Seeking laboratory investigations by diabetic patients during COVID-19 lockdown of Eastern Nepal

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Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern.

OBJECTIVES:Deficiency as well as excess dietary iodine is associated with several thyroid disorders including Grave's disease and goitre. Previously, cross sectional studies conducted among school children in Nepal showed high prevalence of iodine deficiency. In contrast, recently, few studies have revealed emerging trends of excess urinary iodine concentration in children. This paper, reports excess urinary iodine excretion and thyroid dysfunction among school age children from eastern Nepal. RESULTS:It was a community based cross sectional study in which we measured urinary iodine excretion levels among school age children at baseline and after educational program. The educational program consisted of audio-visual and pamphlets on thyroid health. We also screened them for thyroid function status by physical examination and measuring serum thyroid hormones. Our results show that 34.4% of the children had excess urinary iodine concentration above the WHO recommended levels. Overall, 3.2% of the children were identified to have thyroid dysfunction. Urinary iodine concentration was significantly different between types of salt used and between salt iodine content categories

Thyroid Function and Thyroglobulin Level in Iodine-Deficient Children of Eastern Nepal

Iodine deficiency during childhood affects physical and mental development. Iodine deficiency or excess both can negatively impact thyroid function. We conducted this study to assess iodine nutrition and thyroid function in children with insufficient urinary iodine concentration. A community-based cross-sectional study was conducted among the selected schools of Udayapur district. Urinary iodine concentration (UIC) was measured in 1012 school children (6-14 years). Based on UIC data, 83 blood samples were collected to measure serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4). UIC was measured by ammonium persulfate digestion method, and Tg, TSH, fT4, and fT3 were measured using ELISA kits. The median UIE was 236 µg/L, and 11.1% of the children had insufficient UIC. The mean fT3, fT4, and TSH in children with insufficient UIC were 2.55±0.43 pg/mL, 0.96±0.28 ng/dL, and 3.60±1.44 mIU/L respectively. Among children with low UIC levels, the median Tg was 17.5 ng/mL. Overt hypothyroidism was seen in 6%, and subclinical hypothyroidism in 3.6%. The children had sufficient iodine nutrition, and the frequency of thyroid dysfunction was low among the children with insufficient UIC

Visual evoked potentials’ responses in hypothyroidism and hyperthyroidism

Background: Visual Evoked Potentials (VEP) provides important diagnostic and prognostic information regarding the functional integrity of the visual system. This study, describes the effects of less or excess thyroid hormones of adults in visual conduction that helps to know the progression to neurological functional defects.Methods: The study was done in 75 consenting subjects (hypothyroid = 24, hyperthyroid = 25, euthyroid = 26). The VEP parameters N75, P100, N145 latencies and its amplitudes within different thyroid status (hypothyroidism, hyperthyroidism and euthyroidism) were compared. One way ANOVA was used to compare VEP parameters among three groups and Pearson’s correlation to find relation between thyroid hormones and VEP parameters.Results: There was positive correlation of 0.335, 0.338 and 0.301 between amplitudes of N75, P100 and N145 waves and fT3 hormone respectively. Furthermore, fT4 showed a positive correlation of 0.186 and 0.185 with the wave amplitudes of N75 and N145 waves respectively and negative correlation of TSH levels of -0.492, -0.280, -0.397 with amplitudes of N75, P100, N145 waves respectively. Hyperthyroid group had higher in VEP latency than euthyroid group in N75 (73±5.77 vs. 68.54±4.32), P100 (106.42±9.74 vs. 100.94±8.17) and N145 (153.03±16.39 vs. 144.37±7.02) waves. Similarly, hypothyroid group had higher in VEP latency than euthyroid group in N75 (72.12±6.34 vs. 68.54±4.32) wave.Conclusions: Both hypothyroidism and hyperthyroidism led to conduction delay in adults, possibly adversely affecting function of myelin. The prominent visual evoked potential abnormalities in hyperthyroidism and less change in hypothyroidism show that the visual neuropathy is more common in hyperthyroidism

Evaluation of serum adenosine deaminase activity and autoantibodies in systemic lupus erythematosus

