Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient  iron  intake, accompanied  by chronic  intestinal  blood  loss  due  to parasitic  and  malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal. Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.  Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).  Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

Introduction: The response to the endocrine mechanism including thyroid gland hormones to critical illness is a complex phenomenon.1 There is a marked and distinct changes in the levels of thyroid hormones in critical illness.2 The magnitude of the decrease in circulating tri-iodothyronine (fT3) levels (also known as non-thyroidal illness) during the first 24 hour after the onset of acute illness reflects the severity of illness and correlates with mortality. The study aims to evaluate the thyroid function test (TFT) of critically ill patients. The results of the study will be helpful in determining the thyroid picture of the critically ill patients in our setting and definitely help in assessing the outcome of the patient admitted in ICU or ward. Materials and Methods: This is a hospital based cross sectional study. A total of 150 cases with the critical illness assessed as per Acute Physiology and Chronic Health Evaluation II (APACHE II) score were enrolled in the study from 12th December 2021 to 15th June, 2022. Informed written consent and ethical approval were taken. Results: The majority of the cases (52%) were of geriatric age group with the mean age of 57 years. Majority of the study participants (42%) in APACHE II were from 20–24 across all participants, and both sexes. Fifty‑one percent of the patients had reduced fT3 levels. There was an increase in percentage of patients with decreased fT3 levels with increasing APACHE II score, compared to normal fT3 levels at similar APACHE II score and the distribution was found to be statistically significant (p = 0.0233). Of the 68 patients expired, 52 of them had low fT3 levels whereas only 16 cases expired were with the normal fT3 level, making it a strong predictor of severity and outcome. Conclusion: Decrease in the levels of fT3, a condition of non-thyroidal illness, is a crucial prognostic indicator in critically ill patients which in coordination APACHE Score II can be helpful in clinical settings to predict the severity and outcome of such patients.

Introduction:Thyroid peroxidase (TPO) is a key enzyme of thyroid hormone biosynthesis as it catalyzes the iodination and the coupling steps. Subclinical hypothyroidism is the condition of increased Thyroid Stimulating Hormone (TSH) and normal levels of serum free thyroxine (ft4) and free triiodothyronine (ft3) levels. Subclinical hypothyroidism can be progressed to overt hypothyroidism in which ft3 and ft4 levels are decreased along with an increment of TSH levels. Materials and methods: This was the hospital-based retrospective study conducted on the patients who had undergone thyroid function test measurements along with thyroid peroxidase autoantibody level in serum. The study duration was eight months (January 2022 to August 2022). All the data were entered in Microsoft Excel version 10 and analyzed in SPSS version 22 accordingly. Results: In the study among 424 patients, 73.8% were female and 26.2% were male. Firstly, our study revealed subclinical hypothyroidism was predominant (41.7%), followed by euthyroidism (34.7%) overt hypothyroidism (20.3%), and overt hyperthyroidism (3.3%). Secondly, there was no statistically significant difference in age (P value: 0.26) and gender (0.64) between subclinical and overt hypothyroidism. There was no statistically significant difference in serum anti-TPO antibodies level between subclinical (median 6.25) and overt hypothyroidism (median 6.12) (P value: 0.92) when median and interquartile ranges were compared. Correlation analysis revealed a significant positive correlation of TPO antibodies with TSH (0.27, 0.00) and no significant negative correlation with fT4 (-0.02, 0.46) and fT3 (-0.05, 0.37). Conclusion: The current study revealed the elevation of thyroid peroxidase autoantibodies in both subclinical and overt hypothyroid patients though subclinical hypothyroidism was predominant.

Introduction: Type 2 diabetes mellitus, a prevalent global health problem, is a major cause of morbidity and mortality. Metformin, the most widely used hypoglycemic agent can lead to a deficiency of vitamin B12. Very less information is available regarding the relationship between metformin therapy and vitamin B12 deficiency in the Nepalese population. Objectives: The study aims to evaluate the level of vitamin B12 in cases of diabetes mellitus under metformin therapy and to access the relationship of serum vitamin B12 level with the duration of metformin therapy. Methods: A hospital-based cross-sectional study with 300 diagnosed diabetes mellitus cases under metformin therapy were enrolled in the study after the consent was taken. The prior ethical clearance was taken and the duration of the study was from December 2021 to June 2022. Results: The study showed 78% (n=234) of the total diabetic cases under metformin therapy had lower vitamin B12. In 50-60 years, age group, 91% of them were vitamin B12 deficient. Vitamin B12 deficient cases were more with the increase in duration and dose of metformin therapy. All the diabetics who were under medication for 16-20 years had lower vitamin levels. About 94% (n=200) of the diabetics taking more than 1000 mg/day were vitamin B12 deficient whereas only 39% (n=34) of diabetics taking less than 1000mg/day were found to be deficient. Conclusions: Vitamin B12 is deficient in diabetics under long-term and higher doses of metformin therapy. Diabetic patients who are undergoing metformin treatment should monitor their vitamin B12 status as they are more prone to vitamin B12 deficiency.

Background and Aim: Scrub typhus, a potentially severe but treatable infection is a major cause of acute non-malarial febrile illness in children in the rural tropics. The present study aims to explore the association between the liver function tests in the cases of scrub typhus and correlate the levels of these parameters with the severity of the scrub typhus infections, their clinical risk characteristics that may be used to forecast disease severity under routine clinical practice. Methodology: This prospective observational study, conducted at National Medical College Teaching Hospital, a tertiary care referral teaching hospital situated in province two of Nepal over a period of 7 months (November, 2021- May 2022) enrolled 75 scrub typhus cases and their liver function tests were done following standard guidelines. Results:There were deranged liver function tests in the participants. The mean Aspartate Transaminase, Alanine Transaminase, Total Bilirubin and Albumin were425.48 ± 505.56 U/L, 368.54 ± 402.22 U/L, 3.8 ± 3.1 mg/dL and 3.10 ± 0.8 g/dL, respectively. Most of the cases presented with hypoalbuminemia (66.7%), cardiac dysfunction (64%), acute kidney injury (61%) and hepatitis (60%). About 9 % of the subjects presented as multiorgan dysfunction syndrome (MODS). Conclusion: Scrub typhus cases presents with deranged liver function tests results and the values can be helpful in assessment of the disease severity and outcome.