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Body-mass-index (BMI) is widely accepted as an indicator of nutritional status in adults. Mid-upper-arm-circumference (MUAC) is another anthropometric-measure used primarily among children. The present study attempted to evaluate the use of MUAC as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition, and thus to suggest a suitable cut-off value. A cross-sectional study in 650 adult attendants of the patients of Dhaka-Hospital, of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) was conducted during 2012. Height, weight and MUAC of 260 male and 390 female aged 19-60 years were measured. Curve estimation was done to assess the linearity and correlation of BMI and MUAC. Sensitivity and specificity of MUAC against BMI<18.5 was determined. Separate Receiver-operating-characteristic (ROC) analyses were performed for male and female. Area under ROC curve and Youden's index were generated to aid selection of the most suitable cut-off value of MUAC for undernutrition. A value with highest Youden's index was chosen for cut-off. Our data shows strong significant positive correlation (linear) between MUAC and BMI, for males r = 0.81, (p<0.001) and for females r = 0.828, (p<0.001). MUAC cut-off <25.1 cm in males (AUC 0.930) and <23.9 cm in females (AUC 0.930) were chosen separately based on highest corresponding Youden's index. These values best correspond with BMI cut-off for under nutrition (BMI <18.5) in either gender. MUAC correlates closely with BMI. For the simplicity and easy to remember MUAC <25 cm for male and <24 cm for female may be considered as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition.

Background Non-communicable diseases (NCDs) have already become major killers in Bangladesh. Once NCDs are developed, they become chronic health and economic problems. Their primary prevention is linked to their common risk factors. This study was conducted to determine the prevalence of NCD risk factors with a focus on their clustering in Bangladeshi adults. Methods This nationally representative study was done in 4,073 (1,812 men and 2,261 women) adults aged 25 years or older selected from rural and urban households. Multistage cluster sampling design was used. Selected variables were in line with steps I and II of WHO stepwise surveillance except alcohol. Results Forty-four percent used tobacco in any form. Almost 93 % did not consume adequate fruit and vegetables (5 servings or more). Thirty eight percent had low physical activity level (<600 MET-minutes/week). One-quarter (26 %) were overweight (body mass index > =25 kg/m^2). Twenty-one percent had hypertension (blood pressure > =140/90 mmHg or medication) and about 5 % had documented diabetes. Upon examination of risk factor clustering, we observed that 38 % had at least three risk factors. After this threshold, clustering suddenly dropped down to a fairly low level. Using this threshold as a cut-off, clustering of risk factors was associated with age, male gender, urban residence, educational levels and quality of house in multivariate analysis. Conclusion Prevalence of NCD risk factors is fairly high in Bangladeshi adults with a tendency of clustering. If a risk factor such as hypertension is detected, a closer look for other risk factors has to be given in both at clinical and public health settings. Clustering raises risk by more than a summation of risk factors. Our findings, therefore, suggest that Bangladesh could expect a significant increase in NCDs in near future.

PurposeThe significance of niacin in embryonic development has clinical implications in the counseling of pregnant women and may be used to inform nutrition recommendations. This study, therefore, aims to review the associations between maternal periconceptional niacin intake and congenital anomalies.MethodsA systematic search of Ovid MEDLINE, ClinicalTrials.gov, AMED, CENTRAL, Emcare, EMBASE, Maternity & Infant Care and Google Scholar was conducted between inception and 30 September 2020. Medical subject heading terms included “nicotinic acids” and related metabolites, “congenital anomalies” and specific types of congenital anomalies. Included studies reported the association between maternal niacin intake and congenital anomalies in their offspring and reported the measure of association. Studies involved solely the women with co-morbidities, animal, in vitro and qualitative studies were excluded. The risk of bias of included studies was assessed using the Newcastle–Ottawa Scale (NOS). A random effects-restricted maximum likelihood model was used to obtain summary estimates, and multivariable meta-regression model was used to adjust study-level covariates.ResultsOf 21,908 retrieved citations, 14 case–control studies including 35,743 women met the inclusion criteria. Ten studies were conducted in the U.S, three in Netherlands and one in South Africa. The meta-analysis showed that expectant mothers with an insufficient niacin intake were significantly more likely to have babies with congenital abnormalities (odds ratio 1.13, 95% confidence interval 1.02–1.24) compared to mothers with adequate niacin intake. A similar association between niacin deficiency and congenital anomalies was observed (OR 1.15, 95% CI 1.03–1.26) when sensitivity analysis was conducted by quality of the included studies. Meta-regression showed neither statistically significant impact of study size (p = 0.859) nor time of niacin assessment (p = 0.127). The overall quality of evidence used is high—thirteen studies achieved a rating of six or seven stars out of a possible nine based on the NOS.ConclusionInadequate maternal niacin intake is associated with an increased risk of congenital anomalies in the offspring. These findings may have implications in dietary counseling and use of niacin supplementation during pregnancy.

