Overweight and obesity are rapidly increasing globally, and Bardet–Biedl syndrome (BBS) is a rare genetic disorder that can cause obesity. We report a case of a 27-year-old unmarried man with morbid obesity, retinal dystrophy, polydactyly, mental retardation, hypogonadism, and poor scholastic performance diagnosed as BBS who was admitted to our care.

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Obstructive sleep apnea (OSA) and the various components of metabolic syndrome are closely interrelated. We propose the term somnometabolic syndrome to define the condition where OSA coexists with one or more components of metabolic syndrome. Such a definition reinforces the strong association between OSA and metabolic syndrome and will urge the clinician to screen and diagnose OSA in individuals with metabolic syndrome and vice versa. It is hoped that the usage of this new term will not only address the lacunae in screening and treatment of OSA in individuals with metabolic syndrome but will also foster collaboration and research among specialties managing OSA.

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Objective: The correlation between bone mineral density (BMD) and bone markers is well studied in postmenopausal women and elderly men. However, related literature on healthy adults is scarce. This study determined the correlation between parathyroid hormone (PTH), BMD of the left distal radius, and other biochemical markers in apparently healthy Nigerian adults. Methods: This research included 80 (28 males/52 females) healthy participants between 22 and 50 years of age (32.10 ± 5.8 years) who met the inclusion criteria. All the participants were recruited by a systematic random sampling. Interview questionnaires were used to supplement clinical data and anthropometric measures. Fasting samples were analyzed for calcium, inorganic phosphorus, 25-hydroxyvitamin D (25[OH]D), PTH, osteocalcin (OC), alkaline phosphatase, and 24-h calcium excretion. The left distal radius BMD was examined using dual-energy X-ray absorptiometry. The data were statistically analyzed, and the significance level was set at <0.05. Results: It was found that PTH was inversely correlated with left distal radius BMD/z-score (P = 0.004). It showed positive and negative trends with serum-adjusted calcium and inorganic phosphorus (P = 0.09 and P = 0.07, respectively). Neither the OC nor 24-h calcium excretion correlated with PTH (P > 0.05). The OC was inversely correlated with BMD (P = 0.003), but not with 24-h urinary calcium excretion (P > 0.05). None of the participants had osteoporosis. Regression analysis showed that PTH and OC predict radial bone density in participants (P < 0.05). Conclusion: Higher PTH levels correlate with lower left distal radius BMD in apparently healthy participants.

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Introduction: Hypogonadism in males is characterized by low serum testosterone (T) levels together with clinical symptoms and is more common in diabetes mellitus (DM). Association between DM and hypogonadism has been studied in different populations but is not clearly known in Bangladeshi population. Objectives: The objective of this study was to find out the frequency and determinants of hypogonadism and erectile dysfunction (ED) in men with newly detected type 2 DM diabetes (T2DM). Materials and Methods: A cross-sectional study encompassing 1940 newly T2DM male patients (age: 42.57 ± 7.4 years; body mass index [kg/m²]: 26 ± 5.1; mean ± standard deviation) was carried out in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, to see hypogonadism. Measurement of serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle stimulation hormone (FSH) was measured by chemiluminescent technology. Results: Among hypogonadal subjects, according to calculated Free Testosterone (cFT) and Androgen Deficiency in the Aging Male (ADAM) criteria, the frequency of hypogonadotropic hypogonadism was 80% which, on the basis of TT and ADAM criteria, was 92.5%. There was no significant difference for hypogonadism among either the hemoglobin A1c (HbA1c) categories (P = 0.23) or age groups (P = 0.9). Hypogonadal and eugonadal groups significantly differed both according to TT and ADAM (81.5% vs. 43.4%, P = 0.01) and cFT and ADAM (93.3% vs. 47.7%, P ≤ 0.001) criteria for ED. There was a significant difference between the groups for SHBG (21.7 ± 11.6 vs. 30.71 ± 22, P = 0.05) by TT and ADAM criteria. Similarly, cFT and ADAM criteria also revealed a statistically significant difference for SHBG (38.04 ± 19.90 vs. 25.28 ± 19.37 nmol/l, P = 0.03) and total cholesterol (211.40 ± 44.7 vs. 191.3 ± 32.64 mg/dl, P = 0.04). However, in both the groups, LH, follicle-stimulating hormone (FSH), HbA1c, fasting blood sugar, 2 h after 75 g glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein did not differ significantly. cFT significantly correlated with age (r = ‒0.3503, P = 001) and SHBG (r = ‒0.37, P ≤ 0.01) whereas TT with SHBG (r = 0.58, P = 0.01). By multiple regression, ED and SHBG were significant predictors for hypogonadism (P = 0.01 and 0.03, respectively). Conclusion: It was concluded that a significant number of newly detected male T2DM subjects have symptoms of hypogonadism judged on the basis of TT, cFT, and ADAM scores. Poor glycemic control may affect gonadal and erectile functions. This aspect should be considered while diagnosing male subjects as T2DM.

