Browsing by Author "Bhattarai, Aseem"
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Publication Effects of Hemolysis on Serum Markers of Liver Function(Institute of Medicine, 2024) Bhattarai, Aseem; Thapa, Ranjana; Dubey, Raju Kumar; Raut, Mithileshwer; Niraula, Apeksha; Sharma, Vijay Kumar; Tuladhar, Eans TaraABSTRACT Introduction: Samples received in the laboratory are often rejected because of visible hemolysis. Every laboratory has protocols on whether to accept or reject hemolyzed samples based on tests ordered. The objective of the study was to observe and analyze the variations seen in association with hemolyzed samples in liver function test parameters and electrolytes measurement. Methods: This cross-sectional observational study was carried out in 88 laboratory samples in the Clinical Biochemistry Laboratory. Hemolysis was induced by mechanical mixing. This study compared reported values of bilirubin, protein, albumin, aminotransferases (ALT and AST), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), sodium and potassium between hemolyzed and non-hemolyzed samples. Results: Mean values of total bilirubin (TB) and direct bilirubin (TB), ALT, ALP, GGT and sodium (Na) were found to be significantly decreased post hemolysis (p<=0.001) with mean variances (σ2) at 0.30 (TB), 0.38 (DB), 0.56 (ALT), 0.18 (ALP), 0.01 (GGT) and 0.001 (Na). In contrast, mean values of AST (σ2= -0.9, p<0.001) and potassium (σ2 = -0.3, p<0.001) were found to be significantly elevated post hemolysis. Total protein and albumin were also found to be elevated in hemolyzed samples but the average variance was not statistically significant. Degree of hemolysis had highly varying effects in some parameters like AST and total protein, but less varying and more consistent effects on other measured parameters. Conclusion: Free hemoglobin estimation should be considered before rejecting a clinical sample because of hemolysis. Mathematical equations cannot be expected to reproduce corrected values of the analytes in question because of the large variances, so these tests need to be repeated on non-hemolyzed samples for the analytes that are affected. Keywords: Hemolysis; interference; routine chemistry analysisPublication High Sensitive C-Reactive Protein and Lipid Profile Alteration In Subclinical Hypothyroidism for Cardiovascular Risk Assessment(Nepal Health Research Council, 2024) Rajkarnikar, Smrity; Sharma, Vijay Kumar; Baidya, Sujata; Kadel, Pratibha; Tuladhar, Eans Tara; Niraula, Apeksha; Bhattarai, Aseem; Raut, Mithileshwer; Dubey, Raju Kumar; Parajuli, NareshBackground: The purpose of this study was to investigate the association of subclinical hypothyroidism with High sensitive C-reactive protein & lipid profile which can predispose to development of Cardiovascular disease. Methods: This hospital-based comparative cross-sectional study was conducted for a period of six months. A total of 71 patients with subclinical hypothyroidism & 37 healthy control subjects were enrolled for the study. Thyroid hormones, lipid profile, hs- CRP were measured and lipid variables were used to calculate lipid indices. Student t-test were used to compare means & Spearman’s correlation was done to determine the association between variables. ROC curve analysis was used to determine the diagnostic value of tests. Results: Out of 71 cases & 37 control, majority had female preponderance (71.8% in case & 83.8% in control). The mean values between case & control groups for hs-CRP, AIP, LCI and non-HDL cholesterol were statistically significant. There was positive correlation between TSH and hs-CRP (r=0.492, p <0.001), AIP and TSH (r=0.430, p<0.001), LCI and TSH (r=0.269, p =0.005), TSH and non-HDL cholesterol (r=0.308, p=0.001) & AI and LDL (r= 0.712, p<0.001) with weak correlation with statistical significance as per Spearman’s correlation. Area under ROC curve for hs-CRP indicated it as a positive biomarker for CVD assessment. Conclusions: Our findings shows that SCH patients are more at risk of CVD & hs-CRP contributes as a significant marker, thus requiring timely intervention. Lipid indices and AIP must be determined even in patients with a normal lipid profile to improve atherogenic risk. Keywords: Cardiovascular risk; dyslipidemia; hs-CRP; subclinical hypothyroidism.Publication High Serum Homocysteine among Women with Polycystic Ovarian Syndrome Visiting an Infertility Clinic of a Tertiary Care Centre(Nepal Medical Association, 2024) Sharma, Vijay