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

Bartter syndrome is a rare autosomal recessive renal tubulopathy resulting in hypokalemic, hypochloremic metabolic alkalosis with hyperreninemia. It consists of a set of closely related overlapping syndromes having variable presentation. Advances in molecular diagnostics have revealed the underlying mutations in numerous genes that affect the function of ion channels and transporters which normally mediate salt reabsorption in the distal nephron segments. The classic manifestations are childhood onset of fatigue, polyuria, polydipsia, salt craving, vomiting, dehydration, short stature, and failure to thrive. It should be suspected in any young, normotensive individual presenting with persistent hypokalemic alkalosis in the absence of surreptitious diuretic abuse. It requires high index of clinical suspicion for appropriate diagnosis and timely treatment have been shown to reverse the clinical and biochemical abnormalities thereby improve the outcome. Here we report a 19-year-old boy with classical Bartter syndrome that was treated with Potassium supplementation, NSAID, spironolactone and he showed significant improvement on subsequent follow-up.

BackgroundBoth clinical and subclinical low level vitamin D is common1. Various kinds of health hazard including musculoskletal symptoms are frequently seen among the Vitamin D deficients. It is also not uncommon even in a sunny country. Lack of sun exposure, particularly female using veil may be an important cause.ObjectivesTo assess the relationship between using veil and serum vitamin D3 (cholecalciferol) levelMethodsThis prospective cross-sectional descriptive study was conducted during July 2017 to June 2018. Patients with common complaints related to lack of Vitamin D (muscle cramp, myalgia, fatigue, bone pain, generalized weakness, difficulty in getting up, climbing stairs and pain in weight bearing joints) were enrolled. Patient having other disease were excluded from study. Serum cholecalciferol was measured for each patient. Race, occupation, educational status, skin complexion, body mass index, sunlight exposure, covering of body with clothing’s and use of sunscreen were taken under consideration in final analysis. Correlation of serum cholecalciferol level with different types of veils (Burkha, halve sleeve, full sleeve, quarter sleeve and Hijab) of individual’s was analyzed.ResultsA total 79 female patients were enrolled after screening 108. All of them were of multi-ethnic Asian origin. Age distribution of them is 17 to 39 years 34.2%, 40 to 50 years 38%, 51 to 70 years 26.6% and above 70 years 1.3%. Maximum (93.7%) of them were house wife, 91.1% had no adequate sun exposure and 81% had no skin exposure to sunlight. Among clothing 79.7% used Burkha, 5.1% halve sleeve, 2.5% full sleeve and 12.7% quarter sleeve. Among Burkha 28.6% (18), 55.6% (35) & 15.9% (10) and among quarter sleeve 50% (5), 40% (4) & 10% (1) had deficient, insufficient & sufficient vitamin D level respectively while 2 (100%) female with full sleeve and 4 (100%) female with halve sleeve had deficient and insufficient vitamin D level respectively. The cholecalciferol level among the users of veil is shown in Table-1. There was no significant difference between different types of clothing’s (Table: 2).Abstract AB0917 Table 1 Weight, height and Vitamin D level in different types of clothing’s.Type of clothingWt in KgHt in cm Vit D level (range) in ng/mlBurkhaMean68.63150.43(8-40) 23.921N636363Std. Deviation11.7066.5746.3074Halve sleeveMean70.75150.50(25-30) 27.000N444Std. Deviation17.5001.0002.4495Full sleeveMean64.00145.50(15-19) 17.000N222Std. Deviation8.48513.4352.8284Quarter sleeveMean63.40150.10(16-38) 23.350N101010Std. Deviation10.8346.4376.7497TotalMean67.96150.27(8-40) 23.829N797979Std. Deviation11.7906.4886.2418Abstract AB0917 Table 2 Difference of Vitamin D level in relation to clothing’s (ANOVA)GenderSum of SquaresdfMean SquareFP valueFemaleBetween Groups136.315345.4381.1740.325Within Groups2902.5687538.701Total3038.88378ConclusionMain source of Vitamin D is sunlight. Proper exposure to sunlight is essential for adequate vitamin D level even in a sunny country. Regarding in vitamin D absorption from sunlight, there may be no ...