Sushila Patel - Academia.edu (original) (raw)

Papers by Sushila Patel

Annals of Thoracic Medicine, 2008

Though there are few studies addressing brainstem auditory evoked potentials (BAEP) in patients w... more Though there are few studies addressing brainstem auditory evoked potentials (BAEP) in patients with chronic obstructive pulmonary disease (COPD), subclinical BAEP abnormalities in stable COPD patients have not been studied. The present study aimed to evaluate the BAEP abnormalities in this study group. MATERIALS AND METHODS: In the present study, 80 male subjects were included: COPD group comprised 40 smokers with stable COPD with no clinical neuropathy; 40 age-matched healthy volunteers served as the control group. Latencies of BAEP waves I, II, III, IV, and V, together with interpeak latencies (IPLs) of I-III, I-V, and III-V, and amplitudes of waves I-Ia and V-Va were studied in both the groups to compare the BAEP abnormalities in COPD group; the latter were correlated with patient characteristics and Mini-Mental Status Examination Questionnaire (MMSEQ) scores to seek any signifi cant correlation. RESULTS: Twenty-six (65%) of the 40 COPD patients had BAEP abnormalities. We observed signifi cantly prolonged latencies of waves I, III, V over left ear and waves III, IV, V over right ear; increased IPLs of I-V, III-V over left ear and of I-III, I-V, III-V over right side. Amplitudes of waves I-Ia and V-Va were decreased bilaterally. Over left ear, the latencies of wave I and III were signifi cantly correlated with FEV 1 ; and amplitude of wave I-Ia, with smoking pack years. A weak positive correlation between amplitude of wave I-Ia and duration of illness; and a weak negative correlation between amplitude of wave V-Va and MMSEQ scores were seen over right side. CONCLUSIONS: We observed signifi cant subclinical BAEP abnormalities on electrophysiological evaluation in studied stable COPD male patients having mild-to-moderate airfl ow obstruction.

The article describes the results of an empirical study on the psychological boundary of the pers... more The article describes the results of an empirical study on the psychological boundary of the person in prepubescent years. The author also clarifies the interrelation between the psychological boundary and self-consciousness depending on gender, features of self-esteem and level of aspiration.

Journal of Universal College of Medical Sciences

INTRODUCTION Pterygium is a common ocular condition with prevalence varying from 0.7-39% in diffe... more INTRODUCTION Pterygium is a common ocular condition with prevalence varying from 0.7-39% in different population and particularly high in the tropics. Various surgical techniques including inferior conjunctival autograft are available for the treatment of pterygium. This study was done to determine the clinical profile and outcome of primary pterygium surgery using inferior conjunctival autograft. MATERIAL AND METHODS This was a prospective, non-comparative interventional study conducted over a period of one year from January to December 2019 in patients with primary pterygium who presented at cornea department of Lumbini Eye Institute and Research Center, Bhairahawa, Nepal. All the patients with primary pterygium, a detail clinical history and examination were done. Pterygium was excised using inferior conjunctival autografting and followed regularly over a period of 3 months. RESULTS We analysed 626 eyes in 619 patients with primary pterygium in which mean age was 44.63 ± 13.84 ye...

Europasian Journal of Medical Sciences

Background: Chalazion is a common eyelid disease caused by plugged meibomian glands and chronic l... more Background: Chalazion is a common eyelid disease caused by plugged meibomian glands and chronic lipogranulomatous inflammation. It can affect individuals of all ages and may cause local eye symptoms such as irritation and inflammation and cosmetic disfigurement. There are mainly three methods of treating chalazion: Intralesional Triamcinolone Acetonide (0.1-0.3 ml of 40mg/ml), Incision and Curettage and Conservative Treatment (hot compression +lid hygiene + antibiotic ointment) to the affected eyelid. To comparing which method is the best this study has been carried out Methodology: Patients with chalazion presenting to OPD from 15 March to 15 July 2017 were included in the study. They underwent any of the three procedures according to their choice. Follow up visit was done at two weeks to determine effectiveness in terms of reduction of size or complete resolution of the chalazion. Results: Out of 112 patients enrolled in study 65(58%) were females and 47(42%) were male with a male...

