Nepalese Respiratory Journal

Amiodarone Induced Interstitial Lung Disease: An Enigma

2024-08-27T05:37:35+00:00

Amiodarone is an anti-arrhythmic drug that has potential to cause Interstitial Lung Disease (ILD) commonly non-specific Interistitial pneumonia. We present a 75-year male presenting with gradual onset progressive shortness of breath and dry cough after undergoing coronary artery bypass grafting (CABG) and was kept on amiodarone therapy post-surgery to control arrhythmias. The patient was diagnosed as amiodarone induced Non-Specific Interstitial Pneumonia (NSIP) after excluding alternative diagnosis. Early recognition and stoppage of amiodarone, prompt treatment with corticosteroid and respiratory support had favorable clinical outcome in this case.

Varicella Pneumonia in Young Adult Male: A Case Report

2024-08-27T06:03:57+00:00

Varicella infection is a common disease in pediatric age group but is uncommon in adult. Varicella pneumonia is the dreaded complication in these patients leading to mortality, which is more pronounced in adult patients. This is a case report of a young adult male, presenting with Varicella pneumonia in severe hypoxic respiratory failure, which was successfully managed with oxygen therapy, acyclovir, and steroids.

Knowledge about chronic obstructive pulmonary disease among physicians, nurses and students at a regional hospital in Nepal

2024-08-26T12:01:19+00:00

Introduction: In 2019, Nepal had the highest mortality from chronic obstructive pulmonary disease (COPD) globally, and the prevalence of COPD in Nepal is expected to increase. Available research shows that the knowledge of COPD among patients in Nepal is poor and that the practice of COPD management among healthcare personnel needs to improve.

Objectives: To assess the knowledge of COPD among healthcare personnel at a regional hospital and students at a local School of Health Science.

Methods: A cross-sectional, questionnaire-based study was conducted among healthcare pro- fessionals and students in Tansen, Palpa district, Nepal. Scoring was based on a scale of up to 12 points, with a result of 10 points or above considered satisfactory knowledge.

Results: A total of 56 healthcare workers and 208 students participated in the survey. All participants' median (IQR) score was 98,10. Among healthcare professionals, the level of knowledge was below expected on questions regarding vaccinations to prevent pneumonia and spirometry to set the diagnosis. The time spent in the healthcare profession did not increase knowledge scores. Second- and third-year nursing students had a statistically significantly higher level of knowledge than first-year nursing students.

Conclusions: While healthcare personnel showed a high degree of skills in several aspects of COPD knowledge, significant gaps persist, highlighting areas for improvement in COPD care within Nepal.

Comparison of Asthma Control Test and GINA based assessment in Nepalese population: A cross-sectional study

2024-08-26T12:19:58+00:00

Introduction: Asthma has a high age adjusted mortality in low- and middle-income countries like Nepal, which is preventable. Asthma control test (ACT) and GINA based assessment are the two most used tools to monitor effectiveness of the treatment. Utility these tools have not been evaluated in patients with asthma in Nepal.

Objective: This study aims to compare the agreement between ACT and GINA assessment tools in Nepalese population.

Methods: In a cross-sectional observational study, patients aged more than 18 years diagnosed as asthma at least three months prior were included. Active smokers and those with concomitant other respiratory disorder were excluded. ACT translated to native Nepali language was self-administered by the patient. GINA assessment of asthma control was recorded by the physician. Patients were classified as having well controlled, partially controlled and poorly controlled asthma by using both the tools. Spearman’s correlation coefficient was used to evaluate the agreement between the ACT and GINA based classification.

Results: A total of 56 patients were included into the study. The mean age was 39 ± 12 years and the median duration of symptoms was 39.5 (IQR = 25.5-53.5) months. Using the GINA recommended asthma control tool, the number of patients with well controlled, partially controlled and poorly controlled asthma were 21 (38%), 24 (43%) and 11 (20%) respectively. Using the ACT scores, 35 (63%), 11 (20%) and 10 (18%) patients had well, partially, and poorly controlled asthma respectively. Both ACT and GINA score had a good agreement in classifying poorly controlled asthma. ACT and GINA scores had a weak positive yet statistically significant correlation (Spearman’s rho= 0.752, p= 0.019).

Conclusions: ACT and GINA based assessment tools have good agreement to identify poorly controlled asthma in patients with asthma in Nepal.

Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal

2024-08-27T04:31:31+00:00

Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted.

Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023.

Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI < 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score.

Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.

Impact of Corticosteroid on Covid-19 Pneumonia Patients

2024-08-27T05:21:21+00:00

Background: Globally over 704,753890 had COVID -19 Out of which 7,010,681 died compared to 12031 death in Nepal out of1003450 cases Nationwide. Corticosteroids because of their anti- inflammatory effect may have beneficial effect/s on COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids.

Aim: The study aims to see the effect of Corticosteroids on COVID-19 patient outcomes concerning disease progression, length of hospital stay, 28-day mortality, and use of resources like Ventilator.

Method: Single Hospital-based Prospective observational study among RT-PCR positive for COVID-19 patients admitted at Kathmandu Medical College Teaching Hospital from June 01, 2021 –July 31st, 2021 requiring oxygen therapy. Patients were grouped into either usual care, including symptomatic treatment only, or a group receiving both usual care and Corticosteroid.

Results: This study included 160 RT-PCR-positive cases. There were 53 patients with mild symptoms and 107 with moderate symptoms. Patients with mild symptoms who received standard care had an odds ratio of 1.875 for progression to moderate and severe COVID-19 Compared to those who received both standard care and corticosteroid. Similarly, Patients with moderate symptoms who received standard care had an odds ratio of 1.8 for progression to severe and critical COVID-19 Compared to those who received both standard care as well as corticosteroids. Among patients with mild symptoms, the overall use of a ventilator was 35.85 % and mortality was 13.21 %. Similarly, in patients with moderate symptoms at presentation, a ventilator was needed in 33.64 % and mortality was 24.30 %.

Conclusion: Though Corticosteroids seem to have a beneficial role in preventing disease progression, they failed to show a statistically significant reduction of ventilator use and mortality benefit amongst groups.

Recent Trends in Sarcoidosis in Southeast Asia and Nepal

2024-08-26T11:21:28+00:00

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