Binayak Chandra Dwari

Bio: Binayak Chandra Dwari is an academic researcher from Manipal College of Medical Sciences. The author has contributed to research in topics: Drug eruption & Melasma. The author has an hindex of 3, co-authored 8 publications receiving 48 citations. Previous affiliations of Binayak Chandra Dwari include Manipal Teaching Hospital.

A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a tertiary care teaching hospital in pokhara, Nepal.

Abstract: Background: Cutaneous tuberculosis (TB) is essentially an invasion of the skin by Mycobacterium tuberculosis, the same bacteria that causes pulmonary tuberculosis. Aim: This study was conducted to study the common types of cutaneous TB and to find the management pattern in a tertiary teaching hospital in Pokhara, Nepal. Materials and Methods: All the cases of cutaneous TB were biopsied and furthermore investigated by performing Mantoux test, sputum examination, fine needle aspiration cytology, chest X-ray and ELISA. Results: In this study, we found that tuberculosis verrucous cutis (48%) had a higher incidence than other types of cutaneous TB. More males were affected than were females (1.2:1). Commonly affected sites were the limb and the buttock (48%). The most commonly affected age group was 16-25 years (40%). All cases (except two) were more than 15 mm in size in the Mantoux test. The histopathological picture was typical in all except three cases. All patients were treated with antitubercular treatment as per the national guidelines. Conclusion: The most common type of cutaneous TB was tuberculosis verrucous cutis and the most commonly affected sites were the limb and the buttock. As cutaneous TB sometimes reflects the presence of pulmonary tuberculosis, its incidence should not be ignored.

Metronidazole Induced Bullous Fixed Drug Eruptions: A Case Report And A Review Of Literature

Abstract: Metronidazole is a synthetic nitroimidazole drug indicated in trichomoniasis, amebiasis, giardiasis and anaerobic and mixed bacterial infections. The common side effects due to this drug include GI disturbances, weakness, dizziness, ataxia, headache, drowsiness, insomnia, maculopapular skin eruptions, urticaria, pruritus, and occasionally erythema multiforme. We hereby report a case of bullous drug eruption due to metronidazole with an established causality, severity, preventability and predictability in a 99 year old male. Patient gave history of three days treatment with Inj. Metronidazole following which he developed severe generalized itching within one day of the above treatment and noticed the blisters on the second day. A diagnosis of metronidazole induced bullous eruption was made, and the patient was managed with Tab. Prednisolone 30mg/day tapered over 10 days, along with Tab Ranitidine, tab Fexofenadine, tab Cetrizine, Gentian violet paint and Fusidic acid+Betamethasone cream.

Clinical profile and management pattern of melasma patients in Western Nepal:A hospital based study

Abstract: Introduction: Melasma is an acquired hypermelanosis of sun-exposed areas. Melasma is much more common in women than in men. Women are affected in 90% of cases. The patient usually presents with tan to brown patches. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race. Objectives: The objectives of the present studies are to study the demographic details of the melasma patients visiting the Manipal Teaching Hospital (MTH), to study the drugs used in management of melasma and to estimate the treatment cost to the patients. Materials and methods: We went through the records of the patient at MTH and found out the number of patients suffering from melasma and other related data from 25th November 2005 to 30th November 2007. The data obtained were analyzed as per the study objectives. Results: Altogether 107 patient files were included in the study. There were 75 (70.09%) females and 32 (29.90%) males (the total is 107). More than 50% of the patients were above the age 20 years. Most common site of occurrence of pigmentation was forehead accounting for 56.45% (n= 70) of the total case followed by cheeks 12.09% (n=15). Altogether 290 drugs were used in the patients with a Mean □ SD of 2.71 □ 0.89 drugs per patient. The Mean □ SD cost of medications was NRs 458 □ 251.36. Conclusion: The present study analyzed the clinical profile and treatment pattern of the melasma patients visiting MTH. Majority of the patients were of child bearing age. Sun screens were the most commonly employed medications followed by antioxidants 20 (6.89%) and antibiotics 18 (6.2%).

Fixed drug eruption due to co-trimoxazole: a case report.