Journal of Chitwan Medical College

Background: Bacterial keratitis is a common sight threatening condition. Un­treated, it often le... more Background: Bacterial keratitis is a common sight threatening condition. Un­treated, it often leads to progressive tissue destruction with corneal perfora­tion or extension of infection to adjacent tissue. The aim of the study was to study the epidemiological characteristics of bacterial keratitis seen at Lumbini eye institute in western part of Nepal. Methods: A retrospective study was done from 1st November 2017 to 30th October 2018 in which records of all culture-positive bacterial keratitis over a 1 year period. Data regarding age of patient, occupation, type of injury, coex­isting ocular disease was recorded. Clinical evaluation corneal scrapings were collected and subjected to culture and microscopy using standard protocols in all patients. Results: Out of 800 corneal ulcer cases, 305(38.12%) were found to be of bac­terial aetiology. A total of 100(32.78%) bacterial pathogens were isolated of which predominant bacterial species Staphylococcus epidermidis 56(56%) fol­lowed by ...

Journal of Universal College of Medical Sciences

INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival a... more INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries. The present study was aimed to analyse demographic pattern, clinical characteristics, and histopathology findings of OSSN in a tertiary care centre of western region of Nepal. MATERIAL AND METHODS: It was a retrospective study. We analyzed 94 cases of OSSN who presented to cornea department of Lumbini Eye Institute, Bhairahawa, Nepal over a period 1.5 years from 1st July 2017 to 31st December 2018. All the patients with OSSN, detailed clinical history and examination were recorded. Lesions were excised with a 3 mm margin clearance and sent for histopathological examination. RESULTS: Mean age of our patients with OSSN was 48.89±17.955 years ranging from 17 to 85 years. There were 52 (55.32%) male and 4...

American journal of ophthalmology, 2018

To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of fi... more To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. Study Participants: Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. TPK button culture positivity. A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fung...

American journal of ophthalmology, Jan 10, 2018

To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from clos... more To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. Secondary analysis of randomized clinical trial data. Patients presenting with a smear-positive filamentous fungal ulcer, visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). We compare the clinical outcomes of patients who had positive 6-day fungal cultures compared to those who did not, using backwards-stepwise regression with co-variates for all baseline clinical characteristics. The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle corrected visual acuity (BSCVA), 3-month infiltrate and/or scar-size, and rate of re-epithelialization. Patients who tested positive at their 6-day culture had twice th...

JAMA Ophthalmology

Identifying patients with infectious keratitis who are at risk of experiencing a poor outcome may... more Identifying patients with infectious keratitis who are at risk of experiencing a poor outcome may be useful to allocate resources toward high-risk patients, particularly in resource-poor settings. To determine baseline patient and ulcer characteristics that predict a high risk of developing corneal perforation and/or the need to undergo therapeutic penetrating keratoplasty (TPK). This is a secondary analysis of Mycotic Ulcer Treatment Trial II, a multicenter, double-masked, placebo-controlled randomized clinical trial that enrolled 240 patients with smear-positive filamentous fungal corneal ulcers who enrolled between May 2010 and August 2015. Participants had a baseline visual acuity of 20/400 or worse and were randomized to receive oral voriconazole or a placebo (all participants received topical voriconazole, 1%). After 39 participants (16.3%) were enrolled, topical natamycin, 5%, was also added. The primary outcome of this secondary analysis was the rate of corneal perforation or the need to undergo TPK. The mean (SD) age at enrollment was 49 (13) years, 104 participants (43.3%) were women, and all were of Southeast Asian descent. The presence of hypopyon at baseline indicated 2.28 times the odds of the patient developing corneal perforation and/or needing TPK (95% CI, 1.18-4.40; P = .01). Study participants whose infiltrate involved the posterior one-third had a 71.4% risk of developing corneal perforation and/or needing TPK. For each 1-mm increase in the geometric mean of the infiltrate, there was 1.37 (95% CI, 1.12-1.67; P = .002) increased odds of developing perforation and/or needing TPK. Other clinical features such as visual acuity, baseline culture positivity, type of filamentous fungal organism and duration of symptoms, and demographic characteristics, such as sex and occupation, were not significant predictors in the multivariable regression analysis. These results suggest that risk stratification from baseline ulcer characteristics can identify those at highest risk for developing corneal perforation and/or needing TPK. clinicaltrials.gov Identifier: NCT00996736.

