Browsing by Author "Das, SK"
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Publication A Rare Case of Bilateral Aspergillomas in a Patient of Ankylosing Spondylitis(Kathmandu University, 2016) Das, A; Pandit, S; Das, SK; Basuthakur, S; Das, SABSTRACT Pulmonary involvement by Aspergillus sp. mainly includes allergic bronchopulmonary aspergillosis, aspergilloma, and invasive aspergillosis. Aspergilloma (Fungal ball) is the most common form of aspergillous pulmonary involvement, which occurs in preexisting pulmonary cavities, especially secondary to pulmonary tuberculosis. Ankylosing spondylitis is a rare cause of upper lobe fibro-cavitary lesions in pulmonary parenchyma. It may also lead to development of fungal balls in pulmonary cavities. Most common presentation is mild to massive hemoptysis; dyspnoea, chronic cough, expectoration may be other presentation; even the patient may remain asymptomatic. Intaracavitary mobile mass is a valuable sign for fungal ball, best detected by computed tomography (CT) scan of thorax. Lobectomy is the treatment of choice to stop the hemoptysis, if the general condition of the patient is fit; otherwise associated co-morbidities complicate the post-operative scenario. In this situation, bronchial artery embolization may be used as a temporary measure to control hemoptysis. Here, we report a case of bilateral aspergillomas within the cavities located in upper lobes of both lungs in a 74 years old male who was suffering from ankylosing spondylitis for last 42 years. KEY WORDS Aspergilloma, ankylosing spondylitis, hemoptysis, lobectomyPublication 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 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