A Nationwide Nepalese Study to Establish Reference Intervals for Major Biochemical Analytes with Elucidation of Nepalese Features of Reference Values.

Despite immense importance of reference intervals (RIs) for clinical diagnosis, there have been no reliable RIs available for Nepalese. Hence, this nationwide study was organized to establish RIs for 30 common biochemical parameters. This study was conducted following the harmonized protocol provided by IFCC Committee on Reference Interval and Decision Limits (C-RIDL) with recruitment of 617 apparently healthy volunteers (18 - 65 years) by near-equal gender balance from 5 major cities. Fasting blood were collected, serum was separated and measured collectively using Beckman-Coulter/Olympus AU480 chemistry analyzer. The sources of variations of reference values (RVs) were evaluated by multiple regression analysis and nested ANOVA. Latent abnormal values exclusion (LAVE) method was applied to reduce influence of latent diseases. RIs were standardized based on a value-assigned serum panel provided by C-RIDL. By ANOVA, no between-city differences were observed, while sex-related changes were typically noted for urate, creatinine, iron, γ-glutamyl transferase (GGT), immunoglobulin M, and transferrin, but not for high-density lipoprotein cholesterol. Age-related changes were observed for total cholesterol (TC), triglyceride, low-density lipoprotein cholesterol, and C-reactive protein (CRP). RIs were successfully derived all parametrically. The LAVE procedure was effective in lowering upper limits for aspartate aminotransferase, alanine aminotransferase (ALT), and CRP. Compared to other collaborating countries, Nepalese RIs were low for urea, cholesterols, ALT, and high for triglyceride, GGT, CRP, immunoglobulin G, and complements. The RIs for major chemistry analytes were derived and standardized for nationwide use in Nepal. This study distinctly elucidated sources of variation and international features of Nepalese RIs. Supplementary Information: The online version supplementary material available at 10.1007/s12291-023-01123-6.

Serum procalcitonin in bacterial & non-bacterial meningitis in children.

BACKGROUND: Bacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Clinically, it is often difficult to differentiate between bacterial and non-bacterial meningitis. Several studies have demonstrated the raised values of serum procalcitonin (PCT) in bacterial infections including meningitis but without definite cut-off guidelines. Hence, this study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy. METHODS: It was a cross-sectional study done over a period of 5 months (Aug 2016-Dec 2016) in the department of Paediatrics, B P Koirala Institute of Health Sciences (BPKIHS). Fifty children aged 3 months to 15 years with suspected meningitis were enrolled and investigated with relevant investigations like complete blood counts, and cerebrospinal fluid (CSF) analysis along with serum PCT. Patients were classified into bacterial (22) and non-bacterial meningitis (28) according to clinical & CSF findings and data analysed using SPSS software. RESULTS: Serum PCT levels were significantly higher in bacterial meningitis group (median = 2.04 (1.2-3.18) ng/ml) compared with non-bacterial meningitis (median = 0.35 (0.18-0.35) ng/ml); p < 0.001. The sensitivity and specificity of serum PCT in diagnosis of bacterial meningitis at cut-off level of 0.5 ng/ml were 95.45% and 84.61% respectively. Procalcitonin showed maximum area under receiver operating characteristics (ROC) curve 0.991 (0.974-1.00) (p < 0.001) compared to total leukocyte count and CSF cytochemistry. CONCLUSION: Serum PCT has high sensitivity and specificity for early diagnosis of bacterial meningitis in children. Hence it can be a useful adjunct in differentiating bacterial and non-bacterial meningitis for prompt and better management of the children.

Significance of Serum Uric Acid in Pregnancy Induced Hypertension.

