Browsing by Author "Gurung, D"
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Publication Apocrine Carcinoma Developing in a Naevus Sebaceous of Scalp(Kathmandu University, 2012) Paudel, U; Jha, A; Pokhrel, DB; Gurung, D; Parajuli, S; Pant, AABSTRACT Apocrine skin carcinoma is an aggressive cutaneous tumour. We report a case of apocrine carcinoma developing in a naevus sebaceous of scalp in a 45 years old male. Malignant transformation of Naevus sebaceous is a rare complication usually found in elderly patients. Most of these tumours are basal cell carcinoma or squamous cell carcinoma. Only few cases of apocrine carcinoma on naevus sebaceous have been previously reported. This report highlights the potential of naevus sebaceous for malignant transformation. KEY WORDS Apocrine, Basal cell carcinoma, carcinoma, hamartoma, nevus, Sebaceous of Jadassohn, skin.Publication Assessment of Oral Health and Nutritional Status of School Teachers in Dharamshala City, Himachal Pradesh(Kathmandu University, 2024) Gurung, D; Bhardwaj, VK; Fotedar, S; Thakur, AS; Vashisth, SABSTRACT Background Nutrition is associated with oral health and any changes in dietary habits have impacted nutritional profiles which in turn influences oral health status. Objective To assess the oral health and nutritional status among school teachers in Dharamshala city, Himachal Pradesh. Method A descriptive cross-sectional study was undertaken with interviews and documented using a structured and adapted WHO proforma. The oral health was assessed by using WHO oral assessment form 2013 (by tooth surfaces) and the nutritional status by using five day dietary recall and scored according to dental health dietary score. The dental health dietary scores included food group scores (FGS), nutritional evaluation score (NES), decay promoting potential scores (DPPS) for all five days. Result Almost, two third of the school teachers in both types of schools had an excellent Food Group Score (FGS) on all five days of dietary recalls. The mean total Decay Promoting Potential Score (DPPS) was 23.33±3.20 (minute). Approximately one- third of the teachers in both types of schools had DPPS scores within the “watch out” zone of dietary recall, ranging 15 or more on each day. The mean DMFT was 3.79±2.52 with mean total decayed teeth as 1.35±2.03. Similarly, the mean DMFS was 9.68±7.95 with the mean total decayed surfaces as 1.81±2.94. Conclusion The frequency of essential food groups remained consistent throughout the five- day dietary recall period. Carbohydrates formed the primary component whereas proteins were frequently missing from the diets. Frequent absence of protein intake in diet increased loss of attachment. KEY WORDS Nutritional status, Oral health status, WHO oral assessment for adultsPublication Development of Skin Disease Disability Index to Assess the Dermatologic Burden in Nepal(Institute of Medicine, 2013) Shrestha, DP; Shrestha, R; Gurung, D; Lama, L; Rosdahl, IAbstract Introduction: Skin disease is one of the leading cause of morbidity worldwide. Most instruments measuring the impact of skin disease on quality of life are developed in the west and not applicable measuring the impact of skin disease on quality of life are developed in the west and not applicable to the socio-cultural situation in Nepal. The aim of the study was to develop and validate a questionnaire to measure quality of life impairment due to skin disease in Nepal. Methods: Different aspects of quality of life impairment were identified from 35 in-depth. Different aspects of quality of life impairment were identified from 35 in-depth interviews and two focus group discussions, with villagers with various skin diseases. Based interviews and two focus group discussions, with villagers with various skin diseases. Based on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in 212 villagers with skin disease and in 100 healthy villagers. Results: The maximum total Skin Disease Disability Index score was 36. There was a wideThe maximum total Skin Disease Disability Index score was 36. There was a wide variation in total Skin Disease Disability Index score between individuals with skin disease variation in total Skin Disease Disability Index score between individuals with skin disease (range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001).(range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001). Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The difference in mean score for single questions between patients and controls was also highly significant (p<0.001). Conclusions: The questionnaire clearly covered all aspects of quality of life related to skin disease and was, simple, robust, easy to use and well accepted by the selected population. The Skin Disease Disability Index was reliable in the overall score as well as in individual questions.Publication Endovascular Treatment for Traumatic Thoracic Aortic Injury: A Case Report(Institute of Medicine, 2018) Shrestha, UK; Shrestha, KR; Gurung, D; Upreti, MR; Adhikari, A; Gurung, AAbstract As majority of blunt traumatic injury with aortic tear die, we see limited numbers of survival in the hospital. Thoracic endovascular treatment for traumatic aortic injury is rare. Endovascular treatment, where