Chest & Heart Journal

DPLD- An Alarming Issue for Pulmonologists

S M Abdur Razzaque — 2023-03-21

Abstract not available

Chest Heart J. 2021; 45(2) : 53-56

Health Care Seeking Pattern among Out Patient Department (OPD) Patients in a Tertiary Care Chest Hospital, Dhaka

Md Sayedul Islam — 2023-03-21

Introduction: South Asia has one quarter of the global population, but about half of the population live below the poverty line and has limited access to health care. Bangladesh is in the midst of an epidemiologic transition where the burden of disease is shifting from a disease profile dominated by infectious diseases to non-communicable disease. In this regard Chest Disease Hospitals specially in tertiary level are playing important role because both infectious chest diseases including PTB, pneumonia, COVID 19 infection and noncommunicable diseases like COPD, asthma, interstitial lung diseases are abundant among the general population.

Aim of the study: The aim of this survey is to determine patients’ overall necessities which they expect from our hospital and to measure the level of satisfaction with quality of general services and specifically with staff attitude and hospital environment while receiving service in Outpatient department of tertiary level chest hospital like National Institute of Diseases of The Chest & Hospital (NIDCH), Mohakhali, Dhaka.

Materials & Methodology: This prospective cross-sectional study was conducted in Outpatient department, National Institute of the Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka, Bangladesh from February 2021 to June 2021. Data were entered, checked and analyzed by SPSS for windows version 20.0 and MS Excel-2016.

Results: This study was conducted among 357 patients. The mean age was 45.4±17.2 and the male female ratio was 1:0.5. Though NIDCH is situated in the city, 59.1% patient came from rural area and only 31.9% to came from urban area. Nearly half (49.6%) of the patients were from middle income society. Highest number (18.2%) was diagnosed as tuberculosis. Most common comorbid condition was DM (16.8%.). Most of the patients (56.9%) were satisfied with hospital OPD service.

Conclusions: Most of the participants advised to increase the service points to reduce waiting time. The effectiveness of health care may determine to the satisfaction of patients with the health service provided.

Chest Heart J. 2021; 45(2) : 57-70

Radiological Involvement among Asymptomatic and Symptomatic COVID-19 Patients - A Cross- Sectional Study

Nirmal Kanti Sarkar — 2023-03-21

Background and aims: The COVID-19 pandemic is a current problem across the world. Evaluation of the radiological involvement is helpful for early detection of the COVID-19 cases, even when RT-PCR is negative. As RT-PCR is a time-consuming procedure, have high false negative rate, and requires a special laboratory set-up, radiological findings can be used for early detection and proper management of the suspected cases. The aim of this study was to evaluate the radiological involvement (HRCT & chest X-Ray) among asymptomatic and symptomatic COVID-19 patients.

Methods: This cross-sectional study was conducted among suspected and confirmed COVID- 19 patients visited at the outpatient department or admitted to the National Institute of the Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh within the period of April 15, 2020 and June 5, 2020. Chest X-Ray and high-resolution computed tomography scan (HRCT) of the chest was done as well as RT-PCR of nasopharyngeal swab for SARS-CoV-2. Sensitivity, Specificity, PPV and accuracy of HRCT and RT-PCR was evaluated.

Results: Total 53 cases were enrolled in the study. The mean age was 47.4 years with male predominant (52.8%). RT-PCR was positive in 64.2% cases. Ground glass opacity (GGO) with consolidation was the most common (50.9%) HRCT pattern and the left lower lobe was most commonly involved (60.4%). In chest X-Ray, consolidation was the most common finding (22.6%) followed by GGO (20.8%). HRCT has high sensitivity (73.33%) and specificity (75.0%) in detecting parenchymal abnormality following SARS-CoV-2 infection.

Conclusion: Chest X-ray and HRCT can play an important role in the early detection of COVID-19 suspected cases for starting treatment early.

Chest Heart J. 2021; 45(2) : 71-77

Association of Serum D-dimer Level with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

Md Mamun or Rashid — 2023-03-21

Background: Chronic obstructive pulmonary disease (COPD) is a major global health problem and is often associated with systemic inflammation. D-dimer level, an end product of degradation of cross-linked fibrin by plasmin, have been shown in some studies to be increased in patients with COPD exacerbation. But still, there is a debate regarding the diagnostic efficiency of D-dimers tests in COPD exacerbation patients. Therefore, this study is aimed to find the association of D-dimer with acute exacerbation of COPD.

Methods: This was a cross-sectional study conducted at the National Institute of Diseases of the Chest and Hospital (NIDCH) from March 2020 to February 2021. A total of 90 patients with a confirmed diagnosis of COPD were included after screening in according to the inclusion and exclusion criteria. Following informed written consent, physical examination, relevant investigations were done for all patients. In all cases, ethical issues and health issues were maintained properly and collected data were analysed by SPSS 16.

Results: Among 90 COPD patients, mean age of the study population was 56.24±11.24 (SD) years with a majority in age group 51-60 years (50%). Male-female distribution was 97%-male vs 3%-female. Overall frequency of higher D-dimer level was 57.8%. Higher serum D-dimer level was observed in AECOPD patients (p<0.05). Increased serum D-Dimer level was also significantly associated with increased PaCO2 and decreased PaO2. In multivariate analysis, PaCO2 (>45 mmHg) and serum D-Dimer (>0.5 pg /ml) were found to be independent predictors for severe exacerbation of chronic obstructive pulmonary disease.

