Browsing by Author "Bam, Niraj"
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Publication Association Between Vitamin D Levels and Vitamin D Receptor (VDR) Gene Polymorphisms in Nepalese Population(Nepal Health Research Council, 2025) Baidya, Sujata; Kandel, Pratibha; Rajkarnikar, Smrity; Sah, Anil Kumar; Niraula, Apeksha; Tuladhar, Eans Tara; Shakya, Yagya Laxmi; Bam, Niraj; Sharma, Vijay Kumar; Yadav, Binod KumarAbstract: Background: Vitamin D deficiency is a global public health concern. Small variations in the proteins involved in vitamin D metabolism affect levels and physiological roles of vitamin D. However, there is a paucity of data regarding such factors in our population. This study was designed to assess the distribution of polymorphisms of vitamin D Receptor (VDR) gene (rs2238136 and rs731236) in vitamin-D deficient Nepalese population. Methods: A total of 400 apparently healthy individuals visiting our center were enrolled. Five ml of blood was collected in gel vial and EDTA vial. The 25(OH)D levels were estimated in ABBOTT Architect autoanalyzer. After extracting genomic DNA, the VDR gene polymorphism (rs2238136 and rs731236) was analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The amplified products, 135 bp and 716 bp were digested using restriction enzymes Bpu10IA and TaqI for rs2238136 and rs731236, respectively, electrophoresed on 2% agarose gel and visualized under UV illuminator. Statistical analysis was done using SPSS version 21.0. Results: The distribution of both rs2238136 and rs731236 followed Hardy-Weinberg equilibrium. There were 24 AA, 238 GG, and 138 AG genotypes found in rs2238136, whereas 226 TT, 34 CC, and 140 TC genotypes were found in rs731236. In contrast to rs731236, vitamin D levels varied among genotypes of rs2238136. Conclusions: In our population, there was a higher prevalence of GG genotype (rs2238136) and TT genotype (rs731236). Increased prevalence of vitamin D deficiency in our region may be due to these genetic variations.Publication Chicken Bone Aspiration Masquerading as Malignancy: A Case Report of Diagnostic Dilemma(Society of Otolaryngologists of Nepal, 2024) Bam, Niraj; Karki, Prashanna; Pokharel, Milan; Shrestha, Bibek; Dhenga, SonamAbstract: Foreign body (FB) aspiration is rare in adults but may mimic malignancy or tuberculosis, leading to delayed diagnosis. We report a 52-year-old chronic smoker who presented with persistent fever, cough, weight loss, and progressive dyspnoea. Clinical examination revealed signs of left lung collapse, initially suspected as endobronchial malignancy or tuberculosis. Chest CT confirmed complete collapse of the left lung with a hyperdense lesion in the main bronchus. Unexpectedly, bronchoscopy identified and removed a chicken bone lodged in the left main bronchus, leading to complete symptom resolution. Physicians should consider FB aspiration in adults with unexplained respiratory symptoms mimicking lung cancer or tuberculosis. Keywords: Aspiration, bronchoscopy, foreign bodiesPublication Factors determining Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(Institute of Medicine, 2023) Bam, Niraj; Sapkota, Dharmendra; Kuikel, SandipABSTRACT Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently accompanied by increased local and systemic inflammation brought on by airway infection, pollution, or other airway insults. This study aimed to find the factors determining outcomes in patients hospitalized with acute exacerbation of COPD. Methods: An analytical study among diagnosed cases of AECOPD was conducted. Bivariate regression model followed by Multinomial logistic regression (MNLR) was used to contrast outcome variables. A p-value less than 0.05 was considered statistically significant in all analyses. Results: A total of 126 patients with a mean age of 72.04±9.75 years were included in the study. Most of the patients were current smokers or past smokers, cor-pulmonale was present in 34.9% of patients. The most common co-morbidity was hypertension (41.2%). Most (55.6%) patients had early discharge, 31.7% (40) patients had late discharge and 12.7% (16) patients had mortality as the outcome. After bivariate analysis, among all variables of the study qualified to be included in the multivariate MNLR model, Neutrophil Lymphocyte ratio (NLR) was found to be a significant predictor of late discharge in comparison with early discharge while Age and NLR were found to be a significant predictor of Mortality in comparison with late discharge among patients with AECOPD. Conclusion: Older age and higher NLR predicted mortality in comparison to longer hospital stay (>5days). Since NLR is a common variable