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

Background: Successful treatment in patients with hypothyroidism depends on adequate knowledge, a positive attitude, and appropriate practices. Deficiency in any domain may lead to the persistence of symptoms, difficulty issues in pregnancy, as well as adverse effects on offspring in female patients. Objective: To evaluate the knowledge, attitude, and practice (KAP) of reproductive-aged adult (18 – 45 years) females with hypothyroidism and their associations with current treatment status. Methods: This cross-sectional questionnaire-based KAP survey was done at seven places across Bangladesh in government hospitals and private chambers among 393 hypothyroid patients [age: 30.0 (25.0-36.0), years, median (IQR)]. Adult females who could read and understand the Bangla language were included. Patients with known dementia, illiterate, severely ill, and unwilling to participate were excluded. The knowledge domain consisted of ten single-best multiple-choice questions (MCQs: 3-4 choices). The attitude domain had five statements with a five-point Likert scale ranging from strongly agree to strongly disagree. The practice domain had also ten single best MCQs (3-5 choices) to assess the patients’ most common practice behaviors. The questionnaire was supplied to each patient and advised to put a tick mark at the appropriate option. Patients’ treatment status was considered by current serum TSH levels (0.4 – 4.0 mIU/mL). Results: The percent of over-replacement, appropriate replacement, and under-replacement was around 12%, 47%, and 41% of the study population respectively. Around 39% had good knowledge, 78% were highly concerned about thyroid disorders, and only 22% were highly cautious about their practice. Age and educational status might be associated with all three domains. Conclusions: More than half of the reproductive-aged adult females’ treatment status was inappropriate. Discrepancies among the three domains might be associated with the age and knowledge status of the participants. The study findings will help clinicians to manage patients with hypothyroidism more efficiently. J Rang Med Col. March 2023; Vol. 8, No. 2:11-19

Background Despite the wide acceptability of fasting lipid profiles in practice, emerging evidence suggests that random lipid profiles might be a convenient alternative for lipid measurement. The objective of the present study was to compare the fasting and random lipid profile among subjects with type 2 diabetes mellitus (T2DM). Methods The present cross-sectional study included 1543 subjects with T2DM visiting several endocrinology outpatient clinics throughout Bangladesh from January to December 2021. The fasting lipid profile was measured in the morning following 8–10 h of overnight fasting, and the random lipid profile was measured at any time of the day, irrespective of the last meal. The values of fasting and random lipids were compared using the Wilcoxon signed-rank test and Spearman rank correlation coefficients. Results In this study, a good level of correlation was observed between fasting and random lipid levels [r = 0.793, p < 0.001 for triglyceride (TG); r = 0.873, p < 0.001 for low-density lipoprotein cholesterol (LDL-C); r = 0.609, p < 0.001 for high-density lipoprotein cholesterol (HDL-C); and r = 0.780, p < 0.001 for total cholesterol (TC)]. In addition, TG and TC levels increased by 14% and 0.51%, respectively, in the random state compared to the fasting state (p- <0.05), while LDL-C levels decreased by 0.71% (p-value 0.42). No change was noticed in the HDL-C level. The difference between fasting and random lipid profiles was similar irrespective of patients’ age, sex, BMI, glucose-lowering drug(s), and lipid-lowering therapy. Conclusions Random lipid profile correlates significantly with fasting lipid profile with little difference. Hence, it might be a reliable alternative for fasting lipid profile in patients with T2DM.