Madhav Khanal - Academia.edu (original) (raw)

Papers by Madhav Khanal

Atherosclerosis, Sep 1, 2016

Journal of Nepal Medical Association, Dec 31, 2011

Introduction: Different authorities have put forward their criteria to defi ne metabolic syndrome... more Introduction: Different authorities have put forward their criteria to defi ne metabolic syndrome (MetS). The aim of this study was to fi nd the prevalence of MetS in hypertensive individuals by the available three different defi nitions from National Cholesterol Education Program (NCEP), International diabetes Federation (IDF) and WHO and their association with other cardiac risk factors. Methods: After anthropometric measurements fasting blood was analyzed for glucose, lipids, high sensitivity C-reactive protein (hsCRP) and anti-oxidized LDL antibody in 150 hypertensive individuals. A ten-year coronary heart disease risk was predicted using the Framingham risk score (FRS). Results: The prevalence of MetS was 54.7 % by NCEP, 42.0 % by IDF) and 18.7 % by WHO. As many as 63.4 % had MetS by any defi nition, while only 9.4 % fulfi lled all the criteria of the three defi nitions. The association of cardiac risk factors also varied according to the defi nition used. hsCRP was signifi cantly elevated in MetS compared to non-MetS. Body mass index, waist circumference and HDL-C were associated in MetS defi ned by NCEP and IDF. FRS was higher in MetS defi ned by Adult Treatment Panel and WHO defi nitions. An increase in urine albumin and a decrease in eGFR were associated with MetS individuals defi ned by WHO only. Conclusion: There is a wide variation in the prevalence of MetS and associated cardiac risk factors according to three different defi nitions used. The different cardiac risk factors among MetS also vary with the defi nitions used. However, hsCRP and emerging risk factor are signifi cantly elevated in hypertensive individuals with MetS as defi ned by all defi nitions

Nepal Medical College Journal

Estimation of serum aminotransferase levels play important role in the diagnosis and monitoring o... more Estimation of serum aminotransferase levels play important role in the diagnosis and monitoring of hepatic diseases. Studies suggest that in patients with chronic kidney disease, especially in those under hemodialysis, the reference ranges of the serum aminotransferases might not be reflective of hepatic function. Due to this, diagnosis and management of liver diseases in such patients becomes quite challenging. This study aims to estimate and compare serum aminotransferases levels of hemodialysis patients and healthy controls. Seventy-five patients undergoing hemodialysis in Nepal Medical College Teaching Hospital for at least three months were included in the study as cases and apparently healthy individuals with no active illness and regular medication use for the past three months and were recruited as controls. Predialysis blood samples were drawn and were analyzed for serum aminotransferases and other blood parameters. The median serum AST and ALT values for hemodialysis patie...

American Journal of Respiratory and Critical Care Medicine, 1996

Use of the polymerase chain reaction (PCR) to detect Mycobacterium tuberculosis in formalin-fixed... more Use of the polymerase chain reaction (PCR) to detect Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissue would be of great diagnostic value. However, formaldehyde has been reported to decrease the efficiency of amplification by structurally altering the polynucleotide chain. We sought to determine the ability of the PCR assay to detect M. tuberculosis in formalin-fixed, paraffin-embedded tissue in a mouse experimentally infected with the H37Rv strain of M. tuberculosis. Lung tissue from the infected mouse was cultured to determine the number of organisms per gram of tissue. The remaining lung tissue was divided into eight portions, seven of which were fixed in 10% neutral buffered formalin for 24-h intervals over periods lasting from 1 to 7 d, and a control portion was placed in isotonic saline. The tissue samples were then paraffin-embedded, and sections were obtained from each tissue block for PCR analysis. We show that the PCR assay can detect as few as nine organisms in a 5-micron section of tissue, and that up to 7 d of fixation in 10% neutral buffered formalin has a negligible effect on the assay. The PCR assay can detect low numbers of M. tuberculosis organisms in formalin-fixed, paraffin-embedded tissue.

