Tumour Marker Requisition Pattern in a Tertiary Care Centre of Eastern Nepal.

Background Tumor markers have been a valuable tool for decades to aid in the diagnosis, treatment, and monitoring of oncological diseases. Objective To retrospectively analyze the requisition pattern of tumor marker requests at the largest tertiary care center in eastern Nepal. Method A retrospective hospital-based cross-sectional study was conducted to obtain the data for 5 common tumor markers i.e., Alpha-Fetoprotein (AFP), Cancer antigen125 (CA-125), Carbohydrate antigen (CA) 19-9, Carcinoembryonic antigen (CEA), and Prostate-specific antigen (PSA) analyzed in the Department of Biochemistry at B.P. Koirala Institute of Health Sciences, Dharan, Nepal for 5 years. Result A total of 8716 tests for tumor marker was conducted over 5 years. The most common tumor marker requested at our hospital was Prostate-specific antigen (48.77%) followed by Cancer antigen-125 (39.02%), Carcinoembryonic antigen (9.30%), Alpha-Fetoprotein (2.29%), and Carbohydrate antigen 19-9 (0.63%) respectively. The majority of the tumor markers (Alpha-Fetoprotein, Cancer antigen-125, Carbohydrate antigen 19-9, and Carcinoembryonic antigen) were requested from in-patient wards while Prostate-specific antigen was majorly requisitioned from the out-patient department (OPD) [74%] respectively. Conclusion The finding from the present study suggest that though Nepal is one of the developing countries where the specialized health care services are limited only to cities and developed areas, the burden of oncological disease is high. Dharan is one of the small cities in the eastern part of Nepal and serves the majority of the population in the periphery. The number of tumor marker requisitions as per the laboratory data is significant (n=8716) over a period of 5 years where few tests like Alpha-Fetoprotein, Carcinoembryonic antigen, and Carbohydrate antigen 19-9 have just been initiated. Also, the findings delineate that the outpatient departments have requested more tumor markers which might/ might not be inconsistent with the preliminary diagnosis.

Evaluation of Nicotine Dependence in Adult Population of Eastern Nepal.

Background Tobacco consumption is a leading cause of premature death in the world. Tobaccorelated deaths are associated with cardiovascular diseases, pulmonary diseases, oral potentially malignant disorders, cancer, others. Moreover there is also associated nicotine dependence which might result to numerous tobacco-associated diseases. Objective This study was conducted to analyze the degree of nicotine dependence considering its potential health risk, in the Eastern region of Nepal. Method A descriptive questionnaire based study was conducted among current tobacco users of six districts of Eastern Nepal. Fagerstrom Test for Nicotine Dependence (FTND) and Fagerstrom Test for Nicotine Dependency for Smokeless Tobacco (FTNDST) questionnaire were used for tobacco smokers and chewers, respectively. Result Of the total participants, 836 were males and 359 females, among whom 736 were active tobacco smokers and 432 chewers, 34.8% had tried to stop consuming tobacco and 306 (25.6%) had oral lesions in white or red forms. Very low nicotine dependence was found among 244 (31.47%) tobacco smokers and 37 (8.56%) chewers whereas 36 (4.71%) smokers and 103 (23.84%) chewers had very high nicotine dependence. The mean score for FTND was 3.73±2.37 and 5.74±2.12 for FTND-ST. A significant difference in duration and age group with FTND score was observed, however not with FTND-ST. Conclusion The information regarding degree of nicotine dependence can be used as baseline information for planning of preventive strategies and implementation of tobacco cessation and control programs.

Biochemical Parameters in Confirmed Covid-19 Patients: A Hospital Based Study from Eastern Nepal.

