Browsing by Author "Bam, N"
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Publication Clinico-radiological and pathological profile of patients of hemoptysis admitted in a tertiary care centre in Nepal(Institute of Medicine, 2017) Bam, N; Das, SK; Lamsal, MAbstract Introduction: Hemoptysis is a common and alarming symptom in patients visiting outpatient as well as emergency department. It is a non-specific complaint that can occur in different clinical conditions including cardiopulmonary and hematological diseases. The aim of our study is to know the clinico- radiological and pathological profile of patients presenting with hemoptysis. Methods: A prospective observational study was conducted in TUTH from 20th July, 2016 to 10th March, 2017. Patients presenting with hemoptysis were admitted via emergency and OPD were evaluated for the cause of hemoptysis via radiological and clinical clues. HRCT/CECT-chest and Bronchoscopy weredone for selected patients. Results obtained were evaluated. Results: A total of 115 patients were enrolled in this study. Mean age of study population was 50.49+14.07 years and mean amount of hemoptysis was 28.27+14.07 ml. Post TB fibrobronchiectasis was found to be the most common cause of hemoptysis in 29.6%. HRCT/CECT-chest was the most sensitive diagnostic test when employed alone with positive yield of 83.3%. However, it failed to locate three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 100%. Patients diagnosed with lung carcinoma had significant history of smoking, 88.88% patient with diagnosis of lung carcinoma had history of smoking. Conclusion: Hemoptysis is a common symptom arising from varied clinical conditions. Even small amount of hemoptysis should not be ignored and investigated properly. The combined use of bronchoscopy and CT-chest has the best yield in evaluating hemoptysis. In our clinical context, Post TB fibrobronchiectasis was the most common cause of hemoptysis. Keywords: Hemoptysis, Post TB fibrobronchiectasis, chest xray, BronchoscopyPublication Health Related Quality of Life (HRQOL) assessment using St. George's Respiratory Questionaire in patients with stable Chronic Obstructive Pulmonary Disease(Institute of Medicine, 2017) Das, SK; Bam, N; Ghimire, PAbstract Introduction: Despite being a major cause of chronic morbidity and mortality throughout the world and its relentlessly increasing incidence, Chronic Obstructive Pulmonary Disease (COPD) is an often neglected major public health problem in developing countries like Nepal. Though the health expenditure for management of COPD is gradually increasing, little attention has been given to the Quality of Life (QOL), which should be the main target for management of any chronic diseases. This study assesses the Health Related Quality of Life (HRQOL) of stable COPD patients. Methods: A descriptive observational cross-sectional study of 81 stable COPD patients (who were on regular medication for at least 3 months) was conducted in Respiratory out Patient department of Tribhuvan University Teaching Hospital (TUTH). All the subjects were assessed for their HRQOL using the St. George's Respiratory Questionnaire for COPD (SGRQ-C). Socio- demographic data regarding the patients were also recorded. Data entry and statistical analysis were performed using the SPSS software, version 18.0. Results: The mean age of COPD patients was 67 years. Out of the total 81 study cases, 46(56,8%) were female and 67(82.7%) were either current or past smokers, Patients with COPD showed significantly reduced bealth related quality of life (HRQOL) in all domains. Smoking status and baseline hypoxia showed a highly significant association with HROOL, Age, education status, occupation and gender did not affect the QOL scores in a statistically significant manner. Adding methylxanthine to the standard combination inhaler therapy did not show any significant different in term of HRQOL. Conclusion: This study showed that Nepalese COPD patients had reduced HRQOL Smoking and baseline hypoxia had significant negative impact on HRQOL. Keywords: Chronic obstructive pulmonary diseasePublication IgM and IgG Antibodies in Tuberculosis(Institute of Medicine, 2009) Bam, N; Karn, RAbstract Introduction: The diagnosis of tuberculosis relies on the identification of acid-fast bacilli on unprocessed sputum smears using conventional light microscopy. Microscopy has high specificity in tuberculosis-endemic countries, but modest sensitivity which varies among laboratories (range 20% to 80%). Moreover, the sensitivity is poor for paucibacillary disease (e.g., pediatric and HIVassociated tuberculosis). Many supportive investigations including serolological tests being utilized for tuberculosis diagnosis have wide variations in sensitivity, specificity in different studies. The aim of study was to evaluate the recombinant 38 KDa antigen from M. tuberculosis – based Enzyme Immunoassays (EIA) test for its sensitivity, specificity and other statistical parameters. Methods: This hospital based prospective cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, from April 28, 2009 to November 30,2009. Sera from total 90 patients, pulmonary tuberculosis, extrapulmonary