NepMed Repository :: Browsing by Author "KC, S"

Browsing by Author "KC, S"

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Breech Presentation Among Nullipara at Term: An Indication for Caesarean Section
(Kathmandu University, 2012) Dongol, A; Regmi, S; Manandhar, S; KC, S
ABSTRACT Background Breech is the commonest malpresentation. Vaginal breech delivery in a nulliparous lady carries higher risk than in multiparous ladies. Poor neonatal outcome following vaginal delivery has made the mode of delivery a matter of controversy. Objective To evaluate the outcome of planned caesarean section among nullipara ladies with breech presentation. Method This is a prospective, analytical study conducted in Dhulikhel Hospital Kathmandu University Hospital from January 2008 to June 2012 among 102 nullipara ladies at term gestation with breech presentation. All cases underwent caesarean section either elective or emergency. During section cause of breech presentation was searched for. Neonatal condition was evaluated using APGAR Score, need for resuscitation and admission in NICU. Post partum status was also recorded for evaluation of maternal morbidity and mortality. Results These Nullipara ladies often had some reason for breech presentation, the most common being cord around the neck. Perinatal outcome was uneventful in 97(95%) neonates, there were two (2%) still birth and three (3%) needed NICU care. APGAR was good in 92 neonates, average in eight and poor in two. Total 16(15.6%) ladies stayed hospital for more than eight days. Among them 11(10.7%) developed wound infection and five stayed in hospital waiting for baby. Conclusion Nullipara ladies with breech presentation should have elective caesarean section as a preferred route of delivery. KEY WORDS Caesarean delivery, mode of delivery, primi breech, vaginal delivery
Clinico-etiological Profile of Melasma among Female Health Workers in a Tertiary Care Center of Central Nepal - A Cross Sectional Study
(Kathmandu University, 2017) Karn, D; Subedi, A; KC, S
ABSTRACT Background Melasma is an acquired symmetrical dyschromia with profound psychosocial impacts. It is a common pigmentary disorder with less clear etiology and limited management options. There are limited data regarding melasma in our scenario. Objective To evaluate the clinico-etiological profile of melasma, among the female health workers (FHW) in a tertiary health center. Method This is a single center, cross-sectional, descriptive study involving female health workers with or without melasma. A total of 198 female health workers were evaluated at Dhulikhel hospital Kathmandu university hospital for clinic-etiological profile of melasma in January 2017. Video-dermatoscopy was used for the clinical diagnosis of melasma. A structured, self-administered questionnaire was used for assessment. Risk factor assessment of etiological agents as sun exposure, hormonal medication, photo aggravating drugs, stressors as night duty were evaluated. Result The point prevalence of melasma among female health workers 20.7% (n=41). The mean age of respondents was 26.2 ± 3.23 years with duration of disease process 3.6 ± 2.5 years. Centro-facial pattern was the commonest clinical type (53.7%) and video-dermatoscopy revealed mixed pattern as the commonest (56.1%) pigment deposition pattern. Among 132 female health workers doing night duty on regular basis, 23 had melasma while 66 female health workers not doing night duty, 18 had melasma (p = 0.10). Whereas while comparing hours of night duty per week among respondents with melasma (n=23) and without melasma (n=18) were 23.72±10.08 hours and 17.8±4.77 hours respectively (p=0.02). Conclusion The present study reveals higher prevalence of melasma among female health workers having more stressors as night duty. KEY WORDS Female, health worker, melasma
Combination Topical PUVAsol with Methotrexate Versus Methotrexate in the Treatment of Palmoplantar Psoriasis
(Kathmandu University, 2016) Karn, D; KC, S
