Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal.

Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

Clinical Profile and Survival Rate of Interstitial Lung Disease in a Tertiary Care Center of Eastern Nepal.

Background The clinical profiles of interstitial lung diseases are reported mainly from developed world. There have been no data from Nepal. Objective The objective of this study is to describe clinical profile and survival in Eastern Nepal. Method Prospectively collected clinical, radiological and laboratory data of consecutive patients with Interstitial lung disease from an eastern regional tertiary care center were analyzed. The recommended official criteria for diagnosing different types of interstitial lung diseases were followed accordingly. Result The study revealed that, 68.0% of the patient's age was of above 60 years with male predominance (66.0%). Idiopathic pulmonary fibrosis (79.5%) was the commonest interstitial lung disease followed by connective tissue disease associated interstitial lung disease. Persistent cough (97.7%) and dyspnea (95.5%) were the commonest presentations. Renal impairment, ischemic Heart Disease and anasarca were significant co morbidities contributing to mortality. Survival rate of the patients was found to be maximum at 5 months (95%) and minimum at 24 months (42%) from the diagnosis of the disease. Conclusion Widespread use of High-resolution computed tomography has made early recognition of interstitial lung disease in elderly patients. Well planned large scale multicenter prospective studies are needed to broaden our understanding about this serious pulmonary disorder.

Outcomes Bronchoscopic Evaluation in A University Hospital.

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.

Antenatal care practices in Tamang community of hilly area in central Nepal.

BACKGROUND: Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. OBJECTIVE: The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. METHODS: Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ≥ 3 years of children was collected and analyzed in descriptive and inferential ways. RESULTS: Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 +/- 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p less than 0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p less than 0.05). CONCLUSIONS: There was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete.

Substance use among medical students in Kathmandu valley.

INTRODUCTION: Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance. METHODS: A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed. RESULTS: Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances. CONCLUSIONS: Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use.