Silent Myocardial Ischemia (SMI) and its Association with Microalbuminuria in Type 2 Diabetes Mellitus (DM)

Background: As silent myocardial ischemia (SMI) is more common in diabetic population leading to the development of future coronary artery disease (CAD), so its early diagnosis is important. SMI can be diagnosed by conventional cardiac stress testing. Presence of SMI can also be suspected by microalbuminuria (MAU) because recently it is claimed that MAU is one of the important predictor for cardiovascular disease. Objective: The study was designed to explore the association between SMI & MAU in type 2 DM. Methods: It was a cross sectional study carried out in the Department of Biochemistry, BSMMU during the period of July 2006 to June 2008. One hundred diagnosed type 2 DM patients were selected from out patient department of BIRDEM. Enrolled study subjects were advised to do ETT and then categorized as ETT +ve & ETT-ve on the basis of ETT findings. Urinary micro albumin was measured in all study subjects. Unpaired t test, , chi square test, odds ratio were used to see the level of significance Results: Among the 100 type 2 diabetic subjects of both sexes 50 (male -24, female- 26) were ETT +ve designated as type 2 DM with silent MI and rest 50 ( male- 25 , female-25) were ETT ve designated as type 2 DM without silent MI. 21 patients (42%) out of 50 type 2 DM with silent MI & 16 patients (32%) out of 50 type 2 DM without silent MI found to have microalbuminuria. Calculated odds ratio was 1.5. Conclusion: Microalbuminuria is a possible risk factor for SMI in type 2 DM. Urinary micro albumin can be used particularly as a screening test for early detection of SMI.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11016 BSMMU J 2012; 5(1):42-4

Silent Myocardial Ischemia (SMI) and its Association with Microalbuminuria in Type 2 Diabetes Mellitus (DM)

Background: As silent myocardial ischemia (SMI) is more common in diabetic population leading to the development of future coronary artery disease (CAD), so its early diagnosis is important. SMI can be diagnosed by conventional cardiac stress testing. Presence of SMI can also be suspected by microalbuminuria (MAU) because recently it is claimed that MAU is one of the important predictor for cardiovascular disease. Objective: The study was designed to explore the association between SMI & MAU in type 2 DM. Methods: It was a cross sectional study carried out in the Department of Biochemistry, BSMMU during the period of July 2006 to June 2008. One hundred diagnosed type 2 DM patients were selected from out patient department of BIRDEM. Enrolled study subjects were advised to do ETT and then categorized as ETT +ve & ETT-ve on the basis of ETT findings. Urinary micro albumin was measured in all study subjects. Unpaired t test, , chi square test, odds ratio were used to see the level of significance Results: Among the 100 type 2 diabetic subjects of both sexes 50 (male -24, female- 26) were ETT +ve designated as type 2 DM with silent MI and rest 50 ( male- 25 , female-25) were ETT ve designated as type 2 DM without silent MI. 21 patients (42%) out of 50 type 2 DM with silent MI & 16 patients (32%) out of 50 type 2 DM without silent MI found to have microalbuminuria. Calculated odds ratio was 1.5. Conclusion: Microalbuminuria is a possible risk factor for SMI in type 2 DM. Urinary micro albumin can be used particularly as a screening test for early detection of SMI. DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11016 BSMMU J 2012; 5(1):42-4

