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The St. George's Respiratory Questionnaire (SGRQ) is a standardized questionnaire for measuring impaired health and perceived well-being in chronic airway disease, but it is not available in the Nepali language. We translated the original SGRQ into Nepali and validated its use in 150 individuals aged 40 to 80 years with and without COPD. We also examined if the SGRQ could be used as a screening tool to identify individuals at risk for COPD. We translated the SGRQ following a standard protocol. The validation study was then conducted in both community and hospital-based settings in Nepal. We enrolled 100 participants from a community setting who were not actively seeking medical care, 50 of which met criteria for chronic obstructive pulmonary disease (COPD) (post-bronchodilator forced expiratory volume in 1 second [FEV1]/ forced vital capacity [FVC]<70%) and 50 who did not. We also enrolled 50 participants with an established diagnosis of COPD who attended outpatient pulmonary clinics. All participants completed the questionnaire. We used linear regressions to compare average SGRQ scores by disease status categories and by lung function values, adjusted for age, sex, height and body mass index (BMI). All 150 participants (mean age 59.8 years, 48% male, mean BMI 20.5 kg/m 2 ) completed the SGRQ. In multivariable regression, the average SGRQ total score was 23.9 points higher in established cases of COPD and 18.1 points higher in community cases of COPD when compared to participants without COPD living in the community (all p<0.001). The SGRQ total score also increased by an average of 2.1 points for each 100 mL decrease in post-FEV1 (p<0.001). The area-under-the-curve for the SGRQ total score as a predictor of COPD was 0.77 (95% confidence interval [CI] 0.68 to 0.85) and the optimal cutoff to identify COPD was 33 points. We developed a Nepali-validated version of SGRQ, which correlated well with both disease status and severity. AbstractAbbreviations: St. George's Respiratory Questionnaire, SGRQ; chronic obstructive pulmonary disease, COPD; forced expiratory volume in 1 second, FEV 1 ; forced vital capacity, FVC; body mass index, BMI; confidence interval, CI; analysis of variance, ANOVA; percent predicted, % predicted; Global initiative for chronic Obstructive Lung Disease, GOLD; Global Lung Function Initiative, GLI

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59

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Introduction: There is much recent data from Nepal, Sri Lanka and Malaysia that can help us understand the practice patterns of physicians regarding the diagnosis and management of chronic obstructive pulmonary disease (COPD) in these countries. We conducted this survey to understand the practice patterns of physicians related to the diagnosis and management of COPD in these three countries. Methods: This questionnaire-based, observational, multicentre, cross-sectional survey was carried out with 438 randomly selected physicians consulting COPD patients. Results: In the survey, 73.29% of the physicians consulted at least five COPD patients daily (all patients [ 40 years of age). 31.14% of the COPD patients visiting their doctors were

INTRODUCTION: Bronchogenic carcinoma is the most common cancer in the world. It can present in many ways. Accurate diagnosis and categorization into different types is important because of its effect on prognosis and management. We conducted this study to find out the frequency of various histological types of bronchogenic carcinoma and correlate with their clinicopathologic profile. METHODS: This is a retrospective study conducted in 174 histopathologically proven cases of bronchogenic carcinoma that were referred from different parts of the country to a private hospital in Kathmandu over a period of 4 years. RESULTS: The mean age of the patients developing bronchogenic carcinoma was 64 years. Squamous cell carcinoma was the commonest histologic subtype followed by small cell carcinoma. Adenocarcinoma was more common in females. Clinical history was available in 133 cases. Among them, almost all patients had a history of smoking, the average number of pack years being 39.99. Most of the patients consulted doctor for chief complaint of cough and shortness of breath, the average duration of symptoms being 117.53 days. CONCLUSIONS: The lung cancer must be ruled out in all patients who have persistent signs and symptoms of pulmonary disease with a history of smoking. KEYWORDS:  bronchogenic, histopathology, smoking.

Background & Objectives:Sarcoidosis is a multi-system granulomatous disorder of unknown origin.The frequency and the clinical presentation of sarcoidosis vary among the geographical regions. This study is a retrospective analysis of the sarcoidosis patients diagnosed in Nepalese population. The aim of this study was to find the prevalence of sarcoidosis in Nepalese population which has high prevalence of tuberculosis and to understand the clinical profiles and ethnic differences. Materials & Methods: A retrospective chart analysis was done in all the patients from January first, 2005 to December 31st, 2010 who had abnormal chest radiograph and who were diagnosed with sarcoidosis. The study was done at Nepal Medical College Teaching Hospital and Everest Nursing Home. Results: A Forty two patients were diagnosed to have sarcoidosis over a five year period, of which 23/42 (55.0%) were females and 19/42 (45%) were males. The mean age was 36 years with minimum age being 18 years and maximum 72 years. As far as Ethnicity is concerned, 15/42 (36.0%)were Brahmins,08/42(19.0%) were Marwadi, and 07/42(17.0%) were Chhetri. The most common presenting symptom was cough 19/42 (45.0%).Out of the 42 patients, eight were being treated for pulmonary tuberculosis. Most common radiographic findings were bilateral hilar lymphadenopathy15/42 (36.0%). Conclusion: Sarcoidosis is common in Nepal and should be considered in the differential diagnosis before treating the patient empirically for tuberculosis.