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Jouslin K Baranwal,1 Robin Maskey,2 Rajendra K Chaudhari,1 Ojaswee Sherchand1 1Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal; 2Department of Internal Medicine, B.P Koirala Institute of Health Sciences, Dharan, NepalCorrespondence: Jouslin K Baranwal Department of BiochemistryB.P Koirala Institute of Health Sciences, Dharan, NepalEmail drjouslin.baranwal@bpkihs.eduBackground: Management of type 2 diabetes is not limited to blood glucose control, it also addresses blood pressure and lipid levels in order to prevent associated vascular complications and improve the chances of survival and quality-of-life. Although the American Diabetes Association (ADA) has lain specific target levels for glycated hemoglobin, blood pressure and serum low density cholesterol to be achieved by non-pregnant patients with type 2 diabetes mellitus, these are not being achieved in practice. We took on this study to describe the extent of ADA target achievement at our center.Methods: We analyzed data of type 2 diabetes patients who attended the endocrinology clinic at our hospital within the past 1 year from the start of the study. Data of the pregnant women and patients with mentions of conditions that might interfere with measurement of HbA1c were excluded.Results: We analyzed 336 records, 45.8% (n=154) males and 54.16% (n=182) females. The mean age of patients was 52.28± 11.9 years. The percentages of patients who had HbA1c < 7%, blood pressure < 140/90 mm of Hg, and LDL-c < 100 mg/dL were 56.5%, 72%, and 56.3%, respectively. Only 37.8% of patients were found to have achieved all three ADA targets. Our findings show that a higher percentage of patients who were ≥ 50 years of age met LDL-c goals as compared to those < 50 years of age, 61.9% vs 49% (P< 0.05) and that blood pressure control was better among younger age group, 78.9% vs 66.7% (P< 0.05).Conclusion: Our study highlights that a significant proportion of patients missed on achieving the ADA targets. This is worrisome and further studies should be done to find out possible reasons behind this.Keywords: type 2 diabetes mellitus, American Diabetes Association targets, Nepal

Introduction: Lead is a toxic metal which has contaminated our environment and created health problems around the globe. Children are vulnerable to lead as the intake per unit body weight is higher and even low levels can cause neurological damage. Nepal lacks data on sources of lead exposure and its health impacts; hence screening of blood lead is mandatory. Objectives: To determine blood lead levels, its associated risk factors and impact on health in primary school children in Kathmandu municipality, Nepal. Methods: A total of 218 school children between 6-16 years age from Kathmandu were included in the study undertaken from November 2012 to June 2013. Consents were taken from guardians and students. Questionnaire was used to acquire data followed by blood sampling. Lead was measured using atomic absorption Spectrophotometer, hemoglobin and serum calcium was measured using commercial kits. Intelligent Quotient was assessed using Seguin form board. Data was analyzed using SPSS version 20. Results: Overall, 63% (137) had detectable blood lead level (BLL) and 54% (117) had BLL > 5 ug/dl. 55% were male and 45% female. The median BLL (IQR) was 8(0-34) and 4(0-18) in males and females respectively. The mean hemoglobin and serum calcium was 13.7±2.4 and 8.1±1.8 respectively. On risk factors evaluation, the odds of having elevated blood lead level (EBLL) was significantly higher in children living in homes with chipping walls (p value 0.001). Children belonging to families with lower socioeconomic status (p value 0.001) and residing near traffic congested areas (p value 0.007). The median IQ was 73.5(66-91). EBLL showed significant negative correlation with IQ (p value 0.001). EBLL was identified as significant risk factor lowering IQ by 2.35 points per 10 ug/dl rise in blood. Conclusion: Children living in homes with chipping walls, having lower socioeconomic status and residing near traffic congested areas had significantly higher lead level. EBLL showed significant negative correlation with IQ. [ABSTRACT FROM AUTHOR]

Introduction: Thalassemia is one of the most common genetic disorders worldwide. The current study aims at various laboratory parameters including agarose gel electrophoresis (AGE) pattern of patients consistent with clinical symptoms of β thalassemia minor. Methods: A total of 78 blood samples collected from patients visiting BPKIHS, Dharan to workup for anemia and red blood cell indices. From these 78 patients, 8 samples were suspected of β thalassemia minor and were included in the study. The patients were divided in two groups, adult above 15 years of age and children less than 15 years of age. These samples were further investigated using various laboratory indices including electrophoresis. Results: β-thalassemia minor was detected in 8 cases with various hematological parameters and electrophortic mobilities. The electrophoretic mobility pattern revealed that the patient had increased HbA2 and HbF band and decreased HbA1 band. Among hematological parameters, the mean hemoglobin was 8.1± 2.3gm% in >15 years age group and 3.9± 1.7 in <15 years age group, Peripheral smear revealed microcytic, hypochromic, anisopoikilocytic, target cells and solubility test for sickle cell was negative for all samples. The median unconjugated bilirubin level was 1.95 (IQR: 1.6-2.1) in <15 yrs and 2.25 (IQR: 1.7-7.7) in >15 yrs, the median reticulocyte count was 1.65 (IQR: 0.55-2.3) in <15 yrs and 1.8 (IQR: 1-5) in >15 yrs, Reticulocyte production Index was less than two, median HbF was 7.5 (IQR: 4.2-25) in <15 yrs and 8 (IQR: 1.7-18) >15 yrs, median PCV was 23.4 (IQR: 19.5-25.9) in <15 yrs and 14.6 (IQR: 12.2-16.8) in > 15 yrs. The study also revealed that the ß-thalassemia was predominant among Tharus (50%) compare to other ethnicity. Conclusion: Patients of ß thalassemia minor showed decrease in hemoglobin, increased unconjugated bilirubin, abnormal peripheral smear, and abnormal hemoglobin pattern on electrophoretogram. [ABSTRACT FROM AUTHOR]

Competing Interests: Funding Support and Author Disclosures Dr Pilgrim has received grants to the institution from the Swiss National Science Foundation, the Swiss Heart Foundation, the Swiss Polar Institute, Biotronik, Boston Scientific, Edwards Lifesciences, Medtronic, and ATSens; and has received consultancy/speaker fees from Boston Scientific, Biotronik, Edwards Lifesciences, Abbott, Biosensors, Medtronic, and HighLife. Dr Reichlin has received grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the sitem insel support fund, Biotronik, Boston Scientific, and Medtronic, all for work outside the submitted study; has received speaker/consulting honoraria or travel support from Abbott/SJM, Biosense-Webster, Biotronik, Boston Scientific, and Medtronic; and has received support for his institution’s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Importance: Arterial hypoxemia, electrolyte imbalances, and periodic breathing increase the vulnerability to cardiac arrhythmia at altitude., Objective: To explore the incidence of tachyarrhythmias and bradyarrhythmias in healthy individuals at high altitudes., Design, Setting, and Participants: This prospective cohort study involved healthy individuals at altitude (8849 m) on Mount Everest, Nepal. Recruitment occurred from January 25 to May 9, 2023, and data analysis took place from June to July 2023., Exposure: All study participants underwent 12-lead electrocardiogram, transthoracic echocardiography, and exercise stress testing before and ambulatory rhythm recording both before and during the expedition., Main Outcome: The incidence of a composite of supraventricular (>30 seconds) and ventricular (>3 beats) tachyarrhythmia and bradyarrhythmia (sinoatrial arrest, second- or third-degree atrioventricular block)., Results: Of the 41 individuals recruited, 100% were male, and the mean (SD) age was 33.6 (8.9) years. On baseline investigations, there were no signs of exertional ischemia, wall motion abnormality, or cardiac arrhythmia in any of the participants. Among 34 individuals reaching basecamp at 5300 m, 32 participants climbed to 7900 m or higher, and 14 reached the summit of Mount Everest. A total of 45 primary end point-relevant events were recorded in 13 individuals (38.2%). Forty-three bradyarrhythmic events were documented in 13 individuals (38.2%) and 2 ventricular tachycardias in 2 individuals (5.9%). Nine arrhythmias (20%) in 5 participants occurred when climbers were using supplemental bottled oxygen, whereas 36 events (80%) in 11 participants occurred at lower altitudes when no supplemental bottled oxygen was used. The proportion of individuals with arrhythmia remained stable across levels of increasing altitude, while event rates per 24 hours numerically increased between 5300 m (0.16 per 24 hours) and 7300 m (0.37 per 24 hours) before decreasing again at higher altitudes, where supplemental oxygen was used. None of the study participants reported dizziness or syncope., Conclusion and Relevance: In this study, more than 1 in 3 healthy individuals experienced cardiac arrhythmia during the climb of Mount Everest, thereby confirming the association between exposure to high altitude and incidence of cardiac arrhythmia. Future studies should explore the potential implications of these rhythm disturbances.

Introduction: Autoimmune thyroid disease is characterised by the generation of autoantibodies against self-antigens such as thyroid peroxidase, thyroglobulin, and thyroid-stimulating hormone receptor. Recent studies have implicated the role of hypovitaminosis D to immune dysfunction, failure of self-tolerance and generation of autoantibodies. This study aimed to find out the prevalence of autoimmune thyroid disease among hypovitaminosis D patients in a tertiary care centre., Methods: A descriptive cross-sectional study was conducted among participants between the ages of 18 years to 65 years who visited the Department of Biochemistry of a tertiary care centre between the periods of July 2018 to December 2019. The study was initiated after receiving ethical approval from the Institutional Review Committee (Reference number: 42,8/074/075-IRC). Data was collected using a self-administered questionnaire followed by anthropometric measurement and blood collection. Thyroid hormone, thyroid peroxidase antibody and 25-hydroxy vitamin D were measured by chemiluminescence technique. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated., Results: Among 83 patients, 39 (46.98%) (42.32-51.63, 95% Confidence Interval) had autoimmune thyroid disease., Conclusions: The prevalence of autoimmune thyroid disease among patients with hypovitaminosis D was similar to studies conducted in comparable settings., Keywords: autoimmune diseases; prevalence; thyroid; vitamin D.

Introduction: Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre., Methods: This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage., Results: Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia., Conclusions: Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.

Objective: To estimate the prevalence of depression in the working population; to examine if any gender disparity prevails; and to determine the sociodemographic mediators of depression., Methods: Data from previous research was retrieved for this study. Only paid workers were selected (n=160). Sociodemographic variables including prevalence of moderate depression were compared between the genders using Chi square test. Significant variables were subject to logistic regression. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms with a cutoff score of ≥20 considered as moderate depression., Result: The overall prevalence of moderate depression was 15%, with higher prevalence among working women compared to men [ χ 2 (df) = 6.7(1), P =0.01], those practicing religions other than Hinduism [ χ 2 (df) = 5.5(1), P =0.01], those educated up to primary school compared to other education criteria [ χ 2 (df) = 9.4(4), P =0.03], those having vitamin D deficiency compared to others [ χ 2 (df) = 8.5(3), P =0.03], and sedentary lifestyle compared to active lifestyle [ χ 2 (df) = 6.7(1), P =0.009]. The OR (95% CI) for moderate depression was significantly higher in women than in men [3.2 (1.1-9.6), P= 0.03 ] and sedentary lifestyle [2.9(1.1-8.2), P= 0.04 ] even after adjusting for confounding variables., Conclusion: Working women have increased odds of depression compared to men. Among various characteristics, sedentary lifestyle was the most important causative factor for depression among women.

Recent studies link vitamin D deficiency with depression; however evidences from the Nepalese population are scarce. The current study explored the association between vitamin D deficiency and depression among 300 adults of 18 years and above age residing in eastern Nepal. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms and a BDI cutoff score of ≥20 was considered as clinically significant depression. Sociodemographic data were collected using semi-structured questionnaire. Blood samples were collected to measure serum 25‑hydroxy vitamin D (25(OH)D) and classify vitamin D status (deficient, insufficient and sufficient). We used Chi-square test to identify the association of sociodemographic variables and vitamin D status with clinically significant depression. We found a significant association of gender, geographical location of residence, marital status, religion and vitamin D status with clinically significant depression. Binary logistic regression model was used to examine the likelihood of clinically significant depression among vitamin D deficient individuals. Vitamin D deficiency was significantly associated with increased odds of clinically significant depression even after adjusting for confounding variables. This finding suggests Vitamin D deficient people have increased odds of having clinically significant depression., (Copyright © 2018. Published by Elsevier B.V.)