Fasting cut-offs in determining the prevalence of diabetes and intermediate glucose abnormality in a non-obese population.

The study was undertaken to compare the effect of ADA and WHO criteria for screening of diabetes mellitus (DM) and intermediate glucose abnormality (Impaired fasting glucose/Impaired glucose tolerance-IFG/IGT) and to explore an acceptable fasting cut-off in a population-based study. Ten suburb villages with a population of 11,895 were selected purposively. Of the total 6235 eligible (> or = 20y) subjects, 4144 volunteered. We took height, weight, hip- and waist-girth, blood pressure and fasting blood glucose (FBG). All participants were classified into Group-1 (Gr-1: n=453) and Group-2 (Gr-2: n=3691), based on FBG above and below 5.4 mmol/l, respectively. All from Gr-1 and 610 randomized subjects from Gr-2 were investigated for oral glucose tolerance test (OGTT), HbA1c and lipids. The mean (SD) of age, body mass index (BMI) and FBG of all participants was 37.6 (15.2) y, 19.4 (2.9), and 4.7 (0.9) mmol/l, respectively. The prevalence of diabetes and IFG/IGT using American Diabetes Association (ADA) criteria were compared with WHO criteria separately in Gr-1 and Gr-2. For group-1, ADA criteria could diagnose 5.9% as diabetes and 2.1% as IFG, whereas, WHO criteria diagnosed 11.5% diabetes and 19% IGT. Likewise, in Gr-2, ADA detected much less than WHO criteria (DM: 0.3 vs. 2.3%; IFG/IGT 1.0 vs. 14.6%). We compared fasting and 2 hours post-load glucose (2-hBG) values according to percentiles. We found that 11.1 of 2-hBG corresponded with a fasting value that lies between 90 to 95th percentile, equivalent to 5.1-5.7 mmol/l. Using receiver operating characteristics (ROC) curve, we determined the cut-offs 4.6 - 5.4 mmol/l for IFG and > or = 5.5 for diabetes. Taking age and BMI into account the kappa agreements were better between the estimated cut-offs and the given 2-hBG values. The ADA cut-offs were found ineffective for screening. We proposed the modified fasting cut-offs for screening IFG and diabetes among the non-obese population.

Comparison between IS6110 and MPB64 primers for the diagnosis of Mycobacterium tuberculosis in Bangladesh by polymerase chain reaction (PCR).

The study was carried out to evaluate the efficacy of two different primers in PCR based diagnosis of tuberculosis on the basis of the time involvement, steps of PCR, cost and accuracy of results. Among 17 clinically suspected pulmonary tuberculosis patient's (M:F 65:35) sputum samples, 12 were found positive by both primers. Among 81 routine samples (sputum = 12; blood = 27; cerebrospinal fluid = 16; ascitic fluid = 12 and urine = 14), 12 were found to be positive by IS6110 primer while 13 were found positive by MPB64. The result of M. tuberculosis DNA PCR in sputum, ascitic fluid, CSF and urine samples were found to be similar in both the primers used. It is suggested that, M. tuberculosis DNA PCR in blood samples using MPB64 primers sometime gives false positive result and therefore, may not be recommended for blood samples. As in other samples both the primers gave almost the same result and therefore, both the primers can be used for MTB DNA PCR vice versa in order to cross check if one gives dubious result.

Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia.

Body mass index (BMI, kg/m.sq) and waist-to-hip ratio (WHR) are widely used as obesity indices for diabetes and cardiovascular risks. Lower adult height was related to diabetes and stroke. Waist-girth was proved important for visceral obesity. Incorporating waist-girth and height as waist-to-height ratio (WHtR), we reported earlier--"Waist-to-height ratio is an important predictor of hypertension and diabetes". We readdressed this index in a larger sample with two-sample OGTT and lipid profiles. In a cluster sampling of 16,818 rural inhabitants, considering age > or = 20 y, 5713 subjects were found eligible. Of them, 4923 (M/F=2321/2602) volunteered for height, weight, blood pressure, waist-girth and hip-girth. Fasting venous blood (5 ml) was drawn for plasma glucose, total cholesterol (T-chol), Triglycerides (TG) and high-density lipoprotien (HDL-c). Overall, 1565 participants were undertaken for OGTT. The mean (SD) values of BMI, WHR and WHtR for subjects with diabetes and hypertension were significantly higher in either sex. The level significance was highest for WHtR. The prevalence of diabetes and hypertension increased significantly with higher quintiles of BMI, WHR and WHtR (chi sq values were largest in WHtR for both events). Partial correlation coefficients, controlling for age and sex, showed that BMI, WHR and WHtR significantly correlated with systolic and diastolic BP, FBG, T-chol and TG. In the entire correlation matrix, the 'r' values were the highest for WHtR. Taking diabetes and hypertension as dependent variables, logistic regression also showed the highest odds ratio in higher WHtR than BMI and WHR. We conclude that WHtR was proved again a valuable obesity index for predicting diabetes, hypertension and lipidemia.

Prevalence of hypertension in Bangladesh: effect of socioeconomic risk factor on difference between rural and urban community.

Several studies reported that migrant Bangladeshis had greater risk for hypertension, diabetes and coronary heart disease compared with the Europeans and other migrant South Asians. So far, there has been no such study among the native population. This paper reports the hypertension prevalence and related risks among native Bangladeshis. A total of 2,361 subjects over 20 years of age were investigated. Overall prevalence rates of systolic and diastolic hypertension in the study population were 14.4 and 9.1 percent respectively. The prevalence of systolic hypertension was significantly higher in rural than in urban participants (P < 0.001). Compared with the poor the rich class had significantly higher prevalence of both systolic (P = 0.002) and diastolic (P = 0.041) hypertension. With increase of age, body mass index (BMI) and blood glucose level were significantly related to hypertension (P < 0.0001); whereas the trend for increasing waist-to-hip ratio (WHR), adjusting for social class, was not significant. Regression analysis showed that age, BMI, rural area and rich class were the strong predictors for hypertension. This study explored that hypertension prevalence in the native Bangladeshis is almost comparable to that of other Asian populations and South Asian migrants.

Isolation and characterization of Helicobacter pylori strains from peptic ulcer patients in Dhaka, Bangladesh.

To study the association of Helicobacter pylori with peptic ulcer and the associated histopathological changes, to characterize the isolated strains in terms of their protein profile, 83 peptic ulcer cases were studied. A high association of H pylori with peptic ulcer (duodenal ulcer 77%, gastric ulcer 75%) and gastritis (74%) was observed. Age and smoking did not have any relationship with H pylori infection. The infection was predominantly associated with the 'quiescent' form of chronic gastritis. Comparative sodium dodecyl sulfate polyacrylamide gel electrophoresis of whole cell extracts of the local isolates and a reference strain from Australia showed a general homogeneity between the strains with obvious interstrain differences. However, the difference between the local isolates and the reference strain was more marked. Significant association of H. pylori with peptic ulcer along with strain variations were observed.

The value of percutaneous transhepatic cholangiography in the diagnosis of obstructive jaundice.

Percutaneous transhepatic cholangiography (PTC) using Chiba needle was employed to diagnose obstructive jaundice in 31 subjects. It was successful in all 27 (87%) subjects who had dilatation of the biliary tree. Out of them, 15 had features suggestive of carcinoma, 9 had features of stone and 3 had features of stricture of the common bile duct (CBD). Surgery was done in 11 cases and PTC diagnosis of carcinoma of CBD in 4 and stricture of the same in one subject were confirmed. While in the remaining 6 subjects with a PTC diagnosis of CBD stone, 4 were found to be so and 2 had stricture of the duct. Three subjects had complications such as bile peritonitis, cholangitis and shock. In majority of the cases, the biochemical parameters were inconclusive. These results suggest that PTC may be useful in the diagnosis of obstructive jaundice and this procedure should be employed more widely.

Metabolic and hormonal profile of the offsprings of conjugal diabetics.

Oral glucose tolerance response to blood glucose, serum immunoreactive insulin (IRI) and plasma free fatty acid (FFA) levels were studied on 159 offsprings of both parent diabetics (connubials). Fasting serum cholesterol, triglyceride, phospholipid and total lipids were also measured in these subjects. We detected 6 diabetics out of 159 connubials at the time of our study. FFA level in 6 diabetic connubials were higher all time intervals than 153 non-diabetics connubials. Fasting and one hour post glucose response were less in 6 diabetic connubial but two hours post glucose IRI response to both 6 diabetic connubials and 153 non-diabetic connubials were same indicating a delayed insulin secretion in response to oral glucose level in 6 diabetic connubials.

Basal and maximal acid output in chronic duodenal ulcer patients needing surgery.

Basal acid output (BAO) and maximal acid output (MAO) were studied in a group of duodenal ulcer patients needing surgical treatment and in a group of healthy control subjects. The MAO levels in both the patients and the controls were lower than those reported from Europe, North America or Hongkong but were similar to those from India. The BAO levels were similar to those observed by workers in other countries. The MAO levels of the duodenal ulcer patients were much higher than those of the control subjects and there was hardly any overlap between the two groups. The ulcer patients had levels of greater than 15.0 mmol/hour. Whether duodenal ulcer patients from Bangladesh with MAO values of over 15.0 mmol/hour will always need surgery remains to be studied.

Stool findings in "chronic dysentery".

Faecal samples from 63 subjects with self-diagnosis of "chronic dysentery" and 50 control subjects were examined under light microscope. Vegetative form of E.h. was not detected in any of them. E.h. cyst was found in 6.3% of the "chronic dysentery" subjects and in 16% of the control subjects. E. coli and Giardia were also detected less often in the "chronic dysentery" than the control subjects. Lower incidence of protozoa namely E.h. cyst, E. coli cyst or Giardia in the former group was probably due to frequent intake of antiamoebic agents which are also effective against other intestinal protozoa. Incidence of Ascaris, hookworm, and Trichuris was not appreciably different in the two groups. More subjects in the "chronic dysentery" group had normal stool findings (31%) as compared to the control subjects (16%). It has been inferred that E.h. infection is not the cause of symptoms of "chronic dysentery".

Predicting first professional M.B.B.S. examination score from the results of H.S.C. examination.

In a retrospective study carried out in Chittagong Medical College the results of HSC and First-Professional MBBS examination of 725 students were analysed. It was concluded from the analysis that if standard of HSC examination is well maintained the results of the said examination correlates well with students' performance in the First Professional MBBS examination. An analysis of admission into Chittagong Medical College in past 20 academic sessions has been made which shows that an increasing number of students securing high marks in HSC are being admitted into Medical College during recent years. The marking standard of HSC examination has however remained fairly uniform over the years except during early post-liberation period.

Coccinia indica in the treatment of patients with diabetes mellitus.

Coccinia indica is a creeper which grows wildly in Bangladesh and in many parts of the Indian sub-continent. The plant has been used since ancient times as an antidiabetic drug by physicians who practice the Indian system of medicine known as Ayurvedha. We have conducted a double blind control trial with preparation from the leaves of the plant on uncontrolled, maturity onset diabetics. The trial lasted for six weeks for an individual patient. Out of the 16 patients who received the experimental preparations 10 showed marked improvement in their glucose tolerance while none out of the 16 patients in the dummy group showed such a marked improvement. This difference is highly significant (kappa 2 with Yates' correction = 11.7, P < 0.001).