Nepali Translation and Reliability Analysis of Quantitative Androgen Deficiency in the Aging Male Questionnaire.

Background Androgen deficiency is diagnosed on the basis of clinical symptoms and laboratory assessment of testosterone level. Different screening tools have been developed to evaluate the sign and symptoms. Objective In this study, we examine the validity and reliability of the Nepali version of the quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire to screen androgen deficiency in Nepali male. Method English dialectal quantitative Androgen Deficiency in Aging Male questionnaire was forward translated to Nepali version and backward translated. This version was reviewed by a panel of an endocrinologist, a clinical psychiatrist, a physician, and a clinical biochemist. A final Nepali version of qADAM was developed. Thirty-one healthy male aged 31-70 years were administered with the questionnaire in two separate occasions two weeks apart. Cronbach's alpha and test-retest reliability were calculated to identify validity and reliability, respectively. Result In the Nepali translated questionnaire, Cronbach's alpha for internal consistency from ten items is good (0.68). The Cronbach's alpha for internal consistency from nine items without item 7 is 0.706. Seven out of ten items had an R-value of > 0.7. In the total sample, Standard Error Mean (SEM) ranged from 0.00-0.44 for qADAM. SEM% are low for all variables (0.00-11.20%). MDC95 ranged 0.00-1.234. MDC95% ranged 0.00 - 31.05% and was < 30% for majority of variables (90%). Conclusion The final translated Nepali questionnaire seems reliable and valid. A future study measuring the Nepali questionnaire with testosterone level and another biochemical test in control and androgen deficiency patients will help validate the questionnaire.

Microalbuminuria as a Predictor of Pre-eclampsia in Pregnant Women Presenting in the Antenatal Clinic at Dhulikhel Hospital.

Background Pre-eclampsia is described as a pregnancy-specific syndrome that can affect virtually every organ system. The appearance of proteinuria remains an important diagnostic criterion. Proteinuria is an objective marker and reflects system-wide endothelial leak, which characterizes the pre-eclampsia syndrome. Objective To determine protein values using the spot urinary albumin/creatinine ratio amongst the pregnant women and to identify whether this test can be used as the investigation of choice for predicting pre-eclampsia in near future. Method A hospital based observational cross-sectional study conducted from February 2016 to August 2017. The study included pregnant women from 20-28 weeks of gestation. They were tested for spot urinary albumin and creatinine. They were all followed up till term, delivery and post partum. Result The mean age of the study patients was 28 years (N+335), the most common age group being 25 to 29 years (43.6%). Pregnant women with higher values of urinary albumin/creatinine ratio were found to develop hypertension compared to women with normal values of urinary albumin/creatinine ratio in the third trimester with insignificant difference (p < 0.283) statistically. Conclusion Microalbuminuria is one of the predictor of pre-eclampsia however it cannot be used as routine investigation for predicting pre-eclampsia in future; further studies in large scales are needed to prove whether urinary albumin/creatinine ratio can be utilized as predictor for pre-eclampsia or not.

Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study.

Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson's correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors.

Health in Nepalese media.

BACKGROUND: Coverage of health in Nepali print media is quite a recent phenomenon despite readers' ample appetite for it. Dominated by politics, Nepal's print media has been marginally publishing news pieces, features, editorials and op-ed articles, photographs and cartoons on health, though marginally. But the media did not wake up to the issues of human resources for health until lately. METHODS: We content analysed the coverage of health issues including, human resources for health in select Nepali print media Kantipur, Nagarik and Annapurna Post of select three months in 2012 April, August and December. News pieces and their placements, Op-eds, editorials, features, letters to the editor, photos and cartoons were subjected to analysis. RESULTS: Over the study period, the papers covered 544 health news pieces, 44% of political news pieces. Health workforce news pieces contributed 24% to it. However, only 10% of the health news made to the front pages. Coverage of health in editorials, features, Op-eds, photographs, cartoons and letters to the editor is even more meager. For example, only 7% of the editorials are relating to health. CONCLUSIONS: Health is prioritized far less by the print media than politics despite the reader's appetite for it. Print media should give health a top priority, particularly in those areas that relate to health systems like human resources for health, for their massive impact on the lives of the people.

The ratio of aspartate aminotransferase to alanine aminotransferase (AST/ALT): the correlation of value with underlying severity of alcoholic liver disease.

BACKGROUND: Alcoholic liver disease is one of the most frequently diagnosed liver problems in the hospitalized patients in most tertiary care hospitals all over the world .The diagnosis of alcoholic liver disease is most of the time clinical. The AST/ALT ratio is a useful and reliable biochemical marker of liver injury due to alcohol. Whether the value of AST/ALT ratio correlates with clinical severity has not been studied. OBJECTIVES: To study values of AST/ALT ratio in correlation with clinical severity of illness due to alcoholic liver disease using Child-Pugh's grading. METHODS: This is a retrospective study. Inpatient records of all the patients admitted with diagnosis of alcoholic liver disease from July 2009 to 2011 June were analyzed. Data from 174 patients with the diagnosis of alcoholic liver disease-alcoholic hepatitis or alcoholic cirrhosis were retrieved; out of 174 patients, 138 were eligible for the study. The AST/ALT ratio and Child's grading of all the patients were calculated from the documented biochemical and clinical parameters on admission. Demographic profiles of all the patients were also recorded and analyzed. The data was analyzed using software SPPSS 16 version. RESULTS: A total of 138 patients diagnosed as alcoholic liver disease since July 2009 to June 2011 were analyzed. The male-female ratio was found to be 5.34: 1.The mean age of the patients at diagnosis was found to be 47.58 ± 12.83 years. Among 138 patients, Mongolians were found to have the highest prevalence of alcoholic liver disease (38.8%), followed by Newars ( 33.6%), Brahmin and Chhetri (19.1%) and Dalit (7.2%). With respect to AST/ALT ratio and Child's grading of ALD, the mean AST/ALT ratio was found to be 3.03 ± 2.24 in those patients who had Chlild's grade C; likewise the mean AST/ALT ratio was 2.28 ± 1.14, and 1.68 ± 0.83 in patients with Child B and Child A respectively. CONCLUSION: The higher value of AST/ALT ratio is indicative of more severe liver damage due to alcohol.

