UNC-16 interacts with LRK-1 and WDFY-3 to regulate the termination of axon growth

In humans, MAPK8IP3 (also known as JIP3) is a neurodevelopmental disorder-associated gene. In C. elegans, the UNC-16 ortholog of the MAPK8IP3 protein can regulate the termination of axon growth. However, its role in this process is not well understood. Here, we report that UNC-16 promotes axon termination through a process that includes the LRK-1(LRRK-1/LRRK-2) kinase and the WDFY-3 (WDFY3/Alfy) selective autophagy protein. Genetic analysis suggests that UNC-16 promotes axon termination through an interaction between its RH1 domain and the dynein complex. Loss of unc-16 function causes accumulation of late endosomes specifically in the distal axon. Moreover, we observe synergistic interactions between loss of unc-16 function and disruptors of endolysosomal function, indicating that the endolysosomal system promotes axon termination. We also find that the axon termination defects caused by loss of UNC-16 function require the function of a genetic pathway that includes lrk-1 and wdfy-3, two genes that have been implicated in autophagy. These observations suggest a model where UNC-16 promotes axon termination by interacting with the endolysosomal system to regulate a pathway that includes LRK-1 and WDFY-3.

UNC-16 interacts with LRK-1 and WDFY-3 to regulate the termination of axon growth

MAPK8IP3 (unc-16/JIP3) is a neurodevelopmental-disorder associated gene that can regulate the termination of axon growth. However, its role in this process is not well understood. Here, we report that UNC-16 promotes axon termination through a process that includes the LRK-1(LRRK-1/LRRK-2) kinase and the WDFY-3 (WDFY3/Alfy) selective autophagy protein. Genetic analysis suggests that UNC-16 promotes axon termination through an interaction between its RH1 domain and the dynein complex. Loss of unc-16 function causes accumulation of late endosomes specifically in the distal axon. Moreover, we observe synergistic interactions between loss of unc-16 function and disruptors of endolysosomal function, indicating that the endolysosomal system promotes axon termination. We also find that the axon termination defects caused by loss of UNC-16 function require the function of a genetic pathway that includes lrk-1 and wdfy-3, two genes that have been implicated in autophagy. These observations suggest a model where UNC-16 promotes axon termination by interacting with the endolysosomal system to regulate a pathway that includes LRK-1 and WDFY-3.

Autism candidate gene rbm-26 ( RBM26/27 ) regulates MALSU-1 to protect against mitochondrial dysfunction during axon development

Mitochondrial dysfunction is thought to be a key component of neurodevelopmental disorders such as autism, intellectual disability, and ADHD. However, little is known about the molecular mechanisms that protect against mitochondrial dysfunction during neurodevelopment. Here, we address this question through the investigation of rbm-26 , the C. elegans ortholog of the RBM27 autism candidate gene, which encodes an RNA-binding protein whose role in neurons is unknown. We report that RBM-26 (RBM26/27) protects against neurodevelopmental defects by negatively regulating expression of the MALSU-1 mitoribosomal assembly factor. Autism-associated missense variants in RBM-26 cause a sharp decrease in RBM-26 protein expression along with neurodevelopmental defects, including errors in axon targeting and axon degeneration. Using an unbiased screen, we identified the mRNA for the MALSU-1 mitoribosomal assembly factor as a binding partner for RBM-26. RBM-26 negatively regulates the expression of malsu-1 mRNA and MALSU-1 protein, and genetic analysis indicates that this interaction is required to protect against neurodevelopmental defects. Moreover, biochemical evidence suggests that excess levels of MALSU-1 disrupt the biogenesis of mitoribosomes in rbm-26 mutants. These observations reveal a mechanism that can protect mitochochondrial function to prevent neurodevelopmental defects and suggest that disruptions in this process can cause neurodevelopmental disorders.

Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients with ST-Elevation Myocardial Infarction

CHADS₂ and CHA₂DS₂-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA₂DS₂-VASC-HSF score promote atherosclerosis and associated with severity of CAD. Objective of the study was to find out the association of the CHA₂DS₂-VASC-HSF score with the severity of CAD in patients with ST elevation myocardial infarction (STEMI). One hundred (100) patients with STEMI were enrolled in this study after considering inclusion and exclusion criteria over a one year period from October, 2017 to September, 2018 in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Coronary angiogram was done within index hospitalization and coronary artery disease severity was assessed by SYNTAX score system. Patients were divided into two groups on the basis of SYNTAX score. Patients with SYNTAX score ≥23 assigned as Group I and SYNTAX score <23 assigned as Group II. The CHA₂DS₂-VASC-HSF score was calculated. Cut-off value of high CHA₂DS₂-VASC-HSF score was ≥4.0. In this study mean age of study population was 51.8±9.8, male patients were predominant (79.0%). Among the studied patients, highest percentage had history of smoking followed by hypertension, diabetes mellitus and family history of CAD in Group I patients. It was found that DM and family history of CAD and history of stroke/TIA were significantly higher in Group I than Group II. An increasing trend of SYNTAX score was observed according to the CHA₂DS₂-VASc-HSF score. SYNTAX score was significantly higher in CHA2DS2-VASc-HSF score ≥4 than CHA₂DS₂-VASc-HSF score <4 (26.3±6.3 vs. 12.1±7.7, p<0.001). Patients with CHA₂DS₂-VASC-HSF score ≥4 had severe coronary artery disease than CHA₂DS₂-VASC-HSF score <4 assessed by SYNTAX score with 84.4% sensitivity and 81.9% specificity (AUC:0.83, 95% CI: 0.746-0.915, p<0.001). CHA₂DS₂-VASc-HSF score was positively correlated with the severity of CAD. This score could be considered as a predictor of coronary artery disease severity.

