Browsing by Author "Niraula, Apeksha"
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Publication Autoimmune Thyroid Disease in Patients with Hypovitaminosis D in Department of Biochemistry of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Sherchand, Ojaswee; Niraula, Apeksha; Mishra, Bijaya; Subedi, Manish; Maskey, RobinAbstract Introduction: Autoimmune thyroid disease is characterised by the generation of autoantibodies against self-antigens such as thyroid peroxidase, thyroglobulin, and thyroid-stimulating hormone receptor. Recent studies have implicated the role of hypovitaminosis D to immune dysfunction, failure of self-tolerance and generation of autoantibodies. This study aimed to find out the prevalence of autoimmune thyroid disease among hypovitaminosis D patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among participants between the ages of 18 years to 65 years who visited the Department of Biochemistry of a tertiary care centre between the periods of July 2018 to December 2019. The study was initiated after receiving ethical approval from the Institutional Review Committee (Reference number: 42,8/074/075-IRC). Data was collected using a self-administered questionnaire followed by anthropometric measurement and blood collection. Thyroid hormone, thyroid peroxidase antibody and 25-hydroxy vitamin D were measured by chemiluminescence technique. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 83 patients, 39 (46.98%) (42.32–51.63, 95% Confidence Interval) had autoimmune thyroid disease. Conclusions: The prevalence of autoimmune thyroid disease among patients with hypovitaminosis D was similar to studies conducted in comparable settings.Publication Congenital Hypothyroidism among Infants Undergoing Thyroid Function Test in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Mishra, Bijaya; Bhatta, Nisha Keshary; Regmi, Mohan Chandra; Das, Binod Kumar Lal; Khan, Seraj Ahmed; Gelal, Basanta; Niraula, Apeksha; Lamsal, MadhabAbstract Introduction: Congenital hypothyroidism is the most preventable and treatable cause of mental retardation in newborns and infants. Screening for congenital hypothyroidism in newborns and infants is not a routine practice in our part of the world. This study aimed to find out the prevalence of congenital hypothyroidism among infants undergoing thyroid function test in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Biochemistry, from laboratory records starting 14th April, 2013 to 13th April, 2020 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 1502/019). Data of infants whose thyroid function tests were performed were obtained using convenience sampling. Thyroid-stimulating hormone was categorised per the European Society of Paediatric Endocrinology guidelines. Data were entered and analysed using Microsoft Excel 2011 and the Statistical Package for the Social Sciences version 11.5. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 1243 infants, 56 (4.50%) (3.35-5.65 at 95% Confidence Interval) infants were diagnosed with congenital hypothyroidism. Conclusions: The prevalence of congenital hypothyroidism was higher than other studies done in similar settings. An unexpected finding of treatment-induced hyperthyroidism was observed, indicating a lack of regular and timely follow-up of infants diagnosed with congenital hypothyroidism.Publication 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 Knowledge of Internal Quality Control for Laboratory Tests among Laboratory Personnel Working in Department of Biochemistry in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Mishra, Bijaya; Das, Binod Kumar Lal; Khan, Seraj Ahmed; Gelal, Basanta; Niraula, Apeksha; Chaudhari, Rajendra Kumar; Lamsal, MadhabAbstract Introduction: Clinical laboratory holds a central position in patient care, thus, ensuring accurate laboratory test results is a necessity. Internal quality control ensures day-to-day laboratory consistency. However, unless practised, laboratory quality systems cannot be achieved. This depends on the efforts and commitment of laboratory personnel for its implementation. Hence, the aim of this study was to find out the knowledge of internal quality control for laboratory tests among laboratory personnel working in the Department of Biochemistry in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 July 2022 to 30 August 2022 after receiving ethical approval from Institutional Review Committee (Reference number: 2341/022). Semi-structured questionnaire was used to assess knowledge on internal quality control. Three non-respondents were excluded. The operational definition of the knowledge domain was set before finalizing the questionnaire. The convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 20 laboratory personnel, 5 (25%) (6.02-43.98, 95% Confidence Interval) had adequate knowledge of internal quality control. The mean knowledge score was 12±2.44. Conclusions: The prevalence of adequate knowledge of internal quality control for laboratory tests among laboratory personnel working in the Department of Biochemistry was similar to the other study done in a similar setting.Publication Poor Glycemic Control in Type 2 Diabetes Mellitus Patients in Two Tertiary Care Centers during COVID-19 Lockdown: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Oli, Jagatkiran; Pant, Ved Prakash; Niraula, Apeksha; Lamsal, MadhabAbstract Introduction: Lockdown enforced to control the rapid transmission of novel coronavirus has resulted in the confinement of people in the home and restrictions of movement. This may have altered the lifestyle and glycemic control of type 2 diabetes mellitus patients. This study aimed to find the prevalence of poor glycemic control in type 2 diabetes mellitus patients in two tertiary care centres during COVID-19 lockdown. Methods: A descriptive cross-sectional study was conducted among 259 type 2 diabetes mellitus patients in selected hospitals from 1st September to 30th September 2020 after receiving ethical approval from the Departmental Research Unit, Biochemistry under Institutional Review Committee (Reference number: DRU/01/2020). A convenience sampling method was used. Data analysis was done by using Statistical Package for the Social Sciences version 26.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 259 patients with type 2 Diabetes Mellitus, 183 (70.65%) (65.10-76.20 at 95% Confidence Interval) had poor glycemic control during the lockdown period. Mean fasting and post-prandial blood glucose among these patients were 164.16±49.30 mg/dl and 246.76±69.86 mg/dl respectively. Conclusions: Our study depicts that the majority of the type 2 diabetes mellitus patients had poor glycemic control during the lockdown period which was similar when compared to other studies.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 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.