Browsing by Author "Pradhan, Manish"
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Publication Challenges in Diagnosis and Management of Cutaneous Adverse Drug Reaction(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Pradhan, ManishAbstract: Adverse drug reactions commonly involve the skin and represent a significant proportion of all drug‐induced illnesses. Most of the times, adverse cutaneous reactions are not severe and only a few are fatal. Real incidence of cutaneous adverse drug reaction is not known. Due to rampant and multiple drug use, there is difficulty finding the culprit drug, so diagnosis of adverse drug reaction and management becomes difficult. Keywords: Drug Eruptions, Drug Interactions, PolypharmacyPublication Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal(Institute of Medicine, 2020) Sigdel, Prem R; Gnyawali, Diwas; Rai, Bipendra D K; Dhital, Pawan; Parajuli, Purushottam; Chudal, Sampanna; Dhakal, Niraj; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem RABSTRACT Introduction: Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys. Methods: In this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared. Results: There were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN. Conclusion: Laparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN. Keywords: Laparoscopic donor nephrectomy, open donor nephrectomy, renal transplantationPublication Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor(Institute of Medicine, 2022) Rai, Bipendra DK; Gnyawali, Diwas; Poudyal, Sujeet; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Gyawali, Prem R; Sharma, Uttam K; Nepali, Rabin; Gurung, GhanashyamABSTRACT Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors. Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function. Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively. Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney. Keywords: Computed tomography, DTPA, glomerular filtration rate, renal transplant, renal volumePublication Dyslipidemia and Thyroid Dysfunction Associated with Psoriasis(Nepal Health Research Council, 2022) Rizal, Shikha; Joshi, Bishal Raj; Jha, Sanjay Kumar; Pradhan, Manish; Regmi, SunilAbstract Background: Psoriasis is a T-cell mediated inflammatory skin disorder which causes considerable psychosocial disability resulting in major impact on patient’s quality of life. The dominant response of Th1 cells and the high expression of related inflammatory factors appears in both psoriasis and thyroid dysfunction. Psoriasis can lead to increased risk of incidence of cardiovascular events for which dyslipidemia is an important risk factor. This study aims to evaluate thyroid function and lipid profile and its association in patients with psoriasis. Methods: This was a prospective case-control study conducted at the Department of Biochemistry, Nobel Medical College Teaching Hospital from November 2021 to October 2022. Seventy six clinically diagnosed psoriatic patients were taken as case and eighty non-psoriatic patients coming for other skin lesions were included in the study as control. Thyroid function test (serum free T3, T4, TSH) and lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride) were done. Results: Hypothyroidism was most common thyroid abnormalities in our study population which was 13.15% (n=10). The lipid profile parameters were significantly higher in the psoriatic patients than in the controls (p<0.001). The odds of psoriatic patient having thyroid dysfunction was 2.8 times higher compared to other non-psoriatic patients and the odds of psoriatic patient having dyslipidemia was 8.7 times higher compared to other non-psoriatic patients. Conclusions: It is thus useful to assess thyroid function test and lipid profile in patients with psoriasis considering their role in etiopathogenesis and co-morbidity of psoriasis. Keywords: Co-morbidity; dyslipidemia; thyroid dysfunctionPublication Dyslipidemia in Patients with Xanthelasma Palpebrarum Visiting the Department of Dermatology of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Rai, Anjan; Karki, Sunita; Sah, Shree Prasad; Kamat, Laxmi Narayan; Pradhan, ManishAbstract Introduction: Xanthelasma palpebrarum refers to lipid deposition that occurs on eyelids and inner canthi. It is an important cutaneous manifestation of hyperlipidemia, atherosclerosis and coronary artery disease. Few studies have been done in Nepal regarding lipid abnormality in xanthelasma patients. The aim of this study was to find out the prevalence of dyslipidemia among patients with xanthelasma palpebrarum visiting the Department of Dermatology of a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among 80 patients from January, 2021 to February, 2022 in the Department of Dermatology of a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 60512021). Convenience sampling was used. Lipid profile analysis was done among patients with clinical diagnosis of xanthelasma palpabrarum. Data was collected using Microsoft Excel for Mac version 16.16.27 and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 80 patients with xanthelasma palpebrarum, the prevalence of dyslipidemia was 64 (80.00%) (74-86 at 90% Confidence Interval). Among them, 29 (45.31%) were males and 35 (54.69%) were females. Conclusions: In our study, the prevalence of dyslipidemia among patients with xanthelasma palpebrarum was found to be higher than in similar studies conducted in similar settings.Publication Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review(Institute of Medicine, 2019) Rai, Bipendra DK; Poudyal, Sujeet; Dhital, Pawan; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem RABSTRACT Introduction Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has oncological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow-up. Conclusion Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time. Keywords: Nephron sparing surgery, small renal massPublication Retrospective Review of Adrenalectomy in a Tertiary Center in Nepal(Institute of Medicine, 2019) Dhital, Pawan; Rai, Bipendra DK; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem RABSTRACT Introduction Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course. Methods This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, perioperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center. Results There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up. Conclusion A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential. Keywords: Adrenalectomy, adrenocortical carcinoma, phaeochromocytoma