Browsing by Author "Kumar, A"
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Publication A study of metopic sutures in human skulls(Kathmandu University, 2004) Bilodi, AK; Agrawal, BK; Mane, S; Kumar, AThe present study has been carried out in fifty-one adult human skulls for metopic sutures in the department of anatomy, Nepalgunj Medical College, Chisapani. Metopic sutures were found in six skulls (11.46 %) This study showed higher incidences of incomplete metopic sutures (7.84 %). One skull showed double incomplete sutures (one to right of bregma and other in the middle of the frontal bone in the mid line), which was of, a very rare variety seen in frontal bone of (1.96 %), three skulls showed incomplete sutures (3.92 %). Though the number of the skulls was small, the study showed a rare morphological variety, which was well correlated with earlier workers. Key words Metopism, incomplete metopic sutures, nasion, bregma, duplication of incomplete metopic sutures.Publication Anthropometric studies on students of the Nepal Medical College: Elbow breadth(2005) Kumar, A; Ramiah, SBackground: Body mass index is a valuable tool to assess the nutritional status of an individual. It can be used to identify subjects who are underweight and obese. The present study was conducted with a view to identify the prevalence of underweight and obesity among Nepalese medical students. The study also detects the body frame size of these medical students by elbow breadth measurements. Aim of study: To measure Body mass index and body frame size based on elbow breadth measurements. Materials and Methods: A total of 191 (males, 106) students participated in the study. The ratio of male to female was 1.24:1. The elbow breadth was measured by a vernier caliper (Tajima, Japan) to the nearest 0.1 mm. The body mass index (kg/m2 ) (BMI) was calculated using the height and weight measurements taken previously1 . Body frame size was obtained using a table 2 based on elbow width. Data were analyzed using Microsoft excel for Windows 98. Results: The study reveals that the prevalence of underweight and overweight in males of Nepal Medical college Vth batch were 30% and 1% and of IVth batch were 23.2% and 12.15% respectively. Of the females 38.6% and 2.2% of the IVth batch and 36.6% and 4.9% of the Vth batch were underweight and overweight respectively. The body frame size results indicted that 70% of the males and 61% of the females had small body frame. The study revealed a significant degree of under nutrition in male (26.4%) and female (20%) of Nepalese medical students. Conclusion: The present study observed that majority of the medical students of the Nepal Medical College were of small body frame size. Keywords: Anthropometry, Body frame size, Under nutrition, Nepal Medical College, and Medical StudentsPublication Efficacy of first-line, WHO recommended generic HAART regimens in Indian children(Kathmandu University, 2009) Parakh, A; Dubey, AP; Kumar, A; Maheshwari, A; Saxena RAbstract Background: The clinical efficacy of highly active antiretroviral therapy (HAART) in children has been well documented in the developed countries, although most of the regimens are Protease Inhibitor (PI) based which are too expensive. To circumvent this problem World Health Organization (WHO) has recommended Non- Nucleotide Reverse Transcriptase Inhibitor (NNRTI) based regimen for resource-limited countries. Aim: To assess the long-term efficacy of first line World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens in treatment –naïve children. Materials and methods: Observational retrospective analysis was done. Thirty patients on HAART for > 6 months were included (27 on Stavudine; three on Zidovudine with Lamivudine/ Nevirapine). No protease inhibitors were used. Results: median age was seven years (Interquartile [IQR]: 5.62-8.50) and median duration on HAART was 18 months (IQR: 6-24). No new staging events were observed after six months of initiation of HAART. The median CD4% increased from 6.0 % at baseline to 15.5% at six months, 21.7% at 12 months, 25.4% at 18 months, 24.6 % at 24 months 25.3% at 30 months and 23.7% at 36 months. There was only one case of immunological failure. Stratified analysis based on baseline CD4 % show that even patients with a baseline CD4 % of <5% achieved percentage of >25% at 18-24 months and maintained it subsequently. Significant increase in the weight and body mass index Z scores was observed but significant fall in the height Z scores were observed. This sub group of patients with poor linear height velocity would require detailed endocrine evaluation after testing for viral loads. Conclusions: Non- Nucleotide Reverse Transcriptase Inhibitor based HAART regimens are feasible and effective in long term in resource-limited setting despite initiation of treatment in advanced stages. These can be continued in NACO/WHO scale up programmes at present for children. Key words: HAART in children, India, NNRTI based HAART, resource limited settings, WHO prequalified Antiretroviral therapyPublication Profile of Vitiligo in Western Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Kumar, A; Neupane, S; Parajuli, S; Gurung, DAbstract Background Vitiligo is common worldwide. The highest incidence is reported from Indian subcontinent. However, there are only few studies available on epidemiology of vitiligo from Nepal Objective To determine the clinical patterns of vitiligo, the associated sociodemographic factors and its associated disorders among patients attending dermatology outpatient department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center Pokhara. Methods All patients presenting with signs and symptoms suggestive of vitiligo over a period of one-year (from march 2009 to march 2010 ) at the out-patient clinics in the Dermatology Department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center, Pokhara were included in the study. Socio-demographic details regarding age, sex, marital status, education and occupation were recorded .A detailed clinical history related to the presenting complain and clinical examination findings were recorded. Relevant available investigations were ordered based on signs and symptoms to determine if any associated disorders. Results Two hundred and twenty four patients with clinical diagnosis of vitiligo were studied. Males constituted 102 (45%) patients and females 122 (55%) of the total number of patients. Duration of disease at the time of presentation ranged from two weeks to 40 years. The lower limb was the initial site of onset of vitiligo in majority 77 (34.37%) of the patients, followed by the upper limbs, head and neck, trunk and mucosae in decreasing order of frequency. The commonest clinical pattern found was vitiligo vulgaris followed by