BackgroundDiabetes mellitus is a well recognized public health concern and projections of its future effect are alarming.  It is one of the leading causes of end stage renal disease in both developed and emerging nations. The objective of the present study was to assess the progressive deterioration of renal function in Diabetes mellitus among Nepalese.Materials and Methods  It was a hospital based case control study carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2010 and 31st August 2010. The variables collected were age, gender, random blood glucose, serum urea and creatinine levels of the patients. ResultsOut of 440 patients, there was a slight predominance of males (54.1%) as compared to females (45.8%). Patients in between 41-100 years were 2.8 times more at risk of developing kidney disease as compared to age group (0-40 years)(Odds Ratio=2.8, p=0.0001). Diabetic patients were twice at risk of developing kidney disease than non diabetics (Odds Ratio=1.97, p=0.001). There was a significant increase in mean values of serum creatinine (CI 4.3 to 4.8) and urea (CI 118.55 to 153.50) in kidney disease patients with Diabetes mellitus. In non diabetic kidney disease patients, mean values of serum creatinine (CI 3.29 to 3.70) and urea (CI 98.88 to 116.92) were also moderately raised as compared to controls.ConclusionDiabetic renal lesions are not only preventable but also reversible. In summary, glycemic control significantly influences the rate of progression from microalbuminuria to proteinuria and from overt nephropathy to end stage renal disease. The best modality of treatment includes strict control over blood glucose levels and its evaluation at frequent intervals.Key Words: Diabetic Mellitus; Kidney Disease; Case Control Study; NepalDOI: 10.3126/nje.v1i1.4108Nepal Journal of Epidemiology 2010;1 (1):22-25

BackgroundThyroid dysfunction is one of the major public health problems in Nepal. Laboratory tests facilitate early diagnosis before clinical features are obvious, increased sensitivity carries the price of decreased diagnostic specificity. Laboratory tests coupled with supportive clinical findings are frequently used to diagnose thyroid dysfunction. Historically, hypercholesterolemia and raised serum low density lipoprotein (LDL) cholesterol levels have been found to be associated with subclinical hypothyroidism. Therefore, assessment of altered lipid profile plays a supportive role in diagnosis of thyroid dysfunction. The aim of our study was to find out the variations of thyroid hormones and lipid profile in hyperthyroidism and hypothyroidism with their clinical implications.Materials and Methods  It was a hospital based retrospective study carried out from the  data  retrieved  from  the  register  maintained  in  the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st July, 2009 and 30th June, 2010. The variables collected were age, gender, T4, T3, TSH, fT4, total cholesterol and triglyceride levels. Descriptive statistics and testing of hypothesis were used for the analysis of data.Results122 out of the 365 subjects selected for the study had some form of thyroid disorder. Of the 122 cases, 40 had hyperthyroidism, 42 had hypothyroidism and the remaining 40 were diagnosed to have subclinical hypothyroidism.  The frequency of thyroid disorders was much higher in females as compared to their male counterparts. The mean value of each variable in cases, except for age, was statistically significant as compared to controls (p=0.001). Elevated levels of total T3 (CI 2.14 to 2.59), T4 (CI 13.00 to 15.30) and fT4 (CI 2.51 to 2.81) associated with decreased TSH levels (CI 0.29 to 0.35) were found in cases of hyperthyroidism. The TSH values (CI 17.05 to 22.85) were markedly increased while T4 and T3 values were found to be less than the reference range in cases of hypothyroidism. There was significant increase in the mean concentration of total cholesterol (CI 268.83 to 289.79) and triglycerides (CI 154.81to 182.05) in cases of hypothyroidism. The fT4 (CI 1.08 to 1.22) levels were in reference range and TSH levels (CI 9.59 to 10.50) were moderately raised in cases of subclinical hypothyroidism.ConclusionThyroid dysfunction is common across all age groups and shows a strong female preponderance in Pokhara valley. It necessitates the measurement of thyroid hormones in women after the age of 50, in pregnancy and after delivery, and in women and men with hypercholesterolemia. Therefore, timely screening and check ups are necessary in order to curtail the problem of undiagnosed cases, giving specific consideration to patients who have high artherogenic profile. This will reduce the risk of future negative health events in older adults.Key Words: Thyroid hormones; Hyperthyroidism; Hypothyroidism; Lipid profile; NepalDOI: 10.3126/nje.v1i1.4102Nepal Journal of Epidemiology 2010;1 (1):11-16

