Nepalese Respiratory Journal

Trajectory of pulmonary function parameters and radiology progress among patients with Idiopathic pulmonary fibrosis treated with Doxycycline

Subash S Heraganahally, Timothy Howarth, Himanshu Garg — Sat, 31 Dec 2022 00:00:00 +0000

No Abstract Available

Knowledge of Inhaler Therapy among Undergraduates and Resident Doctors in Tertiary Care Hospital, Nepal

Sat, 31 Dec 2022 00:00:00 +0000

Introduction: Inhalation therapy is the administration of the aerosolized medication directly into the lungs and it is the most effective form of management of the obstructive airway disease including chronic obstructive airway disease, asthma and overlap syndrome. There is less data on the knowledge of inhaler therapy among the junior doctors who are managing obstructive airway disease at the first contact point. This study was done to assess the knowledge of undergraduate doctors and resident doctors who are treating the patients before the consultation with senior consultants working in one of the tertiary care hospital . The findings of the study will help find the strategies of filling the gaps of the knowledge of inhalation therapy among junior doctors while managing obstructive airway disease

Objective: The primary objective of the study was to find the Knowledge of Inhaler Therapy among Undergraduates and Resident doctors in Bir Hospital.

Methods: The study was a cross sectional questionnaire based descriptive study conducted in Bir Hospital, National Academy of medical Sciences. The study included purposeful sampling of the medical officers and residents working in medical ward and emergency.

Results: Out of 70 respondents, 79% and 82% percent responded the correct method of the administration of the DPIs and MDIs respectively. Forty percent of the respondents had heard of the breath actuated devices and 88% of the respondents had heard of the spacer device. Forty one percent of the respondents said they teach the patients about the method of inhalation technique while prescribing the inhalation therapy. Seventy three percent of the respondents thought inhaler therapy as the first line therapy for managing COPD and Asthma.

Conclusion: Prescription of inhalers, knowledge among junior MBBS undergraduate doctors regarding inhalation therapy, and correct use of inhalers varied, and was generally inadequate. More effort, academic training and exposure is needed to change the attitude of medical officers and residents regarding the concept of inhalation therapy.

Diagnostic Yield of Bronchoalveolar Lavage in Nepalese Patients Presenting with Chronic Cough with Normal Radiological Imaging in Tertiary Care Hospital

Sat, 31 Dec 2022 00:00:00 +0000

Background: Cough is one of the most common symptoms that lead patients to seek medical attention. The diagnosis of chronic cough is complex and challenging. In our setting, a large proportion of patients with cough are treated empirically without a definite diagnosis. Despite investigation and treatment, fiberoptic bronchoscope with bronchoalveolar lavage (BAL) has been shown to be a useful technique in a selected group of patients with unexplained chronic persistent cough. The aim of the study was to determine the diagnostic yield of bronchoalveolar lavage in Nepalese patients presenting with chronic cough with normal radiological imaging.

Methods: This was a hospital based cross sectional study. The patients presenting with chronic cough (>8 weeks) with normal radiological imaging were enrolled in the study.

Results: 1 patient (2.6%) sputum sample for AFB was negative however BAL sample of the same patient sent for Gene xpert came positive for Mycobacterium Tuberculosis, 5 patients (12.8%) had positive BAL culture, 29 patients (74.4%) had normal cellular pattern in BAL Cytology.

Conclusion: Diagnostic yield of BAL was very low for chronic cough in our study. Patient presenting with eosinophilic pattern in BAL had cough variant asthma suffer from non-productive cough in the absence of other asthma symptoms such as dyspnea and wheezing. Thus, though fiberoptic bronchoscope with BAL is indicated in chronic cough of unknown etiology, its diagnostic yield is low

Study of Point of Care Lung Ultrasound in Patients with Acute Respiratory Failure

Sat, 31 Dec 2022 00:00:00 +0000

Introduction: An acute dyspnea has been a common cause of hospital admission throughout history. When formulating a treatment plan based on limited clinical information, a rapid diagnosis is important. Bedside maneuvers and tests that deliver rapid and reliable results represent a cornerstone of diagnostics medicine.

Methods: This was a one-year cross-sectional research conducted at Chitwan Medical College Teaching Hospital. Consecutive patients with acute dyspnea whom were admitted for ≤ 6 hours were included in the study. A 5MHz micro-convex probe was used as the optimal single probe. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statics.