BACKGROUND AND OBJECTIVE: Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Uric acid (UA) is filtered, reabsorbed and secreted by the kidney. Thus, this study was conducted to assess the serum UA levels in PIH and to evaluate the diagnostic value of serum UA level in PIH. MATERIALS AND METHODS: This is a hospital based comparative cross-sectional study conducted in BPKIHS. Ninety study participants were included; forty five participants were diagnosed of PIH and forty five in control group after obtaining informed consent from study participants from August 2014 to May 2015. Serum UA was done by Uricase method and serum creatinine was done by Jaffe's alkaline picrate method in cobas c311 autoanalyser. Data were expressed in frequency, percentage, mean ± S.D., median (IQR), and Independent t-test, Mann-Whitney U test were applied. p Value <0.05 is considered to be significant. RESULTS: Mean serum UA levels was higher in PIH compared to control group (5.46 ± 1.51 vs 4.03 ± 0.69) respectively. ROC curve demonstrated that serum UA showed a superior diagnostic efficiency (Sensitivity - 79.07%, Specificity - 71.19%) compared to creatinine (Sensitivity - 62.75%, Specificity - 27.45%) in PIH respectively. CONCLUSION: The present study shows that serum UA is significantly raised in PIH compared to the control group. Assessment of uric acid is a convenient and cost-effective method for determination of severity in PIH. Thus, serum uric acid can still be used as prevalent marker for risk assessment in PIH.

The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal.

AIM: C-reactive protein (CRP) is a commonly used biomarker of sepsis, the leading cause of mortality in Intensive Care Units (ICUs). However, sufficient data are still lacking to strongly recommend it in clinical practice. The present study is aimed to find out its reliability in diagnosing sepsis. MATERIALS AND METHODS: CRP was measured in ICU-admitted patients with systemic inflammatory response syndrome and compared using a cutoff of 50 mg/L with the gold standard for diagnosing sepsis, taken as isolation of organism from a suspected source of infection or the Centers for Disease Control criteria for clinical sepsis. RESULTS: CRP had a sensitivity and specificity of 84.3% and 46.15%, respectively. Area under the receiver operating characteristics curve was calculated to be 0.683 (±0.153, P < 0.05). The cutoff value with the best diagnostic accuracy was found to be 61 mg/L. CONCLUSION: CRP is a sensitive marker of sepsis, but it is not specific.

Thyroid dysfunction and dyslipidemia in chronic kidney disease patients.

BACKGROUND: Chronic kidney disease (CKD) is becoming a serious health problem; the number of people with impaired renal function is rapidly rising. Progression of CKD is associated with having a number of complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. This study was conducted to investigate thyroid function and lipid profile in CKD patients. METHODS: A cross-sectional study was conducted among 360 chronic kidney disease patients at B P Koirala Institute of Health Sciences, Dharan, Nepal. Demographic features (age and sex) and medical history of diabetes mellitus, hypertension and cardiovascular diseases of each patient were noted, and blood samples (5 ml) were analyzed for serum urea, creatinine, glucose, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride. RESULTS: Thyroid dysfunction was found in 38.6 % CKD patients, the most common being subclinical hypothyroidism (27.2 %), followed by overt hypothyroidism (8.1 %) and subclinical hyperthyroidism (3.3 %). Hypercholesterolemia, low HDL cholesterol, undesirable LDL cholesterol and hypertriglyceridemia were observed in 34.4, 34.1, 35 and 36.6 % patients respectively. Stage 4 and 5 CKD patients had significantly higher risk of having thyroid dysfunction as compared to stage 3 patients. Significant risk factors for cardiovascular disease in CKD patients included presence of diabetes mellitus, hypercholesterolemia, undesirable LDL cholesterol and being in stage 4 and 5 (as compared to stage 3). CONCLUSIONS: Thyroid dysfunction, hypercholesterolemia, low HDL cholesterol, undesirable LDL cholesterol and hypertriglyceridemia are common in CKD patients. Progression of CKD is accompanied by rise in hypothyroidism and cardiovascular disease.

Anemia among school children in eastern Nepal.

Anemia is one of the most common public health problems in developing countries like Nepal. This study was done to find the prevalence of anemia among the children aged 4-13 years in eastern Nepal. A cross-sectional study was conducted in 2012 in four districts (Morang, Udayapur, Bhojpur and Ilam) of eastern Nepal to find the prevalence of anemia among the school children of eastern Nepal. Children aged 4-13 years were selected randomly from different schools of above districts and 618 venous blood samples were collected. Hemoglobin level was estimated by using cyanmethemoglobin method. The mean hemoglobin level was 12.2 ± 1.82 gm/dl. About 37.9% (n = 234) children were found anemic. Anemia prevalence was 42.4% (n = 78), 31.6% (n = 60), 45.3% (n = 48) and 34.8% (n = 48) among school children of Morang, Udayapur, Bhojpur and Ilam district, respectively. The study finds anemia as a significant health problem among the school children of eastern Nepal.

Iodine status after iodized salt supplementation in schoolchildren of eastern Nepal.

This study was designed to assess the urinary iodine concentrations of schoolchildren at baseline and after iodized salt supplementation in eastern region of Nepal. A cross sectional study was conducted from August 2009 to July 2011 among schoolchildren of three eastern districts of Nepal: Sunsari, Dhankuta, and Tehrathum. A sample of 828 school age children from the three districts was chosen for the study after obtaining written consent from their guardians. The schoolchildren treatment group (n=300) was provided with a supplement of iodized salt for six months. Urinary iodine concentration was estimated by ammonium persulfate digestion microplate method at baseline and after supplementation. Urinary iodine controls L1, L2 (Seronorm, Norway) were analyzed to obtain intra-assay CVs (L1 = 7.4%, L2 = 3.3%) and inter assay CVs (L1=23.5%, L2=11.26%). Median interquartile range urinary iodine concentration in the three districts: Sunsari, Dhankuta and Tehrathum at baseline versus intervention were 272.0 (131.5-473.0) microg/l versus 294.0 (265.0-304.0) microg/l (p=0.379), 247.0 (144.5-332.32) versus 361.0 (225.66-456.52) microg/l (p<0.001), and 349.5 (203.75-458.09) microg/l versus 268.76 (165.30-331.67) microg/l (p<0.001), respectively. This study indicated improved iodine status and increased median urinary iodine concentration after iodized salt supplementation. Regular monitoring of population urinary iodine concentration at national and regional levels should be performed to ensure that all individuals have optimal delivery of iodine nutrition.

Cystinuria, an Atypical Presentation and Challenges of Establishing its Diagnosis in a Poor Resource Set Up.

Cystinuria is an autosomal recessive defect in re-absorptive transport of amino acids: cysteine, ornithine, arginine and lysine from renal proximal convoluted tubules leading to urinary excretion of these amino acids. The phenotypic manifestations are recurrent urolithiasis, hematuria, flank pain and frequent urinary tract infection. An eighteen years old boy, diagnosed case of cystinuria at the age of two years is presented in this case report highlighting the atypical presentation of recurrent infections with multiple organ involvement. The challenges in establishing the diagnosis and the role of simple biochemical tests in confirming the diagnosis in a poor resource setup is highlighted. Performance of simple biochemical tests in the urine sample of this patient was done for the utility of these tests for future diagnostic purpose in any suspected cases of cystinuria in our set up. Keywords: Case report; cystinuria; Nepal.

Knowledge of Internal Quality Control for Laboratory Tests among Laboratory Personnel Working in Department of Biochemistry in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Introduction: Clinical laboratory holds a central position in patient care, thus, ensuring accurate laboratory test results is a necessity. Internal quality control ensures day-to-day laboratory consistency. However, unless practised, laboratory quality systems cannot be achieved. This depends on the efforts and commitment of laboratory personnel for its implementation. Hence, the aim of this study was to find out the knowledge of internal quality control for laboratory tests among laboratory personnel working in the Department of Biochemistry in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 July 2022 to 30 August 2022 after receiving ethical approval from Institutional Review Committee (Reference number: 2341/022). Semi-structured questionnaire was used to assess knowledge on internal quality control. Three non-respondents were excluded. The operational definition of the knowledge domain was set before finalizing the questionnaire. The convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 20 laboratory personnel, 5 (25%) (6.02-43.98, 95% Confidence Interval) had adequate knowledge of internal quality control. The mean knowledge score was 12±2.44. Conclusions: The prevalence of adequate knowledge of internal quality control for laboratory tests among laboratory personnel working in the Department of Biochemistry was similar to the other study done in a similar setting. Keywords: biochemistry; knowledge; laboratory personnel; quality control.

Vitamin D level in patients with moderate-to-severe acne: A case-control study combined with prospective study following oral isotretinoin treatment.

