Browsing by Author "Sigdel, M"
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Publication Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases(Kathmandu University, 2022) Yadav, NK; Pokharel, DR; Kathayat, G; Sigdel, M; Hussain, IABSTRACT Background Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, particularly in developing countries. Early diagnosis with the best diagnostic marker is highly desired for the prevention and timely treatment of CVDs. However, there is still a dearth of an ideal marker for the detection of CVDs. Objective To explore the diagnostic potential of liver aminotransferases (AST and ALT), and alkaline phosphatase for the diagnosis of CVDs without liver involvement. Method This was a cross-sectional study conducted among 200 adult patients with CVDs, who visited the cardiology and emergency units of Manipal Teaching Hospital, Pokhara, Nepal. The study was conducted from January 2018 to December 2020. The baseline data on family history, anthropometry, baseline biochemical parameters, liver enzymes, and cardiac biomarkers were collected using standard and validated methods. The data were analyzed using SPSS version 21 and MedCalc software 2021. Result The diagnostic sensitivity of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were 53.7%, 52.6%, and 33.7% and specificity were 99%, 90%, and 90% respectively. The area under the curve (AUC) of AST, ALT, and ALP were 0.78, 0.73, and 0.52 respectively. ROC curve indicated that serum AST and ALT activity was a better reliable marker than the serum ALP activities. Conclusion Our study suggests that serum aspartate aminotransferase and alanine aminotransferase but not alkaline phosphatase could have some diagnostic potential to diagnose the risk of CVDs. However, they could not replace the currently adopted cardiac biomarkers such as cTnI and CK-MB. KEY WORDS Alkaline phosphatase, Aminotransferases, Cardiovascular diseases, Diagnostic potentialPublication In response to the article entitled “Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College” by Pradhan SB, Joshi MR and Vaidya A published in KUMJ 2009 Vol 7, No. 3, Issue 25, 268-71(Kathmandu University, 2009) Shrestha, R; Gyawali, P; Poudel, B; Sigdel, M; Khanal, MNAPublication Prescribing medication in patients with impaired renal function(Institute of Medicine, 2011) Bharati, L; Sigdel, M; Sakya, RAbstract Introduction: Renal failure has been emerging as a major public health problem in Nepal in recent years. Chronic renal failure affects renal drug elimination and other pharmacokinetic processes. Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Medications with toxic metabolites should be avoided, and alternative medications should be used if potential nephrotoxicity exist. Dosages of drugs cleared renally were adjusted according to creatinine clearance and glomerular filtration rate. Methods:A Descriptive, cross-sectional study was conducted in TUTH. Data were collected from all the renal failure patients admitted at TUTH from 2009 February to April 2009. Parameters studied included age group, gender, duration of hospital stay, causes of renal failure, any associated comorbidity, serum creatinine (Scr) at admission and at discharge, blood urea nitrogen (BUN) and different drugs prescribed. Creatinine clearance (Clcr) in ml/min/1.73 m2 was calculated by using Cockroft-Gault equation. Results: Majority of patient (98.1%) had raised urea level. Renal function at the time of presentation showed that 39.5 % patients had End stage renal failure and 39.5%, 19.7% and 1.3% patients had severe impairment, moderate impairment and mild impairment respectively. Average number of drugs prescribed was 5 to 6. In the list of prescribed medicine, 23% were antibiotic. Of the total antibiotic prescribed, dose adjustment was done for 27.3% and 1.5% drugs were prescribed which are supposed to be avoided in renal failure patients. Similarly in non-antibiotic group, 62.9% drug don’t required dose adjustment (they are safer in renal failure), dose adjustment was done in 22.9 %. The mortality rate of the renal failure at TUTH was found to be 15.3%. Kidney diseases, diabetes and hypertension were found to be the common causes of renal failure accounting for 29.5 %, 24.8% and 22.9% respectively. Conclusions: Most of the patients with renal failure had end stage renal disease at presentation. Though they were prescribed multiple drugs, only few had dose adjustment done and some were even prescribed nephrotoxic drugs. Keywords: Acute renal failure, chronic renal failure, creatinine clearance, end stage renal diseases