Browsing by Author "SM, Shrestha"
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Publication Hepatitis E in Nepal(Kathmandu University, 2006) SM, ShresthaHepatitis E is an acute disease caused by hepatitis E virus that usually manifest as acute jaundice. The hallmark of the disease is its high incidence in young adults, and high mortality in pregnant women from acute hepatic failure. It is a waterborne infection and occurs sporadically or as epidemic outbreaks. Kathmandu valley is a hyper-endemic area for hepatitis E, where during last 30 years three large epidemics and many focal outbreaks have occurred. About 50% of the sporadic cases of acute hepatitis in Kathmandu valley are caused by hepatitis E. This paper describes the epidemiology hepatitis E in Nepal, and its clinical features and management. Key words: Acute hepatitis in Nepal, Hepatitis E, Hepatitis E in pregnancyPublication Pleural effusion in hepatic vena cava disease(Kathmandu University, 2007) SM, ShresthaPleural effusion is not uncommon in developing countries. It is usually considered to be due to tuberculosis and treated with anti-tubercular chemotherapy without much diagnostic workup. Hepatic vena cava disease (HVD), a disease caused by obliterative lesion of the hepatic portion of inferior vena cava induced by bacterial infection is common in developing countries. We report here the occurrence of pleural effusion in 10% of the cases of HVD. Four patients, one with acute and three with chronic HVD that presented with pleural effusion are described. Pleural effusion in HVD responded to treatment with antibiotic and diuretic. In developing countries HVD should be considered in the differential diagnosis of pleural effusion. It is postulated that bacterial infection and sodium retention resulting from acute caval obstruction are important in the pathogenesis of pleural effusion in HVD. Key words: Pleural effusion, Hepatic Vena Cava Disease, Budd-Chiari syndrome, IVC obstruction