Prescribing behavior of diabetes treating physicians in selected health care facilities of the diabetic association of Bangladesh.

BACKGROUND: Practicing behavior of the physicians varies from population to population due to diverse socioeconomic, cultural, and professional factors. Evidence on these issues is almost nonexistent in the developing countries. OBJECTIVE: The prescribing behavior of diabetes treating physicians working in selected hospitals of the Diabetic Association of Bangladesh was studied along with the factors affecting those behaviors. MATERIALS AND METHODS: This was an observational study on 818 prescriptions given by 49 physicians working in 16 health care facilities, which were photocopied by a portable photocopier. The various components of the prescription were scrutinized for presence and absence, and evaluated independently by two expert Diabetologists for their qualitative aspects. RESULTS: The mean ± standard deviation of the total prescribing score (expressed as percentage) was 60 ± 11. Physicians scoring around or below 60% belonged more to lower age (<40 years), less experienced (<7 years) and mid-position (Senior Medical Officers) groups. Most of them also had public medical college background. Physicians with Certificate Course on Diabetology (CCD) had significantly higher score compared with the Non-CCD group (P < 0.001). Direction and duration of drug use were absent in majority of prescriptions (72.0% and 61.6%), respectively. Symptoms were not written in 78.0% and the family histories were not recorded in 98.5% prescriptions. Diet (49.4%) and exercise (51.0%) related advices were not mentioned in a large number of prescriptions. Appropriate change of drug (78.2%) and proper use of drug (99.1%) and brand (93.8%) were found rational, but still, 22.4% of the prescriptions found illegible. CONCLUSION: A large proportion of prescriptions in Bangladesh related to diabetes care still lack standardization and acceptable quality. Nondrug related issues (such as history, symptoms, and dietary/exercise-related advices) are the most neglected ones in a prescription.

A Desmoid Tumor Responding to Systemic Therapy With Tamoxifen and Sulindac.

Desmoid tumors are locally aggressive benign tumors arising from connective tissue and are classified as soft tissue sarcomas that do not metastasize. The name is derived from the Greek word desmos that means tendon-like. These tumors are also known as aggressive fibromatosis and have an unpredictable natural history that varies depending on risk factors. They are treated as sarcomas because of their locally aggressive nature and a high local recurrence rate. The causes behind desmoid tumor development are enigmatic and their clinical course is unpredictable. Disease progression also varies widely depending on multiple syndromic risk factors. At this time, there is no scientific consensus over best treatment practices for this tumor type. Treatment can potentially be a combination of observation, systemic therapy, surgery or radiation therapy. Here, we have described a case of a female patient with a sporadic desmoid tumor that successfully responded to tamoxifen and sulindac.

Saved by the Scan: A Case of Early Detection of Sarcomatoid Mesothelioma.

We report a case of localized sarcomesothelioma detected during screening via a low-dose CT (LDCT) scan. The patient is a 71-year-old female, a current 56-pack-year cigarette smoker with a past medical history of myocardial infarction and stroke with a Zubrod score of zero. A screening LDCT revealed a 1.9 cm × 1.8 cm × 1.4 cm right lower lobe lesion with smooth margins and close association with the hemidiaphragm. A wedge resection with biopsy showed high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins. The patient opted for imaging surveillance, and at 12 months has shown no evidence of tumor recurrence on positron emission tomography (PET)/CT. The case shows that LDCT screening discovers cancers and saves lives. It also presented a dilemma for the patient and her oncologist because common guidelines do not define a recommended treatment.

Severe Rhabdomyolysis in a 35-Year-old Woman with COVID-19 due to SARS-CoV-2 Infection: A Case Report.

