Browsing by Author "Shrestha, Prashanna Raj"
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Publication Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Aryal, Eliz; Bista, Raunak; Shrestha, Prashanna Raj; Regmi, GarimaAbstract Introduction: Dengue is in an increasing trend in our part of the world mostly due to global warming, It can present with various manifestations including cutaneous manifestations. The main objective of our study was to find out the prevalence of dengue fever among patients visiting the Outpatient Department of Dermatology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department of Dermatology in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 09092022\04). Data from 1 June 2022 to 8 September 2022 were collected between 1 December 2022 to 20 February 2023 from the hospital records. The laboratory data of individuals were analyzed to find out the prevalence of dengue fever. A Visual Analogue Scale was used to assess the severity of pruritus. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 7442 patients, dengue fever was found to be in 202 (2.71%) (2.34-3.08, 95% Confidence Interval) patients. The mean duration of fever was 3.02±2.960 days. The mean duration of onset of rash after having a fever was 2.56±2.032 days. The most common cutaneous manifestation was maculopapular rash 70 (34.65%). Conclusions: The prevalence of dengue fever was found to be lower than in the studies done in similar settings.Publication Efficacy and Safety of Intralesional Immunotherapy with Tuberculin Purified Protein Derivative among Cutaneous Wart Patients(Nepal Health Research Council, 2022) Shrestha, Sanju Babu; Bhusal, Mohan; Jwarchan, Jayanti; Gautam, Sujan; Shrestha, Prashanna RajAbstract Background: Cutaneous warts are common skin problems caused by Human Papilloma Virus. Conventional therapies are mostly ablative and limited by recurrences and side effects. Immunotherapy using bacterial, fungal, and viral antigens is an emerging and safer technique to treat warts at local and distant sites. The objective of this study was to measure the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative among cutaneous wart patients in the dermatology department of a tertiary care centre. Methods: A cross sectional, time series design, was conducted between October 2019 and September 2020 among 77 patients of cutaneous warts attending Dermatology out-patient department using convenience sampling. Percentage response was evaluated for patients treated with tuberculin purified protein derivative for eight weeks at an interval of two weeks into complete response (100% clearance), partial response (50-99% clearance), no response (0-49% clearance). Side effects were also recorded. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Results: Out of 77 patients, complete response (100%) was seen in 53.2% patients, partial response (50-99%) in 14.3% and no response (0-49%) was seen in 32.5%. Side effects noted were pain and erythema (19.50%), blisters (2.60%) and flu like symptoms (1.30%). Conclusions: Intralesional PPD is an effective and safer therapeutic option for the treatment of cutaneous warts. Keywords: Immunotherapy; intralesional injections; purified protein derivative of tuberculin; warts Author Biographies Jayanti Jwarchan, Gandaki Medical College Lecturer, Department of Dermatology Sujan Gautam, Kathmandu Medical College Resident, Department of Dermatology Prashanna Raj Shrestha, Kathmandu Medical College Lecturer, Department of DermatologyPublication Extracutaneous Manifestation of Ulcerative Colitis: Pyoderma Gangrenosum, A Case Report Authors(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2025) Sapkota, Rohan; Aryal, Eliz; Shrestha, Prashanna Raj; Bhari, Jyoti; Shrestha, SunnyAbstract: Pyoderma gangrenosum (PG) is a rare, ulcerative skin condition often associated with systemic diseases such as inflammatory bowel disease (IBD), including ulcerative colitis (UC). This case report describes a 79-year-old male patient with a history of ulcerative colitis who presented with increased passages of blood-mixed stools and a solitary ulcer on the left lower shin following minor trauma. The ulcer, measuring 10 cm by 4 cm, exhibited a violaceous border with purulent necrotic tissue. Histopathological examination revealed neutrophilic exudate, dense inflammatory cell infiltrate, perivascular neutrophilic infiltration, extravasated red blood cells, congested blood vessels, and hemosiderin-laden macrophages. The clinical presentation, along with the biopsy findings, confirmed the diagnosis of PG associated with UC. The patient was managed with systemic corticosteroids and antineutrophilic therapy, emphasizing the importance of early diagnosis and treatment to prevent disease progression. This case underscores the need for vigilance in identifying PG in patients with IBD, as prompt intervention can significantly improve outcomes.Publication Immunotherapy with Intralesional Vit D injection in Recalcitrant wart at a Tertiary Care Center: A Descriptive Cross sectional Study(Nepal Medical Association, 2024) Aryal, Eliz; Bhari, Jyoti; Shrestha, Prashanna RajAbstract Introduction: Recalcirant warts are resistant to conventional therapeutic option with high recurrence rate. In recent year, treatment of warts with different immunotherapeutic agent has shown good results, as it regulate epidermal cell proliferation and are involved in the formation of anti microbial peptides. Hence, this study was undertaken to evaluate the efficacy of immunotherapy with intralesional vitamin D in wart. Methods: A descriptive cross-sectional study was conducted from 1 January 2021 to 2 February 2023 at Kathmandu Medical College after approval from the Institutional Review Committee (Reference number: 0110202002). Ninety - two patients with recalcitrant wart of varying sizes and duration were included in the study. Injection vitamin D ( 600000 IU, 15mg/ ml) was injected about (0.2-0.5 ml) to the base of the wart. Maximum of five warts were injected per month, and was repeated after 4 weeks for 3 sessions. Results: Among 92 patient, complete response was seen in 70 patient (76.08%), partial response was seen in 17 patients ( 18.47%) and 5 patient(5.43%)showed no response. Mild pain as observed at the time of injection. Signs of hypervitaminosis D was not observed. Conclusions: Intralesional administration of Vitamin D is an effective treatment option for reclacitrant warts and is, highly effective, cost-efficient, with minimal adverse effects, and can be perfomed in our clinical set upPublication Low Dose Oxybutin in Primary Hyperhydrosis: A Prospective Study from a Tertiary Care Center in Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Aryal, Eliz; Shrestha, Prashanna Raj; Gautam, SujanAbstract: Introduction: Hyperhydrosis is a clinical condition where there is excessive sweating beyond the physiological need of the patient’s body. This can directly or indirectly affect the quality of patients life. Oxybutin is widely used in urology as anticholinergic medication for bladder urge incontinence. It can be used safely at a high doses (over 15 mg/day) to treat urological disorder. It also acts against excessive sweating and can be used in cases of hyperhidrosis. Objectives: To evaluate effectiveness of oxybutin at low dose and to assess the Hyperhidrosis Disease Severity Scale (HDSS) . Materials and Methods: This is a hospital based cross-sectional study in primary hyperhydrosis. Oxybutin was prescribed to all patients of primary hyperhydrosis with gradual increment of dosage of 2.5 mg orally once a day to 5 mg twice a day. Patients were evaluated at zero wk (baseline), 4 wk, 8 wk, 12 wk and follow-up in 16 wks with Hyperhidrosis Disease Severity Scale (HDSS) along with adverse effects were noted. Results: There was a significant difference in HDSS at zero wk (baseline) and 4th wk (p=0.001) at a dose of 2.5 mg once a day of oxybutynin. Also, a significant difference was noted (p=0.022) in HDSS between zero wk (baseline) and 12 wk. Similarly, a significant difference between HDSS at zero wk (baseline) versus the 16th wk was also noted. Conclusion: Oxybutin is an anticholinergic drug with an emerging role in hyperhydrosis. Low doses have shown significant results with minimal side effects. The dose requirement varies among authors. Studies with long-term follow-ups with ideal protocol need to be established in the future.