Browsing by Author "Shreewastav, RK"
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Publication Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal(Kathmandu University, 2020) Ghimire, RH; Ghimire, A; Bista, B; Yadav, S; Shreewastav, RKABSTRACT Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences. KEY WORDS Nepal, Spontaneous pneumothorax, Treatment outcomePublication Study on Status of Serum Biochemical and Hematological Parameters in COVID-19 Positive Patients Attending a Tertiary Care Hospital(Kathmandu University, 2022) Shreewastav, RK; Singh, GK; Jha, KK; Yadav, RK; Gharti, SBABSTRACT Background Coronavirus disease 2019 (COVID-19) presents clinically a variety of pathological and clinical organ dysfunctions, ranging in severity from asymptomatic to fatal. The care and monitoring of COVID-19 patients may benefit from the use of biochemical and hematological markers. Objective To observe the alteration of serum biochemical and hematological parameters in COVID-19 positive patients, attending a Tertiary Care Hospital. Method A descriptive cross-sectional study was conducted on all COVID-19 positive patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal from 15th December 2021 to 15th February 2022. The test results of different serum biochemical and hematological parameters done for these patients were recorded in clinical laboratory services and obtained retrospectively for the analysis. The data were entered in MS excel and analyzed by SPSS version 20. Result Out of 1537 COVID-11699 declared positive patients, 712 (46.32%) were male and 825 (53.68%) female. Mean age of COVID positive patients was 40.03±20.08 years. The level of serum SGOT, SGPT, ALP and GGT was significantly elevated in 39.9%, 42.8%, 32.3% and 47.2% of COVID positive patients respectively. Blood Urea, creatinine, uric acid and sugar level were significantly elevated in 63%, 56.1%, 33.1% and 47.6% patients respectively. The serum level of LDH, D-dimer, CRP and procalcitonin (PCT) were significantly increased in 52.1%, 75.9%, 71.6% and 61.2% of patients respectively. The serum value of total cholesterol, triglyceride, HDL and LDL were significantly lowered in 52.2%, 43.8%, 70.1% and 60.3% of patients respectively. RBC concentration and level of hemoglobin was reduced in 56.6% and 53.6% of COVID positive patients respectively whereas total leukocyte count was elevated in 80.7% with increase in neutrophil in 87.9% and decrease in lymphocyte in 79.4%. Conclusion A portion of COVID-19 positive patients showed drastically altered test results for various serum biochemical and hematological markers, although many of them had normal findings. KEY WORDS Biochemical markers, COVID-19, Tertiary hospitalPublication Thyroid Hormone Abnormalities and Associated Risk Factors among Acute Coronary Syndrome Patients at a Tertiary Care Hospital(Kathmandu University, 2023) Shreewastav, RK; Dhungana, SP; Pokhrel, S; Jayshwal, R; Pandey, HABSTRACT Background Thyroid dysfunction and associated factors like age, sex, diabetes mellitus, hypertension, smoking, family history of coronary artery disease and dyslipidemia contributes the risk for acute coronary syndrome. Objective To find out the prevalence of thyroid dysfunction and associated risk factors among acute coronary syndrome patients at this tertiary care hospital in eastern Nepal. Method A descriptive cross-sectional study was carried out prospectively among acute coronary syndrome patients at a tertiary care Hospital. Diagnosis of acute coronary syndrome was made based on the medical history, Electrocardiogram abnormalities, and cardiac markers. Thyroid function test and estimation of other blood parameters were done in the blood of the patients. Other relevant information and medical history of the patients were collected by using proforma. Result Out of 186 total acute coronary syndrome patients, 127 (68.28%) were male and mean age of all patients was 60.0 ± 13.7 years. Thyroid dysfunction was observed in 52 (27.95%) patients, out of that subclinical hypothyroidism was mostly seen in 30 (16.12%) patients followed by hypothyroidism in 13 (6.98%). The number of patients with hyperthyroidism and subclinical hyperthyroidism was 6 (3.23%) and 3 (1.62%) respectively. Associated factors like hypertension, diabetes mellitus, smoking, family history of coronary artery disease and dyslipidemia was observed in 80 (43.01%), 42 (22.58%), 83 (44.62%), 11 (5.91%) and 79 (42.47%) patients. Conclusion Acute coronary syndrome was predominantly seen in male and subclinical hypothyroidism was a major thyroid dysfunction observed among the patients. Hypertension, dyslipidemia, diabetes mellitus and smoking was found to be associated in a proportion of patients with acute coronary syndrome. KEY WORDS Acute coronary syndrome, Diabetes mellitus, Hypertension, Risk factors, Thyroid function test