BACKGROUND: Vitamin D may have an important role in the pathogenesis of acne vulgaris (AV) as it has an immunomodulatory effect and regulates the proliferation and differentiation of keratinocytes. Oral isotretinoin used in the management of moderate-to-severe acne binds to the retinoid receptor which can form a heterodimer with vitamin D receptor (VDR) and may decrease the level of vitamin D by increasing catabolism. Two studies published so far investigating the effect of oral isotretinoin on serum vitamin D level are contradictory to one another. OBJECTIVE: This study aimed to compare the serum vitamin D levels in patients with moderate-to-severe acne and age- and sex-matched healthy controls and to determine the serum level of vitamin D in patients with moderate-to-severe acne following 3 months of oral isotretinoin treatment. METHODS: A total of 120 patients with moderate-to-severe acne and 90 age- and sex-matched healthy controls were enrolled in the study. The patients were treated with oral isotretinoin at 0.50-0.75 mg/kg/day and serum vitamin D was measured at baseline and 3 months after the treatment. RESULT: Serum vitamin D was insufficient and deficient in 90.50% of cases in comparison with 43.33% of controls (p = 0.001). Serum vitamin D had an inverse correlation with the severity of acne. Following 3 months of oral isotretinoin, there was no significant change in serum vitamin D level (p = 0.127). CONCLUSION: Vitamin D was low in patients with moderate-to-severe acne in compared with control. Vitamin D level did not change with short-term therapy with oral Isotretinoin.

Assessment of Vitamin D Level in Patients with Psoriasis and Its Correlation with Disease Severity: A Case-Control Study.

Background: Chronic plaque psoriasis is a chronic inflammatory skin disorder. Vitamin D has been shown to have effects on keratinocyte differentiation as well as immune regulation in the skin. Objective: The main objective of this study was to assess the 25hydroxyvitamin D [25 (OH) D] level in patients with psoriasis in comparison with healthy control subjects. Materials and Methods: This case-control study included 180 persons (120 cases and 60 age- and sex-matched control subjects) from outpatient department of BPKIHS, a tertiary care hospital in eastern Nepal. Severity of psoriatic skin lesions was assessed using psoriasis area severity index (PASI) scoring. Serum vitamin D level was assessed by chemiluminescent immunoassay. Results: The mean serum 25(OH) D levels in psoriatic patients and controls were 19.57 ± 6.85 ng/mL and 23.63 ± 6.40 ng/mL, respectively. The difference was statistically significant even after adjusting for confounding factors in a multivariate analysis (aOR 2.929, 95% CI 1.376-6.230). Low serum 25(OH) D levels were negatively associated with the severity of disease (r= -0.628, P= 0.01). Conclusion: Serum 25(OH) D levels are significantly lower in psoriatic patients than in healthy control subjects. Deficiency of serum 25(OH) D was associated with severity of disease with an inverse relationship with PASI score.

Poor Glycemic Control in Type 2 Diabetes Mellitus Patients in Two Tertiary Care Centers during COVID-19 Lockdown: A Descriptive Cross-sectional Study.

Introduction: Lockdown enforced to control the rapid transmission of novel coronavirus has resulted in the confinement of people in the home and restrictions of movement. This may have altered the lifestyle and glycemic control of type 2 diabetes mellitus patients. This study aimed to find the prevalence of poor glycemic control in type 2 diabetes mellitus patients in two tertiary care centres during COVID-19 lockdown. Methods: A descriptive cross-sectional study was conducted among 259 type 2 diabetes mellitus patients in selected hospitals from 1st September to 30th September 2020 after receiving ethical approval from the Departmental Research Unit, Biochemistry under Institutional Review Committee (Reference number: DRU/01/2020). A convenience sampling method was used. Data analysis was done by using Statistical Package for the Social Sciences version 26.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 259 patients with type 2 Diabetes Mellitus, 183 (70.65%) (65.10-76.20 at 95% Confidence Interval) had poor glycemic control during the lockdown period. Mean fasting and post-prandial blood glucose among these patients were 164.16±49.30 mg/dl and 246.76±69.86 mg/dl respectively. Conclusions: Our study depicts that the majority of the type 2 diabetes mellitus patients had poor glycemic control during the lockdown period which was similar when compared to other studies. Keywords: COVID-19; glycemic control; healthy lifestyle; lockdown; type 2 diabetes.

