Metabolic Phenotyping Using Metabolic Syndrome Criteria and Cardiometabolic Disabilities Criteria in Bangladeshi Adult Population

Obesity has become a global epidemic and has been found to be associated with numerous comorbidities. Body mass index (BMI) based classification of obesity is simple but co-morbidities do not affect all obese and overweight people. The present study was aimed to find out the frequency of metabolic phenotypes in different BMI groups using metabolic syndrome (MetS) criteria and cardiometabolic disabilities (CA) criteria and also to find out an appropriate method for defining metabolic health among adult population attending out patient department of Bangabandhu Sheikh Mujib Medical University (BSMMU). This cross-sectional analytical study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2016 to February 2017. By non probability sampling, a total of 1023 study subjects were selected from apparently healthy adult individuals attending outpatient department of BSMMU. The study subjects were grouped into three body mass index classes and also further categorized into six groups according to metabolically unhealthy or healthy phenotypes by presence or absence of metabolic syndrome (MetS) criteria as well as cardiometabolic disabilities (CA) criteria respectively. Then agreement among different metabolic phenotypes based on these two criteria were observed. Frequency of different metabolic phenotypes i,e metabolically healthy normal weight (MHNW), metabolically obese normal weight (MONW), metabolically healthy over weight (MHOW), metabolically obese over weight (MOOW), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) were 12.3%, 6.9%, 21.4%, 27.7%, 7.7%, 23.9% by MetS criteria and 7.7%, 11.5%, 11.6%, 37.4%, 6.1%, 25.6% by CA criteria respectively. MOOW followed by MUO were found to be predominant among all phenotypes. Fare agreement was found between two criteria in case of normal weight and overweight groups and good agreement was found in case of obese groups. From this study, it may be concluded that, attention should be given to the metabolically obese phenotypes in different BMI classes to reduce co-morbidities. Bangladesh J Med Biochem 2018; 11(1): 1-8

Raised Serum Homocysteine Level is Associated with Hypertension

An elevated serum homocysteine concentration is associated with an increased risk of coronary, cerebral, and peripheral vascular disease. The objective of the study was to evaluate the association of serum homocysteine level with hypertension (HTN). This cross sectional analytical study was conducted at Sir Salimullah Medical College & Mitford Hospital and National Health Care Network Dhaka, Bangladesh over a duration of 21 months from July 2012 to May 2014. Fifty HTN patients were included as study subjects and age and sex matched fifty non-HTN healtlhy controls were included. All the clinical measurements were taken and serum Hcy was measured for all study subjects. In this study, females were predominant in both groups, mean age of the HTN patients was 41.0±5.6 years and non-HTN healthy subjects was 38.2±5.2 years. BMI and FBG were found higher in HTN group than that of non-HTN group but the differences were not statistically significant. Systolic and diastolic BP were found significantly higher in HTN group than that of non-HTN group. Serum Hcy level was significantly higher in HTN group (19.93±4.12 μmol/L) than that of non-HTN group (13.20±1.88 μmol/L). This study depicted that serum Hcy had significant correlation with SBP and DBP in HTN. In conclusion, it was seen that elevated serum Hcy level is associated with hytpertension. Bangladesh J Med Biochem 2018; 11(1): 22-25

Incretin Hormones, Thyroid Stimulating Hormone and Human Growth Hormone Responses During Ogtt in Newly Diagnosed T2DM Patients

Several research groups have reported variable results about incretin effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1(GLP-1), altered thyroid stimulating hormone (TSH) status, human growth hormone (hGH) deficiency and perturbed cytokines balances in type 2 diabetes mellitus (T2DM).The present case-control prospective interventional study was conducted investigating responses of incretin hormones (GIP, GLP-1), TSH and hGH to oral glucose tolerance test (OGTT) in newly diagnosed Bangladeshi T2DM patient. Blood samples were collected from 36 OGTT positive newly diagnosed T2DM patients as cases and 30 normal adults as controls at '0' minute (fasting) and at 2 hours after OGTT. Laboratory investigations were done and special parameters in serum, i.e. hGH, TSH, Insulin, GIP and GLP-1 were analyzed using enzyme immunoassay (EIA) kits. Statistical analyses were made by Student's 't' test using SPSS programm. T2DM patients (cases) had FBG and BG2Hr levels much higher than controls (p<0.001). No significant differences were observed between controls and cases for F-TSH (p=0.927), TSH2HrA (p=0.413), F-hGH (p=0.532) and hGH2HrA (p=0.773) levels. It was observed that F-GIP (p=0.309) and F-GLP-1 (p=0.984) levels were similar between cases and controls. Interestingly, control subjects responded to OGTT by increasing GIP2HA and GLP-1, 2HR levels about 3 times compared to F-GIP and F-GLP-1 (p<0.001). In cases, F-GIP and F-GLP-1 levels were also raised responding to OGTT but by about 1.5 times only compared to F-GIP and F-GLP-1 (p<0.025). Although no significant differences were observed for F-TSH, TSH2HrA, F-hGH and hGH2HrA between cases and controls, F-GIP and F-GLP-1 levels were raised responding to OGTT in cases by about 1.5 times only compared to about 3.0 times in controls subjects. But responses of GIP and GLP-1 to glucose load were lower leading to reduced insulin levels in these T2DM patients reported earlier. Further studies with a larger sample size including cytokines are warranted. Bangladesh J Med Biochem 2018; 11(1): 9-16