in both the outcome (early vs late discharge and late discharge vs mortality), NLR can be used to predict the outcome (early discharge, late discharge, and mortality) of patients with AECOPD. Keywords: AECOPD; chronic obstructive pulmonary disease; factors; outcomes; predictorsPublication Mini-Nutritional Assessment Questionnaire for Assessing the Nutritional Status of Patients with Chronic Obstructive Pulmonary Disease: A Cross-sectionalStudy(Institute of Medicine, 2025) Bam, Niraj; Shrestha, Bibek; Timla, Bipashna; Pokhrel, Kailash ManiAbstract Introduction Chronic obstructive pulmonary disease (COPD) has systemic effects like malnutrition that increase morbidity and mortality. Nutritional assessment in COPD is not adequately addressed in Nepal even though the assessment is clinically relevant. The objective of the study is to determine the nutritional status of COPD patients based on MNA and to evaluate the correlation between the MNA and demographic, anthropometric and spirometry variables. Methods The study involved 140 stable COPD patients, who were studied using cross-sectional study design. Mini Nutritional Assessment (MNA) was used to determine the nutritional status. Demographic variables, anthropometric and spirometry parameters and clinical variables were taken. The associations were compared based on chi-square, one-way ANOVA, and Pearson correlation whereby p < 0.05 was regarded as significant. Results GOLD stage was associated with nutritional status (p = 0.034), and BMI differed across nutritional categories (p < 0.001). No association was observed between nutritional status and spirometry indices or dyspnea grade (all p > 0.05). MNA score showed a moderately positive correlation with BMI (r = 0.501, p < 0.001), whereas no correlation was noted with FEV1 or mMRC grade. These findings suggest that nutritional impairment is more closely related to anthropometric parameters than to pulmonary function. Conclusion COPD patients have a high prevalence of malnutrition, and poorer nutritional status was associated with more advanced GOLD stages. COPD management should include routine MNA screening and early nutritional interventions to improve clinical outcomes. Keywords: Body mass index, COPDPublication Not all lung masses in smokers are malignant: A rare case of Anthracosis mimicking Lung cancer(Nepalese Respiratory Society, 2025) Bam, Niraj; Pokhrel, Milan; Khanal, KapilAbstract; Anthracosis and Lung cancer may present with similar clinical features such as Dyspnea, cough, and hemoptysis. A chest X-ray and computerized tomography (CT) scan may reveal a lung mass in both conditions, leading to a misdiagnosis. In this case report, we present a 60-year-old female smoker who was initially diagnosed with Lung cancer based on clinical and radiological findings. The lung mass was found to be anthracosis after a bronchoscopy and confirmed by histopathological examination. Thus, we emphasize that overreliance on a single diagnostic modality may lead to a false diagnosis, and a more comprehensive approach is necessary.Publication Plasma Fibrinogen Level in Chronic Obstructive Pulmonary Disease and Its Correlation with GOLD Severity Staging(Institute of Medicine, 2021) Gyawali, Achyut; Bam, Niraj; Pant, Pankaj; Das, Santa KABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction. Methods: This observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done. Results: A total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p<0.001). There was significant negative correlation between plasma fibrinogen level and forced expiratory volume in one second (FEV1%) predicted (r=-0.71, p=0.01). Conclusion: High plasma fibrinogen level on discharge was found in COPD patients with severe airflow obstruction, frequent exacerbations and severe level of dyspnoea during AECOPD. Keywords: Acute exacerbation, AECOPD, COPD, GOLD, plasma fibrinogenPublication Prevalence of Functional Limitation in COVID-19 Recovered Patients Using the Post COVID-19 Functional Status Scale(Nepal Medical Association, 2021) Pant, Pankaj; Joshi, Aishana; Basnet, Babin; Shrestha, Bibek Man; Bista, Navindra Raj; Bam, Niraj; Das, Santa KumarAbstract: Introduction: COVID-19 is an emerging global health pandemic causing tremendous morbidity and mortality worldwide. Chronic symptoms progressing to poor functional status have been reported in a substantial proportion of COVID-19 patients worldwide. This study aimed to determine the prevalence of functional limitation in COVID-19 recovered patients using the post-COVID-19 functional status scale. Methods: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. COVID-19 recovered patients