Background COVID-19 has posed a global threat to almost every part of the world. The disease has varied form of presentation and the modern medicine has still not been able to provide definite treatment for the disease. Objective To assess the biochemical parameters in confirmed patients of COVID-19 admitted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method This is a retrospective hospital based cross-sectional study conducted in the Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan from October to December, 2020. Convenient sampling technique was used to enroll the data of the patients for whom the biochemical parameters were requested by the clinicians. Routine biochemical tests were performed in Cobas c311 autoanalyzer. Result A total of 202 patients with confirmed COVID-19 infections and admitted at COVID Hospital, BPKIHS were enrolled. The findings depict an elevated liver enzyme (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase and cardiac enzymes (creatine kinase-total and creatine kinase- MB) in the study population. Increased serum ferritin (1026.08±220.53), hs CRP (41.52±5.22) and lactate dehydrogenase 360 [303.50-526.75] was found in the patients. Also, majority of the patients (> 50%) had abnormal biochemical findings. Conclusion Biomarkers like C-reactive protein, lactate dehydrogenase and ferritin have shown significant clinical implications in effective management, monitoring, and assessment of the severity of disease in COVID- 19 patients. Simple and cost-effective markers like CRP, LDH, HbA1c could be used for monitoring the severity of COVID-19 infection.

Adenosine deaminase activity in type 2 diabetes mellitus: does it have any role?

BACKGROUND: Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underused, producing hyperglycemia. Diabetic patients are prone to opportunistic infection, thus serum ADA levels in these patients is very important as a screening test for Tuberculosis and autoimmune diseases. Thus, the present study was conducted to estimate the Serum ADA activity, glycated Haemoglobin (HbA1c), fasting and postprandial glucose level in patients with T2DM and to correlate the serum level of ADA with glycated Hemoglobin (HbA1c), fasting and postprandial glucose level in T2DM. METHODS: This is a Hospital based cross-sectional study done in BPKIHs, Dharan, Nepal. 204 diagnosed patients (102 males and 102 females) with T2DM and 102 healthy controls were enrolled in the study. Diabetic patients were categorized into Uncontrolled and Controlled Diabetes on the basis of HbA1C; HbA1c > 7% = Uncontrolled Diabetes, HbA1c < 7% = Controlled Diabetes. RESULTS: Serum ADA levels (U/L) was significantly raised in Uncontrolled Diabetic patients (49.24 ± 16.89) compared to controlled population (35.74 ± 16.78) and healthy controls (10.55 ± 2.20), p value < 0.001. A significant positive correlation was obtained between Serum ADA and HbA1c, Fasting Plasma Glucose and Post-prandial Glucose respectively. CONCLUSION: There is a significant increase in Serum ADA activity in DM with increase in HbA1c levels which may play an important role in predicting the glycemic and immunological status in these patients.

A Study of Occupational Characteristics and their Association with Cardiovascular Disease among Industrial Workers in Eastern Nepal.

Background An understanding of occupational characteristics of a worker is essential to establish policies, legislation in order to protect the health of the worker. The concept of Occupational Safety and Health is in initial stage in our country. Work-related cardiovascular disease (CVD) is caused by occupational factors that increase the oxygen requirements of the heart or decrease the capacity of the heart to use oxygen. It can be very difficult to link a specific work-related exposure to the development of cardiovascular disease in an individual person. This is because of issues of latency, multiple possible risk factors, lack of specific work-related features and various factors that influence diagnosis. Objective To study occupational characteristics and their association with cardiovascular disease among relatively young male industrial workers between 20-59 years of age in Sunsari-Morang industrial corridor of Eastern Nepal. Method A cross sectional study was conducted among men between 20 -59 years of age in two randomly selected industries in the Sunsari-Morang corridor of Eastern Nepal from July 2012 to July 2013. The data was collected using a pre-tested semi-structured questionnaire. Systematic random sampling was done to select the required number of samples. Chi-square and Fisher Exact tests were used. Crude and adjusted analyses were done. Result Majority (85%) were day shift workers. About 40% of the workers worked for 70-80 hrs/week. Most of them have stress sometimes at work. Noise was experienced by 40.9% of the workers. Earplug was used by only 5% of the workers. Hypertriglyceridaemia was seen in 49.3% of the workers. Long working hours, not using earplug and financial stress were seen to be associated with cardiovascular disease on bi-variate analysis. However, only earplug was significant in multivariate analysis. Conclusion Risk of cardiovascular disease was seen more among those who worked for more hours; those who did not use earplug and those who had financial stress. The results need further exploration to establish a causal association between occupational characteristics of the workers and cardiovascular disease in industrial set-up of eastern Nepal.

