NepMed Repository :: Browsing by Author "Verma, Avatar"

Browsing by Author "Verma, Avatar"

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Acute Pneumonitis after instillation of Povidone iodine for Chemical Pleurodesis in Secondary Spontaneous Pneumothorax: A case report
(Nepalese Respiratory Society, 2022) Shahi, Rejina; Bhatta, Narendra; Mishra, Deebya Raj; Verma, Avatar; Katuwal, Srijan; Limbu, Sion Hang; Regmi, Gunjan
Abstract: Secondary spontaneous pneumothorax is common in adult and is often life threatening. Surgical intervention is preferred, however chemical pleurodesis is also widely recommended in the treatment of recurrent pneumothorax of different etiologies. Variety of agents such as erythromycin, tetracycline, autologous blood and talc slurry are available for chemical pleurodesis among which povidone iodine is cheap, easily available, effective and safe. In this paper, we report the case of acute pneumonitis after pleurodesis using povidone iodine in a 33 years old female with a known case of lymphangioleiomyomatosis with a history of recurrent pneumothorax. Chemical pleurodesis was performed using povidone iodine after complete expansion of lung and absence of persistent air leak which was confirmed clinically and radiologically. Post procedure, the patient complained of right sided chest pain and cough. Fever, sputum production and shortness of breath was absent. Chest X-ray revealed new consolidation and infiltrations in the right middle zone. Subsequent CT chest showed extensive parenchymal consolidation and ground glass opacities in the right middle lobe, representing pneumonia with acute lung injury. The acute pneumonitis spontaneously resolved with supportive care and the patient was discharged after seven days. Though drug induced pneumonitis is not a usual complication of povidone iodine, it is a possibility and has to be considered.
Diagnostic Yield of Bronchoalveolar Lavage in Nepalese Patients Presenting with Chronic Cough with Normal Radiological Imaging in Tertiary Care Hospital
(Nepalese Respiratory Society, 2022) Shahi, Rejina; Bhatta, Narendra; Mishra, Deebya Raj; Verma, Avatar; Upreti, Augraj; Aryal, Prakash; Yadav, Devesh Kumar; Regmi, Gunjan
Abstract: Background: Cough is one of the most common symptoms that lead patients to seek medical attention. The diagnosis of chronic cough is complex and challenging. In our setting, a large proportion of patients with cough are treated empirically without a definite diagnosis. Despite investigation and treatment, fiberoptic bronchoscope with bronchoalveolar lavage (BAL) has been shown to be a useful technique in a selected group of patients with unexplained chronic persistent cough. The aim of the study was to determine the diagnostic yield of bronchoalveolar lavage in Nepalese patients presenting with chronic cough with normal radiological imaging. Methods: This was a hospital based cross sectional study. The patients presenting with chronic cough (>8 weeks) with normal radiological imaging were enrolled in the study. Results: 1 patient (2.6%) sputum sample for AFB was negative however BAL sample of the same patient sent for Gene xpert came positive for Mycobacterium Tuberculosis, 5 patients (12.8%) had positive BAL culture, 29 patients (74.4%) had normal cellular pattern in BAL Cytology. Conclusion: Diagnostic yield of BAL was very low for chronic cough in our study. Patient presenting with eosinophilic pattern in BAL had cough variant asthma suffer from non-productive cough in the absence of other asthma symptoms such as dyspnea and wheezing. Thus, though fiberoptic bronchoscope with BAL is indicated in chronic cough of unknown etiology, its diagnostic yield is low
Evaluation of the diagnostic yield of lung cancer on various Bronchoscopic modalities Authors
(Nepalese Respiratory Society, 2023) Shahi, Rejina; Bhatta, Narendra; Verma, Avatar; Upreti, Augraj; Gurung, Kum Bahadur; Chaudhary, Sabnam; Dhakal, Nishchal; Mishra, Deebya Raj
Abstract: Background: The application of cytological techniques in identifying malignant respiratory tract lesions has been widely praised as a significant achievement. Flexible fiberoptic bronchoscopy has greatly transformed respiratory cytology, making procedures such as bronchial brushings, broncho-alveolar lavage, and bronchial forceps biopsy more convenient, accessible, and popular. Methodology: All the suspected cases of lung cancer from 1st Jan, 2020 - 31st Dec, 2022 fulfilling inclusion criteria who have undergone flexible bronchoscopy in our center have been analyzed and enrolled in the study. Results: Out of 90 patients, 85 were found to be malignant. Squamous cell carcinoma was the most common carcinoma (31.1%) followed by adenocarcinoma (26.7%), non-small Cell Lung Carcinoma (17.8%) and small cell carcinoma (12.2%), majority of the cases were of 6-7th decade of life and were smoker. Sensitivities of Bronchoalveolar Lavage (BAL), Bronchial brush, Endobronchial forceps Biopsy (EBB), Transbronchial Lung Biopsy (TBLB) and Transbronchial Needle Aspiration (TBNA) were found to be 32%, 87%, 83%, 55% and 69% respectively. Diagnostic accuracy of BAL, bronchial brush, EBB, TBLB and TBNA were found to be 36%, 87%, 83%, 55% and 61% respectively. Conclusion: With a greater sensitivity (87%) and diagnostic accuracy (87%), bronchial brushing shows great promise as a convenient cytological technique suitable for screening ambiguous cases and early detection of lung cancer, as it saves the time required for processing biopsy samples.
