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   Table of Contents - Current issue
January-April 2023
Volume 2 | Issue 1
Page Nos. 1-61

Online since Monday, February 27, 2023

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Bangladesh endocrine society guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum p. 1
Shahjada Selim, Md Faruque Pathan, Muhammad Hafizur Rahman, Mohammad Saifuddin, Nazmul Kabir Qureshi, Ahmed Salam Mir, Faria Afsana, Tahniyah Haq, A. B. M. Kamrul-Hasan, S. M. Ashrafuzzaman
Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the recognized guidelines and based on expert experience, as comprehensive national guidelines are currently lacking. The Bangladesh Endocrine Society (BES), as a professional body, has been working to develop guidelines for the last couple of years. Most recently, BES formulated practical recommendations for the management of thyroid disorders during pregnancy, which will be termed the “Guideline on Thyroid Disorders in Pregnancy in Bangladesh 2022,” Methods: The BES formed a task force comprising experts in this field to formulate the practical recommendations for the management of thyroid disorders during pregnancy under several sections. The members of this task force comprehensively reviewed the available evidence for the specific conditions. Three well-known databases (Google Scholar, PubMed, and Scopus) were searched to determine the evidence. The task force members were well trained on reviewing the documents and methods of evidence synthesis. Each section of the recommendation was drafted by one member and subsequently reviewed. There was no barrier to the date or type of article published in the aforementioned databases except for articles published other than English. Due to the scarcity of intervention studies, ideas and findings of observational studies, case studies and expert recommendations were considered during the formulation of the guidelines. All members and affiliated persons declared no competing interest, and it was managed and communicated by the President of the BES. Results: The current guidelines for the management of thyroid disease in pregnancy include recommendations about the screening of thyroid function in pregnancy, planning pregnancy in women with thyroid disorders, interpretation of thyroid function tests, management of hypothyroidism and hyperthyroidism in pregnancy, management of thyroid nodules and thyroid emergencies throughout pregnancy, postpartum care, and directions of future research. Conclusions: Our utmost efforts were centered on developing evidence-based recommendations to inform all the levels of clinicians of Bangladesh for the easy understanding and decision-making processes in the management of thyroid disorders in pregnancy and afterward. While we care most to prepare the guideline, all recommendations are the opinion of society and admit the scope of making individualized decisions for the optimal care of patients.
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Prevalence and characteristics of women with polycystic ovary syndrome in Bangladesh – A narrative review p. 20
A B. M. Kamrul-Hasan, Fatema Tuz Zahura Aalpona, Marufa Mustari, Shahjada Selim
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women. PCOS is not a homogeneous disease and can manifest as a range of multifaceted problems, including various reproductive, cosmetic, cardiometabolic, and psychiatric conditions. In Bangladesh, research defining the prevalence and characteristics of PCOS is not ample. This review summarizes the findings from published studies that provide consistent evidence on the prevalence and characteristics of women with PCOS in the country. The small-scale studies conducted among different subgroups of women indicate a high prevalence of the condition. Clinical presentations of PCOS in Bangladeshi women are also highly variable. A substantial portion has obesity, insulin resistance, abnormal glucose tolerance, dyslipidemia, and metabolic syndrome, which significantly threaten their cardiovascular health. Many of them have co-existent other endocrinopathies, including thyroid abnormalities. Moreover, highly prevalent psychiatric comorbidities among these women warrant routine screening for these conditions.
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Comparison of Vitamin D Status between Resident and Nonresident Bangladeshis with Type 2 Diabetes Mellitus: A Single-Center, Cross-Sectional Study p. 29
Muhammad Shah Alam, Syeda Tanzina Kalam, Rahul Saha, A B. M Kamrul-Hasan
Background and Objectives: Vitamin D deficiency (VDD) is highly prevalent in both healthy population and patients with type 2 diabetes mellitus (T2DM) in Bangladesh. Data on Vitamin D status in nonresident Bangladeshi (NRB) individuals with T2DM are scarce. We conducted this study to compare the Vitamin D status between resident and NRBs. Materials and Methods: This cross-sectional study evaluated 234 patients with T2DM (109 resident Bangladeshis [RBs] and 125 NRBs) attending a specialized diabetes hospital in Cumilla city, Bangladesh, from July 2021 to February 2022. Serum 25(OH)D <20 ng/mL defined VDD. Results: The mean age of the study participants was 42.5 ± 9.4 years; the frequencies of obesity, hypertension, dyslipidemia, and uncontrolled diabetes (HbA1c ≥7%) were 79.1%, 45.7%, 93.6%, and 88.9%, respectively. The Middle East countries were the residing countries of most (92.8%) of the NRBs. Higher frequencies of smokers and dyslipidemia were observed among RBs. The body mass index and HbA1c were higher, and low-density lipoprotein cholesterol was lower among NRBs than RBs. In the study participants, the mean 25(OH)D level was 25.7 ± 10.2 ng/mL; 30.3%, 38.5%, and 31.2% of the study participants were sufficient, insufficient, and deficient in Vitamin D, respectively. RBs and NRBs had similar 25(OH)D levels (25.7 ± 11.9 vs. 25.8 ± 8.5 ng/mL, P = 0.948) and VDD status (36.7% vs. 26.4%, P = 0.124). Conclusion: Low Vitamin D is highly prevalent in both RBs and NRBs with T2DM though they have similar Vitamin D levels and comparable rates of VDD. Further studies are needed to determine the factors that influence Vitamin D status in our people.