ABSTRACT Background Non-pustular palmoplantar psoriasis (PPP) is chronic and disabling dermatosis. Topical psoralen and solar ultraviolet - A therapy (PUVAsol) is efficacious and safe therapy in psoriasis management. Objective To study the efficacy and adverse clinical effect profile of topical PUVAsol along with methotrexate in PPP. Method This is a prospective, randomized, clinical trial conducted among 54 patients with moderate to severe PPP. Patients were grouped into two categories. Group I was treated with weekly oral methotrexate only while group II had additional soak PUVAsol therapy twice weekly for a total of three months. Modified palmoplantar psoriasis area severity index (mPPPASI) score was used for quantification of severity. Patients were followed up monthly for the efficacy and adverse clinical event profile for 3 months; additionally patients were followed up monthly for next three months for assessment of relapse. Result The mean age of patients with PPP was found to be 38.7 ± 13 years and male: female ratio was 1.1:1. In comparison to group I patients, statistically significant improvement was observed among group II patients in the third month follow up (p= 0.039). Fifteen patients (35%) achieved mPPPASI 75 during the treatment period. No significant difference was noted among the mPPPASI score during relapse assessment. Eleven (29%) patients had evidence of relapse (mPPPASI more than 25% of baseline) during follow up period. No statistically significant adverse clinical events were noted. Conclusion Topical PUVAsol is an efficacious, safe and cost effective modality in moderate to severe PPP. It could be employed in rotational or maintenance therapy of psoriasis. KEY WORDS Palm, psoriasis, PUVA therapy
Concurrent Vitiligo and Psoriasis
(Kathmandu University, 2012) Karn, D; KC, S
ABSTRACT Coexistence of vitiligo and psoriasis in a single patient is a rare occurrence. The exact pathogenesis of this coexistence is obscure. Various autoimmune disorders are reported to occur more frequently in patients with both diseases. A case of this interesting coexistence seen on a 26 year old female patient who presented to the dermatology department of Dhulikhel hospital is presented here. She also had hypothyroidism. The possible pathogenesis and literature review of this rare condition is discussed here. KEYWORDS Vitiligo, psoriasis, autoimmune disorders, hypothyroidism
Diseases in Disaster: Post-Earthquake Dermatoses, Nepal 2015
(Kathmandu University, 2016) KC, S; Khanal, L; Ojha, A; Karn, D
ABSTRACT Nepal experienced a devastating earthquake measuring 7.8 Richter scale on 25th April 2015. Although the heightened effects were secondary to trauma, the indirect effects were also of prime importance. We came across different dermatoses, directly or indirectly secondary to earthquake. We here present an audit of the cutaneous effects following four months of the major shock presenting to a tertiary care center of central Nepal. A total of 7326 patients presented to the dermatology department over a period of four months following the major shock. Among them a total of 3833 patients (52.32%) had direct or indirect dermatoses following earthquake. KEY WORDS Disaster, dermatoses, Nepal
Knowledge and Practice of Health Care Workers regarding Needle Stick Injuries in a Tertiary Care Center of Nepal
(Kathmandu University, 2015) Singh, B; Paudel, B; KC, S
ABSTRACT Background Needle stick injuries are common health hazards among health care workers. Considering the increasing prevalence of body fluid borne infectious diseases; knowledge regarding the common errors and universal precautions are vital for the prevention of such accidents. Objective This study aimed to assess for knowledge and practice approaches among health care workers regarding needle stick injuries. Method This is a cross sectional survey was conducted using an anonymous, self-reporting 25-item structured questionnaire at a tertiary care center of central Nepal. A total of 165 health care personnel of working experience of more than 6 months were included in the study. Questionnaire included aspects of prevalence and knowledge on needle stick injury, hepatitis B immunization status and post exposure prophylaxis for HIV. Result Prevalence of needle stick injury was found to be 703 per 1000 health care worker (70.3%) during their working tenure and majority of the injury happened among nurses (p<0.05) besides other professions. Seventy nine (47.9%) participants experienced the injury more than one time in their career and the mean number of injury was 2.06±1.16. The practice of needle recapping is still prevalent and 80% participants often use single handed technique. Vaccination against hepatitis B virus was not completed by 31% health workers. Inadequate knowledge about post exposure prophylaxis for HIV was reported by 46% participants. Conclusion High prevalence of needle stick injury with a high rate of ignorance was noted. These issues need to be addressed, through appropriate education and interventional strategies. KEY WORDS Needle stick injury, post exposure prophylaxis.
