Background: Corona virus disease 2019 (COVID-19) has become a global public health issue with significant impacts upon the healthcare delivery systems. Previous studies have consistently found elevated levels of C-Reactive Protein and D-dimer with disease severity. In this study, we aimed to investigate the relationship between C-Reactive Protein, D-dimer level and Computed Tomography severity score in patients with SARS-COV-2 pneumonia. Methods: Our study included 76 patients with COVID-19, admitted in COVID Unit of Chitwan Medical College and Teaching Hospital from June 2020 to December 2020. We included COVID-19 cases confirmed by a RT-PCR test and those undergoing High resolution Computed Tomography of chest and having C-Reactive Protein and D-dimer levels done on admission. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1, < 5%; 2:5–25%; 3:26–50%; 4:51–75%; 5, > 75%; range 0–5; global score 0–25. Results: Overall the median CTSS was 15. Mild, moderate and severe CT severity scoring was reported in 5.3%, 60.5% and 34.2% respectively and D-dimer progressively increased across the CTSS severity groups. The difference was significant for CRP, P = 0.007 but not for D-dimer, P = 0.42. Moreover, higher CTSS scores were significantly associated with higher ICU stay, lower recovery rate and higher O2 requirement at discharge. Conclusions: Radiological severity of COVID-19 pneumonia has significant association with elevated C-Reactive Protein level but not with D-dimer level and other routine laboratory parameters.

Background: Fiberoptic Bronchoscopy is a valuable tool in current respiratory medicine. This study was aimed to evaluate the diagnostic yield of Fiberoptic Bronchoscopy using a wider diameter bronchoscope. Methods: This was a hospital based cross-sectional study carried out in BP Koirala Memorial Cancer Hospital from January 2021 to March 2021. Consecutive sampling technique was used where 150 patients were enrolled in the study. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statistics. Results: The overall yield from the wider Fiberoptic Bronchoscope was 70.07% which was slightly higher compared to literature results from conventional bronchoscopy. Lung mass on CT scan was the most common indication for bronchoscopy and upper lobe bronchus was the most common site for biopsy. Bronchial wash yield was highest for Squamous cell carcinoma with 22.78% followed by Pulmonary Tuberculosis with 21.5%. Endobronchial biopsy yield was highest for Squamous cell carcinoma with 41.21% followed by Adenocarcinoma with 31.42%. Temporary hypoxia and mild bleeding were common but life-threatening complications were rare. Conclusions: Overall findings of our study confirm that the diagnostic yield of Fiberoptic Bronchoscopy is high, particularly when a larger diameter bronchoscope is used which can facilitate wider biopsy forceps for larger tissue sampling.

Background: Clinical assessment, chest X-ray (CXR) and high-resolution computed tomography (HRCT) are used in the Corona virus disease-19 (COVID-19) management. The aim of the study was to determine the clinical characteristics and CXR and HRCT findings in COVID-19 patients with different clinical severity. Methods: This was a hospital-based cross-sectional study conducted at Chitwan Medical College, Department of Pulmonary and Critical Care Medicine from September to December 2020. Data from sixty adult patients with moderate (non-severe), severe, and critical COVID 19 disease having both CXR and HRCT were collected and were analyzed using SPSS version 16. Results: Median age of patients in our hospital-based study was 59.9 years and 76.7% were male, 30% had diabetes, and 35% had hypertension. Respiratory rate (p=0.001) and shortness of breath (p= 0.011) significantly increased and oxygen saturation (SpO2) (p<0.001) decreased with increase in clinical severity of COVID-19 disease. Among the moderate, severe and critical clinical severity groups, there was significant difference in the HRCT findings like ground-glass opacity (GGO), consolidation, septal thickening, crazy paving pattern, bronchiectasis and fibrosis (p<0.05). GGO was the most common finding. Bilateral consolidation in CXR and multiple lobes in both lungs involvement in HRCT were similar across the moderate, severe and critical clinical severity (p>0.05). Conclusions: There was no difference in CXR and HRCT findings across moderate, severe and critical clinical severities of COVID-19; future study performing CXR whenever HRCT is done for any indication may similarly indicate the situation in mild COVID-19 disease.

Background: Risk stratification of Community acquired pneumonia (CAP) is challenging for physicians. Though various biomarkers are available, they are costly or not readily available in all health care settings. This study aimed to analyze the prognostic value of routinely available clinical and blood parameters in relation to the outcome of patients admitted with community acquired pneumonia. Methods: This was a hospital-based observational study of the patients admitted to Chitwan Medical College (CMC), Nepal between August 2021 and December 2021. We enrolled patients 18 years old and above with the diagnosis of CAP in the study and excluded patients with COVID and active pulmonary tuberculosis. The outcomes of the patients were recorded as improved, not-improved, or dead. Fischer exact, Kruskal-Wallis or Mann-Whitney tests were used for analysis wherever appropriate. Results: Total 92 patients with mean age 58.2 years were enrolled in the study. Patients who were not improved or were dead had higher age (p=0.029), respiratory rate (p<0.001), shock index (p=0.013), total leukocyte count (TLC) (p=0.019), urea (p=0.046), creatinine (p<0.01), potassium (p<0.001), bilirubin (p=0.029), and lactate (P<0.05) and lower SpO2 (p<0.01), SpO2/FiO2 (p=0.018), pH (p=0.0497), and PaCO2 (p<0.001). Patients with nervous (p<0.001), cardiovascular (p=0.032) and renal system (p=0.019) involvement were also found to be associated with poor outcome. Conclusions: CAP patients with higher TLC, urea, creatinine, bilirubin and lactate, with lower SpO2, SpO2/FiO2, pH and PaCO2 and with involvement of more than one organ systems were found to have unfavorable prognosis. Higher potassium level was also found to be a potential marker of CAP severity.

Background: Acute febrile illness (AFI) is defined as a fever lasting less than 14 days with no evidence of organ-specific symptoms or signs of infection. Our aim was to determine the most common etiology of AFI with transaminitis and to find the relationship between clinical and laboratory investigation profile, as well as outcomes of illness. Methods: This is a hospital based prospective study conducted in Chitwan Medical College and Teaching Hospital (CMC-TH) from 17 April 2021 to 18 October 2021. All patients >15 years of age admitted with acute febrile illness and elevated transaminases under Pulmonary and Critical Care Medicine (PCCM) Unit of CMCTH were enrolled consecutively. Results: The mean age of the patients (n=103) was 45.1 ± 16.8 years. There were almost equal proportion of males and females. The most common presenting symptom (besides fever) was headache, followed by myalgia, with a median duration of 5 days. Scrub typhus was the commonest diagnosis (60, 58.3%). A diagnosis of Acute Undifferentiated Febrile Illness (AUFI) was given in (39, 37.9%) patients. The three transaminitis severity groups (mild, moderate and severe) were not significantly different by age, gender and comorbidity status. Acute kidney injury and multi-organ dysfunction syndrome (MODS) were significantly associated with severe transaminitis (P<0.05). The mortality rate was also higher in the severe transaminitis group. Conclusions: Scrub typhus has emerged as the most common cause of Acute Febrile Illness with transaminitis requiring hospital admission in this part of the country. Scrub typhus should be suspected in all patients who report with AFI with transaminitis in endemic areas.