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Background: Type 2 diabetes (T2D) is a common and serious chronic debilitating disease. Until recently, type 2 diabetes has been typically regarded as a disease of the middle-aged and elderly. While this age group still maintains a higher risk than younger adults, evidence is accumulating that onset in those under 30 years is increasingly common. Type 2 diabetes and its complications constitute a major public health hazard affecting people in both developed and developing countries. Prevalence of type 2 diabetes has been increasing exponentially, across the World. Multiple risk factors of diabetes, delayed diagnosis, life-threatening complications, sub-therapeutic treatment, and higher treatment costs are some crucial barriers to the control of type 2 diabetes. Aim of the Study: This study aimed to assess the risk factors of T2D in 1st-year MBBS and BDS students of North East Medical College (NEMC), Sylhet, Bangladesh. Methods: This was an observational crosssectional study undertaken at the Endocrine Outpatient Department in a Tertiary Care Hospital, Sylhet, Bangladesh, during the period from November 2017 to February 2018. Non-probability purposive sampling was done. Out of 145 MBBS and BDS students who got admitted in session 2017-2018, data of 143 students were included as a part of regular medical checkup after permission of the concerned authority. As applicable, all data were expressed as frequencies and mean ±SD or mean ±SE. Student’s t-test and Chi-square test were conducted where the p-value <0.05 was considered significant. Data analysis was done using computer-based SPSS version-22.0. Results: Among the total of 143 participants, 36.8% were female, and the male-female ratio was 1:1.7. Among all of them, 53% belonged to the 17-20-year age group whereas the rest 47% belonged to the 21-22-year age group. In analyzing the association of risk factors among participants we observed that the highest number of participants was associated with a family history

Background: Type 2 diabetes (T2D) is a common and serious chronic debilitating disease. Until recently, type 2 diabetes has been typically regarded as a disease of the middle-aged and elderly. While this age group still maintains a higher risk than younger adults, evidence is accumulating that onset in those under 30 years is increasingly common. Type 2 diabetes and its complications constitute a major public health hazard affecting people in both developed and developing countries. Prevalence of type 2 diabetes has been increasing exponentially, across the World. Multiple risk factors of diabetes, delayed diagnosis, life-threatening complications, sub-therapeutic treatment, and higher treatment costs are some crucial barriers to the control of type 2 diabetes. Aim of the Study: This study aimed to assess the risk factors of T2D in 1st-year MBBS and BDS students of North East Medical College (NEMC), Sylhet, Bangladesh. Methods: This was an observational crosssectional study undertaken at the Endocrine Outpatient Department in a Tertiary Care Hospital, Sylhet, Bangladesh, during the period from November 2017 to February 2018. Non-probability purposive sampling was done. Out of 145 MBBS and BDS students who got admitted in session 2017-2018, data of 143 students were included as a part of regular medical checkup after permission of the concerned authority. As applicable, all data were expressed as frequencies and mean ±SD or mean ±SE. Student’s t-test and Chi-square test were conducted where the p-value <0.05 was considered significant. Data analysis was done using computer-based SPSS version-22.0. Results: Among the total of 143 participants, 36.8% were female, and the male-female ratio was 1:1.7. Among all of them, 53% belonged to the 17-20-year age group whereas the rest 47% belonged to the 21-22-year age group. In analyzing the association of risk factors among participants we observed that the highest number of participants was associated with a family history

MD Faruque Pathan,1 Nazma Akter,2 Shahjada Selim,3 M Saifuddin,4 Nazmul Kabir Qureshi,5 ABM Kamrul-Hasan,6 Mohammad Abdul Hannan,7 Md Ashraf Uddin Ahmed,1 Marufa Mustari,3 Ashish Kumar Chakraborty1 1BIRDEM General Hospital, Dhaka, Bangladesh; 2MARKS Medical College & Hospital, Dhaka, Bangladesh; 3Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 4Dhaka Medical College, Dhaka, Bangladesh; 5National Healthcare Network, Dhaka, Bangladesh; 6Mymensingh Medical College & Hospital, Mymensingh, Bangladesh; 7North East Medical College & Hospital, Sylhet, BangladeshCorrespondence: MD Faruque Pathan, BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh, Tel +8801713032888, Email pathan279@yahoo.comAim: In Bangladesh, there is a large population of Muslims with type 2 diabetes mellitus (T2DM) who fast during Ramadan. Changes in the pattern of meal and fluid intake during this long-fasting hours may increase the risk of hypoglycaemia, hyperglycaemia, and dehydration. Our key point of focus was to evaluate the efficacy and safety of Empagliflozin, a sodium-glucose co transporter 2 inhibitor (SGLT2i), in patients with T2DM while fasting during Ramadan.Methods: This was a 24-weeks, multi-centre, open-label, two-arm parallel-group study. In this prospective type of observational study, we enrolled patients taking Empagliflozin and Metformin with or without a DPP-4 inhibitor in one group (n = 274) and a parallel group (n = 219) who were treated with Metformin with or without a DPP-4 inhibitor. The primary endpoint of this study was HbA1c reduction, weight loss and the number of reported or symptomatic hypoglycemic events. In secondary endpoints, we evaluated the changes from baseline in blood pressure, estimated glomerular filtration rate (eGFR), serum creatinine, and serum electrolyte, the proportion of volume depletion (≥ 1 event) and incidence of other adverse events (AEs) of interest potentially related to SGLT2 inhibitor.Resu

Background: Type 2 diabetes (T2D) is a common and serious chronic debilitating disease. Until recently, type 2 diabetes has been typically regarded as a disease of the middle-aged and elderly. While this age group still maintains a higher risk than younger adults, evidence is accumulating that onset in those under 30 years is increasingly common. Type 2 diabetes and its complications constitute a major public health hazard affecting people in both developed and developing countries. Prevalence of type 2 diabetes has been increasing exponentially, across the World. Multiple risk factors of diabetes, delayed diagnosis, life-threatening complications, sub-therapeutic treatment, and higher treatment costs are some crucial barriers to the control of type 2 diabetes. Aim of the Study: This study aimed to assess the risk factors of T2D in 1st-year MBBS and BDS students of North East Medical College (NEMC), Sylhet, Bangladesh. Methods: This was an observational crosssectional study undertaken at the Endocrine Outpatient Department in a Tertiary Care Hospital, Sylhet, Bangladesh, during the period from November 2017 to February 2018. Non-probability purposive sampling was done. Out of 145 MBBS and BDS students who got admitted in session 2017-2018, data of 143 students were included as a part of regular medical checkup after permission of the concerned authority. As applicable, all data were expressed as frequencies and mean ±SD or mean ±SE. Student’s t-test and Chi-square test were conducted where the p-value <0.05 was considered significant. Data analysis was done using computer-based SPSS version-22.0. Results: Among the total of 143 participants, 36.8% were female, and the male-female ratio was 1:1.7. Among all of them, 53% belonged to the 17-20-year age group whereas the rest 47% belonged to the 21-22-year age group. In analyzing the association of risk factors among participants we observed that the highest number of participants was associated with a family history

Background: Type 2 diabetes (T2D) is a common and serious chronic debilitating disease. Until recently, type 2 diabetes has been typically regarded as a disease of the middle-aged and elderly. While this age group still maintains a higher risk than younger adults, evidence is accumulating that onset in those under 30 years is increasingly common. Type 2 diabetes and its complications constitute a major public health hazard affecting people in both developed and developing countries. Prevalence of type 2 diabetes has been increasing exponentially, across the World. Multiple risk factors of diabetes, delayed diagnosis, life-threatening complications, sub-therapeutic treatment, and higher treatment costs are some crucial barriers to the control of type 2 diabetes. Aim of the Study: This study aimed to assess the risk factors of T2D in 1st-year MBBS and BDS students of North East Medical College (NEMC), Sylhet, Bangladesh. Methods: This was an observational crosssectional study undertaken at the Endocrine Outpatient Department in a Tertiary Care Hospital, Sylhet, Bangladesh, during the period from November 2017 to February 2018. Non-probability purposive sampling was done. Out of 145 MBBS and BDS students who got admitted in session 2017-2018, data of 143 students were included as a part of regular medical checkup after permission of the concerned authority. As applicable, all data were expressed as frequencies and mean ±SD or mean ±SE. Student’s t-test and Chi-square test were conducted where the p-value <0.05 was considered significant. Data analysis was done using computer-based SPSS version-22.0. Results: Among the total of 143 participants, 36.8% were female, and the male-female ratio was 1:1.7. Among all of them, 53% belonged to the 17-20-year age group whereas the rest 47% belonged to the 21-22-year age group. In analyzing the association of risk factors among participants we observed that the highest number of participants was associated with a family history

BACKGROUND: Drinking-water salinity has been associated with high blood pressure (BP) among communities in south-west coastal Bangladesh. We evaluated whether access to water from managed aquifer recharge (MAR)-a hydrogeological intervention to lower groundwater salinity by infiltrating rainwater into the aquifers-can reduce community BP. METHODS: We conducted a stepped-wedge cluster-randomized trial with five monthly visits between December 2016 and April 2017 in 16 communities. At each visit following baseline, four communities were randomized to access MAR water. Systolic BP was the primary outcome, measured during each visit using Omron® HEM-907 devices. We also measured participants 24-hour urinary sodium and households drinking- and cooking-water salinity each visit. We used multilevel regression models to estimate the effects of MAR-water access on participants BP. The primary analysis was intention-to-treat. RESULTS: In total, 2911 person-visits were conducted in communities randomized to have MAR-water access and 2834 in communities without MAR-water access. Households without MAR-water access predominantly used low-salinity pond water and 42% (range: 26-50% across visits) of households exclusively consumed MAR water when access was provided. Communities randomized to MAR-water access had 10.34 [95% confidence interval (CI): 1.11, 19.58] mmol/day higher mean urinary sodium, 1.96 (95% CI: 0.66, 3.26; p = 0.004) mmHg higher mean systolic BP and 1.44 (95% CI: 0.40, 2.48; p = 0.007) mmHg higher mean diastolic BP than communities without MAR-water access. CONCLUSIONS: Our findings do not support the scale-up of MAR systems as a routine drinking-water source, since communities that shifted to MAR water from the lower-salinity pond-water source had higher urinary sodium and BP.

Faruque Pathan,1 Shahjada Selim,2 Md Fariduddin,2 Md Hafizur Rahman,3 SM Ashrafuzzaman,1 Faria Afsana,1 Nazmul Kabir Qureshi,4 Tanjina Hossain,5 M Saifuddin,6 AB Kamrul-Hasan,7 Ahmed Salam Mir8 On behalf of the BES Diabetes and COVID Task Force1Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh; 2Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 3Bangladesh Endocrine Society, Dhaka, Bangladesh; 4National Healthcare Network (NHN) Uttara EC, Dhaka, Bangladesh; 5Department of Endocrinology, Green Life Medical College Hospital, Dhaka, Bangladesh; 6Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh; 7Mymensingh Medical College Hospital, Dhaka, Bangladesh; 8Department of Endocrinology, BIHS General Hospital, Dhaka, BangladeshCorrespondence: Shahjada SelimDepartment of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, 1000, BangladeshEmail selimshahjada@yahoo.comBackground: The year 2020 witnessed a largely unprecedented pandemic of coronavirus disease (COVID-19), caused by SARS COV-2. Many people with COVID-19 have comorbidities, including diabetes, hypertension and cardiovascular diseases, which are significantly associated with worse outcomes. Moreover, COVID-19 itself is allied with deteriorating hyperglycemia. Therefore, Bangladesh Endocrine Society has formulated some practical recommendations for management of diabetes and other endocrine diseases in patients with COVID-19 for use in both primary and specialist care settings.Objective: The objective of the article is to develop a guideline to protect the vulnerable group with utmost preference – the elderly and those with comorbid conditions. Therefore, to ensure the adequate protective measures and timely treatment for COVID-19 patients with diabetes, other endocrine diseases or any other comorbidities.Considering and Monitoring Issues: The risk of a fatal outcome from COVID-19 may be up

Background We compared the relationship of past and contemporary sodium (Na) intake with cardiometabolic biomarkers. Methods and Results A total of 1191 participants data from a randomized controlled trial in coastal Bangladesh were analyzed. Participants provided 24-hour urine Na (24UNa) data for 5 monthly visits. Their fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein, blood pressure, and 24-hour urine protein were measured at the fifth visit. Participants mean 24UNa over the first 4 visits was the past Na, and 24UNa of the fifth visit was the contemporary Na intake. We estimated the prevalence ratios of elevated cardiometabolic biomarkers and metabolic syndrome across 24UNa tertiles by multilevel logistic regression using participant-, household-, and community-level random intercepts. Models were adjusted for age, sex, body mass index, smoking, physical activity, alcohol consumption, sleep hours, religion, and household wealth. Compared with participants in tertile 1 of past urine Na, those in tertile 3 had 1.46 (95% CI, 1.08-1.99) times higher prevalence of prediabetes or diabetes mellitus, 5.49 (95% CI, 2.73-11.01) times higher prevalence of large waist circumference, and 1.60 (95% CI, 1.04-2.46) times higher prevalence of metabolic syndrome. Compared with participants in tertile 1 of contemporary urine Na, those in tertile 3 had 1.93 (95% CI, 1.24-3.00) times higher prevalence of prediabetes or diabetes mellitus, 3.14 (95% CI, 1.45-6.83) times higher prevalence of proteinuria, and 2.23 (95% CI, 1.34-3.71) times higher prevalence of large waist circumference. Conclusions Both past and contemporary Na intakes were associated with higher cardiometabolic disease risk.

INTRODUCTION: Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. METHODS AND ANALYSIS: The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02746003; Pre-results.

Background Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. Methodology/Principal Findings We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4 / 100,000 person years (95% C I 513.4-789.2 /100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eightysix percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. Conclusions/Significance Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.

Background Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. Methodology/Principal Findings We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4 / 100,000 person years (95% C I 513.4-789.2 /100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eightysix percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. Conclusions/Significance Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.