Browsing by Author "Shrestha, DP"
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Publication Development of Skin Disease Disability Index to Assess the Dermatologic Burden in Nepal(Institute of Medicine, 2013) Shrestha, DP; Shrestha, R; Gurung, D; Lama, L; Rosdahl, IAbstract Introduction: Skin disease is one of the leading cause of morbidity worldwide. Most instruments measuring the impact of skin disease on quality of life are developed in the west and not applicable measuring the impact of skin disease on quality of life are developed in the west and not applicable to the socio-cultural situation in Nepal. The aim of the study was to develop and validate a questionnaire to measure quality of life impairment due to skin disease in Nepal. Methods: Different aspects of quality of life impairment were identified from 35 in-depth. Different aspects of quality of life impairment were identified from 35 in-depth interviews and two focus group discussions, with villagers with various skin diseases. Based interviews and two focus group discussions, with villagers with various skin diseases. Based on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in 212 villagers with skin disease and in 100 healthy villagers. Results: The maximum total Skin Disease Disability Index score was 36. There was a wideThe maximum total Skin Disease Disability Index score was 36. There was a wide variation in total Skin Disease Disability Index score between individuals with skin disease variation in total Skin Disease Disability Index score between individuals with skin disease (range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001).(range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001). Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The difference in mean score for single questions between patients and controls was also highly significant (p<0.001). Conclusions: The questionnaire clearly covered all aspects of quality of life related to skin disease and was, simple, robust, easy to use and well accepted by the selected population. The Skin Disease Disability Index was reliable in the overall score as well as in individual questions.Publication Frequency and pattern of Skin Disorders in Adolescents in a School of Kathmandu(Institute of Medicine, 2015) Shrestha, DP; Baral, S; Shrestha, R; Gupta, S; Bhattarai, S; Shrestha, S; Rosdahl, IAbstract Introduction: Skin disorders are one of the major causes of morbidity in Nepal. The objectives of this study are to determine the relative frequency and pattern of skin disorders in a cohort of adolescents 9-18 years of age. Methods: The study was conducted in a residential school of Kathmandu. A detailed information about the study was given to the student members of a school club and they in turn, informed all the other students of the dermatologic health camp, which was conducted subsequently. All students appearing at the camp were examined by a dermatologist and information regarding age, gender, school grade and diagnosis were recorded in a pre-validated format. Results: In the school there were a total of 950 students (627 m, 323 f). Of them 242 (116 m, 126 f) had skin disorder with a point prevalence of 25.5%. Female students had significantly higher prevalence (29%) than male (18.5%). The most common skin disorders were acne, eczemas and urticaria, and the 10 most frequent diagnoses comprised 87% of all skin conditions. Conclusion: This study demonstrates that 1/4 of the students had one or more identifiable skin disorders. Despite the wide range of dermatoses, only a few of them accounted for a major proportion of the skin disorders. This study provides data for targeting health care programs for prevention and treatment of skin disorders in this age group. Keywords: skin disorrders, adolscents, frequency, pattternPublication Mobile teledermatology for Dermatological Care in Rural Nepal: Dermatology training of medical officers at primary health care centers(Institute of Medicine, 2017) Shrestha, DP; Baral, S; Shahi, PV; Rosdahl, LAbstract Introduction: Skin diseases are common in Nepal but dermatologists are very few, and there is no adequate training for Medical officers to diagnose and treat common skin diseases. We developed a training program based on Mobile teledermatology and evaluated its effectiveness. Methods: Five medical officers from 3 primary health care centers of Kavre District were trained in their respective working centers. They did 12 days of mobile teledermatology sessions in which they saw minimum of 60 common skin diseases in direct supervision of a dermatologist. Medical officers were involved in all aspect of patient care from history taking, examination of skin lesions, writing down the prescription to counseling and follow