Kumar; Kandel, Pratibha; Baidya, Sujata; Rajkarnikar, Smrity; Niraula, Apeksha; Tuladhar, Eans Tara; Bhattarai, Aseem; Raut, Mithileshwer; Dubey, Raju Kumar; Koirala, PoonamAbstract Introduction: Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age which is characterized by hyperandrogenism, polycystic ovarian morphology, ovarian dysfunction, and hyperinsulinemia. Increased prevalence of cardiovascular disease and higher cardiovascular morbidity is seen in women with polycystic ovary syndrome. This study aimed to estimate the prevalence of high serum homocysteine levels among women with polycystic ovarian syndrome visiting an infertility clinic of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among women with polycystic ovarian syndrome visiting an infertility clinic at the Department of Obstetrics and Gynaecology of a tertiary care centre from 1 June 2023 to 1 September 2023. The study was conducted after obtaining ethical approval from the Institutional Review Committee. Biochemical analysis of gonadal hormones, serum homocysteine and lipid profile was done. A convenience sampling method was used. The point estimate was calculated at a 95% confidence interval. Results: Among 76 women, the prevalence of high serum homocysteine level was found in 54 (71.05%) (60.86-81.25, 95% Confidence Interval). The mean age of patients was 27.46±6.18 years. Conclusions: The prevalence of high homocysteine levels among women with polycystic ovarian syndrome is higher than other studies done in similar settings.Publication Mean Serum Creatine Kinase among Organophosphate Poisoning Cases in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Twayana, Saru; Sharma, Vijay Kumar; Raut, Mithileshwor; Bhattarai, Aseem; Yadav, Binod Kumar; Bajracharya, Sangha Ratna; Tuladhar, Eans TaraAbstract Introduction: Major cases of poisoning are associated with organophosphates. Cholinergic effects and an intermediate phase seen with organophosphate poisoning may implicate myopathy. Creatine kinase is a marker of muscle tissue damage. This study aimed to find out the mean serum creatine kinase among organophosphate poisoning cases in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out among organophosphate poisoning cases in a tertiary care hospital from 13 October 2017 to 30 March 2018. Ethical approval was taken from the Institutional Review Committee [Reference number: 117(6-11-E) 2/074/075]. Blood samples were assayed for serum acetylcholinesterase in the pharmacology laboratory and for serum creatine kinase and lactate dehydrogenase in the biochemistry laboratory. Low serum acetylcholinesterase was taken as the basis for the establishment of organophosphate poisoning. A convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 103 organophosphate poisoning cases, the mean serum creatine kinase was 931.35±446.60 IU/l (845.10-1017.60, 95% Confidence Interval). Conclusions: The mean serum creatine kinase level among organophosphate poisoning cases was higher than in other studies done in similar settings.Publication Positive Thyroid Peroxidase Antibody among Women with Polycystic Ovarian Syndrome Visiting an Infertility Clinic at a Tertiary Care Centre(Nepal Medical Association, 2023) Sharma, Vijay Kumar; Baidya, Sujata; Kandel, Pratibha; Rajkarnikar, Smrity; Niraula, Apeksha; Dubey, Raju Kumar; Raut, Mithileshwer; Bhattarai, Aseem; Tuladhar, Eans Tara; Koirala, PoonamAbstract Introduction: Polycystic ovarian syndrome is the most common endocrine-metabolic disorder, affecting women of reproductive age groups, which shares various symptoms with thyroid dysfunctions. Despite it predisposition of aforesaid cohorts to autoimmunity, these etiologies have not adequately been studied in them. This study aimed to find out the prevalence of positive thyroid peroxidase antibodies among women with polycystic ovarian syndrome visiting an infertility clinic at a tertiary care centre. Methods: This was a cross-sectional study conducted at a tertiary care centre among patients visiting the infertility clinic at the Department of Obstetrics and Gynaecology from 21 September 2022 to 21 February 2023. Biochemical analysis of thyroid hormones, gonadal hormones, anti-mullerian hormone and thyroid peroxidase antibody were done in Abbott ARCHITECT ci4100 and SNIBE Maglumi 800 autoanalyzer. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 70 participants, thyroid peroxidase antibody was positive in 16 (22.86%) (13.02-32.69, 95% Confidence Interval). The mean age of the patients was 28.25±5.26 years. In the individuals with thyroid-stimulating hormone below 2.5 mIU/l, 5 (31.25%) had positive thyroid peroxidase antibody titre. Conclusions: The prevalence of positive thyroid peroxidase antibodies among women with polycystic ovarian syndrome is similar to other studies done in similar settings. Regular monitoring of thyroid peroxidase antibodies is recommended in these women to guide conception in order to evade inevitable adverse pregnancy outcomes.Publication Six-Sigma Methodology for Quality Monitoring in a Teaching Hospital Biochemistry Laboratory in Nepal(Institute of Medcine, 2021) Mishra, Akash; Pokhrel, Rakesh; Budhathoki, Uttam; Yadav, Binod K; Sharma, Vijay K; Tuladhar, Eans T; Bhattarai, Aseem; Raut, MithileshworABSTRACT Introduction: Six-sigma is emerging method of choice for performance testing of clinical laboratory. This study was designed to evaluate the performance of 12 routine biochemical analytes on sigma-scale and calculate the quality goal index (QGI). Methods: A cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Biochemistry Laboratory for 3 months. BT1500 and BT3500 automated biochemistry analyzers were used. Internal quality control (IQC) performed routinely for 12 clinical analytes for both control levels were recorded from both analyzers and used for calculation of coefficient of variation (CV%). Bias was estimated based on the average difference obtained for each analyte from the target values provided. Values for total allowable errors (TEa) were taken from Clinical Laboratories Improvement Act guidelines. Variables used for calculation of sigma values and QGI were CV%, percentage bias and TEa. Results: Both levels of control for alanine-aminotransferase (ALT) in BT1500 and only control level L2 for aspartate-aminotransferase (AST) in both analyzers showed the sigma value greater than six. Sigma-values between three and six were found for uric acid for both levels of control in both analyzers. Less than three sigma values were obtained for parameters urea, creatinine, albumin, triglyceride, total-cholesterol, alkaline phosphatase (ALP) and magnesium for both levels of control in both analyzers indicating the need towards improvement in these methods. Conclusion:The quality of test for urea, creatinine, albumin, triglyceride, total-cholesterol, ALP and magnesium were unacceptable. Hence, appropriate actions should be taken towards measurement method in these parameters to improve accuray and report quality. Keywords: Bias, IQC, quality goal index, six-sigma, total allowable errorPublication Whole-Blood Tacrolimus Trough Concentration in Renal Transplant Recipients at a Tertiary Care Center in Central Nepal: A Cross-sectional Study(Institute of Medicine, Tribhuvan University, 2024) Sharma, Vijay; Niraula, Apeksha; Tuladhar, Eans Tara; Dubey, Raju Kumar; Bhattarai, Aseem; Raut, Mithileshwer; Kadel, Anuradha; Kharal, Nikita; Sapkota, Srijana; Pokhrel, PrakashAbstract: Introduction Tacrolimus, a widely used immunosuppressant for renal transplantation, requires careful monitoring due to its narrow therapeutic index and high pharmacokinetic variability. Hence, this study aimed to evaluate the whole blood tacrolimus trough levels in post-renal transplant patients at TUTH. Methods A total of 257 patients who had undergone kidney transplantation were included in this descriptive cross-sectional study Whole-blood tacrolimus concentration was measured using the ARCHITECT i1000SR analyzer (Abbott Diagnostics, North Chicago, USA) by CMIA. Ethical approval was taken from the Institutional Review Committee of TUTH [Ref. No.: 448(6-11) E2081/082]. Results Among the 257 renal transplant recipients, 197(76.65%) were male and 60(23.35%) were female, with a mean age of 38.06±10.74 years. The mean tacrolimus trough level was 7.58±3.92 ng/mL, with a median of 6.8(IQR: 5.4- 9.1) ng/ml. Females had a slightly higher median tacrolimus concentration [7.2(IQR: 5.7- 9.1)] compared to males [6.8(IQR: 5.7- 9.1)]. Of the determinations, 175(68.09%) were within the therapeutic range (5-15 ng/mL), 68(26.46%) were below it, and 14(5.45%) had elevated tacrolimus levels. Conclusions The median tacrolimus trough level in this study was 6.8 ng/mL (IQR: 5.4–9.1), slightly higher but within the therapeutic range compared to similar studies done in similar settings. Monitoring of tacrolimus trough concentrations is of utmost importance in the management of kidney transplant recipients.