Browsing by Author "Shah, DN"
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Publication Alport’s syndrome(Kathmandu University, 2010) Bastola, P; Joshi, SN; Chaudhary, M; Shah, DNAbstract Alport’s syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed. Key words: Alport’s syndrome, Anterior lenticonus, Oil droplet sign, Anterior capsular cataract, Perimacular flecksPublication Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA(Kathmandu University, 2009) Pokharel, S; Shah, DN; Joshi, SN; Choudhary, MAbstract Background: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent world- wide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. Objective: To determine level of immunoglobulin E (IgE) in the tear film of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Materials and methods: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme – linked immunosorbent assay (ELISA). Results: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p= 0.72). Conclusion: There was high concentration of tear IgE level observed in VKC. Key words: Vernal keratoconjunctivitis, Tearfilm, IgE level, Type I hypersensitivity reaction, Type IV hupersensitivity reaction.Publication The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige’s Syndrome(Kathmandu University, 2010) Bastola, P; Chaudhary, M; Agrawal, JP; Shah, DNABSTRACT Background Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. Objectives To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. Methods A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. Results A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 3.61 (+ Standard deviation 0.50, range 3-4), 3.21 (+Standard deviation 0.63, range 2-4) and 3.67 (+- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 4.3 (+ Standard deviation 1.6, range 2.0-6.5), 5.8 (+Standard deviation 1.4, range 3-8) and 4.5 (+ Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications. Conclusions The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige’s syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal. Key Words essential blepharospasm syndrome, hemifacial spasm, jankovic spasm grading, meige’s syndrome