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Sjogren’s syndrome is a rare autoimmune disease affecting multiple systems with varying clinical features.We report a case of 37 year old woman who presented with recurrent episodes of quadriparesis which was attributable to hypokalemia and initially labelled as hypokalemic periodic paralysis. Later on she was found to have metabolic acidosis rather than alkalosis which pointed towards the diagnosis of renal tubular acidosis (RTA) in the absence of apparent gastrointestinal tract loss. Once the diagnosis of RTA was established, an attempt to search the aetiology revealed that she was having primary Sjogren’s syndrome (pSS) though she did not have any symptom at the time of diagnosis. She was found positive for anti-SSA. Lip biopsy revealed lymphocytic infiltration in periductal as well as parenchymal region. Schirmer test confirmed presence of severe dry eye. A concomitant existence of autoimmune hypothyroidism was a noteworthy association. She responded well with potassium supplementation and symptomatic treatment. Presentation of this case reminds the importance of vigilance while managing a case of recurrent hypokalemia which might be a rare presenting feature of pSS. Bangladesh J Medicine July 2021; 32(2) : 145-148

Collectively, rare genetic diseases affect a significant number of individuals worldwide. In this study, we have conducted whole-exome sequencing (WES) and identified underlying pathogenic or likely pathogenic variants in five children with rare genetic diseases. We present evidence for disease-causing autosomal recessive variants in a range of disease-associated genes such as DHH-associated 46,XY gonadal dysgenesis (GD) or 46,XY sex reversal 7, GNPTAB-associated mucolipidosis II alpha/beta (ML II), BBS1-associated Bardet–Biedl Syndrome (BBS), SURF1-associated Leigh Syndrome (LS) and AP4B1-associated spastic paraplegia-47 (SPG47) in unrelated affected members from Bangladesh. Our analysis pipeline detected three homozygous mutations, including a novel c. 863 G > C (p.Pro288Arg) variant in DHH, and two compound heterozygous variants, including two novel variants: c.2972dupT (p.Met991Ilefs*) in GNPTAB and c.229 G > C (p.Gly77Arg) in SURF1. All mutations were validated by Sanger sequencing. Collectively, this study adds to the genetic heterogeneity of rare genetic diseases and is the first report elucidating the genetic profile of (consanguineous and nonconsanguineous) rare genetic diseases in the Bangladesh population.

Bangladesh is a developing country with a very high prevalence of antibiotic resistance where irrational use of antibiotics is very common. This cross-sectional survey was conducted to assess the knowledge of antibiotics and antibiotic usage behavior (Antibiotic use, self-medication, adherence to therapy) among the people of Bangladesh. The association between participants’ knowledge of antibiotics and their antibiotic usage behavior was also analyzed. A cross-sectional survey based on a structured questionnaire was conducted in the Dhaka district. The questionnaire included questions about demographic information, participants’ knowledge of antibiotics, and their recent antibiotic usage. The data analysis involved the use of descriptive statistics and multivariable logistic regression. Very few participants knew that antibiotics are not effective against most common colds (16.8%), viruses (22.5%), and pains (41.7%). Most respondents (>75%) knew that excessive use of antibiotics and failing to complete a course may render antibiotics less effective in the future. However, only 56.1% were aware of antibiotic resistance. About half (46.6%) of the participants took antibiotics in the last six months, 20.5% of whom resorted to self-medication and 23.1% reported non-adherence to therapy. Greater knowledge of antibiotics was significantly associated with lower rates of self-medication (p=0.037). Misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. The findings suggest that misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. To mitigate these problems, interventions comprised of educational campaigns and redesigning of the healthcare system and policies should be undertaken. Asian J. Med. Biol. Res. September 2020, 6(3): 519-524

Diagnostic criterion for abnormal glucose tolerance (AGT) in pregnancy is still under debate. This study aims to see the diagnostic efficiency of Diabetes in Pregnancy Study Group of India (DIPSI) criterion in context to World Health Organization (WHO) 2013 criterion for detection of AGT in pregnancy. Pregnant mothers (n = 231; age, 26.07 ± 5.21 years; body mass index (BMI), 25.00 ± 4.09 kg/m2; mean ± SD) were screened for AGT including gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP) from July 2016 to July 2017 in the “GDM Clinic” of BSMMU following WHO 2013 and DIPSI protocol with an interval of 3–5 days in between. Out of 231 mothers, 204 completed both procedures. Diagnostic efficiency of DIPSI criterion was assessed in the light of WHO 2013 criterion. Out of 204 mothers, 61 (29.9%) had AGT (GDM = 55, DIP = 6) according to WHO 2013 criterion whereas only 36 (17.6%) had AGT (GDM = 33, DIP = 3) by DIPSI criterion. Among participants, age (25.50 ± 5.11 vs. 27.39 ± 5.28, p = 0.018) and BMI (24.50 ± 3.92 vs. 26.31 ± 4.41, p = 0.003) were significantly higher in AGT group than the group with normal glucose tolerance (NGT).Holding WHO 2013 criterion as gold standard, specificity of DIPSI criterion was very high (93.70%), but sensitivity was relatively low (44.26%). There was a fair agreement between the two criteria (kappa = 0.43; p

We describe a 65-year-old male of Graves’ disease with thyroid-associated orbitopathy who developed thrombocytopenia during the course of illness. Clinical features, temporal relationship with drugs and investigations supported the diagnosis of immune thrombocytoenic purpura. Several immunosuppressive drugs failed to improve thrombocytopenia. At last platelet count returned back to normal and remained stable with addition of dapsone and restoration of euthyroidism.

The study aimed to assess the role of having knowledge and essential hygiene practices to prevent coronavirus pandemic and to find out the relationship between people’s knowledge and good hygiene practices with socio-demographic variables during coronavirus disease 2019 (COVID-19) pandemic situation. In this study, data were collected from 248 respondents for cross-sectional study using voluntary response sampling from April, 30 2020 to May, 30 2020, during lockdown situation in Bangladesh. Descriptive statistics were done to calculate the frequencies and percentages by using Stata SE 14.2 (StataCorp). Chi-square was performed at the significance level of 5% to find the factors which were associated with knowledge about COVID-19. After knowing about COVID-19, 86.29% respondents had taken preventive measures and 71.37% respondents had agreed to stay at home. Among the respondents, 47.98% were involved in services and were positively associated with good general knowledge of preventive practices. Our present findings indicated significant relationship between good general knowledge and practice of general people towards COVID-19 outbreak in Bangladesh. The findings of the study are helpful for the researchers and the population to follow all good promotional practices for preventive measures against coronavirus.

Poor weaning practice and malnutrition among under 5 (yrs) children are still major public health issues in Bangladesh. This study aimed to develop a cheap and nutritious weaning food for the children of Bangladesh. For this purpose, three weaning formulations of Q1, Q2, and Q3 with different ratios of germinated wheat, germinated mung-bean, and soya-bean, and a constant amount of sweet potato, sugar, salt, and milk flavor were processed and evaluated. The prepared formulations were investigated for proximate composition and sensory evaluation and compared with six commercial weaning food products. The proximate composition values indicated that the fat content of formulated foods ranged between 09.29% and 11.40%. The carbohydrate content was ranged between 52.80% and 61.20%, which was low compared with commercial ones. The protein content of the formulated foods was 20.33%–27.70%, and that was approximately two times more than available commercial foods. The energy content was also more than locally available commercial weaning foods, which were 411.40 ± 1.51 kcal to 419.30 ± 1.12 kcal. Sample Q2 had an 8.4 acceptance score in sensory analysis of a 9-point hedonic scale scorecard, which made it more acceptable than the other two samples. The values of mineral elements (Na, K, Fe) were similar to all analyzed varieties of commercial weaning foods. This nutrient-enriched weaning food will easily be affordable for the people of developing countries like Bangladesh. The results showed that the formulated weaning food had the desired characteristics of a weaning food; hence, it could decrease malnutrition in children., Weaning foods, Malnutrition, Germinated, Cereals, Legumes, Bangladesh.

Hyperglycemia is the most common endocrine disorder of pregnancy. As compared to Diabetes in pregnancy(DIP) the management of gestational DM(GDM) has always been a topic of controversy. Medical nutrition therapy(MNT) is the cornerstone of GDM management. 80-90% of GDM mothers can be treated by MNT alone and the rest will require drugs. Considerable controversy surrounds the use of oral anti-diabetic medications in pregnancy. The most widely studied drugs are glyburide and metformin. Conflicting results have been produced by different studies. However recent meta-analyses have shown that they can be an attractive alternative to insulin if long term safety data become available. Till then it might be too early to make a final comment on their use in GDM.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 145-149

Background. To assess fasting C-peptide and insulin indices using homeostatic model assessment (HOMA) in gestational diabetes mellitus (GDM). Methods. Gestational diabetes mellitus (n = 64, age: 27.02 ± 0.53 years, BMI: 26.3 ± 0.5 kg/m2; mean ± SEM) and normal glucose tolerance NGT (n = 56, age: 26.11 ± 0.55 years, BMI: 24.4 ± 0.4 kg/m2; mean ± SEM) screened according to WHO 2013 criteria. Glucose was measured by oxidase method whereas fasting insulin and C-peptide by ELISA. HOMA-IR, HOMA-B and HOMA-%S were calculated. Results. C-peptide was found higher in GDM compared to NGT without any significant difference (P = 0.465). Fasting insulin (P = 0.063) and HOMA-IR (P < 0.001) were significantly higher while HOMA-B (P = 0.015) and HOMA-%S (P = 0.012) were significantly lower in GDM than those of NGT. BMI, bad obstetric history, multiparity and blood glucose were higher (P ≤ 0.05) in GDM while age, duration of gestation, family history of DM did not differ (P = NS). C-peptide (0.185 ± 0.06 vs 0.331 ± 0.44; P < 0.05), fasting insulin (4.88 ± 0.74 vs 10.37 ± 0.74; P < 0.01) and HOMA-IR (1.04 ± 0.14 vs 2.48 ± 0.18; P < 0.011) as well as HOMA-B were found lower in GDM having BMI < 23 kg/m2 than those of GDM with BMI ≥ 23. Conversely, HOMA-%S (115.52 ± 14.63 vs 50.62 ± 3.39; P < 0.011) was higher in the subgroup with BMI < 23 than the rest. Fasting blood glucose (FBG) (P < 0.01) and fasting insulin (P < 0.05) were independent predictors for GDM. Conclusions. Fasting C-peptide did not differ between GDM and NGT. BMI was positively related with resistance and secretion of insulin but inversely with sensitivity. HOMA model analyses revealed decreased insulin sensitivity and secretory capacity in GDM than NGT.

Aims: To compare the insulin sensitivity and secretion indices of pregnant Bangladeshi women with GDM and normal glucose tolerance (NGT). Methods: This cross sectional study was performed with 40 GDM and equal number of NGT pregnant women diagnosed on basis of WHO criterion-2013 during 24–40 weeks of gestation. Glucose was measured by glucose oxidase method and fasting insulin by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate indices of insulin resistance (HOMA-IR), β-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Results: The GDM group had significantly higher insulin resistance as indicated by higher fasting insulin value [GDM vs. NGT; 10.23 (7.94–14.50) vs. 7.07 (5.28–11.07) µIU/ml] and HOMA-IR [GDM vs. NGT; 2.47 (1.75–3.43) vs. 1.50 (0.99–2.22)] and poor β-cell secretion [GDM vs. NGT; HOMA-B: 113.37 (90.30–191.35) vs. 150.98 (109.85–271.72), median (IQR); p

Objective Disorders of sex development (DSD) are defined as conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female. Mutations in genes present in X, Y or autosomal chromosomes can cause abnormalities of testis determination or 46,XY DSD. Leydig cell hypoplasia (LCH), also known as Leydig cell agenesis, is a rare autosomal recessive endocrine syndrome of 46,XY DSD. Our objective here is to present the case of a 27-year-old, phenotypic female who presented with primary amenorrhea and later found to have LCH. Methods We used formatted history and clinical examination followed by necessary hormonal investigations. The diagnosis was confirmed by histopathology of resected testes and genetic mutation analysis. Results The patient's physical examination was unremarkable except 2 ovoid lumps present in the inguinovulvar region. There were no mullerian structures on sonography. Estrogen and both basal and stimulated testosterone levels were low whereas luteinizing hormone and follicle-stimulating hormone were high. Her chromosomal sex was found to be 46,XY. The histopathology of the resected inguinal lumps showed atrophic testicular change lacking Leydig cells with relative preservation of Sertoli cells. Genetic mutation analysis failed to reveal any significant aberration in the LHCGR gene. At present she is on estrogen replacement therapy having undergone bilateral orchidectomy and vaginoplasty. Conclusion LCH represents a unique example of diagnostic dilemma in gender identification. It requires a multidisciplinary approach for optimum outcome.

Bartter syndrome is a rare autosomal recessive renal tubulopathy resulting in hypokalemic, hypochloremic metabolic alkalosis with hyperreninemia. It consists of a set of closely related overlapping syndromes having variable presentation. Advances in molecular diagnostics have revealed the underlying mutations in numerous genes that affect the function of ion channels and transporters which normally mediate salt reabsorption in the distal nephron segments. The classic manifestations are childhood onset of fatigue, polyuria, polydipsia, salt craving, vomiting, dehydration, short stature, and failure to thrive. It should be suspected in any young, normotensive individual presenting with persistent hypokalemic alkalosis in the absence of surreptitious diuretic abuse. It requires high index of clinical suspicion for appropriate diagnosis and timely treatment have been shown to reverse the clinical and biochemical abnormalities thereby improve the outcome. Here we report a 19-year-old boy with classical Bartter syndrome that was treated with Potassium supplementation, NSAID, spironolactone and he showed significant improvement on subsequent follow-up.

We present a 16-year girl, second issue of a consanguineous couple presented with painless symmetrical bony swellings around hips for 3 years. She lost 25 kg weight due to profound anorexia in the first year of illness and developed secondary amenorrhea. Last 7 months she had repeated generalized tonic clonic seizure due to hypocalcaemia. The bony swellings were located in both gluteal regions and were 30x35 cm2, hard and non tender. Mobility of hip joints were restricted. Except for severe wasting as a part of generalized cachexia other systemic examination was unremarkable. Investigations revealed anaemia (Hb-E trait), low albumin, low corrected calcium (during convulsions) otherwise normal, persistently high phosphate & vitamin-D level, normal iPTH & alkaline phosphatase (ALP), low serum ascorbic acid, normal ESR & CRP. X-ray & CT scan of pelvis showed large calcified mass in periarticular soft tissues. Biopsy confirmed presence of dystrophic calcification. Diagnosis of tumoral calcinosis was based on biochemical parameters, imaging and biopsy findings. A homozygous novel mutation in FGF homology domain: B-21 mutated from G to A at 232 in exon 2. As a result glutamic acid is replaced by lysine. Phosphate restricted diet and phosphate lowering agent improved biochemical paramaters. Surgical excision has been withheld. Contemporary manifestation of hFTC and Hb E trait; two disease of autosomal recessive inheritance in an individual makes it extremely rare. High index of suspicion is needed for early diagnosis and treatment.

Bangladesh has been making remarkable progress in health sector. Despite, there are some areas where further intervention is required. People-centered health systems cannot be strengthened without competent management. Core competencies are the essential knowledge, skills and attitudes required for the practice of public health. This was a first kind of effort to assess the core competencies of mid-level public health managers, working at different tiers of health system in Bangladesh. This descriptive cross-sectional study was conducted from July 2012 to June 2013, to assess the core competencies of mid-level public health managers including Civil Surgeons, Programme Managers, Upazilla Health and Family Planning Officers and Upazilla Family Planning Officers. Data were collected by pretested self administered questionnaire based on competency measuring scale consisting of four grades of scoring. The questionnaires were mailed to 678 managers of whom 26% responded. The male female ratio of the respondents was 8:1 with an average age of 51 years. The level of competency was found, on scale, between aware and knowledgeable. Only 12.4% of the managers had postgraduate education in public health and they obtained higher average scores in all domains. The overall scores of managers in analytical, policy development, communication, cultural competency, community dimension of practice, public health science, financial planning and leadership skills were 2.6, 2.5, 2.6, 2.6, 2.7, 2.3, 2.6 and 2.7 respectively. Some two-thirds (65.7%) of the respondents had short training on different public health areas, and they showed better competency. The study findings suggest that there are scopes of improvement in the competency of mid-level public health managers in Bangladesh. As postgraduation and short training in public health might improve the competency level of the mid-level managers, so education and training for them are thus recommended.

Introduction: The healthcare delivery challenges in Bangladesh are phenomenal. Improving maternal and child health, reducing the high maternal and infant mortality & morbidity are challenging. Arrangement of additional expenditure for GDM screening is again challenging. The efficiency of screening could be enhanced by considering women’s risks of gestational diabetes on the basis of their clinical characteristics.Objectives: To find out the use of the clinical prediction model of gestational diabetes mellitus (GDM) is valid for Bangladeshi pregnant women and to assess the risk of gestational diabetes by using clinical prediction model based on maternal characteristics.Materials and Methods: A cross sectional study was carried out from July 2011 to June 2012 among purposively selected 217 pregnant women of ?24 weeks of gestation in the Gynae and Obstetric outpatient department of Combined Military Hospital, Dhaka. Data were collected by face to face interview, anthropometric measurement and record review. Two step oral glucose tests were done for diagnosis of GDM.Results: According to Chadakaran clinical prediction model 84 (38.7%) respondents were at high risk, 92 (42.4%) were at intermediate risk and 41(18.9%) found at low risk of gestational diabetes but only 24(11.05%) developed gestational diabetes. Highest occurrence of gestational diabetes was found in high risk group 17 (20.2%) with zero occurrence in low risk group. Risk score performance at the level of ?380, sensitivity was 100% and specificity 21.8%, 13.6% positive predictive value, 100% negative predictive value and area under curve was 0.385. At the level of 460 score the sensitivity and specificity was found closest (70.8% and 65.3%, respectively) and area under curve was highest 0.657. The receiver operating characteristics curve of the risk score in the study sample for predicting women with glucose tolerance test demonstrated an area 0.763 (95%, 0.682 – 0.845).Conclusion: The use of clinical prediction model is a simple, non invasive, cost effective useful method to identify women at increased risk of gestational diabetes mellitus and could be short listed for further testing.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 64-68

Summary Silent corticotroph adenoma (SCA) is an unusual type of nonfunctioning pituitary adenoma (NFA) that is silent both clinically and biochemically and can only be recognized by positive immunostaining for ACTH. Under rare circumstances, it can transform into hormonally active disease presenting with severe Cushing syndrome. It might often produce diagnostic dilemma with difficult management issue if not thoroughly investigated and subtyped accordingly following surgery. Here, we present a 21-year-old male who initially underwent pituitary adenomectomy for presumed NFA with compressive symptoms. However, he developed recurrent and invasive macroadenoma with severe clinical as well as biochemical hypercortisolism during post-surgical follow-up. Repeat pituitary surgery was carried out urgently as there was significant optic chiasmal compression. Immunohistochemical analysis of the tumor tissue obtained on repeat surgery proved it to be an aggressive corticotroph adenoma. Though not cured, he showed marked clinical and biochemical improvement in the immediate postoperative period. Anticipating recurrence from the residual tumor, we referred him for cyber knife radio surgery. Learning points: Pituitary NFA commonly present with compressive symptoms such as headache and blurred vision. Post-surgical development of Cushing syndrome in such a case could be either drug induced or endogenous. In the presence of recurrent pituitary tumor, ACTH-dependent Cushing syndrome indicates CD. Rarely a SCA presenting initially as NFA can transform into an active corticotroph adenoma. Immunohistochemical marker for ACTH in the resected tumor confirms the diagnosis.

