Browsing by Author "Paudel, Sushil"
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Publication Clinical Outcome of Posterior Instrumented Stabilization and Transpedicular Decompression in Patients Presenting with Thoracic or Lumbar Spinal Tuberculosis in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Bhandari, Dinesh; Pokharel, Sabin; Pokharel, Praja; Paudel, Sushil; Kafle, Dinesh; Pokharel, Rohit KumarAbstract Introduction: Posterior instrumented stabilization is a commonly done surgery in spinal tuberculosis. This study aims to evaluate the clinical, radiological, and neurological outcomes of posterior instrumented stabilization and transpedicular decompression in thoracic and lumbar spinal tuberculosis. Methods: A descriptive cross-sectional study was conducted for one and a half years with at least six months of follow-up in a tertiary care center. The study was approved by the Institutional Review Committee (Reference number: 119 (6-11-5) 2/075-076). Total sampling was done and the study included patients over 18 years of age with spinal tuberculosis of the thoracic or lumbar regions. These patients underwent posterior instrumented stabilization and transpedicular decompression at the tertiary care center. The age, site of involvement, Visual Analog Scale score for back pain, neurological status as per Frankel Neurology grading, and local kyphotic angle in X-ray were recorded. The median, interquartile range and percentage were calculated. The data was entered in Microsoft Excel 2016 and analysis was done using Epi Info software version 7.2. Results: Thoracic level was most commonly involved in 14 (46.68%) cases. The median back pain as assessed by the Visual Analogue Scale score improved from 8 to 2 at the 6-month follow-up. There was improvement in the neurological grading of all cases and there was no loss of correction in the local kyphotic angle till the final follow-up. The median age of cases was 48 years (interquartile range: 28-62.50). Conclusions: Posterior instrumented stabilization and transpedicular decompression in adult patients with thoracic or lumbar spinal tuberculosis achieves improvements in clinical, radiological, and neurological outcomes.Publication Cutaneous Manifestations of Covid-19 in Nepal: A Series of Case Reports(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Pudasaini, Prajwal; Gurung, Gyaltsen; Paudel, Asmita; Paudel, SushilAbstract: Coronavirus Disease 2019 (COVID-19) is an illness caused by SARS-CoV-2. Case series of large population on cutaneous manifestations of COVID-19 are yet to be reported from Nepal. Among the cases in our study, onset of urticarial rash prior to onset of fever and systemic symptoms can be very important in preventing the chain of transmission of COVID-19 infection. Knowledge among medical practitioners of varied cutaneous features of COVID-19 can lead to testing COVID-19 in these cases and an early diagnosis.Publication Dermatological Practice in Nepal during COVID-19 Crisis: Recommendations of National Panel of Experts(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Parajuli, Sudip; Pokhrel, Dinesh Binod; Agrawal, Sudha; Kumar, Ajay; Pokhrel, Kumar; Bastola, Anup; Bhattarai, Sabeena; Shrestha, Shristi; Shrestha, Manisha; KC, Shekhar; Joshi, Smita; Das, Anil Kumar; Shah, Mahesh; Joshi, Shambhu Dutta; Paudel, Sushil; Hirachan, Shashi; Paudel, Upama; Neupane, SaraswotiAbstract: Introduction: Novel Coronavirus disease has caused a substantial halt to the ongoing world in every aspect. There are medical and social implications of the disease. Cutaneous manifestations have been reported to be a part of the disease as well. Dermatologists globally are in dilemma with the clinical practice because of the fear of acquiring the disease. Objectives: This article aims to recommend best practice measures that can be followed in local scenario for re-opening up of dermatological services in the context of Nepal. Materials and Methods: A preliminary draft for guidance on Dermatological services based on recommendations of American Academy of Dermatology, International league of Dermatological societies, National recommendations from Ministry of Health, Nepal was sent to a panel of national experts to determine the level of consensus in first week of April, 2020. A preliminary survey was sent to all the members of Society of Dermatologists, Venereologists, and leprologists of Nepal on first week of June and a second draft was subsequently formed which was sent again to experts and revised based on the opinions of national experts. Results: A total of 19 experts participated in the preparation of draft and reached a national consensus after a series of revisions in preliminary draft. Conclusion: Agreements regarding the opening of practice in dermatology discipline have been summarized. Recommendations have been made for opening of dermatological services – opening of outpatient department, performing dermatosurgical and cosmetic procedures as well as strategies on triage of patients and use of masks. Keywords: Coronavirus, Dermatology, Disease, NepalPublication Disseminated Discoid Lupus Erythematosus