NepMed Repository :: Browsing by Author "Parajuli, Niraj"

Browsing by Author "Parajuli, Niraj"

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Blistering Diseases in a Tertiary Care Hospital: A 10-year Audit
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Parajuli, Niraj; Lama, Laila; Karki, Anupama; Shrestha, Rushma; Tiwari, Sumida; Kayastha, Bhaskar MM
Abstract: Introduction: Cutaneous blisters can occur in variety of conditions. They are broadly classified as immunobullous or non-immunobullous. Immunobullous blistering diseases can further classify as intraepidermal or subepidermal. Non-immunobullous blistering disease are commonly due to infections, drugs among others. Some of the blistering disease carry significant mortality and morbidity. There are only limited data on blistering diseases from Nepal, so this study will provide details on the prevalence of this rare dermatological disease from one of the tertiary care referral hospital in the country. Objective: To assess the clinical pattern and prevalence of various blistering diseases in a tertiary care referral hospital. Materials and Methods: All of the data were obtained from the admission register maintained at department of dermatology and venereology, National Academy of Medical Sciences. All the patients admitted with blistering disease from year April 2008 till March 2018 were included. The details including age, sex, type of blistering disease and length of hospital stay were recorded. Results: A total of 710 patients were admitted in the dermatology ward over the period of 10 years. There were a total of 193 blistering disease admitted during this period. Autoimmune blistering disease was diagnosed in 59 patients whereas 100 patients had non-immunobullous disease. The age grouped range from 4- 93 years with the mean age of 43± 19.71 years. The average number of hospital stay of all blistering diseases was 11.73±11.36 days. Conclusion: Blistering diseases are one of the most common conditions requiring admission in dermatology ward. Some of these diseases carry a significant morbidity and mortality. So, prompt diagnosis and treatment is of utmost importance. Keywords: Autoantibodies, Fluorescent Antibody Technique, Pemphigoid, Bullous, Pemphigus, Skin Diseases, Vesiculobullous,
Clinicoepidemiological Study of Cutaneous Leishmaniasis: A Hospital Based Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Pradhan, Sushmita; Shrestha, Shristee; Khadka, Damber; Parajuli, Niraj; Baral, Suwash; Tsuruta, Daisuke
Abstract: Introduction: Cutaneous leishmaniasis is a tropical disease transmitted by the bite of an intracellular parasite infected sandfly. Visceral leishmaniasis is common in Nepal. However, cutaneous leishmaniasis remains rare with only limited number of cases documented in Nepal. Objectives: To describe the clinical and epidemiological distribution of cutaneous leishmaniasis in Karnali province of Nepal. Materials and Methods: All cases clinically diagnosed from direct microscopic Giemsa-stain smears, histopathology or fine needle aspiration cytology as cutaneous leishmaniasis were enrolled in the study for one year. Demographic data and clinical details were recorded on a printed proforma. Statistical analysis was done using STATA/SE version 15.0 for MacBook. Results: Only 46 cases with age ranging from 2 to 75 years were included in the study. Mean age was 23±2.45 years. Majority of cases below 20 years (47.83%) were infected. Male to female ratio was 0.70:1. Mean duration of the disease was 4.96±0.47 months. Single lesions (73.91%) were mostly present. Single lesions were particularly presented on the face (73.53%). Cutaneous leishmaniasis (95.65%) outnumbered mucocutaneous one on lips (4.35%). Ulcerative-papulonodular type lesions (58.70%) were mostly presented in the cases. Kalikot district (56.52%) had the majority of cutaneous leishmaniasis cases in Karnali province. Majority of the cases presented during the months of February, March, April, August, November, and December (65.22%). Conclusion: The study concluded that the increase in cutaneous leishmaniasis is alarming in the Kalikot district of Karnali province in Nepal. The result of this study would continue contributing to the existing data in the literature and encourage early diagnosis and treatment of cutaneous leishmaniasis.
