International Society of Nephrology.

Chronic kidney disease is a worldwide public health problem. In Nepal, Chronic kidney disease patients are increasing and the management of this disease is very expensive compared to other chronic diseases? We assessed the socioeconomic status of chronic kidney disease patients registered in National Kidney Centre, Banasthali, Kathmandu. The study used descriptive cross sectional design. Ninety six samples were collected between 15- 31 October, 2012.The mean age of the patients was 47 years, with almost half of the patients (46%) from 41-60 years age group. Among the patients, 65 % were male, 85% were married, 80% were literate, 57% were past smoker and 75% were drinker and 59% were from Kathmandu valley. Likewise, most of them were Newar, work as housewife as the main occupation. One third (37%) had to sell their property for the treatment. On an average patient spent Rs.240000 per year in dialysis. Similarly, medication cost was Rs.180000 and transplantation cost was Rs.500000 to 1000000. Preventive measures of the disease and subsidy in the treatment will be beneficial for the needy people. DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.11997Journal of Manmohan Memorial Institute of Health Sciences Vol. 1, Issue 4, 2015Page : 19-23

Introduction: The burden of Overlap Syndrome (coexistence of sleep-related breathing disorders in patients with respiratory diseases) is high in developing countries, and such a phenomenon implies higher morbidity. The study was conducted to measure the prevalence of sleep-related breathing disorders in patients with Respiratory Symptom Complex and to identify factors associated with the severity of sleep-related breathing disorders.Materials and Methods: A hospital-based cross-sectional study of 50 patients with respiratory symptom complex was conducted at BP Koirala Institute of Health Sciences. Structured proforma and Polysomnography were used for analysis.Results: There were 24 patients (48%) with COPD, 18 (36%) with Bronchial Asthma. 6 patients (12%) with Bronchiectasis and 2 patients with Interstitial Lung Disease. 60% (n=30) patients had sleep-related breathing disorder or Overlap syndrome, 14 patients (46.67%) had mild sleep-related breathing disorder while 16 (53.33%) patients had moderate to severe type. 62.5% COPD patients, 55.55% Bronchial Asthma patients, 50% of patients with Interstitial Lung Disease and 50% Post-TB Bronchiectasis patients had a sleep-related breathing disorder. There was a significant positive correlation between the presence of sleep-related breathing disorder in patients with respiratory symptom complex and high neck circumference (0.499, p-value <0.001), waist circumference (0.293, p-value = 0.039) and hip circumference (0.371, p-value = 0.008).Conclusions: Overlap Disorders comprising sleep disorders in patients with chronic respiratory diseases are high in developing countries. Routine sleep history and polysomnography in all patients with Respiratory Symptom Complex can detect sleep-related breathing disorders.

Introduction: Dyslipidemia is highly prevalent among type 2 diabetic patients. It increases the risk of atherosclerosis and consequent mortality in diabetic patients. The aim of this study was to find out the prevalence of dyslipidemia among type 2 diabetic patients. Methods: This was a descriptive cross-sectional study in 355 type 2 diabetic patients at tertiary care hospital from 15th May, 2020 to 15th November, 2020 after taking ethical clearence from Institutional Review Committee (Reference no. IRC-PA-052/2077-78). Convenience sampling was done. Demographic and lipid profile variables were recorded based on the structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Out of total 355 cases of type 2 Diabetes mellitus, prevalence of dyslipidemia was 224 (63.1%). It was more prevalent in male 145 (69.4%) than female 79 (54.1%). Increased Low density Lipoprotein (94.2%) was the most prevalent type followed by mixed dyslipidemia (91.1%). Conclusions: Dyslipidemia was common among type 2 diabetic patients and was higher in male gender, older age, obesity and longer duration of diabetes. Hence type 2 diabetic patient should undergo the routine monitoring of blood sugar and lipid profile so that any abnormalities can be identified and preventive measures along with interventions can be initiated at the earliest.

