Madhab Lamsal

Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

BACKGROUND Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer, and it ranks among the top ten specific causes of death in males. OBJECTIVE To explore the situation of prostate cancer in a healthy population cohort in Eastern Nepal. MATERIALS AND METHODS This study was conducted in the Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010 to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in the study and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal. Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessment of serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormal PSA/DRE findings. RESULTS A total of 1,521 males more than 50 years of age were assessed and screened after meeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. Abnormal PSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were both abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%) and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% and a positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 19.0% CONCLUSIONS The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.

Thyroid Dysfunction and Associated Risk Factors among Nepalese Diabetes Mellitus Patients

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.

Urinary Iodine Excretion among Nepalese School Children in Terai Region

ObjectivesTo assess the current iodine status among school children in Terai region of Nepal.MethodsA cross sectional study was conducted in 2012 among the school children aged 6–12y in three Terai districts (Siraha, Saptari and Jhapa) of eastern Nepal. A total of 1105 casual urine samples were collected from children of different schools of above districts. Urinary iodine excretion was estimated using ammonium persulphate digestion method.ResultsThe median urinary iodine excretion in school children was 226.33μg/L (234.16μg/L, 229.25μg/L and 210.67μg/L in Siraha, Saptari and Jhapa districts respectively). About 12.7% (n = 140) children were found to be iodine deficient and 34.2% (n = 378) children had excessive iodine nutrition.ConclusionsThere was good improvement in iodine nutrition among children in Terai region, with a large part of population showing excessive iodine nutrition.

Anemia among school children in eastern Nepal

Anemia is one of the most common public health problems in developing countries like Nepal. This study was done to find the prevalence of anemia among the children aged 4-13 years in eastern Nepal. A cross-sectional study was conducted in 2012 in four districts (Morang, Udayapur, Bhojpur and Ilam) of eastern Nepal to find the prevalence of anemia among the school children of eastern Nepal. Children aged 4-13 years were selected randomly from different schools of above districts and 618 venous blood samples were collected. Hemoglobin level was estimated by using cyanmethemoglobin method. The mean hemoglobin level was 12.2 ± 1.82 gm/dl. About 37.9% (n = 234) children were found anemic. Anemia prevalence was 42.4% (n = 78), 31.6% (n = 60), 45.3% (n = 48) and 34.8% (n = 48) among school children of Morang, Udayapur, Bhojpur and Ilam district, respectively. The study finds anemia as a significant health problem among the school children of eastern Nepal.

Household salt iodine content estimation with the use of rapid test kits and iodometric titration methods.

BACKGROUND Universal salt iodization remains the best strategy for controlling iodine deficiency disorders in Nepal. AIMS This study was designed to study the salt types and the household salt iodine content of school aged children in the hilly and the plain districts of eastern Nepal. MATERIAL AND METHODS This cross-sectional study was carried out on school children of seven randomly chosen schools from four districts, namely, Sunsari, Dhankuta, Sankhuwasabha and Tehrathum of eastern Nepal. The school children were requested to bring two teaspoonfuls (approx. 12-15 g) of the salt which was consumed in their households, in a tightly sealed plastic pouch. The salt types were categorized, and the salt iodine content was estimated by using rapid test kits and iodometric titrations. The association of the salt iodine content of the different districts were tested by using the Chi-square test. The sensitivity, specificity, positive predictive values, and negative predictive values of the rapid test kits were compared with the iodometric titrations. RESULTS Our study showed that mean±SD values of the salt iodine content in the four districts, namely, Sunsari, Dhankuta, Sankhuwasabha and Tehrathum were 34.2±17.9, 33.2±14.5, 27.4±15.1 and 48.4±15.6 parts per million (ppm). There were 270 (38.2%) households which consumed crystal salt and 437(61.8%) of the households consumed packet salts. CONCLUSIONS Our study recommends a regular monitoring of the salt iodization programs in these regions. More families should be made aware of the need to ensure that each individual consumes iodized salt.

Adenosine deaminase activity in sera of patients with visceral leishmaniasis in Nepal.

This longitudinal study was conducted in BP Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal, between May 2001 and December 2001. The main objective of the study was to identify the role of adenosine deaminase (ADA) activity in patients with visceral leishmaniasis (VL) for management. There was a significant increase in mean ADA activity in sera of 49 patients with VL (323.71±184.51 IU/L) compared with 50 samples of control groups (47.11±24.94 IU/L) from the same endemic area (P<0.001). ADA activities were found to be significantly decreased (50.35±41.35 IU/L) in follow-up cases (n = 19) after 30 days with sodium stibogluconate treatment at a dose of 20 mg/kg/day intramuscularly. The fall in the level of ADA (after treatment) in follow-up cases correlated with the cure of disease, as evident from improvement of vital signs and symptoms and the absence of Leishmania donavani bodies in the sera. The study therefore suggests the possibility of using human serum ADA as a convenient marker to evaluate the diagnosis of VL to support the clinical findings, especially in those settings where there is a lack of highly qualified personnel and diagnostic facilities.

