Browsing by Author "Shrestha, Sanjeet Krishna"
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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 Experience of clinicians with dual bronchodilator therapy in COPD (EXPAND) in Nepal Authors(Nepalese Respiratory Society, 2023) Chokhani, Ramesh; Shrestha, Sanjeet Krishna; Bhattarai, Sharad; Mukhopadhyay, Aniruddha; Gaur, Vaibhav; Gogtay, JaideepAbstract: Introduction: Combination of bronchodilators, particularly long-acting muscarinic antagonists (LAMAs) and long-acting β2 agonists (LABAs) have become the mainstay of pharmacological therapy for COPD. COPD is now a common non communicable disease in Nepal. Objective: The study evaluated the current perception and experience of the clinicians in Nepal on diagnosis and management of COPD with focus on use of dual bronchodilator therapy. Method: This cross-sectional, observational survey evaluated experiences of clinicians (n=96; pulmonologist-13, physician-57, general practitioner-26) in Nepal on diagnosis, management trends, and current perceptions on the use of dual bronchodilator therapy in COPD management. Result: 93% of clinicians were practising in an urban setting for an average of 10 years and an average of 35% of their patients are of COPD. 61% of clinicians use mMRC with (34%) or without (27%) CAT score. 92% of clinicians perceived that most of their patients had 1 (32%) or >1 (59%) exacerbation/year. 54% of clinicians performed spirometry on all their patients with suspected COPD. 49% of clinicians measured blood EOS in their patients with severe COPD before adding ICS. 93% of clinicians preferred dual therapy (separate inhalers or a combination) for their COPD patients, but 83% of clinicians preferred LABA + LAMA in a single inhaler over inhalers given separately. 57% of clinicians preferred LABA + LAMA and 82% preferred the Tiotropium + Formoterol combination. 81% of clinicians stepped up or stepped down their treatment. 56% of patients were taking LABA + LAMA + ICS and 55% of clinicians co-prescribed ICS + LABA with LABA + LAMA. 80% of clinicians checked the inhalation technique at every visit and an average of 54% of their COPD patients were adherent (>80%) to the prescribed inhalation therapy. 78% of clinicians felt that dryness of mouth was the most common side effect of LABA + LAMA. 94% of clinicians believed that managing COPD better could improve cardiovascular outcomes in their patients with coexistent COPD. Conclusion: In the EXPAND survey, Formoterol + Tiotropium was preferred by most clinicians in Nepal amongst the LABA + LAMA combination. There is a good scope for improvement in the utilization of tools like spirometry, mMRC, CAT, and blood EOS in the daily practice of clinicians in Nepal.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 Rehabilitation: Reclaiming Respiratory Health through Multidimensional Care(Nepalese Respiratory Society, 2025) Shrestha, Sanjeet KrishnaNAPublication Recent Trends in Sarcoidosis in Southeast Asia and Nepal(Nepalese Respiratory Society, 2024) Shrestha, Sanjeet KrishnaNAPublication Respiratory Fungal Co-Infections in Covid-19 Patients(Nepalese Respiratory Society, 2024) Guragain, Ankita; Bhusal, Yuvaraj; Rayamajhi, Sulav; Bhattarai, Sanjeet; Shrestha, Sanjeet KrishnaAbstract: Background: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), has been known to cause mild respiratory illness to severe pneumonia. During its pandemic, an increase in viral, bacterial, and fungal coinfections was observed. With Candida, Aspergillus, and Mucor species being the primary fungal pathogens causing secondary pulmonary infections. Risk factors such as prolonged immunosuppressive drug use and comorbidities such as diabetes mellitus and solid organ transplantation increase susceptibility to these coinfections. Objective: The study aimed to determine the incidence of pulmonary candidiasis, invasive aspergillosis, and pulmonary mucormycosis in COVID-19 patients and evaluate various risk factors. Methods: Lower respiratory samples from COVID-19 patients with suspected fungal coinfections were analyzed microbiologically. Macroscopic features such as the morphology of colonies and microscopic characters such as the presence or absence of septations in hyphae, the arrangement of hyphae, the arrangement of conidiophores and conidia, and the presence or absence of rhizoids on lactophenol cotton blue (LPCB) mounts were used for the identification of molds. Morphology of colony, Gram stain, and germ tube test were used for identification of Candida spp. Results: Of 1789 suspected cases, 216 (12.1%) showed positive fungal culture, predominantly in males (67.9%). Candida spp. accounted for 62.9% of cases, followed by Aspergillus spp. (22.2%) and Mucor spp. (7.4%), with 7% showing mixed Aspergillus and Candida infections. Non-albicans Candida spp. were the most common Candida spp., followed by Aspergillus flavus, fumigatus, and nidulans, and Rhizopus among Mucorales. All of the COVID-19 patients were under steroid therapy, and 89.8% of patients had immunocompromising conditions, primarily diabetes mellitus (76.2%), followed by hypertension (14%), both diabetes and hypertension (9.3%), and organ transplantation (0.5%). Conclusion: COVID-19 is associated with a high number of respiratory fungal coinfections, driven by prolonged hospitalization, steroid use, and comorbidities. Careful measures should be adopted by healthcare professionals to minimize the risk of respiratory fungal coinfections and associated fatality.