Nepalese Respiratory Journal

Metabolic Signature and Obstructive Sleep Apnea in Nepalese Patients

Avatar Verma — 2023-11-06

Introduction: Untreated Obstructive Sleep Apnea (OSA) causes sleep related symptoms and also causes increased incidence of RTA, cardiovascular diseases and all cause mortality. Currently OSA has been recognized as the consequence of number of interrelated metabolic and oxidative pathologies. As there are limited data of association of OSA with metabolic stress and its correlation with severity of OSA, study of metabolic profile of these patients in view of defining the Metabolic signature of OSA was carried out in eastern Nepal.

Objectives: To study metabolic profile of OSA and its association with clinical severity. Methods: Hospital based descriptive cross sectional study. Biochemical profile results related to metabolic –oxidative pathway of the OSA patients were obtained. Quantitative and qualitative data were obtained. Quantitative data were compared using Mann–Whitney test while qualitative variables compared using Pearson χ2. Correlation was carried out using Pearson and Spearman’s test. P-value<0.05 considered significant.

Results: 33 patients of OSA were enrolled. Majority of patients had deranged metabolic and oxidative parameters despite mild OSA. Among metabolic stress parameters, most commonly deranged were decreased high density lipoprotein (HDL), increased mean arterial pressure (MAP), waist circumference (WC) and raised fasting blood sugar (FBS). Increased MAP and increased WC was significantly corelated with severity.

Conclusion: Besides symptom complex, OSA is also harbinger of metabolic stress that can lead to various cardiometabolic diseases and premature mortality thus early recognition and treatment can mitigate these consequences.

Incidence, risk factors and outcomes of Acute Kidney Injury in Chronic Obstructive Pulmonary Disease patients with Acute exacerbation

Gunjan Regmi — 2023-11-06

Background: There is little data on the incidence, risk factors and outcomes of the AKI among COPD patients who are admitted to critical care units with exacerbation of symptoms. This observational study was conducted to evaluate the incidence and outcome of AKI with AECOPD.

Method: We performed an observational study of patients who were admitted in the intensive care unit from August 2021 to February 2023 for acute exacerbation of COPD.

Results: During the study period, a total of 108 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. AKI occurred in 49 patients (45.4%). Independent risk factors for AKI in patients with AECOPD were advanced age, coronary artery disease, anemia, acute respiratory failure, and mechanical ventilation. Patients with AKI had worse prognostic implications and were more likely to require mechanical ventilation (42.8% vs 22.03%, P<0.05), had a longer ICU stay (6 ±1.3 days vs 5.41±1.1 days, P<0.05) and longer hospitalization (7.65±1.42 days vs 6.9±1.2 days, P<0.05); and higher in-hospital mortality (28.5 % vs 11.8 %, P<0.05) than those without AKI. Compared to patients without AKI who had in-hospital mortality rate of 11.8%, those with stage 2, or 3 AKI had rates of 41.6% and 85.7% respectively, that is 2.1- fold and 6.0-fold increased risk of in-hospital death, respectively.

Conclusion: Incidence of AKI is relatively high in patient with AECOPD requiring intensive care. Patient with AKI had poor outcomes compared to non-AKI patient with AECOPD. AKI can be a prognostic factor for determining patient survival.

Causes and outcome of infants admitted with respiratory distress in a tertiary care neonatal unit: A five year review

Varsha Verma — 2023-11-06

Background: Respiratory distress is a common cause for admission of infants to a neonatal unit. The aim of this study was to analyze the causes of respiratory distress leading to admission in a neonatal unit.

Method: This is a 5 year retrospective review of neonates admitted initially with diagnosis of respiratory distress in the neonatal unit of a tertiary care hospital from November 2017 to October 2022. Cases were identified and analyzed using electronic database maintained in the neonatal unit and were cross checked with electronic discharge summaries where necessary.

Results: Respiratory distress was found to be the most common cause for admission to the neonatal unit almost comprising of 46% of total admissions. The commonest cause for respiratory distress on admission was found to be transient tachypnoea of newborn (TTN) in term infants and surfactant deficiency respiratory distress syndrome (RDS) in preterm infants. As compared to babies with TTN, who were all discharged home, 18.4% of those with RDS did not survive. The overall mortality of infants presenting initially as respiratory distress was 9.1%. Other common causes for respiratory distress on admission were sepsis, birth asphyxia, shock, congenital heart disease, seizure and polycythemia.

