Background: In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). Methods: In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. Results: Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. Conclusion: This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.

Abstract:Background: anaemia is a major contributor to maternal death in developing countries. Since it reduces resistance to blood loss, death may occur from bleeding associated with normal delivery.

Background There is sparse evidence in the literature assessing emergency department presentation with respiratory disorders among Indigenous patients. The objective of this study was to evaluate the clinical characteristics and outcomes for Indigenous Australians in comparison to non-Indigenous patients presenting to Emergency Department (ED) with respiratory disorders. Methods In this study, two non-contiguous one-month study periods during wet (January) and dry (August) season were reported on, and differences in demographics, respiratory diagnosis, hospital admission, length of hospital stay, re-presentation to hospital after discharge and mortality between Australian Indigenous and non-Indigenous patients was assessed. Results There were a total of 528 respiratory ED presentations, 258 (49%) during wet and 270 (51%) in dry season, from 477 patients (52% female and 40% Indigenous). The majority of ED presentations (84%) were self-initiated, with a difference between Indigenous (80%) and non-Indigenous (88%) presentations. Indigenous presentations recorded a greater proportion of transfers from another healthcare facility compared to non-Indigenous presentations (11% vs. 1%). Less than half of presentations (42%) resulted in admission to the ward with no difference by Indigenous status. Lower respiratory tract infections were the most common cause of presentation (41%), followed by airway exacerbation (31%) which was more commonly seen among Indigenous (34%) than non-Indigenous (28%) presentations. Almost 20% of Indigenous patients reported multiple presentations to ED compared to 1% of non-Indigenous patients, though mortality on follow up did not differ (22% for both). Conclusions The results of this study may be an avenue to explore possibilities of implementing programs that may be helpful to reduce preventable ED presentation and recurrent hospitalisations among Indigenous population.

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: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. Results: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. Conclusions: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.

A study was done at Tribhuvan University Teaching Hospital (TUTH) and Bharatpur District Hospital(BDH) to find out the differences among the acute poisoning cases in those hospitals during 2000-2002. Thestudy aimed to compare the acute poisoning cases in terms of some variables. It was a comparative study ofall the acute poisoning cases admitted in the internal medicine department of TUTH and BDH during2000-2002.The numbers of acute poisoning cases were found to be more at BDH than at TUTH during the sameperiod. Though the majority of the cases were female in both the hospitals, percentages of male poisoningcases were found to be more at BDH. The 16-25 age group was the predominantly affected group at TUTH,while it was below 15 age group at BDH. Pesticide poisoning cases were the commonest poisoning cases atTUTH whereas the numbers of rodenticides poisoning cases were predominant at BDH. The use of drugs issignificantly higher at TUTH. Deaths due to poisoning in TUTH were more than at BDH during the sameperiod. The maximum number of poisoning cases occurred during the months of Bhadra- Mangsir. Owingto the higher rate of use of drugs as poison, the sale of drugs without prescriptions should be discouraged.Similarly the public should be well sensitized about the childhood poisoning.Key Words: Drugs, recovery, pesticides, rodenticides.

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

Background: Sepsis has been defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Sepsis is an important cause of mortality in intensive care unit worldwide. The study aims to identify the outcome of sepsis patient admitted at tertiary care hospital.Methods: This is a descriptive cross-sectional hospital based study on 76 adult patients admitted at intensive care unit of Nobel Medical College with diagnosis of sepsis with an objective of estimating mortality of sepsis and identifying associated symptoms with it. Baseline demographics, clinical and laboratory data were collected and analyzed. Results: Out of 76 patients with sepsis, mean age of the patients was 50.07±18.15 years. Majority of patients 31.6% with sepsis were above age groups >60 years. The most common symptoms among the patients were fever, which was seen in 69 (90.8%) patients. The most common source of infection in those patients was found to be unknown, which was seen in 36.8% of patients. While analyzing the outcome, it was noted that 25 patients with sepsis (32.9%) died during treatment.Conclusions: Sepsis is related with high mortality. Elderly patients are at more risk. Fever is the commonest presentation and source is not identified in majority of cases. Keywords: Intensive care unit; mortality; sepsis.