A prophylactic amputation

A case of amputation of the fourth toe is described in a diabetic patient. The patient had overlapping of third and fourth toes since her childhood and later she developed soft lipomas over the fourth toe and lateral aspect of the dorsum of the foot. The lipomas were excised without relief of pain. Subsequently, the fourth toe was disarticulated with relief of pain and healing of ulcers. The role of prophylactic amputations in such cases is described. Ibrahim Med. Coll. J. 2010; 4(2): 87-8

Underutrition and Adiposity in Children and Adolescents: A Nutrition Paradox in Bangladesh

Many studies reported a high prevalence of undernutrition in the under-5 children in Bangladesh. But very few information are available about undernutrition and adiposity among school children and adolescents in Bangladesh. This study addressed the prevalence of undernutrition and obesity among school going children and adolescents. A total of 15 secondary schools were purposively selected from rural, suburban and urban areas. The teachers were detailed about the study protocol. Then the teachers volunteered to register the eligible (age 10 – 18y) students for the study. Each student’s parent was interviewed for family income. Height (ht), weight (wt), mid-upper arm circumference (MUAC) and blood pressure were taken. Fasting blood samples were collected for fasting plasma glucose, total cholesterol (Chol), triglycerides (TG), high-density lipoproteins (HDL). Body mass index (BMI) was calculated (ht/wt in met. sq) for diagnosis of undernutrition (BMI 25.0). A total of 2151 (m-1063, f-1088) students volunteered the study. Of them, the poor, middle and rich social classes were 25.4, 53.1 and 21.5%, respectively. Overall, the prevalence of underweight, normal, overweight and obesity were 57.4%, 35.0%, 4.9% and 2.7%, respectively. For gender comparison, there has been no significant difference of BMI between boys and girls. By social class, the prevalence of underweight was significantly higher in the poor than in the rich (62.2% v. 43.6%) and obesity was higher in the rich than in the poor (6.1% v. 1.2%) [for both, p<0.001]. Logistic regression showed that the participants from urban (OR 1.51, 95% CI 1.03 – 2.22) and the rich (OR 2.03, 95% CI 1.24 – 3.33) social class had excess risk for obesity. The risk for undernutrition was found just reverse. Undernutrition was found most prevalent among the rural students and among the poor social class; whereas, prevalence of overweight and obesity appears to be increasing with urbanization and increasing family income. Thus, the study showed a nutrition paradox – adiposity in the midst of many undernourished children and adolescents in Bangladesh. Further study may be undertaken in a large scale to establish diagnostic criteria for age specific nutrition assessment in Bangladesh. A prospective children cohort may help assessing the cut-offs for unhealthy sequels of undernutrition and adiposity. Ibrahim Med. Coll. J. 2012; 6(1): 1-

RISK OF OBESITY FOR HYPERTENSION DIFFERS BETWEEN DIABETIC AND NON-DIABETIC SUBJECTS

In recent years, non-communicable diseases (NCD) like obesity, hypertension (HTN) and Type2 diabetes (T2DM) are on the increase, specially in the developing nations. Body mass index (BMI), waist-to-hip ratio (WHR) and Waist-to-height ratio (WHtR) are used as indices of obesity to relate T2DM, HTN and coronary artery disease (CAD). This study addresses whether the risk of obesity for HTN differs between T2DM and non-DM subjects. We investigated 693 diabetic patients from BIRDEM and 2384 from communities. We measured height, weight, waist-girth, hip-girth and blood pressure. All subjects underwent oral glucose tolerance test (OGTT). BMI, WHR and WHtR were calculated. Systolic and diastolic hypertension (sHTN and dHTN)) were defined as SBP >=140 and DBP >= 90 mmHg, respectively. The prevalence of both sHTN and dHTN in T2DM was higher than the non-DM subjects (sHTN: 49.1 vs 14.3%, dHTN 19.6 vs. 9.5%). The comparison of characteristics between subjects with and without hypertension showed that the differences were significant for age, weight, waist-girth, BMI, WHR and WHtR for both T2DM and non-DM subjects (for all p<0.001). The increasing trend of hypertension with increasing obesity was observed more in the non-DM than in the T2DM subjects. The risk (OR) of obesity for hypertension increased with increasing WHR and WHtR in the non-DM than the T2DM subjects. Compared with the non-DM the T2DM participants had two to three folds higher prevalence of HTN. In either group, BMI, WHR and WHtR were significantly higher in the hypertensive than the non-hypertensive subjects. The prevalence of hypertension increased with the increasing BMI, WHR and WHtR but significant only in the non-DM. Further studies may confirm these findings and determine whether there was any altered association between blood pressure and obesity in diabetes possibily, with or without autonomic neuropathy. Ibrahim Med. Coll. J. 2007; 1(1): 1-

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants

Background Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population. Methods 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined. Results The age standardized prevalence of overweight (BMI 23-24.9 kg/m2) and obesity (BMI ≥25 kg/m2) were 17.7 (95 % confidence interval (CI): 16.1, 19.2 %) and 26.2 % (95 % CI: 24.4, 27.9 %), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8 % (95 % CI: 37.9, 41.7 %) and 71.6 % (95 % CI: 69.8, 73.4 %) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity. Conclusions In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity

Prevalence and risk factors of coronary heart disease in a rural population of Bangladesh

Coronary heart disease (CHD) is a major global health problem with the majority of burden observed increasingly in the developing countries. There has been no estimate of CHD in Bangladesh. This study addresses the prevalence of CHD in a Bangladeshi rural population which also aimed to determine the risk factors related to CHD. Ten villages of Nandail sub-district under Mymensingh were selected purposively. All subjects of age ³20y were considered eligible and were interviewed about family income, family history of T2DM, CHD and HTN. The investigations included height, weight, waist-girth, hip-girth, systolic and diastolic blood pressure (SBP & DBP), fasting blood glucose (FBG), triglycerides (TG), cholesterol (Chol) and high density lipoprotein (HDL). Hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR) were also estimated. Finally, electrocardiography (ECG) was undertaken in all participants who had family history of diabetes or hypertension or CHD. Diagnosis of CHD was based on history of angina or changes in ECG or diagnosed by a cardiologist. A total of 6235 subjects were enlisted as eligible (age ³20y) participants. Of them, 4141 (m / f: 1749 / 2392) subjects volunteered for the study. The age-adjusted (20-69y) prevalence of CHD was 1.85 with 95% CI, 1.42 – 2.28. There was no significant difference between men and women. The mean (SD) values of age (p<0.001), SBP (p<0.01), DBP (p<0.05), HbA1c (p<0.05) and ACR (p<0.01) were significantly higher among subjects with CHD than those without; whereas, there were no significant differences in BMI and WHR, TG, Chol and HDL. Logistic regression analysis showed that adjusted for age, sex, social class and obesity, the subjects with higher age (³45y), higher 2hBG (³7.0mmol/l), higher ACR (³17.2) and family history of CHD had significant risk for CHD. The prevalence of CHD is comparable with other Asian population. Family history of CHD and age over 45 years, and who had hyperglycemia and higher ACR were proved to be the independent predictors of CHD. CHD was found to affect participants irrespective of sex, social class, obesity and lipid status. Though the IFG and diabetes groups appeared to have similar biophysical characteristics, only the diabetes group had significant risk for CHD. Further study in a larger sample may be undertaken to confirm the study findings and to explore some unidentified risk factors of CHD. Ibrahim Med. Coll. J. 2010; 4(2): 37-4

Childhood diabetes in a Bangladeshi population

ABSTRACT Backgrounds and Aims: Several epidemiological investigations revealed that the prevalence of Type 2 Diabetes Mellitus (T2DM) has been increasing in the adult population of Bangladesh. But the prevalence of diabetes among the children and adolescents in Bangladesh has not been reported. This study addressed the prevalence of diabetes among the younger people in Bangladesh. Subjects and Methods: We investigated school children of age group 10 -18 years in rural, suburban and urban communities. Investigations included socio-demographic information, height, weight, mid-upper-arm circumference (MUAC), blood pressure (SBP, DBP) and fasting plasma glucose (FPG). We used WHO criteria (1999) for impaired fasting glucose (IFG) and diabetes mellitus (T2DM). Results: A total of 2152 students (boys/girls: 1064/1088) volunteered the study. Their mean (SD) age was 13.3 (2.0) y, BMI was 18.5 (3.1) and MUAC was 21.2 (3.4) cm. The mean (SD) of FPG was 4.6 (0.87) mmol/l. The prevalence of IFG (95% CI) was 3.4% (2.63 -4.17) and T2DM was 1.8% (1.23 -2.37). BMI showed no association with FPG in either sex. In assessing risk for hyperglycemia (FPG &gt; = 5.6 mmol/l), logistic regression showed [odds ratio (OR) with 95% CI] that compared with lower age (&lt;12 vs &gt;16 y) higher age had excess risk (OR 5.2, 2.92 -9.23). Compared with the rural the urban children had higher risk (OR 14.7, 6.41 -33.78). Higher family income was also found to have higher risk (BDT &lt;5000 vs &gt;8000: OR 2.03, 1.30 -3.18); whereas, higher BMI and MUAC were proved to be not significant. Conclusions: The prevalence of IFG and T2DM in Bangladeshi children and adolescents appears to be high. The urban children from the higher family income are the most vulnerable for developin

Effect of Edible Mushroom (Pleurotus ostreatus) on Type-2 Diabetics

The prevalence of non-communicable diseases (NCD) like diabetes, hypertension, dyslipidemia and atherosclerotic cardiovascular diseases (CVD) are on the increase globally and predominantly in the South East Asian Region (SEAR). The increasing NCD and its complications burdened the health cost of Bangladesh. The available literatures suggest that edible mushrooms are effective in controlling metabolic risks like hyperglycemia and hypercholesterolemia. The study addressed the metabolic effects of edible oyster mushroom (Pleurotus ostreatus) in diabetic individuals and to assess the undesirable effects of mushroom. A total of 5000 newly registered diabetic women were screened for eligible participants (urban housewives, age 30 – 50y, BMI 22 – 27, FBG 8 – 12 mmol/l; free from complications or systemic illnesses and agreed to adhere to the study for 360 days). The investigations included weight and height for BMI, waist- and hip-girth for WHR, BP, FBG, 2ABF, T-chol, TG, HDL, LDL, ALT and Creatinine starting from the day 0 (baseline) and each subsequent follow-up days: 60, 120, 180, 240, 300 and 360 for comparison between placebo and mushroom groups and also within group (baseline vs. follow up days), individually for placebo and mushroom. The daily intake of mushroom was 200g for the mushroom group and an equivalent calorie of vegetables for the placebo group. Overall, 73 diabetic housewives (mushroom / placebo = 43 /30) volunteered. The mean (with SEM) values of BMI, WHR, BP, FBG, 2ABF, T-chol, TG, HDL, LDL, ALT and Creatinine of the placebo group were compared with the mushroom group. Compared with the placebo, the mushroom group showed significant reductions of FBG (p<0.001), 2ABF (p<0.001), T-chol (p<0.001), TG (p=0.03) and LDL (p<0.001); whereas, no difference was observed for BMI, SBP, DBP, HDL, Hb, creatinine and ALT. The comparison within groups (baseline vs. follow-up) there were significant reduction of these variables in mushroom but not in the placebo group. Mushroom was found to have significant effect in reducing blood glucose, T-chol, TG and LDL. No impaired function was observed for liver, kidney and hemopoeitic tissue in taking mushroom for 360 days of the study period. Ibrahim Med. Coll. J. 2014; 8(1): 6-1

IN BANGLADESH DIABETES STARTS EARLIER NOW THAN 10 YEARS BACK: A BIRDEM STUDY

BIRDEM is the largest referral center of diabetes in the world. It registered more than 300,000 diabetic patients from 1956 to 2005. This retrospective study compared the biophysical characteristics of diabetic patients registered in 1995 to those registered in 2005. Information on social (income, education), clinical (height, weight, blood pressure) and oral glucose tolerance (OGTT) of patients registered in 1995 and 2005 were retrieved from the BIRDEM registry. The age group ³ 20y was considered eligible. Overall, there were 11489 patients for 1995 and 19580 for 2005. Compared with the registry of 1995, a significant increase of registry for female patients were observed (39.5 vs. 46.7%, p<0.001) and also the rural population (31.9 vs. 47.4%, p<0.001). Likewise, the number of poor social class was also found higher in 2005 (5.2 vs. 25.5%, p<0.001). Young aged (<40y) registry was also significantly higher in 2005 (34.4 vs. 37.1%, p<0.001). Compared with the registered patients of 1995, adjusted for sex and area, those of 2005 had a significantly higher BMI, higher FPG and higher 2hPG (for all, p<0.001). In contrast, a significantly lower age, lower height and lower blood pressure were observed in those of 2005. We conclude that the age at registration for diabetes has decreased significantly in 2005 compared to that in 1995 indicating an earlier onset of diabetes. Significantly higher obesity in the year 2005 than 1995 indicates that there has been an increase in obesity that might be an important contributing factor for earlier onset of diabetes. Ibrahim Med. Coll. J. 2008; 2(1): 1-

Diabetes risk score for identifying cardiometabolic risk factors in adult Bangladeshi population

Context: Simple non-invasive tools to identify high-risk individuals would facilitate screening of cardiometabolic diseases as well as diabetes. Aims: (1) To estimate variations in Bangladesh diabetes risk score (BDRS) according to stages of glucose intolerance, (2) to examine the usefulness of BDRS for identifying metabolic syndrome (MS), dyslipidaemia and 10-year risk of coronary artery disease (CAD) in people with normal glucose tolerance (NGT). Subjects and Methods: Data were taken from a randomised cross-sectional study of 2293 patients in a rural community of Bangladesh in 2009, based on questionnaire interviews, anthropometric measurements, fasting blood samples and oral glucose tolerance test. The BDRS includes age, sex, body mass index, waist-hip ratio and hypertension (HTN). Spearman correlation and logistic regression were done to assess the relationship between BDRS and cardiometabolic risk factors. Results: The mean BDRS increased significantly with higher glucose intolerance (P for trend < 0.001). Among NGT group, the prevalence of cardiometabolic risk factors increased progressively from low-to-medium-to-high-risk score groups; HTN: 7.8%, 12.3% and 19.8% (P for trend: <0.001), dyslipidaemia: 16.3%, 25.3% and 27.4% (P for trend: <0.001), MS: 10.2%, 22.4% and 30.9% (P for trend: <0.001) and CAD risk: 3.6%, 9.0% and 13.8% (P for trend: <0.001), respectively. BDRS was significantly associated with MS (odds ratio [OR]: 1.92, P < 0.001); dyslipidaemia (OR: 1.30, P = 0.018); and CAD risk (OR: 1.93, P < 0.001). Conclusions: BDRS can be used for identifying MS, dyslipidaemia and CAD risk even among people with NGT