Discrepancies between Glycated Hemoglobin and Fasting Plasma Glucose in New-onset Diabetes Mellitus.

Background Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) are commonly used for diagnosing diabetes mellitus in Nepal. Though HbA1c criteria are convenient for diagnosis there is a discrepancy between the fasting plasma glucose and HbA1c for diagnosis. Objective To assess the comparability between fasting plasma glucose and glycated hemoglobin levels in the new-onset diabetes mellitus. Method This is a hospital-based descriptive cross-sectional study including 128 newly diagnosed diabetes mellitus conducted at Dhulikhel Hospital, Kathmandu University Hospital. New onset diabetes patients above 18 years of age who met inclusion criteria were included. The clinical characteristics and biochemical parameters were analyzed. Statistical analysis was done using student's t-test and correlation coefficient. Result There were 128 newly diagnosed diabetes mellitus patients included in the study among which 57.0% were males with a mean age of 49.48±11.40 years. The mean fasting plasma glucose, postprandial sugar (PPBS), and glycated hemoglobin were 205.54±88.93 mg/dL, 331.08±146.61 mg/dL, and 9.59±2.70% respectively. Diabetes was diagnosed using fasting plasma glucose, and glycated hemoglobin criteria in 84.4% and 90.6% of patients. In new-onset diabetic patients, 76.56% of patients had both elevated levels of fasting plasma glucose and glycated hemoglobin. Of the diabetic patients who had fasting plasma glucose ≥126 mg/dL, 90.7% of patients had HbA1c ≥ 6.5% whereas 1.6% of new-onset diabetes had < 126 mg/dL and glycated hemoglobin < 6.5%. There was a strong correlation between fasting plasma glucose and glycated hemoglobin (r=0.723; p<0.01). Conclusion Both fasting plasma glucose and glycated hemoglobin tests have to be used together for diagnosing diabetes mellitus.

Virologic Response Following a Switch to Dolutegravir-based Regimen in People Living with HIV/AIDS at a Tertiary Care Center in Nepal.

Background The dolutegravir-based antiretroviral regimen is the preferred first-line regimen for the management of people living with human immunodeficiency virus in Nepal recently. It is considered safe to transition to a dolutegravir-based regimen for children and adults on Nevirapine and Efavirenz-based regimens. Objective To determine the virologic response following the transition to a Dolutegravir-based regimen in people living with human immunodeficiency virus previously taking Nevirapine and Efavirenz-based regimen. Method This is a retrospective cohort study including people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) who were transitioned to Tenofovir/Lamivudine/Dolutegravir previously on other antiretroviral therapy regimens for at least 6 months and who had their viral load test done before transition. The medical records of patients were reviewed from records available at the antiretroviral therapy clinic of Dhulikhel Hospital. The viral load done at least 3 months after switching to the Dolutegravir-based regimen was recorded. Descriptive analysis of socio-demographic and clinical characteristics data was done. Result Fifty-seven people living with human immunodeficiency virus/ acquired immunodeficiency syndrome who transitioned to a Dolutegravir-based regimen previously on other antiretroviral therapy regimens for at least 6 months were included in this study. Tenofovir/Lamivudine/Efavirenz (47.4%), Zidovudine/ Lamivudine/Nevirapine (22.8%) and Zidovudine/Lamivudine/Efavirenz (17.5%) were the most common antiretroviral regimens before transition. The majority of the patients (86%) had suppressed viral load of fewer than 40 copies/mL before the switch. Following the transition, 96.5% of the patients had suppressed viral load of fewer than 40 copies/mL. Conclusion Dolutegravir-based antiretroviral regimen led to untransmittable viral load following a switch from Nevirapine and Efavirenz-based regimen.

Virological and Immunological Status of the People Living with HIV Undertaking Highly Active Antiretroviral Therapy.