with reverse transcription-polymerase chain reaction negative status were included and assessed using the post-COVID-19 functional status scale. Data entry and analysis was done in Statistical Package for the Social Sciences version 20.0. Descriptive statistics were performed. Results: A total of 106 patients were included for the final analysis. More than half of the patients (56.6%) reported having no functional limitation (grade 0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients (grade 1 to 4). Conclusions: Some form of functional limitation should be anticipated after COVID-19 infection. Post-COVID-19 functional status scale can be a valuable tool in determining the prevalence of functional limitation in COVID-19 recovered patients in acute health care settings. It can potentially guide in planning rehabilitative measures in post-acute care management of COVID-19 survivors.Publication Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity: A Single Centre Study(Institute of Medicine, 2019) Pant, Pankaj; Thapa, Shovit; Das, Santa K; Bam, NirajABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) is a public health problem of epidemic proportion. Several studies have shown low serum vitamin D levels in patients with COPD. The aim of this study was to compare serum vitamin D level in patients with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) COPD stage II, III and IV with controls and correlate serum vitamin D level with severity of COPD. Methods A cross sectional study was conducted from June 2014 to November 2015 at Tribhuvan University Teaching Hospital (TUTH). A total of 154 subjects were enrolled for study that consisted of 77 cases of COPD and 77 controls for comparison. Participants were taken from medical wards and outpatient department. COPD staging was done as per GOLD guidelines and stage II, III and IV were labeled as advanced COPD cases. Both descriptive and inferential statistics were performed in SPSS version 20. ResultsStage II, III and IV COPD were 30%, 36% and 34% respectively. Mean serum vitamin D level was 15.16±7.19 ng/ml in COPD cases and 33.99±12.37 ng/ml in healthy controls showing statistically significant relation of low serum vitamin D in patients with advanced COPD (p <0.0001). Serum vitamin D was found to be in decreasing trend with increasing severity of COPD. Conclusion Patients with advanced COPD (GOLD stage II, III and IV) had low serum vitamin D levels compared to normal population and serum vitamin D level correlated with GOLD severity in Nepalese patients with COPD. Keywords: Chronic obstructive pulmonary disease; global initiative for chronic obstructive lung diseases; vitamin DPublication Survival in Critical Care Patients with COVID-19 Pneumonia: A Single Center Based Observational Study(Institute of Medicine, 2022) Bam, Niraj; Kuikel, Sandip; Sapkota, Dharmendra; Poudel, Sagar; Pant, Pankaj; Das, Santa KABSTRACT Introduction: The severity of COVID-19 pneumonia ranges from asymptomatic to requiring mechanical support for survival. This observational study describes the demographic, management, vaccination status and outcome in Nepalese patients with COVID-19 who were admitted to critical care settings . Methods: Single center based cross sectional study was conducted. All the patients admitted to critical care of Tribhuvan University Teaching Hospital (TUTH) were eligible subjects for this study. Demographic, clinical details and vaccination status of respective patients was obtained from interview and chart review. Data was collected in Microsoft Excel 2016 and statistical analysis was performed using statistical software SPSS 21. Results: A total of 342 patients with mean age 53.95±15.6 years were included in the study. The mean duration of stay in critical care was 6.74±4.43 days. Fever and shortness of breath was the predominant symptom present in the studied patients with all patients having shortness of breath. Out of the 342 patients, 20.2% (n=69) were intubated at least once during their critical care stay, 57.89%(n=198) received only non-invasive ventilation and 21.9% (n=75) received oxygen via other means. The overall survival rate of patients admitted to critical care of TUTH was 60.53% with very low survival rate in intubated patients. Only 8.8% of the included patients had received at least one dose of vaccine. Conclusion: Our study suggest that the prognosis of critical care COVID-19 patients is poor with highest mortality in patients receiving mechanical ventilation. Delay in intubation may contribute to this worse outcome in intubated COVID-19 patients. Keywords: Corona virus, COVID-19, critical care, SARS, survival