Browsing by Author "Bhusal, Yuvaraj"
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Publication ARDS as a presenting feature in sarcoidosis: an uncommon occurrence(Nepalese Respiratory Society, 2022) Shrestha, Sanjeet K; Malla, Jonas; Bhusal, Yuvaraj; Bhattarai, Sanjeet; Lama, Rakesh; Rayamajhi, Sulav; Gurung, Naresh; Shrestha, Ashish; Karthik, Ashish; Pradhan, Pratistha; Rana, Reena; Khetan, KhusbooAbstract: Sarcoidosis though a chronic multi-system granulomatous disease, predominantly involves respiratory system. Often asymptomatic, patients can present with lymphadenopathy, prolonged fever and shortness of breath. Acute respiratory distress syndrome (ARDS) is relatively uncommon presenting feature of the disease. Here we present a case of a 19 years old female presenting in acute respiratory distress syndrome, eventually being diagnosed as Sarcoidosis. Although different diagnostic criteria have been developed for early diagnosis of sarcoidosis, atypical presentations can always pose significant challenge and lag for the diagnosis.Publication Colorectal Polyps in Young Patients Undergoing Colonoscopy(Nepal Health Research Council, 2024) Bhusal, Yuvaraj; Basnet, Bhupendra Kumar; Shrestha, Ramila; Poudel, Mukesh Sharma; Khanal, Ajit; Poudyal, Nandu Silwal; Shah, Manoj Kumar; Khadka, Dibas; Bhusal, SurendraBackground: More than 10 % of colorectal carcinoma occur in patients less than 50 years. Progression of a colorectal polyp to carcinoma may take 5 to 20 years. Implementing screening guidelines and removing such polyps would reduce the progression into carcinoma. The aim of the study was to find the prevalence, distribution and histological analysis of polyps in patients under 50 years undergoing colonoscopy. Methods: Single-center cross-sectional study of 254 consecutive patients less than 50 years who underwent colonoscopy were included in the study. Patients with prior diagnosis of inflammatory bowel disease, colonic polyp(s) or colorectal carcinoma were excluded. Basic demographic data (age, gender), history of smoking and alcohol consumption were recorded. Prevalence of polyps, their location, size and histological type were estimated. Categorical data were expressed as frequencies and percentages. Results: Among 254 patients who underwent colonoscopy, 63 had colorectal polyps. 39 (61.9 %) patients with polyp were males and 33 (52.38 %) patients were of 40-49 years age. Recto-sigmoid polyps were seen in 47 (74.6 %) patients. Regular heavy alcohol consumers and active smokers had higher odds of having polyps. Adenomatous polyps and adenocarcinoma were detected in 12 and 10 patients respectively. Ulcerated or excavated appearance strongly suggested carcinomatous histology (OR: 363.8, (CI: 16.04 – 8250.90). Similarly, polyp size 5 mm or more favored adenomatous polyp or carcinoma [(OR: 177.35, CI: 9.7 – 3229)]. Conclusions: Prevalence of polyps in patients below 50 years age was 24.8 %. Most of the polyps were benign, diminutive (< 5 mm) and located in recto-sigmoid colon. One-third of the polyps were adenoma or adenocarcinoma. Keywords: Colonoscopy; colorectal polyp; screeningPublication Non-resolving long term Mucormycosis in Post-COVID-19 Patient: A Case Report Authors(Nepalese Respiratory Society, 2022) Bhattarai, Sanjeet; Karthak, Ashish; Gurung, Naresh; Shrestha, Ashish; Lama, Rakesh; Bhusal, Yuvaraj; Giri, Bijay; Chhetri, Sujan; Shrestha, Sanjeet KrishnaAbstract: 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.Publication Pulmonary Mucormycosis secondary to Severe Acute Respiratory Illness due to Covid 19 Infection: A Case Report Authors(Nepalese Respiratory Society, 2022) Karthak, Ashish; Shrestha, Ashish; Gurung, Naresh; Bhusal, Yuvaraj; Lama, Rakesh; Rayamajhi, Sulav; Bhattarai, Sanjeet; Regmi, Asim; Ghimire, Anup; Khanal, Kishor; Shrestha, Sanjeet KAbstract: Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.Publication Respiratory Fungal Co-Infections in Covid-19 Patients(Nepalese Respiratory Society, 2024) Guragain, Ankita; Bhusal, Yuvaraj; Rayamajhi, Sulav; Bhattarai, Sanjeet; Shrestha, Sanjeet KrishnaAbstract: Background: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), has been known to cause mild respiratory illness to severe pneumonia. During its pandemic, an increase in viral, bacterial, and fungal coinfections was observed. With Candida, Aspergillus, and Mucor species being the primary fungal pathogens causing secondary pulmonary infections. Risk factors such as prolonged immunosuppressive drug use and comorbidities such as diabetes mellitus and solid organ transplantation increase susceptibility to these coinfections. Objective: The study aimed to determine the incidence of pulmonary candidiasis, invasive aspergillosis, and pulmonary mucormycosis in COVID-19 patients and evaluate various risk factors. Methods: Lower respiratory samples from COVID-19 patients with suspected fungal coinfections were analyzed microbiologically. Macroscopic features such as the morphology of colonies and microscopic characters such as the presence or absence of septations in hyphae, the arrangement of hyphae, the arrangement of conidiophores and conidia, and the presence or absence of rhizoids on lactophenol cotton blue (LPCB) mounts were used for the identification of molds. Morphology of colony, Gram stain, and germ tube test were used for identification of Candida spp. Results: Of 1789 suspected cases, 216 (12.1%) showed positive fungal culture, predominantly in males (67.9%). Candida spp. accounted for 62.9% of cases, followed by Aspergillus spp. (22.2%) and Mucor spp. (7.4%), with 7% showing mixed Aspergillus and Candida infections. Non-albicans Candida spp. were the most common Candida spp., followed by Aspergillus flavus, fumigatus, and nidulans, and Rhizopus among Mucorales. All of the COVID-19 patients were under steroid therapy, and 89.8% of patients had immunocompromising conditions, primarily diabetes mellitus (76.2%), followed by hypertension (14%), both diabetes and hypertension (9.3%), and organ transplantation (0.5%). Conclusion: COVID-19 is associated with a high number of respiratory fungal coinfections, driven by prolonged hospitalization, steroid use, and comorbidities. Careful measures should be adopted by healthcare professionals to minimize the risk of respiratory fungal coinfections and associated fatality.