Role of Intra-arterial Nitroglycerin (Post Procedural, Prehemostasis) to Reduce Radial Artery Occlusion after Transradial Catheterisation: A Doppler-guided Study

The study was intended to evaluate efficacy of Intra-arterial nitroglycerin through the sheath at the end of a transradial procedure to preserve the patency of the radial artery. This prospective observational study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2017 to April 2018, by including a total 200 patients undergoing coronary procedures (CAG and / or PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Doppler study. In this study 102 patients (Group I) received 200 mcg intra-arterial nitroglycerine, prior to trans-radial sheath removal. Another 98 patients (Group II) did not receive intra-arterial nitroglycerine prior to trans-radial sheath removal. Conventional haemostatic compression methods were applied (average 2 hours) in both groups of patients. Evaluation of radial arterial arterial blood flow by colour Doppler study was done on next day after the procedure in both groups. Results of this study in which RAO was determined by vascular doppler study showed that frequency of radial artery occlusion were 13.5% one day after transradial coronary procedures. We found the incidence was 8.8% vs. 18.4%, (p=0.04) in Group I and Group II respectively. The incidence of RAO was significantly lower in post procedural nitroglycerine group. From multivariate logistic regression analysis diabetes mellitus (p = 0.02), hemostatic compression time for more than 02 hours after sheath removal (p = <0.001) and procedure time (p = 0.02) was predictors of RAO. So, the administration of nitroglycerin at the end of a transradial catheterization reduced the incidence of RAO, as shown by 1 day after the radial procedure by doppler ultrasound.

The ANC-1 (Nesprin-1/2) organelle-anchoring protein functions through mitochondria to polarize axon growth in response to SLT-1

A family of giant KASH proteins, including C. elegans ANC-1 and mammalian Nesprin-1 and -2, are involved in organelle anchoring and are associated with multiple neurodevelopmental disorders including autism, bipolar disorder, and schizophrenia. However, little is known about how these proteins function in neurons. Moreover, the role of organelle anchoring in axon development is poorly understood. Here, we report that ANC-1 functions with the SLT-1 extracellular guidance cue to polarize ALM axon growth. This role for ANC-1 is specific to its longer ANC-1A and ANC-1C isoforms, suggesting that it is mechanistically distinct from previously described roles for ANC-1. We find that ANC-1 is required for the localization of a cluster of mitochondria to the base of the proximal axon. Furthermore, genetic and pharmacological studies indicate that ANC-1 functions with mitochondria to promote polarization of ALM axon growth. These observations reveal a mechanism whereby ANC-1 functions through mitochondria to polarize axon growth in response to SLT-1.

Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

Association of Echocardiographic Epicardial Fat Thickness with the Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Estimation of visceral adipose tissue is important as it carries high cardiometabolic risk and several methods are available as its surrogate. Epicardial fat thickness (EFT) is a direct measure of visceral fat rather than anthropometric measurements. EFT can be accurately measured by two-dimensional (2D) echocardiography. It tends to be higher in patients with Acute Coronary Syndrome (ACS). The present study was intended to find out the association between echocardiographic EFT and severity of Coronary Artery Disease (CAD) in patients with ACS. This cross-sectional observational study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from October 2017 to September 2018. Sampling technique was purposive sampling. Comparison between groups was done by unpaired-t test & dichotomous variables were compared by chi-square test. A total of 164 patients was enrolled in the study, prospectively examined EFT on echocardiography and patients were divided into 2 groups, Group I patients with EFT >4.65mm and Group II patients with EFT ≤4.65mm. Coronary angiograms were analyzed for the extent and severity of CAD using Gensini score. The mean EFT (mm) was found 6.1±1.0 in Group I and 3.5±0.7 in Group II (p<0.001). Patients with a higher EFT were associated with a high Gensini score (Group I vs. Group II, 50.3±24.1 vs. 21.9±20.0; p<0.001). Multivariate analysis showed that EFT (OR 6.07, p<0.001) and smoking (OR 2.66, p=0.03) were independent factors affecting significant coronary artery stenosis. By ROC curve analysis, EFT >4.65mm predicated the presence of significant coronary stenosis by 76.1% sensitivity and 69.9% specificity. EFT measured using Transthoracic echocardiography (TTE) significantly correlates with the severity of CAD. It is sensitive, easily available, and cost-effective and assists in the risk stratification and may be an additional marker on classical risk factors for CAD.

The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan

BACKGROUND

Fasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials.

METHODS

We have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast.

RESULTS

We reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin.

CONCLUSIONS

An individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.

Diabetes: an Overview for Clinical Oncologists

Diabetes and cancer are common conditions highly prevalent in the general population. The co-existence of diabetes and cancer in a patient is therefore not unexpected. Diabetes increases the risk of mortality from cancer and morbidity from the treatment of cancer. Furthermore, many cancer chemotherapeutic regimens increase glucose levels, especially those involving glucocorticoids. Many clinical oncologists will deal with patients with diabetes in their clinical work, and some working knowledge of diabetes diagnosis and management is helpful when managing such patients. This overview aims to summarise the clinical diagnosis and management of diabetes, review the potential links between diabetes and cancer, and provide some practical guidance on the management of hyperglycaemia in patients undergoing cancer therapy.

Challenges in the management of people with diabetes and cancer

Although micro- and macrovascular complications of diabetes are the most important cause of mortality and morbidity in people with diabetes, it is increasingly recognized that diabetes increases the risk of developing cancer. Diabetes and cancer commonly co-exist, and outcomes in people with both conditions are poorer than in those who have cancer but no diabetes. There is no randomized trial evidence that treating hyperglycaemia in people with cancer improves outcomes, but therapeutic nihilism should be avoided, and a personalized approach to managing hyperglycaemia in people with cancer is needed. This review aims to outline the link between diabetes therapies and cancer, and discuss the reasons why glucose should be actively managed people with both. In addition, we discuss clinical challenges in the management of hyperglycaemia in cancer, specifically in relation to glucocorticoids, enteral feeding and end-of-life care.

