Role of resmetirom, a liver-directed, thyroid hormone receptor beta-selective agonist, in managing non-alcoholic steatohepatitis: a systematic review and meta-analysis.

BACKGROUND: Resmetirom, a liver-directed, thyroid hormone receptor beta-selective agonist, has recently been approved to treat non-alcoholic steatohepatitis (NASH). This meta-analysis aimed to summarize the efficiency and safety of resmetirom in treating NASH. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) of resmetirom vs. placebo in patients with NASH. The primary outcomes were the changes from baseline in hepatic fat content, liver histology, including NASH resolution, and non-invasive markers of hepatic fibrosis. RESULTS: Three RCTs (n = 2,231) met the inclusion criteria. Compared to placebo, resmetirom achieved greater reductions from baseline in hepatic fat content assessed by magnetic resonance imaging proton density fat fraction (for resmetirom 80 mg: MD -27.76% [95%CI: -32.84, -22.69]; for resmetirom 100 mg: MD -36.01% [95%CI: -41.54, -30.48]; P < 0.00001 for both) and FibroScan controlled attenuation parameter (for resmetirom 80 mg: MD -21.45 dBm [95%CI: -29.37, -13.52]; for resmetirom 100 mg: MD -25.51 dBm [95%CI: -33.53, -17.49]; P < 0.00001 for both). Resmetirom 80 mg outperformed placebo in NASH resolution and ≥2-point non-alcoholic fatty liver disease activity score reduction. Moreover, resmetirom 80 mg and 100 mg were superior to placebo in cytokeratin-18 (M30) reduction. Greater reductions in liver enzymes, lipids, and reverse triiodothyronine were observed in the resmetirom arms with no impact on triiodothyronine. Nausea and diarrhea were more common with resmetirom than with placebo; other adverse events were comparable. CONCLUSION: Resmetirom improves hepatic fat content, liver enzymes, and fibrosis biomarkers in NASH patients. Resmetirom generally does not affect thyroid function and is well-tolerated.

Acute hypothermia in a patient with COVID-19: a case report and summary of the evidence.

Introduction and importance: SARS-COV-2 has many presenting signs including a number of typical and atypical symptoms. However, having the enormous capacity of mutation, the virus is changing its genetic pattern continuously, giving rise to newer and rarer manifestations. Here, the authors report a case of adult COVID-19 along with features of hypothermia which is relatively rare and has future implications in clinical perspective. Case presentation: The patient presented with hypothermia and indicative symptoms of COVID-19 during admission. Comorbidities were assessed, potential differentials were ruled out thorough appropriate clinical examination and investigations. Insulation with a blanket and room heater was used to stabilize the normal body temperature (98.6°F) in the hospital setting, during this period vitals (Blood pressure, Pulse rate and oxygen saturation) were assessed regularly. On the sixth day of hospital admission, he was discharged from the hospital with advice. Clinical discussion: COVID-19 virus can enter into brain through olfactory tract and may cause dysfunction in the medial preoptic area of the hypothalamus containing warm sensitive neurons directly or via cytokine-induced release of prostaglandin E2 from endothelial cells, which acts through a paracrine mechanism that may provoke hypothermia in our case. Conclusions: This case highlights a rare presentation of COVID-19 infection that has not been thoroughly explored. The authors believe the case report holds particular importance especially in dealing with COVID-19 cases in both clinical and home settings.

Role of Teplizumab, a Humanized Anti-CD3 Monoclonal Antibody, in Managing Newly Diagnosed Type 1 Diabetes: An Updated Systematic Review and Meta-Analysis.

