The global pandemic due to coronavirus disease 2019 (COVID-19) has posed an overall threat to modern medicine. The course of the disease is uncertain with varying forms of presentation that cannot be ...managed solely with clinical skills and vigor. Since its inception, laboratory medicine forms a backbone for the proper diagnosis, treatment, monitoring, and prediction of the severity of the disease. Clinical biochemistry, an integral component of laboratory medicine, has been an unsung hero in the disease prognosis and severity assessment in COVID-19. This review attempts to highlight the biomarkers which have shown a significant role and can be used in the identification, stratification, and prediction of disease severity in COVID-19 patients. It also highlights the basis of the use of these biomarkers in the disease course and their implications.
Pan Masala containing Tobacco (PMT) use contributes significantly to the overall world tobacco burden especially in south Asian country like Nepal. Oxidative stress caused by it may leads to ...cardiovascular disease, peripheral vascular disease, hypertension, etc. Therefore, this work proposes to study the antioxidant and oxidative stress along with cardiovascular morbidity in PMT users.
Hundred PMT users and 80 non-user controls with age and sex matched were enrolled. There was a significant difference in blood pressure, albumin, uric acid, vitamin C, vitamin E, malondialdehyde (MDA), total cholesterol, triglycerides, low density lipoprotein cholesterol between the two groups (p < 0.001). We observed statistically significant (p < 0.001) decrease in antioxidant and increase oxidative stress in PMT users. Duration and quantity of PMT user were significantly associated with the MDA level.
Objectives. Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of ...serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods. This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results. The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p<0.001). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol p=0.018 and serum cystatin C p<0.001 was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p=0.022), duration of T2DM (r = 0.326, p=0.021), and UACR (r = 0.528, p<0.001) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p<0.001). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion. Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.
Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in ...Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal.
It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories.
This review paper explores the application of Life Cycle Assessment (LCA) within the domain of civil engineering, aiming to provide a comprehensive overview of current research, methodologies, ...challenges, and future trends. LCA serves as a pivotal tool for assessing the environmental impact of infrastructure projects, yet gaps persist in its integration with socioeconomic dimensions, regional considerations, and dynamic modeling. By analyzing existing literature and scholarly discussions, this review identifies research gaps and proposes directions for enhancing the applicability and effectiveness of LCA in civil engineering. Moreover, it examines future trends such as the integration of advanced technologies, stakeholder engagement, and policy implementation, poised to shape the landscape of LCA practices in the civil engineering sector. Ultimately, this review paper contributes to the understanding of LCA's potential to drive sustainable decision-making in infrastructure development, paving the way for more informed and environmentally conscious practices.
Background. This study was carried out to establish the prevalence of cardiovascular risks such as hypertension, obesity, and diabetes in Eastern Nepal. This study also establishes the prevalence of ...metabolic syndrome (MS) and its relationships to these cardiovascular risk factors and lifestyle. Methods. 14,425 subjects aged 20–100 (mean 41.4 ± 15.1) were screened with a physical examination and blood tests. Both the International Diabetic Federation (IDF) and National Cholesterol Education Programme’s (NCEP) definitions for MS were used and compared. Results. 34% of the participants had hypertension, and 6.3% were diabetic. 28% were overweight, and 32% were obese. 22.5% of the participants had metabolic syndrome based on IDF criteria and 20.7% according to the NCEP definition. Prevalence was higher in the less educated, people working at home, and females. There was no significant correlation between the participants’ lifestyle factors and the prevalence of MS. Conclusion. The high incidence of dyslipidemia and abdominal obesity could be the major contributors to MS in Nepal. Education also appears to be related to the prevalence of MS. This study confirms the need to initiate appropriate treatment options for a condition which is highly prevalent in Eastern Nepal.
Aberrant iodine intake and thyroid autoimmunity affect thyroid function. Deficiencies of iodine including thyroid disorders have serious impact on child physical and mental development. This study ...was conducted to investigate iodine nutrition, thyroid function and thyroid autoimmunity in the Nepalese children, and explore the association of thyroidal autoimmunity with iodine nutrition and thyroid dysfunction.
Five schools from Udayapur district of eastern Nepal were selected for the study. A total of 213 school children aged 6-12 years were enrolled, and anthropometric data, urine samples and blood samples were collected. Urinary iodine concentration (UIC), free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and antithyroglobulin antibody (TgAb) was measured. Independent T test, Man-Whitney test, Chi-square test and Fisher's Exact test were used for testing statistical significance. Spearman's correlation analysis was done to find association between variables.
The median UIC with IQR, mean ± SD fT3, mean ± SD fT4, median TSH and TgAb with IQR was 150.0 μg/L (102.8; 204.0), 2.49 ± 0.83 pg/ml, 1.33 ± 0.42 ng/dl, 2.49 mIU/L (1.58; 4.29), and 21.40 IU/ml (15.54; 31.20) respectively. Elvated TgAb (≥30 IU/ml, thyroid autoimmune condition) was seen in 25.8% (
= 55) children. UIC was less than 100 μg/L in 17.4% (
= 37) of the children. Subclinical hypothyroidism, overt hypothyroidism and sublinical hyperthyroidism was seen in 1.4% (n = 3), 3.3% (
= 7) and 3.8% (
= 8) children respectively. A strong association of TgAb with UIC (r = - 0.210,
= 0.002) and thyroid hormones; fT3 (r = - 0.160,
= 0.019), fT4 (r = - 0.275,
< 0.001), and TSH (r = 0.296,
< 0.001) was seen. The relative risk for thyroid autoimmunity in children with UIC less than 100 μg/L was 1.784 (95% CI: 1.108-2.871,
= 0.024). Similarly, children with thyroid autoimmunity had higher relative risk 7.469 (95% CI: 2.790-19.995,
< 0.001) for thyroid dysfunction.