Ebola Virus Disease – Global Scenario & Bangladesh

Ebola virus disease (EVD), caused by one of the Ebola virus strains is an acute, serious illness which is often fatal when untreated. EVD, previously known as Ebola hemorrhagic fever, is a rare and deadly disease. It first appeared in 1976 in two simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.1,2 On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of EVD in Guinea. On August 8, WHO declared the epidemic to be a ‘Public health emergency of international concern’.3 The current 2014 outbreak in West Africa is the largest and most complex Ebola outbreak.1 It is to be noticed that the most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources and these countries recently emerged from long periods of conflict and instability.1 The virus family Filoviridae includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus. Till date five species have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The recent outbreak belongs to the Zaire species which is the most lethal one, with an average case fatality rate of 78%.1,4 Till 6 December 2014, total 17,834 suspected cases and 6,678 deaths had been reported; however, WHO has said that these numbers may be vastly underestimated.5 The natural reservoir for Ebola has yet to be confirmed; however, fruit bats of the Pteropodidae family are considered to be the most likely candidate species.1,2,6 Ebola can be transmitted to human through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, etc. Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.1 Health care workers have frequently been infected through close contact with patients with suspected or confirmed EVD while treating them and when infection control precautions are not strictly practiced.1 This risk is particularly common in parts of Africa where health systems function poorly and where the disease mostly occurs.7 In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures.8 Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.1 Sixty nine percent of the cases of Ebola infections in Guinea during the 2014 outbreak are believed to have been contracted via unprotected or unsuitably protected contact with infected corpses during certain Guinean burial rituals.9 People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.1 The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, etc. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.1 It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis and it is not easy to diagnose. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations: enzyme-linked immunosorbent assay (ELISA), antigen-capture detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay, electron microscopy and virus isolation by cell culture.1 Supportive care - rehydration with oral or intravenous fluids - and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD.1 Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors like reducing the risks of wildlife-to-human transmission and human-to-human transmission and also on outbreak containment measures.1 Health care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding, wear face protection besides routine measures. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff with utmost care and processed in suitably equipped laboratories.1 The infections of two health care workers in Dallas, USA and a nurse in Madrid, Spain have revealed the truth that even highly developed nations are not immune. Still, Asia has some advantages as it readies itself for Ebola. Flight patterns suggest that the influx of travelers from Ebola-stricken West African countries to the Asian continent is far less than it is to Africa, Europe or North America.10 The recent outbreak affecting several nations also alarmed the public health sector of Bangladesh. But virus and healthcare experts have assured that there is nothing to be anxious about Ebola in Bangladesh as it has been categorized as among the least threatened countries by the World Health Organization (WHO) on August 8, 2014 in its first Emergency Committee meeting.11 Bangladesh Government has already taken effective preventive measures suggested by WHO, which include careful screening of the people coming back home from Ebola affected countries and also giving adequate safety training on the threat of Ebola exposure to the people going to those countries.11 It is a matter of relief and contentment that the Institute of Epidemiology, Disease Control and Research (IEDCR) laboratory of Bangladesh has the capacity to primarily identify an Ebola patient but the identified samples need to be sent to the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta for a confirmed result which could take a couple of days.11 Moreover the WHO has promised all necessary technical support to Bangladesh and requested the government to increase vigilance and screening at ports. As part of an ongoing countrywide 90 day Ebola alert from October 2014, screening centres and health desks have been set up at 25 ports, including three international airports and two seaports of the country. Health directorate officials said 15 isolation wards at district hospitals near the ports have been kept ready to provide treatment if any suspected Ebola patient was found. A 20 bed specialized ward is also set to be opened soon at the Kurmitola General Hospital in Dhaka. Officials said 3,167 personnel - doctors, nurses and sanitary inspectors who work at the health desks at the ports - have been provided specialized training on Ebola detection, management and handling.12 Till date there is no effective treatment or no vaccine could be invented to fight against this lethal virus. Rather we have to surrender to the old dictum - ‘prevention is better than cure’. The only tools at our hands are public awareness and strict maintenance of universal precaution and avoiding handling of remains of infected animals or persons

