Non-communicable disease Division (Collaborative Work)

/Non-communicable disease Division (Collaborative Work)
Non-communicable disease Division (Collaborative Work)2022-07-23T09:30:11+00:00
1307, 2022

Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus: a facility-based cross-sectional study of Bangladesh

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Publication status: Published
Brief description: Diabetes distress (DD) is common and has considerable impacts on diabetes management. Unfortunately, DD is less discussed and frequently underestimated. This study evaluated the prevalence and predictors of DD in adults with type 2 diabetes mellitus (T2DM). A cross-sectional study was conducted at several specialized endocrinology outpatient clinics in Bangladesh from July 2019 to June 2020; 259 adults with T2DM participated. Participants’ DD and depression were measured using the 17-item Diabetes Distress Scale (DDS-17) and 9-item Patient Health Questionnaire (PHQ-9), respectively. DDS-17 scores ≥2 and PHQ-9 scores ≥10 were the cutoffs for DD and significant depression, respectively. The mean (±SD) age of the participants was 50.36 (±12.7) years, with the majority (54.8%) being male; their median (IQR) duration of diabetes was 6 (3-11) years. Among the study participants, 52.5% had DD (29.7% moderate and 22.8% high DD). The prevalence of emotional burden, physician-related distress, regimen-related distress, and interpersonal distress was 68.7, 28.6, 66, and 37.7%, respectively. Depression was present in 40.5%; 28.6% of the participants had DD and depression. The total DDS-17 score was positively correlated with the PHQ-9 score (r = 0.325, p < 0.001). Rural residence (OR 1.94), presence of any diabetic complication (OR 3.125), insulin use (OR 2.687), and presence of major depression (OR 4.753) were positive predictors of DD. In contrast, age ≥ 40 years at diabetes diagnosis (OR 0.047) and diabetes duration of > 10 years (OR 0.240) were negative predictors of DD (p < 0.05 in all instances). The prevalence of DD in our setting is notably high; DD and depression frequently overlap. Screening for diabetes distress may be considered, especially in high-risk patients.

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1307, 2022

Clinico-Epidemiological Characteristics of Children with Cystic Fibrosis: A Tertiary Care Experience

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Publication status: Published
Brief description: Cystic fibrosis (CF) is considered to be rare among individuals from Bangladesh. The objective of the study was to delineate the clinico-epidemiological characteristics of pediatric cystic fibrosis cases. This observational study included pediatric patients (up to 14 years of age) with a clinical diagnosis of CF. Data were collected within the period from February 2021 and October 2021. Written informed consent was obtained from the accompanying parent. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, and outcome information. Data analysis was done with SPSS 26.  A total of 50 patients (66% male) with a mean age of 39.7 ±30.75 (SD) months were included. Twenty-eight patients (57.14%) had siblings with CF, and 41.67% of parents had a history of consanguineous marriage. The majority of them were stunted (86%) and underweight (86%), and half of them had wasting (54%). Median disease duration was 12 months (range: 2 – 72). Cough (100%) and purulent sputum (100%) were the predominant respiratory symptoms, while failure to thrive (98%) and bulky offensive stools (86%) were prime gastrointestinal symptoms. Among the signs, malnutrition (94%), short stature (72%), digital clubbing (64%), and bronchiectasis (40%) were most frequent. Pulmonary hypertension (48%, n=24) was the most common comorbidity identified in the study participants. In hospital, mortality was 16% (n=8). Digital clubbing, bronchiectasis, pancreatic insufficiency, and abnormal liver function tests were significantly higher in the patient who died. Children with cystic fibrosis most commonly present with undernutrition and respiratory symptoms. Failure to thrive was almost a global phenomenon. Pulmonary hypertension was the most common complication found in echocardiography.