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Diabetic neuropathy, a cause of pulmonary dysfunction in patients of type 2 diabetes mellitus: A prospective cross-sectional study p. 35
Piyush Gautam, Ahmad Faraz, Hamid Ashraf, Sangeeta Singhal
Introduction: Diabetic neuropathy (DN) is most commonly associated with diabetic peripheral neuropathy (DPN). About 66% of diabetic patients have either clinical or subclinical neuropathy. Materials and Methods: One hundred and twenty patients were enrolled in our study, 60 patients are of Type 2 diabetes mellitus (T2DM) with neuropathy (DPN), and 60 were of T2DM without neuropathy. They were assessed for neuropathy. Serum fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin A1C (HbA1C), and duration of disease were obtained from the patients. Forced expiratory volume at the 1st s (FEV1) and forced vital capacity were recorded and % FEV1 was calculated. Results: The mean age of T2DM with neuropathy was 49.17 ± 7.1 and in patients of T2DM without neuropathy was 46.63 ± 8.028. The mean value of % FEV1 in T2DM with neuropathy is 95.45 ± 7.16, while in T2DM without neuropathy, it is 83.53 ± 6.22, and the difference was statistically significant. Linear correlation of % FEV1 with fasting plasma glucose (FPG) (r = 0.474, P = 0.008) and HbA1C (r = 0.588, P = 0.001) shows a statistically significant association in diabetic peripheral neuropathy. The standardized β weights of FPG, postprandial plasma glucose, and HbA1C show significant values in patients of DPN. Conclusion: Diabetic peripheral neuropathy (DPN) is associated with decreased pulmonary function as compared to patients of diabetes without neuropathy, the glycemic status of patients may also adversely affect % FEV1. Thus, proper control of hyperglycemia will decrease the further progression of the disease. We also suggest performing pulmonary function test in patients of diabetes mellitus with DN in the preoperative period so as to optimize the perioperative care.
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Atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda Category - III) in thyroid cytology: Experience from a tertiary health care center from Eastern India p. 41
Prateek Das, Rashmi Patnayak, Rajesh Bhola, Amitabh Jena
Introduction: Fine-needle aspiration (FNA) cytology is a reliable method to diagnose thyroid lesions. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is universally followed for thyroid cytology reporting. Out of the six categories described, Category III, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous one. Materials and Methods: In this study conducted in a tertiary health care center in Eastern India over 2 ½-year period, 868 thyroid FNAs were performed and the cytology smears were interpreted using the TBSRTC. There were 32 FNAs in Category III. Histopathology report was available in nine cases. Results: The risk of malignancy (ROM) considering noninvasive follicular thyroid carcinoma with papillary nuclear features (NIFTP) as benign was 9.3% and by considering NIFTP as malignant was 21.8%. Conclusion: The ROM for AUS/FLUS in our study was within the revised ROM criteria. In Category III, surgery is preferable in nodules which harbor suspicious features either clinically or according to ultrasound findings.
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Relation between cardiometabolic risk factors and obesity differs in children and adults p. 45
Tahniyah Haq, Tohfa-E-Ayub, Md Fariduddin, Palash Chandra Sutradhar, Nishat Nayla Aurpa, Md Abul Hasanat
Background: Obesity is a harbinger of cardiovascular disease. It is affecting individuals from an early age. Aim: The aim of the study was to compare cardiometabolic risk factors (CRFs) in obese children and adults; and to see their relationship with obesity. Materials and Methods: Two hundred and thirty-nine overweight and obese individuals (189 ≤20 and 50 >20 years) without secondary causes of obesity were included and data on their CRFs (blood pressure, plasma glucose, glycated hemoglobin, and lipid profile) were obtained from clinic records. Results: Mean age and body mass index (BMI) of ≤20 years of group were 13.77 ± 2.32 years and 33.29 ± 8.45 kg/m2, respectively. The mean age and BMI of >20-year group were 39 ± 1.41 years and 36.81 ± 2.40 kg/m2, respectively. Participants in the ≤20-year group had a lower rate of abnormal glucose tolerance (28.9% vs. 61.9%, P < 0.001) and hypertension (3.6% vs. 15.4%, P < 0.001), but a higher rate of dyslipidemia (98.8% vs. 97.5%, P < 0.001) than the ≤20 years of group. After adjusting for all cardiovascular risk factors, diastolic blood pressure was significantly related to obesity (BMI β = 0.380, P = 0.001; waist circumference β = 0.499, P < 0.001; fat mass index β = 0.407, P = 0.001; waist height ratio β = 0.356, P = 0.004) in the ≤20-year group, while fasting plasma glucose was related to BMI (β = 1.086, P = 0.001) in the >20-year group. Conclusion: There is a high rate of dyslipidemia in young obese individuals. Blood pressure is associated with obesity at a younger age, while dysglycemia is associated with increasing BMI in adults.
