ObjectiveTo investigate whether benchtop auto-analyzers (AAs) and arterial blood gas (ABG) analyzers, for measuring electrolyte levels of patients admitted to intensive care units (ICU), are equal and whether they can be used interchangeably.Materials and methodThis study was conducted on 98 patients admitted to the ICU of the Institute of Medicine, Kathmandu, Nepal between 15 October and 15 December 2016. The sample for AA was collected from the peripheral vein through venipuncture, and that for ABG analyzer was collected from radial artery simultaneously. Electrolyte levels were measured with ABG analyzer in the ICU itself, and with benchtop AA in the central clinical biochemistry laboratory.ResultsThe mean value for sodium by AA was 144.6 (standard deviation [SD] 7.63) and by ABG analyzer 140.1 (SD 7.58), which was significant (p-value <0.001). The mean value for potassium by AA was 3.6 (SD 0.52) and by ABG analyzer 3.58 (SD 0.66). The Bland-Altman analysis with the 95% limit of agreement between methods were −4.45 to 13.11 mmol/L for sodium and the mean difference was 4.3 mmol/L and −1.15 to 1.24 mmol/L for potassium and the mean difference was 0.04 mmol/L. The United States Clinical Laboratory Improvement Amendments accepts a 0.5 mmol/L difference in measured potassium levels and a 4 mmol/L difference in measured sodium levels, in the gold standard measure of the standard calibration solution. The passing and Bablok regression with 95% confidence interval has an intercept of zero and slope one for both sodium and potassium, and the 95% of random difference is −6.32 to 6.32 for sodium and −0.84 to 0.84 for potassium, showing no significant deviation from linearity.ConclusionIt can be concluded that AA and ABG analyzers may be used interchangeably for measurement of potassium in the Institute of Medicine, while the same cannot be concluded for the measurement of sodium, because of the significant difference in sodium measurement by the two instruments.

Background: Type II Diabetes Mellitus (Type II DM) is a metabolic disorder characterized by glucotoxicity and lipotoxicity. Marker of glycemic control are HbA1c, fasting blood glucose and postprandial blood glucose. There is altered lipid parameters in Type II DM which possess significant cardiovascular risk to the patient. Recent studies have shown that ceruloplasmin, an inflammatory marker having antioxidant property,is ideal marker to know the cardiovascular status, degree of insulin resistance and cancer risk.Aims and Objectives: Present study was carried out to determine the relation between glycemic status and serum ceruloplasmin along with lipid parameters which reflects the cardiovascular status in these patients.Materials and Methods: Blood samples were collected from eighty-eight patients with type II diabetes mellitus along with age and sex matched forty-two healthy controls. Fasting lipid profile and blood glucose, postprandial blood glucose, serum ceruloplasmin and HbA1c levels were determined using auto analyser in the department of clinical biochemistry in Institute of Medicine.Appropriate tests of significance were computed by SPSS version 20.Results: Serum ceruloplasmin was found higher in type II DM than non-diabetic group, median 52.0 (95% CI: 49-53) mg/dl versus median 45.0 (95% CI: 41-47) mg/dl, at significant level of 0.001 probability test. Similarly, fasting blood glucose, post prandial glucose, HbA1c and TG/HDL cholesterol ratio correlated significantly with serum ceruloplasmin.The cut off value of 46.5 mg/dL was obtained for serum ceruloplasmin with sensitivity of 87.5% and specificity of 62% which has good discriminating value for type II diabetic patients versus non-diabetic patients.Conclusion: Findings in our study shows that increased glycation coupled with altered lipid profile in type II DM causes enhanced generation of ceruloplasmin which could be used as potential marker for identifying acceleratedglycation and atherogenesis in these subjects.Asian Journal of Medical Sciences Vol.9(2) 2018 13-18

BackgroundDeficiency in 11β-hydroxylase as a cause of congenital adrenal hyperplasia is uncommon. It should be considered in the differential diagnosis of hypertension with virilization in any prepubescent child.Case presentationA 12-year-old Asian boy from eastern Nepal presented with pain in his abdomen and hypertension. He was raised as a male but had absent testicles since birth and had precocious puberty. Plasma testosterone, follicle-stimulating hormone, and luteinizing hormone were below baseline level. Basal 17-hydroxyprogesterone was elevated. Magnetic resonance imaging of his pelvis showed presence of Müllerian structures and karyotyping revealed 46,XX genotype. A clinical diagnosis of 11β-hydroxylase deficiency was made in view of hypertension with severe virilization in a 46,XX individual. Our patient’s legal guardian was unwilling for our patient to change gender and because our patient is underage, the condition was well explained to his parents. He was managed with steroids and antihypertensive drugs. He was on regular follow-up; after 2 years there was no hypertension but he developed true puberty with functional ovaries. He was prescribed leuprolide (gonadotropin-releasing hormone analogue), letrozole (aromatase inhibitor), and a continuation of antihypertensive drugs.ConclusionsThis case highlights the importance of a thorough physical examination of the external genitalia at birth and appropriate referral, and addresses issues in the management of such a disorder. Ethical issues pertaining to consent and who is entitled to give it should be clear so that the affected individual will have optimal psychological development and quality of life.

Patients with invasive prolactinoma present with constellation of symptoms including headache, blurred vision, lethargy, menstrual irregularity and sexual dysfunction. Cabergoline, a potent dopamine agonist, is a known medication prescribed for the treatment of prolactinoma. Here, we report a case of invasive macroprolactinoma with hemorrhage in a 18 years female with dramatic response to cabergoline treatment clinically, biochemically, and radiologically.Jour of Diab and Endo Assoc of Nepal 2017; 1(1): 18-20