Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers.

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODµg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) µg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Depression among Medical Students of Bangladesh.

Now a days depression is one of the leading cause of disabilities all over the world. Depression leads to a wide range of disorders and affects people of all communities. Medical students pass through a relatively high level of stress. Several studies revealed that anxiety and depression is significantly prevalent among medical students and often it persists even when they become physicians. The study was designed with an aim to estimate the prevalence of depression among the medical students of Bangladesh. The cross sectional descriptive type of observational study was conducted among randomly selected 399 Bangladeshi students of third year MBBS from six (6) randomly selected public medical colleges of Bangladesh from February 2017 to July 2017. Data were collected by a semi-structured self-administered questionnaire containing Beck's Depression Inventory. Data were entered and analyzed by SPSS version 20.0. Among 399 medical students, 45.6% were male and 54.4% were female. Regarding presence of depression among the medical students, 35.8% students had normal score. More than one fourth of the students (25.1%) had mild mood disturbance. Borderline clinical depression was found in 15.5% and moderate depression was found in 18.0% of the students. Severe depression was found in 5.3% students and one (0.3%) student was suffering from extreme depression. Overall 39.1% students were suffering from different levels of depression. Depression was prevalent more in female students (45.6%) than male students (31.3%). Suicidal tendency was present in 18.8% students. Among them 14.3% had thoughts of killing themselves but they would not carry them out; 3% would like to kill themselves and 1.5% would kill themselves if they had the chance. Suicidal tendency was also a bit higher in female students (19.3%) than male students (18.1%). A significant number (39.1%) of medical students of Bangladesh are suffering from depression and many of them (18.8%) have suicidal tendency which demands immediate attention of the authority. The findings of the study warrant a need for psychiatric counseling and support services for vulnerable students.

Risk Factors for Hypertension in Young Adults of Bangladesh.

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.

Risk of Abdominal Aortic Calcifications among End Stage Renal Disease Patients under Maintenance Haemodialysis.

Calcification of soft tissue and blood vessel wall occurs more frequently in dialyzed patients. The purpose of the present study was to estimate the risk of abdominal aortic calcification among end stage renal disease patients under maintenance haemodialysis. This case-control study was carried out in the Department of Nephrology at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh from January 2013 to December 2014 for a period of two (02) years. Chronic kidney disease in stage 5 {CKD-5(D)} patients older than 18 years on maintenance haemodialysis (MHD) for more than 3 months were selected as case group. And same age and sex non CKD patients were considered as control group. Serum calcium, serum albumin, serum phosphate and iPTH were estimated by semi-automated biochemistry analyzer from the Department of Biochemistry of NIKDU, Dhaka and NICVD, Dhaka. Plain X-ray abdomen in lateral view was performed for all patients. Total 100 patients were enrolled for this study of which 50 patients were in end stage renal disease (ESRD) group and the rest 50 patients were in non-CKD group. Abdominal aortic calcification on X ray was present in 22(44%) patients of ESRD group and 6(12%) patients of non CKD group of population. Mean±SD serum calcium (corrected) level was significantly high (p<0.001) in ESRD patients (9.79±0.87) compared to non CKD group of population (9.13±0.70). Mean±SD of serum phosphate level was significantly higher (p<0.001) in ESRD patients (5.71±0.96) compared to non CKD group of population (4.20±0.59). However, mean±SD iPTH level showed no significant difference between ESRD (25.33±51.98) and non CKD group of population (38.53±19.52), though iPTH level remain below the target level in ESRD group. Abdominal aortic calcification is significantly higher among ESRD subjects.

Neurological status of children with congenital heart defects.

Congenital heart defect (CHD) is the most common birth defect & a significant cause of childhood morbidity & mortality. Structural brain abnormalities are more common in children with CHD than general population. This study details the cognitive, motor and behavioral development of a child with congenital heart disease who is on medical management. In this retrospective descriptive study, abnormalities in neurobehavioral status of infant & children (6-42 months of age) with CHD, who are on medical management were assessed by a standardized neurobehavioral assessment test, BSID-II. Fifty-eight children were included, who were diagnosed as a case of congenital heart disease & confirmed by Colour Doppler echocardiography in the Paediatric Cardiology Department of Bangabandhu Sheikh Mujib Medical University, Bangladesh. Mean age of the children was 23±13 months (range, 6 to 42 months); M:F = 1:1.9. Among them 22(37.9%) had cyanotic and 36(62.1%) had acyanotic congenital heart disease. Neurobehavioral and neurologic abnormalities were documented in a significant number of children. BSID-II showed 23(39.7%) had delayed metal development, 24(41.4%) had motor impairment and 16(27.6%) had non-optimal behavioral performance. Interestingly, infant and young children with acyanotic congenital heart defects were more likely to demonstrate severe neurologic compromise than were those with cyanotic defects. Findings of this study suggest that the prevalence of neurobehavioral abnormalities in infants and young children with congenital heart defects has been under predicted & indicates that delay in closure (surgery/device) puts the patient at an increased risk of neuro-developmental insult.

Chest pain in children: an update.

Chest pain is a common symptom for children and adolescents. It is the second most frequent complaint leading to referral to paediatric cardiologist, murmurs being the largest. The most common cause of chest pain prompting a child to visit a physician is idiopathic chest pain (21-59%). Other disorders are pulmonary (12-24%), psychologic (17-19%), musculoskeletal (7-16%), gastrointestinal (5-7%), cardiac (1-4%) and miscellaneous (2-4%). Most children with chest pain have normal physical findings. Careful physical examination can reveal important clues and save much unnecessary investigations. When an organic cause is found for the pain then specific treatment is commenced. Depending on the circumstances, a therapeutic trial may be warranted, for example use of an inhaled bronchodilator 15-20 minutes before exercise for suspected exercise induced asthma, use of adequate anti-reflux medication for gastro-oesophageal reflux disease or non-steroidal anti-inflammatory medication for musculoskeletal pain. Where an organic cause is not considered to be present, explanation and reassurance can reduce anxiety and decrease the severity of the symptoms. This article specifically deals with problems of chest pain in children and approach to such problems in the form of relevant investigations and management.

Lactate down-regulates cellular poly(ADP-ribose) formation in cultured human skin fibroblasts.

BACKGROUND: Polyadenosine diphosphate-ribose (poly(ADP-ribose)) is a nuclear polymer which is derived from nicotinamide adenine dinucleotide (NAD(+)) catalysed by poly(ADP-ribose) polymerase 1 (PARP-1). Aside from the well known role of poly(ADP-ribosyl)ation (pADPR) in DNA repair, pADPR is also involved in other cellular processes such as apoptosis and gene expression. However, the factors that regulate the level of pADPR are not fully elucidated. In view of the fact that healing wounds contain high concentrations of lactate (10-15 mM) and exogenous lactate reduce the NAD(+) pool in cultured fibroblasts, we propose that high lactate lowers the level of nuclear pADPR. MATERIALS AND METHODS: Neonatal human dermal fibroblasts (NHDF) were plated to subconfluence and allowed to adhere. Cells were treated with 15 mM l-lactate and pADPR production was assessed by immunofluorescence analysis using 10H antibody. Difference in pADPR production was determined by calculation of positively stained cells compared to total cell numbers. Inhibition of PARP activity was tested by treatment with 100 microM 3-aminobenzamide (3-AB). Specificity of the lactate effect on pADPR synthesis was verified by using the analogue d-lactate. The contents of nicotinamide adenine dinucleotide (NAD(+)) and its reduced form (NADH) in lactated and non-lactated cell cultures were quantified by the enzymatic cyclic assay. RESULTS: We found that exogenous l-lactate (15 mM) can significantly depress pADPR content in cultured fibroblasts. PARP-1 activity was inhibited by 3-AB and analogue d-lactate showed no effect on pADPR synthesis. NAD(+)/NADH ratio was significantly lowered in lactated compared to non-lactated cell culture. CONCLUSIONS: Exogenous l-lactate (15 mM) can depress pADPR content in cultured fibroblasts. In view of the fact that healing wounds contain such high concentrations of lactate, we propose that down regulation of pADPR is associated with elevated tissue repair via pADPR dependent gene expression. This observation is important in understanding the stimulation of lactate-mediated protein expression during wound healing.

Soil properties and crop productivity as influenced by flyash incorporation in soil.

