Endocrine disruptors: emerging health concerns

Abastract not available. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(3): 131-13

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.

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

Efficacy and Safety of Omarigliptin, a Novel Once-Weekly Dipeptidyl Peptidase-4 Inhibitor, in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background No recent meta-analysis has holistically analyzed and summarized the efficacy and safety of omarigliptin in type 2 diabetes mellitus (T2DM). We conducted a meta-analysis to address this knowledge gap. Methods Electronic databases were searched to identify randomized controlled trials (RCTs) that included patients with T2DM who received omarigliptin in the intervention arm. The control arm consisted of either a placebo (passive control group [PCG]) or an active comparator (active control group [ACG]). The primary outcome assessed was changes in hemoglobin A1c (HbA1c), while secondary outcomes included variations in glucose levels, achievement of glycemic targets, adverse events (AEs), and hypoglycemic events. Results From 332 initially screened articles, data from 16 RCTs involving 8,804 subjects were analyzed. Omarigliptin demonstrated superiority over placebo in reducing HbA1c levels (mean difference, –0.58%; 95% confidence interval, –0.75 to –0.40; P<0.00001; I2=91%). Additionally, omarigliptin outperformed placebo in lowering fasting plasma glucose, 2-hour postprandial glucose, and in the percentage of participants achieving HbA1c levels below 7.0% and 6.5%. The glycemic efficacy of omarigliptin was similar to that of the ACG across all measures. Although the omarigliptin group experienced a higher incidence of hypoglycemic events compared to the PCG, the overall AEs, serious AEs, hypoglycemia, and severe hypoglycemia were comparable between the omarigliptin and control groups (PCG and ACG). Conclusion Omarigliptin has a favorable glycemic efficacy and safety profile for managing T2DM

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

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

Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale.

INTRODUCTION: Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. METHODS AND ANALYSIS: The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02746003; Pre-results

Annual Incidence of Snake Bite in Rural Bangladesh

Snake bite is one of the major causes of morbidity and mortality in many rural tropical areas. As a neglected public health problem, estimate of the risk is largely unknown. However, the associated personal and economic impact of snake bite is substantial across developing countries. This national survey investigated the risk and consequences of snake bite among the rural Bangladeshi population. We surveyed 18857 individuals from 24 out of 64 districts in Bangladesh where 98 snake bites including one death were reported. The estimated incidence density of snake bite is 623.4/ 100,000 person years (95% CI: 513.4–789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) received snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of them went directly to either a medical doctor or a hospital. The observed rate of snake bite in rural Bangladesh is substantially higher than anticipated. This coupled with poor access to health services led to an increase in related morbidity and mortality. An improvement in public health actions is therefore warranted