Background & Objective: Non-communicable diseases, particularly diabetes, hypertension and ischemic heart diseases have created an epidemic situation worldwide. Bangladesh is also in the grip of the menace. The only way to get rid of the menace is prevention of these diseases which demands awareness against the diseases. This study was undertaken to assess the level of knowledge of adult people of Puthia Upazila regarding prevention of the seclected non-communicable diseases (NCDs). Methods: The study was carried out in the Department of Community Medicine Rajshahi Medical College, Rajshahi over a period of 2 months from April 2018 to May 2018. All adult people (18 years onwards) residing in the rural area of Puthia Upazila were the respondents (study population) in this study. The survey invited the adult individuals to participate in the study. A total of 1001 individuals voluntarily responded to participate in the study. Of them 648(64.7%) were free from the NCDs and were interviewed to assess their level of knowledge on prevention of selected NCDs. A self-administered questionnaire containing the variables of interest for evaluating knowledge was used. Result: Two-thirds (68.2%) of the respondents were 30–50 years old with mean age of the respondents being 44.3(range: 25-90) years. Males outnumbered females by 11:9. Over half (54%) informed that they had little knowledge and 10.7% were familiar with the NCDs. Around half held the view that diabetes, hypertension, ischemic heart diseases and stroke were NCDs/chronic diseases. Approximately 70% told that the NCDs were on a rising trend. Regarding causes of chronic diseases, the respondents told excess intake of fat and sedentary life-style (67.9%), intake of excess CHO (54.2%), indulgence in smoking (68.2%), less intake of vegetables and fruits (57.4%), excess or additional salt intake (50.5%) and family history of NCD (44.1%). Regarding prevention of NCDs, around 70% were in favor of adopting healthy dietary behaviour and avoiding too much fatty food, followed by regular exercise (71.2%), avoiding or giving up smoking (70.8%) and avoiding or giving up taking extra salt (57.9%). Conclusion: The study concluded that the people of Puthia Upazilla are aware more or less about the selected NCDs (diabetes, hypertension, ischemic heart diseases and stroke). They are also aware that these diseases are increasing. Around two-thirds of the people are aware about the risk factors of these non-communicable diseases and the ways to prevent them. Ibrahim Card Med J 2020; 10 (1&2): 27-32
Metformin-associated lactic acidosis (MALA) in the absence of other risk factors, is extremely rare. A 60-year-old male presented to the emergency department feeling tired and breathless for the preceeding 3 days. He had a 10 year history of type 2 diabetes mellitus (T2DM) and was receiving treatment with metformin. There was no history of fever, cough or orthopnoea. Physical examination was unremarkable. Arterial blood gas analysis showed an increased anion gap metabolic acidosis and raised lactate. Mild pre-renal impairment was also present. There was no evidence of sepsis, heart or liver failure, anaemia or history of alcohol abuse. He received intravenous fluids with resultant normalisation of renal function but lactate levels remained elevated and bicarbonate remained low. At this point a diagnosis of MALA was considered. Metformin was stopped and within 24 hours lactate and bicarbonate levels returned to normal limits. This case highlights the possibility of metformin-treated patients developing lactic acidosis in the absence of other risk factors. Any unwell patient taking metformin should undergo measurement of serum lactate and bicarbonate. Key words: Metformin, Lactic Acidosis
Summary:The objective of this study is to evaluate the efficacy and safety of vildagliptin compared to sulphonylurea (SU) in Type 2 Diabetes during Fasting in Ramadan. This was a prospective, observational cohort study, which enrolledpatients from Bangladesh. Patients aged >18 years with T2DM and HbA1c <8.5% were treated with vildagliptin or SU as add-on to metformin or as monotherapy for 16 weeks.The primary outcome of interest was to compare the proportion of patients with >1 hypoglycemic event(s) (HE) during fasting between the vildagliptin and SU groups. Changes in HbA1c, body weight and treatment adherence were also measured. Of the 100 patients enrolled, 97completed the study and 3 patients discontinued prematurely. Patients experiencing >1 HE(s) were fewer in the vildagliptingroup compared with SU group (4.3% vs. 8.2%; p=0.678). The reduction in HbA1c was 0.1% with vildagliptin from a baseline of 7.1%,however, there was no changewith SU from a baseline of 7.2% (between-treatment difference: "0.1%; p=0.600). A gain of 0.35kg and 0.08 kg was seen with vildagliptinand SUs treatment, respectively. Overall, the incidence of adverse events was similar betweenthe vildagliptin and SU groups (23.4% vs. 20.4%) with no new safety signals.The treatment with vildagliptin was associated with fewer hypoglycemic events compared with SU and was well tolerated in Muslim T2DM patients fasting during Ramadan.
