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.

Study of Prescription Pattern and Factors Associated with Clinical Outcomes in Type 2 Diabetes Mellitus with Reference to Short Term Glycemic Control.

Background Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Though oral hypoglycemic agents (OHAs) or/and insulin are prescribed to control the hyperglycemia, still glycemic control is not seen in most of the cases. Evaluating the treatment pattern including the glycemic control and associated factors are of utmost importance for better patient care. Objective To investigate the treatment pattern and short term glycemic control among Type 2 Diabetes Mellitus (DM2) patients and study the factors associated with it. Method Patients meeting the inclusion criteria with DM2 attending laboratory or Out-Patient Department or Emergency Department in Dhulikhel Hospital and patients who were admitted to the ward taking various OHAs and/or insulin at the time of data collection were considered. Informed consent was taken prior to the interview. The collected data was entered as well as analyzed using the SPSS (Statistical Package for Social Sciences) version 21.0 and the p-value <0.05 was considered statistically significant. Result Among the 118 patients, 50.8% of them were males. Majority (28%) of the patients belonged to the age group of 51-60 years. Out of the 118 patients, 22% had their fasting blood glucose (FBG) level under control whereas 78% had uncontrolled FBG level. Metformin was the most (28%) commonly prescribed drug. Significant association was found between gender; knowledge about disease and medication with short term glycemic control (p=0.034, p=0.004 ans p=0.039 respectively). Conclusion All the patients enrolled in this study were under various anti-diabetic medications, however, majority of them didn't have their glycemia under control. Significant association was found between FBG level and gender, knowledge about disease and knowledge about medication.

Medication Adherence to Levothyroxine Therapy among Hypothyroid Patients and their Clinical Outcomes with Special Reference to Thyroid Function Parameters.

Background Non-adherence to medication in hypothyroid patients leads to poor clinical outcome and increased health care costs. Study related to adherence to levothyroxine in hypothyroid patients is limited worldwide. Objective To determine the adherence pattern and factors affecting adherence in hypothyroid patients and compare the clinical outcomes among adherent and non-adherent patients. Method A cross-sectional study was conducted in Dhulikhel hospital, Kathmandu University hospital. Patients with hypothyroidism on levothyroxine fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 113 patients enrolled in this study, 85.8% of them were females. Majority (76.10%) of them belonged to the age group of 31-40 years. More than half (51.3%) of the patients were adherent to medication. Non-adherence was significantly associated with literate people following medication (p=0.003, OR=0.305), missed appointment to follow-up (p=0.007, OR=0.346) and longer duration of medication (p=0.019, OR=4.385). However, there was no statistically significant association of clinical outcomes with reference to TSH, fT4, fT3 and patients' age, adherence to medication and concomitant use of other drugs. Conclusion More than half of the patients were adhered to the Levothyroxine therapy. Forgetfulness was the main reason for missing the dose and non-specific reasons attributed to discontinuation of medication for these patients. Good adherence was seen among illiterate people. Treatment related factor, patient-provider relationship and patient related factor were determined as the major barrier to medication adherence. Most of the non-adherent patients had uncontrolled TSH.