Browsing by Author "Joshi, SN"
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Publication Alport’s syndrome(Kathmandu University, 2010) Bastola, P; Joshi, SN; Chaudhary, M; Shah, DNAbstract Alport’s syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed. Key words: Alport’s syndrome, Anterior lenticonus, Oil droplet sign, Anterior capsular cataract, Perimacular flecksPublication Antibiotic sensitivity pattern on cluster endophthalmitis caused by Gram negative organism(Institute of Medicine, 2017) Thapa, M; Gautam, P; Joshi, SN; Khanal, SAbstract Introduction: Endophthalmitis is a rare but devastating complication of intraocular surgery occurring in 0.07%-0.3% of total surgeries. With the introduction of Phacoemulsification through corneal incision, incidence of endophthalmitis has increased in recent days. Outcome of endophthalmitis is worse when it is caused by gram negative organisms. Methods: Hospital based prospective study of cluster endophthalmitis following cataract surgery done on a single day. Surgeries were performed at BP Koirala Lions Centre of Ophthalmic Studies, IOM, Kathmandu, Nepal. Results: 8 cases of acute endophthalmitis following cataract surgery were included in the series. Out of them 8, 87.5% (7) had isolates in the both anterior chamber and vitreous tap. Ali patients had infection due to e-coli. 4 cases had mixed growth of E.coli and Staph. aureus in vitreous and anterior chamber both 3 patients had growth of E.coli only in both vitreous and anterior chamber. And 1 patient had growth of E.coli in vitreous only. All the patients complaint of severe pain after few hours of surgery, Visual acuity in 6 patients was CFCF and 1 patient was hand movement (HM), 1 patient had perception of light only. Intravitreal injection of vancomycin (1 mg/0.1ml) and Amikacin (0.4mg/0.1 ml) and Dexamethsone (0.4mg/0.1ml) was given in all cases after AC and Vitreous tap on the first day. On 2nd day all patients underwent vitrectomy and intra vitreal injection repeated in half dose. Out of 8 cases, 3 (37.5%) developed RD. 1 (12.5%) had to undergo evisceration. 1 (12.5%) patients developed cornel opacity, 3(37.7%) patients has good visual recovery visual acuity of 6/6-6/36. Conclusion: Even after aggressive treatment acute postoperative endophthalmitis due to gram negative bacteria has a bad prognosis. Keywords: endophthalmitis, gram negative organisms, E-coliPublication Idiopathic Chylothorax in Infants - Is Octreotide Alone Enough?(Nepal Paediatric Society (JNPS), 2015) Maralihalli, MB; Matti, MR; Joshi, SN; Annigeri, VMAbstract: Five month old female baby presented to us for evaluation of asymptomatic right sided pleural effusion. Pleural fluid analysis revealed it as chylous effusion. Radiological investigations revealed gross right side pleural effusion with partial collapse of right lung. After investigations, diagnosis of asymptomatic idiopathic chylothorax was made. Baby was treated with Inj. Octreotide alone. Pleural drain was not placed. After three doses of Octreotide, there was complete clearance of pleural effusion.Publication Retinoblastoma at a tertiary level eye centre, Nepal(Institute of Medicine, 2018) Shrestha, JB; Shrestha, GB; Joshi, SNAbstract Introduction: Retinoblastoma is the most common intraocular malignant tumor in children occurring in approximately 1 in 18,000 live births. With early detection and management, lives of many children can be saved, eyes can be preserved and vision can be restored. The study was aimed at finding out the clinical features, methods of management and outcome of the disease in a tertiary eye care centre of institute of medicine in Nepal. Methods: A prospective case series study was done between 2014 -2017 at BP Koirala Lions Centre for Ophthalmic Studies, Institute of medicine, Nepal. The diagnosis of retinoblastoma was made on the basis of history and clinical examination. Additional information was obtained from radiological procedure whenever required. International classification of retinoblastoma (Shields) was used to clinically classify the retinoblastoma lesion and the management depended on the stage of the disease. Results: A total of 36 patients with retinoblastoma fulfilled the inclusion criteria of the study, 23 males and 13 females with sex ratio: 0.57. Median age at diagnosis was 36±13.825 months. In 19.4% of cases the disease was bilateral. Leukocoria, red eye and proptosis were common signs observed in 46.5%, 33.3 % and 16.3% of case respectively. Enucleation and exenteration were the commonest modality of treatment. Six patients died during the course of treatment and during follow up period and 8 patients were lost before one year of follow up. Conclusions: Despite the advances in the field of retinoblastoma, the prognosis still remains poor due to delay in presentation in our centre. Key words: management, Nepal, retinoblastomaPublication Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA(Kathmandu University, 2009) Pokharel, S; Shah, DN; Joshi, SN; Choudhary, MAbstract Background: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent world- wide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. Objective: To determine level of immunoglobulin E (IgE) in the tear film of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Materials and methods: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme – linked immunosorbent assay (ELISA). Results: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p= 0.72). Conclusion: There was high concentration of tear IgE level observed in VKC. Key words: Vernal keratoconjunctivitis, Tearfilm, IgE level, Type I hypersensitivity reaction, Type IV hupersensitivity reaction.