Search

Objective: To assess the status of antioxidant vitamins (A, E & C) in cortical and nuclear cataracts patients. Study Design: Prospective Comparative study. Setting: Al-Ibrahim Eye Hospital and Biochemistry Department of Al-Tibri Medical College, Karachi. Period: Sept 2016 to Aug 2017. Material & Methods: A non-probability random sampling technique was used on 80 pre-diagnosed cataracts (cortical and nuclear) patients, and 40 control subjects were selected for the study. The demographic data were collected, and the blood sample of control and cataract patients were analyzed for random blood sugar and antioxidant vitamins (A, E, and C) by Elisa Method. Results: The Blood level of vitamins E was low in cataract patients as compared to control subjects. Conclusions: The blood level of vitamin E is less in cortical and nuclear cataract patients as compared to control but had shown no significant difference between cortical and nuclear cataract patients.

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P

The in vivo effects of fruit pulp juice (MC-PJ) of Momordica charantia and its 1-butanol soluble part (MC-BP) and aqueous soluble part (MC-AP) on blood glucose of type 2 diabetic rats were studied. In vitro insulin secretion in response to MC-BP and MC-AP from whole perfused pancreas was measured. For elucidating the mechanism of insulinotropic action, the insulin secretory activity of MC-BP in the presence of 11 mM glucose, 50 μM verapamil (Ca++ channel blocker), 8 mM diazoxide (K+ ATP channel opener) and 10 mM theophylline (cAMP phosphodiesterase inhibitor) were studied. Serum glucose was measured by glucose oxidase-peroxidase method and rat insulin was assayed by specific ELISA. In the in vivo study, MC-BP significantly opposed the rise of serum glucose compared to control at 105 min (p

Objectives: To determine the status of ALK immunostaining in female breast cancer and to find out the relationship of ALK expression with clinicopathological variables. Study Design: Cross Sectional study. Setting: Department of Pathology Al Tibri Medical College and Hospital Karachi and BMSI Jinnah Post Graduate Medical Centre, Karachi. Period: October 2016 to March 2017. Material & Methods: Total of 110 female cases with breast carcinoma by using non-probability purposive sampling technique. After taking informed consent from the patients, tissue samples were taken from received specimen of mastectomy for hematoxylin and eosin stain. The immunohistochemistry for ALK was assessed by using a DAKO monoclonal antibody using the paraffin embedded blocks of the diagnosed cases of breast carcinoma. Chi square test was used to find out the significance of differences among the variables. Results: Total of 110 cases with different histological classifications of breast cancer were observed i-e invasive ductal carcinoma 95(86%), invasive lobular carcinoma 9(8%), invasive medullary carcinoma 4(3.6%) and papillary carcinoma 2(1.8%). ALK expression was positive in 71(64%) and negative in 39 (35%) patients. Significant association was observed between ALK expression with histological grade (p=0.003), lymph node involvement (p=0.042) and skin involvement (p=0.025). Conclusion: Present study shows higher positive ALK expressions. Present study also indicates significant relationship of ALK with histological grade, lymph node involvement and skin involvement.

Background In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country’s total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. Methods A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. Results A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. Conclusion A mobile-health intervention should be considered as an additional option for non-communicable disease programs.

Aim/background To assess the effectiveness of mobile SMS as a tool for behavior and life style modification in management of diabetes. Methods This interventional study was conducted from July 2014 to April 2015 at Baqai Institute of Diabetology and Endocrinology (BIDE). Demographical and clinical information of subjects (patients and relatives) along with their knowledge and beliefs regarding diabetes was recorded using questionnaire. In Short Message Service (SMS) and non-SMS groups, education regarding diabetes was given. Two messages per day were sent to SMS group for two months. Results Total 648 subjects, SMS (n = 376) and non-SMS (n = 276) groups, were included in study. Mean age of patients and relatives was 45.41 ± 15.13 and 34.58 ± 11.91 in SMS group, while 47.06 ± 14.83 and 31.02 ± 11.51 in non-SMS group, respectively. No significant difference regarding level of knowledge and beliefs among both groups was observed at baseline. After SMS intervention, level of knowledge (p ≤ 0.0001) and beliefs (p ≤ 0.0001) were found to be significantly higher in SMS groups Non-SMS group. Conclusion Mobile SMS are an effective tool to deliver behavior and lifestyle modification advice and support for better management of diabetes and its prevention in people who are at high risk. Education intervention through SMS is found to be an important variable which enhances the knowledge and beliefs of the subjects.

Background Myocardial injury has been defined as an elevated troponin level. The frequency of acute myocardial injury of hospitalized coronavirus disease 2019 (COVID-19) patients ranges from 7% to 36%. COVID-19 patients with cardiovascular disease (CVD) have a four-fold higher risk of mortality (odds ratio, 4.33; CI 95%, 3.16-5.94). In COVID-19 hospitalized patients’ study showed mortality rate was 18.5%. Rhabdomyolysis is considered as muscle necrosis and the release of intracellular muscles elements and enzymes into blood. In one of retrospective cohort study of COVID-19 hospitalized patients, incidence of rhabdomyolysis was 16.7%. Materials and methods This retrospective observational study consisted of 413 COVID-19 hospitalized patients. Patients with rhabdomyolysis was defined as creatine kinase level greater than 1,000 U/L and acute myocardial injury was defined as serum high-sensitivity troponin-T for males greater than 30 ng/l and for female greater than 20 ng/l. The primary outcome was in-hospital mortality of COVID-19 patients with acute myocardial injury and rhabdomyolysis. Results The incidence of acute myocardial injury and rhabdomyolysis in hospitalized COVID-19 patients was 23.9% (99) and 15.7% (65), respectively. The mortality rate of in hospitalized COVID-19 patients who developed acute myocardial injury (28.3%) was significantly higher in comparison to patients who developed rhabdomyolysis (13.8%). Discussion The binding of SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) is a critical step in the pathophysiology in patients with COVID-19. There may be diverse direct and indirect mechanisms of acute myocardial injury in COVID-19 including ischemic injury, hypoxic injury (MI type 2), direct viral myocarditis, stress cardiomyopathy and systemic cytokine storm. Musculoskeletal injury may be caused by direct viral myositis or indirectly by host immune hyperinflammatory cytokine storm response that leads to skeletal muscle fiber proteolysis and fibrosis. Conclusions Acute myocardial injury and rhabdomyolysis were underreported in COVID-19 patients. The incidence and mortality of acute myocardial injury are higher than that of rhabdomyolysis in COVID-19 hospitalized patients. The outcome was worse in COVID-19 patients with severe acute myocardial injury. Patients with acute myocardial injury and rhabdomyolysis may get benefits from rehabilitation programs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection is not confined to the respiratory system, but has also shown extra-pulmonary invasion including the nervous system. About 36.4% of hospitalized patients in China with confirmed coronavirus disease 2019 (COVID-19) infection had neurological manifestations. SARS-CoV-2 virus enters the human body through angiotensin converting enzyme-2 (ACE-2) receptors on the surface of human cells and causes disease. ACE2 receptors are also expressed on the surface of spinal cord cells. More rare neurologic conditions have been reported in the literature to be associated with COVID-19 such as acute transverse myelitis (ATM), Guillain Barre syndrome, acute flaccid myelitis, etc. We report two cases of confirmed COVID-19 who presented four to five days of their COVID-19 symptoms and progressive bilateral lower limb weakness and urinary retention. ATM is an acquired spinal cord disorder. ATM is a relatively common neurological complication of COVID-19, accounting for 1.2% of all neurological complications associated with COVID-19. The mechanism by which COVID-19 causes ATM is not completely understood but has been assumed to be due to the structural resemblance of RNA viruses. Entrance of SARS-CoV-2 to the nervous system can take place through two pathways, either directly or indirectly. The direct pathway is through trans-synaptic transmission from the peripheral nervous system or by hematogenous spread into the blood-brain barrier through ACE-2, while the indirect pathway is through a systemic immune response.

