Background and objectives: Recent publications have reported alarming prevalence of hypovitaminos... more Background and objectives: Recent publications have reported alarming prevalence of hypovitaminosis D in South Asian countries including Bangladesh. But, data on vitamin D levels in different occupational groups are lacking. This study addressed the prevalence of hypovitaminosis D in different occupational groups of Bangladesh. Additionally, the study estimated parathyroid hormone, phosphate, calcium and metabolic syndrome in these groups to see the effect of hypovitaminosis D on these parameters. Materials and method: Seven diverse occupational groups (agrarian workers, rickshaw-pullers, young cricketers and footballers, fishermen, dry fish industry workers, garment-workers and medical students) of Bangladesh were selected based on grade of physical activity and level of sun exposure. Blood was collected for the estimation of 25(OH) vitamin D, fasting glucose,lipid profiles, calcium, phosphate, magnesium and intact parathyroid (iPTH) hormone. Multiple comparisons of these variables...
Bangladesh Journal of Endocrinology and Metabolism
Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the rec... more Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the recognized guidelines and based on expert experience, as comprehensive national guidelines are currently lacking. The Bangladesh Endocrine Society (BES), as a professional body, has been working to develop guidelines for the last couple of years. Most recently, BES formulated practical recommendations for the management of thyroid disorders during pregnancy, which will be termed the "Guideline on Thyroid Disorders in Pregnancy in Bangladesh 2022," Methods: The BES formed a task force comprising experts in this field to formulate the practical recommendations for the management of thyroid disorders during pregnancy under several sections. The members of this task force comprehensively reviewed the available evidence for the specific conditions. Three well-known databases (Google Scholar, PubMed, and Scopus) were searched to determine the evidence. The task force members were well trained on reviewing the documents and methods of evidence synthesis. Each section of the recommendation was drafted by one member and subsequently reviewed. There was no barrier to the date or type of article published in the aforementioned databases except for articles published other than English. Due to the scarcity of intervention studies, ideas and findings of observational studies, case studies and expert recommendations were considered during the formulation of the guidelines. All members and affiliated persons declared no competing interest, and it was managed and communicated by the President of the BES. Results: The current guidelines for the management of thyroid disease in pregnancy include recommendations about the screening of thyroid function in pregnancy, planning pregnancy in women with thyroid disorders, interpretation of thyroid function tests, management of hypothyroidism and hyperthyroidism in pregnancy, management of thyroid nodules and thyroid emergencies throughout pregnancy, postpartum care, and directions of future research. Conclusions: Our utmost efforts were centered on developing evidence-based recommendations to inform all the levels of clinicians of Bangladesh for the easy understanding and decision-making processes in the management of thyroid disorders in pregnancy and afterward. While we care most to prepare the guideline, all recommendations are the opinion of society and admit the scope of making individualized decisions for the optimal care of patients.
Bangabandhu Sheikh Mujib Medical University Journal
Hypovitaminosis D (<20 ng/mL) is thought to increase insulin resistance and meta-inflammation ... more Hypovitaminosis D (<20 ng/mL) is thought to increase insulin resistance and meta-inflammation contributing to the pathogenesis of diabetes mellitus (DM). Correcting vitamin D deficiency in people with prediabetes might halt its progression to DM. The aim of this study was to examine the effect of vitamin D supplementation on insulin resistance, glycemic status, and inflammation in prediabetic adults with vitamin D deficiency. This doubleblind randomized placebo-controlled trial was done among 27 newly detected prediabetic adults with hypovitaminosis D randomly assigned to 60,000 IU of vitamin D weekly for eight weeks followed by monthly for the next four months or placebo along with lifestyle modification in both groups [vitamin D (n= 14) vs. Placebo (n=13). They were comparable in terms of sex, age and borlymass index. Glycemic status, fasting plasma glucose (FPG) and Hemoglobin A1C (HbA1C), insulin resistance (homeostasis model assessment of insulin resistance (HOMA-IR) and inf...
In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public ... more In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.
Background: Vitamin D deficiency (VDD) is found recently common across all age groups and may con... more Background: Vitamin D deficiency (VDD) is found recently common across all age groups and may contribute to Ischemic stroke. V causing isch¬emic stroke has been documented in recent reports. Objectives: To determine the correlation between serum level of Vitamin D with acute ischemic stroke patients admitted to hospital. Materials and methods: A case-control study including 60 acute ischemic patients admitted in the department of neurology as case and 60 apparently healthy genders and age group matched as control were recruited. All the participants were interviewed for medical history. Physical examination was done and imaging reports confirmed the diagnosis of stroke by the neurologist. Data were collected by a pre-tested semi-structured questionnaire, clinical examination [body mass index (BMI), waist circumference (WC), blood pressure] For Laboratory investigation of serum 25-Hydroxy Vitamin D[25(OH)D], venous blood was collected and assayed by High-Performance Liquid Chromatogr...
We report a case of a 26-year old lady who presented with a history of several episodes of limb w... more We report a case of a 26-year old lady who presented with a history of several episodes of limb weakness requiring repeated hospitalization over the last 12 years and about 6 years back, she also developed features of sicca complex. Further investigations revealed hypokalemia, distal renal tubular acidosis and bilateral extensive nephrocalcinosis. Finally, a diagnosis of Sjogren’s syndrome was made. Hypokalemia may be the presenting feature of Sjogren’s syndrome. Sjogren’s syndrome may be suspected in patients with recurrent hypokalemia and renal tubular acidosis. IMC J Med Sci 2022; 16(2): 004. DOI: https://doi.org/10.55010/imcjms.16.014 *Correspondence: Shapur Ikhtaire, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. Email: [email protected]
Background and aims: Hypothyroidism is a common global endocrine disorder. The magnitude of hypot... more Background and aims: Hypothyroidism is a common global endocrine disorder. The magnitude of hypothyroidism at community level in Bangladesh is unknown except some clinic-based studies. The present study was undertaken to determine the prevalence of hypothyroidism in different occupational groups of Bangladeshi population and to assess the risks related to it. Study design: Three occupational groups (house-wives, college students, rickshaw-pullers) of native Bangladeshi population were purposively selected. Investigations included socio-demography, anthropometry, blood pressure and biochemistry [fasting blood glucose, lipids, thyroid stimulating hormone (TSH) and free thyroxin (FT4)]. Laboratory tests were done only on a randomized sample of participants. Results: Overall, 626 (M/F=123 / 503) participants with a mean age of 35.9 (34.75 – 37.02) years volunteered. The mean values of all participant for TSH and FT4 were 2.08 (95%CI: 1.72 – 2.45) μiu/ml and 13.04 (95CI:12.86 – 13.22) pm...
Background and objectives: Metformin improves macrovascular complications in people with diabetes... more Background and objectives: Metformin improves macrovascular complications in people with diabetes mellitus (DM). Although the exact mechanism is not known, metformin has beneficial effects on dyslipidaemia. The aim of the study was to find out if there was an effect of metformin on blood lipids in people with diabetes mellitus. Method: This was a cross-sectional study which included 80 patients with diabetes mellitus. They were divided into 2 groups – (a) Group 1: on metformin and (b) Group 2: without metformin medication. None of the patients were on any other anti-diabetic medication. All data were obtained from patients’ medical records. Individual blood lipids and lipid ratios were compared between two groups. Result: Group 1 included 42 patients with a mean HbA1c of 7.58 ± 0.24% taking an average dose of 820.83 ± 60.40 mg/day of metformin. Group 2 consisted of 38 patients with mean HbA1c of 7.58 ± 0.29%. There was no significant difference in individual plasma lipid levels, lip...
Open Journal of Endocrine and Metabolic Diseases, 2021
Background: Very limited data are available regarding the association of vitamin D with glycemic ... more Background: Very limited data are available regarding the association of vitamin D with glycemic status among adults with newly detected type 2 diabetes mellitus (T2DM) in Bangladesh. Objectives: To determine vitamin D status and its association with glycemic status in Bangladeshi adults with newly detected T2DM. Materials and Methods: This cross-sectional study was carried out in 102 newly detected T2DM diagnosed on the basis of the American Diabetes Association 2017 criteria (age: 42.95 ± 10.68 yrs.; m/f: 44/58) and equal number of age and sex matched controls (age: 40.43 ± 11.04 years) recruited consecutively from the Department of Endocrinology, BSMMU to measure serum vitamin D by high performance liquid chromatography method. Results: Both vitamin D deficiency (<20 ng/ml) (87.3% vs. 74.5%, p < 0.03) and severe vitamin D deficiency (<10 ng/ml) (56.2% vs. 26.3%, p < 0.001) were significantly higher in people with T2DM than control population. The mean level of 25(OH)D was significantly lower in adults with T2DM than control population (12.41 ± 6.85 ng/ml vs. 15.74 ± 6.25 ng/ml, p < 0.001). A significant inverse correlation was observed between vitamin D & HbA 1 c (r = -0.249, p = 0.011) in patients with T2DM. HbA 1 c was linearly associated with vitamin D (β = -0.26, p = 0.009) and severe vitamin D deficiency by binary (OR = 1.37, p = 0.003) and multinomial logistic regression (HbA 1 c ≥ 10%: OR = 4.25, p = 0.04) in people with T2DM after adjustment for age and BMI. Conclusions: Severe vitamin D deficiency was positively associated with T2DM and inversely associated with HbA 1 c in patients with newly detected T2DM.
International Journal of Diabetes and Endocrinology, 2021
Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose int... more Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose intolerance, very limited data are available in Bangladesh. Thus, the study aimed to determine vitamin D status of Bangladeshi adults based on the glucose intolerance status. Materials & Methods: This cross-sectional study was carried out among 70 newly detected DM, age-group & sex-matched 76 newly detected pre-diabetes and 74 healthy control with normal glucose tolerance (NGT) based on American Diabetes Association, 2018 criteria. Participants were included consecutively from the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of 1 year by convenient sampling to see serum 25(OH)D which was measured by high performance liquid chromatography (HPLC) method. Results: Vitamin D levels decreased with increasing degrees of glucose intolerance [NGT: 16.82±6.57; prediabetes: 15.54±8.58; T2DM: 11.01±6.03 ng/ml, p<0.001] but significantly lower in T2DM than other two groups [T2DM vs. prediabetes, p=0.001; T2DM vs. control, p<0.001; prediabetes vs. control, p=NS]. The highest frequency of vitamin D deficiency was among individuals with T2DM (64.3%) followed by NGT (29.7%) and prediabetes (28.9%) [p<0.001]. Only HbA 1 c had predictive association with vitamin D deficiency [OR (95%CI)=2.061 (1.178, 3.608), p=0.011]. Only DM but not pre-diabetes had predictive association with vitamin D deficiency compared with NGT [DM: OR (95%CI)=4.255 (2.117, 8.552), p<0.001; prediabetes: OR (95%CI)=0.963 (0.477, 1.946), p=0.916]. Conclusion: Vitamin D level was lower and frequency of vitamin D deficiency was higher in patients with DM. Only HbA 1 c and DM had predictive association with vitamin D deficiency.
Improved treatment has increased survival of patients with thalassemia. However, they still suffe... more Improved treatment has increased survival of patients with thalassemia. However, they still suffer from several endocrine complications mainly as a result of iron overload from multiple transfusions. Endocrinopathies manifest as early as the first decade of life, affecting growth, puberty, psychological development and quality of life. The presence of concomitant anemia, chronic liver disease and cardiomyopathy affect the development and treatment of endocrine disorders, making endocrinopathies in thalassemia a complex disorder. This review focuses on the pathogenesis, diagnosis and treatment of endocrinopathies in transfusion and non transfusion dependent thalassemia. The main points that should be considered in the management of endocrine disorders in a patient with thalassemia are highlighted in this review. Ibrahim Med. Coll. J. 2021; 15(1): 47-55
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2020
Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regula... more Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regulating mechanisms of our body. The purpose of the study was to determine the pattern of electrolyte imbalance in patients with diabetes mellitus and compare with healthy individuals; and to correlate the degree of electrolyte imbalance with control and duration of diabetes. Methods: This cross-sectional study was conducted over a period of 6 months. It included 90 cases with diabetes mellitus and 50 cases without diabetes mellitus. All subjects had normal serum creatinine level. Serum electrolytes (sodium, potassium, chloride and bicarbonate) were measured in each subject by automated methods. The normal levels of sodium, potassium, chloride and bicarbonate were taken as 136-146, 3.5-5, 102-109 and 22-30 mmol/L respectively. Levels above or below this reference were taken as abnormal. Control of diabetes was determined by measuring HbA1c using high-performance liquid chromatography. Result: The most common abnormalities in patients with diabetes mellitus were hypochloraemia (48.89%), low serum bicarbonate (23.33%) and hyponatraemia (11.11%), though the mean values of serum electrolytes were within the normal reference range. Serum bicarbonate level was significantly lower in the group with diabetes mellitus (p = 0.010). There were a significantly greater number of cases with hyponatraemia and hypochloraemia among cases with diabetes mellitus (p < 0.016). Serum sodium was negatively correlated with glycaemic control (r = -0.39; p <0.001) and duration of diabetes (r = -0.31; p = 0.003). Conclusion: Electrolyte abnormalities are more common in patients with diabetes mellitus even with normal serum creatinine, and this correlates with control and duration of diabetes.
International Journal of Endocrinology and Metabolic Disorders, 2020
Background: Liver is a central organ in the pathogenesis of insulin resistance and increased card... more Background: Liver is a central organ in the pathogenesis of insulin resistance and increased cardiometabolic risk. Alanine transaminase reflects hepatocyte injury and steatosis. To see the association between alanine transaminase and cardiometabolic risk in overweight and obese children. The study was done in 88 overweight and obese 6-18 year old children from January 2017 to March 2018. Serum alanine transaminase and cardiometabolic risk factors (obesity, hypertension, dyslipidaemia, insulin resistance, hyperuricaemia and raised C-reactive protein) were measured. Results: Diastolic blood pressure (77.49 ± 9.44 vs. 72.06 ± 7.50 mmHg, p=0.006), insulin resistance (5.22 ± 4.36 vs. 3.48 ± 1.77, p=0.016) and fasting plasma glucose (4.89 ± 0.91 vs. 4.53 ± 0.55 mmol/l, p=0.038) were significantly higher in participants with raised alanine transaminase. Alanine transaminase increased with increasing waist circumference (r=0.263, p=0.013), systolic blood pressure (r=0.258, p=0.015), diastolic blood pressure (r=0.334, p=0.001), insulin resistance (r=0.452, p=0.001), HbA1c (r=0.303, p=0.004), uric acid (r=0.267, p=0.012) and C-reactive protein (r=0.348, p=0.001). After adjusting for cardiometabolic risk factors, only insulin resistance (β=3.01, p<0.001) and uric acid (β=4.99, p=0.015) were related with alanine transaminase. In addition, alanine transaminase was higher in those with metabolic syndrome (39.07 ± 25.94 vs. 28.48 ± 19.27 U/L, p=0.033). Elevated alanine transaminase was associated with cardiometabolic risk, particularly insulin resistance and raised uric acid.
This study was conducted to assess the association of the visceral adiposity index (VAI) with ins... more This study was conducted to assess the association of the visceral adiposity index (VAI) with insulin resistance and beta cell function in Korean adults with and without type 2 diabetes mellitus. The study was carried out using data from the 2015 Korean National Health and Nutrition Examination Survey (KNHANES VI-3) and included 4,922 adults, aged 20 or older. There were several key findings in the present study. First, in subjects without type 2 diabetes mellitus, homeostasis model assessment of insulin resistance (HOMA-IR) (p < 0.001) and beta cell function (HOMA-B) (p < 0.001), insulin (p < 0.001), fasting blood glucose (FBG) (p < 0.001), and metabolic syndrome (MetS) score (p < 0.001) were positively associated with quartiles of VAI. Second, in subjects with type 2 diabetes mellitus, HOMA-IR (p = 0.038), FBG (p = 0.007), and MetS score (p < 0.001) were positively associated with quartiles of VAI, but associations with HOMA-B (p = 0.879) and insulin (p = 0.104) were not significant. In conclusions, the visceral adiposity index is positively associated with insulin resistance and beta cell function in Korean adults without type 2 diabetes mellitus. The visceral adiposity index is positively associated with insulin resistance but not beta cell function in Korean adults with type 2 diabetes mellitus.
Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals... more Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. IMC J Med Sci 2019; 13(1): 002
Background and objectives: Recent publications have reported alarming prevalence of hypovitaminos... more Background and objectives: Recent publications have reported alarming prevalence of hypovitaminosis D in South Asian countries including Bangladesh. But, data on vitamin D levels in different occupational groups are lacking. This study addressed the prevalence of hypovitaminosis D in different occupational groups of Bangladesh. Additionally, the study estimated parathyroid hormone, phosphate, calcium and metabolic syndrome in these groups to see the effect of hypovitaminosis D on these parameters. Materials and method: Seven diverse occupational groups (agrarian workers, rickshaw-pullers, young cricketers and footballers, fishermen, dry fish industry workers, garment-workers and medical students) of Bangladesh were selected based on grade of physical activity and level of sun exposure. Blood was collected for the estimation of 25(OH) vitamin D, fasting glucose,lipid profiles, calcium, phosphate, magnesium and intact parathyroid (iPTH) hormone. Multiple comparisons of these variables...
Bangladesh Journal of Endocrinology and Metabolism
Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the rec... more Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the recognized guidelines and based on expert experience, as comprehensive national guidelines are currently lacking. The Bangladesh Endocrine Society (BES), as a professional body, has been working to develop guidelines for the last couple of years. Most recently, BES formulated practical recommendations for the management of thyroid disorders during pregnancy, which will be termed the &quot;Guideline on Thyroid Disorders in Pregnancy in Bangladesh 2022,&quot; Methods: The BES formed a task force comprising experts in this field to formulate the practical recommendations for the management of thyroid disorders during pregnancy under several sections. The members of this task force comprehensively reviewed the available evidence for the specific conditions. Three well-known databases (Google Scholar, PubMed, and Scopus) were searched to determine the evidence. The task force members were well trained on reviewing the documents and methods of evidence synthesis. Each section of the recommendation was drafted by one member and subsequently reviewed. There was no barrier to the date or type of article published in the aforementioned databases except for articles published other than English. Due to the scarcity of intervention studies, ideas and findings of observational studies, case studies and expert recommendations were considered during the formulation of the guidelines. All members and affiliated persons declared no competing interest, and it was managed and communicated by the President of the BES. Results: The current guidelines for the management of thyroid disease in pregnancy include recommendations about the screening of thyroid function in pregnancy, planning pregnancy in women with thyroid disorders, interpretation of thyroid function tests, management of hypothyroidism and hyperthyroidism in pregnancy, management of thyroid nodules and thyroid emergencies throughout pregnancy, postpartum care, and directions of future research. Conclusions: Our utmost efforts were centered on developing evidence-based recommendations to inform all the levels of clinicians of Bangladesh for the easy understanding and decision-making processes in the management of thyroid disorders in pregnancy and afterward. While we care most to prepare the guideline, all recommendations are the opinion of society and admit the scope of making individualized decisions for the optimal care of patients.
Bangabandhu Sheikh Mujib Medical University Journal
Hypovitaminosis D (<20 ng/mL) is thought to increase insulin resistance and meta-inflammation ... more Hypovitaminosis D (<20 ng/mL) is thought to increase insulin resistance and meta-inflammation contributing to the pathogenesis of diabetes mellitus (DM). Correcting vitamin D deficiency in people with prediabetes might halt its progression to DM. The aim of this study was to examine the effect of vitamin D supplementation on insulin resistance, glycemic status, and inflammation in prediabetic adults with vitamin D deficiency. This doubleblind randomized placebo-controlled trial was done among 27 newly detected prediabetic adults with hypovitaminosis D randomly assigned to 60,000 IU of vitamin D weekly for eight weeks followed by monthly for the next four months or placebo along with lifestyle modification in both groups [vitamin D (n= 14) vs. Placebo (n=13). They were comparable in terms of sex, age and borlymass index. Glycemic status, fasting plasma glucose (FPG) and Hemoglobin A1C (HbA1C), insulin resistance (homeostasis model assessment of insulin resistance (HOMA-IR) and inf...
In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public ... more In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.
Background: Vitamin D deficiency (VDD) is found recently common across all age groups and may con... more Background: Vitamin D deficiency (VDD) is found recently common across all age groups and may contribute to Ischemic stroke. V causing isch¬emic stroke has been documented in recent reports. Objectives: To determine the correlation between serum level of Vitamin D with acute ischemic stroke patients admitted to hospital. Materials and methods: A case-control study including 60 acute ischemic patients admitted in the department of neurology as case and 60 apparently healthy genders and age group matched as control were recruited. All the participants were interviewed for medical history. Physical examination was done and imaging reports confirmed the diagnosis of stroke by the neurologist. Data were collected by a pre-tested semi-structured questionnaire, clinical examination [body mass index (BMI), waist circumference (WC), blood pressure] For Laboratory investigation of serum 25-Hydroxy Vitamin D[25(OH)D], venous blood was collected and assayed by High-Performance Liquid Chromatogr...
We report a case of a 26-year old lady who presented with a history of several episodes of limb w... more We report a case of a 26-year old lady who presented with a history of several episodes of limb weakness requiring repeated hospitalization over the last 12 years and about 6 years back, she also developed features of sicca complex. Further investigations revealed hypokalemia, distal renal tubular acidosis and bilateral extensive nephrocalcinosis. Finally, a diagnosis of Sjogren’s syndrome was made. Hypokalemia may be the presenting feature of Sjogren’s syndrome. Sjogren’s syndrome may be suspected in patients with recurrent hypokalemia and renal tubular acidosis. IMC J Med Sci 2022; 16(2): 004. DOI: https://doi.org/10.55010/imcjms.16.014 *Correspondence: Shapur Ikhtaire, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. Email: [email protected]
Background and aims: Hypothyroidism is a common global endocrine disorder. The magnitude of hypot... more Background and aims: Hypothyroidism is a common global endocrine disorder. The magnitude of hypothyroidism at community level in Bangladesh is unknown except some clinic-based studies. The present study was undertaken to determine the prevalence of hypothyroidism in different occupational groups of Bangladeshi population and to assess the risks related to it. Study design: Three occupational groups (house-wives, college students, rickshaw-pullers) of native Bangladeshi population were purposively selected. Investigations included socio-demography, anthropometry, blood pressure and biochemistry [fasting blood glucose, lipids, thyroid stimulating hormone (TSH) and free thyroxin (FT4)]. Laboratory tests were done only on a randomized sample of participants. Results: Overall, 626 (M/F=123 / 503) participants with a mean age of 35.9 (34.75 – 37.02) years volunteered. The mean values of all participant for TSH and FT4 were 2.08 (95%CI: 1.72 – 2.45) μiu/ml and 13.04 (95CI:12.86 – 13.22) pm...
Background and objectives: Metformin improves macrovascular complications in people with diabetes... more Background and objectives: Metformin improves macrovascular complications in people with diabetes mellitus (DM). Although the exact mechanism is not known, metformin has beneficial effects on dyslipidaemia. The aim of the study was to find out if there was an effect of metformin on blood lipids in people with diabetes mellitus. Method: This was a cross-sectional study which included 80 patients with diabetes mellitus. They were divided into 2 groups – (a) Group 1: on metformin and (b) Group 2: without metformin medication. None of the patients were on any other anti-diabetic medication. All data were obtained from patients’ medical records. Individual blood lipids and lipid ratios were compared between two groups. Result: Group 1 included 42 patients with a mean HbA1c of 7.58 ± 0.24% taking an average dose of 820.83 ± 60.40 mg/day of metformin. Group 2 consisted of 38 patients with mean HbA1c of 7.58 ± 0.29%. There was no significant difference in individual plasma lipid levels, lip...