Potential role of biochemical markers in the prognosis of COVID-19 patients.

The global pandemic due to coronavirus disease 2019 (COVID-19) has posed an overall threat to modern medicine. The course of the disease is uncertain with varying forms of presentation that cannot be managed solely with clinical skills and vigor. Since its inception, laboratory medicine forms a backbone for the proper diagnosis, treatment, monitoring, and prediction of the severity of the disease. Clinical biochemistry, an integral component of laboratory medicine, has been an unsung hero in the disease prognosis and severity assessment in COVID-19. This review attempts to highlight the biomarkers which have shown a significant role and can be used in the identification, stratification, and prediction of disease severity in COVID-19 patients. It also highlights the basis of the use of these biomarkers in the disease course and their implications.

Study of diagnostic utility of Xpert MTB/Rif test on pleural fluid in the evaluation of patients presenting with Pleural Tuberculosis in Nepal.

Introduction: Existing tests for the diagnosis of pleural tuberculosis (TB) have major limitations in terms of accuracy, time to diagnosis and drug resistance testing. A test which can diagnose pleural TB and detect resistance, like Xpert MTB/Rif, would be optimal for rapid diagnosis and treatment. Methods: A prospective observational study was done in a tertiary care hospital in Eastern Nepal. Fifty-one patients with clinic-radiologic suspicion of pleural TB were included. The results of pleural fluid Xpert MTB/Rif were compared with two Composite Reference Standards. Composite Reference Standard-1 consisted of positive pleural fluid smear, positive culture, positive histology of pleural biopsy, and positive sputum results. Composite Reference Standard-2 included those with Composite Reference Standard-1 and those with high ADA values (>40 U/l) with response to anti-tubercular treatment at 8 weeks of follow-up. Results: Thirty-six patients were diagnosed as Pleural TB. Nine fulfilled Composite Reference Standard-1. Pleural fluid Xpert MTB/Rif was positive in five cases with Composite Reference Standard-1 and nine cases with Composite Reference Standard-2. The sensitivity, specificity, positive predictive value and negative predictive value with reference to Composite Reference Standard-1 were 55.56%, 88.10%, 50%, and 90.24%, respectively. Using Composite Reference Standard-2 as reference, sensitivity, specificity, positive predictive value and negative predictive value were 25%, 93.33%, 90%, and 34.15%, respectively. Two cases were diagnosed Xpert Rif resistant on pleural fluid. Conclusion: Due to low sensitivity, the Xpert MTB/Rif test cannot be recommended as initial test of diagnosis in a high prevalence setting. At the same time its clinical utility lies in testing of patients suspected to have drug-resistant pleural tuberculosis.

Congenital Hypothyroidism among Infants Undergoing Thyroid Function Test in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Congenital hypothyroidism is the most preventable and treatable cause of mental retardation in newborns and infants. Screening for congenital hypothyroidism in newborns and infants is not a routine practice in our part of the world. This study aimed to find out the prevalence of congenital hypothyroidism among infants undergoing thyroid function test in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Biochemistry, from laboratory records starting 14th April, 2013 to 13th April, 2020 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 1502/019). Data of infants whose thyroid function tests were performed were obtained using convenience sampling. Thyroid-stimulating hormone was categorised per the European Society of Paediatric Endocrinology guidelines. Data were entered and analysed using Microsoft Excel 2011 and the Statistical Package for the Social Sciences version 11.5. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 1243 infants, 56 (4.50%) (3.35-5.65 at 95% Confidence Interval) infants were diagnosed with congenital hypothyroidism. Conclusions: The prevalence of congenital hypothyroidism was higher than other studies done in similar settings. An unexpected finding of treatment-induced hyperthyroidism was observed, indicating a lack of regular and timely follow-up of infants diagnosed with congenital hypothyroidism. Keywords: congenital hypothyroidism; Nepal; newborn screening; prevalence.

Prevalence of Vitamin D Deficiency among Patients of Acute Coronary Syndrome in a Tertiary Care Center of Eastern Nepal.

