Association of vitamin D and insulin resistance among the adults with newly detected prediabetes attending in a tertiary care hospital of Bangladesh

Several studies have found an inverse association between vitamin D level and insulin resistance (IR) causing prediabetes and diabetes. So the current study was done to find out the association between serum vitamin D level and IR among adults with prediabetes. This cross-sectional study was carried out in 140 newly detected adults with prediabetes according to ADA 2018 criteria. The 25(OH) D cutoffs to define deficiency and insufficiency were used according to Endocrine Society (USA) criteria, measurement of vitamin D & insulin (fasting) was done by chemiluminescent microparticle immunoassay (CMIA). Data were analyzed using SPSS (version 22.0) and presented as table and figure. P-value ≤0.05 was considered significant. In this study, most of the population was 30 years and above (73%). The Male-female ratio was 1:7, the majority of participants came from urban areas (81%) and it was observed that there was an increasing trend of insulin resistance across increasing severity of vitamin D deficiency though it was not statistically significant (p= 0.74). In conclusion, vitamin-D deficiency/insuffi- ciency is common among individuals with prediabetes in our country, but there were no associ- ation had been found between vitamin D and insulin resistance in individuals with prediabetes BSMMU J 2021; 14(4): 157-16

Castlemans Disease - A Rare Cause of Pyrexia of Unknown Origin (PUO): Case Report

Pyrexia of unknown origin (PUO) is a common problem in medical practice. Patients suffer from fever for long period but initial relevant investigations remain normal. Infection is the most common cause of PUO in developing countries. Other causes are lymphoma, myeloma, connective tissue diseases (CTD), sarcoidosis and malignancy etc. In our country, where no cause can be identified, a usual practice is to start anti-tubercular drugs. We report a patient who was suffering from prolonged fever and usual investigations were within normal limit except high erythrocyte sedimentation rate. In spite of having 6 months anti-tubercular drugs, the patient did not respond. Thorough examination revealed a paraaortic mass which was reconfirmed by ultrasound of abdomen. Laparotomy revealed a mesenteric lymph node that was removed. Histopathologically it was diagnosed as a case of CASTLEMAN'S DISEASE which is a rare cause of PUO. On removal of the lymph node, the patient improved dramatically. Key words: Castleman's disease; PUO DOI: 10.3329/bsmmuj.v2i2.4764 BSMMU J 2009; 2(2): 85-8

Psychiatric Morbidity Among Suicide Attempters Who Needed ICU Intervention

Background: Suicide is a tragic and serious but preventable public health problem all over the world including Bangladesh. Committing suicide has become a burning issue and mortality rate increases especially in young females. Psychiatric evaluation is needed in suicide attempted patients for better management plan to reduce such unnatural mortality, as well as the impairment related to suicidal thought and psychiatric disorders. Objectives: To assess the psychiatric disorders and conditions that needed sufficient clinical attention among the suicide attempters who needed ICU intervention. Methods: This cross-sectional study was carried out in an Intensive Care Unit (ICU) of a private hospital of Dhaka City from July 2008 to December 2008. Total forty four subjects of attempted suicide were included in the study and psychiatric diagnosis was made by using Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV by psychiatrists after initial physical problems subsided. Results: The most common psychiatric diagnosis was Major Depressive Disorder. Female suffered more and among them attention-seeking behaviors were frequent. Thirty-four patients (77.3%) had previous history of psychiatric disorder. Chemicals (like; organophosphorous, kerosene, harpic and other medicine overdose) ingestion was the most frequently used method by the suicide attempters. Conclusion: This study may be helpful for further research regarding suicide attempters and its' association with mental problems. In primary health care setting, the physicians may get a clue to design a system for preventing, early recognition and managing suicidal ideas, thoughts and attempts. Psychiatric consultation should be made mandatory for all patients admitted following attempted suicide. DOI: 10.3329/bsmmuj.v2i2.4761 BSMMU J 2009; 2(2): 73-7

Response surface methodology (RSM) on the hybrid nanofluid flow subject to a vertical and permeable wedge