Conclusion:There is association between serum D-dimer level with acute exacerbation of COPD patients.

Chest Heart J. 2021; 45(2) : 78-85

Electrolyte Abnormalities in Hospitalized COVID- 19 Patients: An Observational Study

Nihar Ranjan Saha — 2023-03-21

Background: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease with multisystem involvement. Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis.

Objective: The primary objective of the present study was to evaluate the pattern of electrolyte abnormalities in hospitalized COVID-19 patients.

Methods: This retrospective study was conducted in the Department of Respiratory Medicine, National Institute of Diseases of the Chest & Hospital, Mohakhali, Dhaka, between January 2021 and June 2021. A total of 51 patients with COVID-19 were included in the study. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes were evaluated. Patients demographic profile, clinical features, admission electrolyte report were documented in case record forms. Collected data were compiled and appropriate analyses were done by using computer based software. Chi-squre test was used to analyse the categorical variaties. A p-value <0.05 was considered significant.

Results: In this study, total 51 hospitalized COVID-19 patients were included in the study. Majority (41.2%) patients belonged to age group 61 to 80 years with mean age 56.3±17.7 years. Two third (66.7%) patients were male with male to female ratio 2:1. Majority (31.4%) of the patients had hypertension followed by diabetes mellitus 29.4%, 23.5% had IHD, 15.7% had COPD and 35.3% were smoker. Most commonly electrolyte abnormality was hyponatraemia (56.9%) followed by hypokalemia (41.2%). Hyponatraemia was significantly higher in severe COVID-19 patient group.

Conclusion: In this study, we found that, Hyponatraemia was the most predominant electrolyte abnormality. Hyponatraemia is a sign of unfavourable prognosis in COVID-19 and baseline electrolyte assessment, even after hospitalization, would be beneficial to assess the risk for severe COVID-19.

Chest Heart J. 2021; 45(2) : 86-92

Outcome of Long Term Nebulization of Gentamicin on Lung Function and Respiratory Health Status among Non-Cystic Fibrosis Bronchiectasis

Chitta Ranjan Paul — 2023-03-21

Background: Bronchiectasis is a disease state defined by irreducible dilations of the airways. If the changes occur in diseases other than cystic fibrosis they are termed non-CF bronchiectasis. Long-term therapy with nebulized gentamicin can eradicate the infection or reduce the bacterial load, decrease the risk of subsequent infections and improve the quality of life in patients with non-CF bronchiectasis with a minimal risk of side effect.

Aims: The aim of this study was to find out the outcome of long term nebulization of gentamicin on lung function and respiratory health status among non-CF bronchiectasis.

Materials & Methods: This prospective randomized controlled trial (RCT) was conducted at the Department of Respiratory Medicine in National Institute of Diseases of the Chest and Hospital from April 2020 to March 2021 in collaboration with the Department of Pathology, Radiology and Respiratory Laboratory. A total of 50 Non-CF Bronchiectasis patients were equally divided into 2 groups, gentamicin group and placebo group. All data were analyzed by using computer based SPSS-23(Statistical Packages for Social Sciences). P value of less than 0.05 was considered as significant.

Results: Out of 50 patients with non-CFbronchiectasis, mean age was found 50.0±11.0 years in gentamicin group and 46.3±11.4 years in placebo group.Eighteen (72.0%) patients were male in group A and Sixteen(64.0%) in group B. Male to female ratio was 2.6:1 in group A and 1.8:1 in group B. Age, sex, occupational status, co-morbidities and BMI, were not statistically significant (p>0.05) between two groups. Following gentamicin therapy,SGRQ (36.0±10.2 vs 41.8±7.9) and 24 hour sputum volume (5.2±3.9 vs 7.8±2.5) was significantly decreased in gentamicin group than placebo group (p= 0.001). After gentamicin therapy, mean mMRC was not statistically significant between two groups (p=0.267). After therapy FEV1 was significantly increased in gentamicin group than placebo group (42.5±9.4% vs 37.4±6.0, p=0.001).

Conclusion. We observed that gentamicin could significantly improve SGRQ and FACED score and reduce sputum volume compared to placebo. After therapy FEV1 was significantly increased in gentamicin group than placebo group. Nebulized gentamicin may be used as an effective suppressive antibiotic therapy in these patient group.

Chest Heart J. 2021; 45(2) : 93-98

An Unusual Case of Bilateral Bronchiectasis Following Foreign Body Aspiration

Bulbul Parveen — 2023-03-21

Foreign body (FB) aspiration can be fatal if it obstructs the glottal opening, larynx, or trachea. Delayed presentations usually occur when the foreign matter obstructs one of the principal or distal bronchi and results in recurrent pneumonia, bronchiectasis, lung abscess or pyopneumothorax. FB aspiration is more common in younger children below the age of three years but not uncommon in older children and young adults.It is an uncommon cause of bronchiectasis. Here, we present a case of a 12 years boy who suffered an incidence of FB aspiration seven months back and presented with bilateral bronchiectasis and pneumonia. Development of bilateral bronchiectasis due to a single airway foreign body is very unusual. Nevertheless, this patient was revealed to have bilateral bronchiectasis along with consolidation.

Chest Heart J. 2021; 45(2) : 99-102