Perceptions of Dhaka City Retailers on User Choice of Self-Monitoring Blood Glucose Devices

Self-Monitoring Blood Glucose (SMBG) Devices are now thought to be an integral component in the prevention and management of diabetes mellitus which is increasingly becoming a major health and economic burden particularly in developing countries. The marketing of these Devices, however, are still not well regulated in most of the countries and this, in turn, may lead to more harm than good to the patients who are using these devices. Retailers are the most important contact points who create the interface among the Manufacturers, Professionals and Consumers for popularization of health related devices. In this study, the Users' Choice of SMBG Devices and its determinants, as reflected in the views of the Sales Persons (in a retail shop) in Dhaka City of Bangladesh, have been explored. Twenty Sales Persons from 20 Retail Shops, purposively selected from among major Dhaka City markets where these devices are commonly sold, were individually interviewed using a pretested Interviewer administered Questionnaire. The instrument consisted of six questions covering the Users' preference regarding quality vs cost and also regarding the guidance and motives for purchasing specific items. The results were analyzed by descriptive statistics. It was found that 90% of the consumers are dependent on the suggestions of the Sales Persons regarding the choice of devices. In 80% of the subjects the cost of the System was found to be the determining factor regarding the choice of a meter. Only among 20% subjects, quality played any role in the choice. In conclusion, the choice of specific SMBG devices in Dhaka City is overwhelmingly influenced by Retailers (who, in most cases are not even qualified Pharmacists or Pharmacy Assistants) and, except in few cases; Users are not concerned with quality. Price, particularly the price of the strip, is the dominant factor on Users' choice of SMBG Devices. Bangladesh J Med Biochem 2018; 11(1): 17-21

Metabolic Phenotyping: A New Concept

not available Bangladesh J Med Biochem 2018; 11(1): iii-iv

Evaluation of Some Predictors of Metabolic Syndrome in an Important Group of Health Care Providers of Bangladesh

Metabolic syndrome (MS), a global epidemic, is a cluster of risk factors for CHD, T2DM, stroke and other various medical problems, which affects specially those who lead sedentary and stressful life. Among the health service providers of Bangladesh, doctors are very important group who leads sedentary and mentally stressful life with low physical exercise. The aim was to evaluate WHR (waist-hip ratio), WHtR (waist-height ratio) and TG, HDL-C for their predictive value of MS. In this cross-sectional study, by convenient and purposive sampling technique, 25-55 years aged 500 Bangladeshi doctors (male 334, female 166) were enrolled. The study was carried out in the Department of Biochemistry, BSMMU, Shahbag, Dhaka, Bangladesh. MS was diagnosed by modified NCEP ATP III criteria. Prevalence of MS was measured at 95% CI. Statistical significance was set at p<0.05. Prevalence of MS was found 38.8% in total study subjects; that in male and female was 24.6% and 14.2% respectively. Performance tests of predictors were done. WHR was the most sensitive (99.19% male & 98.59% female), TG was the most specific (94.79% male & 62.11% female) & accurate (78.1% male & 68.1% female) predictor. ROC curves of predictors were produced and all were found good (AUC>0.6) for their predictive value of MS; WHtR was revealed better than WHR as an index for MS (AUC 0.667 vs. 0.652 in male; 0.706 vs. 0.681 in female). It can be concluded, the prevalence of MS is very high among the doctors of Bangladesh; WHtR can be used as a good and relevant index for MS. Bangladesh J Med Biochem 2018; 11(1): 26-35

Evaluation of LDH and Gamma Interferon as Biochemical Markers for Diagnosis of Pulmonary and Extra-Pulmonary Tuberculosis

