NepMed Repository :: Browsing by Author "Dhungana, Ashesh"

Browsing by Author "Dhungana, Ashesh"

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Clinical Profile and Complications Experienced by Chronic Kidney Disease Patients undergoing Hemodialysis in a Tertiary Hospital of Nepal: An Observational Study
(Nepal Medical Association, 2025) Sah, Bimala; Khan, Imran; Dhungana, Ashesh
Abstract Introduction: Chronic kidney disease is emerging public health problems globally. Hemodialysis is the commonest treatment modality but it causes some complications and fluctuation in parameters. This study aimed to assess the clinical profile and complications experienced by chronic kidney disease patients undergoing hemodialysis. Methods: This was an observational study conducted from December, 2023 to February, 2024 Patients aged 20 and above, receiving hemodialysis more than three months were included in the study. Descriptive analysis was done. Results: Among 110 CKD patients undergoing hemodialysis, 62 (56.36%) were 50 years of age or younger, with a mean 48.76±13.365. The study population included 66 (60%) male and mean age of the patients was 48.76±13.36. In this study group 90 (81.82%) had two session of dialysis per week. Mean Pre-HD systolic blood pressure was 150.64±23.95 mmHg and Post-HD was 147.64±24.38 mmHg. In this study the mean hemoglobin was 9.38±1.85 gm/dl, glucose was 110.85±46.62 mg/ dl, urea 91.81±37.73 mg/dl and creatinine 7.94±2.68 mg/dl. In the patient population undergoing dialysis oliguria was observed in 106 (96.36%), weakness 98 (89.09%) and insomnia was observed in 87 (79.09%). Conclusions: In this study, more than half of the patient were in the age group of less than or equal to 50 years. Common symptoms included reduced urine output, weakness, and insomnia. Hypertension was the most common underlying condition, often occurring with diabetes.
Comparison of Asthma Control Test and GINA based assessment in Nepalese population: A cross-sectional study
(Nepalese Respiratory Society, 2024) Dhungana, Ashesh; Lamichhane, Buddhi Sagar; Shrestha, Prajowl; Shrestha, Deepa Kumari; Niroula, Deepa
Abstract: Introduction: Asthma has a high age adjusted mortality in low- and middle-income countries like Nepal, which is preventable. Asthma control test (ACT) and GINA based assessment are the two most used tools to monitor effectiveness of the treatment. Utility these tools have not been evaluated in patients with asthma in Nepal. Objective: This study aims to compare the agreement between ACT and GINA assessment tools in Nepalese population. Methods: In a cross-sectional observational study, patients aged more than 18 years diagnosed as asthma at least three months prior were included. Active smokers and those with concomitant other respiratory disorder were excluded. ACT translated to native Nepali language was self-administered by the patient. GINA assessment of asthma control was recorded by the physician. Patients were classified as having well controlled, partially controlled and poorly controlled asthma by using both the tools. Spearman’s correlation coefficient was used to evaluate the agreement between the ACT and GINA based classification. Results: A total of 56 patients were included into the study. The mean age was 39 ± 12 years and the median duration of symptoms was 39.5 (IQR = 25.5-53.5) months. Using the GINA recommended asthma control tool, the number of patients with well controlled, partially controlled and poorly controlled asthma were 21 (38%), 24 (43%) and 11 (20%) respectively. Using the ACT scores, 35 (63%), 11 (20%) and 10 (18%) patients had well, partially, and poorly controlled asthma respectively. Both ACT and GINA score had a good agreement in classifying poorly controlled asthma. ACT and GINA scores had a weak positive yet statistically significant correlation (Spearman’s rho= 0.752, p= 0.019). Conclusions: ACT and GINA based assessment tools have good agreement to identify poorly controlled asthma in patients with asthma in Nepal.
Cutaneous Tuberculosis among Patients Presenting to Dermatology Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Parajuli, Niraj; Karki, Anupama; Dhungana, Ashesh
Abstract Introduction: Cutaneous tuberculosis is an uncommon form of extrapulmonary tuberculosis. It can present in various morphological presentations leading to a late diagnosis in many cases. It is mainly associated with significant scarring and morbidity. It is classified as paucibacillary or multibacillary depending on the bacillary load. Similarly, it can be acquired through either an endogenous or an exogenous source. The mainstay of treatment is anti-tubercular medications. The objective of the study was to find out the prevalence of cutaneous tuberculosis among patients presenting to the dermatology outpatient department of a tertiary care centre. Methods: A descriptive cross-sectional study was done among the patient presenting to the outpatient department of dermatology and venerology in a tertiary care centre where all patients data from medical records were taken from April 2016 to March 2021 after taking ethical approval from the Institutional Review Committee (Reference number: 503/2078/79). Demographic details of the patients including age, sex, site and duration of the lesion were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1,30,924 cases, 40 (0.03%) (0.02-0.04, at 95% Confidence Interval) cutaneous tuberculosis was seen. Conclusions: The prevalence of cutaneous tuberculosis was similar to the studies done in similar settings.
Flexible bronchoscopy for removal of airway foreign bodies: A single center experience Authors
(Nepalese Respiratory Society, 2023) Dhungana, Ashesh; Shrestha, Prajowl; Shrestha, Deepa Kumari; Verma, Avatar; Oli, Ritamvara; Thakur, Laxman
Abstract: Background: Airway foreign bodies are rare in occurrence and challenging to manage. The presentation varies depending upon the size, site, and nature of the aspirated material. Although rigid bronchoscopy is the preferred choice in children; distally lodged foreign bodies in adults have high success rate of extraction with flexible bronchoscope. Objective: The aim of this study is to evaluate the utility of flexible bronchoscopy for removal of airway foreign bodies in adolescents and adults. Methods: In a retrospective study conducted between January 2018 to March 2024 at National Academy of Medical Sciences, Bir hospital; medical records of patients undergoing bronchoscopy for airway foreign bodies were extracted. Methods and Material: Demographic parameters, type and location of foreign body, extraction procedure, accessory equipment used, and the success rates were analyzed. Complications during and after the procedure were also recorded. Results: During the study period, a total of 3143 bronchoscopies were performed, of which 18 (0.57%) were done for foreign body extraction. Patients were aged between 12 to 89 years; cough was the commonest symptom and lobar collapse was the commonest radiological sign. Organic foreign bodies accounted for 61% cases and inorganic 39%. Right lower lobe was the commonest site. Successful flexible bronchoscopy assisted extraction was achieved in 89%. Of the 18 patients, 12 (67%) were successfully removed with rat toothed forceps and five (28%) with basket device. No major complications were noted. Conclusions: Flexible bronchoscopy has a high success rate in management of airway foreign bodies and should always be considered as first line in adults.
Knowledge of Inhaler Therapy among Undergraduates and Resident Doctors in Tertiary Care Hospital, Nepal
(Nepalese Respiratory Society, 2022) Shrestha, Bhakta Dev; Dhungana, Ashesh; Shrestha, Prajwol; Thapa, Kamal Raj; Sahani, Bikash; Dhodary, Shyam
Abstract: 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.
Lived Experiences of Chronic Kidney Disease Patients undergoing Haemodialysis in a Tertiary Hospital of Nepal
(Nepal Health Research Council, 2024) Sah, Bimala Kumari; Khan, Imran; Dhungana, Ashesh; Subedi, Madhusudan; Dhital, Rolina
Background: Chronic kidney disease (CKD) poses significant global health challenges, including in Nepal, where the increasing need for hemodialysis are influencing patient’s daily life. This study aimed to explore lived experiences of CKD patients undergoing hemodialysis. Methods: A qualitative, phenomenological research design was employed. In-depth interviews were conducted with 13 hemodialysis patients at Bir Hospital from December, 2023 to January, 2024. Analysis followed Colaizzi’s method, ensuring data quality through established credibility and transferability measures. Results: Four major themes emerged: (i) Journey to receive hemodialysis (ii) Financial Constraints (iii) Psychosocial support (iv) Seeking for special health services. Patients perceived hemodialysis as a hope for existence but faced financial troubles and inadequate special and psychosocial support. Conclusions: The lived experiences of the patients reflected both hope and challenges highlighting the need for improved health services and counseling in hemodialysis wards, along with enhanced governance in the healthcare system. Keywords: Chronic kidney disease; hemodialysis; lived experience; pilot; qualitative.
Role of Fractional Exhaled Nitric Oxide for Monitoring Bronchial Asthma
(Nepal Health Research Council, 2024) Lamichhane, Buddhi Sagar; Dhungana, Ashesh; Shrestha, Prajowl; Thapa, Kamal Raj; Shrestha, Deepa Kumari
Background: Monitoring during treatment of asthma is usually done by various clinical tools, spirometry, sputum eosinophils and fractional exhaled nitric oxide. Fractional exhaled nitric oxide is a simple and noninvasive tool and has a good agreement with asthma control test score. This study aims to correlate fractional exhaled nitric oxide with asthma control test score. Methods: This cross-sectional study was conducted at National Academy of Medical Sciences, Bir hospital, Chest unit, Department of Medicine, over a duration of six months. Patients aged more than 18 years with bronchial asthma diagnosed at least three months prior were included into the study. Those with recent severe exacerbations, known other chronic respiratory disease and smokers were excluded. Asthma control test score was obtained at baseline. All included patients underwent fractional exhaled nitric oxide measurement followed by measurement of Forced vital capacity(FVC) Forced expiratory volume in one second (FEV1) and FEV1/FVC ratio. Results: Forty patients with a mean age of 40.5±11.1 years were included in the study. Majority were females (65%) and the median duration of symptoms was 24 months (Interquartile range= 18-60). Mean fractional exhaled nitric oxide level was 27.8 (±16.0) parts per billion (ppb) and asthma control test score was 19.3 (±4.7). Mean fractional exhaled nitric oxide levels were significantly different across different severity (well controlled, partially controlled and poorly controlled) of asthma (p=0.013). The mean fractional exhaled nitric oxide values and total asthma control test score shows statistically significant negative correlation (Pearson correlation coefficient (r) = -0.462, p=0.003). Asthma control test and FeNO values guided the change of inhaled steroid dose in 17 of the 40 patients. Conclusion: Fractional exhaled nitric oxide can be used when available, along with asthma control test for monitoring control and adjusting the inhaled steroid dose in asthma. Keywords: Asthma control test (ACT); bronchial asthma; Fractional exhaled nitric oxide (FeNO).

Browsing by Author "Dhungana, Ashesh"

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