The mixed convection flow with thermal characteristics of a water-based Cu-Al2O3 hybrid nanofluid towards a vertical and permeable wedge was numerically and statistically analyzed in this study. The governing model was constructed using physical and theoretical assumptions, which were then reduced to a set of ordinary differential equations (ODEs) using similarity transformation. The steady flow solutions were computed using the Matlab software bvp4c. All possible solutions were presented in the graphs of skin friction coefficient and thermal rate. The numerical results show that the flow and thermal progresses are developed by enhancing the controlling parameters (wedge parameter, volumetric concentration of nanoparticles, and suction parameter). Moreover, the response surface methodology (RSM) with analysis of variance (ANOVA) was employed for the statistical evaluation and conducted using the fit general linear model in the Minitab software. From the standpoint of statistical analysis, the wedge parameter and volumetric nanoparticle concentration have a considerable impact on all responses; however, the suction parameter effect is only substantial for a single response

Response surface methodology (RSM) on the hybrid nanofluid flow subject to a vertical and permeable wedge

The mixed convection flow with thermal characteristics of a water-based Cu-Al2O3 hybrid nanofluid towards a vertical and permeable wedge was numerically and statistically analyzed in this study. The governing model was constructed using physical and theoretical assumptions, which were then reduced to a set of ordinary differential equations (ODEs) using similarity transformation. The steady flow solutions were computed using the Matlab software bvp4c. All possible solutions were presented in the graphs of skin friction coefficient and thermal rate. The numerical results show that the flow and thermal progresses are developed by enhancing the controlling parameters (wedge parameter, volumetric concentration of nanoparticles, and suction parameter). Moreover, the response surface methodology (RSM) with analysis of variance (ANOVA) was employed for the statistical evaluation and conducted using the fit general linear model in the Minitab software. From the standpoint of statistical analysis, the wedge parameter and volumetric nanoparticle concentration have a considerable impact on all responses; however, the suction parameter effect is only substantial for a single response

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

Effect of Ramadan Fasting on Anthropometric Measures and Metabolic Profiles among Type 2 Diabetic Subjects

Background: Fasting from dawn to dusk during the month of Holy Ramadan is obligatory for all healthy adult Muslims. Individuals are exempted from fasting if they are suffering from an illness that could be adversely affected by fasting. Although The Quran exempts sick people from fasting, many Muslim diabetic patients may not perceive themselves as sick and are keenly interested to fast. But they fast without proper medical guidance exposing themselves to certain risks as a direct consequence of fasting. So we designed this study to assess the impact of fasting during Ramadan and to evaluate the effects of fasting on their biochemical profiles in patients with diabetes. Objective: The objective of this study was to investigate whether Ramadan fasting has any effect on body weight, blood pressure, fasting glucose, HbA1C, serum lipids, serum creatinine among type 2 diabetic patients. Materials and Methods: Fifty two stable outpatients with type 2 diabetes with intention to fast were studied in the month of Ramadan 1434 Hijri calendar year (11th July to 9th August, 2013) at two points of time: one week before Ramadan (visit 1) and within last 3 days before the end of Ramadan (visit 2). During each visit the height, body weight and blood pressure were recorded. Blood samples were collected for fasting glucose, HbA1C, total cholesterol, triglyceride, high density and low density lipoprotein cholesterol and creatinine. Data were analyzed by Student’s paired t-test using SPSS system and results were expressed as mean ± SD. Probability values were considered to be significant if it was less than 0.05. Results: There were 30 (62.8%) males and 22 (37.2%) females with a mean age of 54.7 ± 11.55 (range 35–80) years and mean duration of diabetes was 5.5 ± 5.2 years (range 9 months–18 years). In this study mean weight of the patients decreased significantly from 60.5 ± 12.6 kg to 58.5 ± 11.3 kg (p<0.001). Blood pressure reduced but not significantly. Fasting blood glucose showed significant reduction from 10.7 ± 4.2 to 8.9 ± 3.7 mmol/L (p=0.002) at the end of the study though HbA1C showed no significant change. Lipid profile and serum creatinine values did not show any significant change. Conclusion: The effects of fasting during Ramadan on stable diabetic patients are minimal. So, stable diabetic patients can fast during Ramadan without significant detrimental effects

Serum Creatinine and Uric Acid Levels in Hypothyroid Patients: A Cross Sectional Study

