Symptoms 6 months following SARS-CoV-2 infection in Nepali women.

In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome.

Differential Gene Expression Analysis of Human Ovarian Follicular Cumulus and Mural Granulosa Cells Under the Influence of Insulin in IVF Ovulatory Women and Polycystic Ovary Syndrome Patients Through Network Analysis.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a commonly occurring reproductive disorder among the reproductive-aged women. Its global occurrence varies based on diagnostic guidelines, ethnicities, and locations of concern. Insulin resistance (IR) is commonly observed around 65-70% of women diagnosed with PCOS, representing a prevalent association. Consequently, the study was designed with an objective of illustrating the effect of insulin on mural and cumulus granulosa cells (GCs) of PCOS patients in comparison to normal ovulating women. METHODOLOGY: This study is a case-control design, wherein a total of 80 participants were recruited meeting criterion of inclusion and exclusion, divided into 8 groups with each group consisting of 10 samples. The process involves the isolation and culturing of mural granulosa cells (MGC) and cumulus granulosa cells (CGC) with and without exposure to insulin. The proteins released by untreated GCs and insulin-treated GCs were extracted, and complex protein mixtures were digested with trypsin, followed by tandem mass spectrometry analysis and data processing using bioinformatics. RESULTS: We found 595 proteins in both control and PCOS samples, of which 310 were contributed by MGCs and 285 by CGCs. The PCOS MGCs expressed 20%, both the normal MGCs and CGCs have equal representation of 16% by each, whereas the PCOS CGCs proteins contributed 15% of the total of the proteomic expression. However, the poor expression observed with the Insulin exposure, the Insulin treated PCOS CGCs contributes 13%, PCOS MGCs contributes 8%. The normal MGCs upon the Insulin treatment give 8% then and there only 4% of proteins expressed by normal CGCs after Insulin treatment. The Venn analysis widened on their precise expression topographies. The examination of strings exhibited important protein-protein interaction pathways. CONCLUSION: This is a pioneering investigation aimed to establish the link between hyperinsulinemia in localized follicular GCs and PCOS mechanisms by comparing them to control group. The examination of various attributes, mechanisms, and traits shown by genes and proteins in individuals with PCOS compared to control populations, alongside the investigation of the dynamics of these genes and proteins following exposure to insulin, holds promise for the formulation of novel hypotheses and strategies in the identification of new biomarkers.

Protein Expression and Bioinformatics Study of Granulosa Cells of Polycystic Ovary Syndrome Expressed Under the Influence of DHEA.

Background: The reproductive system is heavily dependent on ovarian follicles, which are made up of germ cells (oocytes) and granulosa cells (GCs), including cumulus granulosa cells (CGCs) and mural granulosa cells (MGCs). Understanding their normal and steroid-induced functions is the key to understanding the pathophysiology of endocrinal diseases in women. Objective: This study investigated the differentially expressed proteins by CGCs and MGCs of patients with polycystic ovarian syndrome (PCOS) and without subsequent exposure to dehydroepiandrosterone sulfate (DHEAS) and functional differentiation. Design: The present study was observational and experimental study carried out in hospital involving 80 female patients undergoing IVF for infertility. Methods: In this study, we isolated CGCs and MGCs from the follicular fluid of both PCOS and non-PCOS patients undergoing in vitro fertilization (IVF). The cells were cultured and treated with DHEAS for 48 hours, and these cells were extracted, digested, and analyzed by tandem mass spectrometry followed by processing of the results using open-source bioinformatics tools. Results: The present investigation discovered 276 and 341 proteins in CGCs and MGCs, respectively. DHEAS reduced the number of proteins expressed by CGCs and MGCs to 34 and 57 from 91 and 94, respectively. Venn results of CGCs revealed 49, 53, 36, and 21 proteins in normal CGCs, PCOS-CGCs, post-DHEAS, and PCOS-CGCs, respectively. Venn analysis of MGCs showed 51 proteins specific to PCOS and 29 shared by normal and PCOS samples after DHEAS therapy. MGCs express the most binding and catalytic proteins, whereas CGCs express transporter-related proteins. A protein pathway study demonstrated considerable differences between normal and PCOS samples, while DHEAS-treated samples of both cell lines showed distinct pathways. String findings identified important network route components such as albumin, actin, apolipoprotein, complement component C3, and heat shock protein. Conclusion: This is the first study to show how DHEAS-induced stress affects the expression of proteins by MGCs and CGCs isolated from normal and PCOS patients. Further studies are recommended to identify PCOS biomarkers from CGCs and MGCs expressed under the influence of DHEAS.

