United Hospital

Background: Type 2 diabetes mellitus (T2DM) is a major metabolic disorder frequently associated with abnormalities in other endocrine systems, particularly the thyroid gland. Thyroid dysfunction may adversely affect glycemic control, lipid metabolism, and cardiovascular risk, yet comparative data between diabetic and non-diabetic individuals remain limited in many populations. Objective: To evaluate and compare thyroid function parameters and the prevalence of thyroid dysfunction between patients with type 2 diabetes mellitus and non-diabetic individuals, and to assess their association with glycemic control and sex. Methods: This cross-sectional study was conducted at a tertiary care hospital between June and August 2024. A total of 200 adults were enrolled, including 100 patients with T2DM and 100 non-diabetic controls. Fasting blood glucose, 2-hour postprandial glucose, HbA1c, lipid profile, serum creatinine, thyroid-stimulating hormone (TSH), and free thyroxine (FT4) were measured. Thyroid dysfunction was categorized as subclinical or overt hypothyroidism. Statistical analyses included independent t-tests, chi-square tests, and Pearson correlation analysis. Results: Patients with T2DM had significantly higher fasting glucose (156.4 ± 38.2 vs 92.6 ± 10.4 mg/dL), HbA1c (8.4 ± 1.2% vs 5.4 ± 0.4%), and adverse lipid profiles compared to controls (all p < 0.001). Thyroid dysfunction was significantly more prevalent in the T2DM group than in non-diabetic individuals (32.0% vs 14.0%, p = 0.003), with subclinical hypothyroidism being the most common abnormality (22.0%). Mean TSH levels were higher in patients with T2DM (4.2 ± 1.6 vs 2.6 ± 1.1 mIU/L; p < 0.001), while FT4 levels were lower (p = 0.01). Female patients with T2DM showed a higher prevalence of thyroid dysfunction compared to males (42.9% vs 24.1%, p = 0.04). TSH demonstrated a significant positive correlation with HbA1c (r = 0.46, p < 0.001), while FT4 showed a negative correlation (r = −0.29, p = 0.004); no such associations were observed in non-diabetic individuals. Conclusion: Thyroid dysfunction, particularly subclinical hypothyroidism, is significantly more prevalent among patients with type 2 diabetes mellitus and is associated with poorer glycemic control, with a higher burden observed in female patients.

HFpEF accounts for 12-25% of heart failure cases in South Asia, primarily driven by hypertension, diabetes, and obesity. Late diagnosis and healthcare disparities worsen outcomes. This expert consensus aims to provide region-specific guidelines for the diagnosis, management, and prevention of HFpEF. A modified Delphi process with experts from five South Asian countries was conducted, informed by a literature review (2018-2024) and adapted international guidelines. Recommendations include the use of an adjusted H2FPEF score (BMI > 25 kg/m²), essential echocardiographic criteria (E/e' > 9, LAVi > 34 mL/m²) for diagnosis, and SGLT2 inhibitors as first-line pharmacotherapy, with finerenone for cardio-renal protection. Emphasis on lifestyle modification, patient education, and aggressive management of comorbidities is highlighted to reduce hospitalizations. HFpEF presents earlier and is associated with higher comorbidity in South Asia. Adaptations such as lower BMI thresholds and region-specific screening are critical. Cost and accessibility challenges persist in the use of SGLT2 inhibitors and finerenone. Public health measures and infrastructure strengthening are necessary to improve outcomes. Early diagnosis, multidisciplinary management, and tailored treatment strategies can enhance outcomes in HFpEF in South Asia. This consensus serves as a call for regionally focused implementation to reduce the burden of HFpEF.

Background:Trigyceride-glucose (TyG) index is a composite indicator composed of triglyceride (TG) and fasting blood glucose (FBS). It is a simple, reliable and easily accessible marker of insulin resistance (IR) which is associated with different metabolic and cardiovascular diseases (CVD) including coronary artery disease (CAD). Objective: To investigate the correlation between the TyG index and cardiovascular risk factors, and the predictive value of TyG index with severity of CAD assessed by SYNTAX score. Methods: This cross-sectional analytical study was done in the Department of Cardiology, Bangladesh Medical University, Dhaka, Bangladesh, from January 2025 to June 2025 including a total of 50 patients undergoing coronary angiogram (CAG) during the index hospitalization. The TyG index was calculated as Ln [fasting triglyceride (mg/dL) ×fasting glucose (mg/dL)]/2. Linear regression analysis were done to assess relationship between cardiovascular risk factors and TyG index. The severity of CAD was assessed by the SYNTAX score and logistic regression analysis was done to assess predictive value of TyG index with severity of CAD. Results: On the basis of median TyG index level level (9.33) study population were divided into two groups (low TyG index and high TyG index). In univariate linear regression analysis showed positive relation of TyG index with male gender (p=0.039), diabetes mellitus (p<0.001), dyslipidaemia (p=0.004), FBS (p=0.008) and TG/HDL ratio (p<0.001). Multivariate linear regression analysis further indicated diabetes mellitus (p=0.002) and TG/HDL ratio (p<0.001) were independently associated with TyG index. ROC curve analysis revealed strong relationship between TyG index and intermediate to high SYNTAX score with AUC of 0.799 and cut of value 9.53 yielded a sensitivity of 75.0% and a specificity of 76.5%.In univariate logistic regression analysis showed smoking (p=0.012) and TyG index (p=0.017) were significant predictors of intermediate to high SYNTAX score(≥23). On multivariate logistic regression analysis also showed TyG index (p=0.034) was independent predictor of intermediate to high SYNTAX score. Conclusion: TyG index has strong correlation with different clinical risk factors like male gender, diabetes mellitus, dyslipidemia. TyG index may be considered as independent predictor of intermediate to high SYNTAX score. As it is a simple, easily accessible and inexpensive marker, it can be used for risk stratification before CAG to assess severity of CAD. University Heart Journal 2025; 21(2): 75-80

