Bangladesh is in the rising phase of the ongoing pandemic of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is scarce. This study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. The severity of the COVID-19 cases was assessed based on the WHO interim guidance. Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Most of the patients (71.8%) were male. Mild, moderate and severe illness were assessed in 74.76%, 9.71% and 15.53% of patients respectively. Nearly 52.4% of patients had a co-morbidity, with hypertension being the most common (34%), followed by diabetes mellitus (21.4%) and ischemic heart disease (9.7%). Fever (78.6%), weakness (68%) and cough (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty in breathing (37.9%), altered sensation of taste or smell (35.0%), headache (32%) and body ache (32%). The median time from onset of symptom to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.

Background: Altered luteinizing hormone to follicle-stimulating hormone (LH-FSH) ratio and hyperandrogenism are two important pathophysiological characteristics of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the relationship of LH-FSH ratio with androgen in women with PCOS. Methods: This cross-sectional study included 550 newly detected reproductive aged women with PCOS (mean ± standard deviation (SD): age 23.14 ± 4.80 years; body mass index (BMI) 27.64 ± 5.34 kg/m 2) according to revised Rotterdam criteria. Relevant clinical history, physical examination and ultrasonogram of ovaries were done for each participant. Fasting serum LH, FSH and total testosterone (TT) were measured by chemiluminescent microparticle immunoassay from blood collected during follicular phase of menstrual cycle. Results: More than two-thirds (n = 389, about 71%) had altered LH-FSH ratio (cut-off > 1.0) and about 43% (n = 234) had hyperandrogenemia (TT > 46 ng/dL). Frequency of none of the clinical variables or ovarian morphology differed statistically between the groups with or without altered LH-FSH ratio (NS for all). Serum TT and LH-FSH ratio were positively correlated (r = 0.139, P = 0.001). However, menstrual irregularity (P = 0.002), polycystic ovaries (P = 0.045), diabetes mellitus (P = 0.017), obesity (P = 0.009) and hirsutism (P < 0.001) were higher in frequency in the hyperandrogenic group. Serum TT had predictive association with altered LH-FSH ratio (odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.02-1.16), P = 0.02) and LH-FSH had predictive association with hyperandrogenemia (OR (95% CI): 1.15 (1.03-1.28), P = 0.02) in women with PCOS. Conclusions: Serum LH-FSH ratio and androgenemia significantly correlate in women with PCOS. However, manifestations are more frequent with hyperandrogenemia rather than altered LH-FSH ratio.

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Summary Silent corticotroph adenoma (SCA) is an unusual type of nonfunctioning pituitary adenoma (NFA) that is silent both clinically and biochemically and can only be recognized by positive immunostaining for ACTH. Under rare circumstances, it can transform into hormonally active disease presenting with severe Cushing syndrome. It might often produce diagnostic dilemma with difficult management issue if not thoroughly investigated and subtyped accordingly following surgery. Here, we present a 21-year-old male who initially underwent pituitary adenomectomy for presumed NFA with compressive symptoms. However, he developed recurrent and invasive macroadenoma with severe clinical as well as biochemical hypercortisolism during post-surgical follow-up. Repeat pituitary surgery was carried out urgently as there was significant optic chiasmal compression. Immunohistochemical analysis of the tumor tissue obtained on repeat surgery proved it to be an aggressive corticotroph adenoma. Though not cured, he showed marked clinical and biochemical improvement in the immediate postoperative period. Anticipating recurrence from the residual tumor, we referred him for cyber knife radio surgery. Learning points: Pituitary NFA commonly present with compressive symptoms such as headache and blurred vision. Post-surgical development of Cushing syndrome in such a case could be either drug induced or endogenous. In the presence of recurrent pituitary tumor, ACTH-dependent Cushing syndrome indicates CD. Rarely a SCA presenting initially as NFA can transform into an active corticotroph adenoma. Immunohistochemical marker for ACTH in the resected tumor confirms the diagnosis.

Objectives: Data regarding vitamin D level and status among categories of prediabetes are scarce in the literature. This study is aimed to determine the level and status of vitamin D among adults with prediabetes and its different categories. Materials and methods: This crosssectional study was carried out in 111 newly detected adults with prediabetes according to American Diabetes Association 2018 criteria and 74 matched healthy control (normal glucose tolerance). People with prediabetes were categorized into impaired glucose tolerance, impaired fasting glucose and their combination group. Participants were recruited consecutively from the Department of Endocrinology, BSMMU to measure serum 25 hydroxyvitamin D by high performance liquid chromatography and serum intact parathormone, calcium, albumin and phosphate by chemiluminescent enzyme-labeled immunometric assay. Results: Vitamin D level and status were not significantly different between people with prediabetes & control and also in different categories of prediabetes. Severe vitamin D deficiency was significantly higher in people with prediabetes (27.5% vs 10%, p= 0.05). There were no associations between different blood glucose levels with vitamin D among adults with prediabetes. Conclusions:Vitamin D was not associated with prediabetes or its categories. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 120-128

