Effects of diabetes mellitus on retreatment of Tuberculosis: A multi-centered case-control study from Bangladesh.

Objectives: Several studies suggested that diabetes mellitus (DM) worsens the tuberculosis (TB) treatment outcome. But information regarding the association of DM with retreatment of TB is very scarce in Bangladesh. Present study aimed to assess the effects of DM on retreatment of TB. Methods: This case-control study was conducted among 254 patients (127 cases and 127 controls) from January 2022 - December 2022. Patients were recruited by purposive sampling from 92 centers of the Diabetic Association of Bangladesh (BADAS). Data were collected by face-to-face interview and record reviewing with the help of semi-structured questionnaire and checklist respectively. Quality of data was maintained in all stages of the study. Data were analyzed by using IBM SPSS software. Informed written consent was taken from each patient prior to the study. Ethical issues were maintained strictly. Results: Present study matched the age and sex of cases and controls. The study revealed that majority of case (89.0) and controls (97.6) were married. Among cases 78.0 % had DM and among controls 64.6 % had DM. Among diabetic patients, 78.8 % cases' and 64.6 % controls' HbA1C level was not within normal range. The study found that, the number of episodes of previous TB (AOR = 3.088, ρ = 0.019), presence of DM (AOR = 2.817, ρ = 0.012) and uncontrolled HbA1C level (AOR = 2.500, ρ = 0.028) were independently associated with retreatment of TB. Conclusion: The study found that presence of DM, uncontrolled HbA1C level and multiple episodes of previous TB were the risk factors for retreatment of TB. So, a separate guideline for treatment of TB-DM patients should be established to prevent retreatment cases.

Higher HbA1c was observed in young people with diabetes who fasted during COVID-19 pandemic lockdown of 2020 Ramadan in Bangladesh - A Post Ramadan survey.

OBJECTIVE: Muslim people with T1DM should be actively discouraged from fasting during the COVID-19 pandemic, as diabetes has emerged as a significant risk factor for adverse outcomes of COVID-19 infection. We report the experience of young patients with type 1, type 2 and other types diabetes who fasted during Ramadan 2020 at the time of the COVID-19 pandemic time lockdown. RESEARCH DESIGN AND METHODS: A Post- Ramadan survey was designed for young patients who fasted during Ramadan in 2020 during COVID pandemic time. The study was conducted to compared the basal characteristics and other parameters in children and adolescents (<18 years), with young adults (≥18 years) with diabetes at Paediatric Diabetes Center in BIRDEM in Bangladesh. RESULTS: Among the study participants, a significantly higher number of participants were in older age group who fasted for more than 15 days (p = 0.045). A considerable proportion (30.7%) of patients developed mild hypoglycaemia, and only eight patients (2.6%) developed moderate to severe hypoglycemia. There was significant reduction of post Ramadan basal insulin dose in both groups (p = 0.001). Although increased bolus insulin dose requirements were observed in older age group, but decreased requirement was observed in younger age group during Ramadan (p = 0.001). Post Ramadan median HbA1C in both groups was increased with marked increase in older age group compared to younger age group though it did not reach the statistical significance. (p = 0.239) CONCLUSIONS: COVID-19 pandemic had minor impact on fasting during Ramadan in our cohort, they could fast safely with less complications during Ramadan. Our data supports Ramadan focused diabetes education with ample self-care, young people with diabetes can fast safely during Ramadan.

Vitamin D status in children and adolescents with type 1 diabetes in a specialized diabetes care centre in Bangladesh.

OBJECTIVES: High prevalence of vitamin D deficiency (VDD) in children and adolescents with type 1 diabetes (T1D) was found in several epidemiological studies. The current study aimed to assess the Vitamin D status in children and adolescents with T1D and to examine the influence of the disease characteristics on vitamin D status in a specialized care centre in a tertiary hospital in Bangladesh. METHODS: Participants were enrolled in the cross-sectional study at the time of a regularly scheduled visit to the CDiC Paediatric Diabetes Center in BIRDEM 2(Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital in Bangladesh. The demographic and clinical data were collected through medical records with a structured questionnaire. RESULTS: Among sixty study participants, most had inadequate levels of vitamin D: deficiency 31 (51.7%), insufficiency 14 (23.3%) and sufficiency 15 (25.0%). Participants with vitamin D deficiency (VDD) were significantly older compared to the sufficient and insufficient group (p = .029), and were residing in urban areas (p = .036) and from higher socioeconomic status (p = .014). BMI was significantly higher in VDD compared to the sufficient group (p = .040). Although we observed higher median values of daily insulin requirements and HbA1c values in patients with VDD compared to patients with vitamin D insufficiency or vitamin D sufficiency, these differences did not reach statistical significance. CONCLUSIONS: The present study revealed that the prevalence of vitamin D deficiency and insufficiency among T1 diabetes children was very high. Future studies in large sample are required to assess hypovitaminosis D in youth with T1D and also the possible relating factors of vitamin D deficiency.

Rapid atmospheric carbon dioxide fixation by nickel(II) complexes: meridionally coordinated diazepane-based 3N ligands facilitate fixation.

Octahedral complexes of the type [Ni(L)(H2O)3](ClO4)2 (1 and 2), where L is the tridentate 3N ligand 4-methyl-1-(pyrid-2-ylmethyl)-1,4-diazacycloheptane (L1, 1), or 4-methyl-1-(N-methylimidazolyl)-1,4-diazacycloheptane (L2, 2), have been isolated and characterized using elemental analysis, ESI-MS and electronic absorption spectroscopy. The DFT optimized structures of 1 and 2 reveal that the tridentate 3N ligands are coordinated meridionally constituting a distorted octahedral coordination geometry around nickel(ii). In methanol solution, the complexes, upon treatment with triethylamine, generate the reactive red colored low-spin square planar Ni-OH intermediate [Ni(L1/L2)(OH)]+ (1a and 2a), as characterized by ESI-MS and electronic absorption spectroscopy, and energy minimized structures. The latter when exposed to the atmosphere rapidly absorbs atmospheric CO2 to produce the carbonate bridged dinickel(ii) complexes [Ni2(L1/L2)2(µ-CO3)(H2O)2](ClO4)2 (3 and 4), as characterized by elemental analysis and the IR spectral feature (∼1608 cm-1) characteristic of bridging carbonate. The single crystal X-ray structure of 3 reveals the presence of a dinickel(ii) core bridged by a carbonate anion in a symmetric mode. Both the Ni(ii) centers are identical to each other with each Ni(ii) possessing a distorted octahedral coordination geometry constituted by a meridionally coordinated 3N ligand, a carbonate ion and a water molecule. The decay kinetics of the red intermediates generated by 1 (kobs, 7.7 ± 0.1 × 10-5 s-1) and 2 (kobs, 5.8 ± 0.3 × 10-4 s-1) in basic methanol solution with atmospheric CO2 has been determined by absorption spectroscopy. DFT studies illustrate that meridional coordination of the 3N ligand and the electron-releasing imidazole ring as in 2 facilitate fixation of CO2. The carbonate complex 3 efficiently catalyzes the conversion of styrene oxide into cyclic carbonate by absorbing atmospheric and pure CO2 with excellent selectivity.

High HbA1c is not a reason not to fast during Ramadan in Children, adolescents and young adults with Type 1 diabetes - An observational study in Bangladesh.

AIMS: Our aim was to investigate the ability, frequency of acute complications and impact on glycemic control in uncontrolled T1DM who fasted during Ramadan. METHODS: 74 Patients with T1D who insisted on fasting were enrolled 1 month prior to Ramadan and given intensive education by Diabetes team on insulin dose, glucose monitoring and dietary adjustments. Patients were divided into two groups ; group A- HbA1c < 9%(<75 mmol/mol) and group B- HbA1c ≥ 9% (≥75 mmol/mol) and different variables were compared. RESULTS: Most of the patients fasted 58 (78.4%) for more than 15 days. There was no significant difference (p = 0.790), while comparing the breaking the fast in the two groups. Hypoglycaemia was common acute complications among them. There was no significant difference in the frequency of hypoglycaemia between two groups (P = 0.448). There was increased insulin requirement in both groups during Ramadan (p = 0.00001), with an increase in basal insulin in well controlled (from 24 to 34 units). There was significant reduction of Post Ramadan mean HbA1C in both groups [P = 0.0001)]. CONCLUSION: Children, adolescents and young adults with T1D with poor glycaemic control can fast safely during Ramadan with proper education and intensive monitoring.

Risk Factors Associated with Microalbuminuria in Children and Adolescents with Diabetes in Bangladesh.

INTRODUCTION: Diabetic nephropathy is leading cause of morbidity and mortality of type 1 diabetes mellitus (DM). Microalbuminuria is the first clinical sign of nephropathy. METHODS: This was a cross-section study with longitudinal evaluation of urinary albumin xcretion in 199 children with type 1 diabetes attending CDiC Clinic in BIRDEM over a period of two years. The aim of the study was to assess the frequency of microalbuminuria and to determine other risk factors. We collected blood and early morning spot urinary sample and analyzed for HbA1c by Clover A1c and urinary microalbumin by a DCA analyzer. Children had urinary microalbumin 30-300 mg/L on at least two occasions were categorized as having persistent microalbuminuria. Demographic and clinical data were recorded including age at onset of diabetes, age during registration, gender and duration of diabetes which were compared between patients without microalbuminuria and with microalbuminuria. RESULT: Microalbuminuria developed in forty nine children and adolescents (25%). Among them 24% were Type 1, 27% were with Fibrocalculous pancreatic diabetes (FCPD) and 68% were Type 2 diabetes. Median HbA1c was higher 10.8 [9.4-12.4] vs 9.5 [8.0-11.2] (P.006) in adolescents with microalbuminuria. On logistic regression univariate analysis independent predictors of microalbuminuria were older age, systolic blood pressure, BMI SDS and mean HbA1c which remained significant in multivariate analysis as predictors of microalbuminuria. CONCLUSION: We found high prevalence of microalbuminuria which was associated with higher age, systolic blood pressure, BMI SDS and HbA1c.

Lipid Profile in Relation to Glycemic Control in Type 1 Diabetes Children and Adolescents in Bangladesh.

INTRODUCTION: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. METHODS: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10-18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study. RESULTS: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2-21.4] vs. 19.5 [17.3-21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9-15.2] vs. 10.6 [7.9-12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4-11.8] vs. 7.9 [9.3-10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). CONCLUSION: More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents.

Development and validation of a simplified algorithm for neonatal gestational age assessment - protocol for the Alliance for Maternal Newborn Health Improvement (AMANHI) prospective cohort study.

OBJECTIVE: The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population-based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub-Saharan African sites. METHODS: This study used on-going population-based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio-demographic and morbidity data during the pregnancy. When they deliver, trained research assistants visit women within 72 hours to assess the baby for gestational maturity. They assess for neuromuscular and physical characteristics selected from the Ballard and Dubowitz maturation assessment scales. They also measure newborn anthropometry and assess feeding maturity of the babies. Computer machine learning techniques will be used to identify the most parsimonious group of signs that correctly predict gestational age compared to the early ultrasound date (the gold standard). This gestational age will be used to categorize babies into term, late preterm and early preterm groups. Further, the ultrasound-based gestational age will be used to calculate population-based rates of preterm birth. IMPORTANCE OF THE STUDY: The AMANHI gestational age study will make substantial contribution to improve identification of preterm babies by frontline health workers in low- and middle- income countries using simple evaluations. The study will provide accurate preterm birth estimates. This new information will be crucial to planning and delivery of interventions for improving preterm birth outcomes, particularly in South Asia and sub-Saharan Africa.