JAMA ophthalmology, Jan 20, 2017

Fusarium keratitis is common and often results in poor outcomes. No new treatments since natamyci... more Fusarium keratitis is common and often results in poor outcomes. No new treatments since natamycin have become available. To explore the role of adjuvant oral voriconazole on clinical outcomes in Fusarium keratitis. In this prespecified subgroup analysis of a multicenter, double-masked, placebo-controlled randomized clinical trial, 240 patients from the Aravind Eye Care System in India, the Lumbini Eye Hospital and Bharatpur Eye Hospital in Nepal, and the University of California, San Francisco, who had culture-positive fungal ulcer and baseline visual acuity of 20/400 or worse were randomized to receive oral voriconazole vs placebo. Enrollment started May 24, 2010, and the last patient study visit was November 23, 2015. All patients received topical voriconazole, 1%, and after the results of the Mycotic Ulcer Treatment Trial (MUTT) II became available, topical natamycin, 5%, was added for all patients. Data analysis was performed from September 2 to October 28, 2016. The primary ou...

JAMA Ophthalmology, 2016

To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of ... more To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India and Nepal, with 2133 individuals screened for inclusion. Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 (logMAR 1.3) or worse were randomized to receive oral voriconazole vs oral placebo; all participants received topical antifungal eyedrops. The study was conducted from May 24, 2010, to November 23, 2015. All trial end points were analyzed on an intent-to-treat basis. Study participants were randomized to receive oral voriconazole vs oral placebo; a voriconazole loading dose of 400 mg was administered twice daily for 24 hours, followed by a maintenance dose of 200 mg twice daily for 20 days, with dosing altered to weight based during the trial. All participants received topical voriconazole, 1%, and natamycin, 5%. The primary outcome of the trial was rate of corneal perforation or the need for therapeutic penetrating keratoplasty (TPK) within 3 months. Secondary outcomes included microbiologic cure at 6 days, rate of re-epithelialization, best-corrected visual acuity and infiltrate and/or scar size at 3 weeks and 3 months, and complication rates associated with voriconazole use. A total of 2133 patients in India and Nepal with smear-positive ulcers were screened; of the 787 who were eligible, 240 (30.5%) were enrolled. Of the 119 patients (49.6%) in the oral voriconazole treatment group, 65 were male (54.6%), and the median age was 54 years (interquartile range, 42-62 years). Overall, no difference in the rate of corneal perforation or the need for TPK was determined for oral voriconazole vs placebo (hazard ratio, 0.82; 95% CI, 0.57-1.18; P = .29). In prespecified subgroup analyses comparing treatment effects among organism subgroups, there was some suggestion that Fusarium species might have a decreased rate of perforation or TPK in the oral voriconazole-treated arm; however, this was not a statistically significant finding after Holms-Šidák correction for multiple comparisons (effect coefficient, 0.49; 95% CI, 0.26-0.92; P = .03). Patients receiving oral voriconazole experienced a total of 58 adverse events (48.7%) compared with 28 adverse events (23.1%) in the placebo group (P < .001 after Holms-Šidák correction for multiple comparisons). There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. All patients in this study were enrolled in India and Nepal; therefore, it is possible that organisms in this region may exhibit characteristics different from those in other regions of the world. clinicaltrials.gov Identifier: NCT00996736.

Journal of Universal College of Medical Sciences, 2016

JNMA; journal of the Nepal Medical Association

Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exac... more Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exact magnitude of problem and its clinical profile in Nepal is not well known. This study was done to evaluate clinical profile and treatment outcome of patients presenting with mushroom poisoning in the department of internal medicine, BPKIHS, Dharan. It is a prospective observational study conducted in department of internal medicine, BPKIHS, Dharan from 1st January 2008 to 31st December 2009. Informed consent was taken. All the patients were subjected to necessary laboratory investigation. They were followed up at 1 week and 1 month after discharge. All together 60 patients were analyzed. Majority of subjects 56 (93.3%) were from rural areas. Vomiting and diarrhea were the two most common presentations seen in 56 (93.3%) subjects. The latent period for the symptoms were > 6 hours in 4 (6.7%) and < 6 hours in 56 (93.3%) subjects. Fulminant hepatic failure was seen in 6 (10%) subject...

Journal of Telemedicine and Telecare, 2014

We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compare... more We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compared to a conventional clinical examination. A convenience sample of 21 patients with anterior segment disease was enrolled at the Lumbini Eye Institute (LEI) in Bhairahawa, Nepal. An ophthalmologist at the LEI examined each patient and assigned a diagnosis and follow-up interval; this represented the gold standard. An ophthalmic technician also obtained anterior segment photographs of each patient. Slit-lamp photographs and clinical histories were then uploaded to a server for access by three separate readers. These readers, one in Nepal and two in the US, provided a diagnosis and follow-up interval independently. The diagnostic agreement between the examiner and all readers was good (kappa = 0.75, P

