डा.विकास पौडेल | Tribhuvan University (IOM) (original) (raw)
Papers by डा.विकास पौडेल
Nepal journal of dermatology, venereology & leprology, Mar 29, 2022
Pemphigus vulgaris is an autoimmune blistering disorder where biologics are the cornerstone of th... more Pemphigus vulgaris is an autoimmune blistering disorder where biologics are the cornerstone of therapy. In resourcelimited settings, a dermatologist should rely on systemic steroids. Dexamethasone pulse therapy is a cheap and established treatment of pemphigus where a supra-pharmacological dose of dexamethasone is used. High dose of dexamethasone is supposed to have atherogenic potential which could promote a hypercoagulable state. Here, we report a case of a 30-year-old woman in the resource-limited setting of Nepal, who was under monthly dexamethasone pulse therapy for pemphigus vulgaris, who had an acute episode of ST-segment elevated myocardial infarction. In such setting, although steroids are the cornerstone of therapy in various disorders, physicians should be equally cautious in using a high dose of steroids which might lead to fatal complications. This could probably be the first case report of steroid-induced acute myocardial infarction during treatment of pemphigus worldwide.
Sheet Metal & Fabricator, 2004
We report two cases of cutaneous leishmaniasis in natives of central region of Nepal. The first p... more We report two cases of cutaneous leishmaniasis in natives of central region of Nepal. The first patient in our series, an adult female, presented with a small nodule on the philtrum of upper lip and the second case, a male child, presented with two crusted plaques on forehead. The final diagnosis was based on histopathological findings; however, species characterization was not possible because of its unavailability in the country. These patients responded well to the treatment with Miltefosine (First case) and Fluconazole (second case). Moreover, these cases sparks a question about the origin of diseases in this region and calls for further research in future to find out the cause and prevalence of this disease in Nepal. This case report also emphasizes to consider cutaneous leishmaniasis as differential diagnosis for granulomatous presentations in our context.
Med Phoenix, 2022
No abstract available.
Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster vir... more Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male. Keywords: Erectile Dysfunction; herpes zoster; Nepal.
Kathmandu University Medical Journal
The world has changed dramatically since the COVID-19 pandemic began. COVID-19 was first reported... more The world has changed dramatically since the COVID-19 pandemic began. COVID-19 was first reported on 31 December 2019 at Wuhan city of China and was declared pandemic on 11 March 2020. 1 In Nepal, the first case of COVID 19 was reported on 23 January 2020, on a 31year student returnee from Wuhan. 2 With change in global scenario, social, occupational, and personal lives are full of novel challenges for all physicians, including dermatologists. 3
Med Phoenix
Background: Urinary tract infections (UTIs) are one of the most common infectious conditions seek... more Background: Urinary tract infections (UTIs) are one of the most common infectious conditions seeking treatment. There are varieties of microorganisms associated. The bacteriological investigations are incomplete without antibiotic sensitivity test of the isolate. Our aim is to determine age and sex distribution of UTI, bacteriological profile, and antibiotic sensitivity pattern of the organisms. Materials and Methods: A retrospective cross-sectional observational study of records of patients with clinically suspected UTI from Kartik 2076 to Magh 2076 was conducted at National Medical College and Teaching Hospital (NMCTH). It included both inpatient and OPD visit patients who submitted their clean-catch midstream urine sample for culture and antibiotic sensitivity at Microbiology lab of NMCTH. Result: Out of 385 patients, 103 (26.75%) showed bacterial growth. Escherichia coli (47.58 %) was the most common organism followed by Staphylococcus sps. (18.45%) and Klebsiella sps.(17.47%) r...
Nepal Journal of Dermatology, Venereology & Leprology
The COVID-19 pandemic has changed the world dynamics in various prospects. It led to the restric... more The COVID-19 pandemic has changed the world dynamics in various prospects. It led to the restricted mobility of dermatological patients and helped telemedicine platform to flourish than ever. Though teledermatology has its own pros and cons, it’s being used in treatment of various skin disorders. Cutaneous leishmaniasis is an emerging disease in Nepal whose diagnosis is primarily clinical and histological. We are reporting a case of suspected cutaneous leishmaniasis from far western hilly region of Nepal who was empirically treated with fluconazole with the help of teledermatology platform with outstand outcomes.
