Prevalence of coronary heart disease in the urban adult males of eastern Nepal: a population-based analytical cross-sectional study.

OBJECTIVE: Despite being a rising public health problem, the burden of cardiovascular diseases (CVDs) at population level have not been studied in Nepal. The paper aims to bridge the gap and study the prevalence of coronary heart disease (CHD) and associated risk factors in adult males of urban Nepal. METHODS: A population-based analytical cross-sectional study was carried out in the Dharan municipality of Nepal with one thousand males aged > or = 35 years selected by systematic random sampling of the households. Data collection included WHO Rose angina questionnaire and electrocardiograms in all who had positive Rose Questionnaire. Those with documented CHD, positive Rose Questionnaire and positive electrocardiographic changes according to the Minnesota codes were labelled as having CHD. FINDINGS: The prevalence of CHD in the study population was 5.7% (95% confidence interval: 4.26 - 7.13). The significant associated risk factors included tobacco use, history of hypertension, family history and age. CONCLUSION: This is the first population-based prevalence study of coronary heart disease in Nepal. The burden of CHD in the study population is comparable to the findings from urban studies of North India. Nepal urgently requires public health policies and programmes to address CVDs including CHD.

Cardiovascular Risk Factors in Subclinical Hypothyroidism: A Case Control Study in Nepalese Population.

Objectives. To assess cardiovascular risk factors in Nepalese population with subclinical hypothyroidism as compared to age and sex matched controls. Materials and Methods. A case control study was conducted among 200 subjects (100 subclinical hypothyroid and 100 euthyroid) at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Demographic and anthropometric variables including systolic and diastolic blood pressure (BP) were taken. Blood samples were assayed for serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and high sensitivity C reactive protein (hs-CRP). Results. Subclinical hypothyroid patients had significantly higher diastolic BP, total cholesterol, LDL cholesterol, and hs-CRP than controls. The odds ratio of having hypercholesterolemia (>200 mg/dL), low HDL cholesterol (<40 mg/dL), undesirable LDL-cholesterol (>100 mg/dL), high hs-CRP (>1 mg/L), and high diastolic BP (>80 mmHg) and being overweight (BMI ≥ 23 Kg/m(2)) in subclinical hypothyroidism was 2.29 (95% CI; 1.2-4.38, p = 0.011), 1.73 (95% CI; 0.82-3.62, p = 0.141), 3.04 (95% CI; 1.66-5.56, p < 0.001), 2.02 (95% CI; 1.12-3.64, p = 0.018), 3.35 (95% CI; 1.72-6.55, p < 0.001), and 0.9 (95% CI; 0.48-1.67, p = 0.753), respectively, as compared to controls. Conclusion. Subclinical hypothyroid patients are associated with higher risk for cardiovascular disease than euthyroid subjects.

Thyrotoxic hypokalaemic periodic paralysis in a man from Nepal.

A case is presented of a rare complication of hyperthyroidism, known as thyrotoxic hypokalaemic periodic paralysis, in a man from Nepal. A 26-year-old Nepalese man, with known hypokalaemia, was referred to the clinical laboratory services for electrolyte analysis. Results showed Na(+) 120 mmol/l and K(+) 2.8 mmol/l, and he was prescribed potassium chloride. In fact, he had previously been receiving potassium supplementation periodically and his history revealed that he had experienced the same type of attack and was hospitalised 6 months earlier. He had profound tremor and was agitated and irritable during his visit to this hospital. Thyroid function testing showed high T3 (tri-iodothyronine) and T4 (thyroxine) with low thyroid stimulating hormone (TSH) concentration in the serum, indicating thyrotoxic hypokalaemic periodic paralysis. Treatment with neomercazole resulted in an improvement during the follow up visit. Hypokalaemia is believed to be a consequence of a massive shift due to increased sodium-potassium-adenosine triphosphatase (Na(+)K(+)ATPase ) pump activity in the presence of elevated thyroid hormones.

Detection of beta-thalassemia (homozygous) by hemoglobin electrophoresis on agar gel and citrate agar medium: a case report.

A seven month old male baby was admitted to NICU of BPKIHS, Dharan with dyspnoea and distress. He was investigated for hemolytic anemia and suspected of beta Thalassemia (Homozygous) based on the low level of Hb and high HbF%. To investigate further, Hb electrophoresis was carried out using agar gel and citrate agar gel at pH 8.6 and 6.0 respectively along with control. Electrophoretogram showed single narrow band lagging behind the healthy control moved toward anode at pH 8.6 and single narrow band moved parallel to healthy control toward cathode at pH 6.0. Thus the diagnosis of betaThalassemia (Homozygous) is favored.

De Ritis ratio as diagnostic marker of alcoholic liver disease.

Patients suffering from Alcoholic Liver Diseases (ALD) are often diagnosed by spectrum of physical manifestations and laboratories abnormalities. Among biochemical abnormalities De Ritis Ratio (AST/ALT ratio) is more sensitive during any phase of the disease. This ratio is based on common tests of liver function test and can be investigated in any laboratory and is more relevant in countries like Nepal where alcohol abuse is a major cause of liver disease. Clinically diagnosed 103 ALD cases and 73 healthy controls were enrolled for the study. Selected parameters of liver function tests were analyzed by Vitalab Selectra-2 autoanalyser using Merck diagnostic kits and statistically analyzed by student "t" test. The De Ritis ratio was calculated from serum AST and ALT values and was found 2. 30:1 in patients compared to of 1.10:1 in control group. AST and ALT value showed mild to moderate elevation as it was 124.80 +/- 86.24 IU/L and 54.21 +/- 39.72 IU/L in patients compared to 35.00 +/- 23.49 IU/L and 31.48 +/- 17.79 IU/L in controls. The increase in AST and ALT level in patients was statistically significant (p < 0.001) and (p < 0.01) respectively. > or = - Glutamyl Transferase showed 425.26 +/- 36.40 IU in alcoholics compared to 70.55 +/- 27.35 IU/L in controls, a significant increase observed (p<0.001) However Alkaline Phosphatase activity was observed within normal limit. Serum Total Protein (TPR) and Albumin (ALB) showed 6.86 +/- 1.01 g/dl and 2.71 +/- 0.78 g/dl in patients with Albumin: Globulin ratio of 0.61:1 compared to 7.51 +/- 1.74 g/dl and 4.03 +/- 0.61 g/dl in controls with the ration of 1.15:1, a significant decrease in albumin (p < 0.001) without alteration of Total Protein in patients. Total and Direct bilirubin showed 2.32 +/- 1.10 mg/dl and 1.26 +/- 0.88 mg/dl in alcoholics higher than the control of 1.06 +/- 0.60 mg/dl 0.38 +/- 0.31 mg/dl (p<0.001). Diagnosis of ALD is straight forward with history-and compatible clinical features but alcoholic's denial and under estimation of alcohol abuse becomes an obstacle in confirmation. A mild to moderate disproportionate elevation of AST than ALT activity making De Ritis Ratio > 2:1, supported by reversal of Albumin/globulin ratio facilitates the diagnosis.