Metabolic Syndrome in Hypothyroid Patients.

Thyroid functions affect metabolic syndrome (MetS) parameters including blood pressure, fasting plasma glucose, serum triglycerides and HDL-Cholesterol. But the relationship between MetS and thyroid functions is yet to be identified clearly. Metabolic syndrome is a state in which most features of hypothyroidism can be seen. The aim of the present study was to investigate the frequency of MetS in hypothyroid patients. Thirty one patients with overt hypothyroidism, 32 patients with subclinical hypothyroidism (SCH) and 58 euthyroid controls were enrolled in this study. NCEP-ATP III criteria was used to diagnose metabolic syndrome. Majority of the participants were in the age group of 30-40 years. Body mass index and waist circumference, blood pressure, fasting plasma glucose and serum triglycerides were found to be higher in hypothyroid patients compared to that of euthyroid controls (p<0.001). On the other hand serum HDL-C was found to be significantly lower in hypothyroid patients compared to that of euthyroid controls (p<0.001). Prevalence of MetS was 82.5% in the hypothyroid group and 27.6% in eythyroid controls (p<0.001). No significant difference was found between SCH (81.3%) and overt hypothyroid (86.7%) groups in respect to prevalence of MetS (p<0.05). The findings of the study suggest a need to investigate the presence of hypothyroidism during the management of MetS patients.

Small dense LDL and its Association with Hypertension: a Case-Control Study.

Hypertension is one of the most common diseases affecting humans throughout the world. The commonest variety of hypertension is benign essential hypertension. Cardiovascular risk is more in hypertensive patients as their lipid profile is more atherogenic than normotensive subjects. Traditionally, estimation of total serum cholesterol and LDL-C are used as an indicator of atherogenicity. But subjects may develop hypertension and CHD with normal levels of LDL cholesterol. So assessment of LDL cholesterol concentration may not entirely reflect its atherogenic potential. Because LDL-C is not a single entity rather it consists of seven distinct subclasses of different particle size. The size of the LDL particle is inversely correlated to their atherogenicity. Smaller LDL particles are more atherogenic despite their less cholesterol content than the larger more buoyant LDL particles containing more cholesterol. Therefore individuals having smaller LDL particles are more atherogenic and more at risk to develop hypertension inspite of even normal LDL cholesterol concentration. So measurement of small dense LDL particle is more important than any other lipid measure. With this aim 122 subjects were included in this study, among them 82 were diagnosed cases of essential hypertension with the mean age of 42.56±9.98 years and 40 were healthy controls. Serum apo-B was measured in all study subjects. The amount of apoB is almost similar in every LDL subtypes but the amount of cholesterol increases with the increasing particle size. So the ratio of cholesterol to apo-B decreases as the particle size decreases, thus LDL cholesterol / apo-B £ 1 indicates the presence of atherogenic small dense LDL. So the prevalence of small dense LDL was evaluated by calculating the ratio of LDL-C/apo B. The ratio was significantly lower in hypertensive cases (0.093±0.18) compared to controls, indicating presence of sd LDL in hypertensive patients. When the risk ratio was calculated, the patients having small dense LDL in their plasma were found to have 2.87 times more risk for developing CVD then the persons who doesn't have small dense LDL in their plasma.

Performance of Plasma B-Type Natriuretic Peptide as a Diagnostic Biomarker in Heart Failure.

Background: Accurate diagnosis of heart failure (HF) is essential for its proper management and logical drug therapy to reduce morbidity and mortality. On this perspective researcher are in search of a good biomarker as complementary to the clinical parameters to improve the performance of HF diagnosis. B-type natriuretic peptide (BNP) secreted by cardiac ventricles in HF has emerged as a new promising biomarker in this regard. Objective: To evaluate the performance of plasma BNP as a diagnostic biomarker in HF. Methods: In a cross sectional study 180 clinically suspected HF patients were selected. Their plasma BNP were measured and then subjected to echocardiogram. Patients were categorized as HF and without HF on the basis of echocardiogram and against this information the performance of plasma BNP of study subjects were evaluated as a diagnostic biomarker of HF considering 100 pg/ ml as its cut off point. Results: Sensitivity, specificity, accuracy, PPV, NPV, PLR and NLR of plasma BNP for diagnosis of HF found to be 88 %, 63.8 %, 77.2 %, 75.2 %, 81.0 %, 2.4 and 0.2 respectively. Conclusion: Plasma BNP concentration increases in HF. Based on 100 pg/ml as cut off point, plasma BNP shows good performance in diagnosis of HF.

Effect of Oral Zinc Supplementation on the Growth of Preterm Infants.

Objective: To compare the effect of oral zinc supplementation on growth of preterm infants. Design: Randomized controlled trial. Setting: Dhaka Shisu Hospital (Tertiary care hospital). Subjects: 100 appropriate for date preterm infants weighing between 1000 to 2500g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). Intervention: Zinc supplementation was given 2mg/kg/ day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. Primary outcome variable: Increment of weight and length. Results: At enrollment, serum zinc (62.1±12.4μg/dL in Group I and 63.1±14.6μg/dL in Group II) and hemoglobin levels (14.9±2.4g/dL in Group I and 14.4±1.7g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105±16.5μg/dL) than Group II (82.2±17.4μg/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. Conclusion: Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.

Role of B Type Natriuretic Peptide in the Early Diagnosis of Left Ventricular Diastolic Dysfunction in High Risk Subjects.

Background: Brain natriuretic peptide (BNP) reflects left ventricular pressure. It increases in systolic dysfunction. Our aim was to evaluate role of plasma BNP level in early diagnosis of left ventricular isolated diastolic dysfunction. Methods: We studied 60 patients (male=18, female=42) with hypertension, diabetes mellitus, ischemic heart disease, dyslipidemia. The Doppler parameters used for evaluation of diastolic dysfunction are: isovolumetric relaxation time (IVRT), Transmitral flow velocities (E/A) ratio, deceleration time (DT) & pulmonary vein Doppler findings. 49 patients (group-1) had diastolic dysfunction whereas 11 patients (group-2) had normal flow patterns. Plasma BNP level was done in all patients. Results: Mean plasma BNP levels were 40.41±6.82 pg/ml in individuals with normal filling patterns and 183.36±25.28 pg/ml in subjects with abnormal diastolic dysfunction (p<0.001).The accuracy of BNP in detecting diastolic dysfunction was assessed with receiver-operating characteristic(ROC) analysis. The area under the ROC curve for BNP test accuracy in detection of any abnormal diastolic dysfunction was 0.928 (95% CI, 0.861 to 0.994;p<0.001).A BNP value of 63 pg/ml had the sensitivity of 89.9%,specificity of 91.9% and accuracy of 90.3%.PPVwas 97.8% and NPV-66.7% for detecting diastolic dysfunction. Conclusion: Raised plasma BNP level is useful for early diagnosis of isolated left ventricular Diastolic dysfunction.

Plasma BNP as a Biomarker for Clinical Staging of Heart Failure.

Background: Accurate diagnosis and clinical staging of heart failure (HF) is essential for its proper management and logical drug therapy to reduce morbidity and mortality. On this perspective researcher are in search of a good biomarker as complementary to the clinical parameters to improve the performance of HF diagnosis and its clinical staging. B-type natriuretic peptide (BNP) secreted by cardiac ventricles in HF has emerged as a new promising biomarker in this regard. Objective of the study was evaluation of plasma BNP concentration in relation to the severity of HF and its use as a biomarker for clinical staging of HF. Methods: In a cross sectional study 100 HF cases diagnosed by clinical parameters and echocardiography were enrolled and sub grouped into NYHA classes (I, II, II & IV) depending on clinical severity and functional limitations. Plasma BNP measured in all study subjects and summarized in each of these sub groups. Results: Median plasma BNP concentration in NYHA class-I, II, III & IV found to be 82.7, 267.2, 694.8 & 1530.4pg/ml respectively with progressive rising trend and at 95% CI level the plasma BNP in different sub groups were 64.5-112.7, 214.3-293.5, 626.4-902.4 & 1443.1-2384.4pg/ml respectively. Conclusion: Plasma BNP concentration increases progressively with increasing severity of HF to make it to be used for clinical staging of the disease. In mild, moderate and severe HF plasma BNP proposed to be 100-460, 460-1170 and >1170pg/ml respectively.

Study of serum non-HDL cholesterol in cerebrovascular disease.

Background: Non-HDL cholesterol is a potential newer risk factor for cerebrovascular diseases (CVD). Objective: To explore the association of non-HDL cholesterol with cerebrovascular disease. Methods: This case control study was carried out in the Department of Biochemistry, BSMMU, Dhaka during the period of January to December 2007 to evaluate the association of non-HDL cholesterol with CVD in Bangladeshi population. A total number of 135 subjects of both sexes were grouped as Group-􀇿 (CVD cases) and Group-II (Healthy controls). Group-I include 85 cases of which 59 were ischaemic cerebrovascular diseases (ICVD) and 26 were haemorrhagic cerebrovascular diseases (HCVD). By taking the history and doing clinical examination and laboratory investigations, diabetes mellitus, malignant disease, renal disease, liver disease and diuretic medication were excluded from study subjects. Serum non-HDL cholesterol was measured in all study subjects. Statistical analysis was performed by using SPSS for windows version 12.0. Mean values of the findings were compared between groups. One way ANOVA test and multiple comparison (Bonferroni‘t’) test were used to see the level of significance. Results: Serum non-HDL cholesterol found significantly increased in CVD, ICVD and HCVD cases in comparison to control subjects. But ICVD and HCVD cases did not differ with respect to serum non-HDLcholesterol. Conclusion: The result shows that elevated non-HDL cholesterol is associated with CVD. Prospective study with large sample size is required to evaluate the elevated Non-HDL cholesterol as a risk factor of CVD.

Study of oral itraconazole and terbinafine pulse therapy in onychomycosis.

In this open, randomized and comparative study, the safety and efficacy of systemic intermittent itraconazole and terbinafine was examined in 30 patients with onychomycosis. The patient with positive mycological culture and also the patients with positive microscopy and negative culture were investigated. Patients were randomly assigned: 15 patients in each group received either 200mg itraconazole or 250 mg terbinafine twice daily during the first week of a 4 weeks cycle. The treatment duration was 16 weeks and was followed-up for 36 weeks. Both the treatment regimen showed significant reduction in onychomycosis affected areas after 8 weeks and maximum reduction was observed at the end of 36 weeks. At the end point of the follow-up period, the clinical cure rates (no residual deformity or with some deformity) were 86.7% in the itraconazole group and 100% in the terbinafine group. The mycological cure rates were 86.7% and 100% respectively. However, no statistically significant differences between the treatment groups were seen in clinical, mycological (P= 0.864) and severity assessment (P= 0.220). Nausea, abdominal cramp, headache, back pain and flu like syndrome are the adverse effects more frequently reported. At least one adverse effect was reported by 17 patients, of them 12 belonged to itraconazole group and 5 to terbinafine group and the difference was statistically significant (P= 0.027). The overall therapeutic effectiveness, safety and cost affectivity were in favor of Terbinafine pulse therapy.

Lipoprotein -- an independent risk factor for CVD.

A case control study done to evaluate the Lipoprotein(a) [LP(a)] as a risk factor for CVD (cerebrovascular disease). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were included in the study. Among them 120 were CVD cases and 30 were age and sex matched healthy control. Subjects were grouped as group-I (30, healthy control), Group-II (60, Hemorrhagic CVD) and group-III (60, Ischemic CVD). Fasting (12 hr) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr of attack. Lipid profile and LP(a) conc. were measured in all samples. Mean serum LP(a) conc. in Group-I, Group-II and Group-III were found to be 17.6 7.4 mg/dl, 31.9 15.6 mg/dl and 44.8 24.0 mg/dl respectively. Both the groups of CVD cases showed significantly higher level of serum LP(a) conc. compared to healthy control. CVD cases did not differ statistically in respect of their lipid profile when compared with control. Moreover the serum LP (a) conc. of CVD cases found to show no correlation with their lipid profile, suggesting the serum LP(a) conc. a possible independent risk factor for CVD.

Lipoprotein-a: a laboratory tool for clinical categorization of CVD.

A case-control study was done to evaluate the association of Lipoprotein(a)[LP(a)] with CVD (Cerebrovascular disease) and also to assess the implication of serum LP(a) concentration as a differentiating marker between ICVD (Ischemic CVD) & HCVD (Hemorrhagic CVD). 150 non-smokers, non-alcoholic subjects free from DM, renal disease, thyroid disease and liver disease were studied. Among them 120 were CVD cases and 30 were age & sex matched healthy control. Fasting (12 hr.) blood samples were collected from all subjects and in CVD cases samples were collected after 24 hr. of attack. Serum LP(a) concentration were measured in all samples. Mean serum LP(a) concentration in control, HCVD & ICVD were found to be 17.6 +/- 7.4 mg/dl, 31.9 +/- 15.6 mg/dl and 44.8 +/- 24.0 mg/dl respectively. Both HCVD & ICVD cases showed significantly higher level of serum LP(a) concentration compared to control. Moreover ICVD cases showed significantly higher level of serum LP(a) concentration compared to HCVD cases. The exquisite athero-thrombo-embolic potential of LP(a) explain its involvement with CVD but more with ICVD in comparison to HCVD; This finding apparently suggest the prospect of serum LP(a) concentration to be used as a promising laboratory maker to differentiate clinically the ICVD from HCVD following determination of cut-off value between ICVD & HCVD by broad based comprehensive study.

Breast-feeding counselling and its effect on the prevalence of exclusive breast-feeding.

This prospective intervention study was undertaken to assess the impact of repeated breast-feeding counselling on the rate of exclusive breast-feeding up to five months. The study was carried out in two breast-feeding counselling sub-centres, established at the community level in the vicinity of two maternity facilities and one main centre established in an urban children hospital. Eighty-four pregnant mothers who attended the maternity facilities for delivery of babies were randomly selected and repeatedly counselled regarding breast-feeding--once just before delivery and subsequently at the completion of 1, 2, 3, 4, 5, 6, 9, and 12 month(s) of age of the child. These child-mother pairs comprised the intervention group. Another group of 90 child-mother pairs was selected from the maternity facilities. Mothers in this group (comparison group) received a single session of breast-feeding counselling just before delivery of babies. Fifty-nine and 55 child-mother pairs in the intervention and the comparison groups respectively completed the one-year follow-up. In the intervention group, 54.2% and in the comparison group 36.4% of the babies were exclusively breastfed up to five months of age. Forty-two (88%) children in the intervention group and 29 (53%) in the comparison group were given complementary foods at the optimum time, e.g. after completion of five months, and 81% of the children in the intervention group and 100% of the children in the comparison group were given complementary foods in the first year of life. It was observed that repeated organized breast-feeding counselling significantly improved the prevalence of exclusive breast-feeding to 54% which is much above the existing national prevalence (12.7%) in Bangladesh.