Bronchopleural fistula associated persistent pneumothorax in a patient recovering from COVID-19 pneumonia: A case report.

Key Clinical Message: Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID-19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Introduction: Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID-19 complications, including severe viral pneumonia. Case History: A 57-year-old male with multiple comorbidities diagnosed with COVID-19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right-sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion: The occurrence of pneumothorax in COVID-19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion: Pneumothorax and BPF are rare but potentially life-threatening complications in patients recovering from COVID-19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes.

Association of vaccination status with the clinicobiochemical profile, hospital stay, and mortality in COVID-19: A case-control study.

Background and Aims: The effectiveness of coronavirus disease 2019 (COVID-19) vaccines in reducing symptoms, disease advancement, complications, and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been well-established. This case-control study aimed to compare different blood parameters, and prognostic and survival outcomes of COVID-19 patients based on vaccination status. Methods: We performed a case-control study that included hospitalized patients with COVID-19 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Individuals who received vaccination were designated as cases and unvaccinated individuals as controls. Demographics, co-morbidity, clinical data, laboratory data, and disease outcomes were recorded for both groups. Multivariate, Cox, and linear regression were used for analysing blood parameters, hospital admission, survival, and hospital stay, respectively, between cases and controls. Results: Out of 100 participants enrolled, 46 were vaccinated, and 54 weren't. At admission, ferritin and erythrocyte sedimentation rate (ESR) were significantly lower in cases. At discharge, cases showed a higher monocyte than controls. Ferritin, ESR, and d-imer showed excellent performance in determining the severity of symptoms. Significant correlation and regression of ferritin and ESR with the length of hospital stay was observed. Length of hospital stay was significantly lower in cases than in controls. No significant differences between cases and controls were observed in mortality. Conclusion: COVID-19 vaccines effectively reduced hospitalization duration. Ferritin and ESR were significantly lower in vaccinated individuals and showed the best utility in monitoring the disease.

Regulation of Insulin Resistance, Lipid Profile and Glucose Metabolism Associated with Polycystic Ovary Syndrome by Tinospora cordifolia.