up. The effectiveness of training was evaluated by, difference in skin disease knowledge before and after the training, ability to diagnose and treat common skin diseases independently at the end of the training and feedback from the trainees. Results: Altogether 337 skin diseases were seen by 5 medical officers. There was significant difference between the skin disease knowledge before and after the training (p-value 0.009). At the end of the session they were able to diagnose independently 87% (80%-95%) of common skin diseases. All of them strongly agreed that this is the effective way of training Conclusions: Mobile teledermatology is the feasible and effective method of dermatology training to the medical officers at primary health care centres in remote areas, while providing skin care to the villagers at the same time. Keywords: Mobile teledermatology, dermatology training, medical officers, rural NepalPublication Mobile teledermatology for rural Nepal: Dermatologic care using mobile phone in a primary health care centre(Institute of Medicine, 2016) Shrestha, DP; Suwash, B; Gurung, D; Uprety, A; Bhattarai, SAbstract Introduction: Skin diseases are among the five most common health problems in Nepal. We have now tested the validity of mobile teledermatology with mobile phones to find a safe and easy way of diagnosis and treatment of skin diseases for the most vulnerable people in remote areas without access to derma- tologists. Methods: A medical officer at a primary health care centre examined the patient, obtained information of the patient and the skin disease, took photographs of the skin lesions. Then he transmitted all these data via Viber to a dermatologist in Kathmmandu, who in real time formulated diagnosis and treatment and sent it via Viber to the medical officer. Subsequently the patient was examined face to face by a blinded dermatologist at the same primary health care centre. The time taken for each modality of consultation was recorded. A third dermatologist analysed and compared the diagnoses formulated during telederma- tology and the face to face consultations. Results: Altogether 107 skin diseases were diagnosed in 101 patients. There was an overall concordance of 88% between the diagnoses of skin diseases by mobile teledermatology and face to face consultations (Cohen k coefficient 0.85). The average face to face consultation time was 5 minutes, while it was 7 min- utes more for teleconsultation. More than 75% of the photos were of good quality. Conclusions: Mobile teledermatology using smartphones is a reliable, useful, cost effective method to provide expertise for improving dermatologic care for the needy population in rural and remote parts of Nepal. Keywords: teledermatology, dermatologic care, rural Nepal, mobile phonesPublication Pattern Of Skin Diseases In A Rural Village Development Community of Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Shrestha, R; Shrestha, DP; Lama, L; Gurung, D; Rosdahl, IAbstract: Introduction: Skin diseases are a common cause of morbidity in Nepal as per the health services report. There is limited information on the prevalence and pattern of skin diseases in the community. The objective of this study was to determine the pattern of skin diseases in a rural village development community of Nepal. Materials and methods: Two dermatologic health camps were conducted, during which, the villagers were examined by dermatologists. The skin diseases diagnosed were recorded in a proforma. Results: There were 433 individuals examined and 359 (male-47.9%; female-52.1%) had skin disease identified clinically (camp prevalence- 83%). The age of patients ranged from 1 to 80 years (mean-24.5; SD±15.9), with majority in the age group of 10-19 years. The most common skin disease category was eczemas (36.4%), followed by infections (28.4%), acne (22%), pigment disorders (34%) and urticaria (12.3%). Conclusion: Skin diseases were common in the community. The five most common Skin disease categories were eczemas, infections, acne and pigment disorders were the more common conditions. Keywords: Acne, eczema, infection, pattern of skin diseases, pigment disorder, village development communityPublication Prevalence of skin diseases and impact on quality of life in hilly region of Nepal(Institute of Medicine, 2012) Shrestha, DP; Gurung, D; Rosdahl, IAbstract Introduction: Skin diseases (SDs) are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of SDs and impact on quality of life (QoL) in a rural community in Nepal. Methods: A house-to-house survey was conducted in a community with 3,207 inhabitants, to obtain socio-demographic data and identify individuals with SDs. Free examination and treatment was offered at 4 health camps. Individuals with long-standing