Conclusion: Respiratory distress is a common cause for admission to a neonatal unit in both term and preterm infants. Although TTN in term and RDS in preterm are common causes for respiratory distress in newborns, the underlying cause for respiratory distress is diverse and not just limited to the lungs and heart.

Asthma care during pregnancy in South Asia

Rano Mal Piryani — 2023-11-06

Bronchial asthma is among the commonest chronic inflammatory respiratory diseases affecting women of reproductive age group. Adequate attention has not been given to the diagnosis and the management of asthma in countries of South Asia. Management of asthma in pregnant women is more or less same as that of in non-pregnant women and stepwise approach is recommended. To confirm the diagnosis of asthma during pregnancy, spirometry can be used. Patients suffering from very severe asthma or difficult-to control asthma are more prone to develop exacerbations during pregnancy needs hospitalization for care. Well-controlled asthma during pregnancy prevents complications of pregnancy and results in better pregnancy outcomes. It better to follow the guidelines for management of asthma during pregnancy. The pregnant women must be educated regarding the care of asthma during pregnancy, delivery, in postpartum period and thereafter.

New Updated GOLD 2023 guidelines: Insights, Implications and future Directives for Clinicians

Milesh Jung Sijapati — 2023-10-31

No Abstract Available.

Asymptomatic Pulmonary Cryptococcosis And Tuberculosis Co-infection in an immunocompetent Host: A case report

Rashmi Giri — 2023-11-06

Pulmonary Cryptococcosis is a rare fungal infection that mostly occurs in immunocompromised host. However, with advancement in diagnostic approach like tissue biopsy, cryptococcal infections are now increasingly being recognised.In immunocompetent host, cryptococcal infection is often asymptomatic and rarely becomes disseminated.

Symptom development in immunocompetent host largely depends on burden and virulence of pathogen. Due to similarities in clinical, radiological and pathological findings in Cryptococcosis, Tuberculosis and other fungal infections like Blastomycocosis, it is important to have a tissue biospy to confirm the diagnosis.

The aim of this case report is to highlight the investigation necessary to diagnose both fungal infection and Tuberculosis due to similar clinical, radiological features in both. We report a case of Gene Xpert positive Tuberculosis and histopathology proven Pulmonary Cryptococcos in same patient.

Atropine and Kounis syndrome, a rare association mimicking ST segment elevation myocardial infarction in a young patient: A Case Report

Asraf Hussain — 2023-11-06

Kounis syndrome is a hypersensitivity acute coronary disorder which occurs with allergic reaction with drugs, food and insect bite. Atropine is rarely found to be reported with such allergic reactions in the literatures. In this report, we describe a case of a 25 years old male, with a background history of psychotic disorder and cannabis dependent syndrome with persistent bradycardia. When challenged with atropine he developed chest pain, shortness of breath and urticarial rash. ECG showed ST segment changes which settled after symptomatic management. Coronary angiogram revealed normal coronary arteries. Though uncommonly reported, it is one of the confusing and underdiagnosed serious conditions for treating physicians which can potentially mimic ST segment elevation myocardial infarction.

Role of Tranexamic acid in NSAIDS induced angioedema

Rupak Chalise — 2023-11-06

Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin, a key step in kallikrein activation and bradykinin formation. Tranexamic acid is used in the prophylactic management of hereditary angioedema; however, evidence for TXA in Non-Steroidal Anti-inflammatory drug-induced angioedema (NSAIDS-AE) is limited. We describe a patient who presented to the ICU department with NSAIDS-AE and was successfully treated with TXA. This case suggests that TXA may be a beneficial treatment modality in the management of NSAIDS-AE and warrants further investigation.

Pulmonary Alveolar Proteinosis: Conducting the first Whole Lung Lavage in Nepal

A. Uprety — 2023-11-06

A case of Pulmonary Alveolar Proteinosis, probably secondary in etiology, was diagnosed at our institute based on clinical, radiological, and pathological evidence. Patient was planned for conducting whole lung lavage as per the guidelines. With this case, we report the first instance of conducting Whole lung lavage in Nepal and the logistics involved.