Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 μg ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist

Subclinical Hypothyroidism & Infertility: A Review

Subclinical hypothyroidism (SCH) may be of greater clinical importance in women with “unexplained” infertility, especially when the luteal phase is inadequate, and such patients should be investigated for thyroid dysfunction in detail. To date, studies investigating the association between SCH and infertility are still based on the high serum thyroid stimulating hormone (TSH) levels while some older studies are based on the presence of an abnormal serum TSH after a thyrotropin releasing hormone (TRH) stimulation test. The recommendation in the current guidelines to treat subclinical hypothyroidism is based on minimal evidence and it is thought that with treatment the potential benefits outweigh the potential risks. Thyroxine-replacement therapy should be started in patients with SCH caused by conditions which are at high risk of progression to overt hypothyroidism. Ibrahim Med. Coll. J. 2014; 8(1): 17-2

Neck circumference as a marker of overweight and obesity and cutoff values for Bangladeshi adults

Objective: There are several methods of assessing overweight and obesity. Several studies conducted in different populations indicate that neck circumference (NC) can be used as a simple measure of overweight and obesity. This study was conducted to evaluate NC as a marker of overweight and obesity and to determine respective cutoff values for Bangladeshi male and female participants. Research Design/Materials and Methods: This cross-sectional observational study was conducted with during July 2013–June 2014 among randomly selected 871 Bangladeshi participants (male = 496 [56.9%], female = 375 [43.1%], aged >18 years) who visited Outpatient Department of United Hospital, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders, primary health-care centers located in Dhaka, Savar, Gazipur. NC of participants was taken in centimeter to the nearest 1 mm, using plastic tape measure. Main outcome included NC, waist circumferences (WC), body mass index (BMI), and waist: hip ratio (WHR). Results: Pearson's correlation coefficients indicated a significant association between NC and height (men, r = 0.33; women, r = 0.28; P 90 cm in men and > 80 cm in women, respectively. NC ≥34.45 cm in male (AUC: 0.59; P= 0.001) and NC ≥31.25 cm in women (AUC: 0.66; P = 0.008) were the best cutoff value for WHR >0.9 in men and >0.8 in women, respectively. Conclusion: NC measurement is a simple, convenient, inexpensive screening measure to identify overweight and obese participants. Men with NC ≥34.75 cm and women with NC ≥31.75 cm are to be considered overweight while men with NC ≥35.25 cm and women with NC ≥34.25 cm are to be considered obese. NC ≥35.25 cm in male and NC ≥31.25 cm in women were the best cutoff value for abdominal obesity

Guide on Diabetes and COVID-19 for Healthcare Professionals in Bangladesh

The world is suffering from a pandemic of coronavirus disease-2019 (COVID-19), and people with diabetes mellitus (DM) are more vulnerable to the serious effects of the COVID-19. This interaction is alarming, considering the high transmission rate of COVID-19 and the global prevalence of DM. Considering the importance of the link between COVID-19 and DM, Bangladesh Diabetic Association has formed a panel of national and international experts in the field of public health, diabetes, and endocrinology to provide some evidence-based guidance for the prevention and care of people with DM during the COVID-19 pandemic

Guide on Diabetes and COVID-19 for Healthcare Professionals in Bangladesh

The world is suffering from a pandemic of coronavirus disease-2019 (COVID-19), and people with diabetes mellitus (DM) are more vulnerable to the serious effects of the COVID-19. This interaction is alarming, considering the high transmission rate of COVID-19 and the global prevalence of DM. Considering the importance of the link between COVID-19 and DM, Bangladesh Diabetic Association has formed a panel of national and international experts in the field of public health, diabetes, and endocrinology to provide some evidence-based guidance for the prevention and care of people with DM during the COVID-19 pandemic

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a multinational collaborative research study with >10,000 collaborators around the world. GBD generates a time series of summary measures of health, including prevalence, cause-specific mortality (CSMR), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) to provide a comprehensive view of health burden for a wide range of stakeholders including clinicians, public and private health systems, ministries of health, and other policymakers. These estimates are produced for 371 causes of death and 88 risk factors according to mutually exclusive, collectively exhaustive hierarchies of health conditions and risks. The study is led by a principal investigator and governed by a study protocol, with oversight from a Scientific Council, and an Independent Advisory Committee.1 GBD is performed in compliance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).2 GBD uses de-identified data, and the waiver of informed consent was reviewed and approved by the University of Washington Institutional Review Board (study number 9060). This almanac presents results for 18 cardiovascular diseases (CVD) and the CVD burden attributed to 15 risk factors (including an aggregate grouping of dietary risks) by GBD region. A summary of methods follows. Additional information can be found online at https://ghdx.healthdata.org/record/ihme-data/cvd-1990-2022, including:Funding was provided by the Bill and Melinda Gates Foundation, and the American College of Cardiology Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The contents and views expressed in this report are those of the authors and do not necessarily reflect the official views of the National Institutes of Health, the Department of Health and Human Services, the U.S. Government, or the affiliated institutions