OBJECTIVE: Teplizumab has emerged as a potential disease-modifying drug in type 1 diabetes (T1D). This meta-analysis sought to summarize the therapeutic effect of teplizumab in newly diagnosed patients with T1D. METHODS: Randomized controlled trials involving patients with T1D receiving teplizumab in the intervention arm and placebo (or no active intervention) in the control arm were searched throughout the electronic databases. The primary outcome was the change in area under the curve of C-peptide levels from baseline. RESULTS: Seven reports from 6 studies involving 834 subjects met the inclusion criteria. Compared to teplizumab, greater reductions in area under the curve of C-peptide from the baseline values were observed in the control group after 6 months (mean difference [MD] 0.07 nmol/L [0.01, 0.13], P = .02), after 12 months (MD 0.07 nmol/L [0.04, 0.11], P = .0001), after 18 months (MD 0.10 nmol/L [0.06, 0.14], P < .00001), and after 24 months (MD 0.07 nmol/L [0.01, 0.14], P = .03) of interventions. Moreover, fewer patients treated with teplizumab had a decreased C-peptide response after 6 months (odds ratio [OR] 0.21), after 12 months (OR 0.17), after 18 months (OR 0.30), and after 24 months (OR 0.12) of treatment. The preservation of endogenous insulin production was supported by reduced use of exogenous insulin with maintenance of comparable glycemic control for up to 18 months post-treatment. Teplizumab imparted higher risks of grade 3 or higher adverse events, adverse events leading to study medication discontinuation, nausea, rash, and lymphopenia. CONCLUSION: The results of the meta-analysis support teplizumab as a promising disease-modifying therapy for newly diagnosed T1D.

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

BACKGRUOUND: 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.

Orforglipron, a novel non-peptide oral daily glucagon-like peptide-1 receptor agonist as an anti-obesity medicine: A systematic review and meta-analysis.

Background: Orforglipron is a novel once-daily oral non-peptide glucagon-like peptide-1 receptor agonist with several recently published randomized controlled trials (RCTs) evaluating its role in diabetes and obesity. No meta-analysis has analyzed the efficacy and safety of orforglipron; this meta-analysis aimed to address this knowledge gap. Methods: A systematic search was conducted in electronic databases to identify RCTs that included individuals with obesity who were administered orforglipron and compared to either a placebo or an active comparator. The primary outcome of interest was the percent change in body weight. Results: From 12 initially screened articles, data from three RCTs involving 774 people were analyzed with a follow-up duration of up to 36 weeks. Compared to placebo, patients receiving orforglipron 12 mg/day (mean difference (MD), MD -5.48%, 95% CI [-7.64, -3.33], p < 0.01), 24 mg/day (MD -8.51%, 95% confidence interval (CI) [-9.88, -7.14], p < 0.01), 36 mg/day (MD -8.84%, 95% CI [-11.68, -6.00], p < 0.01) and 45 mg/day (MD -8.24%, 95% CI [-12.84, -3.63], p < 0.01) had a significantly greater percent reduction in body weight. The percentage of patients being able to achieve >15% weight loss from baseline was significantly higher with orforglipron 24 mg/day [Odds ratio (OR) 21.90 (95% CI [4.06, 118.15], p = 0.0003), 36 mg/day (OR 17.43, 95% CI [3.18, 95.66], p = 0.001) and 45 mg/day (OR 23.17, 95% CI [4.37, 123.03], p = 0.0002). Total but not severe adverse events were significantly higher with all the doses of orforglipron compared to placebo, with the hazard ratios being higher with higher doses. Gastrointestinal side-effects were predominant side effects, being dose-dependent, with nausea, vomiting, constipation, and gastroesophageal reflux being the predominant ones. Conclusion: Orforglipron at 24-45 mg/day doses is an effective weight loss medication. The efficacy versus side effect profile suggests that 24-36 mg/day is the most optimal dose for orforglipron as an anti-obesity medicine.

Disorders of Sex Development: Experience at a Tertiary Care Hospital in Bangladesh.

In newborns, it is an emergency to decide the appropriate sex for rearing and eventual prevention associated metabolic disturbances. The birth of a baby with ambiguous genitalia inevitably precipitates a crisis for the baby and its family. This retrospective analysis of hospital data was designed to determine the chromosomal and etiological diagnosis of children presented with suspected disorders of sex development (DSD) according to the newer DSD consensus document. We retrospectively analyzed the available medical records of all patients admitted into the inpatient departments of Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh from January 2014 to December 2019, and all patients with the diagnosis of DSD in the hospital record were initially selected for the study. A total of 60 admitted cases with a disorder of sex development were classified according to the new DSD classification. 46XX DSD were 63.3% (n=38), 46XY DSD were 33.3% (n=20), sex chromosome DSD were 3.3% (n=2). Among 38 cases of 46XX DSD, the most common cause was congenital adrenal hyperplasia (97.0%, n=37), one was 46XX testicular DSD. However, among 46XY DSD cases, partial androgen insensitivity/5α-reductase deficiency (50.0%, n=10) was most common disorder. Other causes of 46XY DSD included congenital adrenal hyperplasia (20.0%, n=4), testosterone synthesis defect (20.0%, n=4), testicular regression syndrome (n=1) and persistent Mullerian duct syndrome (n=1). Sex chromosome disorders are mixed gonadal dysgenesis (n=1), chimeric ovotesticular DSD (n=1). In this study, 46XX DSD was the commonest of all, showing the predominance of congenital adrenal hyperplasia, especially salt-losing type. Early detection and prompt treatment may help reduce mortality and morbidity from these acute life-threatening conditions.