Lichen Planus Pigmentosus: A study for association of Thyroid Dysfunction
(Kathmandu University, 2016) Karn, D; KC, S; Timalsina, M
ABSTRACT Background Lichen planus pigmentosus (LPP) is considered a chronic and progressive variant of lichen planus. Although pigmentation occurs in the sun exposed areas, the etiology remains unknown and there are no appropriate treatment guidelines. Association with thyroid disorder has been described in various disorders of pigmentation. Objective The objective of this study was to find the association between LPP and thyroid dysfunction. Method A total of 54 clinically diagnosed cases of LPP and 54 age and sex matched healthy control volunteers were included in this case control study. Thyroid function test and thyroid peroxidase antibody were analysed to determine the probable association between thyroid diseases and LPP. Result Seventeen (31.7%) patients had biochemical evidence of hypothyroidism and 3 had hyperthyroidism among the diseased group. Among the control group two persons were tested positive for hypothyroidism (c2 = 0.34; p <0.05). Similarly, the levels of thyroid peroxidase antibody in the LPP patients were found to be significantly higher than those of controls (p<0.05). Conclusion Thyroid disorder was found to be an associated factor in LPP. Hence, we recommend routine thyroid function tests in patients with LPP. Further research is warranted among large number of patients to elucidate the exact association. KEY WORDS Lichen planus pigmentosus, thyroid disorders
Oral Tranexamic Acid for the Treatment of Melasma
(Kathmandu University, 2012) Karn, D; KC, S; Amatya, A; Razouria, EA; Timalsina, M
ABSTRACT Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. KEY WORDS Melasma, tranexamic acid
Practical Aspects in Topical PUVAsol in Dermatology: An Experience in a Teaching Hospital
(Kathmandu University, 2014) KC, S; Karn, D
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Prevalence of Sexually Transmitted Infections in a Tertiary Care Centre
(Kathmandu University, 2011) Karn, D; Amatya, A; Aryal, ER; KC, S; Timalsina, M
ABSTRACT Background The burden of sexually transmitted infections is huge and is disproportionately affecting developing nations. In Nepal, recent available data on sexually transmitted infections are mostly targeted to high risk population. A prevalence study was thus done to explore the pattern of sexually transmitted infection syndromes among general population of Nepal. Objectives To highlight the prevalence and changing pattern of sexually transmitted infections among general population. Methods A retrospective study. The study was conducted among 145 patients attending Department of Dermatology and Venerology, Dhulikhel Hospital Kathmandu University Hospital, for voluntary counseling and testing from April 2010 to April 2011. Syndromic case management approach was used for the classification and treatment of the patients. Results 106 patients were suffering from Sexually Transmitted Infections and 2 patients were positive for Human Immunodeficiency Virus. The most common diagnosis was genital viral infections (41.7%). Prevalence was highest among drivers/conductors (26.9%) and migrating workers (23.1%). Age group 20 to 24 years was the maximum sufferers (37%). Unsafe sexual activity (66.7%) was the most potential exposure and majority of the patients were not consistent in using condom. Conclusions Genital viral infections constitute the major bulk of sexually transmitted infections. Majority of the patients suffering from sexually transmitted infections were in the age group 20 to 24 years and were mostly drivers, conductors or migrating workers by occupation. In the background of few available baseline data, the results are expected to assist successful target interventions in the near future. KEY WORDS prevalance, sexually transmitted infection
Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser Therapy for Pigmented Skin Lesions: Efficacy and Safety
(Kathmandu University, 2012) Karn, D; KC, S; Amatya, A; Razouria, EA; Timalsina, M; Suwal, A
ABSTRACT Background Nepalese population with Fitzpatrick skin types III-V has high prevalence of pigmentary disorders and it is a growing cosmetic concern. Q-Switched Neodymium- Doped Yttrium Aluminum Garnet (QS Nd-YAG) laser is an efficacious tool in the treatment of pigment disorders. Objective To highlight the efficacy and safety profile of various pigment disorders. Methods A prospective study done in Dhulikhel Hospital, Kathmandu University Hospital from January 2009 to January 2011. Patients undergoing laser for pigmented skin lesions were followed for response and safety profile. We included total 270 patients in the study with various disorders especially nevus, tattoos and melasma. Settings were repeated at 3-4 weeks interval and response was evaluated on clinical basis. Efficacy was then evaluated according to various parameters. Results For nevus, total 840 treatment sessions had been performed with an average of 6.88 sessions (range 3-11). Nd: YAG laser was very efficacious in removal of blue and black colored tattoos with an average of 7.9 and 9.5 sessions respectively. However, red mixed with blue and or green tattoos were relatively resistant to treatment and required average 10.33 treatment sessions. Melasma and freckles both responded to the therapy but recurrence rate was high. Conclusion Our results indicate that QS Nd: YAG laser is an effective modality for pigment disorders among Nepalese population. Nevus and melasma respond well but recurrence rate of melasma is high. Blue tattoos respond well while mixed colored tattoos are quite resistant to Nd: YAG laser alone. Transient pain and temporary hyperpigmentation are common side effects. KEY WORDS Laser, melasma, nevus, tattoo