Objective: Medullary thyroid carcinomas (MTCs) originate from parafollicular C cells and produce the hormone calcitonin, which is primarily responsible for the biochemical dysfunction in calcium metabolism seen in MTC. MTCs constitute only about 5 to 7% of thyroid neoplasms. In rare cases, serum calcitonin can be normal or undetectable.Methods: We present the clinical examination and laboratory findings of a patient with MTC and a review of the literature.Results: A female of 65 years was suspected to have MTC after fine-needle aspiration cytology but serum calcitonin was normal. A total thyroidectomy was performed. Histopathology confirmed MTC. During the 9-year follow-up period, she had persistently normal serum calcitonin level despite lymph node metastasis.Conclusion: Raised serum calcitonin is a biochemical hallmark of diagnosis and recurrence of MTC in the post-surgical period. Our patient, however, is a case of MTC with postsurgical recurrence and metastasis but persistently normal calcitonin. Such cases are challenging in management. We have not found another report in the literature with the combination of normal calcitonin, MTC, and postsurgical recurrence with metastasis in lymph nodes.Abbreviations: CEA = carcinoembryonic antigen; CT = calcitonin; CT-NEG-MTC = calcitonin-negative medullary thyroid cancer; FNAC = fine-needle aspiration cytology; MTC = medullary thyroid carcinoma

Objective: To document the clinical, biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis. Methods: The clinical, biochemical and radiologic data of 18 immunocompetent patients [age: 45.00 (39.25, 56.25) years, median (IQR), m/f (16/2)] with adrenal histoplasmosis presenting in the Department of Endocrinology, BSMMU between 2014 and 2020 were retrospectively analyzed. Results: All patients were seronegative for HIV infection, and 27.8% (5/18) had well controlled diabetes mellitus. The median duration of the symptoms was 6.00 (IQR: 4.00, 11.25) months. All had significant weight loss, anorexia and weakness. Fever was present in 61.1% (11/18) patients and night sweat was present in 27.8% (5/18) cases. Hypotension and hyperpigmentation were present in 55.6% (10/18) and 66.7% (12/18) cases, respectively. Three of 18 patients presented with adrenal crisis. Hyponatremia occurred in 55.6% (10/18) cases, but none had hyperkalemia. Thirteen of 18 patients had adrenal insufficiency whereas 83.3% (15/18) had high adrenocorticotropic hormone. CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin. All were hypodense having radiodensity 21-90 hounsfield unit, and 11.1% (2/18) were heterogeneous in contrast enhancement. None had noticeable calcification whereas 1.1% (2/18) cases had central necrosis with peripheral rim enhancement. Hepatomegaly was present in 6 cases, splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy. Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue. Conclusions: Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.

Background: Increased plasma homocysteine levels are recognized to exert oxidative damage resulting into risk factors for insulin resistance (IR) and vascular disease. Present study was conducted to observe post-partum persistence of abnormal glucose tolerance (AGT) and level of homocysteine after delivery in patient with GDM. Methods: This observational cross-sectional study encompassed 100 subjects (age: 28.58±4.26 years, BMI: 26.7±2.80 Kg/m2; mean±SD) who were diagnosed as GDM during their index pregnancy by any of the internationally acceptable standard criteria. At 6-12 weeks post-partum, each of them underwent anthropometric measurements, 75 gram 2 sample OGTT and measurement of plasma homocysteine level by utilizing the chemiluminescent Immunoassay method. Results: Of the 100 subjects, 32% converted to having AGT during 6 – 12 week of post-partum follow up. Statistically significant difference was found in between the AGT and normal glucose tolerance (NGT) groups in circulating concentration of homocysteine (AGT vs NGT: 9.19±1.15 vs. 6.29±1.31 mmol/L; p=

Background: Gestational diabetes mellitus (GDM) shows insufficient β-cell compensation for insulin resistance (IR) during late pregnancy, whereupon derangements of human placental lactogen (hPL) and prolactin (PRL) have a presumed role in its pathogenesis. Aims: To assess the relationship of serum hPL and PRL with IR and β-cell function in GDM and pregnant women with normal glucose tolerance (NGT). Materials and Methods: This cross-sectional study was performed with 40 women with GDM and an equal number of pregnant women with NGT who were diagnosed on the basis of the WHO 2013 criteria during 24–40 weeks of gestation. hPL was measured by an enzyme-linked immunosorbent assay (ELISA); PRL and fasting insulin were measured by a chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate the indices of IR (HOMA-IR) and β-cell function (HOMA-B). Results: No statistically significant difference was found between the GDM and NGT groups in circulating concentrations of either hPL (6.01 ± 1.76 vs. 5.92 ± 2.10 mg/L, mean ± SD; P = 0.852) or PR [180.27 (125.95–306.20) vs. 166.87 (134.24–284.70) ng/mL, median (IQR); P = 0.704]. There was no relationship of circulatory levels of hPL and PRL with glucose values at different time points during oral glucose tolerance test as well as with AUCglucose (P = NS for all). On multiple regression analysis, neither hPL nor PRL emerged as a significant predictor for fasting insulin, HOMA-IR, and HOMA-B in GDM (P = NS for all). Conclusions: Circulating concentration of hPL and PRL may not be a potential determinant of IR and β-cell dysfunction in GDM.

Introduction: The Mean Platelet Volume (MPV) is a marker of platelet size with increased platelet activation. An elevated MPV is associated with major cardiac adverse events after Coronary Artery Bypass Graft (CABG) surgery. Effect of preoperative MPV on outcome of in-hospital patients after coronary artery bypass graft surgery was investigated in this study. Objective: To investigate the association of preoperative MPV with in-hospital outcome of patients after CABG surgery. Materials and Methods: An observational prospective study was carried out in the Department of Cardiovascular Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period from July 2012 to June 2014. Preoperative mean platelet volume was obtained prospectively in 81 consecutive patients undergoing conventional coronary artery bypass surgery. The patients were divided into two groups according to normal and elevated MPV at 10.60 femtolitre (fL) cut off level. Postoperative mortality and major adverse events were recorded in the early postoperative period. Results: Combined adverse events including post operative Myocardial Infarction (MI), arrhythmia, bleeding and death occurred in 27 patients (33.3%) during the early follow-up. The preoperative mean platelet volume levels were found to be associated with postoperative adverse events (p

This article was published in the European Journal of Medicinal Plants [©2015 European Journal of Medicinal Plants] The Article's website is at: http://www.journalrepository.org/media/journals/EJMP_13/2015/Nov/Shahriar1132015EJMP18866.pdf

Pulsatile system is gaining a lot of interest as it increases patient compliance by means of providing time and site specific drug delivery system. The aim of the present study was to formulate and evaluate pulsatile drug delivery system of amlodipine besylate based on chronopharmaceutical approach for the treatment of hypertension. The basic design involves the preparation of cross-linked hard gelatin capsules by using formaldehyde. Due to formal-dehyde treatment the length, external diameter, thickness, weight of the capsules was increased. Then the drug diluents mixture were prepared and loaded in, which was separated by using hydrogel plugs such as HPMC 50 cP, 100 cP, K100LV, methocel K15, sodium CMC, carbopol 971 and xanthan gum at different amount. Prepared formu-lations were subjected to in vitrodrug release studies. From the in vitro dissolution studies it was found that by increasing the amount of polymer, release rate was decreased. The release rate was above 90% when we used 50 mg and 75 mg polymer (in each hydrogel plug), but in case of using 100 mg polymer the release rate was 70% to 85% in 10 h. That means, in 12 h these formulations can give a satisfactory result which is the most desire in pulsati-le drug delivery system. Furthermore, the release data of all formulations were fitted to various mathematical mo-dels such as zero order, first order, Korsmeyer Peppas, Higuchi and Hixson-Crowell kinetics. The drug release fol-lows mixed order kinetics and mechanism was found to be non-Fickian diffusion. From the result it was concluded that, all formulations showed compliance with chronotherapeutic objective of hypertension and these modified pulsincap formulations can be a best alternative for high blood pressure patient to avoid multiple dosing. However, further studies can be, performed to determine the accurate dosing and better therapeutic effect

In this work, we developed the concept of enzyme catalysis–electrophoresis titration (EC-ET) under ideal conditions, the theory of EC-ET for multiplex enzymatic assay (MEA), and a related method based on a moving reaction boundary (MRB) chip with a collateral channel and cell phone imaging. As a proof of principle, the model enzymes horseradish peroxidase (HRP), laccase and myeloperoxidase (MPO) were chosen for the tests of the EC-ET model. The experiments revealed that the EC-ET model could be achieved via coupling EC with ET within a MRB chip; particularly the MEA analyses of catalysis rate, maximum rate, activity, Km and Kcat could be conducted via a single run of the EC-ET chip, systemically demonstrating the validity of the EC-ET theory. Moreover, the developed method had these merits: (i) two orders of magnitude higher sensitivity than a fluorescence microplate reader, (ii) simplicity and low cost, and (iii) fairly rapid (30 min incubation, 20 s imaging) analysis, fair stability (

Plasmapheresis is a very effective modality of treatment for many of the immune-mediated neurological disorders. It is a relatively new concept in the context of our country. Although it was previously done in one or two of the private hospitals but the expense was beyond the affordability of m59ost of our patients. Since its inception on September, 2012 the National Institute of Neurosciences & Hospital (NINS) has made some major advancement in patient management. Initiation of plasmapheresis at an affordable cost is one such example. In this article we intend to share our experience of the few cases who have received this treatment. Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): 62-64

Summary Congenital adrenal hyperplasia (CAH) due to the three-beta-hydroxysteroid-dehydrogenase (3β-HSD) enzyme deficiency is a rare autosomal recessive disorder presenting with sexual precocity in a phenotypic male. Klinefelter syndrome (KS) is the most common sex chromosome aneuploidy presenting with hypergonadotropic hypogonadism in a male. However, only a handful of cases of mosaic KS have been described in the literature. The co-existence of mosaic KS with CAH due to 3β-HSD enzyme deficiency portrays a unique diagnostic paradox where features of gonadal androgen deficiency are masked by simultaneous adrenal androgen excess. Here, we report a 7-year-old phenotypic male boy who, at birth presented with ambiguous genitalia, probably a microphallus with penoscrotal hypospadias. Later on, he developed accelerated growth with advanced bone age, premature pubarche, phallic enlargement and hyperpigmentation. Biochemically, the patient was proven to have CAH due to 3β-HSD deficiency. However, the co-existence of bilateral cryptorchidism made us to consider the possibility of hypogonadism as well, and it was further explained by concurrent existence of mosaic KS (47,XXY/46,XX). He was started on glucocorticoid and mineralocorticoid replacement and underwent right-sided orchidopexy on a later date. He showed significant clinical and biochemical improvement on subsequent follow-up. However, the declining value of serum testosterone was accompanied by rising level of FSH thereby unmasking hypergonadotropic hypogonadism due to mosaic KS. In future, we are planning to place him on androgen replacement as well. Learning points: Ambiguous genitalia with subsequent development of sexual precocity in a phenotypic male points towards some unusual varieties of CAH. High level of serum testosterone, adrenal androgen, plasma ACTH and low basal cortisol are proof of CAH, whereas elevated level of 17-OH pregnenolone is biochemical marker of 3β-HSD enzyme deficiency. Final diagnosis can be obtained with sequencing of HSD3B2 gene showing various mutations. Presence of bilateral cryptorchidism in such a patient may be due to underlying hypogonadism. Karyotyping in such patient may rarely show mosaic KS (47,XXY/46,XX) and there might be unmasking of hypergonadotropic hypogonadism resulting from adrenal androgen suppression from glucocorticoid treatment.

Pulsatile drug delivery of enalapril maleate is one such system that, by delivering drug at the right time, right place and in right amounts, holds good promises of benefit to the patients suffering from hypertension. The basic design involves the preparation of cross linked hard gelatin capsules using formaldehyde. Then the drug diluent mixtures were prepared and loaded which was separated by using hydrogel plug of polymers of different grades such as HPMC 50 cps, HPMC 100 cps, HPMC K4M, HPMC K15M, HPMC K100M, xanthan gum, carbopol 971 and sodium CMC at different amount (100 and 120 mg). Prepared formulations were subjected to evaluation of various physical parameters and in vitro drug release studies. Dissolution tests were performed using the USP type I basket method at 50 rpm in 6.8 phosphate buffer. From the in vitro dissolution studies it was found that by increasing the amount of polymers, release rate was decreased. Here, 100 mg of HPMC K100M showed 80% drug release in 8 hours whereas 120 mg showed 78.87% drug release in 10 hours. Similar decrease in the release rates were found with the increase of other polymers used in this study. The release data was fitted to various mathematical models such as zero order, first order, Higuchi, Korsmeyer Peppas and Hixson Crowell cube root law. The drug release follows mixed order kinetics and mechanism was found to be non-Fickian diffusion.Bangladesh Pharmaceutical Journal 18(1): 66-71, 2015

Health is the most important aspect for economic sustainability of a country. Bangladesh is facing a lot of challenges in quality healthcare management. The recent advances in information and communication technologies (ICT) could play vital role in improving healthcare services and reaching them to the doorstep of the marginalized people. This research aims to evaluate the present health status of the country and explores the applicability of e-Health as well as the challenges and issues of electronic healthcare development. This study has conducted a survey on patient's views and expectations toward e-Health for quality healthcare management. The survey was conducted in some selected rural and urban hospitals/clinics in the light of effective adoption of ICT in eHealth services. This research would be useful to improve the access, effectiveness and quality of health services utilized by healthcare organizations, doctors, patients, and consumers in an effort to pick up the health status of patients and to face the emergency situations in some cases. Finally, a set of guidelines has been provided to aid the implementation of a successful electronic healthcare system.

Health care is one of the most important dependencies for economic growth and sustainability of a country. Most of the developing countries are facing the challenges of quality healthcare. However, recent advances in mobile communication technologies could play role in improving healthcare systems in developing countries. There is a great potential in using mHealth as one of the supportive systems within the healthcare sector to solve the inequalities in healthcare delivery between rural and urban hospitals/clinics. The emergence of smart mobile phones have created an unprecedented opportunity to provide health services to people in developing countries in an instantaneous, interactive and customized way. This research aims to evaluate the applicability, issues and challenges for implementation of mobile healthcare system in the developing world. To build up and promote mHealth services in the developing countries, this research has conducted a readiness assessment in some selected rural and urban hospitals/clinics of Bangladesh. Finally, a set of guidelines has been suggested to aid the implementation of a successful mobile healthcare system.

Background: Stroke is one of the commonest causes of severe disability and accounts for a large proportion of health care resources. Kidney diseases are related to stroke and reduced estimated glomerular filtration rate (eGFR) appears to be a significant independent prognostic factor for short as well as long term mortality in stroke patients. Objective: The present study has been designed to assess the relationship between stroke and kidney dysfunction based on eGFR. Methods: The present study was a case control study. The study was conducted in the Department of Physiology, Dhaka Medical College and Hospital (DMCH), Dhaka from 1st July 2010 to 30th June 2011. A total of 200 subjects were included with the age limit of 35–85 years. Out of them 100 apparently healthy subjects were selected as control(Group A) for comparison and 100 diagnosed stroke patients were selected as study group (Group B). On the basis of age, group A and group B were further subdivided into group A1(age 35-59 years) consisting of 47 normal persons and group A2(age 60-85 years) consisting of 53 normal person, group B1(age35-59 years) was consisting of 42 stroke patients and group B2(60-85 years) consisting of 58 stroke patients .The study subjects were selected from admitted patients in Department of Medicine, DMCH, Dhaka. Estimated GFR (eGFR) were measured by MDRD equation. The data was analyzed by computer based statistical software (SPSS version 12). Results: The result was expressed as Mean (+SD). The test of significance was calculated and p values

Health is a basic requirement to improve the quality of life. Providing effective health care is an essential component towards the social and economic development of a country. A large number of people in the developing countries, particularly in rural and remote areas, remained with no or little access to health care facilities. However, recent emergence of mobile communication technologies could play in improving healthcare services. There is a great potential in using mHealth as one of the supportive systems within the healthcare sector to solve the inequalities in healthcare delivery between rural and urban hospitals. This research aims to evaluate the potentialities, issues and challenges of developing mobile healthcare system in the developing world. We have proposed a potential mHealth model based on mobile telecommunication networks. This research offers a set of guidelines to aid the implementation of a successful mobile healthcare system.

Phenology, floral and pollen morphological features and seed yield were studied in Indigofera tinctoria L. and I. suffruticosa Mill. Indigofera tinctoria bloomed three times i.e., mid-July, mid-August and early October during the study period. But I. suffruticosa bloomed only once i.e., in early September. The number of flowers/raceme and pods/raceme were higher in I. suffruticosa than those in I. tinctoria . However, the number of seeds/pod, seed size, 1000-seed weight and seed yield were higher in I. tinctoria . Pollen with auriculae near the aperture in Indigofera is being reported here for the first time. Size and exine thickness of pollen grains were higher in I. tinctoria than in I. suffruticosa . The highest number of flowers/raceme and seeds/plant were produced at the second flush in I. tinctoria . Therefore, I. tinctoria plants may be harvested after the maturity of pods from second flush for higher seed yield. DOI: http://dx.doi.org/10.3329/bjb.v42i2.18024 Bangladesh J. Bot. 42 (2): 231-237, 2013 (December

Objectives: The objective of this study was to observe iodine nutrition status (urinary iodine [UI] and total goiter rate [TGR]) of schoolgoing children with the age of 6–12 years in Dhaka city. Materials and Methods: This study comprised 530 schoolchildren of 6–12 years of Dhaka city of Bangladesh selected by multistage random sampling. Goiter classified according to the WHO/ICCIDD/UNICEF, and UI was assessed. UI was estimated using wet digestion method. Results: Iodine nutrition status revealed 83.2% children as deficient, which was relatively more in 6–8 years group (89.5%), followed by 9–10 years (80.6%) and 11–12 years (77.2%), (P = 0.008). Out of 530 children, 55.7% had no goiter (295/530), whereas 20.2% (107/530) had Grade I and 24.2% (128/530) had Grade II goiter. There was no statistical difference for iodine sufficiency/deficiency between the children with or without goiter (χ2 = 0.129, P = 0.719). Highest mean (± standard error of mean [SEM]) and median UI was found in low socioeconomic class (81.48 ± 7.84 and 78.85 μg/L, respectively), followed by average (75.12 ± 6.31 and 65.11 μg/L, respectively) and high socioeconomic status (47.81 ± 2.68 and 34.82 μg/L, respectively) (P Conclusions: Iodine nutrition status of children in Dhaka city of Bangladesh was found to be insufficient as yet. TGR is still much higher though not solely related to iodine nutrition status. Continuous surveillance over the matter is very much needed for a satisfactory iodine nutrition status.

Objectives: The objectives of this study were to assess the views of teachers regarding the reproductive and child health related contents at the medical undergraduate level in Bangladesh. Methodology: A descriptive type of cross-sectional study was carried out from January 2009 to June 2009 among 30 teachers of government and non government medical colleges in Bangladesh. Data were collected by pre tested self administered semi-structured questionnaire. Results: Results of the study shows that a total of 58% of the teachers feel that topics such as maternal health, infant and child care, family planning and adolescent health might be useful in future life. They have shown more interest towards problem solving class with scenario exercises, group discussions and brain storming sessions. They also feel that clinical oriented topics should be included more. It was also revealed that more than 65% of the teachers feel that RCH related contents are the most important or one of the most important topics in the Community Medicine. Conclusion and recommendation: Some of the non-traditional teaching methods like problem solving class with scenario exercises, group discussions and brain storming sessions may be practiced to improve the teaching and assessment in reproductive and child health related contents at the undergraduate medical level in Bangladesh. DOI: http://dx.doi.org/10.3329/jdnmch.v18i1.12236 J. Dhaka National Med. Coll. Hos. 2012; 18 (01): 29-33

A random sample of 15,500 school going children in the age group of 6-16 years from public and private schools of Bhaluka & Gaffargaon were screened for the prevalence of operable congenital heart diseases [CHD] during a period of 12 months.Congenital heart diseases were diagnosed preliminary on the basis of clinical history and or clinical examination & confirmed by supportive investigations. Out of examined sample 350 were found suffering from CHD, giving an overall prevalence of 22.25 per 1000 of children far greater than that of the figure recorded in available literatures for other countries.The prevalence rate was higher in girls than that of boys in the present study which may indicate a negligence of care taking towards female children in family. In consistent, children from lower income group had a higher prevalence rate compared to their middle income group counterparts. One hundred sixty children were found to be suffering from definite operable CHD giving a prevalence of 10.32 per 1000, where again girls were the main victims.Atrial septal defect was the commonest lesion with a prevalence of 9.6 per 1000 followed by ventricular septal defect with a prevalence of 5.8 per 1000 children. Eight cases had a family history of CHD. History of rheumatic fever and or rheumatic heart disease were found to have significant prevalence among cases with CHD as compared to children without CHD.The finding of present survey suggest the need of large scale screening of apparently healthy children for CHD and family members of those suffering from CHD and that special attention to be paid to the occurrence of rheumatic fever or rheumatic heart disease in cases of CHD. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10200 UHJ 2011; 7(1): 3-6