Results: Pneumonia was the most common overall ultrasound diagnosis with combined frequency of 47%. With a Positive Predictive Value of 94.11% and Negative Predictive Value of 97.01%, anterior pneumonia exhibited a sensitivity of 94.11% and specificity of 97.11%. Similarly, Posterior Lateral Alveolar Points (PLAPS) pneumonia had a sensitivity of 94.11% and specificity of 98.08%, with a PPV of 94.11% and NPV of 98.80% respectively. The clinical accuracy for pulmonary edema was the greatest with 96.77%. while COPD/asthma had least accuracy with 81.25%.

Conclusions: POCUS of the lung, has a high sensitivity and specificity, especially for evaluation of acute causes of dyspnea such pulmonary edema and pneumonia. It is more sensitive than Chest X ray alone and should be integrated while making clinical diagnosis.

The Clinical Utility of Lung Function Testing in Respiratory Medicine: A Review

Brendan G. Cooper — Sat, 31 Dec 2022 00:00:00 +0000

No Abstract Available.

Diaphragmatic hernia mimicking as pleural effusion in radiograph

Kamal Raj Thapa, Anu Thapa, Tulasa Basnet, Remoon Shrestha — Sat, 31 Dec 2022 00:00:00 +0000

No Abstract Available.

Catching up with WHO guidelines of DRTB; shorter, easier, better”

Deebya Raj Mishra — Sat, 31 Dec 2022 00:00:00 +0000

No Abstract Available.

A case of Hypomyopathic Dermatomyositis which subsequently developed to overt Myositis with ILD

Prayush Sharma, Abhijit Datta, Mohammed Zakir Hossain — Sat, 31 Dec 2022 00:00:00 +0000

Dermatomyositis (DM) is an inflammatory myositis. Clinically amyopathic dermatomyositis (CADM) and hypomyopathic dermatomyositis (HDM) are rare forms of DM in which skin manifestations are present with no and minimal clinical and laboratory evidence of myositis respectively. A common complication of CADM/HDM is interstitial lung disease (ILD), with the most common histopathologic variant of non-specific interstitial pneumonia (NSIP). This case highlights the development of ILD and severe muscle weakness, including proximal limb muscles, muscles of respiration and muscles of deglutition in a patient with previous diagnosis of hypomyopathic dermatomyositis.

Non-resolving long term Mucormycosis in Post-COVID-19 Patient: A Case Report

Sat, 31 Dec 2022 00:00:00 +0000

With the second wave of COVID-19, there was a surge of cases of mucormycosis co-infection in our health center. We would like to present a case of a 53 years old man with COVID-19 positive status who later developed mucormycosis, with invasion of Maxillary sinus, jugular vein, digastric recess in MRI. He was managed with Amphotericin –B injection along with insulin therapy in sliding scale and Posaconazole thereafter for six months. Debridement of the lesion was done along with removal of inferior alveolar process of maxillary process and 3 molar teeth and a premolar tooth of upper left side.

Retained bronchial foreign body diagnosed after 29 years of penetrating chest trauma

Sat, 31 Dec 2022 00:00:00 +0000

This is a case of retained bronchial foreign body identified by Computed Tomography (CT) scan after 29 years of initial penetrating chest trauma. The patient had a long-standing history of shortness of breath which was diagnosed and treated as recurrent pulmonary infections. The case report is an attempt towards eliciting the importance of CT scan in identifying such foreign bodies. Interpretation & diagnosis of long standing organic foreign bodies may present with occasional diagnostic dilemma. However, prompt and accurate diagnosis is necessary to prevent complications that can be serious and, as in our case, potentially fatal.

A case report of a COPD patient presented in severe metabolic alkalosis

Sat, 31 Dec 2022 00:00:00 +0000

Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.

A brief narrative on work-related asthma (WRA)

Rano Mal Piryani, Suneel Piryani, Milesh Jung Sijapati — Sat, 31 Dec 2022 00:00:00 +0000

Work related asthma (WRA) is caused by exposure at work known as occupational asthma (OA) or exacerbated or aggravated by exposure at workplace known as work-exacerbated asthma (WEA) or work-aggravated asthma (WAA). Worldwide, WRA remains under detected and undermanaged. Failure to detect or treat WRA leads to increased healthcare cost, morbidity and mortality. The diagnostic work-up includes clinical history and detailed occupational history, assessment of the causative agent and the objective measurements. Del Roio LC et al (2020) have developed algorithm for the diagnosis of WRA with three primary diagnostic criteria and five additional criteria. Better knowledge and understanding of clinicians and other healthcare providers about WRA is vital for early consideration of WRA diagnosis among adult patients with asthma. While Optimum awareness of general public about WRA may possibly help in initiating discussion by affected workers with their healthcare service providers. The primary prevention includes reducing the burden of WRA by evading the use of potential sensitizers and restricting their exposure and limiting to workplace asthma triggers when their use cannot be avoided.