Poster Session:PS 0194 ; Endocrinology : Increased Serum Hs-Crp Level in Conjunction with Other Cardiovascular Risk Factors in Subclinical Hypothyroidism

( Rajendra Kc ),( Madhab Lamsal ),( Prahlad Karki ),( Shankar Majhi ),( Nirmal Baral ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Several potential cardiovascular risk factors were reported in patients with subclinical hypothyroidism (SCH) but the association still remains controversial therefore, we aimed to evaluate cardiovascular risk factors in subjects with subclinical hypothyroidism. Methods: A total of 100 subjects with subclinical hypothyroidism and 100 age and gender matched euthyroid controls, were included in the study. Serum free T3, free T4 and TSH were estimated by fl uorescent immunoassay. Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were assayed by enzymatic colorimetric method, and high sensitivity C-reactive protein (hs-CRP) by enzyme immunoassay. Data were analyzed by SPSS version 20. Results: Mean levels of diastolic blood pressure (82.1±6.0 vs 79.1±6.1 mmHg, p=0.001), total cholesterol (199.6±31.6 vs 184.3±30.8 mg/dl, p=0.001) and LDL-C (104.0±27.5 vs 94.6±25.4, p=0.012), and median hs-CRP (0.92 (0.30-2.17) vs 0.56 (0.33-1.35), p=0.03) were significantly higher in SCH than the euthyroids. Within the SCH group, mean diastolic blood pressure, TC, LDL-C, and median hs-CRP levels were signifi cantly higher in subjects with TSH=10 mU/L than those with TSH<10 mU/ L. Individual analysis revealed that the prevalence of borderline elevated total cholesterol (=200mg/dL), elevated LDL-C (=100mg/dL) and raised hs-CRP (=3mg/L) were signifi cantly higher in SCH than ineuthyroid group. TSH levels in SCH was positively correlated with diastolic blood pressure (r=0.33, p=0.001), total cholesterol (r=0.39, p<0.001), LDL-C (r=0.42, p<0.001) and hs-CRP (r=0.51, p<0.001). Conclusions: Subclinical hypothyroidism was associated with higher diastolic blood pressure, higher total cholesterol, LDL-C and higher hs-CRP levels, this might increase the risk of accelerated arteriosclerosis.

Poster Session : PS 0052 ; Cardiology : Predicting Outcomes in Patients of Acute Coronary Syndrome Using Biochemical Markers

( Kumar Krishna Agrawaal ),( Prahald Karki ),( Nikesh Shrestha ),( Madhab Lamsal ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Cardiac biomarkers provide a convenient and noninvasive means to gain insights into the underlying causes and consequences of ACS that mediate the risk of recurrent events and may be targets for specifi c treatment. The role of high sensitivity C reactive protein (hsCRP) for predicting the outcome has been established.There are studies to show the prognostic importance of estimated glomerular fi ltration rate. But our population differs genetically and environmentally as compared to west. Methods: It was a Prospective observational study. The Primary Outcome was taken as all cause mortality.Consecutive patients with the diagnosis of acute coronary syndrome giving consent for the study were enrolled and followed up at 6 weeks and 6 months. Mortality and the likely cause of death were recorded along with the day since admission. HS CRP was estimated on admission, at 6 weeks and at 6 months. The eGFR was calculated using the abbreviated MDRD formula at admission, at 6 weeks and 6 months. Results: There were 108 cases of ACS in duration of 6 months.The study showed 44% of patients had STEMI; 41% had NSTEMI and 23% had UA. The HS-CRP level of > 5mg/dl was highly signifi cant for predicting mortality during hospital stay and at 6 weeks (p-<0.001). There was 11% of in hospital mortality (p<0.001). At 6 months the overall mortality was 28% (p-<0.001). Arrhythmias were observed in 27% patients (p<0.001). Cardiogenic shock complicating STEMI resulted in high patient mortality (p-0.001). There was a statistical signifi cance with low eGFR (median eGFR 45 ml/ min/1.73 m2) levels during the admission. Illiteracy, Smoking and diabetes mellitus of duration more than 10 years was associated with increased risk of mortality. Conclusions: HS CRP> 5mg/dl, the eGFR levels =30ml/min/1.73 m2, Age >75 years, albuminuria and cardiogenic shock were signifi cant in predicting mortality in patients of ACS.

Poster Session : PS 0143 ; Neurology : Brainstem Auditory Evoked Potentials` Responses in Hypothyroidism and Hyperthyroidism

( Vikash Gautam ),( Dilip Thakur ),( Bishnu Hari Paudel ),( Kopila Agrawal ),( Madhab Lamsal ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: To correlate brainstem auditory evoked potentials` (BAEPs) amplitude and latency within different thyroid status (hypothyroidism, hyperthyroidism and euthyroidism). Methods: BAEP and Thyroid Function Tests (TFT) were assessed in consenting 75 subjects (hypothyroid=24, hyperthyroid=25, euthyroid= 26). The mean age in hypothyroid, hyperthyroid, and euthyroid group were 31.46±4.191; 31.52±4.134 and 27.12±2.732 respectively. The BAEP parameters viz, wave I-V latencies, interpeak latencies and amplitudes were recorded. One way ANOVA was used to compare BAEP parameters among three groups and Pearson`s correlation to fi nd relation between thyroid hormones (fT3, fT4, TSH) and BAEP parameters. P value less than 0.05 was considered statistically signifi cant. Results: Wave I (1.78±0.21 vs. 1.64±0.22, vs. 1.56±0.15, p= 0.001), wave III (3.96±0.19 vs. 3.90±0.30 vs. 3.74±0.30, p= 0.001) and wave V (5.97±0.36 vs. 5.91±0.37 vs. 5.60±0.24; p= 0.001) latencies (ms) were signifi cantly more in hypothyroid and hyperthyroid than euthyroid. Wave interval latencies (ms) III-V (2.01±0.32 vs. 2.01±0.41 vs. 1.86±0.32, p= 0.044) and I-V (4.19±0.43 vs. 4.26±0.41 vs. 4.03±0.28, p= 0.007) were longer in hypothyroid and hyperthyroid than euthyroid. Also, the wave I-V amplitude (μV) was more in hypo-hyperthyroid than euthyroid (0.15±0.11 vs. 0.22±0.17 vs. 0.20±0.16, p= 0.052). TSH & Wave I-V amplitude (r= -0.193, p= 0.04); fT3 and wave I latency (r= -0.269, p=0.004) were negatively correlated. However, a positive correlation was between TSH & wave I latency (r= 0.285, p=0.002). Conclusion: Both hypo- and hyperthyroidism led to conduction delay in auditory neurons in adults, possibly adversely affecting function of myelin since, T3 and T4 are known to affect myelinization and synaptic transmission. The prominent auditory evoked potential abnormalities in hypothyroidism and less change in hyperthyroidism are consistent with a possibility that the auditory neuropathy is more common in thyroid defi ciency than its excess.

Non-enzymatic Antioxidant Status and Biochemical Parameters in the Consumers of Pan Masala Containing Tobacco

Shrestha, Raj,Nepal, Ashwini Kumar,Lal Das, Binod Kumar,Gelal, Basanta,Lamsal, Madhab Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.9

Background: Tobacco consumption is one of the leading causes of oral submucous fibrosis, oral cancer and even premature death. The present study was designed to compare the biochemical parameters and non-enzymatic antioxidant status and the lipid peroxidation products in pan masala tobacco users as compared with age-matched non-user controls. Methods: Pan masala and tobacco users of age $33.2{\pm}9.94$ years and age-matched controls ($31.2{\pm}4.73$ years) were enrolled for the study. Plasma levels of vitamin E, vitamin C, albumin, bilirubin, uric acid, glucose, urea, creatinine, aspartate amino transferase (AST), alanine amino transferase (ALT) were measured by standard methods. Serum malondialdehyde (MDA) levels were estimated as a measure of lipid peroxidation. Results: In the pan masala tobacco users, as compared to the controls, the level of vitamin C ($68.5{\pm}5.9$ vs $97.9{\pm}9.03{\mu}mol/L$, $p{\leq}0.05$) vitamin E ($18.4{\pm}5.3$ vs $97.9{\pm}9.03{\mu}mol/L$, $p{\leq}0.001$), albumin ($37.5{\pm}7.01$ vs $44.3{\pm}9.99g/L$, $p{\leq}0.001$), and malondialdehyde ($10.8{\pm}1.29$ vs $1.72{\pm}1.15nmol/ml$, $p{\leq}0.001$) were found to be significantly altered. Malondialdehyde was significantly correlated with vitamin E (r=1.00, p<0.001) and vitamin C (r=1.00, p<0.001) in pan masala tobacco users. Serum levels of AST ($31.0{\pm}16.77$ IU) and ALT ($36.7{\pm}31.3$ IU) in the pan masala tobacco users were significantly raised as compared to the controls (AST, $25.2{\pm}9.51$ IU, p=0.038; ALT, $26.2{\pm}17.9$ IU, p=0.038). Conclusion: These findings suggest that pan masala tobacco users are in a state of oxidative stress promoting cellular damage. Non-enzymatic antioxidants are depleted in pan masala tobacco users with subsequent alteration in the biochemical parameters. Supplementation of antioxidants may prevent oxidative damage in pan masala tobacco users.

Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

Belbase, Narayan Prasad,Agrawal, Chandra Shekhar,Pokharel, Paras Kumar,Agrawal, Sudha,Lamsal, Madhab,Shakya, Vikal Chandra Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.5

Background: Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer, and it ranks among the top ten specific causes of death in males. Objective: To explore the situation of prostate cancer in a healthy population cohort in Eastern Nepal. Materials and Methods: This study was conducted in the Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010 to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in the study and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal. Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessment of serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormal PSA/DRE findings. Results: A total of 1,521 males more than 50 years of age were assessed and screened after meeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ${\leq}4.0$ ng/ml. Abnormal PSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were both abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%) and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% and a positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 19.0% Conclusions: The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.