Browsing by Author "Karki, A"
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Publication Chromoblastomycosis mimicking Squamous Cell Carcinoma: a case report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Shrestha, R; Shrestha, Pan; Karki, AAbstract Chromoblastomycosis (CM), a chronic subcutaneous mycosis, is caused by several dematiaceous fungi, the most common being Fonsecaea pedrosoi . It usually occurs in the lower extremities following traumatic implantation of the organisms. We are reporting a case of rapidly developing case of CM on the unilateral lower limb with a fungating mass like ulcerative lesion and hyperkeratotic warty growth. We could not explain the pattern of this rapid growth which seems to be one of the rare presentations. Scraping from a verrucous lesion in potassium hydroxide preparation revealed mycelia arising from sclerotic bodies The histopathology from the warty lesion showed granulomatous lesion without muriform or medlar bodies. The histopathology from the ulcerative lesion did not show any malignant changes. Our case responded very well to itraconazole. This case is presented here for the rapidity of growth and the development of a fungating mass and bleeding that simulated the behaviour of squamous cell carcinoma.Publication Hemidiaphragmatic paralysis: A rare complication of cervical herpes zoster(Kathmandu University, 2006) Paudyal, BP; Karki, A; Zimmerman, M; Kayastha, G; Acharya, PHerpes zoster, a sequel of the reactivation of the varicella zoster virus, usually presents with cutaneous eruptions associated with intense pain and burning sensation in the affected dermatomes. Motor weakness, however, can sometimes complicate herpes zoster. In this report we present a case that had diaphragmatic motor weakness as a sequel of herpes zoster lesions in the neck. Key words: Herpes Zoster, Postherpetic Neuralgia, Hemidiaphragmatic ParalysisPublication Prevalence of Early Repolarization Patterns in Adults(Kathmandu University, 2016) Barakoti, MP; Karki, A; Chaulagain, MK; Karki, DBABSTRACT Background The finding of persistent Junction point elevation of 1 mm or more in adjacent leads in electrocardiogram is considered to be due to early repolarization. This condition was considered benign in the past but presently it is believed to be the rare cause of idiopathic ventricular fibrillation and sudden death. Objective The main objective of the study is to find out the prevalence of early repolarization pattern in subjects having electrocardiogram at Kathmandu Medical College Teaching Hospital. Method Twelve lead electrocardiograms of patients attending Kathmandu Medical College Teaching Hospital were studied. Data was collected for patient particulars. Electrocardiograms were analyzed for the type of early repolarization. Result The overall prevalence of early repolarization pattern of electrocardiogram was 2.82 %. It’s prevalence in male and female was 4.95 % and 0.77 % respectively. The prevalence of different types of early repolarization electrocardiography pattern was 0.70 %, 1.25% and 0.63% of the population studied for type I, II, and III early repolarization patterns. Type IV or Brugada pattern was not detected in our study. Conclusion The commonest pattern observed was type II that is early repolarization pattern in inferior or inferolateral leads. Having knowledge of early repolarization and its type helps to counsel the physicians about the risk of arrhythmia and sudden cardiac death. KEY WORDS Electrocardiogram, prevalence, repolarizationPublication Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study(Kathmandu University, 2009) Kalakheti, BK; Singh, R; Bhatta, NK; Karki, A; Baral, NAbstract Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A’ and ‘B’ blood group babies of O ‘+ve’ mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O’ positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O’ positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O’ positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O’ Positive blood group and 23 (62%) were from group of babies having other than ‘O’ Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O’ Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve’ blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibilityPublication 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, DABSTRACT 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.Publication Sweet's Syndrome: a case report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2009) Kayastha, BMM; Lama, L; Shrestha, P; Shrestha, R; Karki, AAbstract Sweet's syndrome is a disorder characterized by fever and painful skin lesions. The condition starts suddenly with the appearance of red, slightly raised tender plaques, usually on the back, arms, face or neck. Women are most at risk of Sweet's syndrome, predominantly between 30-50 years of age who have recently had an upper respiratory tract infection. Here we present a 70 years old lady who came with fever and tender erythematous plaques on trunk and limbs. On investigation, leucocytosis with raised ESR was found and the skin biopsy was consistent with Sweet's syndrome. There was dramatic improvement with systemic corticosteroid. Keywords: Sweet's Syndrome