Journal Issue: Volume: 1, No. 1 (2022)
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Volume
Number
Issue Date
2022
Journal Title
Journal ISSN
ISSN 2822-1893 eISSN 2822-2016
Journal Volume
Articles
Launching a New Journal in Era of Evidence based medicine
(Nepalese Respiratory Society, 2022) Sijapati, Milesh Jung
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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, Tulasa
Abstract:
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.
Allergic sensitization and obstructive airway diseases among an adult rural population in Nepal
(Nepalese Respiratory Society, 2022) Drews, Arne; Lama, Poonam; Nepal, Niraj; Joshi, Rajesh Dhoj; Gran, Anja; Schreiber, Jens
Abstract:
Background: The relevance of the obstructive lung diseases asthma and COPD and IgE-mediated allergy in Nepal is still poorly characterized.
Method: In a cross-sectional study in rural Nepal 199 persons were characterized with a questionnaire, skin prick tests, spirometry and total IgE concentration in serum.
Results: About 20% of the women and 50% of the men were current smokers. Half of the study population used biomass fuel at home to cook or to heat and 70% of the study participants experienced dust-exposure at work or at home. 50% of the women and 30% of the men had a history of COPD, while 57% of the women and 53% of the men had symptoms of respiratory allergy. 18% of the women and 16% of the men used inhaler devices. 62% of the women and 66% of the men had a total IgE concentration in serum >100 IU/mL. About 30% of the women had a FEV1 < 80% and about 10 % had a FEV1 < 40%, also 30% of the men had a FEV1 <80% but none of the men had a FEV1 <40%. The FEV1/VC ratio was smaller than 70% in 13 % of the women and 14,6% of the men. We observed a significant inverse correlation between serum IgE with FEV1. 14% of study participants had positive prick test for house dust mite, 5% were positive for cat dander and 3% were positive for mugwort.
Conclusion: In summary this study shows an relevant burden of obstructive pulmonary disorders and IgE-mediated allergy in a rural Nepalese population.
Challenges of Diagnosis and Treatment of ANCA Associated Vasculitis in COVID-19 Pandemic - A Case Report
(Nepalese Respiratory Society, 2022) Sharma, Prayush; Sijapati, Milesh Jung; Gautam, Santosh; Kandel, Ramesh; Simkhada, Suman; Regmi, Sneha Bandhu
Abstract:
As COVID-19 pandemic is spreading worldwide with high infectivity rates of various strains, it is also challenging our healthcare system with its respiratory complications, and limited availability of healthcare providers. On the other hand, a huge vaccination program against COVID-19 is being conducted throughout the world. This viral infection and vaccination program has also brought into account the controversies of some neurological and autoimmune complications. Although the exact mechanism of these complications is still unknown, some autoimmune mechanisms have been predicted. These complications may further challenge the management of this novel viral infection. One of the rare complications of COVID-19 infection and its vaccination is de novo development or flare of ANCA-associated vasculitis, which has also been found in many recent case reports.
Pulmonary Mucormycosis secondary to Severe Acute Respiratory Illness due to Covid 19 Infection: A Case Report Authors
(Nepalese Respiratory Society, 2022) Karthak, Ashish; Shrestha, Ashish; Gurung, Naresh; Bhusal, Yuvaraj; Lama, Rakesh; Rayamajhi, Sulav; Bhattarai, Sanjeet; Regmi, Asim; Ghimire, Anup; Khanal, Kishor; Shrestha, Sanjeet K
Abstract:
Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.