Journal Issue: Volume: 3, No. 2 (2024)
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Volume
Number
Issue Date
2024
Journal Title
Journal ISSN
ISSN 2822-1893 eISSN 2822-2016
Journal Volume
Articles
GLP-1 Receptor Agonists in Obstructive Sleep Apnea: New fronteirs in Metabolic and Respiratory Medicine
(Nepalese Respiratory Society, 2024) Sijapati, Milesh Jung
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Asthma – Inhaled Corticosteroids (ICS): different molecules - different devices – different treatment concepts: what really makes a difference?
(Nepalese Respiratory Society, 2024) Singla, Abhinav; Stegemann-Koniszewski, Sabine; Lücke, Eva; Kahlfuss, Sascha; Schreiber, Jens
Abstract
Bronchial asthma is a chronic, heterogeneous disease with different clinical phenotypes and inflammatory endotypes. Anti-inflammatory treatment with inhaled corticosteroids (ICS) has revolutionized the therapy of asthma and is indicated in almost all patients across all degrees of severity and therapy stages. Nevertheless, there is a broad spectrum of ICS molecules, dosages, combination partners, application concepts (maintenance therapy and/or as-needed therapy), and devices. Thus, there is a large number of variables, whose clinical significance is often unclear. This overview will therefore present clinically relevant aspects in the use of ICS and their combination partners.
Respiratory Fungal Co-Infections in Covid-19 Patients
(Nepalese Respiratory Society, 2024) Guragain, Ankita; Bhusal, Yuvaraj; Rayamajhi, Sulav; Bhattarai, Sanjeet; Shrestha, Sanjeet Krishna
Abstract:
Background: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), has been known to cause mild respiratory illness to severe pneumonia. During its pandemic, an increase in viral, bacterial, and fungal coinfections was observed. With Candida, Aspergillus, and Mucor species being the primary fungal pathogens causing secondary pulmonary infections. Risk factors such as prolonged immunosuppressive drug use and comorbidities such as diabetes mellitus and solid organ transplantation increase susceptibility to these coinfections.
Objective: The study aimed to determine the incidence of pulmonary candidiasis, invasive aspergillosis, and pulmonary mucormycosis in COVID-19 patients and evaluate various risk factors.
Methods: Lower respiratory samples from COVID-19 patients with suspected fungal coinfections were analyzed microbiologically. Macroscopic features such as the morphology of colonies and microscopic characters such as the presence or absence of septations in hyphae, the arrangement of hyphae, the arrangement of conidiophores and conidia, and the presence or absence of rhizoids on lactophenol cotton blue (LPCB) mounts were used for the identification of molds. Morphology of colony, Gram stain, and germ tube test were used for identification of Candida spp.
Results: Of 1789 suspected cases, 216 (12.1%) showed positive fungal culture, predominantly in males (67.9%). Candida spp. accounted for 62.9% of cases, followed by Aspergillus spp. (22.2%) and Mucor spp. (7.4%), with 7% showing mixed Aspergillus and Candida infections. Non-albicans Candida spp. were the most common Candida spp., followed by Aspergillus flavus, fumigatus, and nidulans, and Rhizopus among Mucorales. All of the COVID-19 patients were under steroid therapy, and 89.8% of patients had immunocompromising conditions, primarily diabetes mellitus (76.2%), followed by hypertension (14%), both diabetes and hypertension (9.3%), and organ transplantation (0.5%).
Conclusion: COVID-19 is associated with a high number of respiratory fungal coinfections, driven by prolonged hospitalization, steroid use, and comorbidities. Careful measures should be adopted by healthcare professionals to minimize the risk of respiratory fungal coinfections and associated fatality.
Role of Bronchoscope Utilization in Sputum AFB & Gene Xpert Negative individuals at Kathmandu Medical College Teaching Hospital
(Nepalese Respiratory Society, 2024) Mishra, Navin Kumar; Thakuri, Hema Chand; Shrestha, Sareen; Rai, Utshav; Dhamala, Rasmita; Nepali, Rohit; Dahal, Suresh; Sha, Parmeshwar; Khadka, Gaurav; Lamichhane, Aayush; Gupta, Pulkit; Bhatta, Karuna
Abstract:
Background: Respiratory diseases are among the top most cause of mortality globally as per World Health Organization data with chronic obstructive pulmonary disease (COPD), Lung Cancer, Lower Respiratory tract infection and Tuberculosis (TB) among the top ten causes of mortality. Bronchoscope is still in growing phase in our setting despite its significant utility in establishing diagnosis and treatment of patient. Bronchoscope has pivotal role in various benign (Eosinophilic pneumonia, tuberculosis, Interstitial Lung Disease etc.) as well as Malignant (Lung Cancer) Respiratory diseases etc.
