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

Background Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei . This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia. Case presentation Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole. Conclusion The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species . The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Stevens–Johnson syndrome is a medical emergency which is characterized by skin and mucosal reaction to the use of certain drugs. Atypical Steven–Johnson syndrome can occur due to various microorganisms and Mycoplasma pneumoniae being one of them. We present a clinical course, diagnosis, and successful management of Steven–Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap due to Mycoplasma pneumoniae in a 17-year-old Nepalese female. In the resource-limiting country and hospitals where serology and PCR for M. pneumoniae is not easily accessible, a simple bedside cold agglutination test can be done to increase the suspicion of infectious cause (most common M. pneumoniae ) of SJS-TEN overlap. M. pneumoniae infection should be considered in all cases of mucositis, especially in patients having preceding respiratory tract infections (tracheobronchitis).

Background Preeclampsia is a multisystem disorder characterized by vascular endothelial malfunction occurring after 20 weeks of gestation. Placental soluble fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic factor and placental growth factor (PlGF) is a potent angiogenic factor. The imbalance between these factors during placenta and fetal development has been shown to play a role in endothelial damage in preeclampsia. Preeclampsia is the leading cause of maternal mortality in Nepal. This study was designed to compare the sFlt1:PLGF ratio in pregnant women with and without preeclampsia attending Tribhuvan University Teaching Hospital (TUTH). Method An observational cross-sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving forty-four subjects with preeclampsia and forty-four age- and gestational-week-matched normal pregnant subjects as controls. Blood pressure, urinary protein levels, serum sFlt-1 levels, serum PlGF levels and the sFlt-1:PlGF ratio was compared in both the cases and control. The concentrations of sFlt-1 and PlGF were measured with commercially available ELISA kits. SPSS ver. 20.0 was used to analyze the data. Results There was no significant difference in age or gestational age in either study group. The ratio of the sFlt-1 and PlGF concentrations was significantly higher in women with preeclampsia (31.6 ± 9.6) than in the controls (3.2 ± 1.3). Likewise, diastolic blood pressure was significantly associated ( p -value 0.000), whereas the severity of proteinuria was not associated (p-value 0.773) with the sFlt-1:PlGF ratio in women with preeclampsia. The significantly higher ratio (35.51 ± 8.1 versus 25.4 ± 8.7) was found in women with preeclampsia who developed complications than the group of women with preeclampsia who did not develop complication. Conclusion The sFlt-1:PlGF ratio is significantly higher in Nepalese women with preeclampsia than in normal controls and this finding can be applied for further planned clinical trials.