Tuberculosis is a common disease throughout the world, especially in developing countries. The most common form of the disease is pulmonary tuberculosis (PTB). Extra pulmonary tuberculosis (EPTB) is also a growing problem worldwide. The diagnosis of PTB and EPTB is even harder when smears and cultures are negative. Due to its nature, the diversity of clinical pictures, the diagnosis of EPTB is often difficult and late. Advances in rapid diagnostic techniques are urgently required both for the early management of the new cases of TB and for the individuals already infected with Mycobacterium tuberculosis and are at risk of developing disease. In addition to standard TB diagnostic techniques, use of new biochemical surrogate markers like LDH and gamma interferon are new suggested. This study was undertaken to evaluate the diagnostic value and accuracy of serum LDH and gamma interferon for the diagnosis of PTB and EPTB. This crosssectional study was carried out in the Department of Pathology and Microbiology, NIDCH, Dhaka and by convenient and purposive sampling, 131 patients (male 98, female 33) having age range of 20-90 years were enrolled for the study. Serum LDH and QuantiFERON-TB gold (QFT-G i.e. gamma interferon) were estimated and the result was compared with the culture and histopathology results. Performance tests were done. Prevalence was measured at 95% CI. Statistical significance was set at p<0.05. Of 131 patients 89 (67.9%) had pulmonary tuberculosis (PTB) and the rest 42 (32.1%) had extra-pulmonary tuberculosis (EPTB). Level of LDH and gamma interferon in serum of all patients was found significantly high. TB pleural effusion was detected in 64% cases. The sensitivity, specificity, positive predictive values, negative predictive values and accuracy of LDH and gamma interferon wre calculated both in PTB and EPTB. For LDH it was (SEN 89.22%, SPE 85.66%, PPV 88.82%, NPV 86.11%) and for gamma interferon (SEN 93.01%, SPE 91.64%, PPV 93.73%, NPV 91.18%) in PTB; and for LDH (SEN 89.27%, SPE 87.18%, PPV 84.35%, NPV 90.36%) and for gamma interferon (SEN 94.88%, SPE 93.65%, PPV 90.04%, NPV 95.82%) in EPTB respectively. When calculated in combination, the sensitivity and specificity was 100% and 50% respectively in both PTB and EPTB, and positive and negative predictive values of LDH and gamma interferon in combination were 94.00% and 91.58% in PTB and 90.43% and 96.71% in EPTB respectively. The study concludes that the diagnostic accuracy of LDH and gamma interferon is low when single test is done but it is significantly high when done in combination.Bangladesh J Med Biochem 2017; 10(2): 69-74

Evaluation of Serum Magnesium Level in Preeclampsia

Preeclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Reduced serum magnesium level is found to be associated with elevated blood pressure in preeclampsia. The purpose of this cross-sectional study is to evaluate the serum magnesium level in preeclamptic women. For this study 50 preeclamptic patients, with age range 20 to 40 years having gestational age range from 20 to 40 weeks and 50 age and gestational age matched normotensive pregnant women having no proteinuria were enrolled. Serum magnesium was measured by colorimetric method. The mean(±SD) age and mean(±SD) gestational age of preeclampsia was not significantly different from those of normotensive pregnant women (p=0.203 and p=0.251 respectively). The mean(±SD) body mass index of the preeclamptic patients was significantly higher compared to that of normotensive pregnant women (p<0.001). The mean(±SD) serum magnesium level was 3.37±2.05 mg/dl in preeclamptic group and 2.87±1.38 mg/dl in normal pregnant women; the level did not differ significantly between the subject of preeclampsia and normal pregnant women (p=0.153). Findings of this study suggest that serum magnesium has no association with preeclampsia.Bangladesh J Med Biochem 2017; 10(1): 10-15

Status of Serum Iron and Copper in Women Taking Oral Contraceptive

The oral contraceptive pill fulfills the great human need for birth control with unrivalled effectiveness. The pill can effectively prevent pregnancy and alleviate many menstrual disorders when used correctly. Many biochemical profiles of women taking oral contraceptives are disturbed due to metabolic alterations induced by its hormone content. The study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, during the period of July 2016 to June 2017 to evaluate the status of serum iron and copper in women taking oral contraceptive pills. For this study 120 agematched women were selected and grouped as 60 oral contraceptive user women and 60 non-oral contraceptive user women. Data were analyzed with the help of SPSS version 21. Mean(±SD) level of serum iron and copper were 155.20±21.94 mg/dl and 157.6±14.75 mg/dl in oral contraceptive user women, while in normal healthy women the levels were 103±19.11 mg/dl and 126.28±17.18 mg/dl respectively. Serum iron and copper levels were significantly increased in oral contraceptive user group when compared with that of normal healthy group (p<0.001). From this study it can be concluded that there is significant association of serum iron and copper level with oral contraceptives.Bangladesh J Med Biochem 2017; 10(1): 5-9

Point-of-Care Testing (POCT): Importance in Emergency Medical /Health Care

not availableBangladesh J Med Biochem 2017; 10(2): 43-44