Journal Issue: Volume: 2, No. 1 (2023)
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Volume
Number
Issue Date
2023
Journal Title
Journal ISSN
ISSN 2822-1893 eISSN 2822-2016
Journal Volume
Articles
New Updated GOLD 2023 guidelines: Insights, Implications and future Directives for Clinicians Authors
(Nepalese Respiratory Society, 2023) Sijapati, Milesh Jung
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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.
Incidence, risk factors and outcomes of Acute Kidney Injury in Chronic Obstructive Pulmonary Disease patients with Acute exacerbation
(Nepalese Respiratory Society, 2023) Regmi, Gunjan; Khanal, Kanak; Arjyal, Batsalya; Pyakurel, Kumud; Shah, Vibek Prabhat; Shahi, Rejina
Abstract:
Background: There is little data on the incidence, risk factors and outcomes of the AKI among COPD patients who are admitted to critical care units with exacerbation of symptoms. This observational study was conducted to evaluate the incidence and outcome of AKI with AECOPD.
Method: We performed an observational study of patients who were admitted in the intensive care unit from August 2021 to February 2023 for acute exacerbation of COPD.
Results: During the study period, a total of 108 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. AKI occurred in 49 patients (45.4%). Independent risk factors for AKI in patients with AECOPD were advanced age, coronary artery disease, anemia, acute respiratory failure, and mechanical ventilation. Patients with AKI had worse prognostic implications and were more likely to require mechanical ventilation (42.8% vs 22.03%, P<0.05), had a longer ICU stay (6 ±1.3 days vs 5.41±1.1 days, P<0.05) and longer hospitalization (7.65±1.42 days vs 6.9±1.2 days, P<0.05); and higher in-hospital mortality (28.5 % vs 11.8 %, P<0.05) than those without AKI. Compared to patients without AKI who had in-hospital mortality rate of 11.8%, those with stage 2, or 3 AKI had rates of 41.6% and 85.7% respectively, that is 2.1- fold and 6.0-fold increased risk of in-hospital death, respectively.
Conclusion: Incidence of AKI is relatively high in patient with AECOPD requiring intensive care. Patient with AKI had poor outcomes compared to non-AKI patient with AECOPD. AKI can be a prognostic factor for determining patient survival.
Causes and outcome of infants admitted with respiratory distress in a tertiary care neonatal unit: A five year review Authors
(Nepalese Respiratory Society, 2023) Verma, Varsha; Ghimire, Deen Dayalu; Jha, Saroj Kumar; Joshi, Suchita Shrestha
Abstract:
Background: Respiratory distress is a common cause for admission of infants to a neonatal unit. The aim of this study was to analyze the causes of respiratory distress leading to admission in a neonatal unit.
Method: This is a 5 year retrospective review of neonates admitted initially with diagnosis of respiratory distress in the neonatal unit of a tertiary care hospital from November 2017 to October 2022. Cases were identified and analyzed using electronic database maintained in the neonatal unit and were cross checked with electronic discharge summaries where necessary.
Results: Respiratory distress was found to be the most common cause for admission to the neonatal unit almost comprising of 46% of total admissions. The commonest cause for respiratory distress on admission was found to be transient tachypnoea of newborn (TTN) in term infants and surfactant deficiency respiratory distress syndrome (RDS) in preterm infants. As compared to babies with TTN, who were all discharged home, 18.4% of those with RDS did not survive. The overall mortality of infants presenting initially as respiratory distress was 9.1%. Other common causes for respiratory distress on admission were sepsis, birth asphyxia, shock, congenital heart disease, seizure and polycythemia.
Conclusion: Respiratory distress is a common cause for admission to a neonatal unit in both term and preterm infants. Although TTN in term and RDS in preterm are common causes for respiratory distress in newborns, the underlying cause for respiratory distress is diverse and not just limited to the lungs and heart.