Mayer-Rokitansky-Kuster-Hauser Syndrome Presented with Diabetes Mellitus and Primary Amenorrhea: A Case Report.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital disorder that affects the female reproductive system and is characterized by an underdeveloped or absent uterus and vagina. A 17-year-old unmarried female was admitted into the Department of Endocrinology, Mymensingh Medical College Hospital, Bangladesh in November 2023 for evaluation of primary amenorrhea and poorly controlled diabetes mellitus. She was the 5th issue of non-consanguineous marriage delivered at term by normal vaginal delivery. Her growth pattern and developmental milestones were normal. She had no history of galactorrhea, chronic or cyclic pelvic pain, thyroid dysfunction, excessive exercise, psychiatric illness, or drug abuse. There was no history of such type of illness in her family. She was diagnosed with diabetes mellitus two years back without classic symptoms, and at that time, her blood glucose was 22 mmol/L. She was prescribed metformin and gliclazide. She had no history of hypoglycemia, hyperglycemic crises, or hospital admission. On examination, her body build and nutritional status were normal. Anemia, jaundice, edema, dehydration, lymphadenopathy, acne, hirsutism, acanthosis nigricans, abdominal striae and vitiligo were absent. Her blood pressure was 110/70 without the postural drop, thyroid gland was not enlarged, anthropometric measurements were normal and BMI was 18.4 kg/m2. Her tanner stage was P5 & B4. Genital examination revealed normal female external genitalia, and a blind vaginal pouch was found. Other systemic examinations revealed no abnormality. On laboratory reports, her blood glucose was uncontrolled (HbA1c-10.2%) with glycosuria. Thyroid function test and gonadal hormones were normal. Ultrasonogram of the abdomen revealed uterus, cervix, and upper part of the vagina are absent, and an ectopic left kidney.

Comparison of Decaying Antibody Level After SARS-CoV-2 Infection in Case of Home Treated and Hospital Treated Patients at Different Interval.

The aim of the study was to evaluate the quantities difference and persistence of antibody in home and hospital treated patients at different interval. A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. This study protocol was approved by Institutional Review Board (IRB), BIRDEM. SARS-CoV-2 caused death of huge number of people. The disease most commonly represents with fever, cough, loss of smell sensation, fatigue etc. Who had mild symptoms did not admit at hospital. But when the disease progress to respiratory distress, involvement of lung field more than 50.0% and other complications then the patients need hospital admission. Hospital treated patients showed higher antibody status in comparison to home treated patients. Moreover it was reported that increased amount of antibody developed after 3rd and 4th months of SARS-CoV-2 infection. In this study, statistically significant difference of decaying antibody level between home and hospital treated patients was observed.

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.

Early Impact of Cardiopulmonary Bypass on Renal Function after Valve Replacement Surgery.

Renal dysfunction following cardiopulmonary bypass is well recognized. The pathophysiology of renal injury is multifactorial and culmination of the interplay of several pathophysiological mechanism. Cardiac surgery requiring cardiopulmonary bypass (CPB) is being carried out on an extended patient population of different age groups and undergoing complex surgical procedure, and thus it places them at an increased risk of renal impairment. Valve replacement surgery is a major and complex surgical procedure requiring CPB. This study was therefore designed to observe the impact of CPB and short term outcome on patients with reduced estimated Glomerular Filtration Rate (eGFR) (60-89ml/min/1.73m²) after valve replacement surgery. This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardio Vascular Diseases (NICVD) during the period of January 2015 to August 2016. After fulfillment of enrollment criteria 100 patients were studied for the purpose of the study and they were grouped in two, patients with normal eGFR (≥90ml/min/1.73m²) in Group A and patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. A total of 100 patients, 50 in each group were studied for renal function alteration after valve replacement surgery under cardiopulmonary bypass. The incidence of Acute Kidney Injury (AKI) was higher in Group B. Chi-square test was done and p value was 0.011 which is statistically significant. Postoperative blood loss (ml/hr) (p=0.038), duration of Intensive Care Unit (ICU) stay (in hours) (p=0.009), postoperative hospital stay (days) (p=0.014) was significantly higher and postoperative Urine Output (ml/hr) (p=0.001) was significantly lower in patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. Deterioration of renal function is more in patient with eGFR (60-89ml/min/1.73m²) after valve replacement surgery under cardiopulmonary bypass in comparison with patients with eGFR (≥90ml/min/1.73m²).

Noonan Syndrome Presenting with Stunted Growth: A Case Report.

Noonan syndrome is a genetic disorder of autosomal dominant inheritance that prevents normal development in various parts of the body. A spontaneous mutation without any family history may also result in the condition. Noonan syndrome can affect normal growth. Birth weight may be normal, but growth slows over time. The growth spurt usually seen during the teenage years may be delayed, and bone maturity also is delayed. In this case A 13 year's male admitted inpatient Department of Endocrinology, Mymensingh Medical College Hospital in April 2021 with not attaining appropriate height and delayed development of secondary sexual characteristics. His birth weight was normal; gestational and neonatal history was uneventful. He was diagnosed with severe pulmonary stenosis at four years and underwent cardiac surgery at his four and eleven years. He was noted to have growth failure from the age of 9 years onward. He had no family history of such type of disease. On examination, he was short statured, underweight, having an upper: lower segment ratio of 1.05 with an arm span of 126cm. He had craniosynostosis, high arched palate, the thick helix of ears (outer rim), small, upturned nose, depressed broad nose, deeply grooved philtrum, keratosis pilaris of the face and upper arm, slant eyes with proptosis, keloid scar over mid-chest, widely spaced nipple, shield chest, pectus excavatum and cubitus valgus. His sexual maturation score was A1, P1, B1. He had pulmonary stenosis with pulmonary hypertension. He had mild microcytic anemia with normal liver, renal, blood glucose, and calcium profile. His bone age was delayed (9 years), thyroid function was normal. The growth hormone dynamic test after clonidine stimulation was normal. His karyotype was 46XY. We have considered giving recombinant growth hormone therapy to accelerate his height.

Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh.

Peripheral neuropathy caused by diabetes mellitus (DM) and vitamin B12 deficiency may produce overlapping clinical pictures. Metformin use is a known cause of B12 deficiency in patients with type 2 DM (T2DM). This cross-sectional comparative study was conducted at two specialized endocrine outpatient clinics in Mymensingh and Cumilla cities of Bangladesh over one year from July 2019 to June 2020. Non-pregnant adults (≥18 years of age) receiving drug treatment for T2DM for at least six months were included in this study. The study subjects were divided into two groups: those with ongoing treatment with metformin and those who never received metformin in their lifetime. Out of 99 subjects evaluated, 66 (66.7%) were in the metformin group, and 33 (33.3%) were in the non-metformin group. Subjects in the metformin group had significantly lower B12 levels compared to the non-metformin group [448.5 (343.0-570.9) vs. 549.0 (487.5-847.0) pg/mL, median (IQR), p<0.001]. None of the study subjects in the non-metformin group were either borderline deficient or deficient of B12 compared to five borderline deficient and three deficient subjects in the metformin group. Among the study subjects, 88.9% had peripheral neuropathy (PN) (43.4% mild, 21.2% moderate and 24.2% severe PN); the two groups had similar frequencies of PN. Though median serum B12 levels were lower in mild [483.0 (411.2-620.0) pg/mL], moderate [492.0 (366.5-680.0) pg/mL] and severe PN [524.5 (363.5-654.2) pg/mL] groups compared to absent PN group [540.0 (340.0-685.0) pg/mL]; the difference in B12 levels across the four groups was not statistically significant. B12 levels had weak negative correlation (r = -0.061, p = 0.624) with gram-years of metformin use. Periodic screening for serum vitamin B12 levels should be done to identify metformin-induced B12 deficiency in T2DM, especially those with PN.

Surgical Correction of Cardiac Defects with Ellis Van Crevald Syndrome - A Rare Case Report.

Ellis-Van Creveld (EVC) syndrome is an autosomal recessive disorder. Around 150 cases are described in published literature and in Bangladesh, it is even rare.  The patient usually comes with short stature, dental deformity, and cardiac deformity. Here, we present the case of a patient with ostium primum atrial septal defect (ASD) with moderate mitral regurgitation who underwent surgical repair of ASD and mitral valve replacement.

Coronary Artery Revascularization with the Left Internal Mammary Artery (LIMA) to Diagonal (D) & Left Anterior Descending (LAD) Sequential and LIMA-LIMA "Y" Graft, Our Experiences at National Heart Foundation Hospital and Research Institute.

The Left internal mammary artery (LIMA) is considered the conduit of choice for the surgical treatment (CABG, coronary artery bypass grafting) of Coronary artery disease (CAD) due to its superior long term potency than the other conduits. Sequential anastomosis with the LIMA in CABG increases the number of arterial graft and more completeness the arterial revascularization. To increase the number of arterial graft and improved long term potency, an alternative technique is sequential anastomosis of LIMA to Diagonal (D) & left anterior descending artery (LAD) and LIMA-LIMA "Y" Graft play a vital role in patients with tight proximal lesion. Perioperative data were prospectively collected from all patients with isolated CAD with tight proximal LAD lesion, who underwent off-pump CABG from November 2013 to October 2015 at a single Centre. A total of 321 patients had LIMA to D & LAD sequential and LIMA-LIMA "Y" grafts pattern with severe proximal LAD lesion. The mean age was 54.7±8.4 years, male & female ratio was 29.7:7.5. Left main involvement was in 25% & triple vessel disease was 89% with LVEF 53.6±8.6%. Sequential LIMA to diagonal (side to side) & LAD (end to side) done in all 294 cases and LIMA-LIMA"Y" grafts in 27 cases. Thirty days mortality was 0.935% (3 patients). Postoperative myocardial infarction (MI) occurred in 2 patients (0.623%). Two sequential LIMA graft failed and both the diagonal & LAD bypassed coronary arteries were very narrow, about 1mm in diameter. All the patients underwent postoperative NYHA class evaluation at 3-6 months follow up & found normal and none of the patients suffered for angina. Revascularization with skeletonized sequential LIMA anastomosis to D, LAD & LIMA-LIMA "Y" graft is a safe, feasible with improve overall long-term potency and reproducible alternative in the presence of severe proximal LAD lesion to the complete revascularization of the anterior& lateral myocardial wall. Long term follow-up with coronary angiogram is essential to recommend this technique as standard one.

Frequency of Dysglycemia and Obesity among Undergraduate Students of a Medical College of Bangladesh.

Due to high genetic susceptibility and rapidly urbanizing lifestyle, the prevalence of diabetes mellitus (DM) is rapidly increasing in Bangladesh especially in the younger population. This cross-sectional study was conducted from 14 to 25 November 2019 among the undergraduate students of a government medical college of Bangladesh to find out the frequency of dysglycemia and associated risk factors in them. A total of 364 students were included in the study. Relevant medical history was taken; clinical examinations and anthropometric measurements were done. Capillary blood glucose (CBG) was measured in fasting state. Out of 364 participants, 7(1.92%) had DM and 26(7.14%) were pre-diabetic. Two-fifth (19.5%) was hypertensive or pre-hypertensive. Almost half of them were either overweight (36%) or obese (13.5%) and 39% had abdominal obesity. Subjects with dysglycemia and normoglycemia did not differ in age, gender, smoking status, diastolic blood pressure (BP), body mass index (BMI), waist circumference, and presence of abdominal obesity and other diseases. A higher number of subjects in the dysglycemia group had first degree relative with type 2 DM (T2DM). Systolic BP was also higher in this group. T2DM in the first-degree relative was found to be a significant predictor of dysglycemia in the study subjects. Adoption of a healthy lifestyle with the aim of reduction of these modifiable cardiovascular risk factors is of utmost importance to ensure a healthy future generation.

Frequency and Correlates of Albuminuria in Adult Bangladeshi Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is associated with various metabolic risks imparting a higher risk for cardiovascular diseases (CVD) in affected women. Urinary albumin excretion (UAE) is a marker of endothelial leakiness and reflects early endothelial damage; thus is used as an important cardiovascular (CV) risk marker. UAE as a CV risk marker in PCOS patients is less well established. This cross-sectional study was done in a tertiary hospital of Bangladesh from January to December 2018 and 95 consecutive adult PCOS patients were screened for UAE. Clinical and anthropometric data were collected, and oral glucose tolerance test (OGTT), fasting lipid profile, serum creatinine, urine routine examination, total testosterone, prolactin, and TSH were measured. The urine albumin-to-creatinine ratio (UACR) was measured in a random single-voided urine sample. UACR cutoff ≥30mg/g was used to define albuminuria. The mean age of the subjects was 22.5±5.0 years; 72.6% were overweight/ obese; 68.4% had abdominal obesity; 94.7% had dyslipidemia and 40% of them had metabolic syndrome. Albuminuria was observed in 21.1% of the subjects. A higher frequency of metabolic syndrome was observed in albuminuric subjects than non-albuminuric ones (45% vs. 38.7%), though the difference was not statistically significant (p=0.617). Albuminuric subjects had higher plasma glucose (PG) value at 2 hours of OGTT and a higher frequency of acne. Other clinical, biochemical and hormonal parameters were similar in the two groups. PG 2 hours after OGTT and serum triglyceride (TG) showed positive correlations and LDL cholesterol showed a negative correlation with UACR. Our study emphasizes the need for screening PCOS women for UACR which may be helpful in identifying those subjects with future high risk of CVD.

Frequency and Risk Factors of Erectile Dysfunction among Bangladeshi Adult Men with Type 2 Diabetes Mellitus.

Various forms of sexual dysfunction occur in men with diabetes mellitus (DM) including disorders of libido, ejaculatory problems, and erectile dysfunction (ED). This cross sectional study was conducted in a tertiary hospital of Bangladesh from December 2017 to May 2018 to find out the frequency and risk factors of ED in subjects with type 2 DM (T2DM). One hundred fifty (150) consecutive male patients with T2DM attending the Endocrinology outpatient department (OPD) of the hospital during the study period were evaluated for the presence of ED by using the International Index of Erectile Function-5 (IIEF-5) questionnaire; their socio-demographic, anthropometric, and clinical data were also recorded. Glycemic status was assessed by measurement of fasting plasma glucose (FPG) and HbA1c. Morning serum testosterone was measured in all. Among 150 subjects 68(45.3%) had ED; ED was mild in 14.7%, mild to moderate in 18.0%, moderate in 6.0% whereas severe ED was present in 6.7% of the subjects. The subjects with ED had higher mean age, longer duration of DM, higher body mass index (BMI), higher HbA1c, higher FPG, higher serum creatinine, and lower serum testosterone level than those without ED. Study subjects in the higher age group and higher duration of DM had higher frequencies of ED. IIEF-5 score showed significant negative correlation with age, duration of DM, HbA1c, fasting plasma glucose, serum creatinine and significant positive correlation with serum testosterone. In logistic regression analysis, duration of DM and serum testosterone were found be independent predictors of ED. Frequency of ED among Bangladeshi type 2 diabetic males is high; duration of DM and serum testosterone are independent predictors of ED in them.

Significant Left Main Coronary Artery Disease Does Not Incur Any Additional Risk to the Short Term Outcome of Off Pump Coronary Artery Bypass Grafting Surgery.

Coronary artery disease is the most common form of heart disease and single most important cause of premature death in developed countries. Off pump coronary artery bypass grafting surgery has recently became widespread internationally and has produced good clinical outcome even in left main coronary artery disease following off pump coronary artery bypass grafting surgery. A prospective observational study was conducted in the department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh from January 2015 to September 2016 after fulfillment of enrollment criteria, 428 patients were studied for the purpose of the study and they were grouped in two, significant left main coronary artery disease in group A and non left main coronary artery disease requiring surgery in group B. Comparison of risk factors between groups demonstrates that diabetes mellitus and smoking habit between two groups were almost identical. 69.2% of patient with significant left main coronary artery group were hypertensive and 25.2% were dyslipidaemic in comparison to non left main coronary artery disease group which were 50.9% and 6.5% respectively. Requirement of per operative inotropic support was significantly higher in left main coronary artery group. 33.6% of patient of left main coronary artery group required per operative inotropic support whereas non left main coronary artery group require 24.8%. Postoperative inotropic support, mechanical ventilation time, ICU stay, hospital stay and complication were similar in both these groups. So, we can say that off pump coronary artery bypass grafting surgery for significant left main coronary artery disease is as safe as non left main coronary artery disease.

Prevalence and Predictors of Depression among Patients with Type 2 Diabetes: A Multicenter Cross-sectional Study from Bangladesh.

Depression is a common comorbidity of type 2 diabetes mellitus (T2DM) which adversely affects diabetes management and outcome. Identifying and treating comorbid depression may improve diabetes care. This cross-sectional study was conducted in several tertiary hospitals throughout Bangladesh from July 2017 to April 2018. Nine hundred (900) adult patients with T2DM aging ≥25 years having diabetes for at least 6 months and equal numbers of non-diabetic otherwise healthy controls were recruited from the outpatient departments of these centers. Depression was assessed in all consenting patients and controls by administering the Bangla (local language) version of the PRIME-MD Patient Health Questionnaire (PHQ-9); participants obtaining a score of 5 or more were labeled to have depression. Depression was present in 60.3% of T2DM patients and in 29.4% of controls. Statistically significant difference was found in age, marital status, occupation, body mass index (BMI), waist circumference, systolic blood pressure (BP), diastolic BP and PHQ-9 score between diabetic and non-diabetic subjects (<0.001). T2DM subjects had 4.71-fold higher odds of depression in comparison to the controls (95% CI: 3.76-5.90; p<0.001). Age ≥50 years, unmarried status, years of schooling ≤10 years, underweight, abdominal obesity, and hypertension appeared to be the significant predictors of depression in the study subjects. In T2DM subjects, diabetes in the family members, the presence of other comorbidities, diabetic complications, diabetes duration >5 years, insulin use, using insulin syringe for injection, albuminuria and CKD were the important predictors of depression. Our study found higher prevalence and risk of depression in T2DM patients than their non-diabetic counterparts. T2DM patients should be screened for depression in order to achieve and maintain the treatment goals.

Vitamin D Status in Polycystic Ovarian Syndrome Patients Attending a Tertiary Hospital of Bangladesh.

Vitamin D deficiency is common in patients with polycystic ovarian syndrome (PCOS) and found to have multiple impacts on the disease process. Vitamin D status of women with or without PCOS in Bangladesh is largely unknown. This cross-sectional study was conducted in a tertiary level hospital of Bangladesh from January 2018 to April 2018 to address this lacuna. Sixty (60) newly diagnosed PCOS patients and 50 healthy controls aging ≥18 years were investigated for serum 25-hydroxy vitamin D [25(OH)D] level, fasting plasma glucose and fasting lipid profile in addition to their clinical and anthropometric profiles. None of the PCOS and the controls had sufficient 25(OH)D. Twenty five percent (25%) of PCOS patients were insufficient, 68.33% were deficient and 6.67% of were severely deficient of vitamin D; whereas in the control group the frequency was 12%, 50% and 38% respectively. PCOS patients had higher 25(OH)D than controls (17.53±4.6 vs. 13.79±6.1ng/mL, p<0.001). Although PCOS group had higher frequency of metabolic syndrome than control group (40% vs. 20%), 25(OH)D levels were similar in subjects with or without metabolic syndrome in both PCOS (16.82±4.74 vs. 17.99±4.49ng/mL, mean±SD, p=0.098) and control groups (14.06±5.94 vs. 13.73±6.20ng/mL, mean±SD, p=0.339). 25(OH)D level correlated with none of the clinical, anthropometric, metabolic and hormonal parameters in PCOS patients. Vitamin D deficiency is highly prevalent in Bangladeshi PCOS patients and healthy women of reproductive age.

Outcome of Surgical Repair of Post-Infarction Ventricular Septal Rupture: A Single Center Observational Study.

To review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes in National Heart Foundation Hospital & Research Institute (NHFH & RI). This retrospective review was performed on 19 consecutive cases who had undergone surgical repair of post-infarction VSR between 2009 and 2017. Continuous variables were summarized as mean plus/minus the standard deviation or median. Categorical variables were expressed as percentage of the sample. Comparison between in-hospital survivors versus non-survivors was performed by Student's t-test and chi-square or Fisher's exact test for continuous and categorical variables respectively. A value of p<0.05 was considered statistically significant. Mean age of survivor and non-survivors were 53.53±9.2 and 56.33±1.5 years consecutively. Anterior VSR 14(73.6%) was more common than posterior VSR 5(26.4%). All patients had significant coronary lesions; the frequency of 1-, 2-, and 3-vessel disease was 22.2%, 27.7% and 50.0% consecutively. The left anterior descending coronary artery was the infarct-related artery in all patients with anterior VSR. Mean cardiopulmonary bypass time was 157±58.6 minutes and 249±78.3 minutes in survivor and non-survivor groups consecutively (p=0.018). Operative mortality within 30 days was 21%. Low output syndrome (LOS), multiple organ failure (MOF), septicemia, tracheostomy and prolonged intensive care unit (ICU) stay were the major factor for survivals. Surgical repair of post-infarction VSR carries a high operative mortality. But, stable hemodynamic at the time of VSR diagnosis is a significant predictor of survival and concomitant coronary artery bypass grafting (CABG) improves early survival.

Low Free T3 was Associated with Poor Glycemic Control in Type 2 Diabetes in a Hospital Based Study in Bangladesh.

Clinical significance of low free T3 (FT3) has not been well explained in patients with type 2 diabetes mellitus (T2DM); FT3 level may be associated with diabetes control and also with diabetic complications. This cross-sectional study was carried out among 153 (mean age 46.8±12 years; female 68%, mean duration of diabetes 5.5±0.53 years, 63.4% either overweight or obese) non-pregnant adults with T2DM who had no acute illness and were unaware about their thyroid function status from July 2016 to December 2016. Serum TSH, free T4 (FT4) and FT3 were measured in all patients by radioimmunoassay (RIA). Patients having subnormal FT3 level with normal TSH and FT4 levels were labeled as having low FT3 syndrome. The mean HbA1c of the study subjects was 8.3±1.7%, serum TSH 2.24±0.34µIU/mL, FT4 16.5±6.56fmol/mL and FT3 was 5.36±1.74fmol/mL. Among them, 9.15% were found to have low FT3 syndrome. There was no statistical difference of FT3 level between males and females (5.87±1.50 vs. 5.99±1.85fmol/mL, mean±SD; p=0.165) and among different BMI groups (p=0.179). Patients with uncontrolled diabetes had lower FT3 than those with controlled diabetes (5.91±1.83 vs. 6.15±1.21fmol/mL, mean±SD, p=0.024). The frequency of low FT3 syndrome was 11.1% in uncontrolled diabetic patients whereas none of the patients with controlled diabetes had low FT3. FT3 level showed positive correlations with the duration of diabetes (r=0.296, p=0.002) and FT4 level (r=0.490, p<0.001) only in female subjects. A fair number of clinically stable T2DM patients had low FT3 in our study. Patients with uncontrolled diabetes had lower FT3 than those with controlled diabetes.

Van Wyk and Grumbach Syndrome: An Unusual Presentation of Hypothyroism.

An 18 years-old-girl presented one and half years back with the complaints of short stature, retarded growth, and menorrhagia with sudden severe lower abdominal pain; was diagnosed as bilateral ovarian cysts and underwent bilateral ovarian cystectomy. Later on she was incidentally diagnosed as a case of hypothyroidism when she had been experiencing slowly enlarging left lower abdominal mass with dull ache for the 5 month and then was transferred to the department of Endocrinology for further evaluation. Detailed work up revealed her short stature with obesity, delayed bone age and other features of hypothyroidism which was confirmed by thyroid function testing. She had enlarged left ovary with multiple follicles as shown in ultrasonography. Magnetic resonance imaging (MRI) showed sellar mass which was suspicious of macroadenoma. Levothyroxine replacement was started and she had a dramatic improvement of her problems with disappearance of the ovarian cysts and sellar mass.

Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) Study.

Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy adult and adolescent Muslims. A significant number of patients with diabetes observe fasting during Ramadan. The objectives of this Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) study were to find out the current knowledge, attitude, and practices about Ramadan fasting among people with diabetes in Bangladesh. This retrospective cross-sectional study recruited 648 subjects with diabetes mellitus attending the Endocrinology outpatient department of a tertiary level hospital of Bangladesh within two months of the end of Ramadan in 2016. Socio-demographic data, data related to diabetes treatment, complications and co-morbidities; changes in lifestyle and diabetes treatment during Ramadan and frequency of hypoglycemia were collected from all. The mean age of the study population was 50.32±12.1 years and the majority (98.6%) had type 2 diabetes and 63.9% were overweight or obese. The majority (89.35%) of the patients fasted in Ramadan and among them, more than half of the fasters received physicians' advice for Ramadan fasting (60.6%) and changed diabetes medication (69.90%) during Ramadan. Although the amount of total food consumption was unchanged in more than one half (60.6%) of the fasters, majority of them reduced sugar-sweet intake (75.5%), increased fluid drinking (75.8%) and decreased physical activity (75.8%) during the month. A large portion (37.48%) of them did not check blood glucose and more than half (54.06%) of fasters failed to visit their physicians during Ramadan. Among them 14.85% experienced mild to moderate episodes of hypoglycemia and none had severe hypoglycemia and the most (61.6%) episodes of hypoglycemia occurred in the late evening. Hypoglycemic episodes were more frequent among insulin users, patients who had received fasting advice from physicians and in those who had adjusted diabetes drugs before Ramadan fasting. Safe Ramadan fasting is a great challenge not only for the patients but also the consulting physicians. Current study reflects the necessity of both physicians' expertise and patients' awareness for safe fasting.

Successful outcome of pregnancy with mechanical heart valve with home heparin therapy.

There is high incidence of rheumatic valvular heart disease in developing countries like Bangladesh, for which large number of young females undergo valve replacement with mechanical prosthetic heart valve. Pregnancy with mechanical heart valve carries risk of warfarin embryopathy and increased incidence of maternal thrombo-embolism. We had successful outcome of pregnancy of a patient with mechanical prosthetic heart valve with home heparin therapy.

Inactivation of indispensable bacterial proteins by early proteins of bacteriophages: implication in antibacterial drug discovery.

Bacteriophages utilize host bacterial cellular machineries for their own reproduction and completion of life cycles. The early proteins that phage synthesize immediately after the entry of their genomes into bacterial cells participate in inhibiting host macromolecular biosynthesis, initiating phage-specific replication and synthesizing late proteins. Inhibition of synthesis of host macromolecules that eventually leads to cell death is generally performed by the physical and/or chemical modification of indispensable host proteins by early proteins. Interestingly, most modified bacterial proteins were shown to take part actively in phage-specific transcription and replication. Research on phages in last nine decades has demonstrated such lethal early proteins that interact with or chemically modify indispensable host proteins. Among the host proteins inhibited by lethal phage proteins, several are not inhibited by any chemical inhibitor available today. Under the context of widespread dissemination of antibiotic-resistant strains of pathogenic bacteria in recent years, the information of lethal phage proteins and cognate host proteins could be extremely invaluable as they may lead to the identification of novel antibacterial compounds. In this review, we summarize the current knowledge about some early phage proteins, their cognate host proteins and their mechanism of action and also describe how the above interacting proteins had been exploited in antibacterial drug discovery.