Prediction of Esophageal Varices in Chronic Liver Disease by Liver Stiffness-Spleen Size-to-Plalelet Ratio Risk Score.

Non-invasive tools are needed to rule out the presence of esophageal varices (EV) in patients with chronic liver disease. The aim of this study was to evaluate diagnostic accuracy of Liver stiffness-spleen size-to-platelet ratio (LSPS) for EV detection and identification of high risk EV in patients with CLD. A total of 70 patients with CLD irrespective of the etiology attending at OPD and admitted in Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD) of BIRDEM General Hospital, Dhaka, Bangladesh from January 2016 to October 2017 were enrolled in this observational cross-sectional study. All patients underwent routine laboratory tests, liver function tests, ultrasonography, liver stiffness (LS) measurement and esophagogastroduodenoscopy. Clinical value of LSPS was compared with platelet count, spleen size and LS for detection of esophageal varices. Diagnostic accuracy was assessed by the Area under the receiver operating characteristic (AUROC) curve. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ROC curve. LSPS has better diagnostic accuracy for detection of EV in terms of AUROC, showing superiority over each factor alone. LSPS also detect high risk EV but accuracy was lower than detection of EV. The optimal cutoff values of LSPS for EV and high risk EV were 0.879 and 4.132 respectively, at which AUROC, negative predictive value, and accuracy were 0.910 [95% confidence interval (CI) 0.832-0.988], 90.9% and 90.0% and 0.695 (95% CI 0.520-0.870), 62.5% and 69.4% respectively. LSPS represents a useful, noninvasive method to detect EV and a high risk EV in patients with CLD. Clinicians should recommend those patients with CLD who show higher values of LSPS to undergo further endoscopic examination.

Clinical and Hematological Features of Visceral Leishmaniasis at Mymensingh Medical College Hospital.

Visceral Leishmaniasis is the most severe form of leishmaniasis and can be fatal in the absence of treatment. Mortality is very high in untreated cases 90%. Clinical case series document a 5% case fatality rate for kala-azar patients in the hospital as complication of the disease. Nepal, India, Bangladesh, Brazil and Sudan constitute five countries of the world where more than 90% of visceral leishmaniasis occurs. Mymensingh accounted for more than 50% of total kala-azar case reported in Bangladesh. This observational study was done at SKKRC under Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st august 2013 to 28th February 2014, to find out various clinical features and hematological picture in visceral leishmaniasis. Total 100 diagnosed case of visceral leishmaniasis was taken. Among total patient male and female were nearly equally affected by kala-azar. All age group were affected by kala-azar from below 2 years to above 50 years. Poor people in the society were affected more by kala-azar. Mymensingh was the highest incidence of kala-azar among different district in Bangladesh. Pyrexia, pallor, weight loss were the main symptoms of visceral leishmaniasis. Abdominal distension, jaundice, vomiting, cough, bleeding manifestation were less frequent symptoms of kala-azar. Hepatosplenomegaly were the frequent sign of kala-azar. Majority of patient had anemia, leucopenia and thrombocytopenia. ESR was frequently raised in kala-azar patient among those patient many had high ESR more than 100 mm in 1st hour. In conclusion prolong fever, progressive pallor, anorexia, weight loss, hepatosplenomegaly in endemic area were the main clinical features of visceral leishmaniasis. Anemia, leucopenia, thrombocytopenia, bi-cytopenia, pancytopenia and high ESR were frequently found hematological pictures in visceral leishmaniasis.

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.

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.

Evaluation of Knowledge Regarding Oral Anti-diabetic Agents among Hospitalized Diabetic Patients.

Knowledge regarding oral anti-diabetic agents help to enhance compliance among diabetic patients. Though it is an important aspect of management, data evaluating it is scarce in our country. This cross sectional observational study carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2013 to February 2014 and was undertaken to determine basic knowledge about oral anti-diabetic agents among hospitalized diabetic patients taking or took oral anti-diabetic agents. In this study main outcome measures were socio-demographic characteristics, knowledge regarding oral anti-diabetic agents, frequency of previous hospital admission, regularity in taking oral anti-diabetic agents, causes of irregularity in taking medicine and knowledge related to hypoglycemia. Mean±SD age was 55±7.14 years, of the patients who were included in this study. Only 33% of patients knew side effects of oral anti-diabetic agents, 34% didn't know that drug should not be stopped before giving blood for glucose estimation, in answering to 9 basic question related to oral anti-diabetic agents 56% obtained score within 0-5, overall mean 5.2±1.47. Among them 38% used to take drug irregularly. Correlation with knowledge score and regularity in taking drug showed significant relation (p<0.01). This study has demonstrated unsatisfactory knowledge on oral anti-diabetic agents among type 2 diabetic patients and significant relation with knowledge on oral anti-diabetic agents and patients compliance. An improvement with this respect may be achieved through continuing patients education about diabetes and its treatment.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Biochemical Predictors in Patients with Type-2 Diabetes Mellitus.

Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in the Western world and it is commonly associated with type 2 diabetes mellitus (DM). The aim of this study to determine the prevalence of NAFLD and identify the predisposing factors in type 2 DM patients with NAFLD. Total of 258 patients of type 2 DM were included in this observational study in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 11th May 2013 to 11th November 2013. Patients with characteristic findings on ultrasonography were considered as having fatty liver. They were divided into fatty liver (Group I) and non-fatty liver group (Group II) and were further evaluated by measurement of body mass index, liver function tests and lipid profile. Out of 258 type 2 diabetic patients, 167 (64.7%) patients had fatty liver on ultrasonography. BMI, waist-hip ratio and triglyceride levels in the Group I was significantly higher than Group II. An increase in the levels of ALT, AST, total cholesterol, LDL and a decrease in HDL was observed in Group I as compared to Group II. The prevalence of NAFLD is common among in type 2 diabetic patients and it increases with the rising incidence of obesity. Obesity as well as elevated liver enzymes, triglyceride and cholesterol are significantly raised in NAFLD patients with type 2 DM. It highlights the importance of routine liver function test and lipid profile in subjects with type 2 DM and should be more closely observed for NAFLD and liver complications.

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.

Diagnostic Importance of Platelet in Patients with Acute Coronary Syndrome Admitted in Mymensingh Medical College Hospital.

This cross sectional descriptive study was carried out in the Department of Cardiology, Mymensingh Medical College Hospital from July 2015 to December 2015, included 50 patients admitted with acute coronary syndrome diagnosed on the basis of history, typical anginal type of chest pain, characteristic electrocardiographic changes and increased cardiac biomarkers. Platelet count (PC), Mean platelet volume (MPV) and platelet distribution width (PDW) were measured using automated hematological analyzer and compared them with 50 age and sex matched healthy controls. All platelet parameter indices - platelet count (PC), mean platelet volume (MPV) & platelet distribution width (PDW) - were significantly raised in patients with ACS. In patients with ACS the mean values of platelet count, MPV & PDW were 352.2×109/L), 13.9fL & 15.6fL, respectively; while in normal healthy control the mean values of these indices were 256.2×109/L), 8.1fL & 10.5fL, respectively. Statistically significant difference in mean values of these indices was found (p value <0.05). Larger platelets are haemostatically more active and are a risk factor for developing coronary thrombosis and subsequent acute coronary events (myocardial infarction and unstable angina). Patients with larger platelets can easily be identified during routine hematological analysis and could possibly benefit from preventive treatment.

Fasting serum glucose and glycosylated hemoglobin level in obesity.

Obesity is a condition in which the body fat stores are increased to an extent which impairs health and leads to serious health consequences. The amount of body fat is difficult to measure directly, and is usually determined from an indirect measure - the body mass index (BMI). Increased BMI in obese persons is directly associated with an increase in metabolic disease, such as type 2 diabetes mellitus. This Analytical cross sectional study was undertaken to assess the relation between obesity and glycemic control of body by measuring fasting serum glucose and glycosylated hemoglobin. This study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh from 1st July 2011 to 30th June 2012 on 120 equally divided male and female persons within the age range of 25 to 55 years. Age more than 55 years and less than 25 years and diagnosed case of Hypothyroidism, Cushing's syndrome, polycystic ovary, Antipsychotic drug user and regular steroid users were excluded. Non probability purposive type of sampling technique was used for selecting the study subjects. Measurement of body mass index was done as per procedure. Fasting serum glucose was estimated by glucose oxidase method and Glycosylated hemoglobin by Boronate Affinity method. Statistical analysis was done by SPSS (version 17.0). Data were expressed as Mean±SE and statistical significance of difference among the groups were calculated by unpaired student's 't' test and Pearson's correlation coefficient tests were done as applicable. The Mean±SE of fasting serum glucose was significant at 1% level (P value <0.001) for obese group of BMI. There was no significant difference of glycosylated hemoglobin level between control and study groups. But there was positive correlation within each group. Fasting serum glucose also showed a bit stronger positive correlation with BMI. Both obese male and female persons showed higher levels of fasting serum glucose and glycosylated hemoglobin. The observed positive correlation between BMI with fasting serum glucose and glycosylated hemoglobin emphasizes the importance of maintenance of normal BMI to prevent early onset of type 2 diabetes mellitus.

Primary hyperparathyroidism: a case report.

Primary hyperparathyroidism results from the excessive secretion of PTH and typically produces frank hypercalcaemia. With the advent of multiphasic screening of serum chemistries, it has been recognized that primary hyperparathyroidism is not an uncommon disorder. Here, a 32 years old lady with burning to colicky recurrent upper abdominal pain, polyuria, polydipsia associated with anorexia, dyspepsia, generalized body ache, joint pain, constipation and weight loss has been described. An initial abdominal ultrasound was performed at hospital and revealed features of cholelithiasis and bilateral nephrocalcinosis. Serum biochemistries revealed that her serum calcium was 12.60mg/dl, serum PTH was 222.80ng/dl, serum creatinine was 0.90mg/dl, 99 Tc-sestamibi scanning for parathyroid evaluation revealed features suggestive of parathyroid adenoma adjoining the lower pole of right lobe of thyroid gland. Bone densitometry of femur and spine by DEXA showed osteoporosis with T score value <-3.5 SD. Right hemithyroidectomy with parathyroid adenoma excision was performed. Patient was closely monitored. Serum calcium and parathyroid hormone levels were markedly reduced near to the normal range within two weeks of surgery. Following five months after surgery, serum PTH was 29.59ng/dl, six months after surgery serum calcium was 9.2mg/dl. Patient is now in good physical condition and under regular follow up.

Practical management of diabetes during Ramadan fasting.

Diabetes mellitus is a global epidemic including Bangladesh. It is a chronic, costly and deadly disease. Recent advancement gives us the opportunity to control diabetes and offer the patient to have a normal or near normal life. Fasting during Ramadan is one of the five pillars of Islam. Recent studies show that most of the type-2 diabetic patients can fast during the holy month of Ramadan safely. But they need pre-Ramadan counseling for assessment, education, motivation, dietary and drug adjustment. Ramadan is beneficial for health. Fasting improves metabolic control, reduces weight and helps to control hypertension. Fasting also associated with some risks like-hypoglycemia, diabetic ketoacidosis, hyper osmolar non ketotic coma and dehydration. All of these risks can be significantly reduced by pre-Ramadan counseling. Those who are at very high risks of hypoglycemia and acute diabetic or other complications they should not fast. After recovery they should complete their fast with the consultation of Islamic scholars. If there is hypoglycemia while fasting, fast must be broken. Islam allows us to have a regular blood sugar test during fast. Patient should follow a highly individualized management plan. Close monitoring is essential to prevent complications for safe Ramadan.

Refractive status of medical students of mymensingh medical college.

This study is done to find out the refractive status of medical students of Mymensingh Medical College (MMC), Mymensingh, Bangladesh. They are of the age of 17-19 years. This is a nonrandom purposive cross sectional study done at late part of the November 2008. Visual acuity estimation, automated refraction, streak retinoscopy, fundoscopy using +78D volk lens were done according to the need of the cases. Out of 175 students 53.14% are emmetropic and 46.86% are ametropic, ametropia is nearly equal in both sexes (male 51.22%, female 48.78%). About all students are of highest academic attainment (GPA 5). About one quarter of the ametropic students (21.61%) are not using spectacles. Simple myopia (81.70%) and myopic astigmatism (18.30%) are the types of ametropia. Out of 67 simple myopic students 56 are of bilateral involvement and 11 are of unilateral involvement. There is similarity in the distribution of sex & refractive status in between general population & medical students of Bangladesh. Myopia and myopic astigmatism are prevalent among medical students.

Regular physical exercise: way to healthy life.

Any bodily activity or movement that enhances and maintains overall health and physical fitness is called physical exercise. Habit of regular physical exercise has got numerous benefits. Exercise is of various types such as aerobic exercise, anaerobic exercise and flexibility exercise. Aerobic exercise moves the large muscle groups with alternate contraction and relaxation, forces to deep breath, heart to pump more blood with adequate tissue oxygenation. It is also called cardiovascular exercise. Examples of aerobic exercise are walking, running, jogging, swimming etc. In anaerobic exercise, there is forceful contraction of muscle with stretching, usually mechanically aided and help to build up muscle strength and muscle bulk. Examples are weight lifting, pulling, pushing, sprinting etc. Flexibility exercise is one type of stretching exercise to improve the movements of muscles, joints and ligaments. Walking is a good example of aerobic exercise, easy to perform, safe, effective, does not require any training or equipment and less chance of injury. Regular 30 minutes brisk walking in the morning with 150 minutes per week is a good exercise. Regular exercise improves the cardiovascular status, reduces the risk of cardiac disease, high blood pressure and cerebrovascular disease. It reduces body weight, improves insulin sensitivity, helps in glycemic control, prevents obesity and diabetes mellitus. It is helpful for relieving anxiety, stress, brings a sense of well being and overall physical fitness. Global trend is mechanization, labor savings and leading to epidemic of long term chronic diseases like diabetes mellitus, cardiovascular diseases etc. All efforts should be made to create public awareness promoting physical activity, physically demanding recreational pursuits and providing adequate facilities.

Angiogenesis-a novel therapeutic approach for ischemic heart disease.

Angiogenesis is the biologic process of forming new blood vessels. Undoubtedly, blood vessels growth regulation is a vital aspect in health and disease. Under physiological conditions, angiogenesis is regulated by local balance between endogenous stimulators and inhibitors of this process. In many diseases state body loses control over angiogenesis. Angiogenesis-dependent diseases result when new blood vessels either grow excessively or insufficiently. Insufficient angiogenesis occurs in diseases such as coronary artery disease, stroke and chronic wounds. Myocardial ischemia both acute and chronic has been clearly shown to stimulate angiogenesis in many experimental models. Therapeutic angiogenesis is the biological agents or bioactive material to stimulate the growth of new blood vessels. Traditional coronary revascularization therapies such as coronary angioplasty or bypass graft surgery, act by restoring blood flow through the preexisting coronary vessels. One limitation of these approaches, however, may be the failure to normalize myocardial perfusion, due to the concomitant presence or small of resistance vessel disease. In contrast, therapeutic angiogenesis is based on the concept that coronary collateral development may be stimulated by pharmacological or molecular means and can limit myocardial ischemia. Studies, both in human and animal models support the notion that, various angiogenic growth factors and progenitor cells can enhance new blood vessels. Vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), recombinant proteins and bone marrow stem cells are currently used therapeutic stimulators for angiogenesis. As coronary artery disease is the major cause of death in the developed societies and also an emerging health problem in developing countries like Bangladesh therapeutic angiogenesis may provide hope as a new treatment modality for ischemic heart disease with or in place of current therapies.

Incretin mimetics and DPP-4 inhibitors: new approach to treatment of type 2 diabetes mellitus.

Type 2 diabetes constitutes the main bulk (85-90%) of diabetic population. It is a chronic metabolic disorder with progressive ?beta-cell dysfunction, impaired insulin actions and various other abnormalities. Insulin response of beta-cell is more after oral glucose or following meal than intravenous infusion of glucose. Gut related peptides, the incretin hormones released after meal following activation of the enteroinsular axis plays an important role in glucose homeostasis by pancreatic and extrapancreatic glucoregulatory effects and helps in preservation of beta-cell function. In type 2 diabetes, there is progressive decline of these incretins level, glucagons like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP) with loss of beta-cell mass, beta-cell function and glycemic deterioration. These peptides are rapidly degraded by endogenous proteases, dipeptidyl peptides-4 (DPP-4) giving a very short half life of 2-3 minutes. Currently available anti-diabetic drugs do not address these arms of glucoregulatory dysfunction of type 2 diabetes. Modern therapeutic strategy should be targeted at preservation of beta-cell mass and function by exploiting the incretin hormones and enteroinsular axis. DPP-4 resistant incretin analogues/mimetics (e.g. exenatide, liraglutide) that have been developed by modifications/ substitutions in the polypeptide chain may be an effective alternative of the existing therapy of type-2 DM. DPP-4 inhibitors (e.g. sitagliptin, vindagliptin) prevent the degradation of endogenous GLP-1 and GIP, thereby potentiate their actions and help in glycemic control. Distinctive features of incretin mimetics are: their action is glucose dependent, do not produce hypoglycemia, help in preservation of beta-cell mass and function, help in weight reduction. DPP-4 inhibitors are weight neutral. Ongoing studies will reveal newer avenues and long term outcome of these molecules.