Flexible bronchoscopy for removal of airway foreign bodies: A single center experience Authors
(Nepalese Respiratory Society, 2023) Dhungana, Ashesh; Shrestha, Prajowl; Shrestha, Deepa Kumari; Verma, Avatar; Oli, Ritamvara; Thakur, Laxman
Abstract: Background: Airway foreign bodies are rare in occurrence and challenging to manage. The presentation varies depending upon the size, site, and nature of the aspirated material. Although rigid bronchoscopy is the preferred choice in children; distally lodged foreign bodies in adults have high success rate of extraction with flexible bronchoscope. Objective: The aim of this study is to evaluate the utility of flexible bronchoscopy for removal of airway foreign bodies in adolescents and adults. Methods: In a retrospective study conducted between January 2018 to March 2024 at National Academy of Medical Sciences, Bir hospital; medical records of patients undergoing bronchoscopy for airway foreign bodies were extracted. Methods and Material: Demographic parameters, type and location of foreign body, extraction procedure, accessory equipment used, and the success rates were analyzed. Complications during and after the procedure were also recorded. Results: During the study period, a total of 3143 bronchoscopies were performed, of which 18 (0.57%) were done for foreign body extraction. Patients were aged between 12 to 89 years; cough was the commonest symptom and lobar collapse was the commonest radiological sign. Organic foreign bodies accounted for 61% cases and inorganic 39%. Right lower lobe was the commonest site. Successful flexible bronchoscopy assisted extraction was achieved in 89%. Of the 18 patients, 12 (67%) were successfully removed with rat toothed forceps and five (28%) with basket device. No major complications were noted. Conclusions: Flexible bronchoscopy has a high success rate in management of airway foreign bodies and should always be considered as first line in adults.
Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report Authors
(Nepal Medical Association, 2021) Verma, Avatar; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Shahi, Rejina; LImbu, Sion Hangma; Katuwal, Srijan; Lama, Urmila
Abstract: Non-bacterial thrombotic endocarditis is a rare condition characterized by noninfectious vegetation on cardiac valves which are often associated with malignancy. It often presents with features of embolism rather than cardiac failure. These are usually seen in autoimmune conditions, disseminated intravascular coagulation, malignancy of gut and lung but has also been reported in other malignancies as well. This entity is rare but one must have a clinical suspicion of the disease especially in a patient suffering from malignancy presenting with the embolic phenomenon. In this report, we are presenting a case of non-bacterial thrombotic endocarditis in an inpatient with pleural mesothelioma, a rare malignant neoplasm arising from pleura in a 35 years old mason, and a rare association as well.