Abstract: Background: Cotrimoxazole is a synergistic fixed dose combination of sulfamethoxazole and trimethoprim used in treatment of several infections including urinary, respiratory, gastrointestinal tract infections. Because of itswide spectrum and low cost it is one of the most preferred antimicrobial in Nepal. Fixed drug eruptions (FDEs) are drug rashes which tend to occur at the same site in the particular patient each time when an offending drug is administered. Co-trimoxazole is a drug commonly implicated for causing FDEs. Case report: We report a case of FDE due to co-trimoxazole occurred in a patient for whom it was prescribed by a local practitioner without taking adequate medication history. We also carried out the causality, severity, preventability and predictability as well as the economic impact of the associated adverse drug reaction (ADR). The report suggests that before prescribing any drug, clinicians should take appropriate medication history and upon occurrence of any ADR the patient should be counseled and instructed to communicate with the clinicians wherever they attend for the next time. Keywords: Causality assessment, Co-trimoxazole, Fixed drug eruption, Naranjo algorithm. The full text of this paper is available at Journal of Institute of Medicine website

Transient acantholytic dermatosis (Grover's disease) - a case report

Abstract: Transient acantholytic dermatosis was described by Grover. Its definite cause and pathogenesis is unknown. A 22-year-old man presented to our out-patient department with multiple itchy vesicles and pustules on the neck and chest. The biopsy was done and histopathology findings revealed focal acantholytic dyskeratosis. Case was diagnosed as Grover’s disease. Patient was given vitamin A 50000 IU per day and later dapsone was added. Patient was advised to avoid sunlight and heat. This is the first case of biopsy confirmed Grover’s disease fromNepal.

Harrison's Principles of Internal Medicine

Abstract: The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II

Abstract: The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009 This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs

Cutaneous Tuberculosis: Clinicopathologic Arrays and Diagnostic Challenges

Abstract: The clinicopathological manifestations of cutaneous tuberculosis are diverse The precise diagnosis is often overlooked, due to clinical presentations as those of cutaneous diseases with different etiology and the relative paucity of the pathogens in the lesions Meanwhile, almost all of the diagnostic methods confer lower sensitivity and specificities which augments further diagnostic challenges This article revises the current scenario of the disease's physiopathology and underscores clinicopathological challenges, due to multifaceted presentations of cutaneous tuberculosis, in the diagnosis

Atypical features and systemic associations in extensive cases of Grover disease: A systematic review

Abstract: Background Grover disease is an acantholytic disorder that typically occurs on the trunk of older individuals, primarily white men, in association with heat and xerosis. Cases with extensive and/or atypical distributions have been reported. Objective To review the literature characterizing the population, morphology, associations, and disease course of extensive or atypical eruptions of Grover disease. Methods A systematic literature review identified 50 articles with 69 cases. Results Patient age ranged from 14 to 83 years (mean age, 56 ± 15), with 71% of patients being male and 29% female. Areas of involvement included the trunk (90%), upper and lower extremities (63% and 61%, respectively), face/scalp (28%), neck (21%), groin (11%), buttocks (8%), and axillae (6%). The most common associations included a history of malignancy (61%), recent chemotherapy (38%), and recent transplant (20%). Limitations Extensive cases with typical clinical morphology may not have been examined by biopsy or reported; thus, this review may have publication bias toward more severe or atypical presentations. Conclusions Greater variability exists among patients affected by extensive or atypical Grover disease than among those with typical disease. Malignancy is a common association, and there may be a role for immunosuppression in the pathogenesis of extensive or atypical Grover disease.

Evolution of cutaneous tuberculosis over the past 30 years in a tertiary hospital on the European Mediterranean coast

Abstract: Summary Background. There have been few studies on cutaneous tuberculosis (TB) in Europe in recent years. Objective. To retrospectively analyse the evolution of the various types of cutaneous TB over the past 30 years in an adult population in Spain. Methods. Patients with cutaneous TB diagnosed between 1981 and 2011 at Bellvitge Hospital, Barcelona, Spain, were included in the study. Chest radiography was performed for all patients, and the presence of TB elsewhere in the body was excluded when clinically suspected. Results. In total, 36 patients (15 male, 21 female, mean age 53.72 years) were diagnosed with cutaneous TB. There were 22 patients with lupus vulgaris (LV), 4 with scrofuloderma, 4 with miliary TB, 3 with tuberculous abscess/ulcer, and 1 each with orificial TB, warty TB, and an iatrogenic inoculation from underlying visceral focus. Of the 36 patients, 16 (38.88%) had TB presenting simultaneously in other organs. Mycobacterial culture from skin biopsies was positive for Mycobacterium tuberculosis complex in 17 of the 32 cases tested (53.12%), whereas stains for acid-fast bacilli in skin samples were positive in only 3 of 36 patients (8.33%). Conclusions. Although the number of cases of cutaneous TB diagnosed yearly in our population has declined over the past 30 years, cutaneous TB still exists in Europe, and its incidence is expected to increase, owing to the increased immigration into the continent in recent years. The most common type of cutaneous TB in our adult population was LV. It should be noted that despite being considered a benign form of TB, cutaneous TB can be accompanied by TB in internal organs, and severe complications can occur, such as the development of squamous cell carcinoma in long-lasting lesions.