Browsing by Author "Dahal, Suresh"
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Publication Effect of Covid-19 Vaccination on disease Severity among Covid-19 patients admitted in KMCTH Authors(Nepalese Respiratory Society, 2023) Mishra, Navin Kumar; Karn, Rohit; Shrestha, Milan; Acharya, Abhiskar; Acharya, Sunil; Dahal, Suresh; Neopane, ArpanaAbstract: Background: The COVID-19 Pandemic has affected millions of people globally with significant morbidity and mortality. Though the overall case fatality rate (CFR) in Nepal was less than 1% during the initial peak, the CFR is expected to increase during the current second wave of the pandemic. Since no specific effective therapies exist, breaking the chain of transmission sounds logical. COVID-19 vaccine development is believed to be effective and safe in preventing disease adverse outcomes. Aim: Primary aim of the study was to know the COVID-19 vaccination status among the patients admitted with RT-PCR positive for COVID-19 and secondary aim of the study was to observe the difference between the outcome in terms of resources utilization LIKE NON-INVASIVE VENTILATION (NIV), Hi-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) in vaccinated and unvaccinated patients. Method: This was a hospital-based Prospective Observational Study. All patients admitted at KMCTH from June 01, 2021 –July 31st 2021 with COVID-19 RT-PCR Positive meeting inclusion criteria were enrolled. Ethical Clearance was taken from KMC-IRC. Result: During the study period, a total of 160 RT-PCR Positive Covid-19 cases were admitted at Kathmandu Medical College Teaching Hospital (KMCTH). Out of the total patients, 74 (46.25%) were not vaccinated for covid-19 whereas 86 (53.75%) patients were vaccinated either with Vero cell (39.53%) or Covishield (60.47%) Covid-19 vaccine. The study showed 2.32% of vaccinated patients required ventilatory support compared to 13.50 % of unvaccinated patients requiring ventilatory support having significant ( p value <0.05) impact on outcome. The relative risk for unvaccinated patients going to ventilator was 5.81 times higher than for vaccinated patients. Conclusion: The authors found out that more than half of the individual admitted were vaccinated (53.75 VS 46.25). Moreover, Vaccination (either with Covishield or Vero cell) appears to be effective in limiting requirement of more advance services like NIV, HFNC, and invasive mechanical ventilator. We recommend a larger, multicenter, randomized study in the future.Publication Impact of Corticosteroid on Covid-19 Pneumonia Patients(Nepalese Respiratory Society, 2024) Mishra, Navin Kumar; Karn, Rohit; Shrestha, Milan; Acharya, Abhiskar; Acharya, Sunil; Dahal, Suresh; Neopane, ArpanaAbstract: Background: Globally over 704,753890 had COVID -19 Out of which 7,010,681 died compared to 12031 death in Nepal out of1003450 cases Nationwide. Corticosteroids because of their anti- inflammatory effect may have beneficial effect/s on COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. Aim: The study aims to see the effect of Corticosteroids on COVID-19 patient outcomes concerning disease progression, length of hospital stay, 28-day mortality, and use of resources like Ventilator. Method: Single Hospital-based Prospective observational study among RT-PCR positive for COVID-19 patients admitted at Kathmandu Medical College Teaching Hospital from June 01, 2021 –July 31st, 2021 requiring oxygen therapy. Patients were grouped into either usual care, including symptomatic treatment only, or a group receiving both usual care and Corticosteroid. Results: This study included 160 RT-PCR-positive cases. There were 53 patients with mild symptoms and 107 with moderate symptoms. Patients with mild symptoms who received standard care had an odds ratio of 1.875 for progression to moderate and severe COVID-19 Compared to those who received both standard care and corticosteroid. Similarly, Patients with moderate symptoms who received standard care had an odds ratio of 1.8 for progression to severe and critical COVID-19 Compared to those who received both standard care as well as corticosteroids. Among patients with mild symptoms, the overall use of a ventilator was 35.85 % and mortality was 13.21 %. Similarly, in patients