Metabolic Signature and Obstructive Sleep Apnea in Nepalese Patients
(Nepalese Respiratory Society, 2023) Verma, Avatar; Bhatta, Narendra; Mishra, Deebya Raj; Shahi, Rejina; Uprety, Augraj; Aryal, Prakash; Yadav, Devesh Kumar; Lama, Urmila
Abstract: Introduction: Untreated Obstructive Sleep Apnea (OSA) causes sleep related symptoms and also causes increased incidence of RTA, cardiovascular diseases and all cause mortality. Currently OSA has been recognized as the consequence of number of interrelated metabolic and oxidative pathologies. As there are limited data of association of OSA with metabolic stress and its correlation with severity of OSA, study of metabolic profile of these patients in view of defining the Metabolic signature of OSA was carried out in eastern Nepal. Objectives: To study metabolic profile of OSA and its association with clinical severity. Methods: Hospital based descriptive cross sectional study. Biochemical profile results related to metabolic –oxidative pathway of the OSA patients were obtained. Quantitative and qualitative data were obtained. Quantitative data were compared using Mann–Whitney test while qualitative variables compared using Pearson χ2. Correlation was carried out using Pearson and Spearman’s test. P-value<0.05 considered significant. Results: 33 patients of OSA were enrolled. Majority of patients had deranged metabolic and oxidative parameters despite mild OSA. Among metabolic stress parameters, most commonly deranged were decreased high density lipoprotein (HDL), increased mean arterial pressure (MAP), waist circumference (WC) and raised fasting blood sugar (FBS). Increased MAP and increased WC was significantly corelated with severity. Conclusion: Besides symptom complex, OSA is also harbinger of metabolic stress that can lead to various cardiometabolic diseases and premature mortality thus early recognition and treatment can mitigate these consequences.
Navigating challenges in management of drug resistant tuberculosis: Case experience from Nepal
(Nepalese Respiratory Society, 2022) Verma, Avatar; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Shahi, Rejina; Limbu, Sion Hangma; Katuwal, Srijan
Abstract: Drug resistant tuberculosis (DR TB) a severe form of TB is a disease of concern. Its treatment requires multiple toxic drugs for prolonged duration because of which, often have complicated course requiring close supervision, continuous encouragement from physician, management of side effects and modification of drug regimen for successful outcome. In this report, we are presenting a case of diabetic patient suffering from DR TB highlighting key diagnostic and management challenges.
Small Cell Lung Carcinoma with Pancoast Syndrome: A Case Report
(Nepal Medical Association, 2022) Limbu, Sion Hangma; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Verma, Avatar; Shahi, Rejina; Katuwal, Srijan; Singh, Sunil Kumar
Abstract: Small cell lung cancer mostly arises centrally in the large bronchi. The literature search revealed very limited cases of small cell lung cancer arising at the upper part of the pulmonary sulcus near the thoracic inlet as superior sulcus tumor and also manifesting with typical Pancoast syndrome. We report a case of a 71 years old male patient, presenting with features of Pancoast syndrome including Horner’s syndrome with completed three cycles of chemotherapy resulting in partial response which concludes that small cell lung carcinoma has to be considered despite the clinical findings like pancoast syndrome.
Ultrasound-Guided Percutaneous Transthoracic Biopsy by Pulmonologists
(Nepalese Respiratory Society, 2024) Verma, Avatar; Bhatta, Narendra; Shahi, Rejina; Lama, Urmila; Aryal, Prakash; Pantha, Srijan; Hamal, Sangita; Mishra, Deebya Raj
Abstract: Background: Ultrasound-guided transthoracic needle biopsy (USG-TTNB) is a simple and safe procedure carried out to obtain a tissue sample for confirmation of the diagnosis of various thoracic pathologies. These procedures are usually carried out by radiologists in our country. However, there is good efficacy and fewer complications even in the hands of chest physicians, as shown by many studies published abroad. Considering this, the study is carried out to evaluate outcomes of USG-TTNB by pulmonologists in Nepal. Objective: To study the efficacy and complications associated with USG-guided transthoracic needle biopsies performed by pulmonologists. Methods: Retrospective analysis of 77 patients undergoing USG-TTNB by pulmonologists at BPKIHS from November 2019 to November 2023 were analyzed. The efficacy of the procedure and the complication rate were derived. Efficacy was calculated as proportion of the patients who had undergone the biopsy and resulted in a clinically contributory specimen. Results: Mean age: 62.5 ± 13.7 years; 63.6% female. Transthoracic Fine Needle Aspiration showed a diagnostic yield of 82.6 % of patients, whereas that of trucut biopsy was 86.7 % with a combined diagnostic yield of 94 %. Pneumothorax occurred in four (5.2 %) of patients, and hemothorax occurred in two (2.6 %) of patients. Conclusion: USG-guided percutaneous transthoracic biopsy by a pulmonologist is a procedure with good diagnostic yield and a lower complication rate.

Browsing by Author "Verma, Avatar"

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