DOAJ (DOAJ: Directory of Open Access Journals), Jun 3, 2015
Aluminium phosphide poisoning is one of the major causes of suicidal deaths in developing countri... more Aluminium phosphide poisoning is one of the major causes of suicidal deaths in developing countries like Nepal. It is one of the common fumigant available and is within easy access. It is primarily used for crop protection. However, it is one of the misused chemicals to commit suicide. In this case, the patient had hyperglycaemia, atrial fibrillation, severe metabolic acidosis, and shock and yet survived. The key to her survival was aggressive supportive management. Therefore, knowing all the prognostic factors along with aggressive management can be life saving in conditions when no antidotes are available.
Background Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis predominantly... more Background Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis predominantly affecting upper and lower respiratory tract and kidneys. Unilateral diaphragmatic palsy could be a rare manifestation of GPA. Here we report a case of GPA in a 45-year-old male with unilateral diaphragmatic palsy with pleuropericarditis. Case presentation We report a case of a 45-year-old Khas male who presented with acute onset chest pain and shortness of breath who had elevated right hemidiaphragm, bilateral pleural effusion and pericardial effusion who was later diagnosed as GPA. Conclusions GPA should be suspected in all patients with diaphragmatic palsy and pleuropericarditis with appropriate clinical and laboratory picture.
In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simp... more In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation.
The presence of multiple tracheal and bronchial diverticula is a rare condition. Most cases are a... more The presence of multiple tracheal and bronchial diverticula is a rare condition. Most cases are asymptomatic however, few present with chronic or recurrent symptoms. We present a case of a 22-years old non-smoker male with a history of pulmonary tuberculosis, having multiple tracheal and bronchial diverticula.
<p>Demography, clinical profile, severity of illness and ICU discharge status of patients i... more <p>Demography, clinical profile, severity of illness and ICU discharge status of patients in the three ICUs admitted during the before and after commencement of training period.</p
<p>The trend line is a non-parametric locally weighted scatterplot smoother. The vertical l... more <p>The trend line is a non-parametric locally weighted scatterplot smoother. The vertical line indicates the time that the training intervention started.</p
<p>P-values refer to the evidence for stepwise changes in adjusted subdistribution hazard r... more <p>P-values refer to the evidence for stepwise changes in adjusted subdistribution hazard ratio from the Fine-Gray model for the cumulative incidence of ICU mortality.</p
Anti-Melanoma Differentiation-Associated gene 5 (Anti-MDA-5) dermatomyositis is a rare subtype of... more Anti-Melanoma Differentiation-Associated gene 5 (Anti-MDA-5) dermatomyositis is a rare subtype of inflammatory myopathy characterized by unique skin lesions, rapidly progressive interstitial lung disease, and skeletal muscle inflammation. It has a high mortality rate in the absence of early treatment. However, diagnosis of this entity is challenging in a country like Nepal because of various constraints such as lack of expert rheumatologists and resource limitations. Here we describe a case of one patient who had presented to us with generalized weakness, cough and shortness of breath who was finally diagnosed as anti-MDA-5 dermatomyositis. He responded to combination of immunosuppressives and is currently doing well. This case highlights the diagnostic and therapeutic challenges in managing such cases in a resource-limited setting.
Background: With the evolution of risk factors along with development of newer diagnostic tools, ... more Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21 (77.8%) were females. Majority of patients were either current (n=13, 48%) or reformed (n=8, 29.6%) smokers. Adenocarcinoma (n=17, 62.9%) was the most common pathological diagnosis. The most common location of the lesions was upper lobes (n=19, 70.4%) followed by right lower lobe (n=5, 18.5%). Two patients developed pneumothorax and respiratory failure requiring intubation, one with terminal stage adenocarcinoma died during hospitalization. Conclusions: The presence of adenocarcinoma, female sex, smoking status and upper lobe predominance reflects the current trend of peripheral lung cancers. RP-EBUS is a newer modality and may be a useful initial diagnostic tool for PPLs and with a good safety profile.
Background: With the evolution of risk factors along with development of newer diagnostic tools, ... more Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21...
<p>Common admission diagnoses (APACHE II diagnostic category) and mortality by site during ... more <p>Common admission diagnoses (APACHE II diagnostic category) and mortality by site during study period.</p
BACKGROUND Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of C... more BACKGROUND Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms.. METHODS A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings. RESULTS The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventila...
Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of exce... more Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support.
Vaccination against the virus responsible for COVID-19 has become a key in preventing mortality a... more Vaccination against the virus responsible for COVID-19 has become a key in preventing mortality and morbidity related to the infection. Studies have shown that the benefits of vaccination outweigh the risks. However, there are concerns regarding serious adverse events of some vaccines, although they are fortunately rare. Here, we report a case of a 47-year-old female from Kathmandu who presented with high grade fever, dry cough and erythematous rash a week after exposure to the Oxford-AstraZeneca vaccine. She had hepatosplenomegaly, persistent leucocytosis, anaemia and thrombocytosis along with markedly raised inflammatory markers. Her tests for infectious causes and haematological malignancies was negative and she showed no response to multiple antibiotics. Finally, she had a dramatic response to steroids with disappearance of fever and normalization of other laboratory parameters. Hence, she was diagnosed with Adult-onset Still’s Disease (AOSD). She was under ...
DOAJ (DOAJ: Directory of Open Access Journals), Jun 3, 2015
Aluminium phosphide poisoning is one of the major causes of suicidal deaths in developing countri... more Aluminium phosphide poisoning is one of the major causes of suicidal deaths in developing countries like Nepal. It is one of the common fumigant available and is within easy access. It is primarily used for crop protection. However, it is one of the misused chemicals to commit suicide. In this case, the patient had hyperglycaemia, atrial fibrillation, severe metabolic acidosis, and shock and yet survived. The key to her survival was aggressive supportive management. Therefore, knowing all the prognostic factors along with aggressive management can be life saving in conditions when no antidotes are available.