Plagiarism – A Noble Misconduct

In science, writing is the most important means of communicating research findings. In most cases, authors of the scientific fraternity report the results of their research activities in scientific journals rather than in a standard scientific paper format.1 Scientific writing includes presentation of a number of documents that consists research related topics, new evidence based guidelines and protocols, case presentations, and review articles, which help in educating, promoting and sharing information to the professionals and also to general public. In modern days of wide availability of resources a rising misconduct by the apparently ‘noble’ writers of scientific papers is ‘plagiarism’. The word plagiarism is derived from Latin ‘Plagiare’ which means to kidnap.2 Most academic researchers reach a consensus that plagiarism is a serious breach of publication ethics.3 The World Association of Medical Editors (WAME) defines plagiarism as – ‘the use of others published and unpublished ideas or words (or other intellectual property) without attribution or permission, and presenting them as new and original rather than derived from and existing source’.2,4 In simple words, plagiarism is the use of others’ ideas or work without any credit to the original authors whether intentionally or unintentionally.2 Plagiarism dates back to the foundation of science communication as a discipline. According to the World Association of Medical Editors (WAME) strict definition, plagiarism is when six consecutive words are copied, or 7 to 11 words are overlapping in a set of 30 letters. 5-7 Plagiarism has different forms but can be categorized into two general distinct categories – plagiarism of ideas and plagiarism of text (verbatim). No doubt, plagiarism of ideas is a blatant act of misconduct. Plagiarism of text and recycling of words are also a serious fault in humanities and literature where the essence of work and novelty are wordings and eloquence of the text.8 But, there is a dilemma in scientific writing where the essence of the work is the originality of the scientific content no matter how it is presented.9 Unlike any other author, the author of a scientific paper are ought to follow certain well-established scientific methodology and always be careful not to be affected by his or her intuition or biases that might jeopardize the judgment of a researcher.9,10 For a scientific paper, the author has to take sufficient time to read and understand thoroughly the main source of the article, and then he can organize into his own ideas or thoughts. Before submitting their ideas or manuscript to the journal office, the author should rewrite the article in his own words without seeing from the original source and if in any doubt, should take help of the guide/instructor.4,11,12 Researchers and authors of scholarly papers have to follow ethical codes of Good Scientific Practice (GSP),13 primarily based of the principles of honesty and integrity.11 In the modern-day collaborative and multidisciplinary research, honesty of each and every author is becoming a pillar of trustworthy science.14 Scientists absorb new information, design new studies and publish their experimental results in various related biomedical journals. Because of the ease of using various search engines for researching resources on the internet, large numbers of published papers that contain an enormous amount of study materials can be quickly obtained. As such, plagiarism or duplicate publication may occur either consciously or unconsciously when the authors are preparing their manuscript.15 In fact availability of internet facilities and free online journals are the main sources of today's plagiarism among the students, faculty and researchers of any profession.6,16-19 Unfortunately, digitalization made copy-paste plagiarism and inappropriate re-use of sources from the websites, online journals, and other electronic media widespread.14 According to a recent study, in a sample of 62,213 MEDLINE citations, 0.04% of cases were examples of potential plagiarism and 1.35% of cases were considered duplicate publications. After extrapolation, this corresponded to as many as 3,500 and 117,500 cases of total citations, respectively.15 Publications are the endpoints and fruits of research projects that are meticulously planned and executed. By claiming authorship of scholarly works, researchers get promotion and numerous other academic benefits. However, they also become responsible for what they publish and influence future publications, and science and education at large.14 Unfortunately in the developing world, on the one hand, we lack the means of proper research training for new students, academicians, clinicians, and researchers, due to financial constraints.20 On the other hand, regulating authorities do not have alternative mechanisms to evaluate the professional standing of an individual except an individual's publications. Hence, an undue pressure to publish exists. Also, the lack of a clear idea and understanding of what plagiarism actually is and the consequences that follow upon attempting it often lead one to plagiarize.21 Duplicate publication and redundant publication are misconduct and waste of resources.22 “Readers deserve original content, and merely recycling parts of previously published work constitutes, at best, academic laziness”.3 Though it is completely true for many fields like literature, we are not pretty sure if it is also applicable to science. “Readers” of scientific papers are just looking for science presented in an appropriate format (wordings, graphs, tables, layout, etc). With enough scrutiny, one can find many typographical and grammatical errors in articles published in even prestigious mainstream journals; in most instances, most of the text can be written in more eloquent forms.10 Plagiarism surely deserves penalty. Since plagiarism can range from simple dishonesty to a serious misconduct, penalty depends on the severity of plagiarism. It ranges from formal disciplinary action (apology letters, retraction of the published article) to criminal charges (suspension and prosecution of authors).23-27 Due to the lack of knowledge on plagiarism or awareness among the authors, editors, reviewers, and educational institutions some types of plagiarized articles are allowed to publish unknowingly. All the scientific writers must check for the text duplication unintentionally by using plagiarism detection software before submitting to any journal office. Reviewers also should use plagiarism detection tools in order to avoid false publication practice and finally the editor of the journal should finalize the fate of the article based on the extent of plagiarism by using powerful plagiarism detection software. To detect plagiarism more easily, during the 80’s of last century software started being developed to detect academic and scientific plagiarism. Academic plagiarism is more easily detected by the software as Turnitin and SafeAssign and scientific plagiarism with CrossCheck and eTBlast software. The software consists of algorithms to detect similarities, associated databases and web sites by which it compares the article. Sometimes simple Google Search also helps in detecting plagiarism.28-35 It is very easy to find information on a topic that needs to be explored, but it is not always easy to add that information to own work and not to create a plagiarism. There are several ways to avoid plagiarism:14,36 • Paraphrasing - Important information written in own words. • Quote - It is literally the wording of certain authors and the sentences are always placed in quotes. • Citation - Citing is one of the effective ways to avoid plagiarism. This usually entails the addition of the author(s) and the date of the publication or similar information. Standard document formatting guidelines i.e. APA, MLA, Chicago, etc. are used. • References must be listed at the end of the article and includes sources where authors found the information in the given article. • Always follow the rules to properly cite references, acknowledging ideas taken at conference and formal/informal conversations; • Reference must include full bibliographic information; • Quotation marks should be used if are copied more than six consecutive words; • Citing own material - If the author of the material used it in an earlier paper, he/she shall quote him/herself, because if this is not done, this is self plagiarism. • The author must obtain permission from other authors/publishers to reproduce the tabular, graphic or picture attachments or used text under copyright. In order to publish a good scientific paper, one has to make an honest effort to read the original sources thoroughly and then put down one's own ideas or thoughts in his own words with proper paraphrasing, citation and by using quotation marks where ever necessary to avoid plagiarism.28 Many biomedical journals have policies against plagiarism and duplicate publication because such acts of misconduct should be condemned. It should be realized that while handling editor and reviewers of a certain journal may not be aware that a submitted paper is a duplicate one, in many cases readers or researchers in bioinformatics will eventually detect such wrongdoing. The published authors may be regarded as cheaters once they are caught because plagiarism is such a serious violation of integrity and our value as scholars, and they will be punished as such.1

