Anupama Karki

Bio: Anupama Karki is an academic researcher from Bir Hospital. The author has contributed to research in topics: Outpatient clinic & Medicine. The author has an hindex of 2, co-authored 13 publications receiving 12 citations.

Case Report: Erysipeloid Cutaneous Leishmaniasis Treated with Oral Miltefosine.

Abstract: Cutaneous leishmaniasis (CL) can present with various skin lesions ranging from a single ulcer to diffuse multiple nodules. Here, we present a case of a 67-year-old man with a large erythematous well-defined indurated plaque over the left face for a duration of 4 months. A slit skin smear was performed, and it was stained with Giemsa stain which showed multiple amastigotes confirming the diagnosis of CL. Oral miltefosine was started at a dose of 150 mg/day but had to be stopped after 20 days as the patient developed diarrhea, bipedal edema, and renal impairment. This case emphasizes an uncommon variant of CL and the role of systemic treatment with oral miltefosine and its associated adverse effects.

Prevalence and pattern of hand eczema in a tertiary referral hospital of Nepal

Abstract: BackgroundHand eczema is a very common condition that has a significant effect on an individual’s life in terms of daily functioning including various occupations. Studies show that the point prevalence of hand eczema is around 4% and the lifetime prevalence is 15%. ObjectiveThe objective of this study is to determine the prevalence and pattern of hand eczemas in patients attending the Dermatology outpatient department of Bir hospital. Materials and methodsThis is a retrospective study, where all the cases of hand eczema who presented to the Dermatology Out-Patient Department of Bir Hospital during the period from Baisakh 2075 till Chaitra 2075 B.S were recorded. ResultsEczema was diagnosed in 5,100 new cases (15.74%) and among them, hand eczema was seen in 494 cases, which accounts for 9.68% of all eczemas. The mean age was 37.43 years. Out of all the hand eczemas recorded, 334 (67.6%) were unspecified hand eczemas, pompholyx was seen in 92 (18.6%) cases, chronic hand eczema in 27 (5.5%), contact dermatitis in 20 (4%) patients and finger tip eczema was seen in 15 (3%) cases. ConclusionHand eczema is one of the common dermatological conditions. Our study showed the prevalence of hand eczema to be 9.68%.

Linear lichen sclerosus of the face

Abstract: Lichen sclerosus (LS) is a chronic inflammatory disease of unknown origin that mostly affects women in their fifties and sixties, although it may occur in men and children [1]. LS commonly affects the anogenital region, quite rarely presenting itself as an isolated extragenital lesion [2]. Extragenital lichen sclerosus (ELS) is most common on the neck, shoulders, and upper trunk. However, a linear distribution of ELS lesions is rare [3].

Pattern of sexually transmitted infections in a tertiary care hospital: A five-year retrospective study

Abstract: Introduction: Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health worldwide and especially in a developing country like Nepal. However, adequate studies are lacking in our context with regards to the pattern analysis of the STIs in community and in the tertiary care hospitals. The aim of this study is to understand the prevalence and pattern of different STIs in Nepal. Methods: This is a retrospective observational study in which the record of all patients who attended the STD OPD of NAMS, Bir Hospital from 2071 to 2075 B.S. (April 2014 – March 2019) have been analyzed. Results: Among the 2658 patients who visited the STD OPD, majority (27.5%) had been diagnosed with syphilis. The second commonest diagnosis was condyloma acuminata accounting for 22.6 % of cases. Urethral discharge syndrome and vaginal discharge syndrome comprised of 20.1% and 17% respectively. Genital herpes constituted 6% of cases whereas genital molluscum contagiosum comprised of 3.4% of cases. Genital ulcer diseases accounted for 2.1% of total cases. Conclusions: There was a high magnitude of STIs found in this study, among which syphilis constituted the major burden. The results of this study also urge further awareness programs regarding the clinical features and importance of early treatment of STIs.

Helicobacter pylori seropositivity in psoriasis

Abstract: Background: Psoriasis is a common inflammatory disease characterized by erythematous papules and plaques with silvery white scales. Recently, the role of H. pylori has been studied as a possible etiological factor. Various published studies conducted to see the association of psoriasis with H. pylori show conflicting results. Aims and Objective: The aim of this study was to find out the association of H. pylori infection in patients with psoriasis. Materials and Methods: Cross sectional comparative study was conducted in Outpatient Department (OPD) of Dermatology, Bir Hospital. Any patient presenting at dermatology OPD above 16yrs of age with psoriasis were taken as cases. Age and gender matched patients with skin disease other than psoriasis were taken as controls. The test was done by collecting 2ml of venous blood from each patient. The serum was separated by centrifuging the sample. All the patients were screened for Helicobacter pylori infection by using a commercially available immunochromatographic kit for the detection of immunoglobulin G antibody against H. pylori in the serum. Results: Chronic plaque psoriasis was the most common variant (72.2%) and there was no significant association between psoriasis type and gender. Male to female ratio was 1.61:1. The mean age of onset in male patients was 42.41years and mean onset of disease in females was 40.61years. Our study showed 21.3% of the psoriasis patients had the history of psoriasis in the family. Nail changes were noted in 40.42% of patients. Psoriatic arthritis was present in 3% of cases. In our study H. pylori infection was found in 25(53.19%) of psoriasis patients and 15(31.91%) of the controls. This showed that H. pylori infection was found higher in psoriasis patients than the controls and the difference was statistically significant (p=0.037). Conclusion: This study showed the higher prevalence of H. pylori infection in patients with psoriasis and the differences is statistically significant. It also showed that there is increased prevalence of H. pylori seropositivity with the severity of the disease and with increased duration of illness though it is not statistically significant.

