Browsing by Author "Thapa, Kamal Raj"
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Publication Comparison of Ziehl Neelsen Stain, Auramine Rhodamine Stain and Culture Sensitivity of AFB in Routine and Concentrated Pleural Fluid(Nepalese Respiratory Society, 2022) Thapa, Kamal Raj; Bhattarai, Madhur Dev; Thapa, Anu; Basnet, TulasaAbstract: Background: Nearly one third of the global population is infected with mycobacterial tuberculosis. Pleural tuberculosis accounts for 20% of extrapulmonary tuberculosis. The diagnosis of tuberculous pleural effusion is difficult because of the low detection rate of different diagnostic tests like microscopy and culture. Current study aimed to compare the detection rate of different tests in non-concentrated and concentrated pleural fluid. Methods: A hospital based prospective cross sectional study was carried out over one year duration in the Medicine Department of Bir Hospital. A total of 52 cases were enrolled. Detailed history taking and physical examination; radiological, hematological and serum biochemical investigations were performed. Thoracocentesis was performed in all the patients; 20 ml pleural fluid was sent for microscopy with ZN and AR staining as well as for AFB culture. Up to 500ml of pleural fluid was heparinized and kept on cylindrical jar for two hours and 50 ml of sediment was also sent for microscopy and culture within one hour. The results obtained were documented and analysis was done. Results: A total of 52 patients, 31 (59.6%) males and 21 (40.4%) females were included. Their mean age of study participants was 38.67 ± 17.71 (range 16-82 years). Common presentations were fever (94.2%), cough (92.3%), breathlessness (84.6%), chest pain (65.4%) and significant weight loss (59.6%). Haemoptysis was present in 13.5%, anemia in 48.1%, enlarged cervical lymph nodes in 5.8% of the patients. The detection rates of ZN stain, AR stain and AFB culture in non-concentrated pleural fluid were 3.8%, 9.6% and 11.5% respectively. The detection rates for the same tests using concentrated pleural fluid of the same patients were 7.7%, 25% and 17.3% respectively. Differences in detection rate with AR stain and AFB culture for non- concentrated and concentrated pleural fluid were statistically significant (p value <0.01). Conclusion: The detection of AFB using microscopy with ZN and AR staining as well as culture in solid media is low. The detection rate was significantly increased by using concentrated pleural fluid sample for microscopy and culture.Publication Diaphragmatic hernia mimicking as pleural effusion in radiograph(Nepalese Respiratory Society, 2022) Thapa, Kamal Raj; Thapa, Anu; Basnet, Tulasa; Shrestha, RemoonNAPublication 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, ShyamAbstract: 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.Publication 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 KumariBackground: 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).