Background The major goal of antiretroviral therapy (ART) is immunological recovery and virological suppression. Immunological and virological response in People Living with HIV (PLHIV) undertaking ART has to be monitored to assess the treatment response, diagnosing treatment failure and switching antiretroviral therapy. Objective To assess the immunological and virological response to antiretroviral therapy among Human Immunodeficiency Virus (HIV) infected individuals. Method This is a cross-sectional study including people living with HIV (PLHIV) taking antiretroviral therapy for at least 6 months and was conducted in Dhulikhel Hospital in 2017. The socio-demographic profile, clinical characteristics, CD4 count and viral load were analyzed. Descriptive analysis of socio-demographic and other characteristics was done. Result Fifty-two patients undertaking antiretroviral therapy were included in the study with the mean age of 29.69±9.59 years at diagnosis. The majority of the patients were male (51.9%). Sexual transmission was the dominant mode of transmission (78.9%). The mean CD4 count at baseline was 244.08±214.32 cells/µL. Four patients (7.7%) had a virological failure. There was a discordance between immunological and virological response in patients taking antiretroviral therapy for more than 2 years' duration with four patients with a recent CD4 count of ≤250 cells/µL had virological suppression. The mean CD4 count at treatment increased from 229.65 cells/µL to 453.33 cells/µL after 1 year of commencement of antiretroviral therapy (p<0.001). Conclusion There are optimal CD4 recovery and virological suppression as expected with antiretroviral therapy use.

Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus.

Background The clustering of risk factors in metabolic syndrome increases the risk of atherosclerotic cardiovascular disease and all-cause mortality. The prevalence of coronary heart disease is high in diabetic patients with metabolic syndrome than non diabetic patients with metabolic syndrome. Objective To determine the prevalence of metabolic syndrome in new onset Type 2 Diabetes Mellitus (T2DM) and to study the risk components of metabolic syndrome. Method This is a hospital based cross sectional study conducted in 132 newly diagnosed T2DM patients at Dhulikhel Hospital, Kathmandu University Hospital in Nepal in 2018. The socio-demographic profile, clinical characteristics, and biochemical parameters were analyzed to study the prevalence, risk factors, and concordance between various definitions of metabolic syndrome. Statistical analysis was done using Student's t-test, Chi-square test and Kappa statistics. Result One hundred and thirty two newly diagnosed T2DM patients were included in the study. Majority of the patients (58.9%) were in the age group of 40-60 years with the mean age of 49.72±12.44 years. The prevalence of metabolic syndrome was 111 (84.1%), 106 (80.3.%), 94 (71.2%) and 82 (62.1%) using World Health Organization(WHO), Harmonized, National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) definitions respectively. One hundred and six patients (80.3%) had 3 or more individual components of metabolic syndrome. There was substantial agreement between NCEP ATP III-Harmonized (k=0.714, p<0.001) and Harmonized-WHO (k=0.716, p<0.001) definitions for diagnosing metabolic syndrome. The increased prevalence of metabolic syndrome in females than males is due to increased prevalence of abdominal obesity (p<0.05), dyslipidemia (low HDL cholesterol (p<0.05)) and presence of diabetes. Conclusion The prevalence of metabolic syndrome in newly diagnosed T2DM is high in the Nepalese population. The central obesity and low HDL cholesterol were significant risk factors in female diabetic patients predisposing to metabolic syndrome.

Studies on the luminescence properties of cerium co-doping on Ca2 MgSi2 O7 :Eu2+ phosphor by solid-state reaction method.

Ca2 MgSi2 O7 :Ce3+ , Ca2 MgSi2 O7 :Eu2+ and Ca2 MgSi2 O7 :Eu2+ ,Ce3+ phosphors were prepared using the solid-state reaction method. The crystal structures of the sintered phosphors were of melilite type, which has a tetragonal crystallography. The chemical compositions of the sintered phosphors was confirmed by energy dispersive X-ray spectroscopy. The different thermoluminescence kinetic parameters [activation energy (E), frequency factor (s) and order of the kinetics (b)] of these phosphors were evaluated and compared using the peak shape method. Under ultraviolet excitation, the emission spectra of both Ca2 MgSi2 O7 :Eu2+ and Ca2 MgSi2 O7 :Eu2+ ,Ce3+ phosphors were composed of a broad emission band peaking at 530 nm. When the Ca2 MgSi2 O7 :Eu2+ phosphor is co-doped with Ce3+ ions, photoluminescence, afterglow and mechanoluminescence intensity was strongly enhanced. Ca2 MgSi2 O7 :Eu2+ showed some afterglow with a short persist time. On incorporation of Ce3+ , efficient energy transfer from Ce3+ to Eu2+ was found and the emission intensity of Eu2+ was enhanced. The mechanoluminescence intensities of Ca2 MgSi2 O7 :Ce3+ , Ca2 MgSi2 O7 :Eu2+ and Ca2 MgSi2 O7 :Eu2+ ,Ce3+ phosphors increased proportionally increased with the increase in impact velocity, which suggests that these phosphors can be used as sensors to detect stress in an object.