Background: The plant Tinospora cordifolia (TC), traditionally known as guduchi or giloy, is used for a number of health conditions as a nutritional supplement and rejuvenation medicine. Its nutritional supplementary products are traditionally recommended for a wide range of health issues, including diabetes, menstruation discomfort, fever, obesity, inflammation, and more. Unfortunately, there has not been extensive research into its effectiveness in treating or managing insulin resistance, lipid and carbohydrate metabolism, hormonal imbalance, and metabolic syndrome-associated polycystic ovary syndrome (PCOS). Methods: Consequently, the present study was designed to induce insulin resistance, dyslipidemia, hormonal abnormality, hyperglycemia, and menstrual disturbance of PCOS using dehydroepiandrosterone (DHEA) in mice and study the effect of oral TC extracts on these factors by using ancient and modern technologies. During the 21-day study, 6 mg/100 g/day of DHEA was given to female mice. Levels of glucose, insulin, lipids, and hormones were estimated. In addition to being seen with the naked eye, the morphological and microscopic changes were also observed on histology slides. Results: The study outcomes show that pretreatment with TC preparations significantly improved biochemical and histological abnormalities in female mice. Diestrus phase was only observed in DHEA-treated animals, while cornified epithelial cells were present in TC-treated mice. Pretreatment with TC satva showed significant (p < 0.001) reductions in body weight compared to placebo. Fasting blood glucose, 1-h OGTT, and 2-h OGTT levels were all significantly lower in TC satva- and oil-treated animals in comparison to the disease control group (p < 0.001). Treatment with TC extracts resulted in a normalization of estradiol, progesterone, and testosterone levels (p < 0.05). Treatment with TC extract improved lipid profiles (p < 0.001), LH/FSH ratios (p < 0.01), fasting insulin levels (p < 0.001), HOMA-IR (p < 0.001), HOMA-Beta (p < 0.001), and QUICKI (p < 0.001). Both macroscopic and microscopic alterations were seen to be restored after TC extract treatment. After being treated with TC satva, oil, and hydroalcoholic extract, the severity of PCOS decreased by 54.86%. Conclusions: These findings lead us to the conclusion that TC extracts and satva as nutritional supplements are useful for treating PCOS and associated symptoms. It is recommended that additional research be conducted to determine the molecular mechanism of action of TC nutritional supplements on PCOS-related changes in metabolic profiles. We also recommend further clinical studies to explore the clinical efficacy and effectiveness of TC nutritional supplements in treating and/or managing PCOS.

Metabolic Syndrome among Stable Chronic Obstructive Pulmonary Disease Patients Visiting Outpatient Department of a Tertiary care centre: A Descriptive Cross-sectional study.

Introduction: Metabolic syndrome; a constellation of obesity, hypertension, and disturbances of lipid and carbohydrate metabolism is a common phenomenon in chronic obstructive pulmonary disease. Systemic inflammation plays an important role in both conditions. The aim of this study was to find out the prevalence of metabolic syndrome among stable chronic obstructive pulmonary disease patients visiting the outpatient Department of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the outpatient Department of Pulmonology and General Practice from 1 August 2019 to 31 December 2020. Ethical approval was obtained from Institutional Review Committee [Registration number: 5/(6-11)E2/076/077]. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 57 patients with stable chronic obstructive pulmonary disease, the prevalence of metabolic syndrome was 22 (38.59%) (27.48-49.70, 90% Confidence Interval). The prevalence of metabolic syndrome in patients with Global Initiative for Obstructive Lung Disease stages 1, 2, 3, and 4 were 6 (27.27%), 9 (40.90%), 6 (27.27%) and 1 (4.54%) respectively. Conclusions: The prevalence of metabolic syndrome was similar to the other studies done in similar settings. The screening of metabolic syndrome is necessary and stratification for cardiovascular disease risk is important for timely intervention to prevent and decrease morbidities and mortalities. Keywords: chronic obstructive pulmonary disease; c-reactive protein; metabolic syndrome.

Metabolic Syndrome among Stable Chronic Obstructive Pulmonary Disease Patients Visiting Outpatient Department of a Tertiary care centre: A Descriptive Cross-sectional Study.

Introduction: Metabolic syndrome; a constellation of obesity, hypertension, and disturbances of lipid and carbohydrate metabolism is a common phenomenon in chronic obstructive pulmonary disease. Systemic inflammation plays an important role in both conditions. The aim of this study was to find out the prevalence of metabolic syndrome among stable chronic obstructive pulmonary disease patients visiting the outpatient Department of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the outpatient Department of Pulmonology and General Practice from 1 August 2019 to 31 December 2020. Ethical approval was obtained from Institutional Review Committee [Registration number: 5/(6-11)E2/076/077]. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 57 patients with stable chronic obstructive pulmonary disease, the prevalence of metabolic syndrome was 22 (38.59%) (27.48-49.70, 90% Confidence Interval). The prevalence of metabolic syndrome in patients with Global Initiative for Obstructive Lung Disease stages 1, 2, 3, and 4 were 6 (27.27%), 9 (40.90%), 6 (27.27%) and 1 (4.54%) respectively. Conclusions: The prevalence of metabolic syndrome was similar to the other studies done in similar settings. The screening of metabolic syndrome is necessary and stratification for cardiovascular disease risk is important for timely intervention to prevent and decrease morbidities and mortalities. Keywords: chronic obstructive pulmonary disease; c-reactive protein; metabolic syndrome.

Factors affecting length of hospital stay in chronic obstructive pulmonary disease patients in a tertiary hospital of Nepal: A retrospective cross-sectional study.

Background: Despite the increasing burden of chronic obstructive pulmonary disease in Nepal, studies analyzing the factors associated with inpatient length of hospital stay are lacking. Methods: This is a retrospective, cross-sectional hospital-based study conducted between July 2020 and July 2021 on patients admitted to the inpatient ward of Pulmonary and Critical Care Medicine of Tribhuvan University Teaching Hospital with a primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease. The sample size of our study was 90. Clinical and demographic factors, blood investigation parameters, and treatment received were analyzed via univariate and multivariate analysis to find the factors associated with length of stay. Results: The mean age of chronic obstructive pulmonary disease patients was 68.84 ± 10.22 years, with 42.2% of males and 43.3% of current smokers. The length of hospital stay ranged from 2 to 25 days, with an average stay of 6.69 ± 4.02 days. Factors associated with length of stay are the number of comorbidities (p = 0.007), blood eosinophils at admission (p = 0.022), and use of mechanical ventilatory support (p < 0.001). Conclusions: Proper management of comorbidities and eosinophilic exacerbations as well as careful use of mechanical ventilatory support are required to further reduce the duration of hospital stay in chronic obstructive pulmonary disease patients.

Pattern of Tuberculosis, Trend and Outcome of Patients Registered at DOTS Centre of a Tertiary Care Hospital.

BACKGROUND: Tuberculosis is a common respiratory disease imposing significant health burden. Directly observed treatment short course strategy ensures patient compliance in tuberculosis treatment. The aim of this study was to assess pattern of tuberculosis, trend and outcome of patients registered at Directly observed treatment short course centre of Tribhuvan University Teaching Hospital. METHODS: A retrospective observational study was conducted at Tribhuvan University Teaching Hospital. Tuberculosis patients of all age groups registered from July 2017 to June 2020 at Tribhuvan University Teaching Hospital Directly observed treatment short course centre were included. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics was performed and results were interpreted in mean, frequency and percentage. RESULTS: A total of 2790 tuberculosis patients were included for final analysis. There were 1736 (62.2%) males. Mean age of patients was 37.94±20.28 years. Pulmonary tuberculosis was the most common type of tuberculosis seen in 948 (34%) patients. Fifty percent of total tuberculosis cases were confined to thorax. Tubercular pleural effusion and pleurisy (14.6%), central nervous system (13.2%), bone and joint (12.2%) were common forms of extrapulmonary tuberculosis. The mean incident tuberculosis cases registered annually was 697.5±95.63. Nearly half (49.1%) of the patients completed tuberculosis treatment regimen while 43.3% were referred to other Directly observed treatment short course centre as per their convenience. CONCLUSIONS: This study reflects the trend and pattern of tuberculosis epidemiology at tertiary care hospital of Nepal. There is a huge burden of both pulmonary and extrapulmonary tuberculosis at Tribhuvan University Teaching Hospital with slight annual variation in incident tuberculosis cases. Despite implementation of Directly observed treatment short course, the problem of non-compliance persists among the tuberculosis patients.

Post-COVID syndrome: A prospective study in a tertiary hospital of Nepal.

INTRODUCTION: The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. METHODS: This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. RESULTS: The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. CONCLUSION: Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Delayed early life effects in the threespine stickleback.

Early life conditions can have a decisive influence on viability later in life. However, the influence of embryo density within a nest or body cavity on subsequent viability has received little attention within an ecological setting. This is surprising given that embryos often compete for limited resources, such as nutrients and oxygen, and this could influence their viability later in life through carry-over and compensatory effects. We show that the density of fertilized eggs within the nests of threespine stickleback males (Gasterosteus aculeatus) influences their viability after hatching. Embryos from larger broods hatch earlier and at a smaller size than those from smaller broods, which reduces their survival until the age of four weeks. This indicates a trade-off between the number and viability of offspring that males can raise to the hatching stage, which could explain the high incidence of partial egg cannibalism in nest-brooding fishes-as a strategy to improve the survival of remaining offspring. These results highlight the importance of considering conditions at the embryonic stage when evaluating the impact of early life conditions on viability and the adaptive value of reproductive decisions.

Prevalence of Functional Limitation in COVID-19 Recovered Patients Using the Post COVID-19 Functional Status Scale.

INTRODUCTION: COVID-19 is an emerging global health pandemic causing tremendous morbidity and mortality worldwide. Chronic symptoms progressing to poor functional status have been reported in a substantial proportion of COVID-19 patients worldwide. This study aimed to determine the prevalence of functional limitation in COVID-19 recovered patients using the post-COVID-19 functional status scale. METHODS: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. COVID-19 recovered patients with reverse transcription-polymerase chain reaction negative status were included and assessed using the post-COVID-19 functional status scale. Data entry and analysis was done in Statistical Package for the Social Sciences version 20.0. Descriptive statistics were performed. RESULTS: A total of 106 patients were included for the final analysis. More than half of the patients (56.6%) reported having no functional limitation (grade 0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients (grade 1 to 4). CONCLUSIONS: Some form of functional limitation should be anticipated after COVID-19 infection. Post-COVID-19 functional status scale can be a valuable tool in determining the prevalence of functional limitation in COVID-19 recovered patients in acute health care settings. It can potentially guide in planning rehabilitative measures in post-acute care management of COVID-19 survivors.

Diesel siphoner's lung: An unusual cause of hydrocarbon pneumonitis.

The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage.

Ninety Day Post Discharge Outcome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using the PEARL Score.

BACKGROUND: Chronic obstructive pulmonary disease exacerbation is a leading cause of frequent hospitalizations imposing substantial global health burden. The 90 day post discharge period has been associated with higher readmission rates and substantial risk of death. The aim of this study was to assess post discharge 90 day outcome in patients admitted with acute Chronic obstructive pulmonary disease exacerbation using the PEARL score. METHODS: A longitudinal study was conducted at Tribhuvan University Teaching hospital from February 2019 to November 2019. Patients admitted in respiratory ward with acute Chronic obstructive pulmonary disease exacerbation were stratified into low, intermediate and high risk groups using PEARL score and post discharge 90 day outcome was assessed. Data entry and analysis was done in SPSS version 20.0. Descriptive and inferential statistics were performed. RESULTS: A total of 102 patients were included for final analysis. Mean age of patients was 70.54 ± 10.85 years. There were 53.9% male. Intermediate and high risk PEARL groups had the highest proportion of readmission within 90 days of discharge which was found to be 23 (52.3%) and 9 (50%) respectively. High risk PEARL group had the highest proportion of death within 90 days (11.1%). The difference in these outcomes among three PEARL groups was found to be statistically significant (p-value < 0.05). CONCLUSIONS: PEARL score is a simple tool that can be applied at bedside in assessing 90 dayrisk of readmission or death in acute Chronic obstructive pulmonary disease exacerbation. This can be beneficial in post-discharge planning and early referral especially in resource limited health care setting where advanced facilities are not available.

Diagnostic Fibreoptic Bronchoscopy at Tribhuvan University Teaching Hospital.