Journal of College of Medical Sciences-Nepal, 2010
This case report describes a rare and unusual lesion found in 27 year old female, which was diagn... more This case report describes a rare and unusual lesion found in 27 year old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 5 cm in diameter, almost obstructing the nasal vestibule and characterized by slow growth. Complete excision was performed and the histopathological analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented. Keywords: Pleomorphic adenoma; minor salivary gland tumors; nasal vestibule DOI: 10.3126/jcmsn.v6i1.3603 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 51-53
Our Dermatology Online
Cutaneous leishmaniasis, a vector borne protozoan infection of skin manifests as chronic nodulo-u... more Cutaneous leishmaniasis, a vector borne protozoan infection of skin manifests as chronic nodulo-ulcerative growth in skin. In Nepal, cutaneous leishmaniasis, the most common form, supposed to be rare is gradually rising as an emerging public health concern. These days, a number of imported and native patients are being reported from different parts of Nepal. Since, it's less endemic here; there is high chance of being treated as other diseases. Here, we report a series of cases of cutaneous leishmaniasis, who presented in the outpatient department of dermatology, TU Teaching Hospital in the year 2015-2016 and was treated with meltifosine.
Our Dermatology Online
Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not tran... more Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not transmitted sexually. They may be confused with venereal diseases and be responsible for concerns among patients as well as diagnostic dilemmas for physicians. This study was conducted to determine the prevalence and describe the patterns of non-venereal genital conditions. Methods: This was a hospital-based, cross-sectional, prospective study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. Non-probability purposive sampling was employed to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. Detailed history taking along with a complete cutaneous examination were conducted for all patients and recorded in a preformed proforma. Results: Among 21366 patients, two hundred patients had non-venereal genital dermatoses. The prevalence of non-venereal dermatoses was 0.93 %. The mean age of the patient was...
Med Phoenix, 2021
Corona virus pandemic has begun a new human era including a newer era of medical education. All s... more Corona virus pandemic has begun a new human era including a newer era of medical education. All sorts of medical education, conferences, seminars, and workshops have been affected by the outbreak of the pandemic. 1 The rapid spread of COVID-19 has affected medical students physically, academically, financially, and psychologically. 2 During in pandemic, norms of compulsory social distancing, sanitation, hygiene, and various guidelines and recommendations, not only in the clinical practices but medical schools, have been transitioned from the way of living from traditional into online methods. Besides, practical classes, clinical rotations, and direct patient encounters of clinicians and medical students have been deferred, paused or stopped. Most of the clinicians across the globe are following new standards of online consultation whereas the medical educators are conducting lectures, classes and group learning activities virtually or in hybrid technique. If a similar situation continues, there might be days in future when universities will also conduct written or viva-voce examinations virtually. Thus, there is increasing scope of telemedicine even in post-pandemic status for clinicians, medical educators and students. 3
Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster vir... more Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male.
JNMA: Journal of the Nepal Medical Association, 2021
Introduction: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. Th... more Introduction: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. Methods: This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/ 76/ 77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. Results: Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.77%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), s...
Scabies is a common contagious neglected parasitic skin infestation caused by a mite called Sarco... more Scabies is a common contagious neglected parasitic skin infestation caused by a mite called Sarcoptes scabiei.1 It is more common in children than adults. As the exact number of infected cases worldwide is not known, but is estimated to be up to 300 million and endemic in developing world.2 Though its burden is high, effective mass control strategies are lacking. Ivermectin is effective oral drug for mass scabies treatment and control.3
Journal of Dermatology and Venereology, 2021
Introduction: Dermatophytosis refers to superficial fungal infections of keratinized tissues caus... more Introduction: Dermatophytosis refers to superficial fungal infections of keratinized tissues caused by keratinophilic dermatophytes. It is the most common of the superficial fungal infections. Nowadays, these fungal infections are at a rise and run a prolonged course despite of treatment due to resistance to conventional antifungal agents. There is a felt need to conduct an epidemiological studies to know the change in the pattern and causes of widespread resistance. Objectives: This study was aimed at identifying clinico-mycological patterns of dermatophytic infections in patients attending the dermatology outpatient department of a tertiary care hospital in Birgunj and the adjoining areas. Materials and Methods: The study included cases of clinically diagnosed dermatophytosis from the outpatient department of Dermatology of National Medical College, Birgunj. Clinical and epidemiological data were collected as per proforma and skin scraping, hair plucking, and nail clipping were do...