SDs were interviewed using the Dermatology Life Quality Index (DLQI). Results: Of 735 individuals attending the health camps, 645 (mean age 24.9 years, range 0.5 -90) had one or more SDs. The overall prevalence of SDs was 20.1% (males 18.1%, females 22.5% and children 28.2%). The most common SD categories were eczemas (12.2%), pigment disorders (4.1%), acne (2.7%), urticaria (2.4%) and moles and lumps (1.6%). In the Nepalese culture, the DLQI question on sexuality was too direct so only 9/10 questions were used. In the 75 patients who were interviewed, the mean DLQI score was 10.7 (range 7-19), indicating a large impact on QoL. Conclusions: This population-based study shows that SDs were very common in a rural community in Nepal. The five most common SD categories comprise 77% of all SDs. Targeted training should enable health-care workers to prevent, accurately diagnose and manage these problems on site. An appropriate instrument to measure QoL adjusted to the socio-cultural norms of Nepal has to be developed. Keywords: Prevalence, Quality of life, Skin diseasePublication Severe cutaneous adverse reactions: an evidence based approach(Institute of Medicine, 2005) Shrestha, DP; Gurung, D; Kumar, AAbstract Background: Severe cutaneous adverse reactions (SCAR), comprising mainly Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), although rare, constitute a severe entity with life-threatening consequences. The aetiology is multifactorial but drugs have been implicated in the majority of cases. Depending on the severity of the reaction, it has a wide spectrum of clinical presentations and there is still confusion regarding its classification. Reliable information on the incidence of drug reactions has been difficult to obtain due to lack of standardised systems for data collection and reporting. The situation is poorer in developing countries where specific epidemiological studies have not been published, largely due to the lack of a reporting system and awareness of drug reaction patterns among medical professionals and patients alike. Method: We have reviewed available literature regarding SJS and TEN, and the hospital admission records of such patients at Tribhuvan University teaching hospital. A comparative study was done. Results: Drugs, mainly sulfonamides and anticonvulsants have been the aetiological factors in majority of the cases, and the presentation in the patients have ranged from mild to fatal reactions. In the TU teaching hospital, in almost all cases, steroids have been used in the management. Conclusion:Though a self-limiting disorder, patients with SCAR have a multisystem involvement, and a multi-disciplinary approach is necessary for its management. The need for intensive supportive care and the controversial role of steroids makes its management even more challenging. Thus, it is essential to develop a protocol/guidelines for the management of these disorders appropriate to our context.Publication Skin Diseases and Impact on Quality of Life in the Central Development Region Of Nepal: A Major Public Health Problem(Institute of Medicine, 2014) Shrestha, DP; Gurung, D; Shrestha, R; Rosdahl, IAbstract Introduction: Skin diseases are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of skin diseases and impact on quality of life in the rural areas of central development region of Nepal. Methods: The study was conducted in the 10 VDCs of 4 districts – Dolakha, Kavre, Makawanpur and Chitwan – of the central development region. A house-to-house survey was carried out to obtain socio-demographic data and identify individuals with skin diseases. Then a dermatologic health camp was conducted in each VDC. During the health camp, the skin diseases diagnosed were recorded and villagers with skin diseases more than 1 month duration were interviewed with skin disease disability index, to assess the impact on the quality of life. Results: A total of 7348 inhabitants (male – 3651, female – 3787) were surveyed. Of 2586 individuals with skin disease attending the health camps, 1862 (male – 721 and female – 1141, mean age 31.4yrs, range 6 months – 90years) were included in the study. The overall prevalence of skin diseases was 25%. The most common SD categories were eczemas, pigment disorders, fungal infections, nevi and urticarial. The mean skin disease disability index score in the central development region was 13.7, indicating very large impact on the quality of life. Conclusion: The prevalence of skin diseases and impact on quality of life is very high in the rural areas of the central development region of Nepal. It is a major public health problem. Targeted intervention at the primary health care level should help to reduce the burden. Keywords: skin disease, prevalence, impact, qyality of life