Management of adults with diabetes on the haemodialysis unit: summary of guidance from the Joint British Diabetes Societies and the Renal Association

Diabetic nephropathy remains the principal cause of end-stage renal failure in the UK and its prevalence is set to increase. People with diabetes and end-stage renal failure on maintenance haemodialysis are highly vulnerable, with complex comorbidities, and are at high risk of adverse cardiovascular outcomes, the leading cause of mortality in this population. The management of people with diabetes receiving maintenance haemodialysis is shared between diabetes and renal specialist teams and the primary care team, with input from additional healthcare professionals providing foot care, dietary support and other aspects of multidisciplinary care. In this setting, one specialty may assume that key aspects of care are being provided elsewhere, which can lead to important components of care being overlooked. People with diabetes and end-stage renal failure require improved delivery of care to overcome organizational difficulties and barriers to communication between healthcare teams. No comprehensive guidance on the management of this population has previously been produced. These national guidelines, the first in this area, bring together in one document the disparate needs of people with diabetes on maintenance haemodialysis. The guidelines are based on the best available evidence, or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for this vulnerable population and to encourage and improve education for clinicians and people with diabetes to promote empowerment and self-management.

Temporal and Spatial Post-Transcriptional Regulation of Zebrafish tie1 mRNA by Long Noncoding RNA During Brain Vascular Assembly

Supplemental Digital Content is available in the text.

Objective—

Tie1 (tyrosine kinase containing immunoglobulin and epidermal growth factor homology 1), an endothelial and hematopoietic cell–specific receptor tyrosine kinase, is an important regulator of angiogenesis and critical for maintaining vascular integrity. The post-transcriptional regulation of tie1 mRNA expression is not understood, but it might partly explain Tie1’s differential expression pattern in endothelium. Following up on our previous work that identified natural antisense transcripts from the tie1 locus—tie1 antisense (tie1AS), which regulates tie1 mRNA levels in zebrafish—we attempted to identify the mechanism of this regulation.

Approach and Results—

Through in vitro and in vivo ribonucleoprotein binding studies, we demonstrated that tie1AS long noncoding RNA interacts with an RNA binding protein—embryonic lethal and abnormal vision Drosophila-like 1 (Elavl1)—that regulates tie1 mRNA levels. When we disrupted the interaction between tie1AS and Elavl1 by using constitutively active antisense morpholino oligonucleotides or photoactivatable morpholino oligonucleotides, tie1 mRNA levels increased between 26 and 31 hours post-fertilization, particularly in the head. This increase correlated with dilation of primordial midbrain channels, smaller eyes, and reduced ventricular space. We also observed these phenotypes when we used CRISPR (clustered regularly interspaced short palindromic repeats)–mediated CRISPRi (CRISPR-mediated interference) to knock down tie1AS. Treatment of the morpholino oligonucleotide–injected embryos with a small molecule that decreased tie1 mRNA levels rescued all 3 abnormal phenotypes.

Conclusions—

We identified a novel mode of temporal and spatial post-transcriptional regulation of tie1 mRNA. It involves long noncoding RNA, tie1AS, and Elavl1 (an interactor of tie1AS).

Clinical Study of Postmenopausal Bleeding

Background: Women with postmenopausal bleeding (PMB) should be thoroughly evaluated. A thorough examination may help in the diagnosis of vulval, vaginal, cervical or pelvic pathology.Objective: This study was carried out to find the probable causes in patients presenting with postmenopausal bleeding.Materials and method: This observational study included 50 women with postmenopausal bleeding and was conducted in the department of Obstetrics and Gynaecology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh, from January 2004 to December 2004. Transvaginal ultrasonogram (TVS), diagnostic curettage and cervical biopsy were done and histopathology report was collected.Results: The mean age of the patients was 57.74 years (range 48-75 years), and the median age of menopause was 50 years. Among the patients 18 (36%) had only diabetes and 25 (50%) patients had both diabetes and hypertension. Nineteen patients (38%) were overweight, 5 patients (10%) were obese and 2 (4%) were morbidly obese. Per speculum examination revealed suspected cervical carcinoma in 5 cases (10%) and cervical polyp in 1 case (2%). The most common clinical finding was atrophy of the uterus and vagina in 26 patients (52%). TVS revealed endometrial thickness of 5mm or more in 17 cases (37.7%) and < 5mm in 26 cases (57.7%). Nine patients (18%) had carcinoma, 16 patients (32%) had benign pathology and 19 (38%) patients had endometrial atrophy on histology.Conclusion: A detailed history taking, thorough physical examination and relevant investigations can lead to a correct detection of cause of postmenopausal bleeding. Those who have normal adnexae and thin endometrium (endometrium <5mm) may not need endometrial biopsy.Delta Med Col J. Jul 2017 5(2): 83-88

Use of continuous glucose monitoring in patients with diabetes on peritoneal dialysis: poor correlation with HbA1c and high incidence of hypoglycaemia

BACKGROUND

Achieving adequate glycaemic control in patients with diabetes on peritoneal dialysis is challenging. Traditional assessment of glycaemia using HbA1c is difficult in such patients because of renal anaemia or carbamylation of haemoglobin, and significant glucose excursions may be masked. We describe three patients with diabetes on peritoneal dialysis with similar HbA1c levels, but with very different glucose profiles shown on continuous glucose monitoring.

CASE REPORTS

Patient 1 was treated with gliclazide, and had a number of solutions with high glucose concentration in his dialysis prescription. Continuous glucose monitoring showed glucose levels > 11 mmol/l for > 17 h per day, and < 4 mmol/l for 72 min per day with no symptoms. His HbA1c level was 61 mmol/mol (7.7%). Patient 2 was treated with insulin. Continuous glucose monitoring showed glucose levels > 11 mmol/mol for 3.8 h per day, and < 4 mmol/mol for 3.8 h per day. His HbA1c level was 59 mmol/mol (7.6%). Patient 3 was treated with pioglitazone and gliclazide, and glucose levels were > 11 mmol/l for 8 h per day and < 4 mmol/l for 1.6 h per day. His HbA1c was 62 mmol/mol (7.8%). None of the patients was aware of hypoglycaemia during the periods of low glucose recorded on continuous glucose monitoring.

CONCLUSION

Despite similar HbA1c levels, our three patients had very different glucose profiles. These cases highlight the fact that HbA1c is frequently inadequate in reflecting glucose control in patients with diabetes on peritoneal dialysis, and we suggest that intermittent continuous glucose monitoring may allow safer management of glycaemia in such patients.

Surgical Management of Desmoid Tumor of the Female Pelvis: A Case Report

A 25 years married women having one child delivered vaginaly presented in the department of Obs & Gynae, Bangabandhu Sheikh Mujib Medical University, Bangladesh on April 2013 with pelvic pain and discomfort. No history of previous pelvic trauma was present. Patient examination showed a isolated mass in the right lower abdomen, right adnexa, extending to the pelvic wall upto lower end of ureter. Tumor markers were within normal limit. Intravenous pyelogram (IVP) showed mild right hydroureter and hydronephrosis with obstruction at the lower end of ureter. She was diagnosed as a case of adnexal mass with mild hydroureter & mild hydronephrosis and it was decided to operate on the patient. The surgical approach was transabdominal. On laparotomy a pseudocystic lesion 12×10cm in size was found over the right paracolic gutter and extending down into the pelvis involving the right parametrium. No abnormality was found in the uterus or tubes. The histological examination revealed a desmoid tumor of the pelvis. The patient's recovery was uneventful.

Factors Associated with Periodontal Disease in Pregnant Diabetic Women

There have been an association between systemic diseases and hormonal changes particularly diabetes which has been cited as a risk factor in the progression of periodontitis in pregnant women. The incidence and severity of periodontal diseases are increasing at a higher rate and a common condition in pregnant diabetic women among Bangladeshi population. This cross sectional study included 200 pregnant women who were selected from gynecological department and examined at the dental unit. The clinical parameters used were the Silness and Loe plaque index (PI), gingival scores and periodontal status and any relationship to socio demographic variables (age, occupation, level of education and urban or rural residence) and clinical variables (gestation period, previous pregnancy, type of diabetes and periodontal maintenance) were evaluated. The results showed that these clinical parameters increased concomitantly with an increase in the stage of pregnancy and in women with multiple pregnancies. Increased age, lower level of education, unemployment and patients residing in rural areas were associated with significantly higher gingival scores and periodontal measures. Women with increased age and multiple pregnancies usually have less interest to frequent periodontal maintenance showing a significant statistical relation between an increased age and changes in gingival and periodontal status; however no significant association was found between increased age and plaque index. It is concluded that gingival inflammatory symptoms are aggravated during pregnancy in diabetic women and are related to different clinical and demographic variables.

Effects of vitamin D2 or D3 supplementation on glycaemic control and cardiometabolic risk among people at risk of type 2 diabetes: results of a randomized double-blind placebo-controlled trial

AIMS

To investigate the effect of short-term vitamin D supplementation on cardiometabolic outcomes among individuals with an elevated risk of diabetes.

METHODS

In a double-blind placebo-controlled randomized trial, 340 adults who had an elevated risk of type 2 diabetes (non-diabetic hyperglycaemia or positive diabetes risk score) were randomized to either placebo, 100,000 IU vitamin D2 (ergocalciferol) or 100,000 IU vitamin D3 (cholecalciferol), orally administered monthly for 4 months. The primary outcome was change in glycated haemoglobin (HbA1c) between baseline and 4 months, adjusted for baseline. Secondary outcomes included: blood pressure; lipid levels; apolipoprotein levels; C-reactive protein levels; pulse wave velocity (PWV); anthropometric measures; and safety of the supplementation.

RESULTS

The mean [standard deviation (s.d.)] 25-hydroxyvitamin D [25(OH)D]2 concentration increased from 5.2 (4.1) to 53.9 (18.5) nmol/l in the D2 group, and the mean (s.d.) 25(OH)D3 concentration increased from 45.8 (22.6) to 83.8 (22.7) nmol/l in the D3 group. There was no effect of vitamin D supplementation on HbA1c: D2 versus placebo: -0.05% [95% confidence interval (CI) -0.11, 0.02] or -0.51 mmol/mol (95% CI -1.16, 0.14; p = 0.13); D3 versus placebo: 0.02% (95% CI -0.04, 0.08) or 0.19 mmol/mol (95% CI -0.46, 0.83; p = 0.57). There were no clinically meaningful effects on secondary outcomes, except PWV [D2 versus placebo: -0.68 m/s (95% CI -1.31, -0.05); D3 versus placebo -0.73 m/s (95% CI -1.42, -0.03)]. No important safety issues were identified.

CONCLUSIONS

Short-term supplementation with vitamin D2 or D3 had no effect on HbA1c. The modest reduction in PWV with both D2 and D3 relative to placebo suggests that vitamin D supplementation has a beneficial effect on arterial stiffness.

Bulky Uterus and Multiparity are Important Contributing Factors for Dysfunctional Uterine Bleeding among Bangladeshi Women

Background: Dysfunctional uterine bleeding (DUB) is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. About 1–2% of women with improperly managed anovulatory bleeding eventually may develop endometrial cancer but determinants behind the disease are largely unknown.Objective: The present study aimed to find out the determinants of dysfunctional uterine bleeding.Materials and Methods: In this cross-sectional study 50 patients of dysfunctional uterine bleeding (DUB) were recruited from different tertiary hospitals in Dhaka city. Clinical parameters have been recorded using a predesigned questionnaire and analyzed using SPSS for Windows version 16.0 and Microsoft Office Excel.Results: In the studied patients, about 38% were suffering from type 2 diabetes mellitus, 12% from obesity and 18% from hypertension. Almost all the patients (96%) were suffering from anemia. Histological findings have shown that endometrium of 63% patients were in proliferative phase, about 16% were in secretory phase and 11% patients were with cystic hyperplasia. Ultrasonographic results have shown that about 72% of the patients had bulky uterus. Ninety two percent patients carried more than two pregnancies, and 40% patients carried >5 pregnancies.Conclusion: Bulky uterus and multiple pregnancies may be associated with dysfunctional uterine bleeding in Bangladeshi women.J Enam Med Col 2016; 6(1): 23-27

Musculoskeletal manifestations of diabetes mellitus

The prevalence of Type 1 and Type 2 diabetes are increasing significantly worldwide. Whilst vascular complications of diabetes are well recognized, and account for principle mortality and morbidity from the condition, musculoskeletal manifestations of diabetes are common and whilst not life threatening, are an important cause of morbidity, pain and disability. Joints affected by diabetes include peripheral joints and the axial skeleton. Charcot neuroarthropathy is an important cause of deformity and amputation associated with peripheral neuropathy. A number of fibrosing conditions of the hands and shoulder are recognized, including carpal tunnel syndrome, adhesive capsulitis, tenosynovitis and limited joint mobility. People with diabetes are more prone to gout and osteoporosis. Management of these conditions requires early recognition and close liaison between diabetes and rheumatology specialists.

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Management of diabetes in patients with cancer

Diabetes is common amongst patients with cancer. The co-occurrence of diabetes and cancer may lead to poorer prognosis and complications in patients undergoing cancer therapy. There is no randomized trial evidence that treating hyperglycaemia in patients with cancer improves outcomes, and therefore a pragmatic approach to managing hyperglycaemic in such patients is required. We discuss the management of hyperglycaemia in relation to cancer chemotherapy, glucocorticoids and enteral feeding. We also discuss management of glucose in diabetic patients with cancer approaching end of life care.

New-onset diabetes after renal transplantation

Renal transplantation has important benefits in people with end-stage renal disease, with improvements in mortality, morbidity and quality of life. Whilst significant advances in transplantation techniques and immunosuppressive regimens have led to improvements in short-term outcomes, longer-term outcomes have not improved dramatically. New-onset diabetes after transplantation appears to be a major factor in morbidity and cardiovascular mortality in renal transplant recipients. The diagnosis of new-onset diabetes after renal transplantation has been hampered by a lack of clarity over diagnostic tests in early studies, although the use of the WHO criteria is now generally accepted. HbA1c may be useful diagnostically, but should probably be avoided in the first 3 months after transplantation. The pathogenesis of new-onset diabetes after renal transplantation is likely to be related to standard pathogenic factors in Type 2 diabetes (e.g. insulin resistance, β-cell failure, inflammation and genetic factors) as well as other factors, such as hepatitis C infection, and could be exacerbated by the use of immunosuppression (glucocorticoids and calcineurin inhibitors). Pre-transplant risk scores may help identify those people at risk of new-onset diabetes after renal transplantation. There are no randomized trials of treatment of new-onset diabetes after renal transplantation to determine whether intensive glucose control has an impact on cardiovascular or renal morbidity, therefore, treatment is guided by guidelines used in non-transplant diabetes. Many areas of uncertainty in the pathogenesis, diagnosis and management of new-onset diabetes after renal transplantation require further research.

Mechanisms of translational repression of the Smcp mRNA in round spermatids

The protamine 1 (Prm1) and sperm mitochondria-associated, cysteine-rich protein (Smcp) mRNAs exemplify a widespread pattern of mRNA-specific regulation of mRNA translation in post-meiotic spermatogenic cells, spermatids. Both mRNAs are transcribed and initially stored in free-mRNPs in early spermatids, and translated on polysomes in late spermatids. In this study, we demonstrate that the 5' and 3'-UTRs and the 3' terminus of the Smcp 3'-UTR are required for normal repression of the Smcp mRNA in transgenic mice. RNA affinity chromatography and mass spectrometry sequencing identified Y-box protein 2 (YBX2/MSY2) as the major protein that interacts with the 3' terminus of the Smcp 3'-UTR and a Y-box recognition sequence, GCCACCU, in the translation control element that is necessary for Prm1 mRNA repression. Depletion of YBX2 in Ybx2-null mice prematurely activates Prm1 and Smcp mRNA translation in early spermatids. Fluorescent in situ hybridization reveals that the Smcp intron, the Smcp mRNA, and both Smcp-Gfp transgenic mRNAs are strongly concentrated in the chromatoid body, and that theYbx2-null mutation does not eliminate the Smcp mRNA from the chromatoid body. This and previous findings suggest that the Smcp pre-mRNA is spliced and associates with YBX2 in the chromatoid body, and that repressed free-mRNPs are stored in the general cytoplasm. As YBX2 is the predominant protein in testis free-mRNPs, it likely represses many mRNAs in early spermatids. The mechanisms by which YBX2 represses the Smcp and Prm1 mRNAs are relevant to reproductive medicine because mutations in the human YBX2 gene correlate with abnormal protamine expression and male infertility.

Hysterosalpingography in Infertility

Background: Infertility is a common medical problem. It can be due to problems in either partner, or both. Ovulatory dysfunction, tubal and peritoneal factors comprise the majority of female factor for infertility. Hysterosalpingography (HSG) plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes. Objective: The aim of this study was to evaluate the hysterosalpingographic findings of women with infertility in our setting. Materials and method: This cross sectional study was carried out in the infertility centre at BIRDEM, Dhaka, Bangladesh during the period of September 2002 to February 2003. Out of 100 infertile patients 50 infertile women of reproductive age (21-40 years) indicated for HSG were enrolled in this study. Results: Sixty percent patients had secondary infertility. Majority of the subjects of both primary and secondary infertility (55% and 60%) were in 26-30 years age group. On HSG any sort of uterine pathology was found in 10% cases and unilateral and bilateral tubal block were present in 24% and 20% cases respectively. Conclusion: Hysterosalpingography, a safe, less invasive procedure, has an important role in diagnosing uterine and tubal factors of infertility. DOI: http://dx.doi.org/10.3329/dmcj.v2i1.17790 Delta Med Col J. Jan 2014; 2(1): 9-12

Optimal diabetes care--can we afford it?: evidence-based diabetes care could be highly cost effective

Management of diabetes is expensive and set to get costlier. Managing the condition and it's devastating complications imposing a huge societal and economic toll on healthcare systems worldwide. While many interventions to reduce complications are available, a number of interventions do not have a strong basis in evidence, and lack cost effectiveness. In a time of economic austerity, and unprecedented pressure to reduce costs of health care in the UK, are there ways improving care, without driving up cost?

Achieving Millennium Development Goals 4 and 5 in Bangladesh

Bangladesh has made commendable progress in achieving Millennium Development Goals (MDGs) 4 and 5. Since 1990, there has been a remarkable reduction in maternal and child mortality, with an estimated 57% reduction in child mortality and 66% in maternal mortality. This review highlights that, whereas Bangladesh is on track for achieving MDG 4 and 5A, progress in universal access to reproductive health (5B) is not yet at the required pace to achieve the targets set for 2015. In addition, Bangladesh needs to further enhance activities to improve newborn health and promote skilled attendance at birth.

Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy

This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.

Maternal over weight and obesity: its effect on pregnancy outcome

Obesity in pregnancy remains a significant health problem that result in physiological, emotional, social and economic consequences on woman, their families and society. Obesity is considered one of the nutritional problems complicating pregnancy in our country. This study was conducted in antenatal clinic at out patient department of Obstetrics & Gynecology, BIRDEM Hospital, one of the countries largest tertiary level hospitals, during January 2007 to December 2008. During the study period of two years, a total no. of 100 cases were enrolled in two groups. Out of this 50 were control and 50 were over weight and obese. In this study, Mean of height, weight and BMI of the over weight and obese group were 5.21±0.21, 79.35±13.66, 32.36±4.76 respectively. The Mean of birth weight, APGAR score after 1 min and after 5 min of the over weight and obese group were 3.07±0.75, 7.10±1.11, 9.92±0.98 respectively and in normal weight group were 2.74±0.55, 7.40±1.56, 9.92±1.83 respectively. There was significant difference in birth weight, APGAR score after 1 min between the groups (p<0.05) but there was no significant difference in APGAR score after 5 min between groups (p>0.05). Regarding the fetal outcome in this study, 20% of the over weight and obese group delivered macrosomic baby in comparison to only 4% in the normal weight group. On the other hand 46% of the case group had to refer their babies to the neonatal unit in comparison to only 12% in the control group. Gestational Diabetes Mellitus (GDM) (46%) and Preeclampsia (44%) developed more in obese group. Eighty eight (88%) of obese and overweight mother experienced in caesarean delivery. Asphyxia, Respiratory Distress Syndrome (RDS), congenital anomaly and prenatal death were more in the over weight and obese group than normal weight group. Thus, overweight and obesity has got significant deleterious effect on maternal and perinatal outcomes of pregnancy.

Diabetes and cancer

Diabetes and cancer are common conditions, and their co-diagnosis in the same individual is not infrequent. A link between the two conditions has been postulated for almost 80 years, but only in the past decade has significant epidemiological evidence been amassed to suggest that diabetes and cancer are associated, and the link appears causal. Hyperinsulinaemia, adipocytokines, growth factors and epigenetic changes may be implicated in the pathogenesis of cancer amongst patients with diabetes, and recently, diabetes therapies have also been implicated. There is reasonable circumstantial evidence that metformin may decrease the risk of cancer amongst diabetic patients. Much more research is required to elucidate the link between diabetes and cancer, particularly the potential link with diabetes treatments.

Identification of elements in the Smcp 5' and 3' UTR that repress translation and promote the formation of heavy inactive mRNPs in spermatids by analysis of mutations in transgenic mice

The sperm mitochondria-associated cysteine-rich protein (Smcp) mRNA is transcribed in step 3 spermatids, and is stored in free mRNPs until translation begins ∼6 days later in step 11. To identify sequences that control the timing of Smcp mRNA translation, mutations in both UTRs were analyzed in transgenic mice using green fluorescent protein (GFP), squashes of seminiferous tubules, and quantification of polysomal loading in adult and 21 dpp testes in sucrose and Nycodenz gradients. GFP fluorescence is first detected in step 9 spermatids in lines harboring a transgene containing the Gfp 5' UTR and Smcp 3' UTR. Unexpectedly, this mRNA is stored in large, inactive mRNPs in early spermatids that sediment with polysomes in sucrose gradients, but equilibrate with the density of free mRNPs in Nycodenz gradients. Randomization of the segment 6-38 nt upstream of the first Smcp poly(A) signal results in early detection of GFP, a small increase in polysomal loading in 21 dpp testis, inactivation of the formation of heavy mRNPs, and loss of binding of a Y-box protein. GFP is first detected in step 5 spermatids in a transgene containing the Smcp 5' UTR and Gfp 3' UTR. Mutations in the start codons in the upstream reading frames eliminate translational delay by the Smcp 5' UTR. Collectively, these findings demonstrate that Smcp mRNA translation is regulated by multiple elements in the 5' UTR and 3' UTR. In addition, differences in regulation between Smcp-Gfp mRNAs containing one Smcp UTR and the natural Smcp mRNA suggest that interactions between the Smcp 5' UTR and 3' UTR may be required for regulation of the Smcp mRNA.

