Browsing by Author "Gyawalee, M"
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Publication Clinical Characteristics and Co-morbidities in Patients with Psoriatic Arthritis(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Paudyal, Buddhi Prasad; Gyawalee, MAbstract: Introduction: Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis and occurs in association with psoriasis, a chronic recurring and disfiguring skin disease. There is increasing recognition that both conditions are associated with multitude of co-morbidities. Objective: To delineate the clinical characteristics and co-morbidities in PsA patients attending a rheumatology clinic in Kathmandu valley. Material and Methods: Patients with already developed psoriasis who were seeking medical attention for arthritis during the period between January 2013 to December 2015 were prospectively enrolled. Patients were evaluated both by a dermatologist and a rheumatologist. A structured format was used to record relevant clinical information on psoriasis, PsA, and co-morbidities. Results: Among 55 patients with PsA, all were found to have plaque psoriasis mainly affecting extensor surfaces (64%), multiple areas (16%), and scalp (11%). Nail involvement was observed in 22% of patients. Symmetric polyarthritis was the most frequent (26%) form, followed by oligoarthrtis (18%), distal interphalangeal (DIP) joint arthritis (16%), spondyloarthritis (13%), and enthesitis-dactylitis (7%). Two thirds of patients were either overweight or obese. Almost half (47%) were current or past smokers. Diabetes or pre-diabetes was observed in 7% of cases. Hypertension, hyperlipidemia and ischemic heart disease (IHD) were present in 20%, 16%, and 5% respectively. Fatty liver disease was observed in 13% of the tested patients and 15% of patients were on some psychotropic drugs. Conclusion: Psoriasis with PsA was associated with both cardiovascular and non-cardiovascular co-morbidities. Doctors treating patients with these disorders should consider associated co-morbidities for better patient outcome. Keywords: psoriatic arthritis, co-morbidities, NepalPublication Eosinophilic Fascitis: A Rare Fibrosing Disorder(Kathmandu University, 2012) Paudyal, BP; Gyawalee, M; Sigdel, KABSTRACT Eosinophilic fasciitis is a rare systemic disease characterized by inflammatory thickening of the skin and underlying fascia, peripheral eosinophilia, elevated inflammatory markers and typical biopsy findings. Internal organ involvement is rare unlike in other fibrosing disorders. Though this is usually a benign disease, it is often difficult to diagnose and the course may also be variable. Glucocorticoids are the mainstay of therapy, but in many cases steroid sparing immunosuppressive drugs are required particularly if the diseases has protracted course. The author reports a typical case of this rare disorder which could well be a first report from Nepal. KEYWORDS Eosinophilic Fascitis, fibrosing disordersPublication Pattern Of Sexually Transmitted Infections And Sexual Behavior In Patients With Genital Symptoms(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Gyawalee, M; Pokhrel, DBAbstract: Background: Sexually transmitted infections are a major cause of acute illness, infertility, long-term disability, economic loss and death throughout the world. Despite the availability of effective treatment and preventive measures, incidence of STIs is increasing even in developed countries. STIs, acting as a facilitator for the spread of HIV have become a globally important issue at present context. Objectives: To determine the pattern of sexually transmitted infections along with their sexual behaviour in patients presenting with genital symptoms. Material and Methods: A cross sectional, descriptive study was carried out in the department of dermato-venereology, TUTH. During one year period, a total of 130 consecutive cases were enrolled in this study. The diagnosis of infections was made clinically with relevant laboratory investigations and they were interviewed for their sexual behaviour after taking consent and assuring confidentiality. Results: The average age of this population was 27.84 years. Majority belonged to age group 15-24 years, with male to female ratio of 3.19:1. Many (52.3%) were married. The most common infection was condyloma accuminata (29.2%). The mean age of sex debut was 18.95 years and majority (50.8%) belonged to 15-19 years group. The median number of life time partners was 2.0. Only 43 (33.1%) were on monogamous relationship. The 15-34 age groups had maximum number of sexual partners. Married person living singly had more frequent extramarital contact. Only 10 (7.7%) used condom consistently. Conclusions: Younger people should be educated about monogamous relationship along with correct and consistent use of condom for the prevention of STIs Keywords: Sexually transmitted infections, Sexual behavior