Predicting outcomes in acute coronary syndrome using biochemical markers.

OBJECTIVES: To assess risk prediction in patients with acute coronary syndrome (ACS) during the hospital stay, at 6 weeks and at 6 months period using high sensitivity C-reactive protein (hs-CRP), serum creatinine, cardiac troponin I, creatine kinase total, and MB levels. METHODS: It was a prospective observational study. The primary outcome was taken as all-cause mortality. Patients with ACS were enrolled and followed up at 6 weeks and 6 months duration from the index event. Mortality and cause of death were recorded. The hs-CRP was estimated on admission, at 6 weeks, and at 6 months. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated modification of diet in renal disease (MDRD) formula at admission, at 6 weeks, and 6 months. RESULTS: There were a total of 108 cases of ACS in the duration of 6 months who completed the follow-up. The hs-CRP level of >5mg/dl was highly significant for predicting mortality during hospital stay and at 6 weeks (p<0.001). There was 11% of in-hospital mortality (p<0.001). At 6 months, the overall mortality was 28% (p<0.001). There was a statistical significance with low eGFR (median eGFR 45ml/min/1.73m(2)) levels during the admission. CONCLUSION: hs-CRP levels above 5mg/dl and the eGFR levels ≤30ml/min/1.73m(2) were significant in predicting mortality of the patients with ACS. This may provide simple assessment tools for predicting outcome in ACS in resource-poor settings if validated further.

Effect of Teachers Training Workshop Outcomes on Real Classroom Situations of Undergraduate Medical Students.

BACKGROUND: Faculty development by conducting regular training, workshops and research related to medical education has been a key feature to upgrade quality of medical education. OBJECTIVE: The aim of this study was to explore responses of the health science teachers, students and peers after the workshop after providing training on student assessment tools and teaching-learning methods. METHOD: Two teacher-training workshops were conducted to the faculty members of B.P. Koirala Institute of Health Sciences from the departments of basic, clinical and allied sciences in Oct. 2010 and Jan. 2011. Qualitative questionnaire based study was conducted, and the questions were validated before the study by expert peer review process. The effect of the training workshop in real classroom outcomes was assessed incorporating student's feedback, evaluation by peers and the self-evaluation by the teacher trainees. RESULT: Pre-test and post-test scores of the participating teachers, before and after the workshop were 62.53 and 71.17 respectively. Among the participants 90.3% teachers expressed enhanced in their role as a teacher for medical undergraduates after the workshop. CONCLUSION: In present study, the faculty members showed accrued interest to participate in teacher's training workshops. The peer evaluation of teacher's performance in their real classroom situations were rated higher than evaluation by the students. Therefore, such training workshops will have a greater impact on the ability of teachers in effective teaching in real classroom situations.

Iodized Salt Use and Salt Iodine Content among Household Salts from Six Districts of Eastern Nepal.