Lever's Histopathology of the Skin

Abstract: Remains your authoritative source for comprehensive coverage of those skin diseases in which histopathology plays an important role in diagnosis. This edition maintains the proven, clinicopathologic classification of cutaneous disease while incorporating a “primer” on pattern-algorithm diagnosis. More than 1,800 full-color illustrations, including photomicrographs and clinical photographs, help you visualize and make the most of the clinical diagnostic process.

Structure and function of the skin

Abstract: The structure and function of the skin details the individual components of the epidermis, dermis, and their roles in normal skin health. The individual cell types in the epidermis, the different epidermal layers, and the roles of the keratinocyte are explained. The epidermis and dermis, and their important relation to each other through the dermoepidermal junction are described. The dermal adnexal structures of hair follicles (pilosebaceous units), sweat glands, and nerves are all considered. The functions of skin and barrier function are also listed. Rare but important causes of disordered sweating (hyperhidrosis and hypohidrosis) are described. In addition, presentations of hyperhidrosis are discussed.

Andrews' Diseases of the Skin: Clinical Dermatology

Abstract: Nondermatologists fall naturally into two basic groups: those who minimize the importance of cutaneous disease and who try to ignore the skin, and those who do not. This book, the best of its genre, is for the latter, finding its primary niche as a dermatology text for generalists. Being thoroughly familiar with it would allow any physician to care for skin disease with a high degree of proficiency. By unburdening itself of lengthy histopathological descriptions and ponderous explanations of morphogenesis, the book achieves a lean, workmanlike style. Stripping away the esoteric leaves room for that which is more immediately useful. It is like a jeep, solid and reliable, or, perhaps more accurately, a shop manual for a jeep. The authors are not afraid of dispensing anecdotal reports or of generously sprinkling drug trade names when discussing treatment. This lends a feeling of informality and chattiness to the highly readable text.

Iconography : Psoriasis of early and late onset: A clinical and epidemiologic study from Spain

Abstract: BACKGROUND The existence of 2 distinct forms of psoriasis related to age at onset has been postulated. However, precise data regarding the clinical and epidemiologic characteristics of psoriasis depending on the age at onset are still lacking. OBJECTIVE The purpose of this study was to define the clinical and epidemiologic features of this disease in Spain and to compare patients with psoriasis of early and late onset. METHODS An observational, analytic, cross-sectional, multicenter study was carried out. From January 1999 to November 1999, 179 participating dermatologists completed a questionnaire detailing the clinical and epidemiologic features of the first 10 consecutive patients with psoriasis seen in their clinical practice. The sample distribution was proportional to the Spanish population. Both statistical and descriptive analyses were performed. RESULTS Available data were obtained from 1774 patients. The onset of the disease before 30 years of age was significantly associated with a higher incidence of family history of psoriasis, a more severe and extensive cutaneous involvement, and greater psychosocial impact. Guttate psoriasis, nail involvement, evidence of precipitating factors, and a recurrent clinical course were more frequent in this group of patients. Patients with psoriasis of late onset had a less severe clinical course and a more continuous evolution. Palmoplantar pustulosis was more frequent in this group of patients. No significant relationship was detected between the age at onset and development of joint involvement. CONCLUSION Patients with early and late onset psoriasis often show different clinical and evolutionary features. From the analysis of our data, it seems that 2 different groups of patients with psoriasis related to age at onset can be defined.

Sweet's syndrome with neurologic manifestations in a patient with esophageal adenocarcinoma: case report and review of the literature.

Abstract: Background Sweet's syndrome, also known as febrile neutrophilic dermatosis, can occur in patients with an underlying malignancy and can present with extracutaneous manifestations, including neurologic symptoms. Methods This report describes a 62-year-old man with adenocarcinoma of the esophagus who developed Sweet's syndrome and whose postoperative course was complicated by encephalitis. Results A diagnosis of Sweet's syndrome with neurologic manifestations was made, and the patient was treated with oral corticosteroids. His symptoms improved markedly within 12 h. Conclusion Neurologic symptoms in Sweet's syndrome are infrequently reported and have not been described previously in a patient with adenocarcinoma of the esophagus.