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607, 2022

WILD syndrome: A rare presentation of primary lymphedema, generalized warts and immune deficiency diagnosed in Bangladesh

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Brief description: WILD syndrome is a rare disease characterized by warts, impaired cell mediated immunity, primary lymphedema and anogenital dysplasia. Our patient who is a 13 year old boy presented with swelling of right lower limb since birth. The swelling gradually involved both upper limbs and right side of his face. The swelling over the right lower limb grew to such an extent that he has been unable to do his daily activities for the last 3 years and warty skin lesions over his whole body for the last 5 years. At the same time he has swelling of his external genitalia and warty lesion around the anus. He has recurrent painless swelling of his abdomen with scanty micturition. On examination, he was mildly anemic, non-icteric, non-pitting odema of right leg, normal vital parameters, right sided pleural effusion, pericardial effusion and ascites, no organomegaly. Swelling and distortion of right lower limb with nodular lesions over the right leg, generalized hyper and hypopigmented verrucous papules and paques over whole body, swelling of the glans and flat warts around the anus.  His investigations revealed leucopenia, chylous pleural effusion, lymphedema of right lower limb with venous incompetency and normal arterial supply, reduced CD4 and CD8 T cell count, normal immunoglobulin levels, negative ICT for filarial, histology of skin lesion revealed elephanthiasis verrucosa nostra, and anogenital dysplasia with a large number of koilocytes.

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607, 2022

Breast Cancer with Paraneoplastic Syndrome in a 72 Year Old Male Patient

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Publication status: Published
Brief description: Breast cancer in male is rare which accounts about 1% of all malignant breast neoplasm cases. Since paraneoplastic syndrome is unusual with male breast cancer, very few reported cases are found. A72- year-old gentleman presented with proximal myopathy in all four limbs was referred to Dr. Sirajul Islam Medical College and Hospital in April 2017. He had generalized wasting with reduced tone and reflexes. Planter responses were normal with intact sensory. There were typical Heliotrope rash bilaterally. In background, he had history of radical mastectomy due to stage IIA ductal carcinoma of left breast 7 years back. Three years later, he was found to have multiple metastases in lung and liver, however, deliberately discontinued chemotherapy after first dose. Currently he is on Tamoxifen. Two months back, he was diagnosed to have brain metastasis. Also his serum sodium level was low with low urine osmolality. Considering his background, we diagnosed him dermatomyositis with peripheal neuropathy & SIADH as paraneoplastic presentation of breast malignancy. Despite of normal CPK and NCV, we treated him with steroid as dermatomyositis can present with normal CPK. His myopathy improved after 2 weeks of steroid treatment. Fluid restriction increased his serum sodium level. The aim of reporting this case is to aware physicians about the aggressive nature of male breast cancer, its orthodox paraneoplastic presentation and to differentiate neuropathy from myopathy so that early treatment can improve the outcome.

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607, 2022

Effect of Weight Reduction on Histological Activity and Fibrosis of Lean Nonalcoholic Steatohepatitis Patient

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Publication status: Published
Brief description: Weight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH. We have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m2 was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy. Age, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, ≥ 5% weight reduction and ≥ 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of ≥ 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with ≥ 7% weight reduction in non-lean group only. Smaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.

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1606, 2022

Pattern of drugs prescribed for treatment of hypertensive patients: Bangladesh

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Publication status: Published
Brief description: The exponential increase in patients with hypertension puts an enormous burden on healthcare providers. To describe the trends in the prescription of antihypertensive medication in a tertiary care hospital, Bangladesh is the objective of the study. This is a hospital based descriptive cross sectional study conducted at the Medicine outpatient Department in Dhaka Medical College Hospital. Patients more than 20 years of age suffering from Hypertension were included in the study. Data was collected by interviewing using a semi-structured questionnaire and analysed by computer with the help of SPSS 16. A total hundred patients were included in the study and 61.6% patients were prescribed on single drug and 38.4% patients were prescribed on combined therapy. Among the prescriptions having single anti-hypertensive medication most commonly used drugs are Angiotensin Receptor Antagonist (37.3%), Calcium Channel Blocker (32.8%), and ACE Inhibitor (17.9%), Beta Blocker (6%), Alpha Blocker (3%), Thiazide and non-Thiazide Diuretics 1.5% each. Among the prescriptions having combined drug therapy Angiotensin Receptor Blocker along with Calcium Channel Blocker and Calcium Channel Blocker along with Beta Blocker were equally (28.1%) chosen by the physicians and use of Angiotensin Receptor Blocker along with Diuretics was 25%, ACE Inhibitor with Calcium Channel Blocker 3.1%, ACE Inhibitor with Diuretics 3.1%, Thiazide and Non Thiazide Diuretics was 3.1% and other drugs were used for 9.5%. Pattern of using antihypertensive medications varies according to presence of co-morbidities and duration but does not vary significantly between male and female patients.

1606, 2022

Effect of telmisartan and vitamin E on liver histopathology with non-alcoholic steatohepatitis: A randomized, open-label, noninferiority trial

Project started: 6 June, 2019
Project End:10 January, 2022
Publication status: Published
Brief description: To compare the effect of telmisartan and vitamin E on liver histopathology of non-alcoholic steatohepatitis (NASH) patients. This noninferiority clinical trial was conducted for 1 year. Fatty liver patients with non-alcoholic fatty liver disease (NAFLD) activity score (NAS) ≥ 5 (in liver biopsy) were selected. All methods were in accordance with the Declaration of Helsinki. Patients who received telmisartan and vitamin E were denoted as Group-T and Group-E, respectively. Forty patients >18 years old were assigned and divided into two groups (20 in each group). Histological improvements were primary outcome measures. Significant improvement in NAS score was noted in both groups (Group E [GE]: 6 ± 0.8 to 4.36 ± 1.4; P = 0.00 and Group T [GT]: 5.6 ± 0.7to 4.9 ± 1.2; P = 0.03). Fibrosis score improved from 1.6 ± 0.5 to 1.5 ± 0.5 in GE and from 1.7 ± 0.9 to 1.5 ± 0.7 in GT (P = 0.67 and 0.42, respectively). Steatosis improved in GE from 2.07 ± 0.6 to 1.14 ± 0.66 (P = 0.00) and in GT from 1.94 ± 0.57 to 1.56 ± 0.8 (P = 0.05). Lobular inflammation improved from 2.0 ± 0.4 to 1.6 ± 0.5 in GE (P = 0.02) and from 1.9 ± 0.3 to 1.8 ± 0.4 in GT (P = 0.58). Ballooning score in GE decreased from 1.9 ± 0.3 to 1.7 ± 0.5 (P = 0.03), and in GT, it reduced from 1.9 ± 0.1 to 1.5 ± 0.5 (P = 0.19). NAS improvement was similar in GE (1.6 ± 1.2) and GT (0.6 ± 1.1; P = 0.07) when controlled for weight reduction. Telmisartan was similar to vitamin E in improving the histology of NASH patients.

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1606, 2022

Association of hyperlipidemia with breast cancer in Bangladeshi women

Project started: 12th February, 2020
Project End: 21 March 2021
Publication status: Published
Brief description: The association of circulating lipids with breast cancer is being debated. The objective of this study was to examine the relationship between abnormal plasma lipids and breast cancer risk in Bangladeshi women. This was a case-control study designed using a population of 150 women (50 women in each group). The lipid levels of women with breast cancer were compared to the lipid levels of women with benign breast disease (control group 1) and healthy women (control group 2). Study samples were collected from the Department of Surgery, Bangabandhu Sheikh Mujib Medical University, for a period of 1 year. Ethical measures were in compliance with the current Declaration of Helsinki. Statistical analysis was performed with SPSS version 26. All of the comparison groups shared similar sociodemographic, anthropometric and obstetric characteristics. The incidence of dyslipidemia was significantly higher in breast cancer patients (96%) than in healthy women (84%) and patients with benign breast disease (82%) (P < 0.05 for both). The levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol among the breast cancer patient group were significantly higher than those among both benign breast disease patients and healthy women (P < 0.05), except for high-density lipoprotein (HDL) cholesterol. Adjusting for other factors, body mass index (BMI) (kg/m2) (> 23) [OR 53.65; 95% CI: 5.70–504.73; P < 0.001] and total cholesterol (mg/dl) (≥ 200) [OR 16.05; 95% CI: 3.13–82.29; P < 0.001] were independently associated with breast cancer. Total cholesterol and BMI are independent predictors of breast cancer risk among Bangladeshi women.

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