Introduction: Chronic obstructive pulmonary disease in non-smokers has been an importantconcern in past decade. We studied the risk factors responsible for more severe Chronic obstructivepulmonary disease. Identifying them would help to work against progression to more severe diseaseas well as prevention.Methods: A prospective cross sectional study was done in outpatient clinic of Jinnah postgraduatemedical center from December 2010 to December 2011. All patients fulfilling the criteria for Chronicobstructive pulmonary disease were taken in study. Patients with less than five pack years smokingwith other risk factors for Chronic obstructive pulmonary disease were evaluated.Results: Out of total 90 patients, 74 (82.2%) had mild chronic obstructive pulmonary disease and 16(17.7%) had moderate to severe chronic obstructive pulmonary disease. Patients with single biomassexposure were found to have mild chronic obstructive pulmonary disease except those havingmosquito coil exposure. Patients with mosquito coil and wood smoke exposure were observed tohave moderate to severe chronic obstructive pulmonary disease (p-value 0.009).Conclusions: Wood smokewith mosquito coil smoke exposure is responsible for more severe chronicobstructive pulmonary disease._______________________________________________________________________________________Keywords: biomass; chronic obstructive pulmonary disease; non-smoker; tuberculosis.

Objective: To compare the yield from Gastric lavage (GL) and Broncho alveolar lavage (BAL) samples in adult patients suspected case of Tuberculosis but not producing sputum. Methodology: 80 adults with suspected case of tuberculosis but not producing sputum were recruited. 72 patients were then subjected to one gastric lavage followed by Broncho-alveolar lavage in the same morning. The collected samples were subjected to GeneXpert MTB/RIF assay. Result: Of the 72 patients samples, the mean age was 38.6 years. 41 (56.9%) were male and 31 (43.1%) were female. History of TB contact was present in 25 (34.7%) patients. 37 (51.4%) patients had GeneXpert MTB/RIF positive on BAL and/or GL samples. The GeneXpert MTB/RIF of BAL fluid was positive on 35 (48.6%), which was not significantly greater than that for specimens from GL, which was 28 (38.9%) (p > 0.05). In 26 (36.1%) cases, GeneXpert MTB/RIF was positive in both BAL and GL samples. Conclusion: This study showed the yield of GeneXpert MTB/RIF in GL was comparable to BAL to detect Mycobacterium tuberculosis complex. Patients who can't produce sputum, GL can be a good alternative to BAL to detect Mycobacterium tuberculosis complex in resource poor areas and patients who do not tolerate Bronchoscopy.

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Non Communicable diseases (NCDs) are now endemic in low and middle income countries. Nepal had a high burden of communicable diseases (CDs) which has now been overtaken by NCDs. Although prevention and control of NCDs is prioritized in national policies and strategies, there is no proper monitoring system. This study aims to review the morbidity pattern among the adults seeking preventive general health checkup in a major tertiary care hospital in Kathmandu. 3000 cases were evaluated. 53.6% were males and 46.4% were females. The mean age of cases was 44.9 yrs. Most of the cases ranged from 40 to 60 years of age. Almost half of them were from Kathmandu district. Nearly 78% participants live a sedentary life. Abdominal obesity was seen in 27.5% of females and 21.7% of males. Nearly 49% of cases were overweight and 24% were obese. Almost 21 % of the cases were smokers and about 36% of them consumed alcohol. Only 9% are vegetarians. 10% have diabetes and 20% have hypertension. 69% of females and 43% of males have less than normal bone mineral density. The government and private sectors must focus on strengthening preventive and curative services for early detection of risk factors and management of NCDs.

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