Prevalence of p-16 Positive Laryngeal and Pharyngeal Tumors in Nepalese Population: A Hospital based Cross-sectional Study.

INTRODUCTION: P16 overexpression is considered as a good prognostic marker for oropharyngeal squamous cell carcinoma. However, there are very few literatures on the prevalence and outcomes of p16 overexpression in non-oropharyngeal squamous cell carcinoma and benign head and neck tumors. The aim of our study was to estimate the hospital based prevalence of p16 positive laryngeal and pharyngeal tumors and to compare it with the prevalence of p16 expression in the non tumor tissue (tonsils). METHODS: This was a descriptive cross-sectional study. Cases of all genders >15 years presenting with malignant or benign tumors of larynx and all the subsites of pharynx were included in the study for evaluation of p16 expression by immunohistochemistry. Tonsillar tissue of cases undergoing tonsillectomy for recurrent acute tonsillitis were taken as non-tumorous tissue to evaluate for p16 expression. RESULTS: A total of 48 cases were included in our study with 24 cases having different tumors of head and neck region and 24 cases having recurrent acute tonsillitis who were kept under non-tumor group. Eight cases (33.3%) in the tumor group showed positive stain for p16 in IHC. In non tumor group, 7 cases (29.1%) showed positive IHC staining for p16. CONCLUSIONS: P16 expression can be present in both benign and malignant tumors of various subsites of head and neck region and also in tonsillar tissue affected by inflammation.

Association of serum magnesium level with poor glycemic control and renal functions in Nepalese patients with type 2 diabetes mellitus.

BACKGROUND: Hypomagnesaemia has been shown to be associated with type 2 diabetes mellitus (T2DM) and its complications. The present study investigated the association of hypomagnesaemia with T2DM and its complications in patients hailed mostly from the western hilly region of Nepal. METHODS: This study was conducted among 150 type 2 diabetic patients and 150 of non-diabetic controls between May to September 2016. Relevant demographic, anthropometric, physiological and biochemical variables were measured using standard protocols. Statistical analyses were performed by SPSS version 17.0. RESULTS: Hypomagnesaemia (1.7±0.2mg/dl) was present in 50% of diabetic patients and none in the healthy controls (2.0±0.2mg/dl). It was inversely correlated with levels of glycated hemoglobin (HbA1c) (r=-0.299), total cholesterol (r=-0.219), low density lipoprotein-cholesterol (r=-0.168) and creatinine (r=-0.215) and directly correlated with serum creatinine based glomerular filtration rate (eGFRcr) (r=0.196). Subjects with hypomagnesaemia were significantly older (57.4±11.5years) and had higher levels of HbA1c (8.4±1.2%) and serum total cholesterol (248.3±72.0mg/dl). The methods of diabetes control did not have a significant influence on serum magnesium level. Patient's age (OR: 1.05 (95% CI-1.01-1.09)), poor glycemic control (OR: 6.78 (95% CI-2.56-17.95)) and low eGFRcr (OR: 4.89 (95% CI-1.78-13.40)) were the significant predictors of hypomagnesaemia. CONCLUSION: Half of type 2 diabetic population under study had hypomagnesaemia without regard to the method of diabetes control. Old age, poor glycemic control, and low eGFRcr were the significant predictors of low serum magnesium in these patients. Besides their regular anti-diabetic treatment, clinicians should also consider dietary supplementation of magnesium to prevent further complications of diabetes in these patients.

Prevalence and pattern of dyslipidemia in Nepalese individuals with type 2 diabetes.

BACKGROUND: Atherogenic dyslipidemia is an important modifiable risk factor for cardiovascular disease among patients of type 2 diabetes mellitus. Timely detection and characterization of this condition help clinicians estimate future risk of cardiovascular disease and take appropriate preventive measures. The aim of this study was to determine the prevalence, pattern and predictors of dyslipidemia in a cohort of Nepalese patients with type 2 diabetes. RESULTS: We found mixed dyslipidemia as the most prevalent (88.1%) and isolated dyslipidemia (10.1%) as the least prevalent forms of dyslipidemia in our patients. The most prevalent form of single dyslipidemia was high LDL-C (73.8%) and combined dyslipidemia was high TG, high LDL-C and low HDL-C (44.7%). Prevalence of all single and mixed dyslipidemia was higher in patients with poor glycemic control and hypertension. The glycemic status of patients correlated with their fasting serum lipid profile. Dyslipidemia was associated mainly with male gender, poor glycemic control and hypertension. CONCLUSIONS: Atherogenic dyslipidemia is associated mainly with male gender, poor glycemic control and hypertension. It is highly prevalent in Nepalese patients with type 2 diabetes. Urgent lifestyle modification, sustained glycemic control and aggressive lipid lowering treatment plans are necessary to minimize the future risk of cardiovascular disease in this population.

Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study.

BACKGROUND: Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine. AIM: The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population. PATIENTS AND METHODS: We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis. RESULTS: The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine. CONCLUSIONS: Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.