and Hypothyroidism in a Vitiligo Vulgaris Patient: A Rare Coexistence(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Paudel, Sushil; Neupane, SameerAbstract: Vitiligo vulgaris is a disease with multiple etiological factors including genetic, autoimmunity and several environmental factors. It has a huge psychological burden in the patient. Discoid lupus erythematosus (DLE) in the other hand can be quite disfiguring as well. Thyroid disease along with these chronic skin diseases if occurs in a same patient is really disappointing to him and his family. We report a case of 55years old man with such a rare coexistence in a patient. Keywords: Autoimmunity, Lupus Ertythematosus, Discoid, Nepal, Thyroid Diseases, VitiligoPublication Epidemiological Profile of Skin Diseases in a Tertiary Hospital of Kathmandu: An Annual Census(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Paudel, Sushil; Sharma, Rabindra; Dahal, Sudip; Paudel, Indu AcharyaAbstract: Introduction: Skin diseases are eighth most common reasons for outpatient in Nepal, and fourth cause of disability globally. Skin diseases varies with the reason, season and socioeconomic status. As the socioeconomic conditions are changing, so are the disease patterns. We planned to report the current trend of skin diseases in Kathmandu and compare with similar studies in past. Materials and methods: Outpatient department records of Civil Service Hospital from the year 2075 Bikram Sambat were reviewed after ethical clearance from institution review committee and were analyzed after tabulation. Results: Total number of cases were 9886 (4.51% of total hospital attendance). In total 8097 cases were new, males were 4218 (52.1%) and females 3879 (47.9%). Most common diagnosis was eczemas (18.47%), followed by dermatophytosis (15.29%). Eczemas, chronic urticaria, psoriasis and lichen planus were more common in the adult population of more than 30 years. While infections and acne were more common in young adults, 15-30 years, in both the sexes. Tinea was common during summer and so was scabies in males, while in females, melasma peaked in summer and chronic urticaria during spring and winter. Conclusion: The pattern of skin diseases is changing with the time. Diseases of possible allergic and immunologic etiology are increasing and diseases with infective etiology are still a huge burden on society. Keywords: Nepal, Pattern, Skin diseasesPublication Granuloma Multiforme: First Report from Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Paudel, Sushil; Marahatta, Srijana KoiralaAbstract: Granuloma multiforme (GM) is a reactive skin disorder of unknown etiology, characterized clinically by confluent annular lesions and histologically by focal necrobiosis and histiocytic granulomas. GM is significant because it mimics various conditions and diagnosis is often missed if not taken into consideration. Here, we report a case of granuloma multiforme from Nepal in a 40 year old female with multiple skin colored to mildly erythematous, occasionally itchy annular plaques of duration 6 months, over the upper back and upper chest. Histopathology helped to clinch the diagnosis and differentiate from similar clinical and histologic mimics. Keywords: Granuloma, Necrobiotic disorders, Nepal, SkinPublication 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, RabindraAbstract: 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 sulfatePublication Prevalence of Hepatitis C among Lichen Planus Patients(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Sharma, Rabindra; Paudel, SushilAbstract: Introduction: The association between hepatitis C virus (HCV) infection and lichen planus (LP) has been studied widely. Extrahepatic manifestations including lichen planus are common among patients infected with HCV. The prevalence of HCV among lichen planus (LP) seems to vary geographically. Objective: This study was carried out to determine whether an association exists between LP and HCV infection. Materials and Methods: A total of 68 lichen planus (LP) patients identified clinically and histopathologically were screened for anti-HCV from blood samples. Results: Among the 68 patients of LP only 2 (2.94%) female patients had HCV infection. Conclusion: This study reveals very few patients of lichen planus being infected with HCV which is in line with a similar study done earlier in Kathmandu. Thus due to limited evidence to support an association between HCV and LP routine HCV screening is not recommended at this geographic location. Keywords: Hepatitis C, Lichen Planus, NepalPublication 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, NirajAbstract: 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.Publication Quality Of Life in Patients with Non-Genital Warts: A Cross-Sectional Study using Dermatology Life Quality Index (DLQI) Questionnaire(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Paudel, Sushil; Pudasaini, Prajwal; Kafle, Monique; Acharya, InduAbstract: Introduction: Warts are one of the commonest causes for the dermatology outpatient department visits. These are caused by the Human Papilloma Viruses (HPV). Sometime