Pseudo-hypertriglyceridaemia in glycerol kinase deficiency misdiagnosed and treated as true hypertriglyceridaemia.

High triglyceride in a serum sample with no apparent visible lipaemia is a confusing laboratory condition. This condition of apparent hypertriglyceridaemia might be an asymptomatic condition of pseudo-hypertriglyceridaemia which is seen in individuals with glycerol kinase deficiency. Glycerol is increased in glycerol kinase deficiency, therefore biochemical analysers that measure glycerol to estimate triglyceride report high triglyceride values. Clinicians are often unaware of this laboratory condition; as a result, patients are subjected to aggressive hypolipidaemic drugs and lifestyle changes, and these measures turn ineffective to lower triglyceride levels. In this report, a case of a 50-year-old Nepalese male is presented with an apparent hypertriglyceridaemia refractory to various hypolipidaemic drugs for the last 13 years until a correct diagnosis of his condition was made.

In-House Algorithm for Reporting Discrepant HbA1c Result and Troubleshooting a Case of False Low HbA1c.

We report an unusual case of a patient having low glycosylated hemoglobin (HbA1c) below the reportable range, despite having borderline fasting blood glucose. The patient had decreased erythrocytes count and elevated reticulocyte count, with no evidence of hemoglobinopathy. He reported taking multidrug therapy for borderline lepromatous leprosy. Dapsone induced hemolysis was identified as the cause for the discordant HbA1c. Thus, it is important to be aware of medications and conditions that may lead to a falsely low HbA1c level so that incorrect treatment decisions are not made. In such situations, alternative measure of glycemic control, such as fructosamine is recommended. Further it is also recommended that clinical laboratories have standard protocol to troubleshoot any discrepant HbA1c result.

Hematological and Biochemical Parameters along with IgG Antibody against SARS-CoV-2 in Patients visiting a referral laboratory for recovery check up after COVID-19 infection in Nepal.

BACKGROUND: The laboratory abnormalities for hospitalized patients with the SARS-CoV-2 have been described in various studies. Limited data are available for the recovered patients. This study aimed to evaluate various laboratory findings in the recovered SARS-CoV-2 patients. METHODS: In this cross sectional study, the laboratory findings of various hematological and biochemical parameters along with antibody against SARS-CoV-2 of 150 patients who visited Samyak Diagnostic Pvt. Ltd for recovery check up after SARS-CoV-2 were studied from October 2020 to March 2021. RESULTS: Out of total 150 participants, 84% of SARS-CoV-2 recovered patients, who had mild or moderate illness, reported persistence of milder symptoms. Persistence of high serum inflammatory markers such as CRP, Ferritin and LDH along with abnormal cell count and morphology of leukocyte lineage was present in 45.4% of these patients. Similarly, 98.7 % had SARS-CoV-2 IgG antibody after 37 median days of recovery. CONCLUSIONS: Various laboratory abnormalities may persist after SARS-CoV-2 recovery in addition to the presence of SARS-CoV-2 IgG antibody. Follow up study is needed to determine the period up to which these abnormalities are present and the protection from antibody is conferred.

Broadening the List of Differential Diagnosis for Acute Abdomen - a Case Report from Nepal.

When a patient has an acute abdominal pain, it is important to identify if the underlying cause is life threatening. To that end, a thorough medical history and relevant investigation will be pivotal. Here we report a case of lead toxicity where the patient presented with an acute abdomen following intake of Ayurvedic medicines. The baseline blood lead level was 82.3 µg/dl. The Ayurvedic medicines when analyzed for its lead content, revealed high lead concentration. We observed that the cessation of Ayurvedic medication along with D-penicillamine therapy was beneficial in reducing the blood lead level and in alleviating abdominal pain. Our findings implicate the need of awareness program regarding the potential health hazards associated with the use Ayurvedic medicines.

Blood Lead Levels in Rag-Pickers of Kathmandu and its Association with Hematological and Biochemical Parameters.

INTRODUCTION: Lead poisoning is a common health problem in Nepal and there are a limited number of studies on blood lead levels in various population groups. Rag-pickers are those people who visit from house to house to collect the materials that can be recycled and thus earn their livelihood. The present study was designed to evaluate blood lead level (BLL) and its relationship between hematological and biochemical parameters in rag-pickers working in Kathmandu. METHODS: An observational cross-sectional study among 50 ragpickers working in the selected area of Kathmandu was done in May 2019 after obtaining ethical approval from the Nepal health research council. Capillary and venous blood was drawn from each participant after written consent to measure the BLL, aspartate aminotransferase, alanine aminotransferase, total bilirubin, creatinine, glucose and to test for a complete blood count. Whole blood was also screened for the presence of hemoglobin variants in cases with abnormal red blood cell indices. Data was analyzed using SPSS (Version 20.0). RESULT: All rag pickers were men with mean age of 32.56 ± 12.51 years. The mean BLL among ragpickers was 11.6 ± 7.23 µg/dL. High eosinophil count was found (8.27 ± 5.49 %) in 27 cases (54%) having no significant association with BLL. The mean BLL was higher (12.89 µg/dL) in a cohort of workers who pick and recycle electronic waste. Beta-Thalassemia trait was seen in four cases, all of them had high BLL. No significant association of BLL with the number of years worked by rag picker was found. Similarly, no significant association of BLL with hematological and biochemical parameters was found. CONCLUSION: Rag-pickers working in Kathmandu are at increased risk of lead toxicity. The use of protective gloves, masks, shoes and clothes along with a regular medical examination of this vulnerable group is recommended.

Breast tuberculosis, a rare entity.

Breast tuberculosis is a rare form of extra-pulmonary tuberculosis. It is rare in western countries, usually occurs in multiparous and lactating women but rare in male and older women. It has a varied clinical, radiological and pathological presentation that can be similar to that of a breast abscess or carcinoma. Constitutional symptoms are not usually present making it even harder to diagnose clinically. Here we present a case of a young Nepalese woman with tubercular mastitis who was initially misdiagnosed as breast abscess.