BACKGROUND: Fibreoptic bronchoscopy is one of the most vital procedures performed in health care setting. Globally, several studies have reported findings of fibreoptic bronchoscopy while only few studies have been reported in Nepal. The aim of this study was to perform two year retrospective analysis of diagnostic fibreoptic bronchoscopy at tertiary referral centre. METHODS: A hospital based retrospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Consecutive bronchoscopy reports from June 2017 to May 2019 were included. Data entry and analysis was done in Microsoft Office Excel 2010. Descriptive statistics was performed to obtain clinico-demographic profile of patients, indications and findings of bronchoscopy. RESULTS: A total of 238 bronchoscopy procedures were analyzed. Mean age of patients was 55.02 years with range from 15 to 84 years. Majority of bronchoscopy were performed in male patients (58%). One hundred and twelve patients (47.05%) had no endobronchial lesion. Endoscopically visible tumor was the most common abnormality seen in 57 (23.9%) patients with highest prevalence in 55-65 years followed by extrinsic compression of bronchial tree seen in 13 (5.5%) patients. Bronchioalveolar lavage for routine examination (n=207) was the most commonly performed procedure during bronchoscopy followed by bronchial biopsy (n=55). CONCLUSIONS: Fibreoptic bronchoscopy is an extremely useful tool for evaluation of tracheobronchial pathology. Baseline bronchoscopic findings from tertiary referral centre in Nepal was obtained in this study.

Pattern of Respiratory Diseases, Morbidities and Outcome in Patients Admitted in Respiratory Ward of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Respiratory diseases are a leading cause of morbidity and mortality worldwide imposing a significant global health burden. The admission rate of patients is the indication of the overall workload in the ward. The aim of this study was to find the prevalence of admission of patients in the pulmonology ward among patients visiting the pulmonology department of a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. Medical records of all patients visiting the pulmonology department and admitted to the pulmonology ward from May 2018 to April 2020 were retrospectively reviewed. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics were performed. RESULTS: A total of 30,480 patients visited the pulmonology department in the two-year study period. Out of them, 1296 (4.25%) patients were admitted to the pulmonology ward. Eleven respiratory diseases were identified as primary causes for admission. Acute exacerbation of chronic obstructive pulmonary disease (44.5%), pneumonia (26.3%), tuberculosis (11%), lung cancer (5%), and bronchiectasis (3.9%) ranked the top five causes for admission. CONCLUSIONS: Respiratory diseases impose a tremendous burden in the health care setting. Acute exacerbation of the chronic obstructive pulmonary disease, pneumonia, and tuberculosis remains an important cause of respiratory admissions in our study.

Prevalence of Respiratory Manifestations in Chronic Kidney Diseases; A Descriptive Cross-sectional Study in A Tertiary Care Hospital of Nepal.

INTRODUCTION: Chronic kidney diseases affect patients with multiple respiratory complications by varied etiopathogenesis adversely affecting the outcome in them. The aim of the study is to find out the prevalence of respiratory manifestations among patients with chronic kidney disease. METHODS: The descriptive cross-sectional study was carried out tertiary care hospital from January 2019 to March 2019 after ethical approval. One hundred and sixty five patients with established chronic kidney diseases being treated in a tertiary hospital for a month were included for the study. Clinical evaluation and relevant investigations; chest x ray, pleural fluid analysis, sputum analysis, echocardiography, biochemical investigations and hematological investigations were done to assess the respiratory manifestations of the patients. Statistical Package for Social Sciences version 22 was used for the analysis of the data and point estimate at 95% Confidence interval was calculated along with frequency and proportion for binary data and the analysis was done. RESULTS: The prevalence of respiratory manifestations was 102 (61.8%) at 95% Confidence interval, range occurring between 55% to 69%. Pulmonary oedema 41 (24.84%) was the most common manifestation followed by pleural effusion 18 (10.9%). Pleural effusions were predominantly bilateral and transudative type. Pneumonia 17 (10.3%) was predominantly lobar pneumonia. Sixteen (9.7%) of the patients were screened positive for obstructive sleep apnoea syndrome. Pulmonary tuberculosis was present in 9 (5.45%) patients. CONCLUSIONS: Varieties of respiratory complications can present in varied spectrum in patients with chronic kidney diseases and this carries adverse outcome to patient management as well as affects the quality of life of patient and their family.