Annals of Thoracic Medicine, 2008

Though there are few studies addressing brainstem auditory evoked potentials (BAEP) in patients w... more Though there are few studies addressing brainstem auditory evoked potentials (BAEP) in patients with chronic obstructive pulmonary disease (COPD), subclinical BAEP abnormalities in stable COPD patients have not been studied. The present study aimed to evaluate the BAEP abnormalities in this study group. MATERIALS AND METHODS: In the present study, 80 male subjects were included: COPD group comprised 40 smokers with stable COPD with no clinical neuropathy; 40 age-matched healthy volunteers served as the control group. Latencies of BAEP waves I, II, III, IV, and V, together with interpeak latencies (IPLs) of I-III, I-V, and III-V, and amplitudes of waves I-Ia and V-Va were studied in both the groups to compare the BAEP abnormalities in COPD group; the latter were correlated with patient characteristics and Mini-Mental Status Examination Questionnaire (MMSEQ) scores to seek any signifi cant correlation. RESULTS: Twenty-six (65%) of the 40 COPD patients had BAEP abnormalities. We observed signifi cantly prolonged latencies of waves I, III, V over left ear and waves III, IV, V over right ear; increased IPLs of I-V, III-V over left ear and of I-III, I-V, III-V over right side. Amplitudes of waves I-Ia and V-Va were decreased bilaterally. Over left ear, the latencies of wave I and III were signifi cantly correlated with FEV 1 ; and amplitude of wave I-Ia, with smoking pack years. A weak positive correlation between amplitude of wave I-Ia and duration of illness; and a weak negative correlation between amplitude of wave V-Va and MMSEQ scores were seen over right side. CONCLUSIONS: We observed signifi cant subclinical BAEP abnormalities on electrophysiological evaluation in studied stable COPD male patients having mild-to-moderate airfl ow obstruction.

The article describes the results of an empirical study on the psychological boundary of the pers... more The article describes the results of an empirical study on the psychological boundary of the person in prepubescent years. The author also clarifies the interrelation between the psychological boundary and self-consciousness depending on gender, features of self-esteem and level of aspiration.

Journal of Universal College of Medical Sciences

INTRODUCTION Pterygium is a common ocular condition with prevalence varying from 0.7-39% in diffe... more INTRODUCTION Pterygium is a common ocular condition with prevalence varying from 0.7-39% in different population and particularly high in the tropics. Various surgical techniques including inferior conjunctival autograft are available for the treatment of pterygium. This study was done to determine the clinical profile and outcome of primary pterygium surgery using inferior conjunctival autograft. MATERIAL AND METHODS This was a prospective, non-comparative interventional study conducted over a period of one year from January to December 2019 in patients with primary pterygium who presented at cornea department of Lumbini Eye Institute and Research Center, Bhairahawa, Nepal. All the patients with primary pterygium, a detail clinical history and examination were done. Pterygium was excised using inferior conjunctival autografting and followed regularly over a period of 3 months. RESULTS We analysed 626 eyes in 619 patients with primary pterygium in which mean age was 44.63 ± 13.84 ye...

Europasian Journal of Medical Sciences

Background: Chalazion is a common eyelid disease caused by plugged meibomian glands and chronic l... more Background: Chalazion is a common eyelid disease caused by plugged meibomian glands and chronic lipogranulomatous inflammation. It can affect individuals of all ages and may cause local eye symptoms such as irritation and inflammation and cosmetic disfigurement. There are mainly three methods of treating chalazion: Intralesional Triamcinolone Acetonide (0.1-0.3 ml of 40mg/ml), Incision and Curettage and Conservative Treatment (hot compression +lid hygiene + antibiotic ointment) to the affected eyelid. To comparing which method is the best this study has been carried out Methodology: Patients with chalazion presenting to OPD from 15 March to 15 July 2017 were included in the study. They underwent any of the three procedures according to their choice. Follow up visit was done at two weeks to determine effectiveness in terms of reduction of size or complete resolution of the chalazion. Results: Out of 112 patients enrolled in study 65(58%) were females and 47(42%) were male with a male...

