepatic encephalopathy presents a significant clinical challenge in individuals with advanced liver dysfunction, manifesting as confusion, altered consciousness, and personality changes. This study aimed to compare the efficacy of lactulose and polyethylene glycol in managing Hepatic encephalopathy. Methods: The study is conducted at Tribhuvan University Teaching Hospital in Nepal; the study enrolled 45 cirrhotic patients with altered mental status in each study group. Ethical approval and informed consent were obtained. The basic demographic and clinical data were collected, including laboratory investigation and precipitating factors for Hepatic encephalopathy. The severity of Hepatic encephalopathy was assessed using the West Haven Criteria. Results: In this study there was significant difference between two groups in terms of mean time taken for complete resolution of hepatic encephalopathy, with mean of 2.98 ± 2.129 days in Polyethylene Glycol group compared to mean of 4.67 ± 3.076 days in Lactulose group, with a significant p-value of 0.004. There was also significant difference in length of hospital stay between two groups, with a mean hospital stay of 6.36 ± 3.654 days in Polyethylene Glycol group compared to 9.70 ±5.388 days in Lactulose group, with a significant p-value of 0.001. Conclusions: In conclusion, polyethylene glycol showed promising results in the treatment of Hepatic encephalopathy compared to lactulose polyethylene glycol. demonstrated an improvement and quicker resolution of Hepatic encephalopathy symptoms, highlighting its potential as a cost effective and safe alternative for managing Hepatic encephalopathy in cirrhotic patients. Keywoards: Hepatic encephalopathy; lactulose; polyethylene glycol.Publication Graham-Little-Piccardi-Lassueur Syndrome: Two Case Reports(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Piya, Smriti; Bhusal, Mohan; Thapa, Deeptara Pathak; Shrestha, JoshanaAbstract: Graham-Little-Piccardi-Lassueur Syndrome (GLPLS) is a rare lichen planopilaris (LPP) subtype associated with scarring alopecia. It is thought to be an immune-mediated cause of alopecia. It is characterized by a triad of multifocal cicatricial alopecia of the scalp, noncicatricial alopecia of the axilla, and groin and a follicular lichen planus (LP) eruption. Herein, we present 2 cases of GLPLS. The first case is of a 33-year-old female presented with classical lichen planopilaris (LPP) of the scalp, follicular hyperkeratosis of bilateral arms, and noncicatricial alopecia of armpits. In the second case, a 17-year-old female presents with frontal fibrosing alopecia (FFA) of the scalp, follicular hyperkeratotic papules of the scalp, and noncicatricial alopecia of the bilateral armpits and genitalia. The physician can miss GLPLS due to the rarity of the condition.Publication Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Bhusal, Mohan; Aryal, Eliz; Bhattarai, Sabina; Shrestha, Sanju Babu; Rajouria, AlarkAbstract: Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects. Keywords: Adrenocorticotropic hormone, Clobetasol, Pituitary-adrenal systemPublication Is Aesthetic Dermatology in Unsafe Hands? Authors(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Bhusal, Mohan; Thapa, Deeptara PathakAbstract: Aesthetic Dermatology is one of the growing subspecialities that involves noninvasive to minimally invasive cosmetic procedures. It has overlapping scope with Aestheticians, Beauticians, and Non-Dermatologist medical practitioners, adding ambiguity and ethical issues. There have been global reports of invasive procedures done by Beauticians and Aestheticians leading to complications like scalp burn, infection and stroke which later led to development of guidelines in different countries. There is a strong need to develop similar guidelines in Nepal in collaboration with different stakeholders. Also, it is equally important to create public awareness so that public will be better informed about whom to consult for their skin concerns, and if needed report to governing bodies regarding negligence.Publication Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Bhusal, Mohan; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Koirala, Dinesh; Lamsal, Manoj; Kafle, Pradip KumarAbstract Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women. Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings.