Browsing by Author "Kadel, Anuradha"
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Publication Effect of Altitude on Metabolic Syndrome(2025) Bhatt, Mahendra Prasad; Poudel, Manavi; Pokhrel, Sushant; Kadel, Anuradha; Joshi, MukeshBackground: Metabolic syndrome is a constellation of overweight/obesity, hypertension, and disturbances in lipid and carbohydrate metabolism. Hypoxic and hypobaric conditions of high altitude alter the use of energy producing metabolic fuels which may secondarily affect lipid and blood glucose concentrations. Thus, this study aims to assess prevalence and risk factors of the metabolic syndrome in high and low altitude inhabitants of Nepal. Methods: A hospital based descriptive cross-sectional study was carried out including 58 individuals from high altitude and 58 individuals from low altitude attending Manmohan Memorial Teaching Hospital, Kathmandu. Anthropometric measurements and blood pressure were recorded and blood samples were obtained for laboratory analysis. The samples were analyzed for fasting glucose, triglycerides, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol as per the standard guidelines. Results: Among the study group, 31.8% of high altitude and 68.2% of low altitude are found to have metabolic syndrome according to National Cholesterol Education Program Adult Treatment PlanIII and 35.5% of high altitude and 64.5% of low altitude are found to have metabolic syndrome according to HJSS criteria. The most prevalent defining components were low high density lipoprotein cholesterol (38.8%), high triglyceride (36.2%), elevated fasting blood sugar (33.6%) and Hypertension (34.4%). Among the lifestyle factors, alcohol consumption, unhealthy diet and physical inactivity were found to be an independent risk factors for MetS. Conclusions: High altitude inhabitants have significantly lower metabolic syndrome than that of low altitude inhabitants because of less physical activities in their work and sedentary. Thus, encouragement of food habit, healthy lifestyle, and timely health screening and monitoring help in prevention of metabolic syndrome. Keywords: Altitude; diabetes mellitus; early diagnosis; metabolic syndrome; prevention.Publication 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.