Slide Session : OS-END-30 ; Endocrinology : Pattern of Thyroid Dysfunction and Evaluation of Atherosclerotic Cardiovascular Disease Estimator in Patients with Metabolic Syndrome

( Prabin Gyawali ),( Jyoti S Takanche ),( Bijay Krishna Prajapati ),( Rajendra Koju ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Thyroid dysfunction (TD) and metabolic syndrome (Met S) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of Met S. Although traditional lipid profile parameters are used to manage ASCVD in patients with Met S, there are no reliable biochemical parameters that can be used in early prediction, diagnosis and primary prevention. Nevertheless, recent studies have recognized serum lipid ratios, atherogenic index of plasma (AIP) and non- HDL Cholesterol (non-HDL-C) as a stronger predictive marker of coronary atherosclerosis and ASCVD events than isolated parameters used independently. Thus, the purpose of this study was to evaluate -the pattern of TD in patients with Met S and - serum lipid ratios, non-HDL cholesterol, and AIP as a predictor of ASCVD in patients with Met S. Methods: Between, October 2012 and March 2014, total of 358 previously diagnosed patients with Met S and 341 healthy controls, who visited diabetes and endocrine clinic at Dhulikhel Hospital, Dhulikhel, Nepal were recruited in the study. The thyroid function test parameters were measured to classify TD and the serum lipid concentrations were measured to calculate the lipid ratios, non-HDL-C and AIP. Results: The overall prevalence of TD in patients with Met S was 31.84 % with high prevalence of subclinical hypothyroidism. Patients with Met S had significantly higher significantly higher lipid ratio`s, non-HDL-C (165.78±48.66 vs 135.21±47.88), and AIP levels (0.810±0.023 vs 0.546±0.014) compared to healthy controls (P < 0.05). Conclusions: Patients with Met S develop sub-clinical hypothyroidism greatly. The measurements of serum lipid ratios, non HDL-C, and AIP level predicts high risk of developing ASCVD in patients with Met S.

Pattern of Thyroid Dysfunction in Patients with Metabolic Syndrome and Its Relationship with Components of Metabolic Syndrome

Prabin Gyawali,Jyoti Shrestha Takanche,Raj Kumar Shrestha,Prem Bhattarai,Kishor Khanal,Prabodh Risal,Rajendra Koju 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.1

Background: Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS. Methods: A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship. Results: The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD. Conclusion: Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.

Alcohol, NAFLD, Other : Intestinal Parasitic Infection among the Patients with Viral Hepatitis: A Case Control Study

( Prabodh Risal ),( Dhruba Acharya ),( Prabin Gyawali ),( Meera Hada ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background and Methods: Medical complications in intestinal parasitic infection include diarrhea, anemia and malnutrition. Another important problem is human parasites decreases the secretion of immunoglobulinA (IgA), resulting in increased risk of viral infection including hepatitis. There are many reports on co-infection by intestinal parasites and worms among HIV-infected patients, but the parasitic infection among viral hepatitis has not been studied so far in Nepal. There are some experts considering parasitic infections to be the missing diagnosis in many acute and chronic health problems including hepatitis. We conducted this study to evaluate the frequency of common intestinal parasites among viral hepatitis patients in Kathmandu University Hospital. 289 patients diagnosed as viral hepatitis during the period of August 2012 to April 2013 in Kathmandu University Hospital were enrolled in the study. Blood samples and stool samples were analyzed to see the frequency of co-infection and the association between the presence of parasites in their stools and the level of serum Billirubin, Aspartate Transaminase (AST), Alanine transaminase (ALT), and Alkaline phosphatase (ALP). Results: The laboratory results showed significantly higher prevalence of intestinal parasite among the patients with viral hepatitis compared to the control group. The most common parasite infection was Entamoeba coli, followed by E. histolytica, Trichuris trichuria, Giardia lamblia, Ascaris lumbricoides and hookworm. Among the total positive cases around 30% had multiple parasitic infections. Serum AST and ALT was higher in the patients with intestinal parasitic infection where as serum bilirubin and ALP were not different among the control and viral hepatitis groups. Conclusions: In conclusion, higher prevalence of intestinal parasitic infection was seen in the patients with viral hepatitis, resulting in a more severe disease outcome.

Slide Session : OS-END-09 ; Diabetes : Discrepancies Between the Glycosylated Hemoglobin (HbA1c) Based Criteria and Glucose Based Criteria for Diagnosis of Diabetes and Pre-Diabetes

( Sujan Sharma ),( Raj Kumar Shrestha ),( Siddha Br Magar ),( Prabin Gyawali ),( Rajendra Koju ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The number of people with diabetes is increasing globally; hence necessitate identifying diabetes earlier and more efficiently. Recently, American Diabetes Association (ADA) recommended the use of glycated hemoglobin (HbA1c) as an alternative to glucose based criteria for diagnosing type 2 diabetes and pre-diabetes. Previous studies have suggested that some level of discrepancy may exist between the HbA1c- and glucose-based criteria and may vary by race, ethnicity, sex, and age in various populations. Consequently, evaluation of discrepancies can help to determine which diagnostic criterion should be used to diagnose diabetes in a given population. Hence, we aimed to evaluate the discrepancies between HbA1c- and glucose-based criteria for diagnosis of diabetes and pre-diabetes in Nepalese population. Methods: A total of 2502 subjects aged 30 years or older, who attended university hospital and subjected for measurement of HbA1c, fasting plasma glucose (FPG) and 2-hour plasma glucose (PPG) level were recruited in the study. Newly diagnosed diabetes and pre-diabetes were defined by ADA-glucose based and ADA- HbA1c criteria. Statistical analyses were performed using SPSS software to evaluate discripancies. Results: The percentages of newly diagnosed individuals with diabetes were 12.87 % (322/2502) using the FPG criterion and 14.55 % (364/2502) using the HbA1c criterion. Significant discordance occurred for 3.28% (82/2502) with HbA1c- and Glucose- based criteria and for 1.68% (42/2502) with HbA1c- and FPG- criteria. Among the study subjects, 2.86 % of individuals with a FBG and 2.12% of individuals with HbA1c were found to be pre-diabetes. Conclusions: Significant discordance exists between the HbA1c- and glucose- based diagnostic criteria for diagnosis of diabetes and pre-diabetes in Nepalese population. Hence, we concluded that using glucose based criteria merely may result in an underestimation of diabetes and pre-diabetes.