Oxidative stress, antioxidant status and lipid profile in ischemic heart disease patients from western region of Nepal.

Disturbed lipid profile is one of the most important and potent risk factors in ischemic heart disease (IHD). In recent years, it has been demonstrated that raised oxidative stress promotes several undesirable pathways including the formation of oxidised LDL (O-LDL) and oxidized cholesterol which encourages cholesterol accumulation in arterial tissues. We, therefore, aimed to ascertain the redox balance by measuring oxidative stress (OS) and total antioxidant activity (TAA) along with lipid profile to determine their possible association with IHD. Our study group comprised of 28 confirmed cases of IHD. The inclusion criterion was history of chest pain, ischemic changes in the ECG and good left ventricular (LV) function. Patients with diabetes mellitus, poor LV function, previous infarct and valvular heart disease were excluded. Lipid profile, plasma thiobarbituric acid reactive substances (TBARS), plasma total antioxidant activity (TAA) and urinary TBARS were estimated in these patients by standard procedures and the values were compared with 30 age, sex and socioeconomically matched normal healthy control subjects. Body mass index (BMI) and waist/hip ratio (W/H ratio) was also noted in both the groups. Lipid profile and OS (TBARS levels) were significantly raised in IHD patients. Though statistically not significant but TAA tended to be lower and urinary TBARS levels tended to be higher in patients. BMI, W/H ratio, smoking and alcohol did not show discernible association with lipid profile, OS or TAA. OS is significantly raised in majority of IHD patients. The non association of BMI, W/H ratio, smoking and alcohol with lipid profile, OS and TAA suggest that there are other risk factors which primarily contribute to the initiation and progression of IHD.

A study of oxidative stress, antioxidant status and lipid profile in diabetic patient in the western region of Nepal.

AIMS AND OBJECTIVES: Diabetes mellitus (DM) is often termed as a disease of premature aging. Several studies have indicated lopsided redox balance due to pro oxidant environment as one of the important etiological factors. Some recent researches also indicate a causal relationship with oxidative stress (OS). So far, no study has been undertaken on this aspect in Nepali populations. We, therefore, aimed this maiden study in Nepali population to examine redox balance by measuring OS and antioxidant status along with lipid profile in 37 patients of DM type- 2 and 30 matched normal subjects. METHODOLOGY: Thirty seven patients of DM type-2 without any complications (mean age= 57.6+/- 10.6 years) and 30 normal subjects (mean age= 55.8 +/- 14.8 years) were included in this study. Body Mass Index (BMI) and Waist/Hip (W/H) ratio were measured. Fasting blood sample was collected for the analysis of total antioxidant activity (TAA), plasma and urinary thiobarbituric acid reactive substances (TBARS) and lipid profile by standard procedures in both the groups. The statistical analysis was done with SPSS 10 version. RESULTS: Total cholesterol, triglyceride, VLDL-cholesterol, LDL-cholesterol, plasma and urinary TBARS were significantly raised whereas, plasma TAA was significantly reduced in DM type-2 patients as compared to controls. The comparison of old and fresh cases revealed that though TAA was lower and PTBARS and UTBARS were higher in patients but did not attain the level of significance. W/H ratio is significantly higher in patients compared to normal subjects. But, no significant correlation of BMI and W/H with lipid profile is observed in both control and patients. CONCLUSION: Oxidative stress is raised in type 2 DM patients. This along with deranged lipid profile and decreased antioxidant status could be the risk factors in the development of complications associated with DM.

Oxidative stress and antioxidant status in cardiovascular diseases in population of western Nepal.

OBJECTIVES: To observe if there is any connectivity between oxidative stress and cardiovascular diseases (CVDs). MATERIALS AND METHODS: Patients suffering from different cardiovascular diseases (hypertension, ischemic heart disease, rheumatic heart disease) attending Manipal Teaching Hospital, Pokhara and strictly matched controls were selected for this study. Oxidative stress (OS) was measured by plasma thiobarbituric acid reacting substances (TBARS) where as antioxidant status was measured by estimating vitamin E, vitamin C and total antioxidant activity (TAA) in plasma. RESULTS: The mean level of TBARS, TAA, vitamin C and E were 2.20+0.43 nmol/ml, 547+98 mol/l, 0.88+0.15 mg/dl and 0.75+0.20 mg/dl respectively in patients. The respective values in controls were 1.86+0.43 nmol/ml, 859+139 mol/l, 0.94+0.15 mg/dl and 1.10+0.30 mg/dl. Although the OS seems to be raised in patients, is practically insufficient to oxidize biomolecules and induce CVDs. Despite vitamin C and E levels being well within normal limits, the TAA was significantly and considerably lower in patients. This is a highly interesting observation suggesting that dietary antioxidants other than these vitamins were preferentially consumed to control OS because procedure for TAA used in this study practically measures only total dietary antioxidants. CONCLUSION: OS does not appear to be an etiological factor for the cardiovascular diseases; rather slightly raised OS in patients seems to be a consequence. Further the raised OS was not due to lower nutrient antioxidant (vit. C and vit. E) in the local population studied herein.

Pattern of cardiac diseases in children in Pokhara, Nepal.

OBJECTIVE: The objective of the study was to point out the relative public health problems of cardiac diseases in childhood. MATERIAL AND METHODS: A study of the cardiac diseases in children attending the Paediatric OPD of Manipal Teaching Hospital, Pokhara, Nepal was done over a period of 2 years. The idea was to see the pattern of diseases, as being a developing country, these diseases would be a large public health problem. 107 cases had been studied and it was found that 52% were congenital heart diseases and 25% were rheumatic heart diseases. Other cases included dilated cardiomyopathy, Pericardial diseases and a few cases of hypertension. All the cases were investigated by ECG, X-ray and echocardiographic studies. These cases are under follow up and some have undergone surgical treatment. RESULTS: In this study in a short period of 2 years we had 107 cases of heart diseases of which 51% were CHD, 25% RHD and others were pericardial disease, DCM, hypertension and some had no demonstrable lesions. All the cases of RHD are being followed by regular Penicillin prophylaxis. Among them one has had mitral valve replacement done and 2 had mitral valvotomy. Of the CHD cases 5 cases have had VSD operated upon, one PDA also had surgery and one case of Fallot's is shortly going to undergo corrective surgery. CONCLUSION: Heart disease in neonates could be benign or very significant and a high level of suspicion and knowledge of physiology will differentiate between the two. Early recognition of CHD will help to treat the child and if possible get corrective surgery done. Similarly a history of rheumatic fever is important and all children need to be followed up till at least 18 years of age.