Background: Doctors, despite being the public health leaders, are predisposed to the early development of chronic noncommunicable diseases (NCDs). This study was done to determine the prevalence of risk factors of NCDs among doctors. Methods: A cross-sectional study was conducted among the doctors of a course under the Distance Learning Program at BIRDEM General Hospital, Dhaka. It was done from March 2015 to February 2016. Data were collected using a self-administered questionnaire, and physical and biochemical measurements. However, the measured variables were collected by the investigators. WHO STEPS questionnaire V 3.1, with adaptation to the local context, was used.Results: A total of 404 (223 men and 181 women) of 451 registered doctors participated (89.6%) in the study. The prevalence of smoking was 18.8% among men, and there was no woman smoker. Among the respondents, 17% of men and 0.6% of women drank alcohol at least once in their lifetime. Low physical activity (<600 METmin/week) was reported by 44.4% of men and 34.3% of women. Less than a quarter of them (22.3%) consumed five or more servings of fruit and vegetables. Almost 13% had high blood pressure, and 44.8% were overweight or obese. A total of 3.2% were diabetic, and 5.9% had hypercholesterolemia. Conclusion:High prevalence of NCD risk factors among the doctors in this study highlights the need to create awareness among them.
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.
Spontaneous hypoglycemia is an important entity that may affect multiple organs. The differential diagnosis is broad in individuals with hypoglycemia in the absence of diabetes mellitus. Multiple etiologies may be present concurrently. Drugs, critical illnesses, hormone deficiencies, and non-islet cell tumors should be considered in those who are ill or taking medications. In apparently healthy individuals, endogenous hyperinsulinism due to insulinoma, functional β-cell disorders, or insulin autoimmune conditions are possible, as are accidental, surreptitious or factitious causes of hypoglycemia. Investigations should be guided by clinical scenario. Irrespective of the exact cause of the spontaneous hypoglycemia, treatment consists of correcting the glycemic state and preventing recurrence by alleviating underlying pathology. This review discusses the causes, diagnosis and management of spontaneous hypoglycemia. IMC J Med Sci 2019; 13(1): 001
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Congenital adrenal hyperplasia (CAH) describes a group of autosomal disorders where there is impairment of cortisol biosynthesis. Here is a case of 11-year-old girl who presented with enlargement of external genitalia, excessive growth of hair in pubis, axilla, face and lower limbs along with growth spurt, excessive sweating and deepening of voice for 4 years. On examination she had normal body habitus, hirsutism (modified Ferriman- Gallwey Score-8), acanthosis nigricans in neck and axillary region, Tanner staging revealed stage-II breast development and stage IV female pattern pubic hair. Genitalia examination showed clitoromegaly with normal labia majora, minora and urethral position. Chromosomal analysis showed a normal female 46XX karyotype with normal uterus and bilateral ovaries on ultrasonography. Serum testosterone was elevated and 17- hydroxyprogesterone (17 OHP) was mildly elevated, raising the suspicion of non-classical congenital adrenal hyperplasia which was confirmed later by performing short Synacthen test. Patient and her parents were counseled regarding the diagnosis and clitoroplasty was done and prednisolone 5 mg daily at night in reverse circadian rhythm started. After 3 months of treatment, her hirsutism significantly reduced and menstruation had begun. Birdem Med J 2020; 10(3): 204-206
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