Cutaneous Larva migrans: A Case Series of a Skin-related Neglected Tropical Diseases from Nepal
(Nepal Health Research Council, 2024) Shrestha, Shraddha; Hirachan, Shashi; Parajuli, Niraj
Cutaneous larva migrans is a tropical dermatosis acquired through the helminthic infection. It is caused by penetration of animal hookworm larva in patient with history of walking barefoot on soil or beaches or with history of travel to tropical areas. It usually presents clinically as a pruritic serpiginous lesion with a trailing. Here, we report three cases who presented as asymptomatic to pruritic thread like serpiginous lesion on cutaneous examination. Cutaneous larva migrans was diagnosed clinically and proper treatment was done with complete regression of manifestations within a week. Although the condition is self-limiting, it is an under-diagnosed entity leading to delay in treatment and exacerbation of clinical manifestations including rare pulmonary manifestation called Loefflers syndrome. Keywords: Creeping eruption; ivermectin; larva migrans; skin-NTDs.
Cutaneous Tuberculosis among Patients Presenting to Dermatology Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Parajuli, Niraj; Karki, Anupama; Dhungana, Ashesh
Abstract Introduction: Cutaneous tuberculosis is an uncommon form of extrapulmonary tuberculosis. It can present in various morphological presentations leading to a late diagnosis in many cases. It is mainly associated with significant scarring and morbidity. It is classified as paucibacillary or multibacillary depending on the bacillary load. Similarly, it can be acquired through either an endogenous or an exogenous source. The mainstay of treatment is anti-tubercular medications. The objective of the study was to find out the prevalence of cutaneous tuberculosis among patients presenting to the dermatology outpatient department of a tertiary care centre. Methods: A descriptive cross-sectional study was done among the patient presenting to the outpatient department of dermatology and venerology in a tertiary care centre where all patients data from medical records were taken from April 2016 to March 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 503/2078/79). Demographic details of the patients including age, sex, site and duration of the lesion were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1,30,924 cases, 40 (0.03%) (0.02-0.04, at 95% Confidence Interval) cutaneous tuberculosis was seen. Conclusions: The prevalence of cutaneous tuberculosis was similar to the studies done in similar settings.
Dermatological Diseases in a Chepang Community
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Parajuli, Niraj; Paudel, Sushil
Abstract: Chepang is an indigenous group residing mostly in the hilly region of central Nepal. They are still considered as most marginalized and socio-economically deprived group in the country. There are just a handful of studies on the health status of this community but none of these studies were dedicated on the dermatological issues. A two-day dermatological outreach camp dedicated for Chepang community was conducted at Makawanpur district of central Nepal. Dermatophyte infections and scabies were the most common dermatological problems noted. The poor socio-economic status, poor hygiene combined with illiteracy was the major factor contributing to these conditions and their overall health.
Dermatological Publications from Nepalese Dermatologist Before and During the COVID-19 Pandemic Period: A Review
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Parajuli, Niraj; Chapagai, Badri; Paudel, Sushil
Abstract: Introduction: The COVID-19 pandemic created a nation-wide lockdown with hospital services resorting only to the emergency sections. Dermatology out-patient was closed with majority of services being deferred for a later date or through online platform. Here, we try to find whether Nepalese dermatologists were contributing to sciences through research. Methods: A Google Scholar search using certain key words to search for publications done by Nepalese dermatologist during the pandemic was done for year 2020-2021 described as pandemic period. Similar search was conducted for year 2018-2019 for the same time frame called as pre-pandemic. All the publications were analyzed using appropriate statistical methods. Results: A total of 197 publications were retrieved for pandemic period as compared to only 106 published articles in the non-pandemic period. Among 197 publications, 81 (41.11%) were published in PubMed indexed journal as compared to only 40 (37.73%) publications out of 106 total publications during the earlier period. However, the increase in the number was not statistically significant. Conclusion: An interest among Nepalese dermatologists for academic publications was noted during the pandemic period. This might be due to the proper use of time during the lockdown and closure of out-patient department.
