Tumour Marker Requisition Pattern in a Tertiary Care Centre of Eastern Nepal.

Background Tumor markers have been a valuable tool for decades to aid in the diagnosis, treatment, and monitoring of oncological diseases. Objective To retrospectively analyze the requisition pattern of tumor marker requests at the largest tertiary care center in eastern Nepal. Method A retrospective hospital-based cross-sectional study was conducted to obtain the data for 5 common tumor markers i.e., Alpha-Fetoprotein (AFP), Cancer antigen125 (CA-125), Carbohydrate antigen (CA) 19-9, Carcinoembryonic antigen (CEA), and Prostate-specific antigen (PSA) analyzed in the Department of Biochemistry at B.P. Koirala Institute of Health Sciences, Dharan, Nepal for 5 years. Result A total of 8716 tests for tumor marker was conducted over 5 years. The most common tumor marker requested at our hospital was Prostate-specific antigen (48.77%) followed by Cancer antigen-125 (39.02%), Carcinoembryonic antigen (9.30%), Alpha-Fetoprotein (2.29%), and Carbohydrate antigen 19-9 (0.63%) respectively. The majority of the tumor markers (Alpha-Fetoprotein, Cancer antigen-125, Carbohydrate antigen 19-9, and Carcinoembryonic antigen) were requested from in-patient wards while Prostate-specific antigen was majorly requisitioned from the out-patient department (OPD) [74%] respectively. Conclusion The finding from the present study suggest that though Nepal is one of the developing countries where the specialized health care services are limited only to cities and developed areas, the burden of oncological disease is high. Dharan is one of the small cities in the eastern part of Nepal and serves the majority of the population in the periphery. The number of tumor marker requisitions as per the laboratory data is significant (n=8716) over a period of 5 years where few tests like Alpha-Fetoprotein, Carcinoembryonic antigen, and Carbohydrate antigen 19-9 have just been initiated. Also, the findings delineate that the outpatient departments have requested more tumor markers which might/ might not be inconsistent with the preliminary diagnosis.

Biochemical Parameters in Confirmed Covid-19 Patients: A Hospital Based Study from Eastern Nepal.

Background COVID-19 has posed a global threat to almost every part of the world. The disease has varied form of presentation and the modern medicine has still not been able to provide definite treatment for the disease. Objective To assess the biochemical parameters in confirmed patients of COVID-19 admitted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method This is a retrospective hospital based cross-sectional study conducted in the Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan from October to December, 2020. Convenient sampling technique was used to enroll the data of the patients for whom the biochemical parameters were requested by the clinicians. Routine biochemical tests were performed in Cobas c311 autoanalyzer. Result A total of 202 patients with confirmed COVID-19 infections and admitted at COVID Hospital, BPKIHS were enrolled. The findings depict an elevated liver enzyme (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase and cardiac enzymes (creatine kinase-total and creatine kinase- MB) in the study population. Increased serum ferritin (1026.08±220.53), hs CRP (41.52±5.22) and lactate dehydrogenase 360 [303.50-526.75] was found in the patients. Also, majority of the patients (> 50%) had abnormal biochemical findings. Conclusion Biomarkers like C-reactive protein, lactate dehydrogenase and ferritin have shown significant clinical implications in effective management, monitoring, and assessment of the severity of disease in COVID- 19 patients. Simple and cost-effective markers like CRP, LDH, HbA1c could be used for monitoring the severity of COVID-19 infection.

External Quality Assessment Practices in Clinical Biochemistry Laboratory: What is the need ?