Field experiments were carried out during 1996-97 at Gulawathi, Muthiani and Salarpur Villages, IARI Farm, New Delhi and NCPP Campus, Dadri to evaluate changes in soil characteristics and growth of wheat (Triticum aestivum L.), mustard (Brassica juncea L.), lentil (Lence esculenta Moench.), rice (Oryza sativa L.) and maize (Zea mays L.) by varying amounts of flyash addition (up to 50t ha(-1)) in soils at sowing/transplanting time of crops. Flyash addition in areas adjoining NCPP Thermal Power Plant, Dadri, Ghaziabad, U.P. ranged from 5-12 t ha(-1)] yr(-1) in 1995-96. Shoot and root growth and yield of test crops at different locations after flyash incorporation resulted in beneficial effects of flyash addition in most cases. The silt dominant texture of flyash improved loamy sand to sandy loam textures of the surface soils at the farmers' fields. The increased growth in yield of crops with flyash incorporation was possibly due to modifications in soil moisture retention and transmission characteristics, bulk density, physico-chemical characters such as pH and EC and organic carbon content. The response of flyash addition in the soil on soil health and crop productivity needs to be evaluated on long-term sustainable aspects.

Hydrogen peroxide stimulates macrophage vascular endothelial growth factor release.

Neutrophils gather at the wound site shortly after trauma and release bactericidal reactive oxygen species (ROS) and H2O2 to kill bacteria and prevent infection. Macrophages arrive at the wound in response to environmental stimuli, phagocytose foreign particles, and release vascular endothelial growth factor (VEGF), an angiogenic factor crucial for wound healing. Because oxidants are released early in inflammation and have been found to regulate transcription factors, we investigated a possible role of H2O2 in VEGF stimulation. Human U937 macrophages exposed to H2O2 and allowed to recover in H2O2-free medium rapidly showed an increase in VEGF mRNA. The H2O2-mediated mRNA increase was dose dependent, blocked by catalase, and associated with elevated VEGF in conditioned media. The increase in VEGF was also found in primary rat peritoneal macrophages and the RAW 264.7 murine macrophage cell line. Transcriptional inhibition with actinomycin D revealed no significant difference in mRNA half-life. Transient transfections with a 1.6-kb VEGF promoter-luciferase construct (Shima DT, Kuroki M, Deutsch U, Ng YS, Adamis AP, and D'Amore PA. J Biol Chem 271: 3877-3883, 1996) showed a ninefold stimulation of VEGF gene promoter activity. We concluded that H2O2 increases macrophage VEGF through an oxidant induction of VEGF promoter. This oxidant stimulation can be mediated by activated neutrophils.

Lactate elicits vascular endothelial growth factor from macrophages: a possible alternative to hypoxia.

Macrophages respond to various stimuli to produce angiogenic factors but few mechanistic details are known. We examined the effects of hypoxia, lactate and nicotinamide on the expression of vascular endothelial growth factor by cultured macrophages. These agents were chosen because they down-regulate polyadenosine diphosphoribose levels. Following exposure, conditioned media were analyzed for vascular endothelial growth factor protein. Nicotinamide adenine dinucleotide, polyadenosine diphosphoribose, and vascular endothelial growth factor mRNA were measured in the cellular fraction. Angiogenic capacity of the conditioned media was tested in rabbit corneas and Matrigel implants. All three agents, hypoxia, lactate and nicotinamide, elicited significantly increased levels of vascular endothelial growth factor mRNA and vascular endothelial growth factor in the conditioned media, and these levels were paralleled by their angiogenic activity. Polyadenosine diphosphoribose in the cellular fraction was correspondingly depressed. Anti-vascular endothelial growth factor antibody inhibited most of the angiogenic response whereas anti-basic fibroblast growth factor antibody had little effect. We propose that redox changes associated with the alteration of cellular nicotinamide adenine dinucleotide and polyadenosine diphosphoribose are involved in lactate-mediated VEGF expression.

Detection of interleukin-6 in human dental pulp and periapical lesions.

Pulpal and periapical diseases are characterized by inflammation. The cytokine IL-6 is a major mediator of the host response to tissue injury and infection. This study examined the level of interleukin-6 (IL-6) in six inflamed human pulps and six human periapical lesions of endodontic origin using ELISA. Pulp samples from eight clinically impacted teeth were used as controls. The periapical samples exhibited significant levels of IL-6 (mean = 78.1 +/- 9 pg/mg protein) as did inflamed pulpal tissues mean = 36 +/- 3.9 pg/mg protein) compared to healthy pulp mean = 0.01 +/- 0.02 pg/mg protein). These data indicated that IL-6 was produced and released locally in the inflamed pulpal and periapical lesions.

Removal of intracanal smear by doxycycline in vitro.

UNLABELLED: Cleansing and shaping result in a smear layer on the instrumented canal wall surfaces. The smear layer may inhibit close contact between sealers and dentin, and inhibits diffusion of medicaments. OBJECTIVE: This study assessed the effect of doxycycline hydrochloride (DH) on smear layer on intracanal walls. STUDY DESIGN: Scanning electron microscopy was used to evaluate the remaining smear layer using different concentrations of DH. Single-canal palatal roots of extracted maxillary molars were irrigated with saline-15% EDTA; saline-25 mg/ml DH; saline-50 mg/ml DH; saline-100 mg/ml DH; NaOCl-15% EDTA; NaOCl-25 mg/ml DH; NaOCl-50 mg/ml DH; and NaOCl-100 mg/ml DH. The roots were fractured into halves and the amount of smear layer assessed in the middle and apical third. RESULTS: Doxycycline-HCl of 100 mg/ml was the most effective in removing smear layer. In the saline group, 100 mg/ml of DH was more effective than EDTA. In the hypochlorite group, 50 mg/ml and 100 mg/ml of DH were more effective than EDTA (p < 0.05). CONCLUSION: Doxycycline solution may be an effective irrigant.

Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban populations in Bangladesh.

OBJECTIVE: To compare the prevalence of diabetes between the poor and rich of rural and urban populations in Bangladesh. RESEARCH DESIGN AND METHODS: A total of 1,052 subjects from urban and 1,319 from rural communities (age > or = 20 years) of different socioeconomic classes were investigated. Capillary blood glucose levels, fasting and 2 h after a 75-g glucose drink (2-h blood glucose [BG]), were measured. Height, weight, waist, hips, and blood pressure were also measured. RESULTS: Age-adjusted (30-64 years) prevalence of NIDDM was higher in urban (7.97% with 95% CI 6.17-9.77) than in rural subjects (3.84%, CI 2.61-5.07), whereas impaired glucose tolerance (IGT) prevalence was higher in rural subjects. In either urban or rural areas, the highest prevalence of NIDDM was observed among the rich, and the lowest prevalence was observed among the poor socioeconomic classes. The rural rich had much higher prevalence of IGT than their urban counterpart (16.5 vs. 4.4%, CI 6.8-17.4). Increased age was an important risk factor for IGT and NIDDM in both rural and urban subjects, whereas the risk related to higher BMI and waist-to-hip ratio (WHR) was less significant in rural than urban subjects. Using logistic regression and adjusting for age, sex, and social class, the urban subjects had no excess risk for NIDDM. In contrast, an excess risk for glucose intolerance (2-h BG > or = 7.8 mmol/l) was observed in the rural subjects. CONCLUSIONS: Adjusting for age, sex, and social class, the prevalence of NIDDM among urban subjects did not differ significantly from that among rural subjects. Increased age, higher socioeconomic class, and higher WHR were proven to be independent risk factors for glucose intolerance in either area.

Prevalence of diabetes in a suburban population of Bangladesh.

To determine the prevalence of diabetes and hypertension, 6847 subjects of age 15 years or older, were investigated in a suburban population in Bangladesh. Fasting and post-prandial (capillary) blood glucose (2-hPG) was estimated. According to WHO criteria the crude prevalence of impaired glucose tolerance (IGT) was 7.5% and non-insulin-dependent diabetes mellitus (NIDDM) was 4.1%. The age standardized (30-64 years) prevalence of IGT was 7.7% with 95% confidence interval (CI) 6.96-8.44 and NIDDM was 4.5%, CI 3.94-5.12. Compared with the younger subjects the older subjects (< 40 vs. > or = 40 years) showed significant association with IGT (chi2, 65.9; P < 0.001) and NIDDM (chi2, 92.0; P < 0.001). Higher BMI (< or = 22.0 vs. > 22.1) was also significantly associated with IGT (chi2, 16.6; P < 0.001) and NIDDM (chi2, 83.9; P < 0.001). The higher BMI had stronger association with NIDDM than with IGT. Lower height showed significant association only with NIDDM. The logistic regression analyses also showed that increased age, higher BMI and short stature were independent risks for NIDDM. The study showed an increased prevalence of IGT and NIDDM among the suburban population of Bangladesh and the excess risk was observed with increased age, higher BMI and short stature.

Biochemical alterations in inflammatory periodontal diseases I. Poly (ADP-ribose) synthetase activity in gingiva and gingival fibroblasts from humans with periodontitis.