Genodermatoses Picture: Difficulties Faced And Way Forward in Nepal
(Nepal Health Research Council, 2022) Parajuli, Niraj; Baskota, Rabindra; Jain, Ritu
Abstract Genodermatoses are group of genetic disorders that present with cutaneous manifestations. The exact prevalence on many of these conditions are unknown due to its rarity, need of specialized tests for diagnosis and lack of proper reporting system. Most of the patients are faced with life-long disability and associated stigma. There is a need for specialized centers for proper diagnosis of these conditions and a very elaborated yet simple reporting system in Nepal. These rare conditions should be kept in priority by the government in align with the sustainable development goals to ensure healthy-lives and promote well-being for all. A wider engagement of patient-led support groups might be useful in providing necessary information on the disease to the general population and alleviate the stigma associated with these diseases. Keywords: Epidermolysis bullosa; genodermatoses; rare diseases; Nepal
Patch Testing In Nepalese Population: A Single Center Study From Kathmandu, Nepal
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Paudel, Sushil; Pun, Guma; Parajuli, Niraj; Sharma, Rabindra
Abstract: Introduction: Patch testing is a diagnostic tool used in investigation to identify specific allergens in allergic contact dermatitis (ACD). It helps find the prevalence and the trends of contact sensitization in the community. Objective: To report the two year patch test results from a central hospital in Kathmandu. Materials and Methods: Consecutive consenting patients of suspected ACD were patch tested with an Indian standard Series (Systopic) from June 2014 to August 2016. Results: Out of 141 patients tested, 89 were female (63.12%) and 52 were male (36.88%). Hand eczema was the commonest pattern (53 patients) followed by persistent and recurrent eczema (44 patients) and face eczema (25 patients). Fifty- five patients (39%) had at least 1 positive allergic reaction. Among these, 16.31% were male and 22.70% were female. The most common allergen was nickel sulfate (19.9%) followed by fragrance mix (7.8%) and paraphenyldiamine (PPD) (6.4%). Out of total positive cases 27 (21 females and 6 males) had shown strong positive reactions (++). The Nickel Sulfate was responsible in majority of cases (18/27 cases). Farmers had the highest (57.14%) rate of positive allergic reactions followed by housewives (39.62%). According to the regional eczema, patients with persistent and recurrent eczema of different parts of body had the highest rate of positive allergic reactions (47.72%). Almost half of patient with facial eczema (40%) had positive patch test. Conclusion: Larger studies are required in the different parts of the country to find a more accurate data regarding the sensitization pattern in Nepalese population. Keywords: Allergens, Dermatitis, Allergic Contact, Eczema, Nickel sulfate
Quality of Life in Nepalese Patients with Non-Scarring Alopecia: A Cross-Sectional Observational Study at a Tertiary Center
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Paudel, Sushil; Pudasaini, Prajwal; Parajuli, Niraj
Abstract: Introduction: Alopecia is a dermatological condition characterized by the loss or reduction of hair. Alopecia areata and androgenetic alopecia are fairly common hair disorders. Hair loss causes a significant impact in person’s life which may lead to loss of self-confidence and distorted body image. Materials and Methods: All consenting patients with alopecia areata and androgenetic alopecia, presenting to the out-patient department from September 2020 to August 2021 were enrolled based on convenience sampling method in this observational study. Ethical clearance was obtained from the ethical review committee of same institute (IRC protocol no.9/2021). All patients completed the Nepali Dermatology Life Quality Index questionnaire. Statistical Package for Social Studies version 25 was used for statistical analysis. Mean scores between groups were compared with Mann-Whitney U test. Results: Out of 142 patients, there were 79 (55.6%) males and 63 (44.4%) females. There were 48 (33.8%) patients of alopecia areata while ninety-four (66.2%) had androgenetic alopecia. The mean total of Dermatology Life Quality Index score was 8.16 (±6.126). Mean score of females was 9.16±5.858 which was significantly higher than that of males 7.37±6.258 (p<0.05) and the score of the androgenetic patients (9.45±6.094) was significantly higher than that of areata patients (5.65±5.417) (p<0.001). All sub-domains of the questionnaire were impaired more in female. Increasing duration of the disease and hair loss in any first degree relative increased the impairment in quality of life significantly. Conclusion: The quality of life in females were more affected as compared to males in both kinds of hair loss. However, patients with androgenetic alopecia had a greater impairment than patients with alopecia areata in our population.