Variation of total serum cholesterol among the patient with thyroid dysfunction.

BACKGROUND: Thyroid hormone has its effect in the lipid metabolism. Thus, thyroid disorder is usually associated with the dyslipidaemia. Hypercholesterolemia is an established risk factor for the cardiovascular disease (CVD) and therefore in case of overt hypothyroidism which is associated with hypercholesterolemia, CVD is most likely to occur. OBJECTIVES: controversies still persist about the hypercholesterolemia and sub clinical hypothyroidism. Hence, we conducted our study to elucidate the relation of thyroid hormone with cholesterol in different thyroid disorder. MATERIAL AND METHOD: All patients suspected of thyroid disorder within a period of one year were included in the study and free thyroxine-3 (fT3), free thyroxine-4 fT4, Thyroid Stimulating Hormone (TSH) and total cholesterol (TC) in the serum were estimated. Statistical analysis was carried out by using SPSS. 13. RESULTS: Among the 169 cases, 32.5% of the patients were having thyroid disorder. In which 8.3% were of hypothyroid, 7.1% were of sub clinical hypothyroid, 8.3% were of hyperthyroid, 7.7% were of sub clinical hyperthyroid and 1.2% cases were of pan hypothyroid. We observed significant negative correlation between TC & fT3(r = -0.226, p = 0.003), significant negative correlation between total cholesterol & fT4(r = -0.197, p = 0.010) and significant positive correlation between TC & TSH(r = 0.365, p = 0.000). Total cholesterol was significantly raised in hypothyroidism (Mean ±SD 283 ± 53, p = 0.000) in comparison to euthyroid population (mean ±SD, 195 ± 58). But cholesterol was not significantly increased in sub clinical hypothyroidism (mean ±SD, 240 ± 46) CONCLUSION: Our results show that total cholesterol level in serum is affected by the blood thyroid hormone level. Therefore, screening for hypercholesterolemia could be useful in patients with hypothyroidism to reduce associated disease.

Microalbuminuria and macroalbuminuria in type 2 diabetes.

BACKGROUND: Type 2 diabetes is the leading cause of end stage renal disease worldwide. Prevalence of diabetic nephropathy (DN) varies in the different ethnic groups. Nepal is country with great ethnic diversity. This study has been done to find the prevalence of microalbuminuria and macroalbuminuria in the two ethnic groups Jyapu and Brahmin. METHODS: In our study we have included two ethnic groups Jyapu and Brahmin type 2 diabetic patients. INCLUSION CRITERIA: Age ≥ 30 years, clinically diagnosed type 2 diabetic patients. EXCLUSION CRITERIA: Patients with a history of urinary tract infection, hematuria, renal failure, intercaste marriage and women with menstruation at the time of sample collection. RESULTS: The overall prevalence of albuminuria was 49.05%. The prevalence of microalbuminuria was 35.89% in Jyapu and 37.73% in Brahmin which was comparable. There was significantly higher prevalence of macroalbuminuria in Jyapu 20.75% and Brahmin 3.77%. Association of dietary habit was seen with microalbuminuria and macroalbuminuria in both ethnic groups. CONCLUSIONS: The overall prevalence of albuminuria in type 2 diabetes of our study was high and there was significantly higher macroalbuminuria in Jyapu compared with Brahmin. It, therefore, predicts a higher risk of having kidney disease in Jyapu population.

Waist circumference and waist-hip ratio as predictors of type 2 diabetes mellitus in the Nepalese population of Kavre District.

The objective of the present study was to find out WHR and WC as predictor of Type 2 DM in the population of Kavre district of Nepal. Sixty-five "known type 2 diabetic" and Thirty-five "self-reported non-diabetic" subjects above thirty years of age were included in the present study. Height, Weight, Waist Circumference and Hip Circumference were recorded for every subject. BMI and WHR were calculated by the standard formula. The data was analyzed using SPSS Evaluation Version 15.0 and STATA Special Edition Version 8.2. Our results showed that the optimal cut-off values for WHR, WC. BMI and age in female are 0.87, 0.85 cms, 21.40 kg/m2 and 40 years respectively and for male the respective values are 0.96, 0.87 cms, 23.63 kg/m2 and 44 years. In female, age (82.9%) is the strongest predictor followed by WHR (78.1%), WC (70.2%) and least for BMI (55.0%) whereas for male WC (87.0%) is the strongest followed by WHR (81.6%), BMI (68.5%) and least: for age (6.4.6%) using Receiver Operating Characteristic (ROC) curves. Optimum sensitivity and specificity obtained from the ROC curves corresponded to these cutoff values and area under curve for their predictive ability. The current study showed that the WC and WHR are the best predictors of type 2 DM in both male and female population of Kavre district.