Ability of biochemical parameters to distinguish between bile duct cancer and gall bladder stones--a case control study in a tertiary care hospital of Pokhara Valley.

BACKGROUND: The present study was designed to comparatively assess alteration of biochemical parameters in bile duct cancer and gall stone disease. MATERIALS AND METHODS: A hospital based case-control study was carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2010 and 31st December 2012. The variables collected were age, gender, serum total cholesterol, total bilirubin, AST, ALT, serum alkaline phosphatase, albumin and hemoglobin. One way ANOVA was used to examine the statistical significance of differences between groups. A post-hoc LSD test was applied for the comparison of means of control versus case groups. A p-value of <0.05 (two-tailed) was considered significant. RESULTS: The mean age of cases and controls was 53.2±21.2 years. The levels of serum cholesterol were higher in cases of cancer 192.5±21.5 mg/dl in comparison to stone cases 168.7±16.1 mg/dl (p value: 0.0001). The total bilirubin showed the marked difference in cases of cancer 7.6±3.2 mg/dl in comparison to stone cases 2.5±0.8 mg/dl of bile duct. There was discernible divergence in values of alkaline phosphatase in cases of cancer 251.5±20.1 IU/l when compared to stone cases 173.2±12.6 IU/l of bile duct. In contrast, there was no apparent deviation in values of aspartate transaminases and alanine transaminases in cases of cancer 59.1±8.9 IU/l and 105.5±26.5 IU/l when compared to stone cases 56.9±7.9 IU/l and 84.5±13.5 IU/l respectively. CONCLUSIONS: LFT analysis for pre-operative assessment was a good predictive marker in setting apart bile duct cancer and gall bladder stone.

Serum amyloid a as an independent prognostic factor for renal cell carcinoma--a hospital based study from the Western region of Nepal.

OBJECTIVE: The objective of our present study was to assess the role of serum amyloid A (SAA) in stages and prognosis of renal cell carcinoma. MATERIAL AND METHODS: It was a hospital based retrospective study carried out in the Department of Medicine and Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2008 and 31st December 2011. The variables collected were SAA, CRP. Approval for the study was obtained from the institutional research ethical committee. Quantitative analysis of human SAA and C-reactive protein (CRP) was performed by radial immune diffusion (RID) assay for all cases. RESULTS: Of the 422 total cases of renal cell carcinoma, 218 patients had normal and 204 abnormal SAA. SAA levels were grossly elevated in T3 stage (122.3±SD35.7) when compared to the mean for the T2 stage (84.2±SD24.4) (p value: 0.0001). Similarly, SAA levels were grossly elevated in M1 stage (190.0±SD12.7) when compared to the M0 stage (160.9±SD24.8) (p: 0.0001). There was no significant association with elevated CRP levels (209.1±SD22.7, normal 199.0±SD19.5) . CONCLUSION: The validity of SAA in serum as being of independent prognostic significance in RCC was demonstrated with higher levels in advanced stage disease.

Metabolic changes enhance the cardiovascular risk with differentiated thyroid carcinoma--a case control study from Manipal Teaching Hospital of Nepal.

OBJECTIVE: To evaluate several metabolic changes in patients with differentiated thyroid carcinoma (DTC ) which enhance cardiovascular risk in the western region of Nepal. MATERIALS AND METHODS: This hospital based case control study was carried out using data retrieved from the register maintained in the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st January, 2009 and 31st December, 2011. The variables collected were age, gender, BMI, glucose, insulin, HbA1C, CRP, fibrinogen, total cholesterol, triglycerides, HDL, LDL, VLDL, f-T3, f-T4, TSH. One way ANOVA was used to examine statistical significance of differences between groups, along with the Post Hoc test LSD for comparison of means. RESULTS: fT3 values were markedly raised in DTC cases (5.7±SD1.4) when compared to controls (2.2±SD0.9). Similarly, fT4 values were also moderately raised in cases of DTC (4.9±SD1.3 and 1.7 ±SD0.9). In contrast, TSH values were lowered in DTC cases (0.39±SD0.4) when compared to controls (4.2 ±SD 1.4). Mean blood glucose levels were decreased while insulin was increased and HDL reduced (39.5±SD4.7 as compared to the control 43.1±SD2.2). CONCLUSION: Cardiovascular risk may be aggravated by insulin resistance, a hypercoagulable state, and an atherogenic lipid profile in patients with differentiated thyroid cancer.