BACKGROUND: Universal salt iodization is considered the best strategy for controlling iodine deficiency disorders in Nepal. This study was done to find iodized salt use among Nepalese population and the iodine content of household salts. METHODS: Six districts (Siraha, Saptari, Jhapa, Udayapur, Ilam and Panchthar) were chosen randomly from 16 districts of eastern Nepal for the study. In each district, three schools (private and government) were chosen randomly for sample collection. A total of 1803 salt samples were collected from schools of those districts. For sample collection a clean air tight plastic pouch was provided to each school child and was asked to bring approximately 15 gm of their kitchen salt. The information about type of salt used; 'two child logo' iodized salt or crystal salt was obtained from each child and salt iodine content was estimated using iodometric titration. RESULTS: At the time of study, 85% (n=1533) of Nepalese households were found to use iodized salt whereas 15% (n=270) used crystal salt. The mean iodine content in iodized and crystal salt was 40.8±12.35 ppm and 18.43±11.49 ppm respectively. There was significant difference between iodized and crystal salts use and salt iodine content of iodized and crystal salt among different districts (p value <0.001 at confidence level of 95%). Of the total samples, only 169 samples (9.4% of samples) have iodine content<15 ppm. CONCLUSIONS: Most Nepalese households have access to iodized salt most salt samples have sufficient iodine content.

Status of iron, oxidant and antioxidants in chronic type 2 diabetes mellitus patients.

Diabetes mellitus is a common health problem of the world. Iron may be a part of the cause of the disease and its complications. Iron is a trace element which produces reactive oxygen species (ROS) participating through Fenton reaction and that ROS may be a cause to produce oxidative stress and further diabetic complications. The study aims to access the iron and its effect in producing oxidative stress in type 2 diabetic patients. Serum iron, total iron binding capacity (TIBC) and percentage transferrin saturation are calculated as the index of iron. Malondialdehyde (MDA) is estimated as index of oxidant and vitamin C, vitamin E are measured as index of antioxidants. This is a case control study conducted in the department of Biochemistry in collaboration with department of Medicine at B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. 52 chronic type 2 diabetes mellitus patients and 52 age and sex matched normal healthy controls were included in the study. Plasma iron, TIBC, percentage transferrin saturation were found (89.14±30.50 µg/dL), (266.78±48.80 µg/dL), (36.61±14.31%) in diabetic cases as compared to (83.98±24.19 µg/dL), (279.08±40.23 µg/dL), (31.05±10.98%) of healthy controls. A significant increase in MDA level (6.35±1.52 nmol/ml in cases and 4.18±1.12 nmol/ml in controls, p<0.001) and significant decrease in vitamin C (0.85±0.19 mg/dL in cases and 1.28±0.21 mg/dL in controls, p<0.001) and vitamin E (0.85±0.25 mg/dL in cases and 1.34±0.38 mg/dL in controls, p<0.001) were observed.

Spectrum of thyroid dysfunction in patients visiting Kantipur Hospital, Kathmandu, Nepal.

Thyroid disorder is most common endocrine abnormality in the general population and its prevalence increases with age. The screening of thyroid disorder is advised in high risk population. This hospital based cross-sectional study was conducted in Department of Biochemistry, Kantipur Hospital, Kathmandu, Nepal. Patients having complains of thyroid disease from February 2010 to January 2011 were enrolled in this study. Thyroid parameters such as FT3, FT4 and TSH were measured by ELISA technique. Among total 472 subjects 393(83.27%) were female whereas 79(16.73%) were male. The prevalence of thyroid dysfunction was 36.0% (n=170). The different patterns of thyroid dysfunction in Kathmandu valley were: hypothyroid (11.6%), subclinical hypothyroid (16.9%), hyperthyroid (4.0%), and subclinical hyperthyroid (3.6%) respectively. Subjects having all thyroid parameters normal i.e. euthyroid were 63.9%. In conclusion, this study reveals a higher prevalence of thyroid dysfunction in Kathmandu region. This study recommends community based nationwide epidemiological studies on a regular basis to monitor thyroid dysfunction in Nepalese populations.

Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis.

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis.

Pattern of dyslipidemia and evaluation of non-HDL cholesterol as a marker of risk factor for cardiovascular disease in type 2 diabetes mellitus.

People with type 2 Diabetes have an elevated risk for developing cardiovascular disease (CVD) for which dyslipidemia is the major contributor. Diabetic patients have characteristic pattern of dyslipidemia with decreased level of high density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TG) level. However, in diabetes mellitus, low density lipoprotein cholesterol (LDL-C) which is used as one of the markers for the risk of CVD, is underestimated so in such cases the levels of non-High density lipoprotein cholesterol (non-HDL-C) can be a stronger predictor of CVD as it strongly correlates with atherogenic lipoproteins. Therefore, an attempt has been made to evaluate the level of non-HDL-C as a newer marker for the risk of cardiovascular disease and to find out the pattern of dyslipidemia in diabetes mellitus. The present study comprised of 82 type 2 Diabetic cases and 81 non-diabetic controls. Among the diabetics, the majority of the subjects (61.0%) were HDL-C dyslipidemic. However, among the controls, the maximum numbers of individuals (40.7%) were TG dyslipidemic. Diabetics have significantly elevated ratio of total cholesterol to high density lipoprotein cholesterol (TC/HDL-C) and the significant increased levels of non-high density lipoprotein cholesterol (non-HDL-C) compared to controls which can be used as markers of dyslipidemia and can also be used to predict the risk of cardiovascular disease in type 2 Diabetes Mellitus.

Hyperglycemia, glucose intolerance, hypertension and socioeconomic position in eastern Nepal.

Abstract. The present study was undertaken to evaluate differences between urban and rural Nepali populations in terms of hyperglycemia, socioeconomic position (SEP) and hypertension, through a community based survey in Sunsari District, eastern Nepal. Blood glucose levels were measured in participants (N = 2,006) S30 years old from urban and rural communities and were classified according to WHO criteria (1998) into normoglycemia (NGY), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and hyperglycemia (HGY). SEP was assessed by structured health interview along with anthropometric measurements and behavioral variables. Hypertension was classified per Joint National Committee (JNC-VII) criteria. Ten point three percent and 11.9% of subjects in this survey (13.3% urban and 11.0% rural) gave a family history and personal history of diabetes mellitus, respectively. Of urban participants (n = 736) with no history of diabetes 70 (9.5%) had HGY and 143 (19.4%) had glucose intolerance (IFG and IGT). Of rural participants (n = 1,270) 114 (9.0%) had HGY and 176 (13.9%) had glucose intolerance. There was an increasing trend in numbers of cases of hyperglycemia and intolerance with increasing age (chi2 198.2, p < 0.001), body mass index (BMI) (chi2 35.1, p < 0.001), SEP (chi2 48.5, p < 0.001) and hypertension (chi2 130.6, p < 0.001). Rural participants had a lower odds ratio [0.706; 95% confidence interval (CI) 0.455-1.096] of having hyperglycemia than urban participants. Individuals with medium and higher SEP had a lower odds ratio (0.878; CI 0.543-1.868) and higher odds ratio (1.405; CI 0.798-2.474), respectively, compared to individuals with lower SEP of having HGY. Both urban and rural populations are at risk for hyperglycemia and glucose intolerance. Individuals having a medium SEP had lower risk of diabetes mellitus than individuals from lower and higher SEP.

Association of serum LDL cholesterol level with periodontitis among patients visiting a tertiary-care hospital.

INTRODUCTION: High low-density lipoproteins (LDL) cholesterol is one of the major risk factors for cardiovascular disease. In recent years, some evidence has been presented that periodontitis, an infectious inflammatory condition of the periodontium, is associated with an increased risk of cardiovascular disease. To further elucidate this association, we have studied the levels of LDL cholesterol, a known risk marker for cardiovascular disease, in a periodontally-diseased group. METHODS: The levels of serum LDL cholesterol in 47 subjects with mild to severe (clinical attachment loss equal to or greater than 1 mm) chronic generalized (at least 30% of teeth affected) periodontitis with the mean age of 42.21 ± 1.46 years were measured and compared with those obtained from 42 age (39.83 ± 0.94) and sex matched controls. Both groups were free from systemic illnesses. RESULTS: The mean serum LDL cholesterol in periodontitis patients was found to be significantly higher (P < 0.001) as compared to that of the controls. The mean clinical attachment loss was positively correlated with serum LDL cholesterol (P < 0.01) and gingival index (P<0.05). The frequency of persons with pathologic values of LDL cholesterol was significantly higher in periodontitis patients compared with that of the controls. CONCLUSIONS: These results showed that high serum LDL cholesterol may be associated with periodontitis in healthy people. However, it is unclear whether periodontitis causes an increase in the levels of serum LDL or an increased LDL is a risk factor for both periodontitis and cardiovascular disease.