Non-enzymatic Antioxidant Status and Biochemical Parameters in the Consumers of Pan Masala Containing Tobacco

BACKGROUND Tobacco consumption is one of the leading causes of oral submucous fibrosis, oral cancer and even premature death. The present study was designed to compare the biochemical parameters and non- enzymatic antioxidant status and the lipid peroxidation products in pan masala tobacco users as compared with age-matched non-user controls. METHODS Pan masala and tobacco users of age 33.2±9.94 years and age-matched controls (31.2±4.73 years) were enrolled for the study. Plasma levels of vitamin E, vitamin C, albumin, bilirubin, uric acid, glucose, urea, creatinine, aspartate amino transferase (AST), alanine amino transferase (ALT) were measured by standard methods. Serum malondialdehyde (MDA) levels were estimated as a measure of lipid peroxidation. RESULTS In the pan masala tobacco users, as compared to the controls, the level of vitamin C (68.5±5.9 vs 97.9±9.03 μmol/L, p≤0.05) vitamin E (18.4±5.3 vs 97.9±9.03 μmol/L, p≤0.001), albumin (37.5±7.01 vs 44.3±9.99 g/L, p≤0.001), and malondialdehyde (10.8±1.29 vs 1.72±1.15 nmol/ml, p≤0.001 ) were found to be significantly altered. Malondialdehyde was significantly correlated with vitamin E (r=1.00, p<0.001) and vitamin C (r =1.00, p<0.001) in pan masala tobacco users. Serum levels of AST (31.0±16.77 IU) and ALT (36.7±31.3 IU) in the pan masala tobacco users were significantly raised as compared to the controls (AST, 25.2±9.51 IU, p=0.038; ALT, 26.2±17.9 IU, p=0.038). CONCLUSION These findings suggest that pan masala tobacco users are in a state of oxidative stress promoting cellular damage. Non-enzymatic antioxidants are depleted in pan masala tobacco users with subsequent alteration in the biochemical parameters. Supplementation of antioxidants may prevent oxidative damage in pan masala tobacco users.

Thyroid function testing in eastern Nepal and the impact of CME on subsequent requests.

This study reveals 1 years experience of the introduction of thyroid function tests (TFT) in B P Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal. These were performed on the advice of doctors working in this region. The rational TFT advice by the medical practitioners was evaluated according to how closely the advice was in line with the algorithms recommended in the textbooks. Only about 14% of the TFT advice followed some rational strategy. A retrospective analysis showed that rational TFT advice could have reduced the cost of a TFT investigation to 43.11% without altering the patient management and disease outcome. Continuing medical education (CME) lectures arranged for a limited number of doctors were found to improve the quality of the subsequent TFT advising pattern. This emphasizes the importance of CME while introducing a costly laboratory test panel (e.g. TFT, lipid profile) needing a strategic approach.

Cardiovascular Risk Factors in Subclinical Hypothyroidism: A Case Control Study in Nepalese Population.

Objectives. To assess cardiovascular risk factors in Nepalese population with subclinical hypothyroidism as compared to age and sex matched controls. Materials and Methods. A case control study was conducted among 200 subjects (100 subclinical hypothyroid and 100 euthyroid) at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Demographic and anthropometric variables including systolic and diastolic blood pressure (BP) were taken. Blood samples were assayed for serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and high sensitivity C reactive protein (hs-CRP). Results. Subclinical hypothyroid patients had significantly higher diastolic BP, total cholesterol, LDL cholesterol, and hs-CRP than controls. The odds ratio of having hypercholesterolemia (>200 mg/dL), low HDL cholesterol (<40 mg/dL), undesirable LDL-cholesterol (>100 mg/dL), high hs-CRP (>1 mg/L), and high diastolic BP (>80 mmHg) and being overweight (BMI ≥ 23 Kg/m2) in subclinical hypothyroidism was 2.29 (95% CI; 1.2–4.38, p = 0.011), 1.73 (95% CI; 0.82–3.62, p = 0.141), 3.04 (95% CI; 1.66–5.56, p < 0.001), 2.02 (95% CI; 1.12–3.64, p = 0.018), 3.35 (95% CI; 1.72–6.55, p < 0.001), and 0.9 (95% CI; 0.48–1.67, p = 0.753), respectively, as compared to controls. Conclusion. Subclinical hypothyroid patients are associated with higher risk for cardiovascular disease than euthyroid subjects.

The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal

Aim: C-reactive protein (CRP) is a commonly used biomarker of sepsis, the leading cause of mortality in Intensive Care Units (ICUs). However, sufficient data are still lacking to strongly recommend it in clinical practice. The present study is aimed to find out its reliability in diagnosing sepsis. Materials and Methods: CRP was measured in ICU-admitted patients with systemic inflammatory response syndrome and compared using a cutoff of 50 mg/L with the gold standard for diagnosing sepsis, taken as isolation of organism from a suspected source of infection or the Centers for Disease Control criteria for clinical sepsis. Results: CRP had a sensitivity and specificity of 84.3% and 46.15%, respectively. Area under the receiver operating characteristics curve was calculated to be 0.683 (±0.153, P < 0.05). The cutoff value with the best diagnostic accuracy was found to be 61 mg/L. Conclusion: CRP is a sensitive marker of sepsis, but it is not specific.