Efficacy of carcinogenic embryonic antigen in differential diagnosis of diseases of pancreas and liver--a comparative study in a tertiary care hospital of Western Nepal.

OBJECTIVE: The objective of our present study was to assess the efficacy of carcinoembryonic antigen (CEA) for differentiating and diagnosis of pancreatic and liver diseases in Pokhara valley. MATERIALS AND METHODS: A hospital based retrospective study was carried out using data retrieved from the register maintained in the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st January, 2011 and 31st October, 2011. Estimation of CEA was performed by ELISA reader for all cases. Approval for the study was obtained from the institutional research ethical committee. RESULTS: Of the 771 subjects, 208 (27%), 60(7.8%), 240(31.1%), 54(7.0%) , 75(9.7%), 59(7.7%), 75(9.7%) cases were of active chronic hepatitis , cryptogenic cirrhosis, alcoholic cirrhosis, primary biliary cirrhosis, hepatoma, acute or chronic pancreatitis, carcinoma of pancreas respectively. The majority of cases (104) of active chronic hepatitis had CEA levels <5 ng/ml(50%). CEA levels were found to be increased in cases of alcoholic cirrhosis with maximum number of cases (106) in range of 10 to 20 ng/ml (44%). There were no cases having more than 20 ng/ml of CEA in primary biliary cirrhosis and acute or chronic pancreatitis. In cases of pancreatic cancer, maximum number of cases (35) were having CEA >20 ng/ml(47%). CONCLUSION: High levels of CEA are associated with advanced stage of disease. CEA can thus provide an important improvement in the diagnosis by differentiating pancreatic cancer especially from chronic pancreatitis when there is a high suspicion of malignancy. Increased CEA levels may also signify progression from benign to malignant transformation in the liver.

Des-gamma-carboxyprothrombin for early identification and prognosis of hepatocellular carcinoma--a case control study from western Nepal.

OBJECTIVE: To assess the diagnostic and prognostic value of AFP and des-gamma-carboxyprothrombin (DCP) in combination and alone for hepatocellular carcinoma. MATERIALS AND METHODS: A case control study carried out in the Department of Biochemistry of Manipal College of Medical Sciences, Pokhara, Nepal between 1st January 2010 and 31st December 2011. The variables collected were age, gender, BMI, total proteins, albumin, AST, ALT, total bilirubin, DCP, AFP. Approval for the study was obtained from the institutional research ethical committee. Estimation of AFP was performed by ELISA reader for all cases. Analysis was done using descriptive statistics and confidence interval (CI). The data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. RESULTS: The mean age of HCC cases was 53.6±14.93 yrs. The percentage of females was less than males in both cases (23%) and controls (29%). The specificity of DCP reached 100% when its values was equal or greater than 150 (MAU/ml) for 0, 3, 6, 9, 12 months preceding the diagnosis of HCC. Similarly, the specificity for AFP was also nearly 100% when its value was equal or greater than 200 ng/ml 0, 3, 6, 9, 12 months earlier to the finding of HCC. The specificity of DCP (≥40 MAU/mL) and AFP(≥20 ng/mL) in combination was 93%, 97%, 95%, 96%, 97% in respect to 0, 3, 6, 9, 12 months prior to the diagnosis of HCC. CONCLUSION: The combination of both DCP and AFP will improve the finding of initial HCC and the sensitivity of these markers was utmost at the time of HCC identification and noticeably lesser at former time points.