Penile Color Doppler Ultrasonography in Patients with Type 2 Diabetes Mellitus Presenting with Erectile Dysfunction: A Single-Center Experience from Bangladesh.

Erectile dysfunction (ED) is common in type 2 diabetes mellitus (T2DM). ED is considered the earliest marker of widespread endothelial dysfunction. Color Doppler ultrasonography (CDUS) of the penis is a valuable tool in identifying vasculogenic ED and may predict coronary vascular disease. In Bangladesh, no study has evaluated CDUS of the penis in such patients. This study assessed the penile CDUS characteristics of adult patients with T2DM having ED. This cross-sectional study was conducted from January to December 2021 at a specialized diabetes hospital in Cumilla, Bangladesh. The baseline velocities of the right and the left cavernosal arteries were measured at the penile base. Arterial insufficiency was defined as a peak systolic velocity (PSV) value <25 cm/s and venous insufficiency was described as an end-diastolic velocity (EDV) >5 cm/s at the end of the examination. Eighty-seven subjects were evaluated; the mean age was 44.2±9.2 years, mean duration of DM was 7.9±2.8 years; of them, 31.0% were smokers, 75.9% obese, 92.0% central obese, 69.0% hypertensive, 96.6% dyslipidemic and 51.7% with low testosterone. The mean HbA1c was 9.3±1.9%; DM was uncontrolled in 89.7% of the study subjects. Penile vasculopathy was found in 21.8% (17.2% had arterial insufficiency, 2.3% had a venous leak, and 2.3% had arterial insufficiency with a venous leak). There were no statistical differences between the two groups, with and without penile vasculopathy, except for diastolic blood pressure, which was higher in the vasculopathy group. CDUS may be incorporated into the tools for evaluating diabetic ED to direct specific management.

Status of lipid control in Bangladeshi subjects with type 2 diabetes mellitus on lipid-lowering drugs: a multicenter, facility-based, cross-sectional study.

BACKGROUND: Achievement of lipid targets is crucial in patients with type 2 diabetes mellitus (T2DM) to mitigate the risk of cardiovascular diseases (CVD). Data on lipid-control status among patients with T2DM in Bangladesh are scarce. This study was conducted to determine the lipid-control status among patients with T2DM who were on lipid-lowering drugs in the country. METHODS: This cross-sectional study was conducted in the diabetes outpatient departments of several tertiary hospitals in Bangladesh from January 2022 to December 2022. Adults of both sexes diagnosed with T2DM for at least one year and were on the lipid-lowering drug(s) for a minimum of 3 months were included in the study by consecutive sampling. Patients' data were collected by face-to-face interviews, and blood samples were collected for fasting lipid profile. The lipid target was set at < 200 mg/dL for total cholesterol (TC), < 150 mg/dL for triglyceride (TG), < 100 mg/dL for low-density lipoprotein cholesterol (LDL-C), > 40 mg/dL for high-density lipoprotein cholesterol (HDL-C), and < 160 mg/dL for non-HDL cholesterol (non-HDL-C). RESULT: Three thousand sixty patients (age 44.7 ± 13.3 years, female 57%) with T2DM were evaluated. Overall, almost 81% of the study subjects achieved the LDL-C target. Besides, TC, TG, HDL-C, and non-HDL-C targets were achieved by 40.8, 21.6, 66.3, and 44.1% of patients, respectively. However, all the lipid parameters were under control in only 8.8% of patients. Almost 77.6% of the patients with ischemic heart disease, 81.5% of patients with stroke, and 65% of patients with CKD had LDL levels < 70 mg/dL. Only 10.03% achieved the HbA1c target of < 7%. 7.4% of patients achieved both HbA1c < 7% and LDL < 100 mg/dL and 5% achieved both HbA1c < 7% and LDL < 70 mg/dL. Advanced age (aOR 0.97, 95% CI 0.96, 0.98, p < 0.001), longstanding T2DM (aOR 0.53, 95% CI 0.39, 0.72, p < 0.001), and non-statin therapy (aOR 0.25, 95% CI 0.16, 0.37, p < 0.001) were negatively associated with lipid control (LDL < 100 mg/dL) while using oral hypoglycemic drugs or insulin (aOR 2.01, 95% CI 1.45, 2.77, p < 0.001) and having cardiovascular comorbidity (aOR 3.92, 95% CI 3.00, 5.12, p < 0.001) were positively associated with lipid control. CONCLUSION: Though most patients with T2DM achieved their target LDL level, the prevalence of both glycemic and overall lipid control was low in our study despite lipid-lowering therapy.

Correlation of Serum Anti-Mullerian Hormone with Clinical, Metabolic and Hormonal Parameters in Bangladeshi Women with Polycystic Ovary Syndrome: A Cross-sectional Study.

Metabolic dysfunctions are common in polycystic ovary syndrome (PCOS). Alongside its utility in PCOS diagnosis, anti-Mullerian Hormone (AMH) is emerging as a metabolic risk marker in PCOS. Data relating to the metabolic importance of AMH in Bangladeshi women with PCOS are lacking. This study aimed to evaluate serum AMH in newly diagnosed women with PCOS and correlate the AMH levels with their clinical, hormonal, and metabolic parameters. This cross-sectional study evaluated 150 newly diagnosed women with PCOS attending a tertiary hospital in Bangladesh from January 2020 to December 2020. Alongside clinical assessment, blood glucose, lipids, total testosterone (TT), thyroid-stimulating hormone (TSH), prolactin and AMH were measured. The median age of the study subjects was 21.5 years (interquartile range 18.0-26.0 years); the median AMH level was 5.09ng/dL (interquartile range 3.64-7.73ng/dL) and 52.0% had metabolic syndrome. Age, body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, plasma glucose 2 hours after oral glucose tolerance test, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, TT, TSH, and prolactin levels and the frequencies of hirsutism and metabolic syndrome were similar across the quartiles of AMH. AMH correlated with none of the variables except TT, with which a strong positive correlation was found. Participants with PCOS phenotype A had the highest AMH levels, and the difference in AMH across the phenotypes was statistically significant.

Comparison of fasting and random lipid profiles among subjects with type 2 diabetes mellitus: an outpatient-based cross-sectional study in Bangladesh.

BACKGROUND: Despite the wide acceptability of fasting lipid profiles in practice, emerging evidence suggests that random lipid profiles might be a convenient alternative for lipid measurement. The objective of the present study was to compare the fasting and random lipid profile among subjects with type 2 diabetes mellitus (T2DM). METHODS: The present cross-sectional study included 1543 subjects with T2DM visiting several endocrinology outpatient clinics throughout Bangladesh from January to December 2021. The fasting lipid profile was measured in the morning following 8-10 h of overnight fasting, and the random lipid profile was measured at any time of the day, irrespective of the last meal. The values of fasting and random lipids were compared using the Wilcoxon signed-rank test and Spearman rank correlation coefficients. RESULTS: In this study, a good level of correlation was observed between fasting and random lipid levels [r = 0.793, p < 0.001 for triglyceride (TG); r = 0.873, p < 0.001 for low-density lipoprotein cholesterol (LDL-C); r = 0.609, p < 0.001 for high-density lipoprotein cholesterol (HDL-C); and r = 0.780, p < 0.001 for total cholesterol (TC)]. In addition, TG and TC levels increased by 14% and 0.51%, respectively, in the random state compared to the fasting state (p- <0.05), while LDL-C levels decreased by 0.71% (p-value 0.42). No change was noticed in the HDL-C level. The difference between fasting and random lipid profiles was similar irrespective of patients' age, sex, BMI, glucose-lowering drug(s), and lipid-lowering therapy. CONCLUSIONS: Random lipid profile correlates significantly with fasting lipid profile with little difference. Hence, it might be a reliable alternative for fasting lipid profile in patients with T2DM.

Sexual dysfunction in women with type 2 diabetes mellitus: A single-centre cross-sectional study from Bangladesh.

Objective: Sexual dysfunction among women with diabetes is a common but neglected health issue worldwide. The objective of the present study was to investigate the prevalence of sexual dysfunction and its associated factors among women with type 2 diabetes mellitus (T2DM). Subjects and methods: This cross-sectional comparative study comprises 150 women with diabetes and 100 healthy women without diabetes who visited the endocrinology outpatient department of Mymensingh Medical College Hospital (MMCH). The data were collected from July to December 2019. Sexual dysfunction was assessed by the 19-item Female Sexual Function Index (FSFI). Informed consent was obtained before participation. Collected data were analysed by SPSS 26. Results: More women with diabetes than control subjects reported sexual dysfunction (79% vs. 72%; p = 0.864). The global FSFI score was lower among the diabetes patients than among the healthy controls (20.8 ± 7.2 vs. 23.7 ± 4.8; p < 0.001). Patients with T2DM scored significantly lower in the domains of desire (p = 0.04), lubrication (p = 0.01), orgasm (p = 0.01), and satisfaction (p < 0.001), but not the domain of arousal (p = 0.09). A prolonged duration of diabetes was the primary contributor to orgasm problems (adjusted odds ratio, aOR 1.3, 95% CI 1.1-1.7) and painful intercourse (aOR 1.2, 95% CI 1.1- 1.5). Conclusion: Sexual problems are frequent in women with diabetes. Inclusion of sexual health in comprehensive diabetes management is crucial to address this problem as well as to improve the quality of life of female diabetes patients.

Prescription Pattern of Glucose-lowering Drugs in Patients with Controlled Type 2 Diabetes Mellitus Attending Dhaka Medical College Hospital.

The increasing number of patients with diabetes mellitus imposes an enormous burden on both the healthcare authorities and healthcare providers. The study's objective was to explore the prescription pattern of glucose-lowering drugs for patients with controlled type 2 Diabetes Mellitus (T2DM) attending a tertiary hospital in Bangladesh. This cross-sectional study was conducted at the Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, Bangladesh, for one year (February 2017 to January 2018). A total of 120 patients aged >12 years with T2DM were included in the study. Prescription analysis and demographic data were collected and recorded in the pre-designed case record form. Among the 120 prescriptions, the number of drugs prescribed per encounter ranged from 1 to 4. Oral drugs were prescribed most frequently (n=88, 73.3%), followed by different preparations of insulin; both (oral and insulin) were prescribed in 13.3% (n=16) of cases. Single drugs were used in 76.7% (n=92) of patients, whereas combined fixed-dose formulation and both types of formulation (single drug and combined fixed dose) were used in 17.5% and 5.8%, respectively. Of all, Metformin was the single most common (67.5%; n=81) drug prescribed by the physicians, followed by Gliclazide (n=19, 15.84%), Glibenclamide (n=14, 11.67%), and short-acting insulin (n=14, 11.67%). Besides, the overall drug use pattern in prescription showed most frequently used drugs were Metformin + Sulphonylureas (21.7%), Metformin (19.2%), Metformin + DPP-4 inhibitors (14.2%), Insulins (13.3%), DPP-4 inhibitors (9.2%) and Metformin + Insulin (9.2%) with a small share of other drugs. Moreover, short-acting insulin was used more commonly (n=14, 11.67%) than other formulations of insulin: long-acting insulin (n=13, 10.83%), premixed insulin (n=12, 10%), intermediate-acting insulin (n=5, 4.16%) and ultra short-acting insulin (n=2, 1.67%).

Risk stratification using the 2021 IDF-DAR risk calculator and fasting experience of Bangladeshi subjects with type 2 diabetes in Ramadan: The DAR-BAN study.

