The metabolic syndrome (MetS), first introduced by Haller in 1975, was sometimes also known as insulin resistance syndrome, syndrome X, and plurimetabolic syndrome. In 1989, it was rechristened by Kaplan as the “Deadly Quartet” based on a consolidation of central obesity, impaired glucose tolerance, dyslipidemia, and systemic hypertension. MetS is positively associated with a pro-inflammatory and pro-thrombotic state, attributed to increased pro-thrombotic and inflammatory marker activity. Moreover, MetS is frequently associated with increased atherosclerotic cardiovascular disease, impaired glucose tolerance, hyperuricemia, obstructive sleep apnea, and chronic kidney disease. Despite concerted endeavors worldwide, the complexity of the pathophysiology of metabolic syndrome still needs to be clearly understood. Currently, therapeutic possibilities are confined to individual therapy for hyperglycemia, hypertension, hypertriglyceridemia, hyperuricemia, regular physical exercise, and a restricted diet. In this review, progress regarding the understanding and pathophysiology of MetS; recent emerging technologies, such as metabolomics and proteomics; the relation of MetS with obesity, diabetes, and cardiovascular diseases; and the association of MetS with COVID-19 are discussed.

Background: Urbanization, surplus energy uptake, decreased physical activities are general risk factors of metabolic syndrome However, it’s status, and associated components remain unexplored in the Terai region of Nepal. This study evaluated the prevalence of metabolic syndrome and its components among adults with central obesity of Terai region of Nepal using International Diabetes Federation criteria.Methods: Community based cross-sectional study was conducted in three Terai districts of Janakpur Zone, Nepal. A total of 378 adults having central obesity were selected using cluster sampling by camp approach. Interview, physical and clinical examination, measurement of fasting blood sugar, and lipid profile were conducted for all participants. The prevalence of metabolic syndrome and its components with 95% CI were estimated.Results: The metabolic syndrome prevalence was 74.9% (95% CI:70.2-79.2%), with no significant differences between male (77.7%, 95% CI:71.0-83.5%) and female (72.2%, 95% CI: 65.2-78.3%). The most common factors observed were low high density lipoproteins with highly significant differences between male (77.7%, 95% CI:71.0-83.5%)) and female (90.2%, 95% CI: 85.094.0%-; p=0.001) and hypertriglyceridemia with significant differences between male (57.6%, 95% CI: 50.1-64.5%) and female (46.9%, 95% CI: 39.7-54.2%; p=0.037). Conclusions: Higher prevalence of metabolic syndrome and its risk factors in Janakpur of Nepal likely suggest lack of awareness and health promotion activities for metabolic syndrome and indicate an urgency for a public health program to maintain quality of life. Keywords: Metabolic syndrome; Nepal; prevalence; risk factors; terai

Background & Objective: COVID-19 pandemic has tested health care systems worldwide. The massive wave of infection in Nepal between March to April 2021 overwhelmed the health care institutions throughout the country. This study describes the demographic, clinical, laboratory parameters and outcome of patients hospitalized in a secondary level facility during second wave of infection. Material and Methods: The data was extracted from admitted patients at Janaki Health Care and Teaching Hospital (JHCTH) with COVID-19, between 9th April to 14th June 2021. Demographic, clinical, laboratory parameters, treatment and outcome were recorded from the medical records and analyzed. Results: Out of 122 admitted patients,11%, 18.03%, 33.60% and 35.24% presented with mild, moderate, severe and critical illnesses respectively, with the median saturation of peripheral oxygen (SPO₂) at admission was 89(34-99)% and 17 deaths were recorded a mortality rate of 20.4%.A significantly high mortality rate was found among ventilated patients (73.3%), against non ventilated (7.2%). Mortality rates among critically and severely ill patients were 38.46 % and 6.9% respectively. Mean C reactive protein (CRP) was 51.13(±30.50)mg/dl. Statistically significant CRP levels were observed in patients who presented with mild illness (32.53±10.85 mg/dl) and those who died in hospital (61.08±30.00 mg/dl). Remdesivir use did not offer any mortality benefit. Conclusion: A very high mortality rate (20.40%) observed in this study due to COVID-19 in hospitalized patients, may be associated with a high proportion of severe and critical cases (68.70%) admitted. Further upgrading of health resources should be prioritized to manage severe COVID-19 related mortalities, because of the possibility of a future waves.

