Browsing by Author "Poudel, Dipesh"
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Publication Awake Prone Positioning In COVID Positive Patients: A Retrospective Study(Nepal Health Research Council, 2023) Dangol, Shova; Poudel, Dipesh; Shrestha, Surendra Man; Rawal, Prabhat; Shrestha, KunduAbstract Background: While the advanced health care settings are struggling hard to handle the sudden surge of COVID-19 cases, resource poor settings in developing countries like Nepal can barely stand to fight the increasing number of severe cases. Easily available cost effective interventions would be great blessing for such settings. This study aimed to study if awake prone positioning can be used as such intervention in COVID 19. Methods: The retrospective study involved 150 patients admitted between November 2020 and January 2021 at Nepal Armed Police Force Hospital and met specific inclusion criteria. Data was obtained at four different time points in relation to prone position and was analysed using International Business Machines Statistical Package for the Social Sciences (SPSS) version 23. Results: It was found that among 150 patients, majority (109; 72.7%) were males and 60(40%) had some comorbidities. The mean oxygen saturation was found to increase significantly from 87.18 %(SD 3.531) to 91.08(SD 2.206) after fifteen minutes of prone positioning. One way ANOVA test showed that there was significant difference in oxygen saturation between at least two time points. (F (3,596) = [180.005], p=0.000). Games Howell Post Hoc test for multiple comparisons showed that the mean value of SPO2 was significantly different across all four time points, at significance level 0.05. Conclusions: This study found Awake Prone positioning as a promising cost effective and feasible intervention for improving oxygenation in COVID 19 and thus could be a blessing to the resource poor health care settings. Keywords: Awake prone; COVID-19; oxygen saturation; resource-poor.Publication High-Resolution Computed Tomography (HRCT) Chest Findings in Active Pulmonary Tuberculosis(Nepalese Respiratory Society, 2025) Adhikari, Deepak; Raut, Yuvaraj; Poudel, Dipesh; Paudel, Bigyan; Bhatt, Manali; Adhikari, ShitalAbstract: Background: Tuberculosis (TB) is an airborne infection caused by the acid-fast bacillus Mycobacterium tuberculosis. It is estimated that about 10.8 million people fell ill with tuberculosis worldwide, and about 1.25 million of them died in 2023. In Nepal, nearly half of the population are estimated to harbor latent TB. Early diagnosis and effective treatment are the mainstay of the control of tuberculosis. Objective: This study aimed to evaluate the diagnostic utility of high-resolution computed tomography (HRCT) of the chest in detecting active pulmonary tuberculosis (PTB). Methods: It is a case-control study done in the Department of Radiodiagnosis at Chitwan Medical College, Teaching Hospital from August 2022 to January 2023. Adult patients with presumptive pulmonary TB who underwent both microbiological testing for Mycobacterium tuberculosis, and High-Resolution CT (HRCT) chest imaging were included. Patient’s demographics, clinical features, sputum microscopy for acid-fast bacilli (AFB), GeneXpert for MTB, and relevant HRCT chest findings were recorded in a predesigned proforma. Data were entered into Microsoft Excel and analyzed using IBM SPSS version 20.0. Results: Data from 72 patients with active pulmonary TB were analyzed. Of these, 46 patients (63.9%) had Mycobacterium tuberculosis identified via AFB staining, while the remaining 26 (36.1%) were diagnosed using GeneXpert. The control group included 35 sputum-negative cases where bacteria could not be isolated using GeneXpert. The mean age of patients was 56 years, and the majority were male (68.1%). The most frequent HRCT findings in active TB cases included tree-in-bud appearance (69.4%), enlarged mediastinal lymph nodes (65.3%), and consolidation (56.9%). The tree-in-bud pattern was significantly more common in TB-positive patients compared to controls. Conclusion: Common HRCT chest findings in pulmonary tuberculosis were tree-in-bud appearance, mediastinal lymphadenopathy, and consolidation. Tree-in-bud appearance in HRCT was significantly associated with bacteriologically confirmed pulmonary tuberculosis. When microbiological confirmation is delayed or negative, HRCT chest findings can support early initiation of treatment in suspected cases, thereby reducing community transmission and improving patient outcomes.Publication Pneumothorax, pneumomediastinum and subcutaneous emphysema as respiratory complications of COVID-19(Nepal Health Research Council, 2023) Rawal, Prabhat; Shrestha, Surendra Man; Gurung, Anju; Poudel, DipeshAbstract Background: Pneumothorax, pneumomediastinum and subcutaneous emphysema are respiratory complications of Coronavirus disease 2019 occurring with noteworthy frequency in patients especially with severe disease. They can be life-threatening and often complicate patient managment. Methods: This was a retrospective, observational study of patients admitted in Nepal Armed Police Force hospital from 13/05/2020 to 28/12/2021 diagnosed with pneumothorax, pneumomediastinum or subcutaneous emphysema singly or in combination. Data were collected from clinical charts, imaging records and electronic medical records of Severe Acute Respiratory Syndrome Coronavirus-type 2 positive patients 18 years and older. The frequency and type of the defined complications, the inflammatory markers and ventilatory parameters just prior to their diagnosis, the duration of hospitalization and ICU admission and in-hospital mortality rate were studied. Results: Out of 4013 COVID-19 patients admitted in the hospital during the period, a total of 28 patients were observed to develop the complications, the overall incidence being 0.7% among hospitalized patients and 5.6% among ICU patients. The proportion of subcutaneous emphysema (64.3%) was highest followed by pneumomediastinum (46.4%) and then pneumothorax (39.3%) existing singly or in combination among the 28 patients, where four patients developed the complications spontaneously. Mean Positive End Expiratory Pressure of 12.1±2.6 cmH2O and Peak Inspiratory Pressure or Pressure Support of 30.9±10.3 cmH2O were observed for patients under positive pressure ventilation. Most of the patients who developed the complications (78.6%) died during treatment. Conclusions: Pulmonary air leak complications occur frequently in COVID-19 patients treated with or without positive pressure ventilation signifying increased disease severity, risk of ICU admission and high mortality rate. Hence, clinicians should be vigilant of these complications in all patients affected with COVID-19 and institute timely management. Keywords: Barotrauma; COVID-19; incidence; pneumomediastinum; pneumothorax.