Comparison of normal and abnormal cardiotocography with pregnancy outcomes and early neonatal outcomes

Cardiotocography (CTG) is the most commonly used test for antepartum and intrapartum foetal surveillance in the majority hospitals of developed countries. The purpose of this study was to compare the pregnancy outcome and early neonatal outcome among the normal and abnormal CTG groups. In this prospective study, fifty consecutive normal and fifty consecutive abnormal CTG were collected within one hour before delivery from patients who have singleton pregnancy with gestational age >or=32 weeks and having obstetric or medical indication for CTG. In this study, the measure of pregnancy outcomes were mode of delivery, indications of caesarean section, percentage requiring caesarean section for foetal distress, oligohydramnios, meconium stained liquor, small placenta and cord around the neck. Early neonatal outcomes included apgar score, birth weight, admission into neonatal intensive care unit (NICU), duration of stay in NICU and perinatal mortality. There were significant differences between the two groups regarding pregnancy outcomes and early neonatal outcomes. So, CTG is an important test to assess the foetal condition in both antepartum and intrapartum period. The sensitivity of CTG was 87%, specificity was 66%, positive predictive value was 54% and negative predictive value was 92% in the prediction of abnormal outcomes. So, normal CTG is more predictive of normal outcomes than abnormal CTG regarding abnormal outcomes.

Prevalence and reasons for insulin refusal in Bangladeshi patients with poorly controlled Type 2 diabetes in East London

AIMS

To determine the prevalence and reasons for refusal to commence insulin in Bangladeshi patients with Type 2 diabetes.

METHODS

A survey of 212 Bangladeshi patients seen in a hospital diabetes unit, with poor glycaemic control (HbA(1c)>or= 8.0%) on maximum oral glucose-lowering therapy, in whom insulin was deemed necessary. Patients who refused insulin were invited to attend focus groups. Data were analysed by thematic content analysis using the constant comparative method.

RESULTS

Of 212 patients offered insulin, 122 (57.5%) commenced insulin immediately, 47 (22.1%) started insulin within 6 months and 43 (20.3%) refused to commence insulin despite repeated counselling. Thirty-six (83.7%) of those who refused insulin agreed to participate in focus groups. Reasons for insulin refusal included: disease severity--perceptions that requirement for insulin was an indicator of a more serious stage of their condition; insulin leading to premature death--common suggestion that commencing insulin led to early death; loss of control--including fear of hypoglycaemia, weight gain, loss of independence and reliance on others to give insulin or look for signs of hypoglycaemia; lack of perception of benefits--poor perception of the benefits of improved glycaemic control on quality of life and cardiovascular risk; needle anxiety--a significant proportion of subjects conveyed concern over frequent injections.

CONCLUSIONS

Insulin refusal is common in Bangladeshi subjects with Type 2 diabetes and poor glycaemic control. A number of factors contribute to this, and methods to overcome the barriers to insulin therapy need to be sought.

Gliptins: a new class of oral hypoglycaemic agent

The epidemic of type 2 diabetes worldwide continues unabated. Despite a number of existing therapies, treatment goals are seldom fully achieved. While insulin resistance and beta cell failure remain important in the pathogenesis of the condition, the role of incretin hormones in glucose homeostasis has recently become clearer. Incretins have several glucoregulatory mechanisms, and a novel approach to the treatment of type 2 diabetes focuses on enhancing and prolonging the physiological actions of these hormones. Gliptins inhibit the enzyme dipeptidyl peptidase-IV (DPP-IV), which degrades incretin hormones. These drugs are a promising new class of oral hypoglycaemic medication, which appear to be weight-neutral and have few side-effects, although the published clinical studies are mainly regulatory licensing studies. As these drugs now are available for clinical use, we discuss the mechanism of action, efficacy and potential adverse effects of this new class of oral hypoglycaemic agent.

Ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes attending an Inner London diabetes clinic

BACKGROUND

South Asians have higher risk of diabetic complications compared with white Europeans. The aim of this study was to compare management of cardiovascular risk factors between Bangladeshis and white Europeans.

METHODS

A retrospective survey of all diabetic patients attending an Inner London hospital diabetic clinic over one year was undertaken. Data were obtained from the hospital diabetes database: presence of macrovascular (myocardial infarction, angina, stroke, transient ischaemic attack, cardiac intervention) and microvascular disease (neuropathy, retinopathy, and nephropathy), glycated haemoglobin, blood pressure, lipids, smoking, and body mass index (BMI) were all determined.

RESULTS

A total of 1162 white European and 912 Bangladeshi patients with full data available were included in the analyses. The groups were equivalent in age, sex, duration of diabetes. Compared with white Europeans, Bangladeshis had more macrovascular disease (19.5% v 11.9% p<0.01), sight threatening retinopathy (7.2% v 3.8%, p<0.01), and nephropathy (15.3% v 9.1%, p<0.01). In addition, Bangladeshis had significantly more male smokers (28.1% v 22.1%, p<0.01), poorer glycaemic control (mean HbA1c 8.6% v 8.1%, p = 0.039), greater proportion with uncontrolled hypercholesterolaemia (total cholesterol >5.0 mmol/l, 31.6% v 26% p = 0.05), and poorer control of blood pressure (proportion with BP >140/80 mm Hg, 43.2% v 32.1%, p<0.01).

CONCLUSIONS

South Asians with type 2 diabetes have poorer glycaemic, blood pressure, and lipid control than white Europeans. The reasons for this are probably multifactorial.

Insulin allergy in a patient with Type 2 diabetes successfully treated with continuous subcutaneous insulin infusion

BACKGROUND

Patients with poor control of Type 2 diabetes on maximum oral hypoglycaemic therapy invariably need insulin therapy. Insulin allergy is uncommon, particularly in patients with Type 2 diabetes. Management of the condition can be difficult, and here we report the case of a patient with Type 2 diabetes and insulin allergy successfully managed with a continuous subcutaneous insulin infusion (CSII).

CASE REPORT

A 60-year-old man was referred with insulin allergy. He had poorly controlled Type 2 diabetes (glycated haemoglobin 10.4%), on maximum doses of sulphonylurea and metformin, with osmotic symptoms. He was compliant with diet and tablets. His diabetes was complicated by retinopathy, nephropathy, coronary heart disease, obstructive sleep apnoea, obesity, depression and hypertension. He commenced on twice daily mixed insulin and, shortly after, developed pain, itching and erythema at the injection sites. The sites became indurated and tender, and he had constitutional symptoms. The insulin was changed to other preparations, including short- and long-acting analogues, with similar responses. Triple therapy with rosiglitazone was tried, with no improvement in control. Skin-prick testing confirmed allergy to insulin rather than additives. The patient was reluctant to undergo desensitization. He was commenced on an insulin pump in addition to his oral hypoglycaemics, and achieved fair control (glycated haemoglobin 8.3%) on 88 units of lispro per day, with little or no skin or systemic reaction.

CONCLUSION

This is the first case report of insulin allergy in Type 2 diabetes being successfully managed by CSII.

The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy?

Diabetic maculopathy is a common complication of diabetes mellitus, characterised by macular oedema and frequently accompanied by lipid exudation. It is the major cause of loss of vision from diabetic retinopathy. There is some evidence to implicate serum lipids in exudative maculopathy; cross-sectional studies suggest that higher serum lipid levels are found in patients with macular exudates, and prospective studies have shown an increased risk of exudative maculopathy if baseline cholesterol is higher. The treatment for diabetic maculopathy is laser photocoagulation of the pigment epithelium. With the advent of systemic lipid lowering therapy over the last decade, there may be potential for medical therapy also. There is some anecdotal evidence of the effect of lipid lowering agents (particularly statins) in reducing exudate, and a number of studies have shown that lipid lowering therapy may reduce macular exudates, but numbers in these trials are small. A randomised controlled trial is now required to investigate whether the use of systemic lipid lowering therapy is of benefit in patients with exudative maculopathy, even in the absence of dyslipidaemia.

Complications and cardiovascular risk factors in South Asians and Europeans with early-onset type 2 diabetes

BACKGROUND

Type 2 diabetes is a major cardiovascular risk factor, and early-onset (<40 years) type 2 diabetes is becoming more common.

AIM

To determine the prevalence of complications, and cardiovascular risk factors at diagnosis, in early-onset type 2 diabetes, and to compare these between South Asians and Europeans.

DESIGN

Prospective study of newly-diagnosed type 2 diabetes patients aged <40 years, attending hospital and primary care clinics 1999-2001.

METHODS

Patients were assessed for signs of macrovascular disease, retinopathy, neuropathy and nephropathy. Cardiovascular risk factors were also determined.

RESULTS

Overall, 292 patients were enrolled (165 South Asians). Macrovascular disease was more prevalent in South Asians (15.7% vs. 9.4%, p<0.001), as was microvascular disease (27.3% vs. 16.5%, p<0.001), including retinopathy (17.5% vs. 7.9%, p<0.001), and nephropathy (18.1% vs. 7.8%, p<0.001). South Asians had trends towards greater waist:hip ratio (0.95 vs. 0.90), and higher blood pressure (127/80 vs. 123/76 mmHg). HDL cholesterol was lower (1.0 vs. 1.3 mmol/l, p<0.001) and fasting triglycerides higher (1.9 vs. 1.5 mmol/l, p<0.001) in South Asians. Absolute CHD risk was significantly higher in South Asians (16.9% vs. 13.7%, p<0.001).

DISCUSSION

Complications were common at diagnosis, with a quarter of all patients having evidence of at least one diabetic complication. South Asians had a higher prevalence of established macrovascular and microvascular disease, compared to Europeans, and a higher risk of CHD, predominantly because of lower HDL cholesterol and higher blood pressure.

Effect of oestrogen replacement therapy on bone mass in post-menopausal Bangladeshi women

The female population comprises 48.66% of our total population, of which 10.30% are above the age of 49, many of whom are post-menopausal. Menopause is associated with bone-loss and its consequences. Hormone replacement therapy (HRT), particularly replacement of estrogen, prevents bone-loss. We undertook this prospective case-controlled study to find out whether or not HRT is beneficial to our women. A total of 106 patients were studied, amongst them 60 were cases and 46 were controls. The women in the first group were given either conjugated equine estrogen alone (surgical menopause group) or conjugated equine estrogen plus cyclical progesterone (natural menopause group). Results showed that there was 4.29% increase in bone mineral density in women who received hormone replacement therapy (HRT). This increase was 5.23% in early and 3.56% in late menopause group. Women with natural menopause gained more bone mass (4.22%) than women with surgical menopause (3.9%). Our results also showed that women who denied HRT (controls) lost bone mass (5.26%), the loss was more in those with surgical menopause (6.24%) than those with natural menopause (4.87%). Therefore it can be concluded that post-menopausal hormone replacement therapy prevents bone-loss. However, to evaluate the beneficial effect of long-term HRT, further studies with larger samples are recommended.