Introduction: The Metabolic Syndrome (MS) is a multifactorial disease associated with central obesity, hypertension, atherogenic dyslipidemia and impaired glucose tolerance. Low grade inflammatory and a prothrombotic state are also involved in MS. Aim: To explore the demographic and biochemical parameters of participants with MS in Terai region of Nepal using community based cross-sectional study. Materials and Methods: A cross-sectional study was carried out during September - December 2019 in adult participants with central obesity (n=378) selected from three districts of Terai region of Nepal. International Diabetes Federation (IDF) criteria were used to define MS. C-reactive protein-ultra sensitive, fibrinogen, and apolipoprotein-B were estimated as inflammatory, prothrombotic, and atherogenic dyslipidemia markers, respectively. Result: The MS was present in 283 participants with central obesity. The mean (+/- SD) age, height, weight, and BMI of the participants with MS were 46.36 +/- 12.52 years, 5.56 +/- 0.11 feet, 66.54 +/- 13.45 kg and 27.28 +/- 4.98 kg/m(2), respectively. The mean (+/- SD) of biochemical factors were significantly different than their respective normal ranges: decreased serum High Density Lipoprotein (HDL) cholesterol in mg/dL (male: 34.50 +/- 9.93, p<0.001, female: 36.77 +/- 7.28, p<0.001), raised serum triglycerides level- 184.96 +/- 85.72 mg/dL (p<0.001), and impaired fasting serum glucose level 108.14 +/- 48.27 mg/dL (p=0.002). Significant increase in inflammatory (CRP-US: 1.12 +/- 2.17 mg/L, p<0.001), prothrombotic (fibrinogen: 3.42 +/- 1.04 gm/L, p<0.001) and atherogenic dyslipidemia marker (Apo-B: 149.35 +/- 59.13 mg/dL, p=0.003) from normal values were observed in subjects with MS. Conclusion: Lowered serum HDL cholesterol, increased triglycerides followed with impaired fasting glucose tolerance were observed as the major abnormal biochemical parameters and increased inflammatory and prothrombotic activities were present among participants with MS.

Introduction: Anemia is a condition characterized by a reduced number of red blood cells or lower levels of hemoglobin. The World Health Organization estimates that 1.62 billion individuals globally are affected by anemia, which represents 24.8 percent of the population, highlighting its significant public health concern in both developing and developed nations. Platelets play a vital role in maintaining homeostasis and are often affected by underlying hematological conditions including anemia. The relationship between anemia and platelet count is complicated and is poorly understood. The study aimed to assess the hemoglobin level and platelets count among patients visiting tertiary level care center of Madhesh Province, Nepal and evaluate their association in anemic and non-anemic patients. Methodology: The hospital based cross-sectional comparative study was conducted among 350 patients visiting tertiary care center to analyze blood samples for hemoglobin level and platelet counts and their correlation was assessed. Result: The mean hemoglobin level was 9.97 ± 1.54 g/dL in anemic individuals and 13.46 ± 1.95 g/dl in non-anemic individuals. Platelet counts were 1.81 ± 0.96 lakhs/µl in anemic and 2.03 ± 0.73 lakhs/µl in non-anemic individuals. Anemia found more prevalence in females (36.85%), underweight (15.14%), and vegetarians (34.28%). In overall patients, a weak positive correlation was observed between hemoglobin and platelet count (r = 0.10, p = 0.047) while a very strong positive correlation was observed among anemic patients(r=0.975, p=0.002). Conclusion: Anemia was found more prevalent in females, underweight and vegetarians as well as a very strong positive correlation between hemoglobin levels and platelets counts were observed among anemic patients.

The metabolic syndrome, first introduced by Hermann Haller in 1975, was sometimes also known as insulin resistance syndrome, syndrome X, and plurimetabolic syndrome. In 1989 it was rechristened by Kaplan as "Deadly Quartet" based on a consolidation of central obesity, impaired glucose tolerance, dyslipidemia, and systemic hypertension. Metabolic syndrome is positively associated with a pro-inflammatory and pro-thrombotic state, attributed to increased pro-thrombotic and inflammatory markers activity. Moreover, Metabolic syndrome is frequently associated with increased atherosclerotic cardiovascular disease, impaired glucose tolerance, hyperuricemia, obstructive sleep apnea, and chronic kidney disease. Despite concerted endeavors worldwide, the complexity of the pathophysiology of metabolic syndrome is still not clearly understood. Currently, therapeutic possibilities are confined to individual therapy of hyperglycemia, hypertension, hypertriglyceridemia, hyperuricemia, regular physical exercise, and a restricted diet.