Background: Hypothyroidism is associated with many biochemical abnormalities including increased serum creatinine and uric acid levels. Many studies were done abroad regarding serum creatinine and uric acid levels in hypothyroid patients. We designed this study in our population for evaluation of serum creatinine and uric acid levels in hypothyroid patients.Objective: To assess serum creatinine and uric acid levels in hypothyroid patients and to find out relationship of creatinine and uric acid levels with severity of hypothyroidism.Materials and Methods: This retrospective cross sectional study to evaluate the serum creatinine and uric acid levels of hypothyroid patients and to find out relationship of hyperuricemia and hypercreatininemia with severity of hypothyroidism was done in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka. Results were compared with that of age and sex matched healthy euthyroid controls. Statistical analyses were performed by using SPSS for Windows version 10.0. ANOVA and unpaired ‘t’ tests were done to see the significance among the groups and between groups respectively. Pearson’s correlation coefficient test was done to see the correlation of serum creatinine and uric acid levels with the severity of hypothyroidism.Results: Mean serum creatinine and uric acid levels in cases were 1.38 ± 0.53 and 7.00 ± 2.54 mg/dL respectively compared to 1.01 ± 0.17 and 5.21 ± 1.35 mg/dL in controls.Conclusion: Mean serum creatinine and uric acid levels were found significantly higher in hypothyroid patients compared to controls. These findings suggest that hyperuricemia and hypercreatininemia are associated with hypothyroidism. Therefore, patients presenting with these biochemical abnormalities are recommended to be investigated to explore hypothyroidism

Thyroid hormone profile in apparently healthy pregnant women attending in a tertiary care hospital of Bangladesh

Background: Thyroid dysfunction is not uncommon in pregnancy. It should be evaluated for better outcome of pregnancy. Objective: To observe the thyroid hormone profile in apparently euthyroid pregnant women of any trimester. Methods: This cross-sectional study investigated 350 pregnant women irrespective of gestational age [(age 24±4, m±SDyr; 1st trimester = 101, 2nd trimester=111, 3rd trimester=138) for thyroid stimulating hormone (TSH) and for free thyroxine (FT4)] to assess their thyroid function during pregnancy following the criteria of American Thyroid Association (ATA). Results: Most of the mothers were housewifes (93.1 %, 326/350) of whom 46.6% were primigravida. About 63% mother had associated goiter, 58% (204/350) were euthyroid and 41 % (142/350) were subclinical hypothyroid (SCH). Frequency of goiter (63% vs. 62%, euthyroid vs. dysfunction) was not significantly different between dysfunction and normal groups. FT4 significantly correlated with gestational age (r= - 0.131, p=0.014) and TSH level (r= - 0.612, p< 0.001). Conclusion: It is concluded that many of the apparently euthyroid pregnant mother have dysfunction as defined by ATA reference ranges for TSH and FT4. Simple screening for thyroid function may have greater implication for better pregnancy outcome

Thyroid hormone profile in apparently healthy pregnant women attending in a tertiary care hospital of Bangladesh

Background: Thyroid dysfunction is not uncommon in pregnancy. It should be evaluated for better outcome of pregnancy.Objective: To observe the thyroid hormone profile in apparently euthyroid pregnant women of any trimester. Methods: This cross-sectional study investigated 350 pregnant women irrespective of gestational age [(age 24±4, m±SDyr; 1st trimester = 101, 2nd trimester=111, 3rd trimester=138) for thyroid stimulating hormone (TSH) and for free thyroxine (FT4)] to assess their thyroid function during pregnancy following the criteria of American Thyroid Association (ATA).Results: Most of the mothers were housewifes (93.1 %, 326/350) of whom 46.6% were primigravida. About 63% mother had associated goiter, 58% (204/350) were euthyroid and 41 % (142/350) were subclinical hypothyroid (SCH). Frequency of goiter (63% vs. 62%, euthyroid vs. dysfunction) was not significantly different between dysfunction and normal groups. FT4 significantly correlated with gestational age (r= - 0.131, p=0.014) and TSH level (r= - 0.612, p&lt; 0.001).Conclusion: It is concluded that many of the apparently euthyroid pregnant mother have dysfunction as defined by ATA reference ranges for TSH and FT4. Simple screening for thyroid function may have greater implication for better pregnancy outcome