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Effects on glycemic control by combination therapy of gliclazide-metformin and insulin in type 2 diabetes mellitus patients p. 51
Md Arifur Rahaman, Adhir Kumar Das, Sharmistha Ray, Tazin Islam, Nazma Akther, M. A . Jalil Ansari, Indrajit Prasad, Mohammad Saifuddin, Moinul Islam, Mirza Sharifuzzaman
Background: Diabetes mellitus is one of the most common noncommunicable diseases worldwide, which requires management of the symptoms through lifestyle modification and antidiabetic pharmacotherapies. The purpose of this study was to observe the effects on glycemic control by combination therapy of gliclazide-metformin and insulin in type 2 diabetes mellitus patients according to baseline HbA1c, fasting blood glucose (FBG), and blood glucose 2 h after breakfast. Methods: An observational study was conducted at Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, and Outpatient Department of Ibrahim General Hospital, Mirpur, Dhaka, for 1 year (July 2018–June 2019). In total, 110 type 2 diabetic patients were selected purposively. The patients were divided into two groups. In Group I, 55 patients treated with gliclazide (80 mg) and metformin (500 mg) combination therapy twice daily for consecutive 12 weeks, and in Group II, 55 patients treated with insulin (premixed 30/70) twice daily for consecutive 12 weeks. Results: After 12 weeks of treatment, HbA1c level reduced from (mean ± standard deviation) 8.94 ± 0.91 to 7.82 ± 1.86 in Group I and 10.07 ± 1.28 to 7.90 ± 1.01 in Group II. FBG level reduced from 10.05 ± 1.57 to 7.96 ± 1.62 in Group I and 11.61 ± 2.62 to 7.60 ± 1.23 in Group II. Blood glucose 2 h ABF level reduced from 14.00 ± 2.04 to 10.99 ± 1.41 in Group I and 16.70 ± 3.61 to 10.71 ± 1.52 in Group II. In Group I, 36.4% of patients achieved HbA1c target level, 40% of patients achieved FBG target level, and 25.5% of patients achieved blood glucose 2 h ABF target level. In Group II, 29.1% of patients achieved HbA1c target level, 56.4% of patients achieved FBG target level, and 29.1% of patients achieved blood glucose 2 h ABF target level. Conclusions: On the basis of the study findings, patients of both study groups showed an improvement in the overall glycemic control (HbA1c, FBG, and blood sugar 2 h ABF) during the study. Both groups of drugs are effective in controlling blood glucose, but individual group has a unique beneficial effect.
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Coexistent papillary thyroid carcinoma in a patient with graves' disease p. 55
A B. M. Kamrul-Hasan
A 21-year-old male presented with the features of thyrotoxicosis, and his thyroid function tests revealed primary hyperthyroidism. He also had mild bilateral exophthalmos with lid lag, lid retraction, and a clinical activity score of 1, suggestive of mild Graves' ophthalmopathy. Neck ultrasonography revealed mild diffuse goiter with bilateral fairly large nodules predominantly at the right lobe and bilateral multiple cervical lymphadenopathies. Tc-99m pertechnetate scan demonstrated diffuse goiter with homogeneously increased radiotracer concentration. He had an elevated titer of thyroid-stimulating hormone receptor autoantibody level. Fine-needle aspiration cytology from the largest nodule of the right lobe reported a Bethesda Category-VI lesion compatible with papillary thyroid carcinoma. Graves' disease and papillary thyroid cancer carcinoma might be present concomitantly in the same patient. Although links between these entities have long been investigated, a clear correlation is not established yet.
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A case of phaeochromocytoma with normal metanephrine but high plasma aldosterone p. 58
Wafia Najifa, M A. Jalil Ansari, Indrajit Prasad, Mohammad Saifuddin, Moinul Islam, Mirza Sharifuzzaman, Mohammad Jahangir Alam, Farhana Afrooz, Sadia Jabeen Mustafa, A K. M Fahad
Pheochromocytoma is one of the causes of endocrine hypertension leading to stroke in young patients. The tumor secretes not only catecholamines but also other hormones in rare occasions. Besides, symptomatic tumors may come with normal catecholamine metabolite levels. Here is a case of a 28-year-old male featuring these exceptions who was managed at Dhaka Medical College Hospital.
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Does Obstructive sleep apnea syndrome (OSAS) fit into Endocrinology p. 61
Dhastagir Sultan Sheriff
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