Journal Issue: Volume: 2, No. 2 (2023)
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Volume
Number
Issue Date
2023
Journal Title
Journal ISSN
ISSN 2822-1893 eISSN 2822-2016
Journal Volume
Articles
Impact of wildland fire smoke: Concern for Clinicians Worldwide
(Nepalese Respiratory Society, 2023) Sijapati, Milesh Jung
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Clinical response to withdrawal of Inhaled Corticosteroids in stable mild to moderate chronic obstructive pulmonary disease in a tertiary hospital of central Nepal
(Nepalese Respiratory Society, 2023) Vaidya, Nirish; Shrestha, Satya; Katila, Shreesuna; Adhikari, Samyog; Koju, Pramesh
Abstract:
Introduction: The mainstay treatment according to the Global Initiative for Chronic Obstructive Lung Disease 2023 guidelines for Chronic Obstructive Pulmonary Disease is combination of long acting bronchodilators with addition of inhaled corticosteroids only in patients with increased exacerbations and an eosinophil count of ≥ 300 cells/μL. Despite the recommendations, inhaled corticosteroids are most commonly overprescribed. So, this study aims to follow patients with mild to moderate cases of this disease who are currently on inhaled corticosteroids combination therapy for clinical efficacy after its withdrawal.
Methods: The study was a prospective interventional study conducted at Dhulikhel Hospital that followed individuals with mild to moderate COPD for eight weeks after a sudden ICS withdrawal. Forced Expiratory Volume in first second, modified Medical Research Council grading, COPD Assessment Tool score and number of exacerbations were assessed with follow-up either by telephone or face to face.
Results: Total of 33 patients were enrolled in the study with mean age 68.9 years and standard deviation 9.3 years. Paired t-test analysis showed no significant mean difference in Forced Expiratory Volume in first second and COPD Assessment Tool values before and eight weeks after the withdrawal of Inhaled Corticosteroids.
Conclusions: Our study supported the conclusion of previous larger studies that withdrawing ICS in stable mild to moderate COPD patients makes no difference in clinical symptoms and spirometry.
Effect of Covid-19 Vaccination on disease Severity among Covid-19 patients admitted in KMCTH Authors
(Nepalese Respiratory Society, 2023) Mishra, Navin Kumar; Karn, Rohit; Shrestha, Milan; Acharya, Abhiskar; Acharya, Sunil; Dahal, Suresh; Neopane, Arpana
Abstract:
Background: The COVID-19 Pandemic has affected millions of people globally with significant morbidity and mortality. Though the overall case fatality rate (CFR) in Nepal was less than 1% during the initial peak, the CFR is expected to increase during the current second wave of the pandemic. Since no specific effective therapies exist, breaking the chain of transmission sounds logical. COVID-19 vaccine development is believed to be effective and safe in preventing disease adverse outcomes.
Aim: Primary aim of the study was to know the COVID-19 vaccination status among the patients admitted with RT-PCR positive for COVID-19 and secondary aim of the study was to observe the difference between the outcome in terms of resources utilization LIKE NON-INVASIVE VENTILATION (NIV), Hi-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) in vaccinated and unvaccinated patients.
Method: This was a hospital-based Prospective Observational Study. All patients admitted at KMCTH from June 01, 2021 –July 31st 2021 with COVID-19 RT-PCR Positive meeting inclusion criteria were enrolled. Ethical Clearance was taken from KMC-IRC.
Result: During the study period, a total of 160 RT-PCR Positive Covid-19 cases were admitted at Kathmandu Medical College Teaching Hospital (KMCTH). Out of the total patients, 74 (46.25%) were not vaccinated for covid-19 whereas 86 (53.75%) patients were vaccinated either with Vero cell (39.53%) or Covishield (60.47%) Covid-19 vaccine. The study showed 2.32% of vaccinated patients required ventilatory support compared to 13.50 % of unvaccinated patients requiring ventilatory support having significant ( p value <0.05) impact on outcome. The relative risk for unvaccinated patients going to ventilator was 5.81 times higher than for vaccinated patients.
Conclusion: The authors found out that more than half of the individual admitted were vaccinated (53.75 VS 46.25). Moreover, Vaccination (either with Covishield or Vero cell) appears to be effective in limiting requirement of more advance services like NIV, HFNC, and invasive mechanical ventilator. We recommend a larger, multicenter, randomized study in the future.
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.
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.