Browsing by Author "Risal, P"
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Publication Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study(Kathmandu University, 2019) Risal, P; Adhikari, B; Shrestha, R; Manandhar, S; Bhatt, RD; Hada, MABSTRACT Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson’s correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors. KEY WORDS Hyperthyroidism, Hypothyroidism, Thyroid dysfunction, Thyroid function testPublication Microalbuminuria as a Predictor of Pre-eclampsia in Pregnant Women Presenting in the Antenatal Clinic at Dhulikhel Hospital(Kathmandu University, 2020) Dongol, A; Timilsina, N; Bastakoti, R; Bhatta, RD; Risal, PABSTRACT Background Pre-eclampsia is described as a pregnancy-specific syndrome that can affect virtually every organ system. The appearance of proteinuria remains an important diagnostic criterion. Proteinuria is an objective marker and reflects system-wide endothelial leak, which characterizes the pre-eclampsia syndrome. Objective To determine protein values using the spot urinary albumin/creatinine ratio amongst the pregnant women and to identify whether this test can be used as the investigation of choice for predicting pre-eclampsia in near future. Method A hospital based observational cross-sectional study conducted from February 2016 to August 2017. The study included pregnant women from 20-28 weeks of gestation. They were tested for spot urinary albumin and creatinine. They were all followed up till term, delivery and post partum. Result The mean age of the study patients was 28 years (N+335), the most common age group being 25 to 29 years (43.6%). Pregnant women with higher values of urinary albumin/creatinine ratio were found to develop hypertension compared to women with normal values of urinary albumin/creatinine ratio in the third trimester with insignificant difference (p < 0.283) statistically. Conclusion Microalbuminuria is one of the predictor of pre-eclampsia however it cannot be used as routine investigation for predicting pre-eclampsia in future; further studies in large scales are needed to prove whether urinary albumin/creatinine ratio can be utilized as predictor for pre-eclampsia or not. KEY WORDS Albumin creatinine ratio, Hypertension, Microalbuminuria, Pre-eclampsiaPublication Nepali Translation and Reliability Analysis of Quantitative Androgen Deficiency in the Aging Male Questionnaire(Kathmandu University, 2020) Risal, P; Maharjan, A; Bhatt, RD; Tamrakar, DABSTRACT Background Androgen deficiency is diagnosed on the basis of clinical symptoms and laboratory assessment of testosterone level. Different screening tools have been developed to evaluate the sign and symptoms. Objective In this study, we examine the validity and reliability of the Nepali version of the quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire to screen androgen deficiency in Nepali male. Method English dialectal quantitative Androgen Deficiency in Aging Male questionnaire was forward translated to Nepali version and backward translated. This version was reviewed by a panel of an endocrinologist, a clinical psychiatrist, a physician, and a clinical biochemist. A final Nepali version of qADAM was developed. Thirty-one healthy male aged 31-70 years were administered with the questionnaire in two separate occasions two weeks apart. Cronbach’s alpha and test-retest reliability were calculated to identify validity and reliability, respectively. Result In the Nepali translated questionnaire, Cronbach’s alpha for internal consistency from ten items is good (0.68). The Cronbach’s alpha for internal consistency from nine items without item 7 is 0.706. Seven out of ten items had an R-value of > 0.7. In the total sample, Standard Error Mean (SEM) ranged from 0.00-0.44 for qADAM. SEM% are low for all variables (0.00-11.20%). MDC95 ranged 0.00-1.234. MDC95% ranged 0.00 – 31.05% and was < 30% for majority of variables (90%). Conclusion The final translated Nepali questionnaire seems reliable and valid. A future study measuring the Nepali questionnaire with testosterone level and another biochemical test in control and androgen deficiency patients will help validate the questionnaire. KEY WORDS Nepali translation, qADAM, Reliability analysisPublication Sensitivity and Specificity of Nepali Version of Quantitative Androgen Deficiency in Aging Males (qADAM) Questionnaire in Diabetic Patients(Kathmandu University, 2023) Bhatt, RD; Risal, P; Maharjan, A; Timalsina, D; Qiqiang, HEABSTRACT Background Diabetes mellitus (DM) is a chronic disorder with hyperglycemia that affects multiple systems with hypogonadism and erectile dysfunction some common issues affecting their quality sexual life. Quantitative androgen deficiency in aging males (qADAM) questionnaire is a trusted tool to assess hypogonadism and erectile dysfunction among diabetic patients and has been commonly used in Nepal too. However, the accuracy, sensitivity, and specificity of its Nepali version are yet to be tested. Objective To assess the accuracy, sensitivity, and specificity of the Nepali version of the quantitative androgen deficiency in aging males questionnaire among diabetic patients. Method A cross-sectional study was conducted among diabetic patients attending Dhulikhel Hospital, Kathmandu University Hospital. The Patients were asked to complete the valid Nepali translated version of quantitative Androgen Deficiency in Aging Males questionnaire. Participants’ serum total and free testosterone, lipid profile, fasting blood glucose, HbA1c and Sex Hormone Binding Globulin (SHBG) were measured in clinical biochemistry laboratory and the accuracy, sensitivity and specificity of Nepali version of quantitative androgen deficiency in aging males were analyzed. Result The translated Nepali version of quantitative androgen deficiency in aging males questionnaire showed 61.9% sensitivity, 45.5% specificity, and 56.7% accuracy in diagnosing hypogonadism in reference to serum testosterone level. Conclusion This Nepali translated version of quantitative androgen deficiency in aging males questionnaire can be a noninvasive tool to assess hypogonadism and erectile dysfunction. KEY WORDS Diabetes, Hypogonadism, Nepali Translation, Quantitative androgen deficiency in aging malesPublication The Ratio of Aspartate Aminotransferase to Alanine Aminotransferase (AST/ALT): the Correlation of Value with Underlying Severity of Alcoholic Liver Disease(Kathmandu University, 2013) Gurung RB; Purbe, B; Gyawali, P; Risal, PABSTRACT Background Alcoholic liver disease is one of the most frequently diagnosed liver problems in the hospitalized patients in most tertiary care hospitals all over the world .The diagnosis of alcoholic liver disease is most of the time clinical. The AST/ALT ratio is a useful and reliable biochemical marker of liver injury due to alcohol. Whether the value of AST/ALT ratio correlates with clinical severity has not been studied. Objectives To study values of AST/ALT ratio in correlation with clinical severity of illness due to alcoholic liver disease using Child-Pugh’s grading. Methods This is a retrospective study. Inpatient records of all the patients admitted with diagnosis of alcoholic liver disease from July 2009 to 2011 June were analyzed. Data from 174 patients with the diagnosis of alcoholic liver disease - alcoholic hepatitis or alcoholic cirrhosis were retrieved; out of 174 patients, 138 were eligible for the study. The AST/ALT ratio and Child’s grading of all the patients were calculated from the documented biochemical and clinical parameters on admission. Demographic profile of all the patients were also recorded and analyzed. The data was analyzed using software SPPSS 16 version. Results A total of 138 patients diagnosed as alcoholic liver disease since July 2009 to June 2011 were analyzed. The male-female ratio was found to be 5.34: 1.The mean age of the patients at diagnosis was found to be 47.58 ± 12.83 years. Among 138 patients, Mongolian were found to have the highest prevalence of alcoholic liver disease (38.8%), followed by Newars ( 33.6%), Brahmin and Chhetri (19.1%) and Dalit (7.2%). With respect to AST/ALT ratio and Child’s grading of ALD, the mean AST/ALT ratio was found to be 3.03 ± 2.24 in those patients who had Chlild’s grade C; likewise the mean AST/ALT ratio was 2.28 ± 1.14, and 1.68 ± 0.83 in patients with Child B and Child A respectively. Conclusion The higher value of AST/ALT ratio is indicative of more severe liver damage due to alcohol. KEY WORDS Alcoholic liver disease, AST/ALT ratioPublication Variation of total serum cholesterol among the patient with thyroid dysfunction(Kathmandu University, 2010) Risal, P; Maharjan, BR; Koju, R; Makaju, RK; Gautam, MAbstract Background: Thyroid hormone has its effect in the lipid metabolism. Thus, thyroid disorder is usually associated with the dyslipidaemia. Hypercholesterolemia is an established risk factor for the cardiovascular disease (CVD) and therefore in case of overt hypothyroidism which is associated with hypercholesterolemia, CVD is most likely to occur. Objectives: controversies still persist about the hypercholesterolemia and sub clinical hypothyroidism. Hence, we conducted our study to elucidate the relation of thyroid hormone with cholesterol in different thyroid disorder. Material and Method: All patients suspected of thyroid disorder within a period of one year were included in the study and free thyroxine-3 (fT3), free thyroxine-4 fT4, Thyroid Stimulating Hormone (TSH) and total cholesterol (TC) in the serum were estimated. Statistical analysis was carried out by using SPSS. 13. Results: Among the 169 cases, 32.5% of the patients were having thyroid disorder. In which 8.3% were of hypothyroid, 7.1% were of sub clinical hypothyroid, 8.3% were of hyperthyroid, 7.7% were of sub clinical hyperthyroid and 1.2% cases were of pan hypothyroid. We observed significant negative correlation between TC & fT3(r = -0.226, p = 0.003), significant negative correlation between total cholesterol & fT4(r = -0.197, p = 0.010) and significant positive correlation between TC & TSH(r = 0.365, p = 0.000). Total cholesterol was significantly raised in hypothyroidism (Mean ±SD 283±53, p = 0.000) in comparison to euthyroid population (mean ±SD, 195±58). But cholesterol was not significantly increased in sub clinical hypothyroidism (mean ±SD, 240±46) Conclusion: Our results show that total cholesterol level in serum is affected by the blood thyroid hormone level. Therefore, screening for hypercholesterolemia could be useful in patients with hypothyroidism to reduce associated disease. Key words: Thyroid hormone, Cholesterol, Nepal