School children of eastern Nepal have adequate iodine nutrition. Thyroid autoimmunity is very common, while thyroid dysfunction is sparse in children. An association of thyroid autoimmunity with iodine nutrition and thyroid dysfunction was seen in children.
Objectives. To assess thyroid function and associated risk factors in Nepalese diabetes mellitus patients. Methods. A cross-sectional study was carried out among 419 diabetes mellitus patients at B. ...P. Koirala Institute of Health Sciences, Dharan, Nepal. Information on demographic and anthropometric variables and risk factors for thyroid dysfunction was collected. Blood samples were analysed to measure thyroid hormones, blood sugar, and lipid profile. Results. Prevalence rate of thyroid dysfunction was 36.03%, with subclinical hypothyroidism (26.5%) as the most common thyroid dysfunction. Thyroid dysfunction was much common in females (42.85%) compared to males (30.04%) p=0.008 and in type 1 diabetes (50%) compared to type 2 diabetes mellitus (35.41%) p=0.218. Diabetic patients with thyroid dysfunction had higher total cholesterol, HDL cholesterol, and LDL cholesterol in comparison to patients without thyroid dysfunction. Significant risk factors for thyroid dysfunction, specifically hypothyroidism (overt and subclinical), were smoking (relative risk of 2.56 with 95% CI (1.99–3.29, p<0.001)), family history of thyroid disease (relative risk of 2.57 with 95% CI (2.0–3.31, p<0.001)), and female gender (relative risk of 1.44 with 95% CI (1.09–1.91, p=0.01)). Conclusions. Thyroid dysfunction is common among Nepalese diabetic patients. Smoking, family history of thyroid disease, and female gender are significantly associated with thyroid dysfunction.
Oxidative stress and malnutrition are shown to have pathogenic effect in Chronic Obstructive Pulmonary Disease (COPD).
This study was done to assess the burden of oxidative stress in COPD and to ...determine its relation to their nutritional status.
In this cross-sectional study, 100 COPD cases from emergency and medical ward and meeting inclusion criteria, along with age, sex and occupation (mainly farmers, housewives and drivers) matched 100 controls without COPD and meeting inclusion criteria were enrolled. Oxidative stress was assessed by measuring lipid peroxidation product, Malondialdehyde (MDA) and antioxidants, like Vitamin C, E and Red Blood Cell Catalase (RBCC). Mini Nutritional Assessment (MNA) tool and Body Mass Index (BMI) were used to assess nutritional status.
Chi-square test was applied for categorical variable. Student t-test was applied for comparison of means. Analysis of Variance (ANOVA) was applied for comparison between groups followed by Bonferroni post hoc analysis. Pearson correlation method was used for quantitative variables. Statistical significance was defined as p< 0.05 (two tailed).
COPD cases had significantly high MDA level with low level of Vitamin E and catalase as compared to controls (p < 0.001). Most of the COPD cases were underweight (BMI ≤ 18.5 Kg/m(2)) and malnourished (MNA score less than 7). Bonferroni post-hoc analysis, showed significantly high burden of oxidative stress in underweight and malnourished cases as compared to normal weight (p < 0.05) among COPD cases. Highly significant correlation was seen between BMI and plasma MDA level (r = -0.27, p = 0.008) in COPD cases.
This study shows impaired oxidant/antioxidant balance along with malnutrition and underweight in COPD, which signals for considering antioxidant therapy along with nutritional management.
Spectrum of renal disease varies in different ethnic population, geographical location, and by environmental factors. The purpose of this study was to find out the clinical spectrum and occurrence of ...different pediatric renal diseases at a teaching hospital in the Eastern part of Nepal. All cases of renal diseases from one month to 15 years of age, attending the pediatric renal outpatient department and/or were admitted to the wards during the period of February 2012 to January 2013, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols. Renal diseases accounted to be 206 cases (6.9%) of total annual pediatric admissions, of which (58%) were male and (42%) female. Acute glomerulonephritis (AGN) was the most common disorder (37.7%) followed by nephrotic syndrome (26.1%), urinary tract infection (21.3%), acute kidney injury (AKI) (17.9%), obstructive uropathy (1.9%), chronic kidney disease (CKD) (1.2%), and others. In AGN group, the most common cause was post-infectious glomerulonephritis (PIGN) (32.9%) followed by lupus nephritis (4%) and Henoch-Schonlein purpura nephritis (0.8%). Urine culture was positive in (9.22%) and the most common organism was Escherichia coli (57.9%). The causes of AKI were urosepsis, septicemia, and AGN (18.9%) each, followed by dehydration (13.5%). Mortality was found in 5% of cases and the etiologies were AKI in (72.7%), PIGN (18.1%), and CKD (9%). Renal diseases are a significant problem among children and are one of the common causes of hospital admission. These patients need comprehensive services for early identification and management.
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