Introduction: Study of clinical profile of the patients and diagnostic yield of the selected bronchoscopic procedures gives us important information in clinical decision making and better patient care. There are hardly very few studies regarding these entities. Therefore, we decided to study clinical characteristics and outcomes of the patients who underwent bronchoscopic evaluation in our setting. Methods: This was a cross-sectional study the consecutive patients who underwent bronchoscopy from 1st May 2013- 30th April 2015 in division of pulmonary, critical care and sleep medicine. The main procedure performed was bronchoalveolar lavage. Results: The mean age was 54.71 years with 76 (76%) males. Recurrent hemoptysis in 58 (58%) patients were the commonest indication. Total 95 (95%) patients have chest X-ray abnormalities. The commonest bronchoscopic finding was bronchiectasis 23 (23%) of patients followed by chronic bronchitis in 18 (18%) and endobronchial tuberculosis in 16 (16%). Total 10 (71%) of the 14 bronchoscopically suspected lung cancer patients have intraluminal lesions. Bronchoalveolar lavage culture for tuberculosis showed growth in 46 (46%), positive for malignancy in 7 (7%) positive Ziehl Neelson stain for tuberculosis in 6 (6%).Conclusions: Bronchoscopic evaluation of patients with pulmonary diseases gives us a lot of information that may help us in better patient care and bronchoalveolar lavage has high diagnostic yield in diagnosing pulmonary tuberculosis.Keywords: bronchoalveolar lavage;clinical profile;fiberoptic bronchoscopy. | PubMed

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial “glue” compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse.

BackgroundMany patients attending routine respiratory clinical service in developing countries also present with complains of daytime sleepiness and sleep abnormalities. A large proportion of them might have Sleep Related Breathing Disorders (SRBD) and as such, it is underestimated. Within this background we conducted a study to explore the presence of SRBD among patients presenting with symptom complex of respiratory diseases in Routine Respiratory Clinical Service by use of Epworth Sleepiness Scale (ESS). Material and MethodsA cross-sectional study of 50 patients with respiratory symptom complex was conducted in respiratory clinical service of Division of Pulmonary, Critical Care and Sleep Medicine at B. P. Koirala Institute of Health Sciences (BPKIHS) from 2014-2015. Targeted Comprehensive Sleep History and Epworth Sleepiness Scale (ESS) were used to recognize the presence of SRBD among these patients. Results 74% patients had ESS score ≥10. Mean ESS was 12.32 (±4.76). 72% subjects had daytime fatigue, 62% loud snoring, 58% daytime sleepiness and 46% sleep fragmentation. ESS ≥10 reflected excessive daytime sleepiness (sensitivity 86.67%; 95% CI, 69.28 -96.24; specificity 45%, 95% CI, 23. PPV 70.27%, 95% CI, NPV 69.23%, 95% CI,. ConclusionEpworth Sleepiness Scale has utility in predicting SRBD in patients with respiratory symptom complex with high overall predictive accuracy. It can be used in routine clinical care to identify and predict patients having Sleep Related Breathing Disorder and refer them to clinical sleep services for further evaluation.

Introduction: In the background of resource limited setting like Nepal, we set out to identify if specific clinical characteristics and basic lab parameters would guide differentiation of Tuberculous from other causes of exudative pleural effusion.Methodology: Retrospective study of 109 consecutive patients with exudative pleural effusion.Results: Compared to Tubercular pleural effusions (41.3%), increased age, increased duration of symptom and increased pack years statistically favoured a diagnosis of Malignant pleural effusion(21.1%), whereas presence of fever, cough and increased pleural ADA levels favoured Tubercular pleural effusions. With regards to Parapneumonic effusions (26.6%), a shorter duration of symptom, smaller effusions, higher pleural Neutrophils, lower pleural lymphocyte neutrophil ratio and lower ADA favoured the diagnosis as compared to Tubercular pleural effusions.Conclusions: The appreciation of important clinical and pleural biochemical differences between Tubercular and other major causes of exudative pleural effusions aids in improved clinical decision making with minimal resources in resource limited settings like ours.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 33-39