Journal of Chitwan Medical College

Background: Bacterial keratitis is a common sight threatening condition. Un­treated, it often le... more Background: Bacterial keratitis is a common sight threatening condition. Un­treated, it often leads to progressive tissue destruction with corneal perfora­tion or extension of infection to adjacent tissue. The aim of the study was to study the epidemiological characteristics of bacterial keratitis seen at Lumbini eye institute in western part of Nepal. Methods: A retrospective study was done from 1st November 2017 to 30th October 2018 in which records of all culture-positive bacterial keratitis over a 1 year period. Data regarding age of patient, occupation, type of injury, coex­isting ocular disease was recorded. Clinical evaluation corneal scrapings were collected and subjected to culture and microscopy using standard protocols in all patients. Results: Out of 800 corneal ulcer cases, 305(38.12%) were found to be of bac­terial aetiology. A total of 100(32.78%) bacterial pathogens were isolated of which predominant bacterial species Staphylococcus epidermidis 56(56%) fol­lowed by ...

Journal of Universal College of Medical Sciences

INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival a... more INTRODUCTION: Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjunctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. In recent times, the incidence of OSSN seems to be on the rise, especially in developing countries. The present study was aimed to analyse demographic pattern, clinical characteristics, and histopathology findings of OSSN in a tertiary care centre of western region of Nepal. MATERIAL AND METHODS: It was a retrospective study. We analyzed 94 cases of OSSN who presented to cornea department of Lumbini Eye Institute, Bhairahawa, Nepal over a period 1.5 years from 1st July 2017 to 31st December 2018. All the patients with OSSN, detailed clinical history and examination were recorded. Lesions were excised with a 3 mm margin clearance and sent for histopathological examination. RESULTS: Mean age of our patients with OSSN was 48.89±17.955 years ranging from 17 to 85 years. There were 52 (55.32%) male and 4...

American journal of ophthalmology, 2018

To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of fi... more To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. Study Participants: Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. TPK button culture positivity. A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fung...

American journal of ophthalmology, Jan 10, 2018

To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from clos... more To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. Secondary analysis of randomized clinical trial data. Patients presenting with a smear-positive filamentous fungal ulcer, visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). We compare the clinical outcomes of patients who had positive 6-day fungal cultures compared to those who did not, using backwards-stepwise regression with co-variates for all baseline clinical characteristics. The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle corrected visual acuity (BSCVA), 3-month infiltrate and/or scar-size, and rate of re-epithelialization. Patients who tested positive at their 6-day culture had twice th...

JAMA Ophthalmology

Identifying patients with infectious keratitis who are at risk of experiencing a poor outcome may... more Identifying patients with infectious keratitis who are at risk of experiencing a poor outcome may be useful to allocate resources toward high-risk patients, particularly in resource-poor settings. To determine baseline patient and ulcer characteristics that predict a high risk of developing corneal perforation and/or the need to undergo therapeutic penetrating keratoplasty (TPK). This is a secondary analysis of Mycotic Ulcer Treatment Trial II, a multicenter, double-masked, placebo-controlled randomized clinical trial that enrolled 240 patients with smear-positive filamentous fungal corneal ulcers who enrolled between May 2010 and August 2015. Participants had a baseline visual acuity of 20/400 or worse and were randomized to receive oral voriconazole or a placebo (all participants received topical voriconazole, 1%). After 39 participants (16.3%) were enrolled, topical natamycin, 5%, was also added. The primary outcome of this secondary analysis was the rate of corneal perforation or the need to undergo TPK. The mean (SD) age at enrollment was 49 (13) years, 104 participants (43.3%) were women, and all were of Southeast Asian descent. The presence of hypopyon at baseline indicated 2.28 times the odds of the patient developing corneal perforation and/or needing TPK (95% CI, 1.18-4.40; P = .01). Study participants whose infiltrate involved the posterior one-third had a 71.4% risk of developing corneal perforation and/or needing TPK. For each 1-mm increase in the geometric mean of the infiltrate, there was 1.37 (95% CI, 1.12-1.67; P = .002) increased odds of developing perforation and/or needing TPK. Other clinical features such as visual acuity, baseline culture positivity, type of filamentous fungal organism and duration of symptoms, and demographic characteristics, such as sex and occupation, were not significant predictors in the multivariable regression analysis. These results suggest that risk stratification from baseline ulcer characteristics can identify those at highest risk for developing corneal perforation and/or needing TPK. clinicaltrials.gov Identifier: NCT00996736.

JAMA ophthalmology, Jan 20, 2017

Fusarium keratitis is common and often results in poor outcomes. No new treatments since natamyci... more Fusarium keratitis is common and often results in poor outcomes. No new treatments since natamycin have become available. To explore the role of adjuvant oral voriconazole on clinical outcomes in Fusarium keratitis. In this prespecified subgroup analysis of a multicenter, double-masked, placebo-controlled randomized clinical trial, 240 patients from the Aravind Eye Care System in India, the Lumbini Eye Hospital and Bharatpur Eye Hospital in Nepal, and the University of California, San Francisco, who had culture-positive fungal ulcer and baseline visual acuity of 20/400 or worse were randomized to receive oral voriconazole vs placebo. Enrollment started May 24, 2010, and the last patient study visit was November 23, 2015. All patients received topical voriconazole, 1%, and after the results of the Mycotic Ulcer Treatment Trial (MUTT) II became available, topical natamycin, 5%, was added for all patients. Data analysis was performed from September 2 to October 28, 2016. The primary ou...

JAMA Ophthalmology, 2016

To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of ... more To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India and Nepal, with 2133 individuals screened for inclusion. Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 (logMAR 1.3) or worse were randomized to receive oral voriconazole vs oral placebo; all participants received topical antifungal eyedrops. The study was conducted from May 24, 2010, to November 23, 2015. All trial end points were analyzed on an intent-to-treat basis. Study participants were randomized to receive oral voriconazole vs oral placebo; a voriconazole loading dose of 400 mg was administered twice daily for 24 hours, followed by a maintenance dose of 200 mg twice daily for 20 days, with dosing altered to weight based during the trial. All participants received topical voriconazole, 1%, and natamycin, 5%. The primary outcome of the trial was rate of corneal perforation or the need for therapeutic penetrating keratoplasty (TPK) within 3 months. Secondary outcomes included microbiologic cure at 6 days, rate of re-epithelialization, best-corrected visual acuity and infiltrate and/or scar size at 3 weeks and 3 months, and complication rates associated with voriconazole use. A total of 2133 patients in India and Nepal with smear-positive ulcers were screened; of the 787 who were eligible, 240 (30.5%) were enrolled. Of the 119 patients (49.6%) in the oral voriconazole treatment group, 65 were male (54.6%), and the median age was 54 years (interquartile range, 42-62 years). Overall, no difference in the rate of corneal perforation or the need for TPK was determined for oral voriconazole vs placebo (hazard ratio, 0.82; 95% CI, 0.57-1.18; P = .29). In prespecified subgroup analyses comparing treatment effects among organism subgroups, there was some suggestion that Fusarium species might have a decreased rate of perforation or TPK in the oral voriconazole-treated arm; however, this was not a statistically significant finding after Holms-Šidák correction for multiple comparisons (effect coefficient, 0.49; 95% CI, 0.26-0.92; P = .03). Patients receiving oral voriconazole experienced a total of 58 adverse events (48.7%) compared with 28 adverse events (23.1%) in the placebo group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001 after Holms-Šidák correction for multiple comparisons). There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. All patients in this study were enrolled in India and Nepal; therefore, it is possible that organisms in this region may exhibit characteristics different from those in other regions of the world. clinicaltrials.gov Identifier: NCT00996736.

Journal of Universal College of Medical Sciences, 2016

JNMA; journal of the Nepal Medical Association

Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exac... more Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exact magnitude of problem and its clinical profile in Nepal is not well known. This study was done to evaluate clinical profile and treatment outcome of patients presenting with mushroom poisoning in the department of internal medicine, BPKIHS, Dharan. It is a prospective observational study conducted in department of internal medicine, BPKIHS, Dharan from 1st January 2008 to 31st December 2009. Informed consent was taken. All the patients were subjected to necessary laboratory investigation. They were followed up at 1 week and 1 month after discharge. All together 60 patients were analyzed. Majority of subjects 56 (93.3%) were from rural areas. Vomiting and diarrhea were the two most common presentations seen in 56 (93.3%) subjects. The latent period for the symptoms were > 6 hours in 4 (6.7%) and < 6 hours in 56 (93.3%) subjects. Fulminant hepatic failure was seen in 6 (10%) subject...

Journal of Telemedicine and Telecare, 2014

We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compare... more We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compared to a conventional clinical examination. A convenience sample of 21 patients with anterior segment disease was enrolled at the Lumbini Eye Institute (LEI) in Bhairahawa, Nepal. An ophthalmologist at the LEI examined each patient and assigned a diagnosis and follow-up interval; this represented the gold standard. An ophthalmic technician also obtained anterior segment photographs of each patient. Slit-lamp photographs and clinical histories were then uploaded to a server for access by three separate readers. These readers, one in Nepal and two in the US, provided a diagnosis and follow-up interval independently. The diagnostic agreement between the examiner and all readers was good (kappa = 0.75, P