Prothrombin time and activated partial thromboplastin time in women with gestational diabetes mellitus

Impact of gestational diabetes mellitus (GDM) on the coagulation system still remains unclear and there is limited data available regarding haemostatic changes in GDM in Bangladesh. This study was aimed at determining plasmaprothrombin time (PT), activated partial thromboplastin time (APTT) in women with GDM. This cross sectional study encompassed 44 GDM (age: 28.5±3.8 years, BMI: 27.2±4.0kg/m2; mean±SD) and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on the basis of WHO criterion 2013 at or after 24 weeks of gestation to see PT and APTT. Plasma glucose was measured by glucose oxidase method, PT and APTT by automated coagulation analyzer. There was no statistically significant difference between the GDM and NGT groups for PT (12.3±0.5 vs. 12.2±0.4 sec, mean±SD; P=0.40) or APTT (30.53±1.01 vs. 30.9±4.5 sec, mean±SD; P=0.56). In conclusion, PT and APTT do not differ between women with or without GDM. BSMMU J 2022; 15(3): 146-15

Fasting with diabetes during Ramadan: An updated review

Introduction: In reality, many Muslims have an intense spiritual urge to participate in fasting, even those who could get an exemption. There are many cultural variations in the Muslim population in different parts of the world, even in the same country with different social and family backgrounds. Thus, persons with diabetes should seek medical advice before planning to fast or proceed to fast during Ramadan. Materials: This was a narrative, non-systematic review of the international literature from the major medical online database (PubMed and Google Scholar) in 2023. The term “Ramadan fasting” and “Diabetes” was used to search, and the relevant literature was captured and narrated in a concise thematic account. Results: Practically, there are certain risks associated with fasting for patients with diabetes, which might exacerbate their existing illnesses. Along with the globally increasing prevalence of diabetes, there is an increased number of the population who intend to or fast. The article captured a wide array of topics related to Ramadan fasting by patients with diabetes, including its epidemiology, risk stratification, lifestyle modification, assessment of safety and efficacy profiles of pharmacotherapies, hypo or hyperglycemia, and the impact of diabetes education. Conclusion: Fasting with diabetes poses a range of risks and thus pre-Ramadan risk stratification is essential. Particular attention should focus on the patient’s current risk factors, complications, comorbidities, and the roles of newer antihyperglycemic medicines and advanced technology for safer fasting practices to mitigate the risks of hypoglycemia and or hyperglycemic crises.

Fasting with diabetes during Ramadan: An updated review

Introduction: In reality, many Muslims have an intense spiritual urge to participate in fasting, even those who could get an exemption. There are many cultural variations in the Muslim population in different parts of the world, even in the same country with different social and family backgrounds. Thus, persons with diabetes should seek medical advice before planning to fast or proceed to fast during Ramadan. Materials: This was a narrative, non-systematic review of the international literature from the major medical online database (PubMed and Google Scholar) in 2023. The term “Ramadan fasting” and “Diabetes” was used to search, and the relevant literature was captured and narrated in a concise thematic account. Results: Practically, there are certain risks associated with fasting for patients with diabetes, which might exacerbate their existing illnesses. Along with the globally increasing prevalence of diabetes, there is an increased number of the population who intend to or fast. The article captured a wide array of topics related to Ramadan fasting by patients with diabetes, including its epidemiology, risk stratification, lifestyle modification, assessment of safety and efficacy profiles of pharmacotherapies, hypo or hyperglycemia, and the impact of diabetes education. Conclusion: Fasting with diabetes poses a range of risks and thus pre-Ramadan risk stratification is essential. Particular attention should focus on the patient’s current risk factors, complications, comorbidities, and the roles of newer antihyperglycemic medicines and advanced technology for safer fasting practices to mitigate the risks of hypoglycemia and or hyperglycemic crises. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 41-57

Fasting with diabetes during Ramadan: An updated review

Introduction: In reality, many Muslims have an intense spiritual urge to participate in fasting, even those who could get an exemption. There are many cultural variations in the Muslim population in different parts of the world, even in the same country with different social and family backgrounds. Thus, persons with diabetes should seek medical advice before planning to fast or proceed to fast during Ramadan. Materials: This was a narrative, non-systematic review of the international literature from the major medical online database (PubMed and Google Scholar) in 2023. The term “Ramadan fasting” and “Diabetes” was used to search, and the relevant literature was captured and narrated in a concise thematic account. Results: Practically, there are certain risks associated with fasting for patients with diabetes, which might exacerbate their existing illnesses. Along with the globally increasing prevalence of diabetes, there is an increased number of the population who intend to or fast. The article captured a wide array of topics related to Ramadan fasting by patients with diabetes, including its epidemiology, risk stratification, lifestyle modification, assessment of safety and efficacy profiles of pharmacotherapies, hypo or hyperglycemia, and the impact of diabetes education. Conclusion: Fasting with diabetes poses a range of risks and thus pre-Ramadan risk stratification is essential. Particular attention should focus on the patient’s current risk factors, complications, comorbidities, and the roles of newer antihyperglycemic medicines and advanced technology for safer fasting practices to mitigate the risks of hypoglycemia and or hyperglycemic crises. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 41-57

Fine needle aspiration cytological diagnosis of thyroid nodule with its clinical correlation

Background: Nodular goiter is common in Bangladesh. Thyroid nodules are important for their malignant potential especially the solitary and cold ones and when functionally euthyroid. Objectives: This study was designed to investigate the frequency of malignancy and cellular aberration detected by fine needle aspiration cytology (FNAC) in euthyroid nodules and its correlation with clinical findings. Methods: Subjects with nodular goiter attending Endocrine out patient department [n=150, nonpregnant, age (mean± SD): 37±12 years; sex (male: female): 21:129] were recruited for this study. All subjects underwent clinical risk stratification, estimation ofFT4 and TSH as well as ultrnsonogram (USG) and isotope scan of thyroid. Thyroid nodules were categorized into malignant, suspicious, benign and indeterminant on the basis of cellular character by FNAC. Statistical analysis was done by Chi-square and multiple regression analysis. Results: Patients were mostly females (86%) and 4.7% had family history of thyroid problems. Some had recent changes of size (14.7%), pain in the nodule (4%) and dysphagia (6%). Nodules were solitary in 45.3% and the rest (54.7%) had multinodular goiter. Enlarged regional lymph node was found in 12.7% patients. About 41 % were partially-cold followed by cold nodules (26.7%), patchy (16.7%), isoform (12%) and hot (4%) by isotope scan. Frequency of malignant (10%) character was highest in cold nodules followed by uniform (5.6%), patchy (4.0%) and partially cold (1.6%) while none in hot nodules; which were 22.5%, 11.1 %, 4.0%, 9.8% and 16.7% respectively for suspicious nodules. About 17% showed cellular aberration and 4.7% were clearly malignant, whereas 124 (82.7%) were benign. Of the malignant, 4 were solitary and 3 were multinodular; which were 10 and 9 among the suspicious ones. A significant number (77%, 20 out of 26) among the malignant/suspicious nodules fell into moderate to high risk category (x2=22.861, p<0.001), while 23.1 % of the FNAC proven malignant/suspicious nodules were of low risk category. Enlarged lymph nodes (p<0.001), increased diameter of nodules of >4 cm (p=0.039) and recent changes in nodular size (p=0.042) were independently and signifi­cantly related to cellular aberration. Conclusions: FNAC is a useful tool for cellular diagnosis of thyroid nodules. Clinical suspicion for malignancy strongly correlates with the FNAC findings. But a good number of clinically Low risk categories would escape malignant cellular character unless FNAC is done

Vitamin D supplementation on prediabetic adults with vitamin D deficiency: a double-blind placebo-controlled randomized clinical trial

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 inflammatory marker high sensitivity C reactive protein (hs-CRP) were measured at baseline and after six months of intervention. Vitamin D levels (ng/mL) increased in both groups from baseline (vitamin D vs. placebo: 12.2±5.9 vs. 3.9±3.5, mean±SD). FPG (mmol/L) significantly decreased in the Vitamin D group (before vs. after: 5.9±0.6 vs. 5.5±0.7, P=0.016, mean±SD), whereas HbA1C (%) and hs- CRP (mg/L) significantly increased in the placebo group (before vs. after- HbA1C: 5.8±0.3 vs. 6.0±0.4, P<0.001; hs-CRP: 5.0±4.4 vs. 5.6±4.9, P=0.039, mean±SD). Percent changes in glycemic status, HOMA-IR, and hs-CRP were statistically similar between the groups. Our study failed to demonstrate the positive effects of vitamin D supplementation on reducing glucose, insulin resistance, or inflammatory marker in prediabetic adult patients with hypovitaminosis D. BSMMU J 2022; 15(3): 167-17

Serum adiponectin profile in obese Bangladeshi children attending an obesity clinic

Background and objective: Childhood obesity plays major role in the pathogenesis of various cardiovascular and metabolic diseases. Serum adiponectin has been found to be associated with several cardiometabolic risk factors. The study investigated the serum adiponectin levels and its relationship with obesity and cardiometabolic risk factors in Bangladeshi obese children. Material and methods: Overweight or obese children, between 6-18 years of age, attending the obesity clinic of the Department of Endocrinology, BSMMU were enrolled. Waist circumference (WC) and blood pressure (BP) were measured and blood samples were taken for estimation of glucose, insulin, lipid profile and adiponectin. Fasting plasma glucose (FPG), serum insulin and lipid profile were estimated by automated analyzer. Insulin resistance (HOMA-IR) was calculated from fasting insulin and fasting plasma glucose values. Serum adiponectin (total) was measured by ELISA method using DRG ELISA kit, Germany. Results:A total of 78 overweight or obese children of 6-18-year of age were enrolled. The mean (±SD) age of the study population was 12.22 ± 2.56 years and the mean BMI was 28.79 ± 4.54 kg/m2. Mean (±SD) serum adiponectin was 36.93 ± 17.85 µg/ml in 78 overweight/obese children. One way ANOVA showed no significant (P= 0.582) difference of adiponectin levels among children with overweight and different grades of obesity. There was no significant correlation between adiponectin and measures of generalized (r=0.035, p=0.763) or central (r=0.098, p=0.392) obesity. Also, no significant correlation was found between serum adiponectin level and any of cardiovascular risk factors of obesity or metabolic health. Conclusion: The study showed high serum adiponectin level in obese Bangladeshi children. Also, no association was found between serum adiponectin levels with grades of obesity and cardiometabolic risk factors among obese children of Bangladesh. IMC J Med Sci. 2023; 17(2):009. DOI: https://doi.org/10.55010/imcjms.17.019 *Correspondence: Palash Chandra Sutradhar, Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Kotwali, Dhaka-1000, Bangladesh. Email: [email protected]

Fine needle aspiration cytological diagnosis of thyroid nodule with its clinical correlation

Background: Nodular goiter is common in Bangladesh. Thyroid nodules are important for their malignant potential especially the solitary and cold ones and when functionally euthyroid. Objectives: This study was designed to investigate the frequency of malignancy and cellular aberration detected by fine needle aspiration cytology (FNAC) in euthyroid nodules and its correlation with clinical findings. Methods: Subjects with nodular goiter attending Endocrine out patient department [n=150, nonpregnant, age (mean± SD): 37±12 years; sex (male: female): 21:129] were recruited for this study. All subjects underwent clinical risk stratification, estimation ofFT4 and TSH as well as ultrnsonogram (USG) and isotope scan of thyroid. Thyroid nodules were categorized into malignant, suspicious, benign and indeterminant on the basis of cellular character by FNAC. Statistical analysis was done by Chi-square and multiple regression analysis. Results: Patients were mostly females (86%) and 4.7% had family history of thyroid problems. Some had recent changes of size (14.7%), pain in the nodule (4%) and dysphagia (6%). Nodules were solitary in 45.3% and the rest (54.7%) had multinodular goiter. Enlarged regional lymph node was found in 12.7% patients. About 41 % were partially-cold followed by cold nodules (26.7%), patchy (16.7%), isoform (12%) and hot (4%) by isotope scan. Frequency of malignant (10%) character was highest in cold nodules followed by uniform (5.6%), patchy (4.0%) and partially cold (1.6%) while none in hot nodules; which were 22.5%, 11.1 %, 4.0%, 9.8% and 16.7% respectively for suspicious nodules. About 17% showed cellular aberration and 4.7% were clearly malignant, whereas 124 (82.7%) were benign. Of the malignant, 4 were solitary and 3 were multinodular; which were 10 and 9 among the suspicious ones. A significant number (77%, 20 out of 26) among the malignant/suspicious nodules fell into moderate to high risk category (x2=22.861, p4 cm (p=0.039) and recent changes in nodular size (p=0.042) were independently and signifi­cantly related to cellular aberration. Conclusions: FNAC is a useful tool for cellular diagnosis of thyroid nodules. Clinical suspicion for malignancy strongly correlates with the FNAC findings. But a good number of clinically Low risk categories would escape malignant cellular character unless FNAC is done

Increased frequency of positive antithyroid antibody in nodular goiter

Background: Nodular goiter is mostly a benign thyroid tumor. A change of frequency of nodular goiter in areas with sufficient iodine intake has been documented in several reports. However, contrary to common belief it may also be associated with autoimmunity is being observed recently by many investigators.Objectives: To observe association between thyroid autoimmunity and nodular goiter. Methods: This cross sectional study included two hundred cases and one hundred controls. Clinically suspected nodular thyroid patients were confirmed by USG. Selection of healthy control was done after exclusion of nodule clinically and by USG. Data were collected through a structured questionnaire.Results: Frequency of positive anti-thyroid antibodies was significantly higher in nodular goiter cases, when anti-TPO and anti-TG considered together (42.5% vs. 25.0%; ?2=8.792, p=0.003) as well as individually (anti-TPO: 37.0% vs. 20.0%; ?2=8.955, p=0.004 and anti-TG: 31.0% vs. 9.0%; ?2=17.861, p&lt;0.001) in the patients with nodular goiter than that of control. Conversely, there was no statistical difference between STN and MNG for antibody status when considered together (41.lvs. 42.5%; ?2=0.093; p=0.769) or separately (for anti-TPO: 34.2% vs. 38.6%; ?2=0.374, p=0.648 and anti TG: 27.4% vs. 33.1%; ?2=0.698, p=0.431). Also there was no statistical disparity for frequency of positivity of the two antibodies in STN (p=0.359) and MNG (p=0.167).Conclusion: Significant number of nodular goiter cases was positive for anti-thyroid antibodies