Background: Vitamin D level has profound clinical implications but there is dilemma of optimal vitamin D cut-off level among Bangladeshi population as well in many parts of the world. This study aimed to determine the sufficient level of vitamin D [25 hydroxyvitamin D, 25(OH)D] in relation to intact parathormone (iPTH) in apparently healthy adult volunteers. Materials and Methods: This cross-sectional study was carried out among 130 apparently healthy adult participants [age (years): 37.57±12.23, mean±SD; m/f: 67/63] in Bangabandhu Sheikh Mujib Medical University, Dhaka. Demographic profile, sunlight exposure and dietary history were taken, physical examinations were done and fasting blood was taken to measure 25(OH)D, iPTH, calcium, albumin and phosphate. Serum 25(OH)D was measured by high performance liquid chromatography whereas iPTH, serum calcium, albumin and phosphate were measured by chemiluminescent Method. Results: The mean serum 25(OH)D of apparently healthy Bangladeshi adults was 15.44 – 18.44 ng/ml. Vitamin D level was significantly affected by age group [p=0.002], sunlight exposure time [p=0.013] and body surface area [p=0.023] along with sunscreen use [p=0.026]. Serum 25(OH)D had negative predictive association with iPTH [β=-0.220, p=0.012] and positive predictive association with daily sunlight exposure time [β=0.235, p=0.007]. Serum 25(OH)D level above 30 ng/ml was sufficient to keep maximum suppression of iPTH at 54.56 pg/ml by using the quadratic model. Conclusion: The optimal level of 25(OH)D for apparently healthy adults in Bangladesh is above 30.0 ng/ml. J MEDICINE 2022; 23: 139-145

Background: Risk stratification is an essential and first component of the pre-Ramadan assessment of patients with diabetes mellitus (DM) who wish to fast. Limited data are reported from Bangladesh regarding risk stratification of people with DM who wish to fast. Objective: To determine the risk status of people with DM who wish to fast during Ramadan. Methods: This cross-sectional observational study was done among Muslim people of DM with at least one year of experience of Ramadan in previous years after their diagnosis. Along with baseline characteristics, the individual 14 risk elements of the International Diabetes Federation and Diabetes & Ramadan International Alliance (IDF-DAR) risk calculator- 2021 were assessed. Patients were categorized into low, moderate, and high risk with a total score of 0-3, 3.5-6, and ≥6.5 respectively. Moderate and high-risk patients were counseled about their risk of fasting and requested to reconsider their wishes. Results: Among 569 participants, (mean age 50.97±12.02 years, male-female ratio 36.2:63.8) 37.8%, 38.8%, and 23.4% had high, moderate, and low risk respectively. Risk scores were significantly higher in older age (p<0.001), male sex (p=0.024), residence in Chattagram than Rajshahi division (p=0.009) as well as housewife and businessman than other occupations (p=0.012). Despite knowing the risks of fasting, 88.8% of people with high risk and 96.8% of people with moderate risks still wished to fast. The people who still wished to fast despite knowing their risks of fasting had significantly lower percent of macrovascular disease (p=0.039), lower creatinine levels (p<0.001), with a lower percent of dipstick proteinuria (p=0.010), and use of insulin (p=0.021) than those who changed their decision. Conclusions: Nearly 90% of persons with DM with moderate/high risk for fasting still wished to fast despite their exemption. These at-risk population needs guidance, monitoring, and follow-up for safe fasting. J Rang Med Col. September 2022; Vol. 7, No. 2:4-11

Background and objectives: Metformin improves manifestations of polycystic ovary syndrome (PCOS) by reducing insulin resistance. The objective of this study was to determine how metformin, in combination with lifestyle changes, affects the clinical manifestations of PCOS. Materials and Methods: Patients with PCOS attending the outpatient of a tertiary care hospital were enrolled in the study. Revised Rotterdam Consensus 2003 criteria were used to diagnose cases of PCOS. Clinical information, anthropometric measurement, serum progesterone and polycystic ovarian morphology (PCOM) of each subject were recorded in a prescribed data sheet at baseline and after a period of nine months. Randomized placebo controlled double blind design was used to assign participants in respective groups. Participants were randomly assigned to receive 9-month course of either metformin (1500 mg/day) or placebo. Both groups were advised regarding schedule of lifestyle modification. Outcome variables were clinical manifestations related to metabolic, reproductive and androgenic status of PCOS. Results: Out of 80 enrolled PCOS cases, 49 completed the study (metformin=26, placebo=23). The mean age of the study participants of metformin and placebo groups was 23.52±5.18 and 22.09±3.58 years respectively (p=0.262). Menstrual cycle significantly improved in both the study groups (before vs. after - metformin: 19.2% vs. 76.9%, p=0.003; placebo: 19.2% vs. 47.8%, p=0.02) after 9 months, but compared to placebo group no such significant (p=0.12) improvement occurred in metformin group. Severity of hirsutism, presence of acne, serum progesterone level and ovulatory status improved significantly in both groups after completion of the study. Except acanthosis nigricans, other metabolic manifestations did not significantly improve in metformin compared to placebo group after the intervention. While comparing the percentage changes, body mass index (BMI) and waist circumference (WC) reduced significantly in metformin than placebo group (BMI in kg/m2- metformin vs. placebo: -3.63±8.22 vs. +1.42±6.67, p= 0.024; WC in cm - 2.81±7.74 vs. +1.68±7.89, p= 0.05). No significant adverse event was observed in metformin group. Conclusion: Metformin, in conjunction with lifestyle modifications, has favorable impacts on clinical manifestations of PCOS. Ibrahim Med. Coll. J. 2021; 15(2): 1-12