Browsing by Author "Shrestha, Apurba"
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Publication Clinico-demographic, Thyroid, and Lipid Biomarkers in Patients with and without Type 2 Diabetes Mellitus in a Paramilitary Hospital, Nepal(Nepal APF Hospital, 2025) Shrestha, Mahendra Raj; Shrestha, Apurba; Bhat, Dinesh Singh; Maharjan, RajendraAbstract Introduction: Diabetes disrupts the hypothalamic regulation of thyroid-releasing hormone and impacts the synthesis of triiodothyronine (T3) and thyroxine (T4), leading to disrupted lipid biomarker levels. This study was aimed how HbA1c correlates with body mass index (BMI), thyroid and lipid biomarkers in patients with and without type 2 diabetes mellitus (T2DM). Methods: This case-control study was conducted at the Tertiary Care Paramilitary Hospital between July 2023 and June 2024, along with 202 T2DM patients and 211 controls. Ethical approval was taken from Ethical Review Board (Reference number:3795). Data on clinico-demographic and anthropometric variables were collected. Fasting venous blood samples were analyzed for HbA1c, thyroid, and lipid profiles. Correlational analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 17 with significance set at p<0.05. Results: The prevalence of T2DM among hospital visitors was 8.12% (202/2,488) [males: 60.40% (122/202); ageMedian: 51 years; BMIMedian: 25.68 kg/m2]. Among T2DM patients, 18.81% (38/202) had dysthyroidism, predominantly hypothyroidism (17.82%, 36/202), especially in females (100.00%, 11/11) and those who were overweight. Additionally, 54.95% (111/202) of T2DM patients had dyslipidemia, with hypertriglyceridemia (50.99%, 103/202) being the most common, particularly among males (94.52%, 69/73) and overweight patients. T2DM patients had significantly higher BMI, triglycerides, and thyroid-stimulating hormone (TSH) levels compared to non-T2DM patients. HbA1c was positively correlated with total cholesterol (p=0.041) and triglycerides (p=0.004), HDL with T3 (p=0.005), and BMI with age (p=0.048). Conclusions: T2DM affected less than one-tenth of hospital-visiting patients, primarily males and those aged 50–59. Dyslipidemia was common among T2DM patients, with dyslipidemia and hypothyroidism being most prevalent in overweight males and females, respectively. Regular testing of triglycerides, TSH, and T4 in T2DM patients can help reduce morbidity.Publication Prevalence of Diabetic Retinopathy among Diabetic Patients Attending a Tertiary Care Hospital in Nepal: An Observational Study(Nepal APF Hospital, 2026) Chhetri, Sundip Dware; Shrestha, Apurba; Thapa, Ashish; Sah, Dayanand Prasad; Kunwar, Meena; Lamichhane, KritiAbstract: Introduction: The global rise of type II diabetes has increased the number of individuals at risk for retinal complications such as diabetic retinopathy, a leading cause of vision impairment. In Nepal, a significant number of patients are diagnosed with diabetic retinopathy only at advanced stages. Diabetic retinopathy is commonly linked to longer duration of diabetes, uncontrolled blood sugar, and elevated blood pressure. Timely detection and management are crucial to prevent irreversible vision loss. This study aimed to assess the prevalence of diabetic retinopathy among diabetic patients visiting a tertiary care hospital. Methods: A hospital-based observational study was conducted between September 1, 2025 and December 26, 2025, at a tertiary care hospital. Ethical approval was obtained from the Institutional Review Committee (Reference number: NAPFH-041/2025). Detailed demographic, clinical, and ocular examination findings were recorded. A purposive sampling technique was used. Data were analyzed with Microsoft Excel and Statistical Package for the Social Sciences version 17. Results: Out of 195 diabetic patients, the mean age was 54.7±10.17 years. The overall prevalence of diabetic retinopathy was 18 (9.23%), of which 17 (8.71%) had non-proliferative diabetic retinopathy, and 1 (0.51%) had proliferative diabetic retinopathy. Diabetic macular edema was present in 1 (0.51%) of cases. Diabetic retinopathy was more common in patients with longer duration of diabetes and associated complications, including nephropathy. Conclusions: Diabetic retinopathy continues to be a major complication among patients with diabetes in Nepal, with many cases identified late due to inadequate prior eye screening. Regular monitoring and early treatment are vital to avoid vision-threatening consequences.Publication Role of Tocilizumab in the Treatment of COVID-19 Patients with Cytokine Storm: A Case Series(Nepal Medical Association, 2022) Basnet, Ajaya; Shrestha, Mahendra Raj; Thapa, Rossu; Tamang, Basanta; Shrestha, Apurba; Rawal, Prabhat; Shrestha, Sailendra Kumar Duwal; Karki, Lochan; Rai, Shiba KumarAbstract The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms.