Journal Issue: Volume: 43, No. 1 (2021)
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2021
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Plasma Fibrinogen Level in Chronic Obstructive Pulmonary Disease and Its Correlation with GOLD Severity Staging
(Institute of Medicine, 2021) Gyawali, Achyut; Bam, Niraj; Pant, Pankaj; Das, Santa K
ABSTRACT
Introduction: Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction.
Methods: This observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done.
Results: A total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p<0.001). There was significant negative correlation between plasma fibrinogen level and forced expiratory volume in one second (FEV1%) predicted (r=-0.71, p=0.01).
Conclusion: High plasma fibrinogen level on discharge was found in COPD patients with severe airflow obstruction, frequent exacerbations and severe level of dyspnoea during AECOPD.
Keywords: Acute exacerbation, AECOPD, COPD, GOLD, plasma fibrinogen
Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study
(Institute of Medicine, 2021) Bajracharya, Manjita; Acharya, Ramesh P; Neupane, Ram P; Sthapit, Rekha; Tamrakar, Apurva R
ABSTRACT
Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation.
Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes.
Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant.
Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.
Keywords: Chronic obstructive pulmonary disease, magnesium sulphate, peak expiratory flow rate
Risk Score for Prediction of Severe Postoperative Complications After Pancreaticoduodenectomy
(Institute of Medicine, 2021) Shah, Surendra; Bhandari, Ramesh S; Vaidya, Pradeep; Singh, Yogendra P; Lakhey, Paleswan Joshi
ABSTRACT
Introduction: Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study.
Methods: This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed.
Results: A total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy hemorrhage (PPH) was 11.6% (5/43). Severe postoperative complications were present in 13.9% (6/43) patients. In univariate analysis, pancreatic duct diameter (p=0.045) and Risk Score (p=0.02) were significantly associated with severe postoperative complications after PD. However none of them were significant in multivariate analysis.
Conclusion: Risk score failed to predict severe postoperative complication after pancreaticoduodenectomy.
Keywords: Pancreaticoduodenectomy, postoperative pancreatic fistula, severe postoperative complications
Diurnal Variability of Peak Expiratory Flow Rate in Healthy Adult Employees of a Medical College of Kathmandu
(Institute of Medicine, 2021) Khakurel, Gita; Gautam, Kalyan; Chalise, Sanat
ABSTRACT
Introduction: Peak expiratory flow measurement is a simple measure of respiratory capacity to diagnose airflow obstruction and monitor treatment response in patients with pulmonary diseases. But there is wide diurnal variability in its values. The objectives of this study was to determine the diurnal variability of peak expiratory flow rate in healthy adults.
Methods: This cross-sectional study was done in employees of Kathmandu Medical College, Duwakot between March to August 2020. A total of 74 subjects of 30-45 years were included in the study. After adequate training, subjects were asked to record their own peak expiratory flow five times a day by Mini-Wright peak flow meter. Diurnal variability was expressed as amplitude percent mean and standard deviation percent mean. Data analysis was done by student’s unpaired t-test and one-way ANOVA.
Results: The mean peak expiratory flow rate (in L/min) were lowest in morning (male: 478.75±45.91; female: 362.86±20.51) followed by progressive rise throughout the day and highest at evening (male: 531.88 ±43.95; female: 415.71±20.97) with slight fall at bedtime (male: 486.88±46.38; female: 362.86±20.51). The difference in peak expiratory flow rate at different time periods was statistically significant in both males and females (p<0.001). The diurnal variability as calculated by amplitude percent mean and standard deviation percent mean were found to be significantly higher in females (p=0.001 and 0.004 respectively).
Conclusion:There is a variation of peak expiratory flow rate recorded during different time points of the day in healthy adults.
Keywords: Diurnal variation, peak expiratory flow rate, spirometry
A Tale of β-Lactamases and Multidrug Resistance in Pseudomonas aeruginosa Isolated from Inpatients in a University Hospital
(Institute of Medicine, 2021) Yadav, Santosh K; Sharma, Sangita; Mishra, Shyam K; Sherchand, Jeevan B
ABSTRACT
Introduction: In this era of modern medicine, antimicrobial resistance can be regarded as a major health calamity. The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains poses therapeutic challenges and lead to treatment failure in hospitalized patients. This study was conducted to determine various types of β-lactamases among MDR P. aeruginosa isolates recovered from hospitalized patients.
Methods: This study was conducted at Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. The clinical samples collected from inpatients were processed for detection of P. aeruginosa isolates and antibiotic susceptibility profile was determined. The MDR strains were identified and ceftazidime-resistant isolates were subjected for detection of extended-spectrum-β-lactamase (ESBL), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC).
Results: A total of 161 P. aeruginosa isolates were recovered during the study period encompassing 73.3% (n=118) MDR isolates. The MDR isolates included 50.0% (n=59) from lower respiratory tract infections; and 39.8% (n=47) were from the intensive care unit patients. The MDR isolates showed a high resistance profile towards piperacillin, cephalosporins, and fluoroquinolones (>85%). Resistance to carbapenems and aminoglycosides were up to 80% and 60% respectively. Extended spectrum-β-lactamase, MBL, and KPC mediated resistance were seen in 34.7%, 43.6%, and 14.4% MDR isolates, respectively.
Conclusion: Multidrug resistance as well as resistance mediated by β-lactamases production were high among P. aeruginosa isolates. Therefore, early detection of antimicrobial resistance and rational use of antibiotics play a critical role to fight against this MDR pathogen.
Keywords: Metallo-β-lactamase, multidrug resistance, Pseudomonas aeruginosa