Influence of Er(3+) concentration on the photoluminescence characteristics and excitation mechanism of Gd2O3:Er(3+) phosphor synthesized via a solid-state reaction method.

An Er(3+) -doped phosphor of Gd2O3(Gd2O3:Er(3+)) was prepared using a conventional solid-state reaction method. The structure and particle size were determined from X-ray powder diffraction measurements. The average particle size of the phosphor was in between 20 and 50 nm. The particle size and structure of the phosphor were further confirmed by transmission electron microscopy (TEM) analysis. Luminescence spectra were recorded under excitation wavelengths of 275, 380, 515 and 980 nm. The visible upconversion and downconversion luminescence spectra of the Gd2O3:Er(3+) phosphor were investigated as a function of Er(3+) ion concentration. The upconverted emission at 980 nm excitation shows enhanced red emission with respect to green emission as the dopant concentration increased. Similar results were observed for downconversion emission under 275 and 380 nm excitation wavelengths. The mechanisms responsible for populating the (4)S3/2 and (4)F9/2 levels, for green and red emissions, respectively, are different for different excitations and for different concentrations of Er(3+).

Antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital.

BACKGROUND: Enteric fever is still an important public health problem in developing countries including Nepal. A changing antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A and emergence of multi drug resistance has increased to a great concern. Aim of the study was to investigate the antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A. METHODS: Study was carried out at the department of microbiology in Kathmandu Medical College. Blood culture samples were collected from suspected enteric fever patient and tested microbiologically by standard procedure. Antibiotic susceptibility test was performed by Kirby-Bauer disc diffusion method and results were interpreted by National Committee for Clinical Laboratory (NCCLS) guideline. RESULTS: Of total 78 (2.0%) Salmonella serotype isolated from 3,980 blood culture samples, in which 47 (60.3%) were S. typhi and 31 (39.7%) were S. paratyphi A. Isolates were from all age group median age being the 25 years. Among the tested antibiotics S. typhi was susceptible towards Ciprofloxacin (100%) followed by Gentamicin (97.9%), Ofloxacine (95.7%), Ceftriaxone (95.7%) and Chloramphenicol (93.6%). In case of S. paratyphi A most of the tested antibiotics showed high percentage of susceptibility and least susceptible antibiotic for S. paratyphi A was Ampicillin (25.8%). Three isolates of S. typhi showed multidrug resistance. CONCLUSIONS: A considerable variation was observed in the antimicrobial susceptibility pattern of S.typhi and S. paratyphi A. Hence antibiotic susceptibility test must be sought before instituting appropriate therapy to prevent from further emergence of drug resistance.

Clinical profile of patients with pleural effusion admitted to KMCTH.

BACKGROUND: Pleural effusion is the common findings in patients presenting with cardiopulmonary symptoms but specific studies are lacking in Nepal. OBJECTIVE: The main objective of this study is to fi nd out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fluid to aid diagnosis of patients with pleural effusion. MATERIALS AND METHODS: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior- Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profile, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profile, Monteux test, chest X-ray and USG findings and pleural fluid analysis[Biochemical, Haematological, Microbiological (culture and stain) and cytological]. This study was analysed by using SPSS 16. RESULTS: The mean age of the patient was 44.89 +/- 21.59 and must patients with pleural effusion belong to age group 21-30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. CONCLUSION: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21-30 yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure.