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Background: In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups. Methodology: Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups. Principal findings: The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh. Conclusions/Significance: For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence. Author summary: Bangladesh was in 2003 one of the world's countries that was most the affected by soil-transmitted helminthiasis, an infection of parasitic intestinal worms, with prevalence estimates as high as 55%. Following recommendations put forth by the World Health Organization (WHO), Bangladesh initiated a national deworming program based on school mass drug administration at six-month intervals, which started in 2008. Data collected between 2017 and 2020 showed that this program has lead to a striking decrease in prevalence, which was now between 10.5% and 1% depending on the species. Entering a close to elimination setting, the disease's control strategy can be refined according to local endemicity to reduce overtreatment. To inform such a shift, we predict the prevalence across Bangladesh at high spatial resolution and highlight zones of different endemicity. We also show the potential reduction of overtreatment and financial resources that could be achieved by treating according to WHO recommendations at the predicted endemicity levels. [ABSTRACT FROM AUTHOR]

Water-in-diesel emulsion fuel has become a popular alternative fuel for diesel engines. The main limitation is related to its stability, whereby it relies heavily on surfactants to remain homogeneous, therefore causing production costs to rise. This paper highlights the application of real-time non-surfactant emulsion fuel supply system (RTES), a water/diesel emulsifying device without surfactants, to produce water-in-diesel emulsion fuel in a common rail direct injection diesel engine powered vehicle. In this study, RTES was installed near to the diesel fuel pump to ensure water-in-diesel emulsions were continuously fed to the engine. The test vehicle was set up on a roller dynamometer and operated following a modified West Virginia University (WVU) 5-Peak cycle. Fuel consumption and exhaust emissions were measured to determine the optimum water percentage of emulsion fuel and suitable timing for emulsion fuel to be introduced into the fuelling system based on the vehicle speed. The results revealed that the optimum water percentage of the emulsion fuel for the test vehicle is 10 wt%, as it was capable to reduce fuel consumption as well as nitrogen oxides and smoke emissions of a common rail direct injection diesel engine powered vehicle. [ABSTRACT FROM AUTHOR]

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT–PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07–9.77). Female participants were 5.50 times (95% CI: 2.22–13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13–3.20), pain/discomfort (OR 1.82, 95% CI: 1.04–3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22–3.84). Comorbid patients were 1.75 times (95% CI: 1.07–2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31–8.18), usual-activity (OR 3.08, 95%CI: 1.21–7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09–6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35–8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background Dengue–COVID-19 coinfection is one of the greatest emerging challenges in dengue-endemic areas during the continuing pandemic. With coinciding clinical and laboratory pictures, early diagnosis becomes burdensome, with management discrepancy. Methods A descriptive study was performed on dengue–COVID-19 coinfected patients during July–August 2021 for an overview of disease progression, severity and outcome. A total of 11 patients who were positive for dengue NS1 and/or antidengue IgM were included in this study. Results In total, 45.5% patients developed severe COVID-19 disease, 45.5% patients developed group B dengue fever and 9% patients developed group C dengue fever. Concurrent severity of both diseases was seen to be rare, except for in one patient. Conclusion Early diagnosis and compatible management still stand as basic principles to prevent fatality and morbidity. [ABSTRACT FROM AUTHOR]

Keywords: Asia; epidemiology; gout; Pacific; registry EN Asia epidemiology gout Pacific registry 1432 1434 3 08/03/23 20230801 NES 230801 Gout is the most prevalent inflammatory arthropathy in adults. Variables collected can be categorized into the following domains: demographics, comorbid conditions, gout history, gout treatments, serum urate levels, and gout flare (if present) (Table S1). In this Registry, participants will be considered as having gout when they have at least 1 episode of acute arthritis (gout flare) and are diagnosed as having gout by reporting physicians. [Extracted from the article]

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cause severe life-threatening diseases called acute respiratory distress syndrome (ARDS) owing to cytokine storms. The mortality rate of COVID-19-related ARDS is as high as 40% to 50%. However, effective treatment for the extensive release of acute inflammatory mediators induced by hyperactive and inappropriate immune responses is very limited. Many anti-inflammatory drugs with variable efficacies have been investigated. Colchicine inhibits interleukin 1 beta (IL-1β) and its subsequent inflammatory cascade by primarily blocking pyrin and nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 (NLRP3) activation. Therefore, this cheap, widely available, oral drug might provide an added benefit in combating the cytokine storm in COVID-19. Here, we sought to determine whether adding colchicine to other standards of care could be beneficial for moderate COVID-19 pneumonia in terms of the requirement for advanced respiratory support and mortality. Methods and findings: This blinded placebo-controlled drug trial was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 300 patients with moderate COVID-19 based on a positive RT-PCR result were enrolled based on strict selection criteria from June 2020 to November 2020. Patients were randomly assigned to either treatment group in a 1:1 ratio. Patients were administered 1.2 mg of colchicine on day 1 followed by daily treatment with 0.6 mg of colchicine for 13 days or placebo along with the standard of care. The primary outcome was the time to clinical deterioration from randomization to two or more points on a seven-category ordinal scale within the 14 days post-randomization. Clinical outcomes were also recorded on day 28. The primary endpoint was met by 9 (6.2%) patients in the placebo group and 4 (2.7%) patients in the colchicine group (P = 0.171), which corresponds to a hazard ratio (95% CI) of 0.44 (0.13–1.43). Additional analysis of the outcomes on day 28 revealed significantly lower clinical deterioration (defined as a decrease by two or more points) in the colchicine group, with a hazard ratio [95%CI] of 0.29 [0.098–0.917], (P = 0.035). Despite a 56% reduction in the need for mechanical ventilation and death with colchicine treatment on day 14, the reduction was not statistically significant. On day 28, colchicine significantly reduced clinical deterioration measured as the need for mechanical ventilation and all-cause mortality. Conclusion: Colchicine was not found to have a significant beneficial effect on reducing mortality and the need for mechanical ventilation. However, a delayed beneficial effect was observed. Therefore, further studies should be conducted to evaluate the late benefits of colchicine. Clinical trial registration: Clinical trial registration no: ClinicalTrials.gov Identifier: NCT04527562 https://www.google.com/search?client=firefox-b-d&q=NCT04527562. [ABSTRACT FROM AUTHOR]

Background: Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. Methods: This cross-sectional survey was conducted in Dhaka Medical College from March 01–May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. Findings: The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. Conclusions: Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalization. Knowing the details of the clinico-pathological presentation and outcome of the disease may aid the better understanding of the disease. Objective: The study was designed to assess the clinico-pathological profile and to estimate immediate hospital outcome of acute pancreatitis patients admitted into a tertiary care hospital. Materials and methods: This hospital based cross-sectional type of observational study was conducted at Dhaka Medical College Hospital (DMCH), for one-year period (June 2018-May 2019). Total 106 established cases of acute pancreatitis were included in this study. Data was analyzed by the SPSS 22 Windows version and graph & chart were expressed by using SPSS 22 and MS Excel. The result was presented with tables and charts. Results: Among 106 patients, mean age of the patients was 42.5 ±11.3 SD (years), with male predominance (male: female-1.2:1). All of the patients complained abdominal pain (100%) while anorexia (48.1%), 43.4% had vomiting and 31.1% had fever. Regarding clinical signs, abdominal distension (45.3%), paralytic ileus (34.9%) and dehydration (43.4%) were found to be the major clinical signs. The common location of pain was in epigastric region (73.6%) with radiation to back in 20.8% patients. Pain was severe agonizing in nature in 76.4% cases. Of all, gall stone disease (17.0%) was the most prevalent cause. According to APACHE-II score, 74.5% patients had mild pancreatitis (APACHE-II <8) while according to Glasgow criteria, 66.0% had mild disease (Glasgow score <3). Mean APACHE-II score was 7.07±2.50 and Glasgow score was 2.90±2.33. Mean hospital stays were 8.9±3.6 days and NPO (nothing per oral) 4.9±1.9 days. Among the patients, 77.4% patients were alive and mortality rate was 22.6%. Conclusion: Although, a larger portion of the patients had no identifiable cause but gall stone was the most common etiology. Pain commonly located in epigastric region with radiation to back. Of all the cases, more than sixty percent of the patients had mild pancreatitis estimated by APACHE II score and Glasgow score. Mean hospital stays were about 9 days and nothing per oral was about 5 days. Overall mortality rate was 22.6%. [ABSTRACT FROM AUTHOR]

Background: Gout is the most prevalent inflammatory arthritis in the Asia‐Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. Methods: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi‐sectoral consensus panel formulated the final recommendations. Results: The Asia‐Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate‐lowering therapy (3 statements), urate‐lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non‐responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non‐pharmacologic interventions (5 statements). Conclusion: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care. [ABSTRACT FROM AUTHOR]

Recommender systems suggest items of interest to users based on their preferences. These preferences are typically generated from user ratings of the items. If there are no ratings for a certain user or item, it is said that there is a cold start problem, which leads to unreliable recommendations. Existing studies that reviewed and examined cold start in recommender systems have not explained the process of deriving and obtaining the auxiliary information needed for cold start recommendation. This study surveys the existing literature in order to explain the various approaches and techniques employed by researchers and the challenges associated with deriving and obtaining the auxiliary information necessary for cold start recommendation. Results show that auxiliary information for cold start recommendation is obtained by adapting traditional filtering and matrix factorization algorithms typically with machine learning algorithms to build learning prediction models. The understanding of similar or connected user profiles can be used as auxiliary information for building cold start user profile to enable similar recommendations in social networks. Similar users are clustered into sub-groups so that a cold start user could be allocated and inferred to a sub-group having similar profiles for recommendations. The key challenges of the process for obtaining the auxiliary information involve: (1) two separate recommendation processes of conversion from pure cold start to warm start before eliciting the auxiliary information; (2) the obtained implicit auxiliary information is usually ranked and sieved in order to select the top rated and reliable auxiliary information for the recommendation. This study also found that cold start user recommendation has frequently been researched in the entertainment domain, typically using music and movie data, while little research has been carried out in educational institutions and academia, or with cold start for mobile applications. [ABSTRACT FROM AUTHOR]

Background: Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. Methods: We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. Findings: Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02–1.48, p = 0.03), those who required a prolonged time for clinical improvement (p<0.001), and those showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00–1.19, p<0.001) of initial positivity. Patients with severe COVID-19 at presentation developed post-COVID-19 syndrome (p = 0.02). Patients with fever (RR: 1.5, 95% CI: 1.05–2.27, p = 0.03), cough (RR: 1.36, 95% CI: 1.02–1.81, p = 0.04), respiratory distress (RR: 1.3, 95% CI: 1.4–1.56, p = 0.001), and lethargy (RR: 1.2, 95% CI: 1.06–1.35, p = 0.003) as the presenting features were associated with the development of the more susceptible to develop post COVID-19 syndrome than the others. Logistic regression analysis revealed female sex, respiratory distress, lethargy, and long duration of the disease as risk factors. Conclusion: Female sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome. [ABSTRACT FROM AUTHOR]

Background: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion. [ABSTRACT FROM AUTHOR]

Background: Snakebite is a neglected public health problem in many countries of the world. Being a tropical country Bangladesh is also facing this problem. In this case series we have tried to focus the illiteracy, prejudice and mismanagement happen in snake bite cases from primary to tertiary level and how effective management can save life of snake bite victim. Case presentation: Among the 29 snake bite cases admitted in a medicine ward of tertiary care hospital four were venomous bites-two male and two female. Our patients came from around Dhaka city. Though victim failed to bring the snake, by studying clinical features and syndromic approaches we suspected Kraits as the culprit in three cases and Cobra in one case. Time period between bite and attend to hospital ranged from 4 hr to 16.30 hours. All victims had inappropriate application of tourniquet to their limbs as a first aid management. Most of them first visit OZHA (traditional healer). Two of them developed respiratory failure. All cases were managed in ICU with polyvalent ASV. One developed anaphylaxis which was managed with adrenaline. All patients recovered completely. Conclusion: Arrival to hospital without delay, facilities for management with trained physicians and proper supply of ASV may reduce death from snake bite and reduce financial burden to the patient. Developing public awareness to remove prejudice about snakes and identifying venomous snake bite is also necessary. [ABSTRACT FROM AUTHOR]

Background: We report relationship of wealth indices with self-reported diabetes data in Bangladeshi people. As a secondary objective we examine whether educational achievement can be used as a proxy of wealth indices. Methods: We have analyzed data of a nationally representative STEPS survey (STEPwise Surveillance of NCD risk factors) done in 2010 in 8808 adults selected at their households using a multistage cluster sampling approach to describe association of socioeconomic status with diabetes mellitus. We created wealth indices using principal component analysis based on a 20-item household asset items; and then divided subjects in to quartiles. Results: Prevalence of documented diabetes was 3.9% but it was more than 11 times (9.3%) in the fourth quartile (richest) compared to the first quartile (0.8%). This may either mean that the detection rate is higher among the higher socioeconomic group or there are some intervening factors accompanied by the economic achievements that favors occurrence or detection of diabetes in Bangladeshi adults. Conclusion: Future studies need to identify the factor(s) that provides such a putative effect. Educational achievement also has shown similar trend. Therefore, education might be a proxy variable to determine socioeconomic status instead of a long list of household asset items. [ABSTRACT FROM AUTHOR]