Atherosclerosis is a systemic pathologic process, may involve aorta and is important cause of systemic embolization. The risk of embolism is increased for mobile and complex aortic plaques that are >4 mm thick. The most common manifestations are stroke, transient ischemic attack (TIA) and peripheral embolization. Imaging modalities used include transesophageal echocardiogram (TEE), CT angiography and magnetic resonance angiography (MRA). The mainstays of medical treatment are antiplatelets and statin. The role of anticoagulation is reserved for plaques with thrombotic component. There were two patients who presented with large acute ischemic stroke with high grade, floating aortic arch thrombus and complex aortic arch plaques. In one of cases, after 10-day follow-up CT aortic angiography showed completely resolved thrombus after being treated with IV tissue plasminogen activator (TPA) followed by low molecular weight heparin (LMWH). The risk of embolism depends on size of aortic plaques and mobility. TEE is modality of choice for thoracic aortic plaques. Aortic plaques >4 mm are independent predictors of recurrent ischemic stroke. There are limited data available for off-label use of intravenous thrombolysis and mechanical thrombectomy (MT) in presence of aortic arch thrombus in acute ischemic strokes. These two case reports help in recognition of aortic arch complex plaques as independent risk factor for recurrent stroke. The right patients may consider about the use of intravenous alteplase and MT performed via trans-brachial access after excluding aortic dissection and aneurysm. In future, multicenter, randomized controlled trials will be required for safety of IV TPA and MT.

Background: Bangladesh has one of the largest diabetic populations in the world and its Rajshahi region has distinct geographical and cultural identity. Determinants and basic defects of the disorder which vary substantially among populations due to racial and environmental heterogeneity. Materials & Methods: This study was conducted to characterize the new patients attending the Rajshahi Diabetic Center which gives an idea about the proportion and risk indicators of DM among people in the Rajshahi region. It was a hospital based observational analytic study with a hybrid research strategy having both cross-sectional and nested case-control designs. A multistage sampling technique was followed with 660 subjects. Results: Out of the total subjects attending the OPD of RDC for the first time, 65% were found to suffer from T2 DM. mostly (75%) of middle age (37% within 30-40 yrs and 37% within 41-50 yrs), only 2% cases had age 51yrs. The mean ±SD calorie consumption (2549±637) of the diabetic subjects was higher than that in non-T2 DM subjects and it came mainly from CHO (59.3%) and fat (55.9%). 47.3% of subjects were normal weight, 36.1% over weight and 16.6% obese. Fasting serum Insulin was significantly higher in the T2 DM group as compared to non-T2DM (Serum Insulin level µIU/ml, M±SD) (13.5±4.9) subjects (p=

Aims: Radial approach is gaining the momentum as a default technique for coronary procedures. Limited trails are available for post coronary artery bypass graft (CABG) patients to compare the merits of femoral & radial access. Methods: It is a single-center study conducted in between January, 2013 to December, 2015. During this study period, post CABG patients were blindly assigned to its five high volume operators. Coronary angiography & intervention procedures were performed by left radial or femoral approach as per assigned operator's choice. Contrast volume was the primary endpoint whereas the procedure & fluoroscopy time, procedural success, access site major bleeding, pre discharge major adverse cardiac event (MACE) were the secondary endpoint both for coronary angiogram (CAG) & percutaneous coronary intervention (PCI). Results: Total 380 post CABG patients were included in this study period. Radial access (n=155) was lower than femoral access (n=225). Compared with femoral access, diagnostic CAG required relatively lower contrast volume though statistically not significant via radial access (70±34 vs. 72±40 ml, p=0.267). Procedure time (25.2±10.7 vs. 26.9±6.8 min, p=0.735), fluoroscopy time (10.7±5.5 vs. 9.5±4.7 min, p=0.424) were almost similar in both access for CAG. Other secondary clinical endpoints were similar among both groups. Interestingly, adhoc PCI was more frequent in radial group (n=54 out of 155, 34.8%) than in femoral group (n=44 out of 225, 19.6%) with p=0.01. Contrast volume in between two groups was pretty similar with p=0.226. The incidence of other secondary endpoints was also not statistically significant. Conclusion: Coronary angiography for post CABG patients through left radial approach seems to be effective, non-inferior in terms of contrast volume, procedure & fluoroscopy time & other clinical end points comparing to femoral access. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 11-16

Background: Diabetes is one of the most prevalent non-communicable diseases (NCDs) all over the world and leading cause of death, disability, and economic loss. Diabetes imposes a heavy economic burden on individuals, their families and society as a whole. The aim of this study is to estimate the economic burden of type 2 diabetes mellitus (T2DM) in Bangladesh and to find association between glycemic control and Health Related Quality of Life with cost-of-illness (COI). Methodology: This will be an analytical cross-sectional cost-of-illness study. Within a specific time period participants aged ≥18 years, registered with Bangladesh Diabetic Somiti and having type 2 diabetes for more than one year will be recruited from selected hospitals inside and outside Dhaka to cover all level of health care services. A pre-tested electronic questionnaire will be used for data collection. The questionnaire will include demographic, clinical, behavioral information of the participants and all cost related information related to diabetes management during last one year. Descriptive statistics will include mean (±SD) or median (percentile) or relative frequencies (percentage) depending on the data. Two samples independent t-test or Mann-Whitney U-test, ANOVA or Kruskal-Wallis test and chi-squared tests will be used for univariate analysis. The multivariable regression analysis and bootstrap method will also be employed to analyze the relationship between the total cost of care (dependent variable) and several potential explanatory variables (independent variables). Logistic regression analysis will be performed to assess the factors affecting glycemic control and health related quality of life (HRQoL). The calculated total cost-of-illness will be projected for T2DM in Bangladesh by a mathematical modelling. Result & discussion: The results of the study will be useful as background information to forecast the economic burden of type 2 diabetes mellitus in Bangladesh and will be beneficial to conceptualize health strategies at national level. Furthermore, recognizing the factors of cost-of-illness will help both patients and health care providers to improve the management plan and cost control and hence, to have better quality of life. Evidence about the magnitude of the burden of T2DM is important for public health policymakers who are involved in making health care priorities and allocating scarce resources to facilitate the greatest benefits for type 2 diabetic people in Bangladesh. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.501-507

The best kept secret in pain management is in your own hands. Pain Care Essentials offers the readers a fingertip access to numerous topics in still emerging field of pain medicine, including physical rehabilitation in pain management, peripheral nerve blocks, neuropathic pain, pediatric and elderly pain. This book provides an overview of pain mechanisms as currently understood, and details a variety of approaches to pain management used across a wide range of complementary disciplines. Divided into four convenient sections; the book addresses Fundamentals and Evaluation, Treatment Modalities (including opioids, interventions and alternative medicine), common Chronic Pain and Urgent Pain Problems. Integrative care concepts are presented, emphasizing multi-disciplinary approaches to address the pain. Expert contributors describe therapeutic approaches of various pain conditions and implementing self-care management options.

Objectives Hypertension is strongly related to body mass index (BMI). Obesity has been the single main contributor to hypertension. Furthermore, the clinical manifestations are normally associated with BMI in hypertensive patients. This study aimed to evaluate the relationship between clinical features and BMI among hypertensive patients in both males and females. Methodology A retrospective cross-sectional study was conducted among 296 patients having a self-reported history of hypertension and on anti-hypertensive medication. The study was conducted in the medical outpatient department of a secondary care hospital in Karachi during six months (January 2020 to June 2020). A detailed history was taken from each patient about hypertension-related symptoms, and clinical examination was performed. Blood pressure was measured using a sphygmomanometer with a stethoscope. Results Of the 296 patients, 156 (52.2%) were males and 140 (47.3%) were females; 16 (5.4%) of them were underweight, 91 (30.7%) were normal weight, 129 (43.6%) were overweight, and 60 (20.3%) were obese; in addition, 106 (35.8%) reported edema and 71 (24.0%) reported nausea and so on. As far as the association of clinical features and BMI was concerned, our study results showed that only edema (p=0.017) and nausea (p=0.044) were significantly associated with the BMI of the patients. Patients with edema were more likely to be obese than those without edema (29.2% vs. 15.3%), whereas patients with nausea were more likely to be overweight than those without nausea (57.7% vs. 39.1%). Conclusions Our study showed that among the clinical features, edema and nausea were significantly associated with the BMI of the patients, whereas the relationship with others was insignificantly related to BMI of the patients in both male and female patients.

ObjectiveTo assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.Design, setting and participantsThis cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.Primary and secondary outcome measuresRisk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.ResultsOverall, 44.5% of the subjects were found ‘at risk’ of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.ConclusionA significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Aims The aim was to find out the proportion of Self-monitoring of Blood Glucose (SMBG) Users and factors affecting the nonuse in three large hospitals of Dhaka city. Methods Under an observational cross-sectional design 598 type 2 diabetic subjects were recruited (convenient sampling) from the OPDs of 3 large tertiary care hospitals [one public hospital (PUBH), one Not-for-profit Hospital (NFPPH), and one For-profit private hospital (FPPH)] in Dhaka City. Data were analyzed by both univariate and multivariate analysis as appropriate. Results Overall 71% of subjects were SMBG Nonusers (PUBH 86%, NFPPH 67%, and FPPH 46%). Monthly income status and advice showed the highest impact (OR 4.66 and 3.74 respectively) on the use. Physicians (54%), relatives (34%), and friends (8.2%) were the major sources of advice. Irregular diabetes check-up and distrust of results were also among the major reasons for not using SMBG among the Nonusers. Conclusion Nearly three-fourth of type 2 diabetic patients in Dhaka city do not use SMBG and the proportion is especially high in public hospitals. Poor income status of patients, lack of coordinated advice/motivation by Caregivers, irregularity in diabetes checking, and distrust on results are major predictors for not using SMBG by the patients., Type 2 DM, Monitoring glycemic status, Self blood glucose monitoring, Home blood glucose monitoring, SMBG, SMBG nonuse predictors.

AMP-activated protein kinase (AMPK) and c-AMP-response element binding protein (CREB) are found to be important proteins in metabolic system. AMPK has become the focus as a novel therapeutic target for the treatment of metabolic syndromes. Oyster mushroom is traditionally used as remedy of diabetes and hypertension. The present study aims to observe the stimulation of AMPK and CREB in streptozotocin-induced diabetic model rats through Oyster mushroom administration. Long Evan’s rats were used to create type 2 model diabetic rats through intraperitoneal injection of streptozotocin at 90mg/kg body weight of 48hr old pups. Rats were divided into three groups: diabetic control rats, glibenclamide treated diabetic rats (positive control) and mushroom treated diabetic rats (experimental group). Mushroom was administered orally at a dose of 1.25g/kg body weight in semisolid forms. After five weeks rats were sacrificed, serum and tissues were collected for future analysis. Glucose was measured using glucose-oxidase method, lipid profile by enzymaticcolorimetric method. Proteins from different tissues were extracted using RIPA cell lysis buffer, AMPK and CREB were identified using western blot and immuno-precipitation techniques. A significant decreased of fasting glucose was found after 35 days of experiment when it compared with control diabetic rats (M ± SD, mmol/l, Diabetic control group: 8.0±1.1; Mushroom treated diabetic group: 6.4±1.0; p=0.021). Glibenclamide treated diabetic rats have also shown decreased fasting glucose compared to control diabetic rats. In paired ‘t’ test analysis, it has been found that serum fasting glucose level was significantly decreased on 35th day compared the 0 day in both mushroom treated group (p=0.027) and in glibenclamide treated group (p=0.005). Serum TG level was decreased on 35th day compared to 0day in mushroom treated diabetic model rats only (M±SD, mg/dl, 0 day: 84±13; 35th day: 61±6, p=0.002). No significant changes of cholesterol, HDL and LDL were noticed in the experimental groups following treatment with mushroom. Western blot analyses have shown increased band intensity of AMPK and p-CREB in mushroom treated diabetic model rats. Therefore, it can be concluded that Anti-hyperglycemic property of Oyster mushroom could be explained through increased expression of AMPK and activation of CREB.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.661-668

Background : The guide extension catheter – Guidezilla (Boston Scientific, United States of America) is a useful adjunctive tool in percutaneous revascularization of complex coronary lesions, and provides an extension to the guide catheter with better coaxial alignment, support and stability. Objective : The objective of this study was to describe the usefulness and easy deliverability of stent by Guidezilla in the trans-radial treatment of complex coronary lesions as our initial experience. Methods : This prospective observational study was conducted at the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka from July 2016 to September 2017. The transradial approach was used in all cases. Clinical, angiographic and procedural data of percutaneous coronary interventions performed using Guidezilla , including indications for use of Guidezilla were collected and analyzed. Results : A total of 19 procedures (in 18 patients) were evaluated. 57.89% of cases were related to left circumflex coronary artery or obtuse marginal branch. The commonest challenge for use of Guidezilla was proximal angulation (63.15%) and calcification (47.4%). Commonest type of lesion was ACC/ AHA Type C lesion (63.2%). Successful stent deployment was achieved in 16 of the 19 procedures (84.2%). Among the unsuccessful cases, there was stent damage in one case and distal dissection after deployment of a stent in other. Stent deployment was not possible in two cases, due to diffuse lesion and heavy calcification. Conclusions : Guide extension catheter is a good trans-radial back-up support for calcified, complex and tortuous coronary anatomy, which otherwise may have been considered unsuitable for PCI. The use of such support can reduce the necessity for the more expensive alternative of deploying multiple small stents in order to traverse the lesions. Bangladesh Heart Journal 2018; 33(1) : 54-60

Psoriasis is chronic inflammatory skin disease characterized by scaly skin, which affects 24% population globally. Role of different SNPs among ACE (angiotensin converting enzyme), eNOS (Endothelial nitric oxide synthase) and MTHFR (Methyltetrahydrofolate reductase) has been established in different genetic disorders, till date there is very limited data available which quadrate the role of these important genes in the pathogenesis of Psoriasis. The present study was conducted to determine the association of ACE, eNOS and MTHFR polymorphisms with psoriasis in the Pakistani population. A total of 240 psoriatic patients and 264 healthy controls were genotyped by polymerase chain reaction (PCR) for rs464699 Insertion/Deletion (ID) polymorphism in intron 16 of ACE, rs869109213 VNTR (a/b) polymorphism in intron 4 of eNOS and by restriction fragment length polymorphism (RFLP) for rs2274976 G1793A, rs1801133 C677T and rs1801131 A1298C of MTHFR. In order to statistically analyze the genotype-phenotype association, logistic regression analysis was applied to the genotype data of psoriatic patients and controls. The ACE genotype DD was found to be significantly associated with risk of psoriasis (Odds Ratio [OR] = 1.93(95% Confidence Interval [CI] = 1.25–2.98), p= 0.02) under the recessive model. eNOS (a/b) polymorphism also demonstrated association with susceptibility to risk of psoriasis in the current cohort (OR = 1.88 (95% CI = 1.25–2.83), p = 0.001) under dominant model. In the case of MTHFR rs2274976 revealed significant association with psoriasis (OR = 2.93 (95% CI = 1.88–4.58) p ≤ 0.001) under the dominant model as well as the recessive model (OR = 1.34 (95% CI = 1.34–15.04) p = 0.005). rs1801133 also had marginal association with psoriasis by conferring protection against disease susceptibility under the dominant model (OR = 0.63 (95% CI = 0.4–1.0) p ≤ 0.05), while rs1801131 did not show any association with psoriasis. In conclusion, in the Pakistani population ACE (ID), eNOS (a/b) and MTHFR G1793A polymorphism were observed to be significantly associated with the disease.

Chronic pain is not only agonizing for the patient but also has both physiological and psychological adverse effects. In addition, chronic pain also results in burdening a person financially and limiting his/her ability to complete his/her work hours. The complex nature and types of chronic pain cannot be managed by any single treatment. There is always addition of new modalities and ideas for management. Epiduroscopy and adhenolysis , RFA though are used for few years in developed countries with success but are relatively new in Pakistan

Coronary artery dissection is a rare but well-recognized complication of coronary angiography with high morbidity and mortality rate. We present the case of a 54-year-old male who experienced iatrogenic left main-stem (LMS) dissection during transradial coronary angiography for inferior STEMI. The patient was successfully treated by prompt bail-out stenting. Intracoronary stenting is of value in stabilising the patients before emergency bypass surgery and can save lives in LMS complications. Ibrahim Card Med J 2015; 5 (1&2): 67-71

Background Increased awareness amongst large population groups is a major determinant for the prevention of diabetes and its complications as well as related metabolic disorders. Knowledge and attitude are the principal markers of awareness that need to be studied in various population groups in specific racial and cultural contexts. The present study was undertaken to explore knowledge, attitude and practice (KAP) regarding -diabetes mellitus (DM) among nondiabetic (nonDM) and type 2 diabetes mellitus (T2DM) patients in Bangladesh. Methods A cross-sectional study was conducted among 18,697 adults (aged 18 years and above; 7796 male and 10,901 female; 6780 nonDM and 11,917 T2DM) selected purposively from the OPD of 19 healthcare centres in and around Dhaka and in northern parts of Bangladesh. KAP were assessed by a pre-structured, interviewer-administered questionnaire and categorised using predefined scores of poor (mean + 1 SD). Univariate and bivariate statistical analysis were done as appropriate. Multivariate linear regression was done to examine the association between diabetes related KAP and other covariates. Results The mean (±SD) age (years) of all the study participants was 46 ± 14, mean BMI 24.4 ± 4.1 and mean waist-hip ratio (WHR) was 0.93 ± 0.07. The proportion of poor, average and good knowledge scores among T2DM subjects were 17%, 68% and 15% respectively. The corresponding values for attitude score were 23%, 67% and 10% respectively. The KAP regarding diabetes was found to be better among people who were living with diabetes compared to their counterparts. DM males showed better knowledge and practice regarding diabetes, compared to nonDM counterparts (M ± SD; 44.18 ± 16.13 vs 40.88 ± 15.62, p =

Introduction: Polycystic Ovarian Syndrome (PCOS) is a major cause of female infertility which is thought to be associated with Insulin Resistance (IR). However the nature and degree of IR have been shown to vary in different populations. PCOS women have also been reported to have increased prevalence of subclinical hypothyroidism which has been postulated to be determinants of IR. The natures of thyroid involvement have also been shown to vary between populations.Objectives: The study was undertaken to explore the distribution of IR and thyroid dysfunction as assessed by Thyroid Stimulating Hormone (TSH) levels among PCOS subjects and also to investigate the association of IR with TSH in women with PCOS.Materials and Methods: One hundred and fifty one PCOS patients (age in years 24±5; M±SD) were studied. PCOS was diagnosed by Rotterdam criteria. Fasting serum C-peptide was measured by Enzyme Linked Immuno Sorbide Essay (ELISA) and serum TSH was measured by Microparticle Enzyme Immunoassay (MEIA). Serum glucose was estimated by Glucose-Oxidase method (GOD-PAP). Insulin sensitivity was assessed by using Homeostasis Model Assessment (HOMA).Results: The mean serum C-peptide (nmol/l) and HOMA%S were 0.67 (±0.35) and 85 (±42) respectively. The median (Range) serum TSH level (?lU/ml) of the study subjects was found to be 2.49 (0.66 to 20.86). Insulin sensitivity was found to be 26%, 47%, 17% and 10% in those who had HOMA%S level at the range of 150 respectively. Of the total PCOS subjects, 85% had normal level of TSH value whereas only 15% PCOS subjects had subclinical hypothyroidism. The median serum TSH level of the insulin resistance and non-resistance groups were 2.25 (0.89-5.71) and 2.58 (0.74-20.86) respectively. On Pearson's correlation analysis insulin sensitivity was not found to be any significant association with TSH in the PCOS subjects.Conclusion: The study revealed that there was no significant association with IR and TSH in the PCOS subjects.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 69-73

Background The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh. Methods A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients’ medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient’s perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost. Results Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient. Conclusions The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Electronic supplementary material The online version of this article (10.1186/s12913-019-4440-3) contains supplementary material, which is available to authorized users.

Background and objectives: Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. Materials and Methods: This cross-sectional study recruited 265 postmenopausal women of 40&ndash, 70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP &ge, 140 or DBP &ge, 90&thinsp, mmHg), and the 2017 ACC/AHA guidelines (SBP &ge, 130&thinsp, mmHg, or DBP &ge, 80&thinsp, mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen&rsquo, s Kappa (&kappa, ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). Results: The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis &amp, Koch&rsquo, s approach detected highest agreement for ISH (&kappa, = 0.74, substantial, PABAK = 0.76, substantial, AC1 = 0.84, excellent, p &lt, 0.001) and pre-hypertension/elevated blood pressure (&kappa, = 0.12, slight, PABAK = 0.42, moderate, AC1 = 0.83, excellent, 0.001). Conclusions: The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.

Objective The aim was to estimate the burden of macro- and micro-vascular complications on hospitalisation and healthcare cost among people with type 2 diabetes mellitus in Bangladesh. Methods A cross-sectional study was carried out in 2017. A total of 1253 patients were recruited from six hospitals. Information related to cost and complications of type 2 diabetes were collected. Multiple logistic and non-parametric regression analyses were performed to evaluate the effect of complications on hospitalisation and average annual cost. Results Overall, 63.4% of the participants had complications of which 14.8% and 20.7% had macro- and micro-vascular complications respectively and 27.9% had both. Use of insulin, presence of both hypertension and dyslipidaemia, coronary artery diseases, stroke, nephropathy, and retinopathy were significantly associated with hospitalisation. Further, use of oral hypoglycaemic agent with a combination of insulin, presence of coronary artery diseases, stroke, nephropathy, and retinopathy increased the average annual cost. Conclusion The prevalence of macro- and micro-vascular complications were very high in Bangladesh and majority of them are key drivers for hospitalisation and increased healthcare cost. An improvement of primary prevention strategy for complications is urgently needed which in turn will reduce the long-term healthcare cost for type 2 diabetes in Bangladesh.

ObjectiveTo determine the prevalence of non-communicable disease (NCD) risk factors among nurses and para-health professionals (PHPs) working at primary healthcare centres in Bangladesh. In addition to this, we also investigated the association of these risk factors with the categories of health professions.DesignCross-sectional study and the sampling technique was a census.SettingThe study site was a medical university of Bangladesh where the study population was recruited by NCD Control Programme of Directorate General of Health Services to participate in a 3-day training session from November 2017 to May 2018.ParticipantsA total of 1942 government-employed senior staff nurses (SSNs) and PHPs working at Upazila Health Complexes.Primary and secondary outcome measuresThe data were collected using a modified STEPwise approach to NCD risk factors surveillance questionnaire of the World Health Organisation (V.3.2). The prevalence of NCD risk factors was presented descriptively and the χ² test was used to determine the association between NCD risk factors distribution and categories of health professions.ResultsThe mean age of the participants was 37.6 years (SD 9.5) and most of them (87.6%) had a diploma in their respective fields. Physical inactivity (86.9%), inadequate fruits and/vegetable intake (56.3%) and added salt intake (35.6%) were the most prevalent behavioural risk factors. The prevalence of central obesity, overweight, raised blood glucose and raised BP were 83.5%, 42.6%, 19.2% and 12.8% respectively. Overall, the NCD risk factors prevalence was higher among PHPs compared with SSNs. A highly significant association (pConclusionHigh NCD risk factors prevalence and its significant association with SSNs and PHPs demand an appropriate risk-reduction strategy to minimise the possibility of chronic illness among them.

Background: Knowledge about diabetes is the cornerstone of self-management, which is crucial for diabetes care. Improving patients’ knowledge and self-management toward their condition can achieve better control, delay complications, and improve their quality of life. However, there are great variations in the level of knowledge from population to population and this needs to be explored in different ethnic and sociocultural groups for designing appropriate preventive strategies. Due to lack of adequate studies in Bangladesh, this study aimed at assessing diabetes-related knowledge, its determinants and examined which subgroups of patients have the largest knowledge deficits. Materials and Methods: This cross-sectional study was carried out among 504 study participants with type 2 diabetes in the outpatient clinic of the Bangladesh Institute of Health Sciences (BIHS) hospital, a tertiary care center in Dhaka, Bangladesh. Sociodemographic information, anthropometric knowledge about diabetes were collected by semistructured, interviewer-administered questionnaires by the face-to-face interview technique. Respondents who achieved a 50% or higher score from a 16-item diabetic knowledge assessment questionnaire were considered to have good knowledge and their counterparts were considered as possessing poor knowledge about diabetes. Descriptive statistics was used to estimate the prevalence of knowledge. A univariate and multivariate logistic regression was carried out to identify significant factors associated with diabetic knowledge. Results: The participants’ mean age (±SD) was 52 ± 11years; among them, 57.3% were women, 17.1% were illiterate, and 31.5% belonged to a lower-income family. About one-third of them (29.2%) had good knowledge, and male participants were more educated and had higher diabetes knowledge compared with their counterparts. In particular, gender, education, occupation, monthly family income, and duration of diabetes showed a significant correlation with overall knowledge. On multivariate regression, age, education, duration of diabetes, and family members correlated independently with knowledge. Conclusions: On the basis of the current study, it is suggested that about two-third of the patients attending a tertiary care hospital had poor knowledge about diabetes. These results highlight the need for a coordinated educational program with a prioritized focus on older, newly diagnosed, and less educated groups, which reinforces the necessity for patient education.

Objective (s): Aim of the study was to explore the effect of the most widely used low dose OCP (Shukhi) on glycemic and lipidemic factors of under weight (Low BMI) Bangladeshi women.Materials and Methods: This case control study was conducted at the Department of Cell and Molecular Biology, Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM) and Family Planning Center of Dhaka Medical College Hospital during the period of Jan 2011 to Dec 2011. A total number of 40 women were included in this study having age range between 25-45 years. Twenty nine (29) were with normal BMI (>18.5) and 11 were with low BMI (

Objective: To detect the frequency of lymph node micro-metastasis in clinically negative nodes (cN0) after elective neck dissection in patients of oral cavity carcinoma. Study Design: Cross sectional descriptive study. This was a multi-center study conducted at four hospitals of Karachi, including Dow University Hospital, PNS Shifa Hospital, Zubaida Medical Center and Hashmani’s Hospital, over a period of two years from June 2013 to June 2015. Materials and Methods: A total of 48 patients were included in this study. Inclusion criterion was all patients of squamous cell carcinoma of the oral cavity with clinically negative nodes (cN0). Surgery was done in all the cases for the primary tumour as well as elective neck dissection. The neck specimen was sent for histopathology after marking the different level. Results: The overall positive neck nodes were found in 17 out of total 48 cases (35.4%). The incidence was found to be highest in level II lymph nodes (64.7%) followed by level Ib lymph nodes (58.8%). Level IV lymph node was not involved in any case. Lower alveolus and palatal carcinoma has the highest incidence for nodal metastasis (50% each) followed by tongue (42.6%), upper alveolus (40%) and lowest in buccal carcinoma (22.7%). Conclusion: The incidence of cervical lymph node metastasis in oral carcinoma is fairly high, so elective neck dissection should be routinely performed in oral carcinoma. Secondly most of the metastasis is in level I, II and III, so classical supra-omohyoid neck dissection is enough in most cases.

Background: To evaluate the safety of radial versus femoral artery approach in routine coronary angiography (CAG) practice.Methods: We retrospectively evaluated consecutive patients in Ibrahim Cardiac Hospital & Research Institute, a tertiary care centre, who underwent diagnostic CAG over a period of 12 months. Procedure duration was calculated as time from initiation of local anesthesia to completion of the procedure. Contrast volume and fluoroscopy time were recorded.Results: 3346 patients who underwent a diagnostic CAG were included in this study. The radial approach was used in 3030 patients (90.5%) and the femoral approach in 316 patients (9.5%). As the radial group was disproportionately large compared to femoral group the size of the radial group was reduced to 1010 using a systematic sampling procedure, where every 3rd patient of radial group was chosen.Fluoroscopy and procedural times were not significantly different (3.41±1.14 vs. 3.85±1.43 min, p=0.314 & 11.87±4.61 vs. 13.74±6.33 min, p=0.180, respectively) comparing the radial and femoral approaches. While contrast utilization during the procedure was significantly lower in the radial than the femoral approach (57.60±22.42 vs. 69.52±24.30 mL respectively, p=0.030).Conclusion: Transradial coronary angiography can be safely performed as the transfemoral approach.Bangladesh Heart Journal 2015; 30(2) : 68-73

Older Indian diabetics lack proper health literacy making them vulnerable to complications. Assessment of health literacy was done by hospital-based cross-sectional study. Face-to-face interview was conducted by pretested structured questionnaires. Diabetes patients aged ≥60 years consisted of 56.22% males and 43.78% females; in addition, 34.2% respondents were without formal schooling. Diabetes was known to 63.56% respondents. Total knowledge and practice score of the respondents was good (18.9% and 35.1%), average (30.7% and 46.9%), and poor (50.4% and 18%), respectively. Knowledge and practice score was strongly associated ( P < .01) with religion, educational status, and diabetes duration with positive relationship ( R2 = 0.247, P < .01) between knowledge and practice score. The study highlights lack of health literacy among older diabetics undergoing ayurveda management. Baseline statistics will pave the way toward ayurpharmacoepidemiology.

Background and Aims: Smoking is a classical and major risk factor for cardiovascular disease. Inflammatory activators and metabolic disorders are the mediators of smoking-induced atherosclerotic progression. The aim of the present study was to investigate whether smoking alter inflammatory or metabolic status and affect subclinical atherosclerosis in apparently healthy persons.Methods: A total number of 149 adults, age 30-60 yrs, were recruited in the study. Participants were divided into sub-groups of smokers (76) and non-smokers (73). All participants were interviewed and underwent physical examinations and blood collection. High-sensitivity C reactive protein (Hs-CRP) was measured to assess degree of underlying inflammation. Fasting plasma glucose and lipid profile were measured to assess metabolic condition. Data were analyzed using statistical Package for Social Program (SPSS) for Windows version 17.Results: Hs-CRP (p=0.017), Fasting glucose (p=0.003), Triglyceride (p=0.005) was significantly high in smokers in comparison with nonsmokers. BMI (p=0.012) and BFM (%) (p=

Background and Aims: Chronic obstructive pulmonary disease (COPD) is thought to have increased association with metabolic syndrome (MS) which represents a cluster of factors that increase the risk of cardiovascular diseases and diabetes mellitus. However, the extent of association of COPD with MS and its individual components are still an unsettled issue, and it is likely to vary from population to population. Under the above context, this study was undertaken to investigate the association of MS and its components with COPD. Materials and Methods: With a cross-sectional analytic design, 77 COPD and an equal number of non-COPD (apparently healthy) participants were studied purposively. The two groups were found to be matched by age, sex, and monthly income groups. The data of COPD patients and non-COPD participants were collected from a tertiary level hospital in Kolkata and a locality of Greater Kolkata, respectively. They were interviewed, and the frequencies of MS were assessed using 3 criteria (National Cholesterol Education Program-Third Adult Treatment Panel [NCEP ATP III], modified NCEP ATP III, and International Diabetic Federation [IDF]). Anthropometric measurements were taken, and fasting blood sample was collected to test the fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein (HDL) of respondents. Logistic regression was applied to estimate the odds ratio (OR). Results: Among the COPD subjects, 44%, 46%, and 31% had coexisting MS as defined by NCEP ATP III, modified NCEP ATP III, and IDF criteria, respectively. The corresponding percentages in the non-COPD groups were 31%, 38%, and 32%. On multivariate analysis, a significant association of MS (P < 0.015) with COPD was found only when the NCEP ATP III criteria were used. The (mean ± standard deviation) FBG concentration among COPD and non-COPD groups was 130 ± 65 mg/dl and 97 ± 26 mg/dl, which was significantly different (P < 0.001). The difference in systolic blood pressure (SBP) (P < 0.063) and HDL level (P < 0.058) lied just outside the statistical significance among COPD and non-COPD groups. Gender, exercise habit, family history of hypertension, and smoking habits were important confounders for the association of COPD with individual MS components. Using NCEP ATP III criteria, female gender (OR = 3.48), COPD groups (OR = 3.05), and family history of hypertension (OR = 3.31) were found as determinants (P < 0.05) of MS. Using modified NCEP ATP III criteria, female (OR = 3.66) and family history of hypertension (OR = 3.84) were found as determinants (P < 0.05) of MS. Conclusions: COPD is associated with MS only when the NCEP ATP III is used for the diagnosis of MS. No association can be revealed on using the IDF criteria for MS. Body mass index (BMI), and waist circumference does not seem to be appropriate measures for assessing the presence of MS among COPD patients. Among the components of MS BMI, SBP, FBG, TG, and HDL are significantly associated with COPD.

Aims Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver-related morbidity and is frequently associated with insulin resistance (HOMA-IR) syndrome. Recently serum gamma glutamyl transferase (GGT) has been considered as surrogate marker of NAFLD leading to oxidative stress and hepatocellular damage. In the present study we examined the association of serum GGT and HOMA-IR with NAFLD in Bangladeshi adult subjects. Materials and methods Under a cross-sectional analytical design a total of 110 subjects were recruited who came for their routine health check up in the BIHS Hospital, Darussalam, Dhaka, Bangladesh. After whole abdomen ultrasonography, 62 were diagnosed as non-NAFLD and 48 were NAFLD subjects. Serum glucose was measured by glucose-oxidase method, lipid profile and liver enzymes by enzymatic colorimetric method, glycosylated hemoglobin (HbA1c) was measured by high performance liquid chromatography (HPLC), serum insulin were measured by enzyme-linked immunosorbent assay. HOMA-IR was calculated by homeostasis model assessment (HOMA). Results NAFLD subjects had significantly higher levels of GGT and HOMA-IR as compared to their non-NAFLD counterparts. Multiple linear regression analysis showed a significant positive association of HOMA-IR with GGT after adjusting the effects of waist circumference (WC) and HbA1c. In binary logistic regression analysis, HOMA-IR and GGT were found to be significant determinants of NAFLD after adjusting the effects of WC and HbA1c. Conclusion These results suggest that elevated levels of GGT and insulin resistance are more likely to develop NAFLD and thus support a role of these determinants in the pathogenesis of NAFLD in Bangladeshi adult subjects.

Cardiovascular diseases (CVD) are rising rapidly among the postmenopausal woman but they are less likely to identify their risk by an appropriate risk assessment tool. This review evaluates available literature on cardiovascular risk assessment among postmenopausal women to provide a concise view of risk factors and disease burden among them, present risk assessment systems including their drawbacks, emergence of new risk factors and their role in risk prediction, and finally use of hormone replacement therapy during menopause. Results demonstrate that menopause is a transition point for developing CVD not due to physiological changes only but psychosocial factors like depression and marital stress are also responsible. Both conventional and emerging risk factors burden are high among postmenopausal women. Though data regarding CVD risk assessment among postmenopausal population is lacking but existing evidences claimed underestimation or overestimation of risk among women. Moreover application of different tools on same population has revealed significant variation in result. In this regard, recalibration of conventional tools with local data and new risk factors has showed improvement of risk prediction. Hormone replacement therapy during early menopause has reported beneficial to prevent CVD but in secondary prevention it has no role. All of these findings demand further studies on cardiovascular risk assessment, especially in developing countries where women after menopause are not in consideration of health strategy makers.

Objective: To explore lipid abnormalities in normoglycemic first-degree diabetic relatives (FDRs) and prediabetic and diabetic subjects in the natural history of diabetes.Research design and methods: Thirty six impaired fasting glucose (IFG), 61 isolated impaired glucose tolerance (I-IGT), 64 combined IFG-IGT, 73 diabetic, and 32 FDRs along with 57 normoglycemic healthy controls without family history of diabetes in 1st degree relatives, were selected purposively following 2003 ADA cut-off values and 2006 WHO/IDF grouping. Anthropometry and blood pressure of the subjects were taken. Fasting and 2-h plasma glucose and HbA1C were measured. Fasting plasma triglyceride, total cholesterol and HDL cholesterol were measured by enzymatic colorimetric method.Results: Serum triglyceride was higher in IFG, I-IGT, IFG-IGT, diabetic and FDRs compared to Control [145 (59- 307), 128 (66-584), 166 (68-764), 161 (69-750) and 130 (81-281) vs. 108 (47-219) mg/dl, P

Objectives The present study aimed to explore the relationship of circulating vaspin levels with insulin sensitivity and anthropometric factors. Methods This study was conducted with 65 newly diagnosed type 2 diabetes mellitus (T2DM) patients with age-matched 65 healthy controls. Serum glucose was measured using glucose-oxidase method, lipid profiles by enzymatic end-point methods, and fasting insulin and vaspin levels were assessed with ELISA techniques. Homeostasis model assessment for insulin sensitivity (HOMA%S) and insulin secretory capacity (HOMA%B) were estimated from the fasting glucose and insulin levels using HOMA-CIGMA software. Results Fasting serum insulin (μU/ml) was higher in the diabetic group than controls (16.0 ± 7.9 vs. 10.9 ±3.3, respectively, p =0.0001). The mean (±SD) HOMA%S of the diabetics was significantly lower than that of the controls (48 ±31 vs. 76±55, respectively, p = 0.001). The HOMA%B of the T2DM group was nearly 50% of that of the controls (71± 40 vs. 131 ±46, respectively, p = 0.001). The T2DM group exhibited significantly lower serum vaspin (ng/ml) levels than the controls (0.62 ±0.26 vs. 0.83± 0.28, respectively, p =0.001). Vaspin levels were negatively correlated with waist circumference (r =0.17, p =0.043) and positively correlated with HOMA%S (r =0.243, p =0.007) among all of the participants. The association of serum vaspin with diabetes remained highly significant (p =0.008) in binary logistic regression analysis performed after adjusting for the effects of confounders. Conclusions Serum vaspin level is positively associated with insulin sensitivity and negatively correlated with serum glucose, BMI and waist-height ratio.

Congenital pulmonary valve stenosis is a common congenital heart disease andIsolated pulmonary valve stenosis comprises 8-10% of all congenital heart disease. It is an acyanotic heart disease,but can present with severe cyanosis if it is associated with patent foramen ovale (PFO). Severe pulmonary stenosis with cyanosis can be misdiagnosed clinically. Proper evaluation and modern technique of treatment modality can save a life easily. We report a 5 years old boy with severe pulmonary valvular stenosis with PFO who was clinically misdiagnosed as a case of congenital cyanotic heart disease (Tetralogy of Fallot). After taking proper history, clinical examination and investigations we treated the baby by balloon pulmonary valvuloplasty (BPV) successfully without any complication. The short term (6 months) outcome of BPV showed excellent result. Ibrahim Cardiac Med J 2013; 3(1&2): 53-58

This study aims to evaluate the risk indicators of diabetic retinopathy in patients with type 2 diabetes screened by fundus photographs at a tertiary care diabetes centre in Karachi, Pakistan. A cross-sectional study was conducted at the outpatient department of Baqai Institute of Diabetology and Endocrinology from October 2009 to March 2010. Patients ≥30 years of age were recruited randomly. Demographic, anthropometric, clinical and biochemical data were collected, and ophthalmic screening was done by two field fundus photography. Fundus photographs of 366 patients were graded according to the modified Early Treatment Diabetic Retinopathy Disease Severity Scale (ETDRS) criteria. Retinopathy was present in 27.3 % patients. Fifteen percent of patients had non-sight-threatening retinopathy while 12 % had sight-threatening retinopathy. Patients with retinopathy had significantly increased mean duration of diabetes, systolic and diastolic blood pressure and HbA1c (p

Background: No published information is available on the status of childhood obesity in Bangladeshi primary school children of urban middle and upper-middle income group. The aim of the study was to explore the proportion of childhood obesity in the primary school children of middle and upper-middle income group in capital city and to gather information on their dietary pattern and physical activity. Methods: One hundred and fifty children (age 9 ± 1 years, height (ht) 118 ± 20 cm, weight (wt) 36 ± 8 kg, wt/ht% 126 ± 24, mean ± SD) were selected purposively from the primary schools of Dhaka city. On the basis of predefined scoring, subjects were classified as underweight, normal, overweight and obese if their weight-for-height values were 120% of median values for Bangladeshi children respectively. Dietary intake and energy expenditure of the study subjects were calculated by standard techniques. Results: The proportion of childhood overweight and obesity was 52% and 20%. The proportion of overweight and obesity was higher (78%) among girls compared to boys (54%). Similarly, height, weight and other anthropometrics indices were significantly (p < 0.05) higher in girls compared to boys. The daily intake of carbohydrate and protein was significantly (p < 0.05) higher among obese group. Total energy balance was significantly correlated with weight-for-height% (r = 0.541, p = 0.0001). Conclusions: A higher proportion of overweight and obesity had been found in girls’ children than their counter parts in this study. Positive energy balance with higher energy intake from carbohydrate and fast/processed food culture habit were found among primary school children of middle and upper-middle income group in the capital city of Bangladesh.

Background Feasible and cost-effective as well as population specific instruments for monitoring physical activity (PA) levels are needed for the management and prevention of non-communicable diseases. The WHO-endorsed Global Physical Activity Questionnaire (GPAQ) has been widely used in developing countries, but the evidence base for its validity, particularly for rural populations, is still limited. The aim of the study was to validate GPAQ among rural and urban residents in Bangladesh. Methods A total of 162 healthy participants of both genders aged 18–60 years were recruited from Satia village (n = 97) and Dhaka City (n = 65). Participants were invited to take part in the study and were asked to wear an accelerometer (GT3X) for 7 days, after which they were invited to answer the GPAQ in a face to face interview. Results Valid accelerometer data (i.e., ≥10 h of wear times over ≥3 days) were received from 155 participants (rural = 94, urban = 61). The mean age was 35 (SD = ±9) years, 55% were females and 19% of the participants had no schooling, which was higher in the rural area (21% vs 17%). The mean ± SD steps/day was 9998 ± 3936 (8658 ± 2788 and 12,063 ± 4534 for rural and urban respectively, p = 0.0001) and the mean ± SD daily moderate-to-vigorous physical activity (MVPA) was 58 ± 30 min (51 ± 26 for rural and 69 ± 34 for the urban, p = 0.001) for accelerometer. In case of GPAQ, rural residents reported significantly higher moderate work related PA (MET-minutes/week: 600 vs. 360 p = 0.02). Spearman correlation coefficients between GPAQ total MVPA MET-min/day and accelerometer MVPA min/day, counts per minute (CPM) or steps counts/day were acceptable for urban residents (rho: 0.46, 0.55 and 0.63, respectively; p

Background: Diabetes mellitus coexists at a greater frequency with hypertension, obesity, central obesity, and dyslipidemia. Obesity has been identified as the most important modifiable risk factor in the aetiology of type-2 diabetes mellitus. Central obesity has been shown to be the most pathogenically important in the causation of metabolic disorders including type-2 diabetes. Aims: To determine the association of central obesity with type 2 diabetes in Bangladeshi women. Subjects and Methods: A total of 60 type 2 diabetic female subjects along with 60 healthy female subjects were recruited in this study. Anthropometric indices were measured using standard techniques. Serum glucose was measured using glucose-oxidase method, insulin was measured using ELISA and thyroid hormones were measured using chemiluminescence based automated Immulite Auto analyzer (DPC, USA). Insulin secretory capacity and insulin sensitivity were estimated using fasting glucose and fasting insulin by HOMA-CIGMA software. Results: Waist circumference of the control (89±8) subjects was significantly (p=0.046) lower than the diabetic (94±11) subjects. Waist-hip ratio of the control subjects was significantly lower compared to diabetic subjects. Fasting plasma insulin level in control subjects (7.6±2.2) was significantly (p=0.009) lower compared to diabetic subjects (11.8±9.8). Plasma lipid profile and thyroid hormone status in control and diabetic subjects were not found significantly different. Insulin secretory capacity (HOMA %B) and insulin sensitivity (HOMA%S) in control subjects (93±21, 95±39 respectively) were found to be significantly higher com-pared to diabetic subjects (45±32, 67±42 respectively). In age-adjusted binary logistic regression analysis, waist circumference was found to be significantly associated with diabetes. In multiple linear regression analysis TSH was found to be significantly associated with waist circumference. Conclusion: Waist circumference may be an independent indicator for the development type 2 diabetes in Bangladeshi women which may have influenced by thyroid stimulating hormone (TSH). DOI: http://dx.doi.org/10.3329/bjms.v13i3.19149 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.278-284

Objectives Serum free insulin like growth factors-1 (IGF-1) and insulin like growth factor binding protein-1 (IGFBP-1) may have an association with insulin resistance and B-cell secretory dysfunction. Present study is undertaken to explore the independent association of IGF-1 and IGFBP-1with two basic defects in type 2 diabetic patients in a Bangladeshi population. Methods Sixty eight type 2 diabetes mellitus (DM) subjects are studied along with age-, sex- and BMI-matched 61 healthy controls without family history of diabetes or prediabetes. Insulin, free IGF-1 and IGFBP-1 are measured by the standard ELISA method. Insulin secretory capacity (HOMA B) and insulin sensitivity (HOMA S) are calculated using fasting glucose and fasting insulin by HOMA-CIGMA software. Results Fasting free IGF-1 and IGFBP-1 levels are not significantly different between the study groups. But the level of free IGF-1 is significantly higher ( p = 0.03) in type 2 DM subjects compared to controls in the low BMI group (BMI ⩽ 23). In stepwise multiple regression analysis, positive association of HOMA B with free IGF-1 is evident. Similarly positive association of HOMA B and HOMA S with IGFBP-1 is shown in different models. In the same analysis, both free IGF-1 and IGFBP-1 are inversely associated with fasting insulin in different models of stepwise multiple regression analysis. Conclusion Both IGF-1 and IGFBP-1 are negatively associated with fasting insulin levels. Moreover B-cell secretory dysfunction is positively associated with IGF-1 and both B-cell secretory dysfunction and insulin sensitivity are also positively associated with IGFBP-1 in type 2 diabetic patients.

Gestational diabetes mellitus (GDM) is one of the commonest complications of pregnancy; but its pathophysiology is still not fully understood. Recently attention has been focused on the relation between iron metabolism and glucose intolerance in the genesis of GDM. The present study was conducted to investigate the association of body iron store with various covariates of metabolic syndrome. A total 100 subjects were included in this study: 43 were healthy nondiabetic and nonanemic pregnant women (Control group) and 57 were pregnant women having Diabetes Mellitus (GDM group). Glucose level was measured by using glucose-oxidase method, fasting serum C-peptide by chemiluminescent enzyme immunoassay, Glycosylated hemoglobin (HbA1c) by using a modified high performance liquid chromatography (HPLC) method and insulin sensitivity (HOMA%S) and insulin secretory capacity (HOMA%B) were calculated by Homeostasis Model Assessment. Serum transferrin receptor (STfR) was measured by Enzyme-Linked Immunosorbent Assay and serum ferritin level was assessed by Microparticle Enzyme Immunoassay. Serum iron concentration was measured by IRN method. The age of the study groups were found to be matched (p=0.522). Gestational weeks and parity of the study groups were significantly higher in GDM than Controls (p=0.004 and p=0.015 respectively). HbA1c level (%, M±SD) was significantly higher in GDM group (6.09±1.1) as compared to Control Among the marker of body iron status hemoglobin level showed no difference between GDM (11±1.25) and Control groups (10.6±0.8), but serum iron concentration [median (range)] was significantly lower in GDM group [6(2-19)] as compared to Control [12(2-36)].Serum Iron was strongly correlated with HOMA%B in univariate Spearman correlation analysis (r =0.347, P=0.008).On multivariate linear regression analysis also found Serum Iron associated (p=0.011) with HOMA% B in GDM group. GDM in Bangladeshi subjects does not seem to be associated with iron deficiency or elevated body iron store. GDM subjects may show lower serum iron, but this is probably related to chronic inflammatory state of diabetes rather than iron deficiency. DOI: http://dx.doi.org/10.3329/bmj.v40i3.18678 Bangladesh Medical Journal 2011 Vol.40(3):55-60

Background and Aims: A substantial number of diabetic patients, diagnosed at relatively younger age, who don’t fit to typical type 2 and type 1 class of diabetes. These patients usually present with very high level of glycemia. The uniqueness of this group of patient provide the opportunity to explore the pathophysiology of nerve functional status at an early stage of diabetes. The present study was aimed to determine markers of endothelial dysfunction and evaluate nerve functional status of a group of newly diagnosed clinically uncomplicated young diabetic patients. Material and Methods: A total number of 32 (male-13 and female-19) newly diagnosed young (diabetes diagnosed under 30 yrs) were consecutively recruited from BIRDEM Out-patient department and 30 age-, BMI-matched healthy subjects with no family history of diabetes up to second generation served as controls. Serum fructosamine was measured by reduction test with NBT method. Serum C-peptide, endothelin-1 and tissue plasminogen activator (t-PA) by ELISA and von Willebrand factor (vWF) by Radial Immunodiffusion (RID) methods. Urinary albumin measured by immunoturbidimetry method. Nerve functional status was evaluated by nerve conduction velocities (NCV), distal latencies (DL), compound muscle action potential (CAMP), F wave latencies (FWL), nerve action potential (SNAP) for motor and sensory nerve as appropriate following the standard protocol. Results: Severe hyperglycemia in the diabetic group was reflected in their mean (SD) fasting C-peptide and fructosamine level. Altered endothelial dysfunction, as evidenced by significantly high tissue plasminogen activator (t-PA) (p

Women living in developing countries are more prone to osteoporotic fractures than women in developed countries. The objectives of this study were to estimate the burden of osteopenia and osteoporosis and examine their correlates among Bangladeshi women. This cross-sectional study consisted of 500 women aged 16-65 years attending gynecology and family planning clinics of a tertiary hospital which cares urban/suburban low income population in Dhaka, Bangladesh. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck using dual X-ray absorptiometry. We calculated T scores based on sex-matched reference data from Caucasian women provided by the manufacturer. Osteoporosis was defined as a BMD at either site more than 2.5 standard deviations (SD) below the young healthy adult woman mean while the osteopenia was defined as a BMD between 1 and 2.5 SD below the mean as suggested by the World Health Organization. Separate multivariable logistic regression analysis was used to examine the correlates of osteopenia/osteoporosis among 16-45 and 46-65 year old women. Overall, 43.6 and 5.5 % of 16-45 year old women, and 40.7 and 41.8 % of 46-65 year old women had osteopenia and osteoporosis based on T scores either of the two sites (lumbar spine or femoral neck), respectively. Body mass index was negatively associated with osteopenia/osteoporosis at both lumbar spine and femoral neck, while age was positively associated. The burden of osteopenia/osteoporosis is very high in Bangladeshi women which warrants appropriate interventional strategies to minimize future fractures and reduce related social and economic burden of the society.