Case Reports in Dermatological Medicine, 2021
Molluscum contagiosum is a viral infection caused by the Poxvirus characterized by multiple umbil... more Molluscum contagiosum is a viral infection caused by the Poxvirus characterized by multiple umbilicated papules. It is common in children and can be present at any body site. Severe molluscum is common in immunocompromised patients. We report a 20-year-old HIV-positive individual with widespread molluscum contagiosum, recalcitrant to topical therapy, under antiretroviral therapy, who was treated with oral isotretinoin and had a dramatic outcome. Although studies are needed to confirm the effectiveness of oral isotretinoin therapy in molluscum contagiosum, its easy availability, cost, and excellent safety profile appear to offer a promising therapeutic option.
Angiokeratoma corporis diffusum universale, a clinical variant of angiokeratoma, is a generalized... more Angiokeratoma corporis diffusum universale, a clinical variant of angiokeratoma, is a generalized vascular ectasia that is associated with overlying epidermal changes rather than a true vascular neoplasm. It is the cutaneous hallmark of several rare inherited lysosomal diseases associated with specific enzyme deficiencies in the metabolism of glycoproteins. Herein, we present possibly the first case report from Nepal of angiokeratoma corporis diffusum universale in a 14-year-old female from consanguineous parents who presented herself with characteristic clinical and laboratory features of angiokeratoma corporis diffusum with progressive mental and motor developmental delay along with seizures, dystonia, and recurrent chest infections. Resource constraints limited confirmation with an enzyme assay and electron microscopy. We report this unusual case with the intention of re-emphasizing the importance of clinical evaluation in reaching a diagnosis in a resource-deficient setting.
Nepal journal of dermatology, venereology & leprology, Mar 29, 2022
Pemphigus vulgaris is an autoimmune blistering disorder where biologics are the cornerstone of th... more Pemphigus vulgaris is an autoimmune blistering disorder where biologics are the cornerstone of therapy. In resourcelimited settings, a dermatologist should rely on systemic steroids. Dexamethasone pulse therapy is a cheap and established treatment of pemphigus where a supra-pharmacological dose of dexamethasone is used. High dose of dexamethasone is supposed to have atherogenic potential which could promote a hypercoagulable state. Here, we report a case of a 30-year-old woman in the resource-limited setting of Nepal, who was under monthly dexamethasone pulse therapy for pemphigus vulgaris, who had an acute episode of ST-segment elevated myocardial infarction. In such setting, although steroids are the cornerstone of therapy in various disorders, physicians should be equally cautious in using a high dose of steroids which might lead to fatal complications. This could probably be the first case report of steroid-induced acute myocardial infarction during treatment of pemphigus worldwide.
Sheet Metal & Fabricator, 2004
We report two cases of cutaneous leishmaniasis in natives of central region of Nepal. The first p... more We report two cases of cutaneous leishmaniasis in natives of central region of Nepal. The first patient in our series, an adult female, presented with a small nodule on the philtrum of upper lip and the second case, a male child, presented with two crusted plaques on forehead. The final diagnosis was based on histopathological findings; however, species characterization was not possible because of its unavailability in the country. These patients responded well to the treatment with Miltefosine (First case) and Fluconazole (second case). Moreover, these cases sparks a question about the origin of diseases in this region and calls for further research in future to find out the cause and prevalence of this disease in Nepal. This case report also emphasizes to consider cutaneous leishmaniasis as differential diagnosis for granulomatous presentations in our context.
Med Phoenix, 2022
No abstract available.
Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster vir... more Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male. Keywords: Erectile Dysfunction; herpes zoster; Nepal.
Kathmandu University Medical Journal
The world has changed dramatically since the COVID-19 pandemic began. COVID-19 was first reported... more The world has changed dramatically since the COVID-19 pandemic began. COVID-19 was first reported on 31 December 2019 at Wuhan city of China and was declared pandemic on 11 March 2020. 1 In Nepal, the first case of COVID 19 was reported on 23 January 2020, on a 31year student returnee from Wuhan. 2 With change in global scenario, social, occupational, and personal lives are full of novel challenges for all physicians, including dermatologists. 3
Med Phoenix
Background: Urinary tract infections (UTIs) are one of the most common infectious conditions seek... more Background: Urinary tract infections (UTIs) are one of the most common infectious conditions seeking treatment. There are varieties of microorganisms associated. The bacteriological investigations are incomplete without antibiotic sensitivity test of the isolate. Our aim is to determine age and sex distribution of UTI, bacteriological profile, and antibiotic sensitivity pattern of the organisms. Materials and Methods: A retrospective cross-sectional observational study of records of patients with clinically suspected UTI from Kartik 2076 to Magh 2076 was conducted at National Medical College and Teaching Hospital (NMCTH). It included both inpatient and OPD visit patients who submitted their clean-catch midstream urine sample for culture and antibiotic sensitivity at Microbiology lab of NMCTH. Result: Out of 385 patients, 103 (26.75%) showed bacterial growth. Escherichia coli (47.58 %) was the most common organism followed by Staphylococcus sps. (18.45%) and Klebsiella sps.(17.47%) r...
Nepal Journal of Dermatology, Venereology & Leprology
The COVID-19 pandemic has changed the world dynamics in various prospects. It led to the restric... more The COVID-19 pandemic has changed the world dynamics in various prospects. It led to the restricted mobility of dermatological patients and helped telemedicine platform to flourish than ever. Though teledermatology has its own pros and cons, it’s being used in treatment of various skin disorders. Cutaneous leishmaniasis is an emerging disease in Nepal whose diagnosis is primarily clinical and histological. We are reporting a case of suspected cutaneous leishmaniasis from far western hilly region of Nepal who was empirically treated with fluconazole with the help of teledermatology platform with outstand outcomes.
Journal of College of Medical Sciences-Nepal, 2010
This case report describes a rare and unusual lesion found in 27 year old female, which was diagn... more This case report describes a rare and unusual lesion found in 27 year old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 5 cm in diameter, almost obstructing the nasal vestibule and characterized by slow growth. Complete excision was performed and the histopathological analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented. Keywords: Pleomorphic adenoma; minor salivary gland tumors; nasal vestibule DOI: 10.3126/jcmsn.v6i1.3603 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 51-53
Our Dermatology Online
Cutaneous leishmaniasis, a vector borne protozoan infection of skin manifests as chronic nodulo-u... more Cutaneous leishmaniasis, a vector borne protozoan infection of skin manifests as chronic nodulo-ulcerative growth in skin. In Nepal, cutaneous leishmaniasis, the most common form, supposed to be rare is gradually rising as an emerging public health concern. These days, a number of imported and native patients are being reported from different parts of Nepal. Since, it's less endemic here; there is high chance of being treated as other diseases. Here, we report a series of cases of cutaneous leishmaniasis, who presented in the outpatient department of dermatology, TU Teaching Hospital in the year 2015-2016 and was treated with meltifosine.
Our Dermatology Online
Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not tran... more Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not transmitted sexually. They may be confused with venereal diseases and be responsible for concerns among patients as well as diagnostic dilemmas for physicians. This study was conducted to determine the prevalence and describe the patterns of non-venereal genital conditions. Methods: This was a hospital-based, cross-sectional, prospective study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. Non-probability purposive sampling was employed to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. Detailed history taking along with a complete cutaneous examination were conducted for all patients and recorded in a preformed proforma. Results: Among 21366 patients, two hundred patients had non-venereal genital dermatoses. The prevalence of non-venereal dermatoses was 0.93 %. The mean age of the patient was...