Open Journal of Endocrine and Metabolic Diseases, 2021
Background: Very limited data are available regarding the association of vitamin D with glycemic ... more Background: Very limited data are available regarding the association of vitamin D with glycemic status among adults with newly detected type 2 diabetes mellitus (T2DM) in Bangladesh. Objectives: To determine vitamin D status and its association with glycemic status in Bangladeshi adults with newly detected T2DM. Materials and Methods: This cross-sectional study was carried out in 102 newly detected T2DM diagnosed on the basis of the American Diabetes Association 2017 criteria (age: 42.95 ± 10.68 yrs.; m/f: 44/58) and equal number of age and sex matched controls (age: 40.43 ± 11.04 years) recruited consecutively from the Department of Endocrinology, BSMMU to measure serum vitamin D by high performance liquid chromatography method. Results: Both vitamin D deficiency (<20 ng/ml) (87.3% vs. 74.5%, p < 0.03) and severe vitamin D deficiency (<10 ng/ml) (56.2% vs. 26.3%, p < 0.001) were significantly higher in people with T2DM than control population. The mean level of 25(OH)D was significantly lower in adults with T2DM than control population (12.41 ± 6.85 ng/ml vs. 15.74 ± 6.25 ng/ml, p < 0.001). A significant inverse correlation was observed between vitamin D & HbA 1 c (r = -0.249, p = 0.011) in patients with T2DM. HbA 1 c was linearly associated with vitamin D (β = -0.26, p = 0.009) and severe vitamin D deficiency by binary (OR = 1.37, p = 0.003) and multinomial logistic regression (HbA 1 c ≥ 10%: OR = 4.25, p = 0.04) in people with T2DM after adjustment for age and BMI. Conclusions: Severe vitamin D deficiency was positively associated with T2DM and inversely associated with HbA 1 c in patients with newly detected T2DM.
International Journal of Diabetes and Endocrinology, 2021
Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose int... more Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose intolerance, very limited data are available in Bangladesh. Thus, the study aimed to determine vitamin D status of Bangladeshi adults based on the glucose intolerance status. Materials & Methods: This cross-sectional study was carried out among 70 newly detected DM, age-group & sex-matched 76 newly detected pre-diabetes and 74 healthy control with normal glucose tolerance (NGT) based on American Diabetes Association, 2018 criteria. Participants were included consecutively from the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of 1 year by convenient sampling to see serum 25(OH)D which was measured by high performance liquid chromatography (HPLC) method. Results: Vitamin D levels decreased with increasing degrees of glucose intolerance [NGT: 16.82±6.57; prediabetes: 15.54±8.58; T2DM: 11.01±6.03 ng/ml, p<0.001] but significantly lower in T2DM than other two groups [T2DM vs. prediabetes, p=0.001; T2DM vs. control, p<0.001; prediabetes vs. control, p=NS]. The highest frequency of vitamin D deficiency was among individuals with T2DM (64.3%) followed by NGT (29.7%) and prediabetes (28.9%) [p<0.001]. Only HbA 1 c had predictive association with vitamin D deficiency [OR (95%CI)=2.061 (1.178, 3.608), p=0.011]. Only DM but not pre-diabetes had predictive association with vitamin D deficiency compared with NGT [DM: OR (95%CI)=4.255 (2.117, 8.552), p<0.001; prediabetes: OR (95%CI)=0.963 (0.477, 1.946), p=0.916]. Conclusion: Vitamin D level was lower and frequency of vitamin D deficiency was higher in patients with DM. Only HbA 1 c and DM had predictive association with vitamin D deficiency.
Improved treatment has increased survival of patients with thalassemia. However, they still suffe... more Improved treatment has increased survival of patients with thalassemia. However, they still suffer from several endocrine complications mainly as a result of iron overload from multiple transfusions. Endocrinopathies manifest as early as the first decade of life, affecting growth, puberty, psychological development and quality of life. The presence of concomitant anemia, chronic liver disease and cardiomyopathy affect the development and treatment of endocrine disorders, making endocrinopathies in thalassemia a complex disorder. This review focuses on the pathogenesis, diagnosis and treatment of endocrinopathies in transfusion and non transfusion dependent thalassemia. The main points that should be considered in the management of endocrine disorders in a patient with thalassemia are highlighted in this review. Ibrahim Med. Coll. J. 2021; 15(1): 47-55
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2020
Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regula... more Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regulating mechanisms of our body. The purpose of the study was to determine the pattern of electrolyte imbalance in patients with diabetes mellitus and compare with healthy individuals; and to correlate the degree of electrolyte imbalance with control and duration of diabetes. Methods: This cross-sectional study was conducted over a period of 6 months. It included 90 cases with diabetes mellitus and 50 cases without diabetes mellitus. All subjects had normal serum creatinine level. Serum electrolytes (sodium, potassium, chloride and bicarbonate) were measured in each subject by automated methods. The normal levels of sodium, potassium, chloride and bicarbonate were taken as 136-146, 3.5-5, 102-109 and 22-30 mmol/L respectively. Levels above or below this reference were taken as abnormal. Control of diabetes was determined by measuring HbA1c using high-performance liquid chromatography. Result: The most common abnormalities in patients with diabetes mellitus were hypochloraemia (48.89%), low serum bicarbonate (23.33%) and hyponatraemia (11.11%), though the mean values of serum electrolytes were within the normal reference range. Serum bicarbonate level was significantly lower in the group with diabetes mellitus (p = 0.010). There were a significantly greater number of cases with hyponatraemia and hypochloraemia among cases with diabetes mellitus (p < 0.016). Serum sodium was negatively correlated with glycaemic control (r = -0.39; p <0.001) and duration of diabetes (r = -0.31; p = 0.003). Conclusion: Electrolyte abnormalities are more common in patients with diabetes mellitus even with normal serum creatinine, and this correlates with control and duration of diabetes.
