Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases

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.

Association of Anthropometric Parameters with Lipid Profile among Adult Population of Kaski District, Nepal

Background Anthropometric parameters of individuals are good at predicting functional impairment, mortality, and future cardiometabolic diseases. The relationship between anthropometric parameters and lipid profiles have been studied in different parts of the world. But to date, no such studies have been conducted in Nepal. Objective To investigate the association between anthropometric parameters and lipid profile in the adult population of Kaski district, Nepal. Method This study was carried out at Manipal Teaching Hospital, Pokhara, Kaski, Nepal. The fasting lipid profiles were analyzed in a total of 400 subjects aged > 18 years with an automated OCD Vitros 350 dry chemistry analyzer. The Kolmogorov-Smirnov test was used to test the normality of the data. The mean values of fasting lipids were compared within the subjects with different body mass index groups using ANOVA and waist circumference, waist-hip ratios, waist-height ratios, and neck circumference using independent samples t-test. The anthropometric indices evaluated were body mass index, waist circumference, waist-hip ratio, waist-height ratio, head circumference, neck circumference, and mid-upper arm circumference. Pearson's correlation coefficients and multiple regression analysis were performed to identify the association between the lipid profile and anthropometric parameters. The difference was considered statistically significant when p values (two-tailed) were < 0.050. Result The mean values of the serum lipid parameters other than high-density lipoprotein cholesterol were found to be higher in the subjects with an above than normal BMI, waist circumference, waist-hip ratio, waist-height ratio, and neck circumference. Pearson's correlation coefficient and multiple regression analysis showed that waistheight ratio best predicts serum triglycerides (β=0.622, p < 0.001) and high-density lipoprotein cholesterol (β=-0.711, p < 0.001) among all measured anthropometric parameters. Conclusion Among all the studied anthropometric parameters, the WHtR was found to be the most powerful predictor of serum triglycerides and high-density lipoprotein cholesterol.

Serum total adenosine deaminase activity in Nepalese patients with Rheumatoid Arthritis

Objective: Several studies indicate that serum adenosine deaminase (ADA) activity could be a potential marker for the diagnosis of patients with rheumatoid arthritis (RA). However, there has been no such study that could independently verify this finding in Nepali population. The present study therefore aims to measure the total ADA activity in the sera of Nepalese RA patients and verify its diagnostic potential. Materials and Methods: A total of 69 RA patients who visited Universal College of Medical Sciences Teaching Hospital (UCMSTH), Bhairahawa, Nepal for their medical treatment were enrolled for this study. An equal number of age and sex-matched healthy controls were also included in the study. Blood samples were collected from each study subjects and analyzed for serum total ADA, Creactive protein (CRP) and rheumatoid factor (RF). Results: Serum total ADA activity was found to be significantly (p<0.0001) higher (30.0 }10.1 U/L) in all RA patients compared to healthy controls (13.5 } 3.6 U/L). However, no significant difference (p>0.05) in the ADA activity was found between the smokers and non-smoker RA patients. Out of total 69 RA patients, only 16 (23.1%) were positive for CRP and 11 (15.9%) were positive for RF. Conclusion: Measurement of serum total ADA activity could be a reliable marker for the diagnosis of RA in Nepali population with relevant clinical scenarios when there is absence of CRP and RF in the serum.  DOI: http://dx.doi.org/10.3126/ajms.v4i2.6208 Asian Journal of Medical Sciences 4(2013) 30-35

Frequency of Type 2 Diabetes mellitus and Impaired Glycemia in a Teaching Hospital of South-Western Nepal

Objective: The aim of this study was to determine the frequency of type 2 diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) among patients visiting a tertiary level teaching hospital in south-western Nepal. Material & Methods: This is a retrospective study conducted among subjects (n=17082) who visited outpatient department of the Universal College of Medical Sciences Teaching Hospital (UCMSTH), Bhairahawa, Nepal for their medical checkup.  Data related to age, sex, hospital number and blood glucose concentration of the study subjects were collected from hospital records and analyzed for the frequency study. Results: The average frequency of type 2 diabetes was found to be 6.1% over a period of five years and it was significantly (p=0.0232) higher in males (3.4%) than in females (2.8%). Frequency of IFG and IGT were found to be 2.31% and 2.70% respectively. The frequency of type 2 diabetes, IFG and IGT was significantly higher in males and age group of 51-60 years. Conclusion: The frequency of type 2 diabetes and impaired glycemia is increasing every year in south-western part of Nepal. We recommend that efforts be made by all the stakeholders to curb this emerging medical problem before it becomes epidemic in the general population. DOI: http://dx.doi.org/10.3126/ajms.v2i3.5485 Asian Journal of Medical Sciences 2 (2011) 202-206