Unveiling the occurrence of COVID-19 in a diverse Bangladeshi population during the pandemic.

Introduction: COVID-19 pandemic hit Bangladesh with relatively low intensity, unlike its neighbors India and European countries and USA. Methods: The present report included data of 8,480 individuals tested for COVID-19 RT-PCR of the workers and officials from readymade garments (RMG) industry in Chandra area in Gazipur. The present data looked into the clinic-demographic factors associated with the susceptibility of the condition. Result: The data elucidated the susceptibility of the individuals to SARS-CoV-2 based on age, gender, pre-existing health conditions, and the presence of symptoms. It was observed that individuals aged over 60 had the highest rate of COVID-19 positivity, and men exhibited a higher infection rate compared to women. Regardless of age, fever and cough were the most frequently reported symptoms. Two-thirds of the individuals included in this report appeared to be asymptomatic carriers. The prevalence of comorbidities among individuals who tested positive for COVID-19 was notably higher, and this exhibited a gender-specific pattern. Discussion: Although our study provides important epidemiological insights into the initial year of the pandemic among Bangladeshi populations, it can also add value for future drug and vaccine development. However, it is essential to acknowledge the limitations like - restriction of public movement, unavailability of vehicle yielding a selection bias, due to the lockdown conditions imposed owing to the pandemic and the diverse characteristics of the participants. The report emphasizes the significance of figuring out how age, gender, and underlying health conditions impact susceptibility to and transmission of COVID-19, thereby providing valuable insights for public health strategies and future research initiatives.

Vitamin D3 and B12 supplementation in pregnancy.

AIM: To assess the efficacy of vitamin D3 or B12 supplementation during pregnancy. METHODS: Pregnant women at 6-14 weeks in the intervention arm received oral high dose intermittent vitamin D3 and/or low dose B12 supplementation if they had vitamin D or vitamin B12 deficiency. The control arm received prescribed dietary instruction only. An additional observational arm for those mothers at booking with normal vitamin D and vitamin B12 level was also recruited. All groups received standard care during pregnancy. RESULTS: The primary endpoint of either vitamin D or B12 at term was not met. At baseline 25% participants in both the interventional and control arms had severe D deficiency (<30 nmol/l), reducing to under 3.4% in both groups. No maternal differences in vitamin D or B12 levels were found at delivery between the intervention, control, or observational groups. No significant difference in any of the pregnancy or birth outcomes was observed between three groups. CONCLUSIONS: In this study, oral supplementation of high dose intermittent vitamin D or low dose vitamin B12 regime failed to correct the relevant nutritional deficiencies in Bangladeshi pregnant women as per protocol. Both dietary supplementation and high dose vitamin D corrected severe vitamin deficiency.

Impaired fasting glucose and impaired glucose tolerance in rural population of Bangladesh.

The prevalence of type 2 diabetes is rapidly rising all over the world at an alarming rate. Over the past 30 years, the increase in prevalence is rising exponentially in South Asian region, data suggest a three fold increase (from 2.0 to 7.0%) in the urbanizing population of Bangladesh within 5 years. However, the prevalence of various degrees of glucose intolerance, i.e., type 2 diabetes, impaired glucose tolerance and impaired fasting glucose considered vital for prevention are still unknown in this population. The objective of the study was to estimate the prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) with their demographic and anthropometric characteristics in a reasonable large sample compare to other studies conducted in Bangladesh. A random sample of 5000 rural population aged > or =20 years was included in this cross sectional study. Fasting blood glucose (FBG) level was measured from 3981 individuals and 2-hr blood glucose (BG) was done on 3954 subjects, excluding known diabetic cases (n= 27). Height, weight, waist and hip circumference including blood pressure and demographic information was also collected. The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly detected type 2 diabetes (T2DM) were 1.3%, 2.0% and 7.0% respectively. IFG, IGT, IFG+IGT were more prevalent in females than males. Age, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) were higher in glucose-intolerant subjects than in normal glucose tolerant (NGT) group. FBG and 2-hr BG values were correlated in NGT and DM subjects. Our data suggest that estimation of FBG value identifies more people with diabetes compared to 2-hr BG estimation. These findings need to be further examined in other settings with urban and rural populations for the justification of FBG for screening of diabetes in Bangladeshi population for development of intervention strategy for the prevention and management of abnormal glucose tolerance. The significance of IFG as a precursor of diabetes and CVD will become evident only from longitudinal studies in different ethnic groups.

Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study.

The aim of the study was to determine the temporal changes in the prevalence of type 2 diabetes mellitus and its associated risk factors in a rural population of Bangladesh. A total of 4757 subjects age >/=20 years both male and female were enrolled randomly in a cross-sectional study in 1999. The same area and population was reinvestigated in 2004 following the same selection procedure, on a sample of 3981 individuals. Structural and economical changes were noted for the last 5 years in the locality. An increased prevalence of diabetes was found with 6.8% in the present survey compared with 2.3% in the earlier survey (p<0.05). Age, BMI and systolic blood pressure were found to be significant risk factors following both for FBG and for OGTT. WHR was found to be a significant risk factor for men only. A substantial agreement was observed between FBG and OGTT (kappa 0.63) compared to the previous investigation in 1999 (kappa 0.40). Differences in the indices of obesity, that is BMI, WHR and waist girth, may in part explain the increased prevalence, which in turn may explain due to fast-expanded urbanization. The state of affairs warrants immediate measures necessary to prevent the epidemic particularly in the localities that are in the transition phase from rural to semi-urban facilities.

Corrigendum: Prevalence of Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh.

This corrects the article on p. 218 in vol. 39, PMID: 26124992.

Antidiabetic activity of Caesalpinia bonducella F. in chronic type 2 diabetic model in Long-Evans rats and evaluation of insulin secretagogue property of its fractions on isolated islets.

Caesalpinia bonducella F., is a shrub widely distributed throughout the coastal region of India and is ethnically used by the tribal people of Andaman and Nicober Island as a remedy of symptoms of diabetes mellitus. This ethnic report prompted the detail investigation of hypoglycemic activity of Caesalpinia bonducella seeds, initially on physiological hyperglycemic model and then on type 1 and type 2 sub-acute diabetic animal models which has already been reported. Evaluation of different extracts from Caesalpinia bonducella in chronic type 2 diabetic model alongwith insulin secretagogue activity of five fractions isolated from the Caesalpinia bonducella seed kernel are presented in this paper. Both the aqueous and ethanolic extracts showed potent hypoglycemic activity in chronic type 2 diabetic model. Two fractions BM 169 and BM 170 B could increase secretion of insulin from isolated islets.

Diabetes and impaired fasting glycemia in a rural population of Bangladesh.

OBJECTIVE: To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a rural population of Bangladesh. RESEARCH DESIGN AND METHODS: A cluster sampling of 4,923 subjects >/=20 years old in a rural community were investigated. Fasting plasma glucose, blood pressure, height, weight, and girth of waist and hip were measured. BMI and waist-to-hip ratio (WHR) were calculated. Total cholesterol, triglycerides, and HDL cholesterol were also estimated. We used the 1997 American Diabetes Association diagnostic criteria. RESULTS: The crude prevalence of type 2 diabetes was 4.3% and IFG was 12.4%. The age-standardized prevalence of type 2 diabetes (95% CI) was 3.8% (3.12-4.49) and IFG was 13.0% (11.76-14.16). The subjects with higher family income had significantly higher prevalence of type 2 diabetes (5.9 vs. 3.5%, P < 0.001) and IFG (15.6 vs. 10.8%, P < 0.001) than those with lower income. Employing logistic regression in different models, we found that wealthy class, family history of diabetes, reduced physical exercise, and increased age, BMI, and WHR were the important predictors of diabetes. Total cholesterol, triglycerides, and HDL cholesterol showed no association with diabetes and IFG. CONCLUSIONS: The prevalence of diabetes and IFG in the rural population was found to be on the increase compared with the previous reports of Bangladesh and other Asian studies. Older age, higher obesity, higher income, family history of diabetes, and reduced physical activity were proved significant risk factors for diabetes and IFG, whereas plasma lipids showed no association with diabetes and IFG. Further study may address whether diabetes is causally associated with insulin deficiency or insulin resistance.

Diabetes and impaired fasting glycemia in the tribes of Khagrachari hill tracts of Bangladesh.

OBJECTIVE: To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a tribal population of Bangladesh. RESEARCH DESIGN AND METHODS: A cluster sampling of 1,287 tribal subjects of age > or =20 years was investigated. They live in a hilly area of Khagrachari in the far northeast of Bangladesh. Fasting plasma glucose, blood pressure, height, weight, waist girth, and hip girth were measured. Lipid fractions were also estimated. We used the 1997 American Diabetes Association diagnostic criteria. RESULTS: The crude prevalence of type 2 diabetes was 6.6% and IFG was 8.5%. The age-standardized (20-70 years) prevalence of type 2 diabetes (95% CI) was 6.4% (4.96-7.87) and of IFG was 8.4% (6.48-10.37). Both tribesmen and women had equal risk for diabetes and IFG. Compared with the lower-income group, the participants with higher income had a significantly higher prevalence of type 2 diabetes (18.8 vs. 3.1%, P < 0.001) and IFG (17.2 vs. 4.3%, P < 0.001). Using logistic regression, we found that increased age, high-income group, and increased central obesity were the important risk factors of diabetes. CONCLUSIONS: The prevalence of diabetes in the tribal population was higher than that of the nontribal population of Bangladesh. Older age, higher central obesity, and higher income were proven significant risk factors of diabetes. High prevalence of diabetes among these tribes indicates that the prevalence of diabetes and its complications will continue to increase. Evidently, health professionals and planners should initiate diabetes care in these tribal communities.

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 Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh.

BACKGROUND: Depression and glucose abnormality are increasing in Bangladesh including its rural area. This study was designed to determine the prevalence of depression in an urbanizing rural population of Bangladesh with or without glucose abnormality (including diabetes mellitus [DM], and pre-diabetes which combines impaired fasting glucose and impaired glucose tolerance pre-DM). METHODS: A total of 2,293 subjects aged ≥20 years were investigated. Sociodemographic and anthropometric details, blood pressure, fasting (fasting plasma glucose) and 2 hours after 75 g plasma glucose (2-hour plasma glucose), were studied. Montgomery-Asberg Depression Rating Scale was used to assess depression. RESULTS: The overall prevalence of DM was 7.9% and pre-DM was 8.6%. Prevalence of depression was 15.31% (n=351; 95% confidence interval [CI], 1.59 to 1.36) with mean depressive score 17.62±3.49. Female were more likely to have depression (17.16%). The 22.35% of male and 29.46% of female with pre-DM and 26.58% male and 36.27% female with DM had depressive symptoms. There was no significant variation in the mean age of different groups (healthy, depressed and with glucose abnormality). Depression was significantly associated with age, marital status, occupation, high physical activity, and low body mass index. The odds ratio (OR) for depression was significantly increased in patients with glucose abnormality compared with those without pre-DM (OR, 2.49; 95% CI, 1.76 to 3.51; P<0.000) and DM (OR, 3.27; 95% CI, 2.33 to 4.60; P<0.000). CONCLUSION: Prevalence of depression found alarming in our study area though lesser than previous studies and it is significantly related to glucose abnormality. The study reveals that mental health should get more focused specially along with metabolic diseases.

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.

Association of general and central obesity with diabetes and prediabetes in rural Bangladeshi population.

BACKGROUND AND AIMS: Recent data shown that both general and central obesity indices are significantly associated with diabetes (T2DM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]). Data regarding association of obesity with T2DM and prediabetes in rural Bangladeshi population is scarce. This study aims to observe the association of general and central obesity with diabetes (T2DM) and prediabetes in rural Bangladeshi population. MATERIALS AND METHODS: A total of 2293 rural Bangladeshi adults aged ≥20 years were randomly selected in a population-based, cross-sectional survey which was conducted in 2009. The association of general (defined by body mass index [BMI]) and central obesity (defined by waist circumference [WC] and waist hip ratio [WHR]) with T2DM and prediabetes was assessed by using receiver operating characteristic curve analysis and logistic regression. RESULTS: Subjects with T2DM, IGT and IFG had a higher rate of general and central obesity than normal subjects. WHR was more closely associated with T2DM than WC and BMI. However, all three obesity indices were significantly associated with IGT and IFG. CONCLUSIONS: In rural Bangladeshi population, both general and central obesity showed good association with T2DM and prediabetes.

Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement.

Since their introduction in clinical practice in the 1950's, Sulfonylureas (SUs) have remained the main-stay of pharmacotherapy in the management of type 2 diabetes. Despite their well-established benefits, their place in therapy is inappropriately being overshadowed by newer therapies. Many of the clinical issues associated with the use of SUs are agent-specific, and do not pertain to the class as such. Modern SUs (glimepiride, gliclazide MR) are backed by a large body of evidence, experience, and most importantly, outcome data, which supports their role in managing patients with diabetes. Person-centred care, i.e., careful choice of SU, appropriate dosage, timing of administration, and adequate patient counseling, will ensure that deserving patients are not deprived of the advantages of this well-established class of anti-diabetic agents. Considering their efficacy, safety, pleiotropic benefits, and low cost of therapy, SUs should be considered as recommended therapy for the treatment of diabetes in South Asia. This initiative by SAFES aims to encourage rational, safe and smart prescription of SUs, and includes appropriate medication counseling.

Lack of R117H mutation in the cationic trypsinogen gene in patients with tropical pancreatitis from Bangladesh.

The etiology of nonalcoholic chronic pancreatitis, occurring in tropical regions, is unknown. Although environmental factors may play a role in its pathogenesis, a specific genetic predisposition may be necessary. The genetic mutation responsible for hereditary pancreatitis was described recently. Unlike in patients with hereditary pancreatitis, we found a lack of the R117H mutation in the cationic trypsinogen gene in all patients with tropical pancreatitis from Bangladesh.

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.

Effect of soluble dietary fibre fraction of Trigonella foenum graecum on glycemic, insulinemic, lipidemic and platelet aggregation status of Type 2 diabetic model rats.

The soluble dietary fibre (SDF) fraction of Trigonella foenum graecum (Tf-sdf) has previously been shown to reduce postprandial elevation in blood glucose level of Type 2 model diabetic rats by delaying the digestion of sucrose. The Tf-sdf has now been investigated for its chronic effect on serum fructosamine, insulin and lipid levels, and on platelet aggregation in Type 2 diabetic rats. Tf-sdf was administered orally twice daily at a dose of 0.5 g kg(-1) for 28 days. It lowered the serum fructosamine level (P<0.05) with no significant change in the insulin level as compared with the control. Atherogenic lipids, i.e. triglycerides, cholesterol and LDL-cholesterol were found to decrease significantly in Tf-sdf fed rats (P<0.01). HDL-cholesterol showed an opposite trend (P=0.024), but serum non-esterified fatty acid (NEFA) values paralleled the atherogenic lipids (P=0.001). No significant effect on platelet aggregation (%) was found although there was a tendency to lower the aggregation (P=0.069). It is concluded that Tf-sdf has a beneficial effect on dyslipidemia and has a tendency to inhibit platelet aggregation in Type 2 model diabetic rats.

Management of acute diarrhoea in diabetic patients using oral rehydration solutions containing glucose, rice, or glycine.

OBJECTIVE: To assess the risk of hyperglycaemia with two standard oral rehydration solutions that contain carbohydrate compared with a carbohydrate free solution during rehydration of diabetic patients with acute diarrhoea. DESIGN: Prospective randomised allocation to one of three oral rehydration solutions (World Health Organisation (glucose), rice, or glycine) groups after admission to hospital with acute diarrhoea. SETTING: Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS: 45 diabetic patients aged between 15 and 60 who had had diarrhoea for fewer than three days on admission. MAIN OUTCOME MEASURES: Fluctuation of blood glucose concentrations measured three times a day, daily stool output, and time taken for recovery from diarrhoea. RESULTS: There were no significant differences in blood glucose concentrations, stool output, and duration of recovery from diarrhoea among the three groups. CONCLUSIONS: Oral rehydration solutions containing glucose, rice powder, or glycine can be safely administered to diabetic patients with acute diarrhoea and some dehydration.

Predicting first professional M.B.B.S. examination score from the results of H.S.C. examination.

In a retrospective study carried out in Chittagong Medical College the results of HSC and First-Professional MBBS examination of 725 students were analysed. It was concluded from the analysis that if standard of HSC examination is well maintained the results of the said examination correlates well with students' performance in the First Professional MBBS examination. An analysis of admission into Chittagong Medical College in past 20 academic sessions has been made which shows that an increasing number of students securing high marks in HSC are being admitted into Medical College during recent years. The marking standard of HSC examination has however remained fairly uniform over the years except during early post-liberation period.

Coccinia indica in the treatment of patients with diabetes mellitus.

Coccinia indica is a creeper which grows wildly in Bangladesh and in many parts of the Indian sub-continent. The plant has been used since ancient times as an antidiabetic drug by physicians who practice the Indian system of medicine known as Ayurvedha. We have conducted a double blind control trial with preparation from the leaves of the plant on uncontrolled, maturity onset diabetics. The trial lasted for six weeks for an individual patient. Out of the 16 patients who received the experimental preparations 10 showed marked improvement in their glucose tolerance while none out of the 16 patients in the dummy group showed such a marked improvement. This difference is highly significant (kappa 2 with Yates' correction = 11.7, P < 0.001).

Stool findings in "chronic dysentery".

Faecal samples from 63 subjects with self-diagnosis of "chronic dysentery" and 50 control subjects were examined under light microscope. Vegetative form of E.h. was not detected in any of them. E.h. cyst was found in 6.3% of the "chronic dysentery" subjects and in 16% of the control subjects. E. coli and Giardia were also detected less often in the "chronic dysentery" than the control subjects. Lower incidence of protozoa namely E.h. cyst, E. coli cyst or Giardia in the former group was probably due to frequent intake of antiamoebic agents which are also effective against other intestinal protozoa. Incidence of Ascaris, hookworm, and Trichuris was not appreciably different in the two groups. More subjects in the "chronic dysentery" group had normal stool findings (31%) as compared to the control subjects (16%). It has been inferred that E.h. infection is not the cause of symptoms of "chronic dysentery".