Diabetic Retinopathy and Homocysteine in Newly Diagnosed Type 2 Diabetes Mellitus

Background: Diabetic retinopathy is the commonest complication that occurs from the very beginning in patients with diabetes mellitus (DM). DM itself leads to increased homocysteine (Hcy) level. It is postulated that hyperhomocysteinaemia causes retinal vascular damage as Hcy is an established vasculotoxic agent and auto-oxidation of Hcy leads to oxidative stress, endothelial dysfunction, platelet activation and thrombus formation.Objective: The aim of the study was to evaluate the serum Hcy in newly diagnosed type 2 diabetic subjects with diabetic retinopathy.Materials and method: A case control study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period of January 2006 to December 2007. Total 85 newly diagnosed type 2 diabetic subjects were included in this study, 40 were case having retinopathy and 45 were age and sex matched control without retinopathy. Serum Hcy was measured and compared between case and control.Results: Serum Hcy level in cases was significantly higher (p<0.05) compared to that of control (15.11±5.49 μmol/L vs. 12.59±4.01 μmol/L). Odds ratio was also determined for hyperhomocysteinemia (OR=2.23; CI 0.9-5.45).Conclusion: Hyperhomocysteinaemia is associated with diabetic retinopathy in newly diagnosed type 2 diabetes

Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin

Background: In recent years the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) in patients of chronic liver disease (CLD) of various origins has gained much attention. This variable is readily available, easy to interpret, and inexpensive and the clinical utility of the AST/ALT ratio in the diagnostic workup of patients with CLD is quite promising. Objective: The present study was designed to find out the link between aminotransferase (AST/ALT) ratio with commonly measured biochemical parameters of liver function tests in CLD of viral origin. Materials and method: This cross sectional study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh. Forty four biopsy proven diagnosed subjects of chronic viral hepatitis without cirrhosis of both sex were selected purposively. With aseptic precaution 5 mL venous blood was collected from each subject and common liver function tests (serum AST, ALT, AST/ALT ratio, alkaline phosphatase, total bilirubin, serum total protein, serum albumin, serum globulin, serum albumin/globulin ratio, prothrombin time) and viral serology (HBsAg, Anti HDV antibody, Anti HCV antibody) were performed. Data were analyzed by SPSS version 19 for Windows. Pearson’s correlation test was done to determine association between AST/ALT with other biochemical parameters. Results: Mean(±SD) age of the study subjects was 32.55±10.55 years (range 20-50 years) with 48 (77.7%) male and 14 (22.6%) female subjects. Pearson’s correlation test was done between AST to ALT ratio with other biochemical parameters and prothrombin time showed significant positive correlation (p <0.01). Conclusion: In our study we found significant positive correlation between AST/ALT with prothrombin time in CLD subjects without cirrhosis