Effectiveness of teachers' training in assessment techniques: participants' perception.

BACKGROUND: Medical education has experienced a rapidly changing scenario especially during the past three decades. Teachers training programs have emerged in recent years as a more in depth and comprehensive mechanisms for strengthening instructional skills and formulating assessment techniques among faculty members. OBJECTIVE: The present study was carried out with the aim of assessing effectiveness of teacher training workshop on assessment techniques at B.P. Koirala Institute of Health sciences (BPKIHS), Dharan, Nepal. Methods: In this prospective questionnaire based study, the 26 entry level teachers were enrolled. They were requested to fill the questionnaire before and after the workshop on the assessment techniques at BPKIHS, Dharan. METHODS: Twenty six teachers majority of whom were entry level teachers comprising of medical, dental, nursing and allied sciences participated in pre- and post test analysis on the various components of written and oral examinations. A two and half days long training was conducted having 9 hours of teaching interactive sessions, 6 hours of group exercises, daily evaluation and 3 hours of presentation by participants. There was high degree of agreement with most topics of the assessment training. RESULTS: There was a significant gain in knowledge (p < 0.001) by the participants. All the participants (100%) agreed upon the training being informative and learned new things about assessment. More practice session with longer duration with invited resource persons were also suggested for an effective session. CONCLUSION: Thereis an immense opportunity for a better and comprehensive training in evaluation techniques in medical education..

Preparing tutors for problem-based learning: an experience from B. P. Koirala Institute of Health Sciences, Nepal.

BACKGROUND: Problem based learning (PBL) has made major impact on curricular designing and practice in medical education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and opportunity for both educationists on how to impart change and medical teachers on how to internalise the change. OBJECTIVES: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. MATERIALS AND METHODS: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and Post-test question were taken from various topics relevant to PBL such as learning strategy and principles of adult learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants' perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the questionnaire. RESULTS: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and update with new trends and tools in PBL. CONCLUSION: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies in PBL.

Subclinical hypothyroidism in eastern Nepal: a hospital based study.

BACKGROUND: Subclinical hypothyroidism itself is associated with serious complications and also there is a known risk of subclinical hypothyroidism patients getting converted into overt disease. OBJECTIVES: The objective of the present study was to fi nd out the prevalence of subclinical hypothyroidism in the suspected cases i.e. amongst the cases attending the thyroid laboratory at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. MATERIALS AND METHODS: It was a retrospective cross sectional study. Data of the free T3, free T4 and TSH estimations of the year 2007 of the Thyroid lab at BPKIHS, Dharan, Nepal was analyzed. ELISA based free T3, free T4 and TSH tests in the serum had been performed in all the cases. RESULTS: Total cases were 1714 including 24.446% males and 75.554% females. Cases with raised TSH levels were 26.021%, cases with normal TSH levels were 54.66% and cases with low TSH levels were 19.316%. Total 350 cases (20.42 %) had subclinical hypothyroid dysfunction which includes 84 (4.901 %) males and 266 (15.519%) females. And the maximum percentage of cases in either gender was between the age groups 20 -59 years. CONCLUSION: The prevalence of subclinical thyroid hypothyroidism amongst the suspected cases was 20.42 % which is much higher compared to the other parts of the world. The highest percentage was found in the female age group 20 - 59 years. The routine screening of the whole population is not cost effective and on the basis of the present study it is suggested that there may be routine screening of the selected populations, especially women between 20 to 59 years of age in Nepal region. The preferred screening method advised is a sensitive ELISA based TSH test.

Assessment of iodine nutrition status among school age children of Nepal by urinary iodine assay.

The present study was undertaken to evaluate the iodine status of Nepalese school age children by measuring urinary iodine excretion (UIE). A population based cross-sectional study was conducted during November-December 2006 among 1,094 school age children. Spot urine samples were collected from all children and UIE was measured during February to March 2007 by an ammonium persulfate digestion microplate (APDM) method. The median UIE at the national level was 193.10 microg/l, indicating adequate iodine intake in Nepalese schoolchildren. The proportion of the population having UIE below 50 microg/l and below 100 microg/l were 4.5% and 22.0%, respectively. Determination of precision of the method was done following calculation of the inter- and intra-assay coefficient of variation (CV). At low, medium and high concentrations of urinary iodine the intra-assay CVs were 6.3, 1.8 and 1.9%, respectively. The inter-assay CVs for low, medium and high concentrations of urinary iodine were 11.9, 4.9 and 6.2%, respectively. Therefore, current iodine nutrition status is at satisfactory levels in Nepal. An effective monitoring program must be continued to ensure optimal iodine status and prevent the population from developing iodine deficiency disorder (IDD).

Plasma and aqueous humur ascorbic acid levels in people with cataract from diverse geographical regions of Nepal.

Ascorbic acid in aqueous humor of the eye has a role as an antioxidant in delaying cataract formation. In a cross-sectional comparative study, ascorbic acid levels from aqueous humor and venous blood obtained from patients with cataracts in mountainous regions (1,300-2,000 meters) and subtropical lowlands (<100 meters) of Nepal were measured spectrophotometrically with the objective of comparing the levels of aqueous humor ascorbic acid in patients with cataracts from these two diverse geographical regions. Of 131 patients included in the study, 59 were from the mountainous region of Nepal (Group A) and 72 were from the subtropical lowlands (Group B). The mean (+/- SD) plasma ascorbic acid level (mg%) of the subjects in Group A was 0.65 (+/- 0.20) and Group B was 0.85 (+/- 0.31). The aqueous ascorbic acid levels ranged from 12-28 mg % (mean +/-SD = 17.5+/-4.52) and 14-50 mg % (mean +/-SD =23.47+/-8.66) in Groups A and B, respectively. The difference of the plasma and aqueous humor ascorbic acid levels between the two groups was statistically significant (p<0.01). The plasma and aqueous humor ascorbic acid levels in the people with cataracts from the mountainous region of Nepal were significantly lower than those from subtropical lowlands. This may be because of the effect of high altitude and ultraviolet rays on ascorbic acid metabolism.

Oxidative stress in benign prostate hyperplasia.

Benign Prostate Hyperplasia (BPH) is the common health problem in ageing male. Free radicals and reactive oxygen species (ROS) are produced more with advancement of age leads to oxidative stress. This study aims to assess Malondialdehyde (MDA), the marker of lipid peroxidation and vitaminic antioxidants e.g. alpha-Tocopherol (Toc) and Ascorbate (Asc) status in plasma of BPH patients. This is a case control study conducted in Department of Biochemistry in collaboration with Dept of Surgery, BPKIHS. Forty eight (n = 48) confirmed patients of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA, Asc and alpha-Toc were estimated. Plasma MDA level showed 4.81 +/- 1.87 nmol/ml in BPH patients compared to 3.69 +/- 1.56 nmol/ml in healthy controls (p < 0.001). There were significant decrease in plasma alpha-Toc and Asc level which were 0.85 +/- 0.12 mg/dl and 0.93 +/- 0.13 mg/dl in BPH patients compared to 1.37 +/- 0.31 mg/dl and 1.44 +/- 0.38 mg/dl in healthy controls respectively. Inverse correlation of plasma MDA with a- Toc (r = -0.09) and Asc (r = -0.51) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.