available, is the trend for traumatic aortic injury for all age group. Both morbidity and mortality are significantly decreased with endovascular intervention. Twenty nine years old male patient driving a car collided with truck and had thoracic aortic pseudoaneurysm with multiple skeletal fractures that underwent successful endovascular stent graft along with fixation of all fractured bones. Key words: Endovascular stent graft, Thoracic aortic injury, Thoracic aortic pseudoaneurysm, Thoracic endovascular aortic repairPublication Mobile teledermatology for rural Nepal: Dermatologic care using mobile phone in a primary health care centre(Institute of Medicine, 2016) Shrestha, DP; Suwash, B; Gurung, D; Uprety, A; Bhattarai, SAbstract Introduction: Skin diseases are among the five most common health problems in Nepal. We have now tested the validity of mobile teledermatology with mobile phones to find a safe and easy way of diagnosis and treatment of skin diseases for the most vulnerable people in remote areas without access to derma- tologists. Methods: A medical officer at a primary health care centre examined the patient, obtained information of the patient and the skin disease, took photographs of the skin lesions. Then he transmitted all these data via Viber to a dermatologist in Kathmmandu, who in real time formulated diagnosis and treatment and sent it via Viber to the medical officer. Subsequently the patient was examined face to face by a blinded dermatologist at the same primary health care centre. The time taken for each modality of consultation was recorded. A third dermatologist analysed and compared the diagnoses formulated during telederma- tology and the face to face consultations. Results: Altogether 107 skin diseases were diagnosed in 101 patients. There was an overall concordance of 88% between the diagnoses of skin diseases by mobile teledermatology and face to face consultations (Cohen k coefficient 0.85). The average face to face consultation time was 5 minutes, while it was 7 min- utes more for teleconsultation. More than 75% of the photos were of good quality. Conclusions: Mobile teledermatology using smartphones is a reliable, useful, cost effective method to provide expertise for improving dermatologic care for the needy population in rural and remote parts of Nepal. Keywords: teledermatology, dermatologic care, rural Nepal, mobile phonesPublication Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples(Kathmandu University, 2020) Adhikari, S; Khadka, S; Sapkota, S; Sharma, BR; Ghimire, A; Chalise, M; Gurung, D; Kunwar, SABSTRACT Background Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum beta- lactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum beta- lactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking. KEY WORDS Antimicrobial susceptibility testing, Extended spectrum beta-lactamase, Fresh chicken liver samples, Multi-drug resistant, SalmonellaPublication Pattern Of Skin Diseases In A Rural Village Development Community of Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Shrestha, R; Shrestha, DP; Lama, L; Gurung, D; Rosdahl, IAbstract: Introduction: Skin diseases are a common cause of morbidity in Nepal as per the health services report. There is limited information on the prevalence and pattern of skin diseases in the community. The objective of this study was to determine the pattern of skin diseases in a rural village development community of Nepal. Materials and methods: Two dermatologic health camps were conducted, during which, the villagers were examined by dermatologists. The skin diseases diagnosed were recorded in a proforma. Results: There were 433 individuals examined and 359 (male-47.9%; female-52.1%) had skin disease identified clinically (camp prevalence- 83%). The age of patients ranged from 1 to 80 years (mean-24.5; SD±15.9), with majority in the age group of 10-19 years. The most common skin disease category was eczemas (36.4%), followed by infections (28.4%), acne (22%), pigment disorders (34%) and urticaria (12.3%). Conclusion: Skin diseases were common in the community. The five most common Skin disease categories were eczemas, infections, acne and pigment disorders were the more common conditions. Keywords: Acne, eczema, infection, pattern of skin diseases, pigment disorder, village development communityPublication Prevalence of skin diseases and impact on quality of life in hilly region of Nepal(Institute of Medicine, 2012) Shrestha, DP; Gurung, D; Rosdahl, IAbstract Introduction: Skin diseases (SDs) are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of SDs and impact on quality of life (QoL) in a rural community in Nepal. Methods: A house-to-house survey was conducted in a community with 3,207 inhabitants, to obtain socio-demographic data and identify individuals with SDs. Free examination and treatment was offered at 4 health camps. Individuals with long-standing SDs were interviewed using the Dermatology Life Quality Index (DLQI). Results: Of 735 individuals attending the health camps, 645 (mean age 24.9 years, range 0.5 -90) had one or more SDs. The overall prevalence of SDs was 20.1% (males 18.1%, females 22.5% and children 28.2%). The most common SD categories were eczemas (12.2%), pigment