DOTS centre at a tertiary care teaching hospital.

In April 2002 Directly Observed Treatment - Short course (DOTS) centre was established in Nepal medical college teaching hospital(NMCTH) by National tuberculosis centre(NTC) with the aim to expand the services of DOTS to the general population. In this communication, we describe the experience of establishing a DOTS centre at Nepal's one of the premier medical institute and discuss the lessons learned. Since April 2002 to July 2004 (28 months), patients diagnosed with tuberculosis were enrolled for the treatment at the NMC DOTS clinic. 103 patients were diagnosed as suffering from tuberculosis, of them 8 patients were transferred out and 95 patients were given treatment at NMC DOTS clinic. Forty Patients were sputum positive cases, out of which 35 were new sputum positive cases and 5 were relapsed patients.20 patients had sputum negative pulmonary tuberculosis and 35 patients were diagnosed as having extra pulmonary tuberculosis. Cure rate of 97.0% (34/35) were achieved in the new sputum positive cases and 92.0% (37/40) in overall sputum positive cases. Despite tremendous patient load at tertiary care facility, it is possible to achieve a good sputum conversion and cure rate, by using DOTS.

Sleep apnoea syndrome in Nepal.

Sleep apnoea syndrome is a well recognized entity. Sleep studies of diagnosed patients with sleep apnoea were analyzed to understand the clinical profiles of Nepalese patients with this disorder. Eighty nine patients were diagnosed to have sleep apnoea syndrome during the period of 15 months starting from November 2003. All these patients were subjected to a detailed clinical evaluation including symptoms, presence or absence of other risk factors and co-morbidities, general physical and systemic examination and relevant investigations before performing polysomnography. Clinical profiles of patients who were confirmed to have sleep apnoea syndrome with apnoea hypopnoea index (AHI) more than five were included in the study. Forty one patients (46.1%) were found to have mild disease (AHI 6-20), 22 patients (24.7%) had moderate disease (AHI 21-40) and 26 patients (29.2%) were found to have severe disease. The common symptoms were snoring, excessive daytime sleepiness, frequent awakenings, nocturia, and choking spells during sleep. Obesity was found to be the most important risk factor associated with sleep apnoea. Males having collar size more than 16 inches and females with collar size more than 14.5 inches were found to have an increased risk to develop this problem. Hypertension (66.3%), chronic obstructive pulmonary disease (43.2%) and cardiac diseases (19.1%) were the common co-morbidities associated with this disorder. Sleep apnoea syndrome is not an uncommon problem in Nepalese population. It could be the cause of various cardiovascular problems and may complicate patients with chronic obstructive pulmonary disease.

Allergic bronchopulmonary aspergillosis--a case report.

A 24 years old male presented with recurrent symptoms of cough and breathlessness for 6 years but increased in past 6 months. Fleeting radiological opacities, peripheral eosinophilia and central type bronchiectasus in high resolution CT scan gave the suspicion of allergic bronchopolmonary aspergilosis. Confirmation of the diagnosis was done by skin prick and immunological tests. The patient showed an excellent response to oral prednisolone.

Transbronchial needle aspiration in the diagnosis of respiratory diseases.

Thirty-three patients were subjected to transbronchial needle aspiration during the routine diagnostic bronchoscopy. Of the 17 patients with submucosal diseases, Transbronchial needle aspiration (TBNA) had a yield of 88.2% as against 81.2% for bronchial biopsies, 54.5% for bronchial brush smears and 41.1% for bronchial aspirates. TBNA also had a good yield in endobronchially visible growths. Nine patients had mediastinal or hilar lymph nodes as evident in contrast enhanced CT scans. TBNA was attempted from eight lymph node sites in six patients with bronchogenic carcinoma and was positive for malignant cells from four of these sites, while normal lymphoid cells were obtained from the other four sites. TBNA could also diagnose the disease from the left hilar lymph node in one patient with sarcoidosis, an extra tracheal bronchogenic carcinoma in another patient and an extra bronchial metastasis in yet another patient where conventional bronchoscopic techniques failed. TBNA was found to be a safe, cost effective and valuable diagnostic tool in the diagnosis of pulmonary diseases.