INTRODUCTION: Vitamin D deficiency is an emerging risk factor for cardiovascular diseases. Very few studies have been done to find out vitamin D deficiency status among cardiovascular patients in Nepalese setup. This research aims to find out the prevalence of vitamin D deficiency among patients of acute coronary syndrome admitted in a tertiary care center of eastern Nepal. METHODS: This was a descriptive cross-sectional study conducted among patients of acute coronary syndrome admitted in a tertiary care hospital from 1st February 2018 to 31st July 2018. Ethical clearence was taken from Institutional Review Committee of B.P. Koirala Institute of Health Sciences (Reference number: 259/074/075-IRC). Convenience sampling method was used. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: A total of 33 (64.7%) at 95% Confidence Interval (51.58-77.82) patients of acute coronary syndrome had vitamin D deficiency in our study with 19 (37.3%) having mild deficiency and 14 (27.4%) having moderate deficiency. None of the patients had severe vitamin D deficiency in our study. The mean vitamin D levels were lower in diabetics (23.57±9.28ng/ml) as compared to non-diabetics (31.91±12.50ng/ml), in hypertensive patients (24.36±7.67ng/ml) as compared to non-hypertensive patients (30.97±13.72ng/ml), and in patients with dyslipidemia (22.86±6.44ng/ml) as compared to those without dyslipidemia (37.68±13.15ng/ml). CONCLUSIONS: Prevalence of vitamin D deficiency among patients of acute coronary syndrome in our study was comparable to various other homologous international studies.

Diagnostic Accuracy of Serum Cystatin C for Early Recognition of Nephropathy in Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. MATERIALS AND METHODS: This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. RESULTS: The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol (p=0.018) and serum cystatin C (p < 0.001) was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p=0.022), duration of T2DM (r = 0.326, p=0.021), and UACR (r = 0.528, p < 0.001) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = -0.925, p < 0.001). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450-0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265-0.593) though nonsignificant. CONCLUSION: Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.

Approach to Sample Collection, Transport and Processing of Suspected or Confirmed COVID-19 Patients for Biochemistry Investigations.

During this global pandemic period of COVID-19, the health care system is the most affected area. Health care workers including clinicians, laboratory professionals, and other allied health workers pose a high threat for acquiring and transmission the disease. Apart from the diagnosis of disease by the RT-PCR, other laboratory investigations are equally essential in disease prognosis and monitoring. This biosafety guidance is intended to provide and insight to the clinicians, nurses, and laboratory professionals in handling the blood and other body fluid samples for biochemical investigations concerning the proper methods of sample collection, transport, processing, and disposal. Every day, the laboratory receives samples of the patient with confirmed and suspected cases of COVID-19 patients. This poses a high threat of contamination to the health professionals and thus, a proper risk assessment and standard precautions protocol must be followed to ensure safety, minimize the risk of contamination and disease transmission.

Biochemical status of serum iron in histopathological grades of oral submucous fibrosis.

BACKGROUND: Oral submucous fibrosis is a multifactorial, chronic disease of oral mucosa characterized by mucosal atrophy and fibrosis leading to functional morbidity; amongst many iron deficiency is considered as one of the risk factor. Also the iron level is considered to be depleted due to increased utilization during collagen synthesis. This study was conducted to evaluate the level of iron in patients with fibrosis and correlate with different histopathological grades. METHODS: A total of 40 clinically diagnosed and histopathologically confirmed cases of submucous fibrosis were considered. Clinical data were recorded and status of iron was estimated through serum iron and total iron binding capacity by ferrozine method using a digital auto-analyzer. The level of iron was correlated with the histopathological grades and epithelial dysplasia. RESULT: The mean age of patients was 37.07 ± 14.63 years with the male to female ratio of 6.5:1. Areca nut consumption was associated with all the cases among which 87.5% of cases were exposed to commercial forms. 37.5% of cases were in early grade whereas 60% in moderately advanced histopathological grade. The level of mean serum iron and total iron binding capacity was higher in moderately advanced than in early grade. However no statistically significant difference was observed within the histopathological grades. CONCLUSION: Iron is influenced by many factors like dietary intake, food habits, metabolic reactions, chronic diseases, etc. Serum iron is reduced in patients with oral submucous fibrosis which should be supplemented to impede the carcinogenic potential and improve the treatment outcome.