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Polyostotic fibrous dysplasia is a disorder that features the replacement of multiple areas of bone with fibrous tissue, which may cause fractures and deformity. It begins in childhood and progresses onward, affecting both sexes equally. A 23-year-old male presented with recurrent fractures of all long bones and multiple vertebrae with low trauma. X-ray showed extensive multilocular cystic lesions with ground-glass diffuse refractions throughout all long bones, multiple fracture lines and dislocation of joints, scoliosis, and compression of multiple vertebrae. Severe cortical thinning is also seen in all bones. He was managed with bisphosphonate, and significant improvement was observed.

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Background: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. The aim of this study is to observe and compare the effect of commonly used regimens of insulin on body mass index (BMI) among Type 2 diabetes patients. Methods: An observational study was conducted in two diabetic centers in Dhaka starting from July 2018 to June 2019. During the 12 weeks of the data collection period, a total of 100 patients were included according to selection criteria and then divided into two equal groups. Patients who were prescribed with premixed (conventional or analog) 30/70 insulin twice daily with or without oral Antidiabetic drugs were included in Group I (n = 50) and the patients who were prescribed with insulin glargine once daily with a bolus insulin (conventional or analog) three times before large meals with or without oral Antidiabetic drugs were included in Group II (n = 50). BMI was calculated from the height and weight of the patients initially as baseline data and again after 12 weeks of treatment in both groups. Fiber Bragg grating, 2 h ABF, and hemoglobin A1C (HbA1c) change were also observed among the patients of both insulin groups from diagnostic reports during the study period. Results: After 12 weeks of treatment, mean body weight (±standard deviation [SD]) was increased significantly from 59.82 ± 12.33 kg to 60.40 ± 13.38 kg in Group I (P = 0.01) and from 59.00 ± 12.36 kg to 60.33 ± 12.97 kg in Group II (P = 0.02). Mean BMI (±SD) increased significantly from 23.71 ± 4.69 kg/m² to 24.10 ± 4.17 kg/m² in Group I (P = 0.01) and from 24.00 ± 4.30 kg/m² to 24.43 ± 4.59 kg/m² in Group II (P = 0.02) during the study period. The mean BMI compared between two study groups (24.10 ± 4.17 vs. 24.43 ± 4.59) kg/m² m+ after 12 weeks of treatment was not statistically significant (P = 0.816). About 64.0% of patients in Group I and 68.0% in Group II have shown weight gain and BMI change after 12 weeks. Mean HbA1c (±standard deviation [SD]) reduced significantly from 10.40% ± 2.17% to 7.76% ± 1.41% in Group I and from 10.41% ± 1.80% to 7.63% ± 1.37% in Group II. About 48.0% of patients in Group I and 56.0% of patients in Group II achieved glycemic target <7%. About 28.0% of patients in Group I and 20.0% of patients in Group II had hypoglycemia. Conclusion: From the current study, it can be concluded that both insulin regimens significantly cause weight gain, BMI change and also significantly effective in glycemic control. However, in comparison between the two groups, there was no significant difference. Hence, both premixed and glargine-based basal-bolus regimen can be prescribed as per patient need. This result may provide some preliminary information for further investigation

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Background: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype and severity at presentation are different in patients with and without diabetes. Objective: The objective of the study was to identify the subtype and severity of stroke at presentation in diabetic versus nondiabetic subjects in our population. Methods: This cross-sectional comparative study was conducted in the Departments of Neurology and Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, from July 2011 to December 2011. Forty-seven stroke patients with diabetes and 47 nondiabetic patients with stroke were included in the study. Results: The mean age of the patients of the diabetic group was lower than the nondiabetic group (60.4 [standard deviation (SD) ± 10.5] vs. 65.4 [SD ± 10.3], P< 0.05), but there was no sex difference between the two groups. Hypertension and stroke severity was more in diabetics (Scandinavian Stroke Scale: 21.2 vs. 28.1, P< 0.001). Ischemic stroke was significantly more in the diabetic group than that of the nondiabetic group (83.0% vs. 59.6%, P< 0.01). Subtypes of hemorrhagic stroke and ischemic stroke were almost similar in both the diabetic and nondiabetic groups. Conclusion: Stroke in diabetic patients is different from stroke in nondiabetic patients in several aspects. The diabetic stroke patient is younger, ischemic stroke and stroke severity is more, but hemorrhagic stroke is less in diabetic individuals.

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