Renal Impairment Among Patients With Pelvic Organ Pro- lapse in a Tertiary Care Center
(Kathmandu University, 2013) Dongol, A; Joshi, KS; KC, S
ABSTRACT Background Pelvic organ prolapse is a multidimensional phenomenon. The manifestations of renal involvement following pelvic organ prolapse ranges from acute to chronic renal failure and may also lead to end stage renal failure. Prolonged duration and its severity in pelvic organ prolapse are responsible for renal impairment. Objectives This study will find out the incidence of renal impairment among women with pelvic organ prolapse undergoing surgical management. It will also help to establish the association of renal impairment with degree and duration of pelvic organ prolapse. Methods This prospective study includes cases of pelvic organ prolapse who underwent surgical management from the year 2009-2012 in Dhulikhel hospital. Total 140 cases were assessed with age, duration and different symptoms. Clinical examination was done to find out the degree of prolapse and graded according to Baden Walker classification. Urine routine and microscopic examination, renal function test and abdominopelvic sonography were performed routinely. Renal impairment was assessed using hydronephrosis and creatinine clearance. Creatinine clearance was calculated using patient’s weight and serum creatinine value by Cockcroft and Gault formula. Results Among 140 cases, 8 (5.7%) patients had procedentia, 106 (75.7%) had third degree, 22 (15.7%) had second degree, and four (2.8%) patients had first degree uterine prolapse. The mean duration of prolapse was found to be 11.47 years. Total 5 (3.57%) patients had hydronephrosis. Four had moderate and one had severe hydronephrosis. Total 49 (34.1%) patients had moderate to severe renal failure. Forty six (32%) in stage III moderate reduction in creatinine clearance, 2 (1.4%) with severe reduction and 1(0.7%) in end stage renal failure. Conclusion Renal impairment is a common entity among women with pelvic organ prolapse. Both hydronephrosis and degree renal impairment correlates correspondingly with the duration and severity of prolapse. KEY WORDS Creatinine Clearance, hydronephrosis, pelvic organ prolapse, renal impairment
Study on Corticosteroids use Pattern in Dermatological Practice and Investigating Adverse Effect of Corticosteroids Including its Associated Factors
(Kathmandu University, 2015) Shakya Shrestha, S; Bhandari, M; Shrestha, R; Thapa, SR; Karki, A; Prajapati, M; Shrestha, S; KC, S; Karna, D
ABSTRACT Background Corticosteroids are highly effective drugs with anti-inflammatory and immunosuppressive properties. Due to this, they have become a mainstay of pharmacotherapy in dermatology. However, improper and long term uses are associated with a number of serious adverse effects. Objective To investigate the corticosteroids use pattern, adverse effects and various factors associated with adverse effects in dermatological practice. Method A cross-sectional study was conducted in a dermatology department of tertiary care hospital. All patients using at least one corticosteroids, either topically or systemically or the combination were included in this study. Informed consent was taken from the patients and interviewed using structured questionnaire. Statistical analysis was performed by using SPSS 20. p-value < 0.05 was considered as statistically significant. Result Among the 60 participants under this study, 81.67% of them were females. The mean (±SD) age of the patients was 31.03 years (±15.0). A majority (58.30%) of the patients was prescribed with topical corticosteroids with low potency (25%). Most of them had used corticosteroids for urticaria. Adverse effects were reported by 33.30% of the patients. The most common adverse effect reported was the shedding of skin. Adverse effects was significantly associated with gender; use of systemic corticosteroids; regular use of corticosteroids; discontinuation of dose abruptly; and missed dose. However, there was no significant association between adverse effects and the duration of use of corticosteroids. Conclusion In conclusion, the present study suggested that the proper counselling and clear instruction regarding the use of corticosteroid should be provided to the patients for avoiding the abrupt discontinuation of the prescribed medication leading to treatment failure. KEY WORDS Adverse effect, corticosteroid, dermatology, treatment failure.

Browsing by Author "KC, S"

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