Abstract Objectives To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction Background There is a paucity of data regarding the best timing for heparin administration in STEMI. Methods We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results 11 observational studies and 4 clinical trials with a total of 72249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR=0,68; 95% CI 0.54-0.86) as well as at longer follow-up (mean follow-up time 14.4 months OR=0,61; 95% CI 0.44-0.85). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR=1,7; 95% CI 1.43-2.04), and did not show increase in major bleedings (OR 0.92, 95% CI 0.81-1.05) Conclusion A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complicationsMajor outcomes analysis Safety analysis

Abstract Background Antimicrobial resistance (AMR) disproportionately affects low and middle income countries (LMICs) including Bangladesh, driven by poorly implemented infection prevention and control (IPC) and misuse of antimicrobials. Robust Antimicrobial Stewardship (AMS) programs mitigate this risk by optimizing prescribing to best-practice standards. This study aimed to assess healthcare workers’ (HCWs) knowledge, attitude and perception (KAP) toward AMS. Methods An online questionnaire was shared via IPC Alliance BD to different health-related institutes and hospitals, inviting voluntary and anonymous participation of HCWs on KAP between January to March 2025. Results A total of 721 participants from 171 hospitals and institutes (78 public and 93 private), comprising 29% medical officers or equivalent, 29% nurses, 28% professors or equivalent and 14% administrative staff and other roles were enrolled. The average age was 36 years, and females accounted for 54% of respondents. Overall, 43% of respondents were familiar with the term AMS, reached through various sources. Only 11% received AMS training, and 18% had access to standard treatment guidelines. Despite 66% reporting availability of culture and sensitivity (C/S) testing, only 26% routinely recommended C/S and 15% shared an antibiogram. Empirical therapy predominated (> 94%), with a 60% preference for broad-spectrum agents. However, 67% believed rational use and proper IPC can reduce AMR. Knowledge, attitudes, and perceptions varied significantly by age, gender, and education (P < 0.05). Conclusion Antimicrobial resistance in Bangladesh necessitates strengthened laboratory capacity, expanded public awareness, and improved healthcare worker’s KAP via structured training and continuous monitoring, with robust antimicrobial stewardship as the operational benchmark.

Background and objective: Acute coronary syndromes (ACS), particularly those affecting the left main coronary artery (LMCA), are associated with high morbidity and mortality. The objective of the present study was to investigate long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for ACS affecting the LMCA compared to those with non-LMCA involvement.Methods: This interventional study was conducted at the Department of Cardiology of MH Shamorita Medical College Hospital in Dhaka, Bangladesh, from January 2023 to June 2024. A total of 101 patients with ACS who underwent PCI participated in the study. Of whom, 51 were in the LMCA group and 50 were in the non-LMCA group. Follow-up assessment was done at the third, sixth, and 12th months, focusing on major adverse cardiovascular events (MACE) as the primary endpoint and persistent symptoms, repeat revascularization, and stent thrombosis as secondary endpoints.Results: The mean age of the LMCA and non-LMCA groups was 56 and 54 years, respectively, with a higher female proportion in the LMCA group. The patients in the LMCA group presented with more complex lesions, with a mean synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score of 23.6. The MACE rate was notably higher in the LMCA group at 6%, compared to 2% in the non-LMCA group (p=0.013). Myocardial infarction (MI) occurred in 4% of the LMCA group, with no events in the non-LMCA group. Persistent symptoms and repeat revascularization were also more prevalent in the LMCA group (6% and 4%, respectively, p-value <0.05).Conclusions: Patients with ACS involving the LMCA experienced higher rates of adverse outcomes, particularly MI and repeat revascularization, following PCI compared to non-LMCA cases.

Background. Denosumab discontinuation is associated with a sharp rebound in bone turnover and increased incidence of (multiple vertebral) fractures within months. Current strategies often rely on a fixed serum C-terminal telopeptide (CTX) threshold to

Introduction: Patients with astigmatism, especially those with more than two diopters, appear to have keratoconus as a co-morbidity. Understanding the coexistence of these two diseases may aid in these patients' early detection and management. Purpose: The purpose of the present study was to establish the rate of keratoconus among the patients with &gt;2D astigmatism in Bangladesh. Methods: 80 astigmatic patients &gt;2D among the age group 10-45 years old participated in this cross-sectional study between May and August 2024 at Noor Makka and Makka Eye Hospitals, Dhaka, Bangladesh. Keratoconus and subclinical cases were identified by using corneal topography, slit lamp, and corneal asymmetry, along with general visual evaluation by an ophthalmology consultant. Statistical package for the social sciences (SPSS) software was used as the data analysis tool. Results: This study analyzed the socio-demographic information and the eye characteristics of people with astigmatism. Out of 80 studied participants, keratoconus appeared in 65%, mainly from the age group 17-30 (56.25%). Among the study participants, males and females were 47.50% and 52.50%, respectively. The average astigmatism level was recorded at 4.697 diopters. The research established a significant statistical correlation between Keratoconus diagnosis and corneal biomicroscopy (p = .001) and corneal topography (p = .000), where most of the keratoconus patients showed thinning patterns in their stromal structure. The research also established a connection between age and gender to keratoconus. Conclusions: This cross-sectional study revealed a high prevalence of diagnosed keratoconus among astigmatic patients, particularly affecting younger individuals.