Objective: To find out the efficacy of bronchoscope in detecting tuberculosis among sputum smear acid-fast bacilli (AFB) and GeneXpert negative individuals.
Method: A single center, prospective, cross sectional study design was conducted which included all patients seen by Pulmonary Medicine department of Kathmandu Medical College Teaching Hospital (KMCTH). Patients were offered bronchoscopy if clinical history, examination, sputum microbiology and imaging findings demanded.
Results: A total of 111 cases underwent Fiberoptic bronchoscopy (FOB) at our center during the study period for various indications. Out of which 62 (55.86%) were male and 49 (44.14%) were Female. Among a total of 45 cases with strong clinical suspicion of pulmonary tuberculosis but sputum AFB and GeneXpert-negative tuberculosis who underwent FOB, a total of 30 (66.67%) individuals were confirmed to have tuberculosis in bronchoalveolar lavage (BAL) GeneXpert, out of which 17 (56.67%) were male and 13 (43.33%) were female.
Conclusion: FOB is very useful in establish diagnosis of Tuberculosis in selected patients with negative Sputum AFB and GeneXpert result.
Evaluation of the diagnostic yield of lung cancer on various Bronchoscopic modalities Authors
(Nepalese Respiratory Society, 2024) K.C, Rajesh; Maharjan, Swojay; Shrestha, Kushal; Sedhain, Shashwot; Adhikari, Gopal; Maharjan, Sirapa; Panta, Chiranjibi; Basnet, Ashok; Basnet, Bina; Karmacharya, Bina
Abstract:
Introduction: Lung cancer is responsible for a major portion of cancer-related mortality worldwide, despite advancements in diagnostic technologies and treatment modalities. Bronchoscopy plays a central role in the diagnosis of lung cancer by allowing direct visualization of the airways and facilitating tissue sample collection through endobronchial brush, endobronchial wash, and endobronchial biopsy.
Objective: To analyze the histomorphological patterns of lung malignancies and compare the diagnostic efficacy of different bronchoscopic techniques, like specifically bronchial wash cytology, endobronchial brush cytology, and endobronchial biopsy.
Methods: A retrospective analysis of fiberoptic bronchoscopy (FOB) morphological findings, including bronchial wash and endobronchial brush cytology and endobronchial biopsy, was conducted in 78 patients aged 18 years and older with findings suspicious for malignancy on CT scan. Frequencies of various histopathological subtypes of lung cancer were tallied with the different diagnostic procedures and corresponding FOB findings. Diagnostic accuracy, sensitivity, and specificity of endobronchial brush cytology and bronchial wash cytology, both individually and in combination, were evaluated using biopsy as the reference standard. Associations between demographic variables, tumor and nodal staging, and bronchoscopic findings were also assessed.
Results: Of the 78 patients, 63 (80.8%) had a confirmed diagnosis of malignancy on biopsy. The most frequently identified histopathological subtypes of lung cancer were squamous cell carcinoma (47.4%), followed by non- small cell lung carcinoma, not otherwise specified (14.1%), and small cell carcinoma (10.3%). On FOB, the tumors most frequently appeared as endobronchial growths (68.3%), followed by areas of unhealthy mucosa (55.6%) and polyploidal lesions (19%). Endobronchial brush cytology yielded a sensitivity of 49.2%, a specificity of 60%, and an overall diagnostic accuracy of 51.28%. In comparison, endobronchial wash cytology showed lower sensitivity (12.7%), higher specificity (86.7%), and a reduced diagnostic accuracy of 26.92%. When combined, these cytological methods yielded a sensitivity of 55.65%, a specificity of 52.02%, and a diagnostic accuracy of 54.4%. There was no significant association between clinical or bronchoscopic variables and malignancy status.
Conclusions: The study reinforces the critical diagnostic role of bronchoscopic modalities in detecting pulmonary malignancies. The combination of endobronchial brush and bronchial wash cytology marginally improved sensitivity but with moderate specificity. The relatively low sensitivity of cytological techniques, especially endobronchial wash, highlights their limitations as standalone diagnostic tools.