tuberculosis and non-tubercular chest infection patients who did not have past TB or exposure history , 30 in each group were used for Pathozyme Myco kit evalution to determine the IgM and IgG antibodies activity against the recombinant 38 KDa antigen of Mycobacteria . Results: In overall tuberculosis, IgM TB had sensitivity 48.3%,specificity 76.7%, positive predictive value 80.6% which was statistically significant(p=0.025) . The IgG TB had sensitivity 66.7%,specificity 83.3%,positive predictive value 88.9% which is statistically highly significant(p<0.001) to diagnose tuberculosis. Utilizing IgM and IgG both together, sensitivity decreased to 44.3%, but specificity increased to 90.0% and positive predictive value 88.5%, which was statistically significant (p=0.006) for the diagnosis of tuberculosis. Conclusions: IgG TB antibody has high sensitivity and specificity for tuberculosis diagnosis, but IgM antibody should also be evaluated along with IgG antibody to increase specificity. Keywords: Extrapulmonary tuberculosis (EPTB), 38 kDa antigen, IgM, IgG TB antibody, Pathozyme-Myco, Pulmonary tuberculosis (PTB)Publication Prevalence of nosocomial lowerrespiratory tract infections caused by Multi-drug resistance pathologens(Institute of Medicine, 2011) Shrestha, S; Chaudhari, R; Karmacharya, S; Kattel, HP; Mishra, SK; Dahal, RK; Bam, N; Banjade, N; Rijal, BP; Sherchand, JB; Ohara, H; Koirala, J; Pokhrel, BMAbstract Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to the hospitalized patients. Extended spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing bacterial strains causing hospital acquired lower respiratory tract infection are increasing in numbers. Only a limited number of studies related to MBL producers have been done in Nepal. Objective: The goal of this study was to determine the etiology of nosocomial lower respiratory tract infections and to assess the current levels of antimicrobial resistance with special reference to ESBL and MBL producing bacterial strains. Methods: A total of 100 specimens including sputum and endotracheal secretion from patients diagnosed of nosocomial lower respiratory tract infection were collected and processed according to the standard methodology. Combination disk method was done for the detection of ESBL and MBL producing isolates. Results: Out of total 100 specimens, 87% was monomicrobial while the rest were polymicrobial. 96.5 % were gram negative while 3.5% were gram positive. All E.coli, Klebsiella spp and S. aureus were found to be MDR followed by Acinetobacter spp (97.2%) and P. aeruginosa (76.2%) About 28.6 % of E. coli, 8.33% of Klebsiella spp and 2.4 % of Pseudomonas aeruginosa were ESBL producers. Acinetobacter spp. was not found to produce ESBL during the study. MBL was present in 17.4% of the gram negative isolates. Conclusion: We found a high prevalence of MDR strains as a cause of nosocomial LRTI including significant proportions of ESBL and MBL producers. The rate of Acinetobacter spp., including MBL producers, in our hospital setting was alarmingly high which prompts a special attention for the management of such patients as well as urgent need for implementation of infection control strategies. Keywords: MDR, LRTI, ESBL, MBL, nosocomial infectionPublication The role of blood eosinophil level in acute exacerbation of Chronic Obstructive Pulmonary Disease(Institute of Medicine, 2018) Nizam, S; Yogi, KN; Bam, N; Das, SKAbstract Introduction: Chronic Obstructive Pulmonary Disease (COPD) has great implications on global health accounting for significant morbidity and mortality. The aim of this study was to assess blood eosinophil level in patients presenting with acute exacerbation of COPD and to check whether pre-treatment blood eosinophil level ≥2% has better improvement with the standard therapy (oxygen, corticosteroids IV/Oral and inhaled corticosteroids/ inhaled beta 2 agonist/ inhaled muscarinic antagonists along with antibiotics and diuretics) as well as shorten the duration of hospital stay. Methods: Blood eosinophil level was measured in 106 eligible patients on admission with the diagnosis of AECOPD,under the Department of Pulmonology and Critical Care Medicine, TUTH from December 2016 to August 2017 were included in this observational study. Clinical information was obtained and PFTs were done. Results: A total 106 patients were enrolled. The mean age of the patients was 67±12 years with smoking history of mean pack year 24± 10.7. Among this population, 46.22% patients had blood eosinophil level ≥2% which had better improvement in general physical examination (edema and cyanosis/ P= 0.05 and 0.01), vital signs (tachycardia P=0.05) including (SPO2 P=0.01 ) and chest findings (crackles P= 0.01) with standard therapy compared to blood eosinophil level <2%. Similarly, significant shorter duration of hospital stay was observed in patients with blood eosinophil level ≥2% with standard therapy in comparison with blood eosinophil <2% (p=0.01). Conclusion: Blood eosinophil level represents a potentially important biomarker that could aid treatment decision making as well as gives us a predictive idea regarding the duration of hospital stay upon admission with AECOPD