Quality of Life in Patients with Acne: A Questionnaire Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2018) Parajuli, Niraj; Kayastha, Bhasker Mohan Meher
Abstract: Introduction: Acne vulgaris is a self-limited disorder of the pilosebaceous unit. It is primarily seen in adolescent age group. Acne can present with pleomorphic lesions consisting of comedones, papules, pustules and nodules. Both inflammatory and non-inflammatory acne can produce scarring. It has been found that acne significantly affects self-image and quality of life. Effective treatment results in improvement of quality of life. Objective: The objective of this study was to find the impairment of quality of life in patients with acne. Materials and Methods: A total of 140 randomly selected patients coming to Dermatology OPD of Bir Hospital with complaints of acne were enrolled. A standard Dermatology Life Quality Index (DLQI) and Cardiff Acne Disability Index (CADI) questionnaires were used. Results: The average score of DLQI in my study was 9.5±5.6 with a minimum score of 0 and maximum score of 25. Similarly, the mean CADI score was 5.9±2.88 with minimum score of 0 and maximum score of 12. This study found acne to be more common in females as compared to males. Most common age group for acne was 16-20 years. Almost half of the patients (46%) complained of flare-ups during summer season. Similarly, majority (60%) of patients could relate to some aggravating factors. Most common aggravating factors were topical medications, fatty foods and stress. Conclusion: Acne is a common skin condition among the adolescents. This study conducted in Dermatology and Venereology Department of Bir Hospital showed that there is invariably some impairment in quality of life in acne patient. Keywords: Acne vulgaris, adolescent, quality of life, self concept, surveys and questionnaires
Sexually Transmitted Infections in A Tertiary Hospital of Kathmandu: A Retrospective Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Paudel, Sushil; Parajuli, Niraj; Dahal, Sudip; Paudel, Sudarshan
Abstract: Introduction: Sexually transmitted infections (STIs) are the diseases that are transmitted by sexual contact if a partner is infected with agent known to cause infection of genitalia. This group of diseases pose a huge public health problem. This study aims to provide an insight on the prevalence of STIs in a tertiary care center dedicated to civil servants. Methods: This is a retrospective cross-sectional study. All patients diagnosed with STI in a dermatology out-patient of Civil Service Hospital, a tertiary care hospital situated in Kathmandu over a period of two years from January 1 2018 to December 30 2019 were included in the study. The diagnosis was made by clinical and laboratory investigations. Results: The total number 157 cases of STIs were enrolled in this study, of which 119 (75.8%) were males and 38(24.2%) were females. The mean age of patients was 27.8±8.8 years, ranging from 15 to 60 years. Seventy three (46.5%) patients were married, while 81 (51.6%) patients were unmarried. Unmarried males were significantly more vulnerable to acquire STIs (p=0.005). Males were having significantly more premarital or extramarital sexual exposures as compared to females (p<0.001). The most common presentation was condyloma acuminata in 84(53.5%) patients. Consistent use of condom was reported only in 3 (2.5%) males and 1 (2.6%) females in this study. No association was noted between the education level attained to the practice of safe sexual methods (p=0.535). Conclusion: The proportion of males was higher than females in our study which might be due to the reluctances of female to see doctor for sexual problems. The level of education did not seem to make people aware of practicing safe sex. Sexual education seems must in all level of education.
Teledermatology- A Life-Saving Experience and its Usefulness in Nepal: A Case Report
(Nepal Health Research Council, 2025) Parajuli, Niraj; Buda, Caleb; Tiwari, Sanjib
eledermatology is a means of diagnosing and managing dermatological cases virtually using digital tools. This is an important method which has been in use in Nepal and has a lot of potential to provide quality care to the patients from the remote corners of Nepal. It has been mostly used to manage chronic dermatological conditions. Here. we report a patient, suffering from multiple painful ulcers and a steadiliyy declining quality of life, was diagnosed with pyoderma gangrenosum via mobile teledermatology. Prompt intervention based on this remote diagnosis led to successful management and significant clinical improvement. We try to put an emphasis on the mobile teledermatology that it is even useful in hard to diagnose cases and provide proper management. We also would like to highlight that this modality should be promoted and used more often to provide specialists medical services to the rural communities Nepal. Keywords: Digital dermatology; pyoderma gangrenosum; teledermatology; telemedicine.

Browsing by Author "Parajuli, Niraj"

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