Browsing by Author "Nepali, Rohit"
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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.