Background: Liver diseases is apparently increasing and emerging as a major public health problem. Worldwide,  chronic hepatitis B has  become  the tenth leading cause of death  and  persons infected with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV), are about 350 million and  125 million respectively. The aim of current retrospective comparative study was concerned primarily to evaluate the significance of non invasive serological markers for diagnosing liver diseases and their predictive implications in Pokhara valley. Materials and Methods: It was a hospital based retrospective study carried out using the data maintained in the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st June 2009 and 31st   October 2010.  The variables collected were total protein, albumin, AST, ALT, total bilirubin, direct bilirubin.  Descriptive statistics and testing of hypothesis were used for the analysis. Data was analyzed using EPI INFO and SPSS 16 software. Results: Of 515 subjects, 120 were suffering from viral hepatitis and 88 had non alcoholic fatty liver disease. In cases of viral hepatitis, mean values of AST (CI 730.65 to 902.68) and ALT (CI 648.14 to 847.59) were markedly increased as compared to controls. Mild to moderate elevations in serum levels of aspartate aminotransferase (CI 43.42 to 49.49), alanine aminotransferase (CI 43.90 to 53.92) were the most common laboratory abnormalities found in patients with nonalcoholic fatty liver disease. Conclusion: Non invasive tests have demonstrated a reasonable ability to identify significant fibrosis, cirrhosis in particular, nor is it surprising that liver disease specialists and patients favour a non invasive approach.Key words: Viral hepatitis; Nonalcoholic fatty liver disease; Nepal.DOI: http://dx.doi.org/10.3126/nje.v1i2.5137 Nepal Journal of Epidemiology 2011;1 (2):60-63

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Background In the 21st century, cardiovascular diseases will continue to dominate the disease spectrum and death statistics in both the industrialized and developing worlds. Coronary artery disease (CAD) is the foremost cause of cardiovascular disease related deaths worldwide, with >4.5 million deaths taking place in the developing world. Augmented serum uric acid levels are recurrently come across with hyperlipidemia, atherosclerosis, obesity, glucose intolerance, renal disease, and hypertension which all play a fundamental role in the pathogenesis of coronary artery disease.  Materials and methods It was a hospital based case control study carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2010 and 31st December 2010. The variables collected were age, gender, serum uric acid, total cholesterol, low density lipoproteins, triglycerides, high density lipoproteins and very low density lipoproteins. Approval for the study was obtained from the institutional research ethical committee. Results There was insignificant difference for age between groups. In cases of  hyperuricemia, there was marked increase in levels of serum uric acid (8.043± 0.43 mg/dl) when compared to controls (4.28 ± 0.66 mg/dl. In patients suffering from coronary artery disease with hyperuricemia, there was marked increased in levels of serum uric acid(8.222 ± 0.39 mg/dl)  found to be statistically significant when compared to controls (4.285 ±0.66 mg/dl) and values were quite similar to hyperuricemic patients (8.043 ± 0.43 mg/dl).Further, in patients suffering from coronary artery disease with hyperuricemia, there was marked increased in mean values of serum total cholesterol (257.56 ± 22.65 mg/dl) ) when compared to controls (173.22 ± 32.63mg/dl). Conclusion Hypercholesterolemia due to hyperuricemia is most common modifiable factor for coronary artery disease. Allopurinol and newer urate-lowering agents restores endothelial function in coronary artery disease patients. The ability of physicians to pharmacologically manage serum urate levels, a better understanding of the interaction between hyperuricemia, gout and vascular disease may be critical for the reduction of morbidity and mortality in high-risk coronary artery disease patients.Key words: Hyperuricemia; Coronary artery disease; Nepal DOI: http://dx.doi.org/10.3126/nje.v1i3.5571 Nepal Journal of Epidemiology 2011;1(3) 81-85