acrofacial, segmental and mucosal types. Lesions showing leukotrichia were observed in 40 (18.87%) patients and koebnerization was observed in 42 (18.75%) patients. Eleven children had halo nevi. Associated abnormalities included alopecia areata (13 patients), diabetes mellitus (12 patients) and one patient had atopic dermatitis. A positive family history was obtained in 14(6.25%) of the patients. Conclusion Vitiligo vulgaris is on of the common clinical-type skin disorder observed in Nepal. There w e re associated disorders/abnormalities in some patients such as alopecia areata , diabetes mellitus and atopic dermatitis. Keywords Clinical Profile; Vitiligo; Western Nepal.Publication Scimitar syndrome(Kathmandu University, 2008) Kumar, A; Paudel, KAbstract A seven month old female child admitted to intensive care unit with increasing respiratory distress. Clinical examination revealed absence of cyanosis, wide and xed normal intensity second heart sound. Chest radiograph revealed crescent like radio opacity in right lower lung and subsequent contrast enhanced computed tomography (CT) chest demonstrated abnormal vessel in right lung draining into the inferior vena cava. Key words: Scimitar syndrome, partial anomalous pulmonary venous return, computed tomographyPublication Study of Pterion in skulls of awadh area-in and around Lucknow(Kathmandu University, 2003) Saxena, RC; Bilodi, AKS; Mane, SS; Kumar, ATwo hundred and three skulls of known sex (100 male and 103 female) were studied to find out the variations of Pterion. Sphenoparietal variety of Pterion was seen predominantly along with frontotemporal and stellate varieties. Key Words: Pterion, Sphenoparietal, frontotemporal, stellate.Publication Study of serum carbonic anhydrase activity, uric acid, C-reactive protein levels and lipid parameters in patients with Psoriasis(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2013) Das, S; Biswas, UK; Kumar, A; Roy, ANo Abstract:Publication The significance of lipid profile and positive Troponin in predicting cardiac event(Kathmandu University, 2009) De Silva LDR; Kumar, A; Sathian, BAbstract Background: Diagnosis of Acute cardiac event in the early stage of its onset is important in the treatment process. The development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac Troponin I ( cTnI )had made it possible. However Troponin indicates cardiac events only after its onset or after cardiac tissue necrosis. Traditionally such high risk subjects were identified using lipid profiles. The identification of subjects with high risk of developing cardiac event in the future is more significant as it will provide time to prevent such incidents. Objectives: In this study we proposed to study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive Troponin I test. Material and Methods: In this retrospective study data of the 259 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both Troponin and lipid profiles tests were compared with the lipid profiles of 105 normal healthy subjects (controls). The Trponin was detected qualitatively when a specimen contains Troponin I (cTnI) above the 99th percentile (TnI >0.5 ng/ml). The Total cholesterol (TC), High density lipoproteins cholesterol (HDL), Very low density lipoproteins (VLDL), and Triacyl glycerol levels (TG) were also analysed and low density lipoprotein level (LDL) was calculated using Friedelwald formula. Results: Subjects with chest pain and positive Troponin test ( with confirmed cardiac event ) were found to have significantly elevated levels of TC, TG , LDL and significantly reduced HDL levels when compared to the subjects who had only chest pain ( Negative Troponin) and healthy controls. Conclusion: Traditional lipid profile levels still can be used in screening populations to identify the subjects with high risk of developing cardiac event which is identified by highly sensitive and specific positive Troponin test. Key words: Troponin, Chest pain, Cardiac event, lipid profile,Publication Understanding Of Nepalese Patients With Vitiligo About Their Disease(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Agrawal, S; Kumar, A; Shyngwa, PMAbstract: Introduction: Vitiligo, a pigmentary disorder, may influence considerably patients’ health-related quality of life (QoL) and psychological wellbeing. Previous reports indicated that the patients' illness understandings influence adherence behaviors and actions in various chronic dermatological conditions. Objectives: To know the understanding of Nepalese patients with vitiligo about their disease by using illness perception questionnaire and also to investigate the potential factors that might influence it. Material and Methods: The illness perception questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 154 patients with vitiligo of 13 years or more age attending the dermatology OPD. Results: A total of 146 patients completed the questionnaire. The belief about the causes of vitiligo was considered as “germs or virus” by 64.4% patients while half of the patients believed that vitiligo was due to “chance or fate”. Vitiligo was considered to be a serious condition (83.6%) and have had serious consequences on their life (63%). Approximately half of the patients believed that their disease had serious economic and financial consequences more so in female patients and in those with generalized disease. Although 43.8% patients believed that their illness was likely to be permanent rather than temporary, 75% patients believed that vitiligo would improve with the time and their treatments were effective (75.3%). However, females felt that there were very little that could be done to improve their vitiligo. Conclusion: The knowledge about vitiligo is unsatisfactory and needs accessible, accurate, community based education about the natural history of vitiligo and the effectiveness of treatment. Keywords: Illness perception questionnaire, VitiligoPublication Unusually large prostatic utricle cyst(Kathmandu University, 2009) Paudel, K; Kumar, AAbstract Prostatic utricle cyst is one of the uncommon conditions and only a few cases have been reported. We present a case of unusually large prostatic utricle cyst in a 13- year- old male. He presented with burning urination and post-void dribbling of urine. A cystic mass was felt on digital per rectal examination. Ultrasound pelvis revealed a well-de ned midline cystic mass posterior to the urinary bladder. Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated uid containing cystic lesion communicating with posterior urethra. Surgical resection of the cyst was performed through the posterior sagittal approach. Follow up of the patient after three months of operation, there was complete resolution of the symptoms. Key words: Prostatic utricle cyst, MRI, Ultrasound