Journal of Chitwan Medical College, 2013

Nowadays it is observed that the chronic kidney disease (CKD) is a growing health problem worldwi... more Nowadays it is observed that the chronic kidney disease (CKD) is a growing health problem worldwide and the most common illness associated with this is hypertension (HTN) and diabetes mellitus (DM). This study tries to find out illness associated with CKD and assess the renal parameters according to age and sex group. This is a cross sectional descriptive study. Diagnosed cases of Chronic Kidney Disease patients visiting at KIST Medical College from September to November 2011 are included in this study. SPSS-17 version is used for data analysis and appropriate statistical tests are done. Among 150 patients, 57% are male and 43% are female. Mean age of the study population is 48.62±18.09 years. Level of urine protein for male is higher than female. Mean urea, creatinine, potassium, uric acid, phosphorus and protein creatinine ratio (PCR) are higher in younger age group. The result also depicts hypertension is the leading illness associated with CKD (50%). Only 8% diabetes mellitus ...

Journal of Nepal Medical Association, 2011

Nepal Medical College journal : NMCJ, 2011

The immune response against mycobacterium tuberculosis (MTB) is cell mediated. T-cells become sen... more The immune response against mycobacterium tuberculosis (MTB) is cell mediated. T-cells become sensitized when they encounter MTB antigens and subsequently activated effector T-cells produce a number of cytokines including interferon- gamma (INF-gamma) to fight the infecting organisms. Demonstration of either production of INF-gamma or presence of effector T-cells sensitized to MTB specific antigens in vitro can be diagnostic for TB infection. Aim of this study was to determine the efficacy of commercially available T-SPOT.TB kit which is used for the in vitro diagnosis of TB infection and to determine if this test has any cross reactivity in leprosy patients. Blood sample was taken from 30 sputum AFB positive, 30 sputum AFB negative healthy controls and 10 cases of paucibacillary leprosy patients. The blood samples were processed to separate peripheral blood mononuclear cells. The final cell suspensions were cultured along with MTB specific antigens namely- Early Secretory Antigenic...

Nepal Medical College Journal, 2021

Cardiovascular diseases are the leading cause of death in hemodialysis patients. We aimed to eval... more Cardiovascular diseases are the leading cause of death in hemodialysis patients. We aimed to evaluate non-traditional cardiovascular risk factors: homocysteine, high sensitive C-reactive protein, oxidized LDL antibodies, phosphate, and red cell distribution width in chronic kidney disease patients under maintenance hemodialysis along with traditional cardiovascular risk factors like age, hypertension, diabetes mellitus, among others. A total of 78 diagnosed chronic kidney disease patients under maintenance hemodialysis visiting a tertiary care center were included in the study, of which 59% were male. Hyperhomocysteinemia was present in 79.5% of the participants, with the median homocysteine level being 28.43 μmol/L. The median hsCRP level was 4.74 mg/L, and 59% and 24.4% of the total participants were at high and moderate cardiovascular risk respectively. The median oxidized LDL antibody level was 4235 U/mL, which is within the reference range. The median red cell distribution widt...

Nepal Medical College journal : NMCJ, 2013

Dyslipidemia is one of the primary causes for cardio vascular disease (CVD) and development of my... more Dyslipidemia is one of the primary causes for cardio vascular disease (CVD) and development of myocardial infarction (MI) which often leads to coronary artery disease (CAD). The elevated level of total cholesterol (TC), triglycerides (TG), low-density lipoproteins-cholesterol (LDL-C), and lowered high-density lipoprotein-cholesterol (HDL-C) are the predictable risk factor for CAD with type-II diabetic patient. The present study was undertaken taken with an objective to frame out the lipid profile in type-II diabetic patients attending OPD (outpatient department) of Nepal Medical College Teaching Hospital (NMCTH) Jorpati, Kathmandu. Samples of 148 individuals with age varying from 30-73 were analyzed. Out of which 96 patients were diabetic and 52 were control group. The mean +/- SD (mg/dl) levels of Cholesterol, TG and LDL-C were found significantly higher compared to non-diabetic, and these are statistically significant when compared with healthy control group. The study concludes t...