Introduction Chikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management. Case presentation The six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases. Conclusion From this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly. [ABSTRACT FROM AUTHOR]

The supply of water for rural populations in developing countries continues to present enormous problems, particularly where there is arsenic contamination in the groundwater, as exists over significant parts of Bangladesh. In response, improvements in the sustainability of water supplies are feasible through the use of a combination of water sources wherein rainwater harvesting is employed for a portion of the year. This can potentially reduce the duration of the year during which arsenic-contaminated groundwater is utilized. As demonstrated, a rainwater cistern volume of 0.5 m3 in the Jessore district area of Bangladesh can provide rainwater for periods averaging 266 days of the year, which allows groundwater at 184 μg/L arsenic to be used as a water supply for the remainder of the year. This dual supply approach provides the body burden equivalent to the interim drinking water guideline of arsenic concentration of 50 μg/L for 365 days of the year (assuming the water consumption rate is 4 L/cap/day for a family of five with a rainwater collection area of 15 m2). If the water use rate is 20 L/cap/day, the same cistern can provide water for 150 days of the year; however, although this is insufficient to supply water to meet the body burden equivalent guideline of 50 μg/L. Results are provided also for different rooftop areas, sizes of cisterns and alternative arsenic guidelines [World Health Organization (WHO) and Bangladeshi]. These findings provide useful guidelines on supply options to meet sustainability targets of water supply. However, they also demonstrate that the use of cisterns cannot assist the meeting of the 10 μg/L WHO target arsenic body burden, if the arsenic contamination in the groundwater is high (e.g., at 100 μg/L). [ABSTRACT FROM AUTHOR]

Polycystic Ovary Syndrome (PCOS) is a condition that involves various metabolic dysfunctions such as insulin resistance (IR), hyperandrogenemia, obesity, dyslipidemia, and steroid hormone irregularities. Although the exact cause of PCOS is still unknown, it is known to cause several hormonal disturbances, including hyperandrogenemia, IR, and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamicpituitary-ovarian (HPO) axis, and ovarian tissue insulin resistance results in impaired metabolic signaling. This causes hyperandrogenemia, which is one of the primary causes of the symptoms of PCOS. Androgens may also lead to IR by modifying muscle tissue composition and functionality and increasing levels of free fatty acids, perpetuating the IR-hyperinsulinemia-hyperandrogenemia cycle. Obesity exacerbates hormonal imbalances, and in combination with dyslipidemia, amplifies cardiovascular and cerebrovascular risks. This review discusses the complex risk factors of PCOS, including genetic, epigenetic, and environmental factors. It also discusses the interconnected etiologies of metabolic dysfunctions of PCOS, its effective management, and metabolic consequences such as cardiovascular and cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Psoriatic Arthritis (PsA) is a complex seronegative inflammatory arthritis associated with psoriasis, characterized by a wide range of clinical manifestations. This study aimed to explore the prevalence of PsA in arthritic patients along with associated demographic and clinical characteristics in a tertiary care setting in Bangladesh. Methods: This cross-sectional study was conducted at the Rheumatology Clinic of Dhaka Medical College Hospital over a period of 6 months from March 2018 to August 2018. A total of 600 arthritis patients underwent screening for PsA, with subsequent evaluations of confirmed cases based on the CASPAR criteria. Demographic and clinical characteristics were documented through face-to-face interviews and physical examination. For data collection, a pre-structured questionnaire was used. Disease activity was assessed using the DAPSA score. The study was conducted according to the 'Declaration of Helsinki'. The statistical analysis was done with SPSS v-21. Results: The prevalence of PsA in arthritis patients was 5%. Age distribution of PsA showed a majority in between 30-39 years age group with a mean of 36.33±11.86 (SD). Slight female predominance was reported with a percentage of 53.3%.Almost three-fourths of study patients presented with a current diagnosis of psoriasis while the rest had a personal history or family history. A higher incidence (67.7%) of plaque psoriasis was observed followed by sebopsoriasis (20%) and for the rest of the patients, the type of psoriasis was unknown. The disease mostly involved multiple joints (90%), with ankle and metacarpal joints being the most commonly affected at 43.3% and 33.3%, respectively. Disease activity was high in the majority of the patients according to the DAPSA score, representing 53.34% of the patients, with the remainder exhibiting moderate to low disease activity. Conclusion: The study revealed a significant incidence of PsA among the arthritic population which indicates a pressing need for further extensive research on PsA across diverse populations. [ABSTRACT FROM AUTHOR]