Aims: To risk-stratify patients with type 2 diabetes mellitus (T2DM) according to the IDF-DAR 2021 guidelines and observe their responsiveness to risk-category-based recommendations and fasting experience. Methods: This prospective study, conducted in the peri-Ramadan period of 2022, evaluated adults with T2DM and categorized them using the IDF-DAR 2021 risk stratification tool. Recommendations for fasting according to the risk categories were made, their intention to fast was recorded, and follow-up data were collected within one month of the end of Ramadan. Results: Among 1328 participants (age 51.1 ± 11.9 years, female 61.1 %), only 29.6 % had pre-Ramadan HbA1c < 7.5 %. According to the IDF-DAR risk category, the frequencies of participants in the low-risk (should be able to fast), moderate-risk (not to fast), and high-risk (should not fast) groups were 44.2 %, 45.7 %, and 10.1 %, respectively. Most (95.5 %) intended to fast, and 71 % fasted the full 30 days of Ramadan. The overall frequencies of hypoglycemia (3.5 %) and hyperglycemia (2.0 %) were low. Hypoglycemia and hyperglycemia risks were 3.74-fold and 3.86-fold higher in the high-risk group than in the low-risk group. Conclusion: The new IDF-DAR risk scoring system seems conservative in the risk categorization of T2DM patients in terms of fasting complications.

Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh.

INTRODUCTION: Insulin pen devices and disposable plastic insulin syringes are two common tools for insulin administration. This study aims to compare the simplicity, convenience, safety, and cost-effectiveness of insulin pens versus syringe devices in patients with type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional study was conducted at 14 diabetes clinics throughout Bangladesh from November 2021 to April 2022 among adults with T2DM injecting insulin by pen devices or disposable insulin syringes at least once a day for at least one year by purposive sampling. The simplicity, convenience, and safety of insulin devices were assessed using a structured questionnaire, and the study subjects were scored based on their answers; higher scores indicated a poorer response. Total scores for simplicity, convenience, and safety were obtained by adding the scores for relevant components. Their average monthly medical expense and cost of insulin therapy were recorded. The median values of the total scores and monthly expenses were compared between pen devices and disposable syringe users. RESULTS: 737 subjects were evaluated; 406 were pen users, and 331 were vial syringe users. The pen users had lower median scores for simplicity [6.0 (5.0-8.0) vs. 7.0 (5.0-9.0), p = 0.002], convenience [4.0 (3.0-6.0) vs. 5.0 (4.0-6.0), p < 0.001], and safety [7.0 (6.0-8.0) vs. 7.0 (6.0-9.0), p = 0.008] than vial syringe users. Pen devices were more expensive than vial syringes in terms of average medical expense per month [BDT 5000 (3500-7000) vs. 3000 (2000-5000), p < 0.001], the total cost of insulin therapy per month [BDT 2000 (1500-3000) vs. 1200 (800-1700), p < 0.001] and cost per unit of insulin used [BDT 2.08 (1.39-2.78) vs. 0.96 (0.64-1.39), p < 0.001]. Non-significant differences in favor of pens were observed in HbA1c levels [8.7 (7.8-10) vs. 8.9 (7.9-10)%, p = 0.607] and proportions of subjects having HbA1c < 7% (6.9 vs. 6.3%, p = 0.991). CONCLUSION: Insulin pens are simpler, more convenient, and safe but more expensive than vial syringes. Glycemic control is comparable between pen and syringe users. Long-term follow-up studies are needed to determine the clinical and economic impacts of such benefits of insulin pens.

Sexual dysfunction in women with type 2 diabetes mellitus: A single-centre cross-sectional study from Bangladesh

ABSTRACT Objective: Sexual dysfunction among women with diabetes is a common but neglected health issue worldwide. The objective of the present study was to investigate the prevalence of sexual dysfunction and its associated factors among women with type 2 diabetes mellitus (T2DM). Subjects and methods: This cross-sectional comparative study comprises 150 women with diabetes and 100 healthy women without diabetes who visited the endocrinology outpatient department of Mymensingh Medical College Hospital (MMCH). The data were collected from July to December 2019. Sexual dysfunction was assessed by the 19-item Female Sexual Function Index (FSFI). Informed consent was obtained before participation. Collected data were analysed by SPSS 26. Results: More women with diabetes than control subjects reported sexual dysfunction (79% vs. 72%; p = 0.864). The global FSFI score was lower among the diabetes patients than among the healthy controls (20.8 ± 7.2 vs. 23.7 ± 4.8; p < 0.001). Patients with T2DM scored significantly lower in the domains of desire (p = 0.04), lubrication (p = 0.01), orgasm (p = 0.01), and satisfaction (p < 0.001), but not the domain of arousal (p = 0.09). A prolonged duration of diabetes was the primary contributor to orgasm problems (adjusted odds ratio, aOR 1.3, 95% CI 1.1-1.7) and painful intercourse (aOR 1.2, 95% CI 1.1-1.5). Conclusion: Sexual problems are frequent in women with diabetes. Inclusion of sexual health in comprehensive diabetes management is crucial to address this problem as well as to improve the quality of life of female diabetes patients.

Efficacy and Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus Fasting During Ramadan: A Real-World Study from Bangladesh.

Aim: In Bangladesh, there is a large population of Muslims with type 2 diabetes mellitus (T2DM) who fast during Ramadan. Changes in the pattern of meal and fluid intake during this long-fasting hours may increase the risk of hypoglycaemia, hyperglycaemia, and dehydration. Our key point of focus was to evaluate the efficacy and safety of Empagliflozin, a sodium-glucose co transporter 2 inhibitor (SGLT2i), in patients with T2DM while fasting during Ramadan. Methods: This was a 24-weeks, multi-centre, open-label, two-arm parallel-group study. In this prospective type of observational study, we enrolled patients taking Empagliflozin and Metformin with or without a DPP-4 inhibitor in one group (n = 274) and a parallel group (n = 219) who were treated with Metformin with or without a DPP-4 inhibitor. The primary endpoint of this study was HbA1c reduction, weight loss and the number of reported or symptomatic hypoglycemic events. In secondary endpoints, we evaluated the changes from baseline in blood pressure, estimated glomerular filtration rate (eGFR), serum creatinine, and serum electrolyte, the proportion of volume depletion (≥1 event) and incidence of other adverse events (AEs) of interest potentially related to SGLT2 inhibitor. Results: During Ramadan, HbA1c reduction was significant in Empagliflozin arm (-0.49% vs -0.12%); [p < 0.001]. From before to the end of the study, significant weight reduction was seen in the Empagliflozin arm (-1.4 kg vs -0.09 kg); [p < 0.001]. We observed no significant increase in the incidence of hypoglycemia (0.7% vs 0.4%, p = 0.267) and volume depletion (2.6% vs 1.8%; p = 0.55) in both arm. All these milder forms events did not require any hospital admission. There was no report of serious adverse events or any discontinuation, or reduction of prescribed doses of empagliflozin during Ramadan. Conclusion: Empagliflozin is efficacious and safe for treating adults with T2DM during Ramadan.

Demographic, Clinical and Biochemical Characteristics of Patients with Fibrocalculous Pancreatic Diabetes in North-East Bangladesh.

Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes mellitus occurring primarily in tropical countries like Bangladesh and has distinct characteristics. The present study aimed to describe the demographic, clinical and biochemical characteristics of patients with FCPD. This cross-sectional study was conducted at Mymensingh Medical College Hospital, Bangladesh, from January 2019 to December 2021. All patients with FCPD (previously or newly diagnosed) admitted to the inpatient Endocrinology department of the hospital were evaluated. Out of the 15 patients, 73.3% were aged 10-29 years at diagnosis, the male: female ratio was 11:4, rural: urban ratio was 9:6, 20.0% had FCPD in the first-degree family members, 73.3% were underweight, none were overweight/obese or central obese and one of them was hypertensive. Diabetes was uncontrolled in all, with a mean HbA1c of 10.5±1.9%. All but one had low C-peptide and all required insulin to manage diabetes. Although their average (mean or median) lipid parameters were normal, 73.3% of them had dyslipidemia. Among diabetic complications, diabetic nephropathy (66.7%) and neuropathy (66.7%) were more frequent, whereas diabetic retinopathy (6.7%), ischemic heart disease (6.7%) and peripheral vascular disease (6.7%) were less frequently observed; 13.3% had a history of diabetic ketoacidosis. Malnutrition manifested as abnormal skin and hair conditions and anemia was also common in the study subjects. Patients with FCPD are usually young males from rural residences. Microvascular diabetic complications are common, but macrovascular complications and DKA can occur in FCPD.

Endocrine research in Bangladesh: Evolution and current trend.

Background: The contribution of Bangladesh to global endocrine research is not quantified. We intend to summarize the progress Bangladesh has made in endocrine research. Methods: Global and country-specific data up to December 2021 from the PubMed database were retrieved using the keywords 'diabetes mellitus', 'obesity', 'thyroid', 'adrenal' and 'pituitary'; the keywords 'gonad' OR 'hypogonadism' OR 'PCOS' OR 'sexual dysfunction' were used for retrieving data of reproductive endocrinology research; and 'bone metabolism' OR 'osteoporosis' OR 'vitamin D' were used for bone metabolism research. Bangladeshi contributions to endocrine research were compared to global and country-specific data during the periods '1972-2021' and '2012-2021'. Results: Bangladesh has 2,467 articles in the PubMed database in different fields of endocrinology during the period 1972-2021, which is 0.132% of the total global endocrine publications published in this timeframe. We observed a gradual increment in the number of Bangladeshi publications over the last five decades in all fields of endocrinology. Over the last 10 years, the contribution has risen to 0.226% with 2003 publications. Conclusions: Currently, Bangladesh contributes very little to global endocrine research. An urgent call to amplify research works by Bangladeshi endocrinologists is of utmost importance to catch up with the global publications in endocrinology.

Relationship of Serum Uric Acid Level with Acute Ischemic Stroke: A Single-Center, Hospital-Based Study from Bangladesh.

The role of uric acid as a risk factor for cerebrovascular disease, particularly acute ischemic stroke, is controversial and there is little information about this in our setting. This cross-sectional study was conducted at the departments of Medicine and Neurology of a tertiary hospital in Bangladesh over one year, from January 2018 to December 2018, to estimate serum uric acid (SUA) levels and assess its risk factor potential in patients with acute ischemic stroke. Forty-five patients with acute ischemic stroke were enrolled and a similar number of age and sex-matched healthy individuals were recruited for comparison. All known risk factors for stroke were searched and SUA levels were measured. SUA was higher (6.66±2.33 vs. 5.23±1.81 mg/dL; p=0.002) and hyperuricemia was more frequent (64.4% vs. 24.4%, p<0.001) in stroke patients in comparison to the controls. Hypertension was more frequent among stroke patients. In multivariate analysis, hyperuricemia [OR 4.51 (95% CI 1.67-12.16; p<0.05)] and HTN [OR 6.31 (95% CI 2.26-17.61; p<0.001)] were found to be independent risk factors of acute ischemic stroke. The stroke and control groups had no differences in age, sex, residence, education, monthly income, occupation, fasting plasma glucose, triglyceride and high-density lipoprotein cholesterol levels. Total cholesterol and low-density lipoprotein cholesterol levels were higher in the stroke patients. SUA may be used as a marker for increased risk of ischemic stroke. However, larger-scale studies are needed to get more insight into our findings.

Etiology of Chronic Abnormal Uterine Bleeding According to the FIGO's PALM-COEIN Classification in Bangladeshi Women of Reproductive Age: A Cross-Sectional Study.

Chronic abnormal uterine bleeding (AUB) is common, but there is a lack of standardized methods for investigating and etiological categorization of AUB. The PALM-COEIN classification system of AUB is getting important to overcome this issue. This cross-sectional study was conducted from January 2019 to December 2019 at Mymensingh Medical College Hospital, Mymensingh, Bangladesh, to determine the causes of AUB in women of the reproductive age group and categorize the causes of AUB as per the PALM-COEIN classification. A total of 380 women with chronic AUB were evaluated. The distribution of PALM-COEIN causes of AUB were AUB-P (1.8%), AUB-A (9.2%), AUB-L (13.2%), AUB-M (5.8%), AUB-C (1.1%), AUB-O (24.7%), AUB-E (1.6%), AUB-I (6.6%), and AUB-N (36.1%). The participants' mean age was 29.6 (±10.5) years, the majority (78.2%) of them was married, only a few (9.5%) had comorbid diseases, including hypertension (HTN) (1.1%), diabetes mellitus (DM) (5.3%), and hypothyroidism (8.7%). Women in the AUB-M classification had higher age than others; anemia was more prevalent in the AUB-P group, the AUB-O group had the highest TSH levels and hypothyroidism frequency. The PALM-COEIN classification helps ascertain the cause of AUB practically and should be used in routine clinical practices to manage these patients better.