Hypertension and Obesity Among Civil Aviation Pilots.

BACKGROUND: Raised blood pressure (BP) is a risk factor for cardiovascular disease, which is a common cause of sudden in-flight incapacitation among pilots. Prevalence of hypertension (HT) among pilots as per new criteria is largely unknown. This study aims to understand the prevalence of hypertension and obesity in civil aviation pilots and their correlation.METHODS: Enrolled were 1185 civilian pilots reporting for medical evaluation to a regulatory medical establishment in India. Their height, weight, and blood pressure (BP) were measured. Pilots were categorized as hypertensive or normotensive as per JNC VIII criteria and hypertensive, having elevated BP, or normotensive as per new ACC/AHA criteria of 2017. Data were analyzed for prevalence of obesity and overweight as per both WHO and Asia Pacific criteria. Results were analyzed using SPSS version 17.RESULTS: Prevalence of hypertension was 4.1%. Maximum hypertensives were in the 26-35 yr age group. Under the new ACC/AHA guidelines, prevalence of HT was 18.7%. Prevalences of overweight and obesity as per WHO criteria were 39% and 7.3% and as per Asia Pacific guidelines were 23.3% and 46.3%, respectively. As BMI increased above 23, risk of developing hypertension or white coat hypertension as per JNC VIII criteria increased by 6.86 times (OR 6.86, 95% CI 0.9-52.58).CONCLUSIONS: Prevalence of HT rose from 4.1% to an alarmingly high 18.7% when new criteria were applied. Prevalence of obesity was 7.3% but increased to 46.3% when Asia Pacific guidelines were applied. Risk of hypertension increased as BMI increased above 23 kg · m-2.Bhat KG, Verma N, Pant P, Marwaha MPS. Hypertension and obesity among civil aviation pilots. Aerosp Med Hum Perform. 2019; 90(8):703-708.

The best anthropometric index to access the risk of hypertension in the population of Kavre district, Nepal

The relation of anthropometric factors with blood pressure is important for determining cardiovascular risk, as previous studies have shown positive association between these variables. But there is no common opinion about the effectiveness of which of the anthropometric tools indicating obesity are the most important to follow up. The present study was carried out to examine this relationship, and to find the most correlated anthropometric index in a Nepalese population. A cross-sectional descriptive study including 238 subjects (75.63%male and 24.37% female, aged 18-87 years old) was conducted among subjects from Kathmandu University, Dhulikhel Municipality, Banepa Municipality and Panauti Municipality of Kavre District, Nepal. Age, weight, height, waist circumference, hip circumference and blood pressure of the subjects were measured. Body mass index and waist hip ratio was calculated. Pearson correlation and linear regression analysis were used to analyze the data. The mean systolic and diastolic blood pressures were 120.2±16.1 and 81.9±11.3 mmHg respectively. In terms of body mass index, 4.2% of the subjects were obese (>29.9 kg/m2). As for waist hip ratio and waist circumference cut-off points, 57.57% and 21.84% subjects had cardiovascular risk. Significant positive correlation of obesity indicators with both systolic and diastolic blood pressure was observed. For systolic blood pressure, the correlation coefficient was 0.42 with body mass index, 0.44 with waist circumference, and 0.48 with waist hip ratio. For diastolic blood pressure, it was 0.41 with body mass index, 0.45 with waist circumference, and 0.53 with waist hip ratio. Using the Pearson correlation test, waist hip ratio was found to be the most correlated factor for blood pressure among the total population. Specifically, waist hip ratio for male population and waist circumference for female population were the most correlated indices. Therefore, these indices can be considered and utilized to assess risk for elevated blood pressure condition and cardiovascular disease in our study population

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