Background Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis predominantly... more Background Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis predominantly affecting upper and lower respiratory tract and kidneys. Unilateral diaphragmatic palsy could be a rare manifestation of GPA. Here we report a case of GPA in a 45-year-old male with unilateral diaphragmatic palsy with pleuropericarditis. Case presentation We report a case of a 45-year-old Khas male who presented with acute onset chest pain and shortness of breath who had elevated right hemidiaphragm, bilateral pleural effusion and pericardial effusion who was later diagnosed as GPA. Conclusions GPA should be suspected in all patients with diaphragmatic palsy and pleuropericarditis with appropriate clinical and laboratory picture.
In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simp... more In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation.
The presence of multiple tracheal and bronchial diverticula is a rare condition. Most cases are a... more The presence of multiple tracheal and bronchial diverticula is a rare condition. Most cases are asymptomatic however, few present with chronic or recurrent symptoms. We present a case of a 22-years old non-smoker male with a history of pulmonary tuberculosis, having multiple tracheal and bronchial diverticula.
<p>Demography, clinical profile, severity of illness and ICU discharge status of patients i... more <p>Demography, clinical profile, severity of illness and ICU discharge status of patients in the three ICUs admitted during the before and after commencement of training period.</p
<p>The trend line is a non-parametric locally weighted scatterplot smoother. The vertical l... more <p>The trend line is a non-parametric locally weighted scatterplot smoother. The vertical line indicates the time that the training intervention started.</p
<p>P-values refer to the evidence for stepwise changes in adjusted subdistribution hazard r... more <p>P-values refer to the evidence for stepwise changes in adjusted subdistribution hazard ratio from the Fine-Gray model for the cumulative incidence of ICU mortality.</p
Anti-Melanoma Differentiation-Associated gene 5 (Anti-MDA-5) dermatomyositis is a rare subtype of... more Anti-Melanoma Differentiation-Associated gene 5 (Anti-MDA-5) dermatomyositis is a rare subtype of inflammatory myopathy characterized by unique skin lesions, rapidly progressive interstitial lung disease, and skeletal muscle inflammation. It has a high mortality rate in the absence of early treatment. However, diagnosis of this entity is challenging in a country like Nepal because of various constraints such as lack of expert rheumatologists and resource limitations. Here we describe a case of one patient who had presented to us with generalized weakness, cough and shortness of breath who was finally diagnosed as anti-MDA-5 dermatomyositis. He responded to combination of immunosuppressives and is currently doing well. This case highlights the diagnostic and therapeutic challenges in managing such cases in a resource-limited setting.
Background: With the evolution of risk factors along with development of newer diagnostic tools, ... more Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21 (77.8%) were females. Majority of patients were either current (n=13, 48%) or reformed (n=8, 29.6%) smokers. Adenocarcinoma (n=17, 62.9%) was the most common pathological diagnosis. The most common location of the lesions was upper lobes (n=19, 70.4%) followed by right lower lobe (n=5, 18.5%). Two patients developed pneumothorax and respiratory failure requiring intubation, one with terminal stage adenocarcinoma died during hospitalization. Conclusions: The presence of adenocarcinoma, female sex, smoking status and upper lobe predominance reflects the current trend of peripheral lung cancers. RP-EBUS is a newer modality and may be a useful initial diagnostic tool for PPLs and with a good safety profile.
Background: With the evolution of risk factors along with development of newer diagnostic tools, ... more Background: With the evolution of risk factors along with development of newer diagnostic tools, the clinical and pathological characteristics of lung cancers show a changing trend over time. The diagnosis of lung cancers presenting as peripheral pulmonary lesions (PPL) remains a challenge. This study aims to look at the current trend of PPLs who underwent diagnostic workup in a tertiary care center located in India. Methods: This retrospective analysis using a prospectively maintained hospital database was performed in patients who underwent diagnostic evaluation of PPLs and were subsequently diagnosed with lung cancer. Radial probe endobronchial ultrasound (RP-EBUS) guided biopsy was the initial diagnostic modality used. The data was processed and analyzed using the Microsoft Excel Sheet version 2013 and SPSS version 20. Results: Sixty patients underwent evaluation for PPLs during the study period. Lung cancer was the final diagnosis in 27 patients. Mean age was 60±12 years and 21...
<p>Common admission diagnoses (APACHE II diagnostic category) and mortality by site during ... more <p>Common admission diagnoses (APACHE II diagnostic category) and mortality by site during study period.</p
BACKGROUND Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of C... more BACKGROUND Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms.. METHODS A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings. RESULTS The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventila...
Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of exce... more Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support.
Vaccination against the virus responsible for COVID-19 has become a key in preventing mortality a... more Vaccination against the virus responsible for COVID-19 has become a key in preventing mortality and morbidity related to the infection. Studies have shown that the benefits of vaccination outweigh the risks. However, there are concerns regarding serious adverse events of some vaccines, although they are fortunately rare. Here, we report a case of a 47-year-old female from Kathmandu who presented with high grade fever, dry cough and erythematous rash a week after exposure to the Oxford-AstraZeneca vaccine. She had hepatosplenomegaly, persistent leucocytosis, anaemia and thrombocytosis along with markedly raised inflammatory markers. Her tests for infectious causes and haematological malignancies was negative and she showed no response to multiple antibiotics. Finally, she had a dramatic response to steroids with disappearance of fever and normalization of other laboratory parameters. Hence, she was diagnosed with Adult-onset Still’s Disease (AOSD). She was under ...
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