Background & objective: Diabetes is major global epidemic with an ever-increasing trend. For diabetic patients hypoglycemia is a fact of life. The gravity of the problem demands that the diabetics must be aware about the symptoms of hypoglycemia as well as its immediate corrective measures to overcome the crisis. But, a substantial proportion of diabetic patients is unaware of all the symptoms of hypoglycemia leading to delayed management. This study was intended to assess the diabetic patients‟ perception about hypoglycemia. Methods: The study was carried out in the Department of Community Medicine, Rajshahi Medical College, Rajshahi over a period of 2 months from April 2018 to May 2018. The diabetic patients in the rural area of Puthia Upazila were the respondents (study population). A total of 107 diabetic patients were consecutively included in the study. A self-administered questionnaire containing the variables of interest for evaluating perception of the respondents about diabetic hypoglycemia was used. Respondents‟ level of knowledge about hypoglycemia was measured using Likert Scale Score. Score „1‟ was assigned for each correct answer and score „0‟ for each wrong answer. As there were more than one question in assessing respondents‟ level of knowledge, combined scores were used to measure respondents‟ perception about hypoglycemia. Result: Over one-third (36.4%) of the respondents was middle aged (40 – 50 years old) and 29% were upper middle aged (50 – 60 years old) with mean age of the respondents being 51.3 years (range: 30-93 years). Approximately 55% were male with male to female ratio being roughly 11:9 More than two-thirds of the respondents took measures to control diabetes and their compliance to treatment was also commendably high (83%). The proportion of controlled diabetics was no less (57%). But their knowledge about common symptoms and causes of hypoglycemia was poor (no more than 25% on an average). The knowledge about measures to be taken to correct hypoglycemia was even poor (no more than 20% on an average). The perception of the significance of symptoms of hypoglycemia and the importance of their correction were disappointingly low (< 10%). Overall half (49.5%) of the respondents had very poor level of knowledge, over one-third (34.6%) had poor knowledge, 13.1% had average knowledge and only 2.8% had good knowledge about symptoms of hypoglycaemia. Conclusion: The study concluded that over two-thirds of the diabetic patients of Puthia Upazilla adopt measures to control diabetes and their compliance to treatment is appreciably high. The proportion of controlled diabetes is also appreciable. But their knowledge about symptoms, causes of hypoglycemia, measures to be taken to correct hypoglycemia and the importance of taking immediate measure to correct hypoglycemia are all inappreciably low. Ibrahim Card Med J 2018; 8 (1&2): 31-38
Back ground: Treatment compliance in patients with Alzheimer’s disease is particularly important as patients receiving regular treatment have a greater chance of slowing or delaying disease progression. Transdermal delivery has the potential for providing continuous drug delivery and steady plasma levels. Current study aimed to evaluate safety and tolerability of rivastigmine patch, to assess patient compliance and to assess the efficacy of treatment in patients with dementia (with probable Alzheimer’s disease). Methods: A total of 112 dementia patients (with a diagnosis of probable Alzheimer’s disease) from 12 centers were enrolled who were residing with someone in the communities throughout the study. After eligibility, and baseline assessments, patients were entered a 24-week open label treatment phase. All patients were started with application of one 5 cm² patch, followed by an up-titration to the target dose of 10 cm² patch size. Efficacy assessments were performed at weeks 12 and 24 in terms of MMSE and GDS score. Safety was monitored at all assessment points based mainly on the frequency of adverse events. Results: Analysis of baseline and available data until the drop out revealed no significant differentials. Around 95% of the study participants could receive 10 cm² patch size, showing a very high tolerability of the patch. Concurrent medication use also showed significant reduction to 16.3% patient in the end from 25% at baseline. The average MMSE score increased to 19.3 (±3.1) at 12th week and to 20.6(±3.4) at 24th week from 16.8 (±3.2) at baseline. GDS score reduced to 3.7 (±1.4) at 12th week and to 3.2 (±1.3) at 24th week from 4.3 (±1.5) at baseline. Only eight occasions of adverse event was reported (8.2%); no serious adverse event (SAE) were reported. Lost to follow up in the study was 14 (12.5%). Analysis of baseline data shows no significant difference. Their withdrawal seems to be unrelated to the adverse events and treatment outcome. Among the lost to follow up only one 1 (7.1%) had some side effect. Conclusion: Our study supports the pharmacokinetic rationale for the rivastigmine patch, indicating that smooth and continuous delivery of rivastigmine translates into an improved tolerability profile versus conventional oral administration, while maintaining clinical effectiveness. Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 5-14
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