Browsing by Author "Shrestha, Smriti"
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Publication Profile of Clients of HIV Testing and Counseling in a Tertiary Care Center and Need of Testing in Tuberculosis(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Shrestha, Smriti; Karn, Dharmendra; Tamrakar, Dipesh; Madhup, Surendra; Karmacharya, Biraj ManAbstract: Introduction: Sexually transmitted infection is public health issue that amplifies HIV burden globally. At National Center of AIDS and STD Control, annual reported STI are rising steeply recently. Incidence of HIV is 0.03% while prevalence in adult population is less than 1%. National HIV testing guidelines 2017 recommends HIV tests should be performed in tuberculosis and medical conditions. However, it is not routinely done in Nepal. Objective: To assess profile of STI and HIV among patients attending HIV testing and counseling center of tertiary hospital, and to assess fraction of tuberculosis patients undergoing HIV testing. Materials and Methods: All patients attending HIV testing and counseling center were tested for HIV. Tests for STI were done based on patient symptoms. Data collected were analyzed with SPSS. Results: Suspected STI (41.1%) was commonest cause of HIV testing. Among STI, gram positive diplococcic were noted in 11.5% and 3.4% had PCR positive Chlamydia. Only 19.4% (7 out of 36) of total tuberculosis patients in hospital were screened for HIV, among which, 57.14% (4 out of 7) were seropositive for HIV, which is noteworthy. Conclusion: Our study shows patterns of STI, and that gonorrhea and chlamydia could be underdiagnosed in Nepal. Every patient with tuberculosis should routinely be screened for HIV. But only small fraction of tuberculosis patients underwent HIV screening, out of which HIV positivity was high, reflecting the gap and need for routine HIV screening in TB patients. Keywords: Acquired Immunodeficiency Syndrome, HIV infections, Sexually Transmitted Diseases, TuberculosisPublication Pyoderma Gangrenosum with Positive Antinuclear Antibody, in the Absence of Systemic Association(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2018) Shrestha, Smriti; Aryal, AlishaAbstract: Pyoderma gangrenosum is an uncommon neutrophilic dermatosis, seen on legs, and infrequently on hands and other anatomical sites. It is associated with systemic diseases in 50-70% of the cases. Antinuclear antibody (ANA) seropositivity has been reported in pyoderma gangrenosum associated with connective tissue disorders. However, there are very few case reports of pyoderma gangrenosum in patients of systemic lupus erythematosus, while we did not find any reports of ANA seropositivity in isolated pyoderma gangrenosum. Hence, we report this unique case of pyoderma gangrenosum with classical clinicohistopathology, positive ANA but no systemic association. As anticipated, our patient responded promptly to steroids. Keywords: Antibodies, connective tissue diseases, lupus erythematosus, vasculitis, leukocytoclasticPublication Variations of Dermatological Findings in New-Borns of a Community Hospital in Nepal(Nepal Paediatric Society (JNPS), 2017) Shrestha, Asim; Shrestha, SmritiAbstract: Introduction: Skin manifestations are common in neonates. The prevalence of skin changes and their association with neonatal and maternal factors are not adequately documented in Nepal. It is important to differentiate common benign skin lesions from infrequent skin changes that cause morbidity, requiring medical management. The objectives of this study were to determine the pattern of skin lesions in new-borns and their association with maternal and neonatal variables. Material and Methods: This was a prospective, cross-sectional study conducted in obstetric unit of the hospital from December 2016 to May 2017. Outborn babies and babies shifted to NICU were excluded. Results: A total of 935 new-borns were examined. The commonest skin lesions were Mongolian spot (66.7%), Erythema toxicum (46.6%), Milia (44.4%), Epstein pearls (26.4%) and Salmon patch (11.9%). Mothers aged 35 years or older (63.6%) had statistically significant association with Erythema toxicum (p=0.01). Erythema toxicum was more in primiparity, term pregnancy and caesarean section delivery. Milia was associated with male babies. Salmon patch was seen more in term pregnancy. Congenital melanocytic nevus, haemangioma and port-wine stain were noted in three, two and one new-borns respectively, which alter morbidity and hence are important to diagnose in time. Conclusion: We found that 93.8% of neonates had at one or more skin lesions. The majority of skin lesions were benign and transient. Erythema toxicum was seen commonly in mothers aged 35 and more. Salmon patch was seen more in term pregnancy.