International Journal of Endocrinology and Metabolic Disorders, 2020
Background: Liver is a central organ in the pathogenesis of insulin resistance and increased card... more Background: Liver is a central organ in the pathogenesis of insulin resistance and increased cardiometabolic risk. Alanine transaminase reflects hepatocyte injury and steatosis. To see the association between alanine transaminase and cardiometabolic risk in overweight and obese children. The study was done in 88 overweight and obese 6-18 year old children from January 2017 to March 2018. Serum alanine transaminase and cardiometabolic risk factors (obesity, hypertension, dyslipidaemia, insulin resistance, hyperuricaemia and raised C-reactive protein) were measured. Results: Diastolic blood pressure (77.49 ± 9.44 vs. 72.06 ± 7.50 mmHg, p=0.006), insulin resistance (5.22 ± 4.36 vs. 3.48 ± 1.77, p=0.016) and fasting plasma glucose (4.89 ± 0.91 vs. 4.53 ± 0.55 mmol/l, p=0.038) were significantly higher in participants with raised alanine transaminase. Alanine transaminase increased with increasing waist circumference (r=0.263, p=0.013), systolic blood pressure (r=0.258, p=0.015), diastolic blood pressure (r=0.334, p=0.001), insulin resistance (r=0.452, p=0.001), HbA1c (r=0.303, p=0.004), uric acid (r=0.267, p=0.012) and C-reactive protein (r=0.348, p=0.001). After adjusting for cardiometabolic risk factors, only insulin resistance (β=3.01, p<0.001) and uric acid (β=4.99, p=0.015) were related with alanine transaminase. In addition, alanine transaminase was higher in those with metabolic syndrome (39.07 ± 25.94 vs. 28.48 ± 19.27 U/L, p=0.033). Elevated alanine transaminase was associated with cardiometabolic risk, particularly insulin resistance and raised uric acid.
This study was conducted to assess the association of the visceral adiposity index (VAI) with ins... more This study was conducted to assess the association of the visceral adiposity index (VAI) with insulin resistance and beta cell function in Korean adults with and without type 2 diabetes mellitus. The study was carried out using data from the 2015 Korean National Health and Nutrition Examination Survey (KNHANES VI-3) and included 4,922 adults, aged 20 or older. There were several key findings in the present study. First, in subjects without type 2 diabetes mellitus, homeostasis model assessment of insulin resistance (HOMA-IR) (p < 0.001) and beta cell function (HOMA-B) (p < 0.001), insulin (p < 0.001), fasting blood glucose (FBG) (p < 0.001), and metabolic syndrome (MetS) score (p < 0.001) were positively associated with quartiles of VAI. Second, in subjects with type 2 diabetes mellitus, HOMA-IR (p = 0.038), FBG (p = 0.007), and MetS score (p < 0.001) were positively associated with quartiles of VAI, but associations with HOMA-B (p = 0.879) and insulin (p = 0.104) were not significant. In conclusions, the visceral adiposity index is positively associated with insulin resistance and beta cell function in Korean adults without type 2 diabetes mellitus. The visceral adiposity index is positively associated with insulin resistance but not beta cell function in Korean adults with type 2 diabetes mellitus.
Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals... more Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. IMC J Med Sci 2019; 13(1): 002
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