Browsing by Author "Sapkota, N"
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Publication Mirror Ear: A Rare Case of Polyotia(Kathmandu University, 2024) Amatya, N; Shrestha, BL; Karmacharya, S; Sapkota, N; Subba, SABSTRACT Polyotia is an anomaly of the external auricle in which the accessory auricle is large enough to closely resemble an additional pinna rather than a skin remnant and cartilage. Polyotia, also known as mirror ear or accessory ear, is a type of ear anomaly in the tragus area, but the term refers to substantial anomalies which resemble an accessory ear, unlike a pre-auricular tag. It is an extremely rare condition and to date, less than 30 cases of polyotia have been reported according to a review of the literature. A variety of theories has been proposed for development of such abnormal external auricle. We report two cases of polyotia which presented to Dhulikhel Hospital ENT OPD that was successfully corrected surgically. An 8-year-old boy and a 14-year-old boy presented with a large accessory anomalous auricle on left and right ear respectively. The accessory auricle was composed of an elastic cartilaginous component covered with skin and was positioned anteriorly to the original auricle in both the cases. The anomaly was not as large as the patient’s external auricle, rather it mirrored the external auricle. On the opposite ear both the cases presented with pre- auricular skin tag. Surgical correction was done by dissecting the skin free from the duplicated cartilage via an incision along the free edge of the helix the duplicated cartilage was contoured to fill the pre-tragal hollow and the tragus reconstructed with a free cartilage graft. KEY WORDS Accessory auricle, Accessory ear, Duplicated pinna, Mirror ear, PolyotiaPublication Therapeutic Drug Monitoring of Antiepileptic Drugs at a Tertiary Care Hospital of Eastern Nepal(Kathmandu University, 2019) Mandal, NK; Rauniar, GP; Rai, DS; Pradhan, B; Poudel, P; Sapkota, NABSTRACT Background Therapeutic drug monitoring (TDM) is the process of measuring drug level in body fluids. It is done to maintain plasma concentration of the drug under therapy within a specific target range for maximum therapeutic efficacy without unnecessary exposure to adverse effects. Objective This study aims to evaluate necessity of therapeutic drug monitoring in Phenytoin, Carbamazepine and Lamotrigine therapy among epileptic patients. Method A prospective, cross-sectional study was conducted for a period of one year at BP Koirala Institute of Health Sciences, Dharan, Nepal. After taking detailed history, blood samples were collected from epileptic patients on monotherapy with the selected drugs. Plasma levels of these drugs were analyzed using High Performance Liquid Chromatography technique (HPLC). Out of total 42 selected patients, 21 were tested for phenytoin, 17 for carbamazepine and four for lamotrigine. The result was categorized into therapeutic, sub-therapeutic and above-therapeutic groups based on reference range. Result Out of total 21 samples tested for phenytoin, 15(71.4%) had plasma drug level within therapeutic range, 5(23.8%) had within subtherapeutic range and 1(4.8%) had above therapeutic range. Analysis of carbamazepine plasma level showed 14(82.3%) at therapeutic level, 1(5.9%) at sub-therapeutic level and 2(11.8%) at above-therapeutic level. Lamotrigine testing in four samples showed 2(50% in) both within therapeutic range and above-therapeutic range. Conclusion Therapeutic drug monitoring of phenytoin, carbamazepine and lamotrigine showed variation in plasma level irrespective of the therapeutic dose. It is suggested that dose adjustment of antiepileptic drugs should be done after establishing ‘individual therapeutic range’ following regular plasma monitoring. KEY WORDS Anti-epileptic, High performance liquid chromatography, Therapeutic drug monitoring