Immunotherapy with Intralesional Vit D injection in Recalcitrant wart at a Tertiary Care Center: A Descriptive Cross sectional Study.

INTRODUCTION: Recalcirant warts are resistant to conventional therapeutic option with high recurrence rate. In recent year, treatment of warts with different immunotherapeutic agent has shown good results, as it regulate epidermal cell proliferation and are involved in the formation of anti microbial peptides. Hence, this study was undertaken to evaluate the efficacy of immunotherapy with intralesional vitamin D in wart. METHODS: A descriptive cross-sectional study was conducted from 1 January 2021 to 2 February 2023 at Kathmandu Medical College after approval from the Institutional Review Committee (Reference number: 0110202002). Ninety - two patients with recalcitrant wart of varying sizes and duration were included in the study. Injection vitamin D ( 600000 IU, 15mg/ ml) was injected about (0.2-0.5 ml) to the base of the wart. Maximum of five warts were injected per month, and was repeated after 4 weeks for 3 sessions. RESULTS: Among 92 patient, complete response was seen in 70 patient (76.08%), partial response was seen in 17 patients ( 18.47%) and 5 patient(5.43%)showed no response. Mild pain as observed at the time of injection. Signs of hypervitaminosis D was not observed. CONCLUSIONS: Intralesional administration of Vitamin D is an effective treatment option for reclacitrant warts and is, highly effective, cost-efficient, with minimal adverse effects, and can be perfomed in our clinical set up.

Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dengue is in an increasing trend in our part of the world mostly due to global warming, It can present with various manifestations including cutaneous manifestations. The main objective of our study was to find out the prevalence of dengue fever among patients visiting the Outpatient Department of Dermatology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department of Dermatology in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 09092022\04). Data from 1 June 2022 to 8 September 2022 were collected between 1 December 2022 to 20 February 2023 from the hospital records. The laboratory data of individuals were analyzed to find out the prevalence of dengue fever. A Visual Analogue Scale was used to assess the severity of pruritus. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 7442 patients, dengue fever was found to be in 202 (2.71%) (2.34-3.08, 95% Confidence Interval) patients. The mean duration of fever was 3.02±2.960 days. The mean duration of onset of rash after having a fever was 2.56±2.032 days. The most common cutaneous manifestation was maculopapular rash 70 (34.65%). Conclusions: The prevalence of dengue fever was found to be lower than in the studies done in similar settings. Keywords: dengue fever; prevalence; rash.

Efficacy and Safety of Intralesional Immunotherapy with Tuberculin Purified Protein Derivative among Cutaneous Wart Patients.

BACKGROUND: Cutaneous warts are common skin problems caused by Human Papilloma Virus. Conventional therapies are mostly ablative and limited by recurrences and side effects. Immunotherapy using bacterial, fungal, and viral antigens is an emerging and safer technique to treat warts at local and distant sites. The objective of this study was to measure the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative among cutaneous wart patients in the dermatology department of a tertiary care centre. METHODS: A cross sectional, time series design, was conducted between October 2019 and September 2020 among 77 patients of cutaneous warts attending Dermatology out-patient department using convenience sampling. Percentage response was evaluated for patients treated with tuberculin purified protein derivative for eight weeks at an interval of two weeks into complete response (100% clearance), partial response (50-99% clearance), no response (0-49% clearance). Side effects were also recorded. Statistical Package for the Social Sciences version 20.0 was used for data analysis. RESULTS: Out of 77 patients, complete response (100%) was seen in 53.2% patients, partial response (50-99%) in 14.3% and no response (0-49%) was seen in 32.5%. Side effects noted were pain and erythema (19.50%), blisters (2.60%) and flu like symptoms (1.30%). CONCLUSIONS: Intralesional PPD is an effective and safer therapeutic option for the treatment of cutaneous warts.

Bimatoprost versus Clobetasol Propionate in Scalp Alopecia Areata: A Prospective Non-Randomized Open-Label Clinical Trial.

Background: Alopecia areata (AA) is one of the most common forms of alopecia presenting to the dermatology out patient department (OPD) worldwide as well as in Nepal. It is mostly diagnosed clinically. Treatment depends on the extent, location, and severity of the condition. Various treatment options available are topical, intralesional, and oral medications. Bimatoprost is a relatively newer treatment modality in AA. Aim and Objective: To compare the efficacy and safety of topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream in scalp AA. Materials and Methods: A total of 50 patients attending the dermatology OPD of a tertiary hospital between March 2018 and February 2019 were included in this prospective non-randomized open-label clinical trial. Patients were divided into two groups i.e., Group A- topical bimatoprost solution 0.01% and Group B- topical clobetasol propionate cream 0.05%, and followed up at weeks 4, 8, and 12. The improvement was analyzed subjectively by hair regrowth and objectively by Severity of Alopecia Tool (SALT) score. Side effects, nature of terminal hair and onset of initial response were also recorded. Results: Out of 50 patients, 27 were males and 23 were females with a mean age of 28.5 ± 9.34 years and mean duration of disease of 18.67 ± 46.1 weeks. Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost (p = 0.282 and P = 0.246, respectively). Side effects were seen more in the clobetasol group compared to bimatoprost group (p = 0.002). Onset of cosmetically acceptable hair regrowth was seen earlier in the bimatoprost group (p = 0.017) and also the nature of regrown hairs was more pigmented in bimatoprost group (p = 0.024). Conclusions: There is no significant difference in hair regrowth between clobetasol and bimatoprost in the treatment of AA on scalp at the end of 12 weeks, although bimatoprost has an advantage of lesser side effects, more rapid response and growth of more pigmented hairs.

Effects of Face Masks on Pulse Rate and Blood Pressure Components During Stairs Climbing.

BACKGROUND: The use of face masks has been associated with physiological changes in body. This study aims to know the changes in pulse rate and blood pressure components after wearing face masks during stairs climbing. METHODS: An experimental study was conducted among 60 apparently healthy young adults between 18-35 years of age. The pulse rate and blood pressure of the participants were recorded during rest at ground floor and after climbing the stairs till 5th floor at brisk and regular pace without wearing the face masks. The uniform KN95 masks were distributed and proper coverage of nose, mouth and chin were ensured. After 5 minutes interval, the pulse rate and blood pressure were recorded again at rest in ground floor and after climbing stairs with use of KN95 masks. RESULTS: At rest, the difference in mean pulse rate was statistically significant after wearing masks in participants between 21-25 years of age (86.46±14.59 bpm, p=0.014). After climbing the stairs, the mean pulse rate (131.16±18.48 bpm), mean systolic blood pressure (137.67±16.13 mmHg) and mean rate pressure product (182.87±41.70) were higher in participants (age group: 26-30 years) wearing masks and the difference was statistically significant (p=0.001; 0.013; 0.001respectively). During stairs climbing, the change in mean systolic blood pressure (32.66±16.73 mmHg), mean pulse pressure (43.77±24.64 mmHg) and mean rate pressure product (96.58±37.23) were higher in participants (age group: 26-30 years) and the difference was statistically significant (p=0.036; 0.047 and 0.009 respectively). CONCLUSIONS: The changes in systolic blood pressure, pulse pressure and rate pressure product are found to increase after wearing face masks during stairs climbing. It can be suggestive of increase workload to the heart by wearing face masks in addition to climbing the stairs.

Profile of skin biopsies and patterns of skin cancer in a tertiary care center of Western Nepal.

BACKGROUND: Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise. OBJECTIVES: To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal. MATERIALS AND METHODS: The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features. RESULTS: The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life. CONCLUSIONS: The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.