Lipid Profile of Postmenopausal Women with Central Obesity

Background: Following menopause there are changes in values of lipid profile parameters. Abdominal obesity has also been linked to significant metabolic abnormalities including changes in lipid parameter values. So, we designed this study to observe the pattern of lipid profile parameters in postmenopausal central obese women. Objective: To assess the lipid profile status of postmenopausal women with central obesity. Materials and Methods: This cross sectional study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period of January 2005 to December 2005. Seventy four postmenopausal women with central obesity and age matched 56 nonobese postmenopausal women were included in the study. Central obesity was defined having waist hip ratio more than 0.8. All statistical analyses were done by SPSS 12.0. p values <0.05 were considered significant. Results: Statistically no significant difference was observed between the central obese women and nonobese women in total cholesterol and LDL-cholesterol levels. But HDL-cholesterol was found lower and triacylglycerol was found higher in postmenopausal central obese women. Conclusion: Dyslipidaemia is a feature of postmenopausal women with central obesity

Serum Lipids and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetic Subjects

Background: Diabetic retinopathy is the commonest and usually the first observable vascular complication of diabetes mellitus. Along with hyperglycaemia, dyslipidaemia is a contributing factor for the occurrence of diabetic retinopathy. It is postulated that dyslipidaemia results in formation of hard exudate by increasing blood viscosity and altering the fibrinolytic system. A case control study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of January 2006 to December 2007 to evaluate the serum lipid profile in newly diagnosed type 2 diabetic subjects with diabetic retinopathy. Materials and Methods: Total 85 newly diagnosed type 2 diabetic subjects were included in this study, 40 were cases having retinopathy and 45 were age and sex matched controls without retinopathy. Serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were compared between cases and controls. Unpaired t-test and chi-square test were done between groups as tests of significance. Results: All the parameters of lipid profile showed dyslipidaemic trend both in cases and controls. In the cases TG was significantly higher and HDL-C was significantly lower than that of controls (p < 0.05) whereas no significant difference was found between cases and controls with respect to serum TC and LDL-C. Conclusion: It can be concluded that high TG and low HDL-C are associated with diabetic retinopathy in newly diagnosed type 2 diabetes

Association of High Density Lipoprotein Cholesterol with Renal Function in Type 2 Diabetic Subjects in a Bangladeshi Population

Background: Abnormalities in lipid metabolism are associated with renal diseases. Association of serum lipid parameters with renal function is less studied in subjects with type 2 diabetes in Bangladeshi population. Objective: To assess the correlation of high density lipoprotein cholesterol with glomerular filtration rate (GFR) in type 2 diabetic subjects. Materials and Methods: One thousand three hundred thirty confirmed diabetic subjects advised for HbA1c, serum creatinine, serum total cholesterol, serum triglycerides, serum HDL cholesterol and LDL cholesterol were included in the study. Serum total cholesterol, HDL cholesterol, triglyceride, serum creatinine, HbA1c were measured by standard methods and serum LDL cholesterol was calculated by Friedewald’s formula. GFR was calculated by MDRD4 variables prediction equation. Total subjects were grouped according to sex; both males and females were subdivided into three subgroups depending on GFR values. Results of lipid parameters were compared by one-way ANOVA among different groups and correlation of lipid parameters with GFR were expressed by Pearson r. Results: HDL cholesterol was significantly different among different GFR groups (p<0.05) and positively correlated with GFR (r = 0.1386, p<0.001) in males. Total cholesterol and LDL cholesterol showed feeble positive correlation with GFR (r = 0.0789, p<0.05 for total cholesterol and r = 0.0768, p<0.05 for LDL cholesterol), but are not significantly different among GFR groups (p>0.05) in males. Total cholesterol, HDL cholesterol, LDL cholesterol, non-HDL cholesterol and LDLC/HDL-C were significantly different among three different GFR groups (p<0.01) and only HDL cholesterol and LDL-C/HDL-C showed weak correlation with GFR (r = 0.0770, p<0.05 for HDL cholesterol and r = -0.0803, p<0.05 for LDL-C/HDL-C) in females. Conclusion: The study revealed that HDL cholesterol was significantly and positively correlated with glomerular filtration rate in both male and female diabetic subjects and assessment of lipid parameters might be a helpful tool to prevent or delay the progression of renal insufficiency