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The authors identified 1,800,948 patients who made 2,326,701 health care encounters eligible for HIV testing before implementation (1/08-6/12) and 1,362,479 eligible encounters after implementation (1/13-6/15). The sameday HIV testing rate increased from 36.7% to 44.1%, a significant increase. The positive test result rate increased from 0.02% to 0.04% (p < 0.001). During the postimplementation period, fewer HIVinfected patients had a CD4+ cell count below 200 and/or HIV viral load of 10,000 copies/mL or higher at diagnosis.

Background and aims The objectives of this study were to estimate the prevalence of microalbuminuria and examine the association of microalbuminuria with metabolic syndrome (MetS) and its component in a Bangladeshi adult cohort. Methods This cross-sectional study included 175 subjects (84 males and 91 females; aged 19–59 years), recruited from the outdoor Department of Medicine and Endocrinology of a medical college hospital in Dhaka, Bangladesh. Lipid profile and fasting blood glucose (FBG) were measured in serum and albumin and creatinine were determined in urine samples. Microalbuminuria was defined as the urinary albumin-to-creatinine ratio (ACR) of 30 to 300 mg/g. The MetS was defined according to the criteria of the National Cholesterol Education Program (NECP). The association of microalbuminuria with MetS and its components was evaluated by multivariate logistic regression analysis. Results Among the study subjects, 66.3% were hypertensive and 70.3% were diabetic individuals. Overall, the prevalence of microalbuminuria was 29.7% with 31% in males and 28.6% in females. Microalbuminuria was 2.6 fold higher in hypertensive and diabetic adults than in the non-hypertensive or non-diabetic adults. The prevalence of microalbuminuria was much more frequent in persons with the MetS (36.0%) than the persons without the MetS (5.4%). The levels of FBG, systolic blood pressure (SBP), diastolic blood pressure (DBP) and triglycerides were significantly higher (p < 0.01 for all cases) in subjects with microalbuminuria. In regression analysis, after adjusting for sex, age, and body mass index, microalbuminuria was strongly correlated with MetS followed by elevated BP and FBG (p < 0.01 for all cases). Conclusions Microalbuminuria was strongly associated with MetS in Bangladeshi adults. Elevated BP and FBG were the most predominant components of MetS among the study subjects. Comprehensive management of MetS at its early stage can be effective to prevent and reduce the progression of kidney injury and cardiovascular complications.

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Thyroid hormones play an important role in regulating energy balance and metabolism of glucose and lipids. A relationship between dyslipidemia and atherosclerosis is well established in clinical hypothyroidism. Whether subclinical hypothyroidism (SCH) is associated with lipid profile alteration, is the main concept behind the study. SCH is defined as an elevated thyroid stimulating hormone (TSH>5mIU/l) and normal free thyroxine level (FT4 9.5- 25.0 pmol/l). It is highly prevalent in elderly subjects, especially in women but it is frequently overlooked. We examined 40 women with SCH and 50 healthy controls (TSH 0.5-5.0 mIU/l and FT4 9.5- 25.0 pmol/l). None of the patients had been previously treated with thyroxine. In all participants we measured blood pressure, BMI, TSH, FT4 and fasting serum lipid profile. We conclude that SCH in middle aged women is associated with hypertension and significant increase of TC (p<0.001), LDL-C (p<0.001), TG (p<0.001) and decreased level of HDLC p<0.001) in comparison to euthyroid Controls. SCH patients showed significant positive correlation between TSH and total cholesterol (r=.492, p<0.01), LDL-C (r=.355, p<0.05) and TG (r=.274, p<0.05) and negative but nonsignificant corelationship with HDL-C (r = - .058,p=0.361). Dyslipidemia is one of the established risk factors of cardiovascular diseases. Therefore, this study indicates that monitoring of lipid level in SCH patients would be helpful in preventing cardiovascular diseases.Bangladesh J Med Biochem 2015; 8(1): 10-15

Compelling evidence now exists that pro-inflammatory cytokines and nitric oxide (NO) are newly identified endogenous regulators of myocardial contractility. The mechanism(s) responsible for the inotropic and chronotropic effects of these novel mediators can be explained on the basis of recently established principles of myocardial excitation contraction coupling (E-C). A novel hypothesis is proposed that cytokines and NO-mediated alterations in E-C coupling contribute to the reversible myocardial depression and beta-adrenergic desensitization observed in a diverse group of clinical conditions that activate host inflammatory responses, including congestive heart failure. The results of in vitro studies indicate that cytokines and NO have both immediate, short-term, as well as long-term effects on cardiac performance. Basic studies into these cytokine signaling pathways in cardiac myocytes have the potential to provide important new insights relevant to the design of new management strategies for the treatment of congestive heart failure patients.

In suboccipital craniectomy where the bone is not repositioned, there may be a significant cosmetic defect due to lack of skull bone in the suboccipital region. It may accompanied by sensory symptoms, including pain. To prevent any cosmetic defect and sensory symptoms we repositioned the bone chips at the craniectomy site in 42 suboccipital craniectomies before the closure of the scalp. At a mean follow-up of 22 months (range: 5-44 months), two patients complained of mild discomfort in the healed wound or of occasional local pain. One patient complained of mild itching at the site. In two patients, bone chips were accumulated at the lower part of the suboccipital craniectomy and failed to form a uniform bone cover at the operated site. In one patient, all bone chips were reabsorbed and there was no bone at the operated site. There was pseudomeningocele formation in one patient. In the rest of the cases there was satisfactory bone coverage at the operated site, both clinically and radiologically. The wound sites were aesthetically acceptable in 40 cases. Our study suggests that in the majority of cases where suboccipital craniotomy is not possible or not done, repositioning of the bone chips at the craniectomy site is associated with satisfactory aesthetic and functional outcome and formation of bone coverage at the operated site.

low serum HDL-cholesterol and high BMI3. The National Cholesterol Education Program's Adult Treatment Panel lll (NCEP-ATP lll) report identified the metabolic syndrome as a multiplex of risk factors for cardiovascular diseases that deserve more clinical attention 4 . Modified NCEP-ATP lll for MetS includes raised fasting plasma glucose, hypertension, hypertriglyceridemia, low serum HDL cholesterol and increased waist circumference 1 .Hypothyroidism is caused by suboptimal concentration of circulating thyroid hormones. The prevalence of hypothyroidism has been reported to vary in different countries. The worldwide prevalence of hypothyroidism is ABSTRACT Thyroid functions affect metabolic syndrome (MetS) parameters including blood pressure, fasting plasma glucose, serum triglycerides and HDL-Cholesterol. But the relationship between MetS and thyroid functions is yet to be identified clearly. Metabolic syndrome is a state in which most features of hypothyroidism can be seen. The aim of the present study was to investigate the frequency of MetS in hypothyroid patients. Thirty one patients with overt hypothyroidism, 32 patients with subclinical hypothyroidism (SCH) and 58 euthyroid controls were enrolled in this study. NCEP-ATP III criteria was used to diagnose metabolic syndrome. Majority of the participants were in the age group of 30-40 years. Body mass index and waist circumference, blood pressure, fasting plasma glucose and serum triglycerides were found to be higher in hypothyroid patients compared to that of euthyroid controls (p<0.001). On the other hand serum HDL-C was found to be significantly lower in hypothyroid patients compared to that of euthyroid controls (p<0.001). Prevalence of MetS was 82.5% in the hypothyroid group and 27.6% in eythyroid controls (p<0.001). No significant difference was found between SCH (81.3%) and overt hypothyroid (86.7%) groups in respect to prevalence of MetS (p<0.05). The findings of the study suggest a need to investigate the presence of hypothyroidism during the management of MetS patients.