warts can cause significant embarrassment and consequently impair the quality of life. Materials and Methods: All consenting patients with non-genital warts presenting to the clinic from September 2020 to February 2021 were enrolled in this observational study. Clinical evaluation for non-genital warts, sites involved and patient demographics was recorded. All participants were asked to complete the Nepali Dermatology Life Quality Index (DLQI) questionnaire. Results: Out of total 80 patients, 55 (68.8%) were males. The mean age of the study population was 23.86±7.42 years, mean duration was 21.98±26.69 months and the mean DLQI score was 8.0±5.15. The embarrassment or self- consciousness was the most prominent psychological aspect in the patients with the warts, followed closely by the difficulty in carrying out daily household activities. All items measured in DLQI were more impaired in women than in men. Clothing habits and sexual functions were affected based on the site of involvement with the warts. Shorter duration of disease had higher negative impact in the quality of life. Conclusion: Patients with warts had moderate impact in their quality of life. Females seem to be affected more due to their warts. Shorter duration of disease had higher negative impact in cases of warts.Publication Relationship between Facet Joint Tropism with Lumbar Disc Herniation at A Particular Motion Segment(Nepal Health Research Council, 2023) Shrestha, Sandesh; Lakhey, Rajesh Bahadur; Paudel, Sharma; Paudel, SushilAbstract Background: Lumbar disc herniation is one of the important and common causes of low back pain. There are various modifiable and non-modifiable risk factors for the development of lumbar disc herniation. Any change in the orientation or asymmetry of the facet joint i.e. facet tropism may lead to abnormal shearing stress on the intervertebral disc and may lead to development of disc herniation. Methods: This is a cross-sectional observational study of 46 patients aged 18-40 years with clinical features of Prolapsed Intervertebral Disc and Magnetic Resonance Imaging evidence of single level prolapsed disc who presented to Tribhuvan University Teaching Hospital from December 2019 to June 2021. MRI measurement of facet tropism of normal level (L4-L5 or L5-S1) adjacent to herniated level was used for comparison. The p - value ? 0.05 was considered statistically significant. Overall association of tropism with lumbar disc herniation in affected and normal level combined and at each individual level was studied using McNemar Test. Results: We found a highly significant association of facet tropism with lumbar disc herniation (p-value <0.001). Considering the individual levels, at L4-L5 level, the association between facet tropism and lumbar disc herniation was highly significant (p-value <0.001). However, at L5-S1 level the association was not significant (p-value <0.388). Conclusions: The results of our study show strong association between FT and lumbar disc herniation at a particular motion segment. Keywords: Facet tropism; inter-vertebral disc prolapse; lumbar disc herniation; magnetic resonance imagingPublication Relationship between Facet Joint Tropism with Lumbar Disc Herniation at A Particular Motion Segment(Nepal Health Research Council, 2023) Shrestha, Sandesh; Lakhey, Rajesh Bahadur; Paudel, Sharma; Paudel, SushilAbstract Background: Lumbar disc herniation is one of the important and common causes of low back pain. There are various modifiable and non-modifiable risk factors for the development of lumbar disc herniation. Any change in the orientation or asymmetry of the facet joint i.e. facet tropism may lead to abnormal shearing stress on the intervertebral disc and may lead to development of disc herniation. Methods: This is a cross-sectional observational study of 46 patients aged 18-40 years with clinical features of Prolapsed Intervertebral Disc and Magnetic Resonance Imaging evidence of single level prolapsed disc who presented to Tribhuvan University Teaching Hospital from December 2019 to June 2021. MRI measurement of facet tropism of normal level (L4-L5 or L5-S1) adjacent to herniated level was used for comparison. The p - value ? 0.05 was considered statistically significant. Overall association of tropism with lumbar disc herniation in affected and normal level combined and at each individual level was studied using McNemar Test. Results: We found a highly significant association of facet tropism with lumbar disc herniation (p-value <0.001). Considering the individual levels, at L4-L5 level, the association between facet tropism and lumbar disc herniation was highly significant (p-value <0.001). However, at L5-S1 level the association was not significant (p-value <0.388). Conclusions: The results of our study show strong association between FT and lumbar disc herniation at a particular motion segment. Keywords: Facet tropism; inter-vertebral disc prolapse; lumbar disc herniation; magnetic resonance imagingPublication 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, SudarshanAbstract: 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.