BACKGROUND Rhabdomyolysis is a skeletal muscle injury that has different etiologies and can be a manifestation of coronavirus disease 2019 (COVID-19). Because it is a life-threatening condition, rapid diagnosis is necessary to prevent acute complications. Diagnostic criteria for rhabdomyolysis are elevated serum creatine kinase, liver enzyme levels, and myalgia. Rhabdomyolysis can easily be missed in patients with COVID-19. Herein, we report the case of a female with rhabdomyolysis as a manifestation of acute COVID-19. CASE REPORT A 35-year-old female was found to have rhabdomyolysis associated with COVID-19. Her creatine kinase and liver enzyme levels were significantly elevated. Ringer's lactate infusion was administered at a controlled rate to treat the rhabdomyolysis along with boluses of normal saline, with close monitoring of her oxygen saturation and kidney function. The patient's creatine kinase and liver enzyme levels peaked on Day 2 and then decreased. Her medical condition improved, and she was discharged on Day 4. CONCLUSIONS Our case highlights the need to monitor the creatine kinase level of hospitalized patients with COVID-19. Fluid management can be challenging in patients with rhabdomyolysis due to COVID-19 because of the risk of fluid overload and acute respiratory distress syndrome. Clinicians should be aware that a significant elevation in liver enzyme levels and myalgia can be the presenting features of rhabdomyolysis in patients with COVID-19.

Prognostic Relation Between Severity of Diabetes Mellitus (On or Off Insulin) ± Chronic Kidney Disease with Cardiovascular Risk After Percutaneous Coronary Intervention.

The presence of either diabetes mellitus (DM) or chronic kidney disease (CKD) is associated with a worse prognosis after percutaneous coronary intervention (PCI). It is also known that outcomes in patients treated with insulin (insulin requiring type 2 diabetes mellitus [ITDM]) are worse than those who are not on insulin (non-insulin type 2 diabetes mellitus [NITDM]). We sought to compare long-term outcomes in patients who underwent PCI with varying severity of DM with and without CKD. We retrospectively studied 17,898 patients who underwent PCI from January 2009 to December 2014 in the Mount Sinai Cath Lab. Patients were categorized into groups by the presence or the absence of CKD and by the DM status (none, NITDM, or ITDM). In the absence of CKD, adjusted hazard ratios (95% confidence interval [CI]) for death or myocardial infarction associated with NITDM and ITDM were 1.65 (95% CI 1.02 to 2.67) and 3.78 (95% CI 2.23 to 6.40), respectively. Analogous risks in the presence of CKD were 3.34 (95% CI 1.99 to 5.61) and 6.26 (95% CI 3.84 to 10.2). This study shows that irrespective of renal status, the need for insulin in the setting of DM identifies a group with substantial risk of death or myocardial infarction at 1 year.

Obesity and associated type 2 diabetes and hypertension in factory workers of Bangladesh.

BACKGROUND: Recent data suggest that the prevalence of obesity and its associate cardiometabolic risks are increasing in Bangladesh. Published data of obesity in Bangladeshi industry workers is scarce. The purpose of this study was to assess the prevalence of general and central obesity in Bangladeshi factory workers and their associations with diabetes and hypertension. METHODS: A total of 791 male factory workers aged ≥ 20 years in capital Dhaka city of Bangladesh were investigated in a population-based cross-sectional survey. According to the International Association for the Study of Obesity and the International Obesity Task Force guidelines for Asian population, general obesity was defined as body mass index (BMI) ≥ 25 kg/m(2), central obesity was defined as a waist circumference (WC) of ≥ 90 cm and waist hip ratio (WHR) of ≥ 0.90. Pearson's correlation coefficient and logistic regression analysis were used to observe the association between anthropometric indices (BMI, WC and WHR) and cardiometabolic risk indicators (FBG, 2 hBG, SBP and DBP). RESULTS: The prevalence of overweight (BMI 23-24.9 kg/m(2)) and general obesity (BMI ≥ 25 kg/m(2)) in this study population was 29.8 and 43.5% respectively. Central obesity defined by WC and WHR was 35.3 and 78.3% respectively. Both general and central obesity were found to be significantly associated with diabetes and hypertension in separate logistic regression analyses. CONCLUSION: The prevalence of general and central obesity in Bangladeshi factory workers was high, and it was associated with diabetes and hypertension.