Health Care services is considered as an amalgamation between the doctor undergoing the examination and laboratory personnel behind the proper diagnosis of the patient. It has evolved to a large extent from a simple process of examination to handling the prescription to the patient. During this evolution, there has been a remarkable development in the field of laboratory diagnosis. A good laboratory is abided by the rule of quality services including quality control; both internal and external. External quality assessment program contributes to the long term accuracy of the analytical method used by the laboratory. It determines the number of quality element of the practicing laboratory and helps in the upliftment of the status of the laboratory to laboratory accreditation and certification. This review article is intended to review the importance of the external quality assessment program over internalquality control, its need in the laboratory and the current practices in externalquality assessment. Medline search was done for the articles published in English language from 1945 to 2018. Keywords employed to search the articles were external quality assessment, EQA programs, quality assurance, and quality control in clinical biochemistry, respectively. We searched for any articles with the details of external quality assessment tools that were original articles, review, editorial and the official website of the EQAS program. The unavailable articles were searched through research gate and the authors were requested for full text. A total of 5 full text original research article were found and rest of the articles like review article, editorial, national policy were studied in detail. Standard textbooks for clinical chemistry and chapters for EQA under quality assurance was reread in detail. Studies and policy makers have depicted that External Quality Assessment scheme (EQAS) as an integral component for the efficient and high quality laboratory operation. The western countries haizve their own laboratory accreditation body which conducts the EQAS program and offers participation to other clinical laboratories. Countries in South East Asia have shown to be burgeoning in the field of EQA program with establishment of their own laboratory accreditation bodies and incorporating the non-accredited laboratories in EQA programs.

Adenosine deaminase activity in type 2 diabetes mellitus: does it have any role?

BACKGROUND: Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underused, producing hyperglycemia. Diabetic patients are prone to opportunistic infection, thus serum ADA levels in these patients is very important as a screening test for Tuberculosis and autoimmune diseases. Thus, the present study was conducted to estimate the Serum ADA activity, glycated Haemoglobin (HbA1c), fasting and postprandial glucose level in patients with T2DM and to correlate the serum level of ADA with glycated Hemoglobin (HbA1c), fasting and postprandial glucose level in T2DM. METHODS: This is a Hospital based cross-sectional study done in BPKIHs, Dharan, Nepal. 204 diagnosed patients (102 males and 102 females) with T2DM and 102 healthy controls were enrolled in the study. Diabetic patients were categorized into Uncontrolled and Controlled Diabetes on the basis of HbA1C; HbA1c > 7% = Uncontrolled Diabetes, HbA1c < 7% = Controlled Diabetes. RESULTS: Serum ADA levels (U/L) was significantly raised in Uncontrolled Diabetic patients (49.24 ± 16.89) compared to controlled population (35.74 ± 16.78) and healthy controls (10.55 ± 2.20), p value < 0.001. A significant positive correlation was obtained between Serum ADA and HbA1c, Fasting Plasma Glucose and Post-prandial Glucose respectively. CONCLUSION: There is a significant increase in Serum ADA activity in DM with increase in HbA1c levels which may play an important role in predicting the glycemic and immunological status in these patients.

Microglial recruitment of IL-1ß-producing monocytes to brain endothelium causes stress-induced anxiety.

Psychosocial stress contributes to the development of anxiety and depression. Recent clinical studies have reported increased inflammatory leukocytes in circulation of individuals with stress-related psychiatric disorders. Parallel to this, our work in mice shows that social stress causes release of inflammatory monocytes into circulation. In addition, social stress caused the development of prolonged anxiety that was dependent on inflammatory monocytes in the brain. Therefore, we hypothesize that chronic stress drives the production of inflammatory monocytes that are actively recruited to the brain by microglia, and these monocytes augment neuroinflammatory signaling and prolong anxiety. Here we show that repeated social defeat stress in mice activated threat appraisal centers in the brain that spatially coincided with microglial activation and endothelial facilitation of monocyte recruitment. Moreover, microglial depletion with a CSF1R antagonist prior to stress prevented the recruitment of monocytes to the brain and abrogated the development of anxiety. Cell-specific transcriptional profiling revealed that microglia selectively enhanced CCL2 expression, while monocytes expressed the pro-inflammatory cytokine interleukin-1ß (IL-1ß). Consistent with these profiles, the recruited inflammatory monocytes with stress adhered to IL-1R1+ neurovascular endothelial cells and this interaction was blocked by microglial depletion. Furthermore, disruption of IL-1ß signaling by caspase-1KO specifically within bone marrow-derived cells revealed that monocytes promoted anxiogenesis through stimulation of neurovascular IL-1R1 by IL-1ß. Collectively, the development of anxiety during stress was caused by microglial recruitment of IL-1ß-producing monocytes, which stimulated brain endothelial IL-1R1. Thus, monocyte IL-1ß production represents a novel mechanism that underlies behavioral complications associated with stress-related psychiatric disorders.