Browsing by Author "Jha, AK"
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Publication Clinical Profile of Patients Presenting with Breast Cancer in Nepal(Kathmandu University, 2012) Acharya, SC; Jha, AK; Manandhar, TABSTRACT Background Breast cancer is the second most common cancer in women in Nepal. Even though the evaluation and treatment of patients is done as per western guidelines, there are considerable variations in risk factors, presenting stage and prognostic factors such as receptor status. Objective To evaluate the clinical profile of patients presenting with breast cancer in Nepal. Method The study was conducted at Department of Radiotherapy and Oncology, Bir Hospital and Department of Radiation Oncology, BP Koirala Memorial Cancer Hospital, Bharatpur from 16th July 2007 to 15th June 2008 for a period of one year and 114 patients were enrolled. Detailed history, clinical examination and necessary investigations performed. Histological features including receptor status were recorded. Tumor Node Metastasis (TNM) staging system was as per American Joint Committee on Cancer (AJCC), fifth edition. Data was collected in preformed case report form and was managed using SPSS version 13. Results The incidence was high (34.2%) among perimenopausal women age ranging from 41 to 50. The majority of women presented with lump (98.2%) and others with pain (21.9%), nipple retraction (16.7%), ulceration (7.9%), discharge (7%), or symptoms of metastasis (6.1%). Regarding receptor status, the majority (64.0%) were Estrogen receptor (ER) and Progesterone receptor (PR) negative with 21.9 percent. ER+PR+, Younger women were more likely to be both ER and PR negative. Where available, Her- 2 immunohistochemistry showed that 45.0 % of post menopausal women were Her-2 neative, compared to 64.0 % of premenopausal women. Incidence of Triple negative disease was 41.3 %. The most common stage at presentation was stage III (26.3%). Conclusion Majority of patients were perimenopausal, presenting with locally advanced disease (Stage III and Stage II) and with average tumor size two to five cm and were hormonal receptor negative. These findings are similar to other South Asian population but is inverse than profile reported in Western populations. KEY WORDS Breast Cancer, Estrogen Recepter (ER), Progesterone Recepter (PR), Human Epidermal Growth Factor Receptor - 2 (Her-2/neu)Publication katG (SER 315 THR) Gene Mutation in Isoniazid Resistant Mycobacterium tuberculosis(Kathmandu University, 2011) Marahatta, SB; Gautam, S; Dhital, S; Pote, N; Jha, AK; Mahato, R; Mishra, S; Poudel, BH; Ramasoota, P; Kaewkungwal, J; Singhasivanon, PABSTRACT Background Isoniazid (INH) together with Rifampicin (RFP) forms the cornerstone of a short chemotherapy course for tuberculosis (TB) treatment. Mutation at codon 315 of katG gene is most prevalent in isoniazid resistant Mycobacterium tuberculosis (MTB) and is high in area with high TB incidence. Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) has been found to be a reliable and effective tool for the identification of the specific gene alteration. Objective The objective of this study was to screen Ser315Thr mutation of KatG gene of INH resistant MTB strain by PCR-RFLP technique. Methods Altogether 37 INHr MTB isolates obtained from German Nepal Tuberculosis Project (GENETUP) Kathmandu Nepal was included in the study. Deoxyribonucleic Acid (DNA) extraction was performed according to protocol of SORPOCLEAN™ from the culture isolates. Amplification of the fragment with katG codon 315 was performed in a Biometra Thermocycler using primers. The amplified fragment was cleaved with MspI. The restriction fragments obtained were electrophoresed in a 2% agarose gel and were visualized using transilluminator. Results The katG Ser315Thr mutation was observed in 23 (62.2%) out of 37 INH resistant isolates. The drug susceptibility profile of INHr MTB isolates showed all isolates to be resistant to INH and RFP whereas 26 and 27 MTB isolates were resistant to Ethambutol (EMB) and Streptomycin (S) respectively. Seventeen (17) patients were harbouring katG gene mutated strain among Ethambutol and Streptomycin resistant cases. Conclusion The study identified high prevalence of Ser315Thr mutation in katG. The isolates harbouring this mutation were also simultaneously resistant to RFP. Ser315Th could be a potential genetic marker for predicting MDR-TB. KEY WORDS Isoniazid resistant MTB, katG gene, Mycobacterium tuberculosis, PCR-RFLP, mutation.Publication Publication Post Kala Azar Dermal Leishmaniasis (PKDL) Presenting with Ulcerated Chronic Paronychia Like Lesion(Kathmandu University, 2012) Jha, AK; Anand, V; Mallik, SK; Kumar, PABSTRACT A 50-year-old lady, resident of urban Bihar, presented with inflamed proximal nail fold of a single digit for one and half months. The lesion on distal finger was remarkable for ulceration. Mucocutaneous examination revealed multiple hypopigmented macules and patches, notable for absence of scaling. The presence of ulceration was not consistent with chronic paronychia, hence, she was asked for biopsy. She declined and opted for trial of antibiotic and anti-fungal treatment. At two weeks of follow up, no improvement was noted at all. At the same time, she developed multiple juicy papules in perioral area and on neck. She tested positive by rK 39 tests. Histopathology from periungual area showed LD body. She was diagnosed as Post Kala-azar dermal leishmaniasis and was treated with miltefosine 50 mg twice daily for three months, resulting in complete resolution of all lesions. KEYWORDS Post Kala azar dermal leishmaniasis, kala-azar, paronychia, ulceration, miltefosinePublication Teledermatology consulting centre: Which rural area is suitable?(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Shrestha, S; Jha, AKAbstract Keywords: Telemedicine; Teledermatology; Nepal; Sindhupalchowk; Teleconsulting centre; rural areas