Browsing by Author "Gurung, Naresh"
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Publication A case report of a COPD patient presented in severe metabolic alkalosis Authors(Nepalese Respiratory Society, 2022) Shrestha, Ashish; Gurung, Naresh; Karthak, Ashish; Bhattarai, Sanjeet; Lama, Rakesh; Shrestha, Utsav Kumar; Khanal, Kishor; Ghimire, Anup; Regmi, Ashim; Shrestha, Sanjeet KrishnaAbstract: Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.Publication A case report of hemophagocytic lymphohistiocytosis (HLH) associated with sarcoidosis(Nepalese Respiratory Society, 2024) Gurung, Naresh; Karthak, Ashish; Saraf, Awin; Shrestha, Sanjeet KrishnaAbstract: Hemophagocytic Lymphohistiocytosis (HLH) is a rapidly progressing, fatal disorder characterized by severe systemic hyperinflammation presenting with unremitting fever, organomegaly (hepatosplenomegaly), cytopenias, raised inflammatory markers, liver failure, neurological issues, coagulopathy, and multiorgan failure. It is classified as primary due to mutations inherent to the individual causing increased macrophage activation or due to underlying secondary causes ranging from infections, malignancies, metabolic disorders, or rarely, rheumatological disorders such as juvenile idiopathic arthritis, SLE, sarcoidosis, and so on. However, the association between sarcoidosis and HLH has been rarely reported in the literature, which can present with features of sepsis, making the diagnosis challenging and requiring high clinical suspicion. We report the case of a patient with sarcoidosis presenting with recurrent fever, bilateral lower limb swelling, and fatigue, eventually developing fatal HLH that was unresponsive to high-dose steroids.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 Asymptomatic Pulmonary Cryptococcosis And Tuberculosis Co-infection in an immunocompetent Host: A case report(Nepalese Respiratory Society, 2023) Giri, Rashmi; Khetaan, Khusboo; Aryal, Gopi; Karthik, Ashish; Shrestha, Ashish; Gurung, Naresh; Shrestha, Sanjeet K.Abstract: Pulmonary Cryptococcosis is a rare fungal infection that mostly occurs in immunocompromised host. However, with advancement in diagnostic approach like tissue biopsy, cryptococcal infections are now increasingly being recognised.In immunocompetent host, cryptococcal infection is often asymptomatic and rarely becomes disseminated. Symptom development in immunocompetent host largely depends on burden and virulence of pathogen. Due to similarities in clinical, radiological and pathological findings in Cryptococcosis, Tuberculosis and other fungal infections like Blastomycocosis, it is important to have a tissue biospy to confirm the diagnosis. The aim of this case report is to highlight the investigation necessary to diagnose both fungal infection and Tuberculosis due to similar clinical, radiological features in both. We report a case of Gene Xpert positive Tuberculosis and histopathology proven Pulmonary Cryptococcos in same patient.Publication 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 Outcome of Pulmonary Rehabilitation on Post-Covid Pneumonia Survivors with Residual Lung Fibrosis(Nepalese Respiratory Society, 2025) Suvedi, Rashmi; Gyawali, Manju; Shahi, Reema; Shrestha, Asmita; Thapa, Anisha; Adhikari, Shradha; Tarmakar, Suraj; Chaudhary, Deepak; Karthak, Ashish; Gurung, Naresh; Shrestha, Sanjeet KrishnaAbstract: Background: A significant proportion of COVID-19 survivors develop residual pulmonary fibrosis, leading to persistent dyspnea, reduced exercise capacity, and impaired quality of life. Pulmonary rehabilitation (PR) may help address these sequelae, but evidence remains limited, particularly in low-resource settings. Objective: To evaluate the effect of an 8-week pulmonary rehabilitation program on functional outcomes in post-COVID pneumonia patients with residual lung fibrosis at Nepal Mediciti Hospital. Methods: This prospective cohort study was done from June 2020 to June 2021 and included adult patients with confirmed residual pulmonary fibrosis on imaging after COVID-19 pneumonia. Participants underwent a structured PR program comprising supervised aerobic and resistance training, breathing exercises, and patient education. Functional status was assessed using the 6-Minute Walk Test (6MWT), Modified Medical Research Council (MMRC) dyspnea scale, and ergometer pre- and post-intervention. Results: Participants showed statistically significant improvements in all key outcomes. Mean MRC total score increased from 49.03 to 56.66 (mean difference 7.63, p < 0.001). Mean 6MWT distance improved substantially from 177.6 meters to 276.9 meters (mean difference 99.3 meters, p < 0.001). Significant reductions were observed in perceived fatigue and dyspnea, both at rest and after the 6MWT (p ≤ 0.003 for all Borg scale comparisons). The distribution of improvements varied among individuals, but most showed positive gains. Age showed a slight, non-significant negative correlation with the magnitude of 6MWT improvement. Conclusion: Pulmonary rehabilitation significantly improves functional capacity, dyspnea, and quality of life in patients with post-COVID residual lung fibrosis. These findings highlight the importance of integrating PR into post-COVID care pathways in resource-limited settings like Nepal.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 Six-Minute Walk Test as a Discharge Criterion and Predictor of Three-Month Readmission in Pulmonary Medicine Patients(Nepalese Respiratory Society, 2025) Krishna Shrestha, Sanjeet; Poudel, Saroj; Lama, Rakesh; Giri, Rashmi; Karthak, Ashish; Gurung, Naresh; Singh, Summer J; Bhattarai, SanjeetAbstract; Background: The six-minute walk test (6MWT) is a commonly used tool for measuring functional capacity and predicting outcomes in respiratory disease patients. Objective: To determine the three-month readmission rate among patients who have completed and those who have not completed the 6MWT at hospital discharge. Methods: A prospective observational study was carried out at a tertiary care hospital between June and August 2024 with, 250 respiratory disease patients admitted through the Emergency Department or OPD to the respiratory ward. All patients received a 6MWT before discharge, per ATS guidelines, which measures six-minute walk distance (6MWD), oxygen supplementation, and Borg scale scores for dyspnea and fatigue. Readmission was monitored for three-month periods through OPD visits. Results: Out of 250 patients, the mean age was 65.2 ± 14.0 years, and 46.8% were male. 80.4% of patients passed the test, and 19.6% failed. Oxygen supplementation was required by 28.8%, with comparable pass rates in both groups. The three-month readmission rate was 12.4%, with significantly higher odds among those patients who failed (34.7%, OR=6.94) versus those who passed (7.0%). Patients walking less than 300 meters had a 4.52-fold higher readmission risk, an each 100-meter increase in 6MWT reduced odds by 20 (OR=0.8). Most patients reported minimal dyspnea (49.2%) and fatigue (44.4%). Conclusion: The 6MWT served as an important assessment for the functional capacity of patients with respiratory disease. Failure to complete the test (OR=6.94) or walking less than 300 meters (OR=4.52) considerably increased the risk of readmission. The test is, therefore, a useful predictor for determining readmission risk and discharge criteria. Further research is required to explore interventions that will enhance the functional capacity and prevent readmission.