Clinical Biochemistry, 2014

Objectives: The mortality rate of chronic kidney disease (CKD) patients is very high due to cardi... more Objectives: The mortality rate of chronic kidney disease (CKD) patients is very high due to cardiovascular diseases (CVD) which cannot be fully justified by traditional CVD markers. Since, mineral bone disorder is common in CKD, product of serum calcium and phosphorus (Ca × PO4) can be a predictor of future CVD. So, our study aims to assess the utility of higher Ca × PO4 in prediction of CVD risk in predialysis CKD patients. Design and methods: 150 CKD patients defined by NKF-KDOQI guideline not undergoing dialysis were recruited. Anthropometric and electrocardiographic parameters were recorded. We evaluated CVD risk by: i) Biochemical CVD markers, ii) NCEP ATP III guideline postulated risk factors and iii) Framingham risk scores. Results: Higher Ca × PO4 is associated with presence of Left Ventricular Hypertrophy, oxidative stress, microinflammation, hyperhomocysteinemia, hypercholesterolemia, hypertriglyceridemia and increased LDLc. Compared to cases with Ca × PO4 b 55 mg2/dL2, cases with ≥55 mg2/dL2 had relative risk (RR) of 1.82 (95% CI 1.25-2.64) for CVD, 3.24 (95% CI 2.37-4.41) for stroke and 2.43 (95% CI 1.37-4.31) for coronary heart disease (CHD). Moreover, compared to lowest quartile of Ca x PO4, the highest quartile group had RR of 2.13 (95% CI 1.06-4.28) for CVD, 2.61(95% CI 1.80-3.75) for stroke and 2.84 (95% CI 1.15-7.0) for CHD. Conclusion: In predialysis patients, higher Ca × PO4 is independent predictor of CVD risk.

Nepal Medical College journal : NMCJ, 2010

Present study was undertaken during a period of 6 months (September 2008-February 2009) to see an... more Present study was undertaken during a period of 6 months (September 2008-February 2009) to see an correlation of 24 hours urine protein estimation with random spot protein-creatinine (P:C) ratio among a diabetic patients. The study comprised of 144 patients aged 30-70 years, recruited from Kantipur hospital, Kathmandu. The 24-hr urine sample was collected, followed by spot random urine sample. Both samples were analyzed for protein and creatinine excretion. An informed consent was taken from all participants. Sixteen inadequately collected urine samples as defined by (predicted creatinine--measured creatinine)/predicted creatinine > 0.2 were excluded from analysis. The Spearman's rank correlation between the spot urine P:C ratio and 24-hr total protein were performed by the Statistical Package for Social Service. At the P:C ratio cutoff of 0.15 and reference method (24-hr urine protein) cutoff of 150 mg/day, the correlation coefficient was found to be 0.892 (p < 0.001). Th...

Journal of Nepal Medical Association, 2019

Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household l... more Introduction: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operator’s technique, extreme temperatures, humidity, patients’ medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline. Methods: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults ≥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified B...

Introduction:Diagnosis of pheochromocytoma, paraganglioma and neuroblastoma requires biochemical ... more Introduction:Diagnosis of pheochromocytoma, paraganglioma and neuroblastoma requires biochemical confirmation of excessive catecholamine production based on the measurement of catecholamines or their metabolites in the plasma or urine. The associated morbidity and mortality of such ...

International Journal of Biochemistry Research & Review, 2017

Journal of Nepal Medical Association, 2021

Introduction: Lead is naturally available toxic heavy metal which is one of the main causes of en... more Introduction: Lead is naturally available toxic heavy metal which is one of the main causes of environmental pollution and produces detrimental effects on health, particularly young children. Lead toxicity has become an emerging global burden of disease varying with the age, socio-economic status, occupation, industrialization, social customs and behaviours. The objective of this study was to find out the baseline blood lead level among children between 8-18 years. Methods: A descriptive study was conducted in Gokarneshwor Municipality, Kathmandu with a total of 160 children between 8-18 years of age from 2018 to 2019 after taking ethical approval from Research and Institutional Review Committee (Reference number: 17-074/075). Informed written consent was taken from the principal along with their respective parents and semi structured questionnaires were asked to students. Sample size was calculated and simple random sampling was done. The data was analyzed using Statistical Package...

Asian Pacific journal of cancer prevention : APJCP, 2011

Understanding the relationship between ethnicity and free prostate specific antigen (fPSA) could ... more Understanding the relationship between ethnicity and free prostate specific antigen (fPSA) could identify the population that should be targeted for intervention and prevention program regarding prostate disease. In this study, we therefore examine the effects of aging and ethnicity on fPSA, measured in serum by chemiluminescent assay (CLIA) method of 351 men visiting Tribhuvan University Teaching Hospital (TUTH) for fPSA test from December to March. Medicinal records abstracts were used to obtain information regarding the ethnicity and age of the cases. Those cases whose age and surname could not be obtained were excluded in our study. The subjects were stratified in four ethnic groups viz; Indo-Nepalese, Tibeto-Nepalese, Indigenous and Other based on the origin. The relationship between age and fPSA level was analysed using bivariate coorelation. The age and the fPSA level of the cases were expressed in Mean ± SEM. The association among different age-group and ethnicity with fPSA ...