with moderate symptoms at presentation, a ventilator was needed in 33.64 % and mortality was 24.30 %. Conclusion: Though Corticosteroids seem to have a beneficial role in preventing disease progression, they failed to show a statistically significant reduction of ventilator use and mortality benefit amongst groups.Publication Prevalence of COPD among Patients on Bronchodilator Therapy Presenting to a Tertiary Care Center(Nepalese Respiratory Society, 2025) Mishra, Navin Kumar; Thakuri, HemaChand; Shrestha, Sareen; Rai, Utshav; Dhamala, Rasmita; Nepali, Rohit; Dahal, Suresh; Sha, Parmeshwar; Khadka, Gaurav; Lamichhane, Aayush; Bhatta, KarunaAbstract; Background: Chronic Obstructive Pulmonary Disease (COPD) is the most common non-communicable disease in Nepal and the third leading non-communicable disease globally. Despite its significant burden on public health, proper research is limited in local settings. Objective: This study aims to find out the utilization of spirometry in establishing the diagnosis of COPD. Method: A single-center, prospective, cross-sectional study design was conducted that included all patients more than 40 years old on bronchodilator therapy for COPD coming to the Pulmo OPD of Kathmandu Medical College Teaching Hospital (KMCTH). COPD was diagnosed by GOLD COPD. Criteria of fixed post-bronchodilator FEV1/FVC ratio <0.70. A Chhabra et al. 2014 reference equation from the North Indian population was taken for percentage prediction. Result: A total of 6789 patients visited the pulmo OPD. 877 (12.92%) patients were being treated for COPD at different centers. Out of 877 patients, only 371 cases (42.3%) were properly diagnosed with COPD followed by bronchodilator therapy, and 185 (21.09%) cases were mistakenly treated for COPD, i.e., overdiagnosis, as proven by spirometry later on. Among 692 COPD-confirmed patients, 380 (54.91%) were female and 312 (45.09%) were male. Conclusion: We conclude that a significant proportion of individuals who are on bronchodilators lack spirometry confirmation to diagnose COPD. Moreover, our study also shows a slightly increased prevalence of COPD among females.Publication Role of Bronchoscope Utilization in Sputum AFB & Gene Xpert Negative individuals at Kathmandu Medical College Teaching Hospital(Nepalese Respiratory Society, 2024) Mishra, Navin Kumar; Thakuri, Hema Chand; Shrestha, Sareen; Rai, Utshav; Dhamala, Rasmita; Nepali, Rohit; Dahal, Suresh; Sha, Parmeshwar; Khadka, Gaurav; Lamichhane, Aayush; Gupta, Pulkit; Bhatta, KarunaAbstract: Background: Respiratory diseases are among the top most cause of mortality globally as per World Health Organization data with chronic obstructive pulmonary disease (COPD), Lung Cancer, Lower Respiratory tract infection and Tuberculosis (TB) among the top ten causes of mortality. Bronchoscope is still in growing phase in our setting despite its significant utility in establishing diagnosis and treatment of patient. Bronchoscope has pivotal role in various benign (Eosinophilic pneumonia, tuberculosis, Interstitial Lung Disease etc.) as well as Malignant (Lung Cancer) Respiratory diseases etc. Objective: To find out the efficacy of bronchoscope in detecting tuberculosis among sputum smear acid-fast bacilli (AFB) and GeneXpert negative individuals. Method: A single center, prospective, cross sectional study design was conducted which included all patients seen by Pulmonary Medicine department of Kathmandu Medical College Teaching Hospital (KMCTH). Patients were offered bronchoscopy if clinical history, examination, sputum microbiology and imaging findings demanded. Results: A total of 111 cases underwent Fiberoptic bronchoscopy (FOB) at our center during the study period for various indications. Out of which 62 (55.86%) were male and 49 (44.14%) were Female. Among a total of 45 cases with strong clinical suspicion of pulmonary tuberculosis but sputum AFB and GeneXpert-negative tuberculosis who underwent FOB, a total of 30 (66.67%) individuals were confirmed to have tuberculosis in bronchoalveolar lavage (BAL) GeneXpert, out of which 17 (56.67%) were male and 13 (43.33%) were female. Conclusion: FOB is very useful in establish diagnosis of Tuberculosis in selected patients with negative Sputum AFB and GeneXpert result.