Periodontal diseases are characterized in part by generation of oxygen free radicals, which can cause breaks in cellular DNA strands. Repair of damaged DNA is dependent upon the synthesis of poly (ADP-ribose)(PADPR) catalyzed by PADPR synthetase, an enzyme known to be activated by the broken ends of DNA strands. We measured the activities of PADPR synthetase and of PADPR glycohydrolase, which degrades PADPRS, in gingival biopsy specimens from 16 sites with adult periodontitis and 12 clinically healthy control sites. The results indicated that sites with periodontitis displayed markedly reduced PADPR synthetase activity compared with healthy control sites, whereas PADPR glycohydrolase activity was not changed. The mean specific activity of PADPR synthetase for the diseased specimens was one-sixth of that of the healthy specimens (p < 0.001). The PADPR synthetase activity was negatively correlated with the Gingival Index (rs = -0.60), pocket depth (rs = -0.70) and bleeding upon probing (rs = -0.72). Cultured fibroblasts derived from clinically characterized healthy and diseased gingival sites reflected similar patterns of enzyme activity. The mean specific activity of PADPR synthetase for the diseased-site cultures (n = 9) was 56 +/- 7% (p < 0.001) of the cultures from healthy control sites (n = 6). These results suggest that a reduced level of PADPR synthetase activity is associated with increased inflammation and periodontal destruction, and that the ability to synthesize PADPR is compromised in adult periodontitis.

Lactate stimulation of macrophage-derived angiogenic activity is associated with inhibition of Poly(ADP-ribose) synthesis.

Injury and inflammation lead to hypoxia and elevated lactate in wounds. This redox environment establishes cells in a reparative phenotype and leads macrophages to release angiogenic substances by unclear mechanisms. We investigated compounds known to modulate polyadenosine diphophoribose (pADP-R) levels in their effect on macrophage-derived angiogenic activity. Macrophages cultured from rabbit bone marrow were exposed to lactate, nicotinamide, and/or beta-nicotinamide adenine dinucleotide (NAD+). Supernatants were assayed for angiogenesis, and macrophages were analyzed for NAD+ content, poly(ADP-ribose) synthetase activity, and total (ADP-ribose)n synthesis. Lactate-, nicotinamide-, and lactate and nicotinamide-treated macrophages elicited significantly increased angiogenic activity compared with control or NAD+-treated cells. Lactate treatment decreased NAD+ content by 42 +/- 4% and (ADP-ribose)n synthesis by 37 +/- 5%. Nicotinamide reduced poly(ADP-ribose) synthetase activity and poly(ADP-ribose) synthesis. Thus, macrophage-derived angiogenic activity may be mediated by the redox environment involving NAD+ metabolites.

Decreased signal intensity of cerebral cortex on T2-weighted MR images.

To define the frequency of decreased signal intensity (DSI) in cerebral cortex on T2-weighted images relative to aging and to the incidence of identifying white matter pathology, T2-weighted MR brain images of 906 patients consecutively examined between July 1989 and June 1991 were reviewed. MR images of cerebral cortex were divided into five areas: frontal lobe (F), pre- and postcentral gyri (C), parietal lobe (P), occipital lobe (O) and temporal lobe (T). Each area was separately and independently evaluated for the presence or absence of DSI. The frequency of DSI in each area was plotted against patients' ages. The severity of leukoaraiosis was evaluated in relation with DSI in each cortical area. Patients with DSI in area F numbered 61 (5.7%), in area C 236 (26.0%), in area P 174 (15.9%), in area O 428 (47.2%), and in area T 10 (1.1%). The number of patients with DSI in each area increased with age. The greater the severity of leukoaraiosis, the greater the chance of finding DSI of the cerebral cortex. The incidence of DSI in the cerebral cortex increased with the patient's age as well as with the severity of co-existent white matter pathology.

MRI of white matter changes in the Sjögren-Larsson syndrome.

We report a case of Sjögren-Larsson syndrome with spastic diplegia and conduction aphasia. MRI demonstrated the white matter changes deep in the cerebral hemispheres. We analyse the MRI findings and compare the results with neuropsychological signs.

Prevalence of diabetes and hypertension in a rural population of Bangladesh.

OBJECTIVE--To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh. RESEARCH DESIGN AND METHODS--A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured. RESULTS--The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30-64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01-3.45) for NIDDM and 15.67% (95% CI 12.59-18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) > or = 140 mmHg was 10.5% and with diastolic blood pressure (dBP) > 90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI ( < 22.0 vs. > or = 22.1) was 1.94 with CI 1.55-2.43 and for dBP it was 2.2 with CI 1.40-3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP. CONCLUSIONS--High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.