Med Phoenix, 2021
Corona virus pandemic has begun a new human era including a newer era of medical education. All s... more Corona virus pandemic has begun a new human era including a newer era of medical education. All sorts of medical education, conferences, seminars, and workshops have been affected by the outbreak of the pandemic. 1 The rapid spread of COVID-19 has affected medical students physically, academically, financially, and psychologically. 2 During in pandemic, norms of compulsory social distancing, sanitation, hygiene, and various guidelines and recommendations, not only in the clinical practices but medical schools, have been transitioned from the way of living from traditional into online methods. Besides, practical classes, clinical rotations, and direct patient encounters of clinicians and medical students have been deferred, paused or stopped. Most of the clinicians across the globe are following new standards of online consultation whereas the medical educators are conducting lectures, classes and group learning activities virtually or in hybrid technique. If a similar situation continues, there might be days in future when universities will also conduct written or viva-voce examinations virtually. Thus, there is increasing scope of telemedicine even in post-pandemic status for clinicians, medical educators and students. 3
Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster vir... more Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male.
JNMA: Journal of the Nepal Medical Association, 2021
Introduction: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. Th... more Introduction: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. Methods: This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/ 76/ 77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. Results: Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.77%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), s...
Scabies is a common contagious neglected parasitic skin infestation caused by a mite called Sarco... more Scabies is a common contagious neglected parasitic skin infestation caused by a mite called Sarcoptes scabiei.1 It is more common in children than adults. As the exact number of infected cases worldwide is not known, but is estimated to be up to 300 million and endemic in developing world.2 Though its burden is high, effective mass control strategies are lacking. Ivermectin is effective oral drug for mass scabies treatment and control.3
Journal of Dermatology and Venereology, 2021
Introduction: Dermatophytosis refers to superficial fungal infections of keratinized tissues caus... more Introduction: Dermatophytosis refers to superficial fungal infections of keratinized tissues caused by keratinophilic dermatophytes. It is the most common of the superficial fungal infections. Nowadays, these fungal infections are at a rise and run a prolonged course despite of treatment due to resistance to conventional antifungal agents. There is a felt need to conduct an epidemiological studies to know the change in the pattern and causes of widespread resistance. Objectives: This study was aimed at identifying clinico-mycological patterns of dermatophytic infections in patients attending the dermatology outpatient department of a tertiary care hospital in Birgunj and the adjoining areas. Materials and Methods: The study included cases of clinically diagnosed dermatophytosis from the outpatient department of Dermatology of National Medical College, Birgunj. Clinical and epidemiological data were collected as per proforma and skin scraping, hair plucking, and nail clipping were do...
Case Reports in Dermatological Medicine, 2021
Molluscum contagiosum is a viral infection caused by the Poxvirus characterized by multiple umbil... more Molluscum contagiosum is a viral infection caused by the Poxvirus characterized by multiple umbilicated papules. It is common in children and can be present at any body site. Severe molluscum is common in immunocompromised patients. We report a 20-year-old HIV-positive individual with widespread molluscum contagiosum, recalcitrant to topical therapy, under antiretroviral therapy, who was treated with oral isotretinoin and had a dramatic outcome. Although studies are needed to confirm the effectiveness of oral isotretinoin therapy in molluscum contagiosum, its easy availability, cost, and excellent safety profile appear to offer a promising therapeutic option.
Angiokeratoma corporis diffusum universale, a clinical variant of angiokeratoma, is a generalized... more Angiokeratoma corporis diffusum universale, a clinical variant of angiokeratoma, is a generalized vascular ectasia that is associated with overlying epidermal changes rather than a true vascular neoplasm. It is the cutaneous hallmark of several rare inherited lysosomal diseases associated with specific enzyme deficiencies in the metabolism of glycoproteins. Herein, we present possibly the first case report from Nepal of angiokeratoma corporis diffusum universale in a 14-year-old female from consanguineous parents who presented herself with characteristic clinical and laboratory features of angiokeratoma corporis diffusum with progressive mental and motor developmental delay along with seizures, dystonia, and recurrent chest infections. Resource constraints limited confirmation with an enzyme assay and electron microscopy. We report this unusual case with the intention of re-emphasizing the importance of clinical evaluation in reaching a diagnosis in a resource-deficient setting.