disorders (4.1%), acne (2.7%), urticaria (2.4%) and moles and lumps (1.6%). In the Nepalese culture, the DLQI question on sexuality was too direct so only 9/10 questions were used. In the 75 patients who were interviewed, the mean DLQI score was 10.7 (range 7-19), indicating a large impact on QoL. Conclusions: This population-based study shows that SDs were very common in a rural community in Nepal. The five most common SD categories comprise 77% of all SDs. Targeted training should enable health-care workers to prevent, accurately diagnose and manage these problems on site. An appropriate instrument to measure QoL adjusted to the socio-cultural norms of Nepal has to be developed. Keywords: Prevalence, Quality of life, Skin diseasePublication Profile of Vitiligo in Western Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Kumar, A; Neupane, S; Parajuli, S; Gurung, DAbstract Background Vitiligo is common worldwide. The highest incidence is reported from Indian subcontinent. However, there are only few studies available on epidemiology of vitiligo from Nepal Objective To determine the clinical patterns of vitiligo, the associated sociodemographic factors and its associated disorders among patients attending dermatology outpatient department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center Pokhara. Methods All patients presenting with signs and symptoms suggestive of vitiligo over a period of one-year (from march 2009 to march 2010 ) at the out-patient clinics in the Dermatology Department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center, Pokhara were included in the study. Socio-demographic details regarding age, sex, marital status, education and occupation were recorded .A detailed clinical history related to the presenting complain and clinical examination findings were recorded. Relevant available investigations were ordered based on signs and symptoms to determine if any associated disorders. Results Two hundred and twenty four patients with clinical diagnosis of vitiligo were studied. Males constituted 102 (45%) patients and females 122 (55%) of the total number of patients. Duration of disease at the time of presentation ranged from two weeks to 40 years. The lower limb was the initial site of onset of vitiligo in majority 77 (34.37%) of the patients, followed by the upper limbs, head and neck, trunk and mucosae in decreasing order of frequency. The commonest clinical pattern found was vitiligo vulgaris followed by acrofacial, segmental and mucosal types. Lesions showing leukotrichia were observed in 40 (18.87%) patients and koebnerization was observed in 42 (18.75%) patients. Eleven children had halo nevi. Associated abnormalities included alopecia areata (13 patients), diabetes mellitus (12 patients) and one patient had atopic dermatitis. A positive family history was obtained in 14(6.25%) of the patients. Conclusion Vitiligo vulgaris is on of the common clinical-type skin disorder observed in Nepal. There w e re associated disorders/abnormalities in some patients such as alopecia areata , diabetes mellitus and atopic dermatitis. Keywords Clinical Profile; Vitiligo; Western Nepal.Publication Psoriasis: Clinical and Epidemiological Features in a Hospital Based Study(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Shrestha, D P; Gurung, DNA Keywords: Psoriasis, prevalence, clinical types, ethnic distribution, age at onset, age at first medical visit, NepalPublication Skin Diseases and Impact on Quality of Life in the Central Development Region Of Nepal: A Major Public Health Problem(Institute of Medicine, 2014) Shrestha, DP; Gurung, D; Shrestha, R; Rosdahl, IAbstract Introduction: Skin diseases are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of skin diseases and impact on quality of life in the rural areas of central development region of Nepal. Methods: The study was conducted in the 10 VDCs of 4 districts – Dolakha, Kavre, Makawanpur and Chitwan – of the central development region. A house-to-house survey was carried out to obtain socio-demographic data and identify individuals with skin diseases. Then a dermatologic health camp was conducted in each VDC. During the health camp, the skin diseases diagnosed were recorded and villagers with skin diseases more than 1 month duration were interviewed with skin disease disability index, to assess the impact on the quality of life. Results: A total of 7348 inhabitants (male – 3651, female – 3787) were surveyed. Of 2586 individuals with skin disease attending the health camps, 1862 (male – 721 and female – 1141, mean age 31.4yrs, range 6 months – 90years) were included in the study. The overall prevalence of skin diseases was 25%. The most common SD categories were eczemas, pigment disorders, fungal infections, nevi and urticarial. The mean skin disease disability index score in the central development region was 13.7, indicating very large impact on the quality of life. Conclusion: The prevalence of skin diseases and impact on quality of life is very high in the rural areas of the central development region of Nepal. It is a major public health problem. Targeted intervention at the primary health care level should help to reduce the burden. Keywords: skin disease, prevalence, impact, qyality of life