Browsing by Author "Paudyal, BP"
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Publication A Diagnosis Missed for Several Years- Wegener’s Granulomatosis(Kathmandu University, 2011) Paudyal, BP; Pantha, S; Ranjitkar, N; Manandhar, A; Arjyal, AABSTRACT Wegener’s granulomatosis is a form of systemic vasculitis of small to medium sized vessels and affects upper respiratory tract, lungs and kidneys along with various organs. It causes necrotizing granulomatous inflammation of the affected parts and presents with positive antineutrophil cytoplasmic antibodies in more severe forms. Being a systemic disease with the potential to affect any organ-systems with a wide range of clinical presentations, it is associated with a risk of delay in diagnosis with resultant setback in institution of appropriate treatment. Confusion may arise due to an extent of histological similarity between Wegener’s granulomatosis and the more prevalent tuberculosis, both causing granulomatous inflammation of the affected parts. Here, we present two cases of this rare disorder where the diagnosis was missed for several years in the beginning causing a delay in institution of specific therapy which led to the development of complications. KEY WORDS delayed diagnosis, multisystem disease, systemic vasculitis, Wegener’s granulomatosisPublication Awareness about Sexually Transmitted Infections and Human Immunodeficiency Virus Infection among Patients with Genital Symptoms(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Gyawalee, Madhu; Paudyal, BP; Pokhrel, DBAbstract: Introduction: Sexually transmitted infections (STIs) are a major cause of public health problem. In developing countries, human immunodeficiency virus (HIV) infection is spreading rapidly, with sexually transmitted infections acting as a cofactor for the spread of HIV. Yet adequate awareness regarding these infections is lacking. Objective: To explore the knowledge and awareness about STIs and HIV infection in patients visiting Dermatology and Venereology Clinic of Institute of Medicine, Tribhuvan University Teaching Hospital (TUTH) with genital symptoms. Material and Methods: A cross sectional descriptive study was carried out in the department of dermato-venereology, TUTH for a period of one year. Total of 130 consecutive cases were enrolled. After taking consent and assuring confidentiality they were interviewed regarding awareness of STIs and HIV/AIDS. Results: Out of 130 cases, 95% and 98.5% had heard of an STI and HIV/AIDS respectively. Only 43.8% could mention discharge from genitalia as a symptom of STI whereas 38.5% could mention none. Most (91.5%) knew about the sexual mode of transmission of both STIs and HIV. None could mention about mother to child transmission of an STI, whereas 15% knew that an infected mother can transmit HIV to her baby. About 58% were aware that condoms could protect them from acquiring an STI, 63% perceived this as best method of prevention from HIV. When only 26% knew that being faithful to one partner is the best mode of prevention from an STI, 45% mentioned avoiding contact with multiple partners could prevent them from HIV transmission. Conclusions: Awareness programme on STIs as a whole could improve knowledge and awareness on HIV and STIs and hence prevent both. Keywords: knowledge, awareness, STIs, HIVPublication Delayed presentation of Sheehan’s syndrome: a case report(Kathmandu University, 2005) Paudyal, BPSheehan’s syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intrapartum or postpartum haemorrhage. We present an elderly lady with this syndrome who had slowly progressive panhypopituitarism 24 years after a severe haemorrhage associated with the delivery of triplets.Publication Eosinophilic Fascitis: A Rare Fibrosing Disorder(Kathmandu University, 2012) Paudyal, BP; Gyawalee, M; Sigdel, KABSTRACT Eosinophilic fasciitis is a rare systemic disease characterized by inflammatory thickening of the skin and underlying fascia, peripheral eosinophilia, elevated inflammatory markers and typical biopsy findings. Internal organ involvement is rare unlike in other fibrosing disorders. Though this is usually a benign disease, it is often difficult to diagnose and the course may also be variable. Glucocorticoids are the mainstay of therapy, but in many cases steroid sparing immunosuppressive drugs are required particularly if the diseases has protracted course. The author reports a typical case of this rare disorder which could well be a first report from Nepal. KEYWORDS Eosinophilic Fascitis, fibrosing disordersPublication 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 Twelve episodes of meningitis in the same patient!(Kathmandu University, 2007) Paudyal, BPRecurrent bacterial meningitis is potentially life-threatening; resultant complications and adverse events during management take their extra toll on the patient. A rare case with 12 consecutive episodes of pyogenic meningitis, probably the maximum number ever reported in the literature, has been presented. A minor head injury but with no subsequent cerebrospinal fluid (CSF) leak during childhood was the index event in this patient. High resolution computerized tomography (HRCT) scan of the base of the skull clearly revealed a bony dehiscence missed on numerous previous imagings. Culprit micro organisms involved in recurrence were Streptococcus pneumoniae and Neisseriae meningitides. Though surgical repair would have been definitive treatment, medical management with pneumococcal and meningococcal vaccination and prophylactic penicillin have been used in this patient to prevent further recurrences.