Introduction: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with no single specific and sensitive test available for its diagnosis. Adenosine deaminase (ADA) is an enzyme that can act as an indicator of cellular immunity reflecting the extent of inflammation. The aim of this study was to investigate the role of serum adenosine deaminase activity and its association with antinuclear antibodies (ANA) and anti-dsDNA (anti-double stranded deoxyribonucleic acid) in SLE patients.Material and methods: In this study, we included 36 diagnosed case of SLE as per the American Rheumatology Association (ARA) criteria and 30 healthy control. Serum ADA activity was measured by a spectrophotometric technique based on Giusti and Gallanti. ANA and Anti ds-DNA were measured by indirect Enzyme-Linked Immune Sorbent Assay (ELISA). Normal values of serum ADA activity, ANA and anti ds-DNA was < 25 IU/L, < 10 U/mL and < 25 IU/mL respectively.Results: The mean ADA activity (37.03 ± 13.03 IU/L) in SLE patients was higher as compared to control (18.23 ± 10.12 IU/L), and the difference was statistically significant (p < 0.001). Median values of ANA and anti-dsDNA in SLE patients was 16.9 (8.5, 42.8) and 24.7 (20.5, 45.0) respectively. Serum ANA was positive in 25 out of 36 cases, anti-dsDNA was positive in 17 out of 36 cases and ADA was positive in 29 out of 36 cases. We observed a weak positive correlation between ANA and anti-dsDNA (r = 0.46, p = 0.005), whereas a moderate correlation between ANA and ADA (r = 0.525, p = 0.001) in SLE patients.Conclusion: Serum ADA was significantly higher in SLE patients as compared to control and more specific than autoantibodies. Determination of ADA activity is a reliable, cost-effective, and easy test that can be used as an alternative parameter for diagnosing and evaluating disease activity in SLE patients

Thyroid Dysfunction and Associated Risk Factors among Nepalese Diabetes Mellitus Patients

Objectives. To assess thyroid function and associated risk factors in Nepalese diabetes mellitus patients. Methods. A cross-sectional study was carried out among 419 diabetes mellitus patients at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Information on demographic and anthropometric variables and risk factors for thyroid dysfunction was collected. Blood samples were analysed to measure thyroid hormones, blood sugar, and lipid profile. Results. Prevalence rate of thyroid dysfunction was 36.03%, with subclinical hypothyroidism (26.5%) as the most common thyroid dysfunction. Thyroid dysfunction was much common in females (42.85%) compared to males (30.04%) p=0.008 and in type 1 diabetes (50%) compared to type 2 diabetes mellitus (35.41%) p=0.218. Diabetic patients with thyroid dysfunction had higher total cholesterol, HDL cholesterol, and LDL cholesterol in comparison to patients without thyroid dysfunction. Significant risk factors for thyroid dysfunction, specifically hypothyroidism (overt and subclinical), were smoking (relative risk of 2.56 with 95% CI (1.99–3.29, p<0.001)), family history of thyroid disease (relative risk of 2.57 with 95% CI (2.0–3.31, p<0.001)), and female gender (relative risk of 1.44 with 95% CI (1.09–1.91, p=0.01)). Conclusions. Thyroid dysfunction is common among Nepalese diabetic patients. Smoking, family history of thyroid disease, and female gender are significantly associated with thyroid dysfunction

Serum nitrite level and adenosine deaminase activity is altered in visceral leishmaniasis

ABSTRACT In this study we sought to determine if there is alteration in nitric oxide (NO) production and adenosine deaminase (ADA) activity among patients with visceral leishmaniasis (VL) and the effect of four weeks of chemotherapy on these levels. Fifty-three VL patients diagnosed clinically and by direct demonstration of the LD bodies in the bone marrow smear were studied. They were treated with Sodium Stibogluconate and sampled at the baseline and four weeks. Forty-three healthy individuals coming from the same endemic area were taken as control. Total nitrite Keywords: NO, ADA, Visceral leishmaniasis INTRODUCTION Intramacrophage infection by Leishmania donovani (LD), an obligate intracellular protozoan, results the potentially fatal visceral leishmaniasis (VL) or kalaazar. The elimination of leishmania parasite by macrophage depends upon the mounting of effective cell-mediated immune response. During leishmaniasis infection, the microbicidal interaction between the parasite and host cells involves the presentation of leishmania antigen by macrophage to T-helper (Th) cell through MHC II molecule along with the co-stimulatory molecules (B7-1/B7-2 and CD40). 1, 2 Activation of Th cell causes proliferation of IFN-γ producing CD4+ Th subset. 3 IFN-γ and TNF-α, the defining cytokines of the Th1 subset in turn activates the macrophage to generate NO which is the most relevant anti-leishmanial oxidant. Contrary results have been found in the NO level during L. donovani infection both in vitro and in vivo experiments. 4, 5 Also studies reported hitherto have generally originated from in vitro culture and animal experiments. However no study has so far been conducted to investigate NO production in patients with visceral leishmaniasis. Therefore we aimed to determine serum nitrite level in VL patients as surrogate marker of NO production and compare it with the healthy subjects. Assessments of NO metabolites may be useful tool in the evaluation of the effector mechanism of macrophage and clinical manifestation of patients. Adenosine deaminase (ADA) is an essential for the proliferation, maturation and function of T lymphocytes. Its activity increases during antigenic and mitogenic responses of lymphocytes and is considered as an important immunoenzyme marker for assessing cell-mediated immunity in diseases characterized by T lymphocytes proliferation and maturation