Introduction: Type 2 diabetes mellitus is the commonest form of diabetes affecting more than 90% of the diabetic population worldwide. The prevalence of type 2 diabetes and its complications are increasing in the world, including developing nations like Nepal. This study aimed to determine the association between the lifestyle risk factors and the risk of type 2 diabetes mellitus in Nepalese population. Methods: This is hospital based cross sectional observational study done in the urban area of Nepal. Records of clients coming for the general health checkup in Grande International Hospital were evaluated in this study. Comparisons of the lifestyle factors in participants having and not having type 2 diabetes mellitus were done. Results: Significant associations with diagnosis of diabetes mellitus (DM) type 2 were seen in age (P ≤ 0.001), associated hypertension (P ≤ 0.001), dyslipidemia, family history of DM (P ≤ 0.001), alcohol use (P ≤ 0.001), and tobacco use (P ≤ 0.001). Logistic regression analysis showed that the odds of having diabetes were high in age group above 40 (OR – 6.9, CI 3.82 – 12.47), history of hypertension (OR- 3.84, CI 2.42 – 6.08), tobacco users (OR-2.26, CI 1.12 – 4.53), alcohol users (OR-3.99, CI 2.47 – 6.44), family history of DM (OR-2.44, CI 1.53 – 3.89), and abdominal obesity in both males (OR-3.9, CI 2 – 7.4) and females (OR-9.6, CI 3.78 – 24.35). Conclusions: The modifiable risk factors - obesity, smoking and alcohol use carry significant risks of developing type 2 diabetes. These red flag signs call for urgent attention to look for and rectify the modifiable risk factors in Nepalese population to prevent diabetes.
Background Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. Methods In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. Results Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79–0.84) compared with CPT (0.58; 95% CI, 0.47–0.70) and CPT + REM (0.67; 95% CI, 0.60–0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients. Conclusions This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes. ClinicalTrials.gov identifier. NCT04570982.
Background: ABO discrepancy is any deviation from the expected pattern of red cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO discrepancies and to identify the correct blood group for safe blood transfusions. Methods: This is a retrospective descriptive study. It was done on 9970 samples collected between June 2017and May 2018. All ABO typing records kept at the Grande International Hospital (GIH) blood bank laboratory were reviewed. Results: During the study period, 9970 blood grouping tests were performed. ABO discrepancies occurred in 26 of them. Discrepancies were more prevalent in the age of 20-30 and 30-40 years. Majority were seen in patients with history of pregnancy/miscarriage (30%) and with any Carcinoma (23%). The most common blood group involved was B with 34% frequency. 96% were reverse discrepancy type, 84% with extra antibody which was resolved by incubating the sample at 37°C for 30 minutes signifying most probably A and B subgroups and auto/allo antibodies. Conclusion: This study emphasizes the need of considering ABO discrepancies in blood banks for donors and recipients for safe blood transfusion to avoid any fatal complications. This discrepancy ratio of 1/384 is more than in other studied population of other countries and also higher than ABO mismatched transfusion in standard centers in Nepal. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.
Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID‐19 patients with obesity and chronic diseases such as diabetes and hypertension.
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