Assessing the preprocedural risk of mortality following percutaneous coronary intervention (PCI) is crucial for clinical decision‐making, quality registries, and performance monitoring. This systematic review aims to summarize preprocedural factors associated with in‐hospital mortality post‐PCI. A systematic search of MEDLINE, EMBASE, CINAHL, and Web of Science was conducted up to April 2024, without language restrictions, to identify preprocedural factors associated with in‐hospital mortality post‐PCI. The information was systematically evaluated and descriptively summarized following the CHhecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies (CHARMS) checklist. The search initially identified 9552 studies, with 28 articles ultimately included in the final analysis. The pooled prevalence of in‐hospital mortality post‐PCI was 1.63%, whereas it was 6.40% for patients with acute coronary syndrome (ACS). A total of 77 independent preprocedural factors were found to be significantly associated with in‐hospital mortality, of which 22 were consistently reported across multiple studies and identified as potential key factors. Factors most frequently reported in various studies included, but not limited to, ACS ( n  = 27, 96.4%), renal failure ( n  = 24, 85.7%), age ( n  = 19, 67.9%), gender ( n  = 16, 57.1%), cardiac events ( n  = 15, 53.6%), ejection fraction ( n  = 15, 53.6%), vascular disease ( n  = 12, 42.9%), heart failure ( n  = 12, 42.9%), body mass index ( n  = 10, 35.7%), lesion location ( n  = 9, 32.1%), diabetes ( n  = 8, 28.6%), and vessel disease ( n  = 8, 28.6%). Eleven articles (39.2%) used imputation methods to handle missing data. Logistic regression was used by 19 articles (67.9%), and five articles (18.6%) used the machine learning (ML) method. Nineteen articles (67.9%) reported the discriminatory performance of the models using receiver operating characteristic (ROC) score ranging from 0.776 to 0.960. Incorporating the 22 preprocedural factors identified in this study can aid clinicians in decision‐making for high‐risk cases. To improve risk adjustment models, these factors should be integrated, missing data carefully managed, models validated, and ML techniques utilized.

Introduction People who inject drugs (PWID) contribute significantly to the global HIV burden. Various individual and contextual factors exacerbate the risk of HIV among PWID, this problem is particularly acute in low- and middle-income countries, where resource constraints impede effective prevention and treatment efforts. Although Bangladesh is classified as a low HIV prevalence country, and despite national efforts, including surveillance through the Integrated Biobehavioural Survey (IBBS), gaps in evidence and actionable insights persist. This study aims to analyse the latest IBBS 2020 data to identify risk factors associated with HIV vulnerability among PWID in Bangladesh, informing culturally relevant and targeted harm reduction strategies to mitigate these risks. Method This study analysed data from IBBS, which used a two-stage cluster sampling and Time Location Sampling methods to recruit participants. Data were collected across four domains: (1) Sociodemographic characteristics, (2) Drug and Injection-Related Behaviours, (3) Sexual Behaviours, and (4) Co-infections, with blood samples collected for HIV, hepatitis-C, and syphilis serological testing. Sample weights were applied to adjust for the complex survey design. Descriptive statistics summarized participant characteristics and risk behaviours. Two binary logistic regression models were used to identify HIV risk factors: The Fully Adjusted Model, which included all plausible confounders and used the Wald backward elimination method to determine significant predictors, and the Partially Adjusted Model, which controlled for age, gender, and education to explore intermediate factors through adjusting confounding or mediation. Result Overall, the prevalence of HIV among PWID was 4.1%. Social exclusion (AOR: 1.71, 95% CI 1.1, 2.7). Hepatitis C infection (AOR: 2.57, 95% CI 1.6, 4.0), drug use of more than 10 years (AOR: 3.74, 95% CI 1.3, 10.8), injecting once or more daily (AOR: 5.23, 95% CI 2.6, 10.7), having multiple injecting partners (AOR: 3.11, 95% CI 1.8, 5.3) sharing injecting accessories (AOR: 2.55, 95% CI 1.5, 4.4) and engaging with a commercial sex partner (AOR: 1.80, 95% CI 1.1, 2.9) emerged as significant predictors of HIV risk among PWID patients. Conclusion This study reveals the heightened HIV risk among PWID in Bangladesh, driven by intertwined social, behavioural, biological, and structural factors. It underscores the urgent need for tailored, holistic interventions combining harm reduction, structural reforms, and biomedical strategies to address vulnerabilities, reduce high-risk behaviours, and improve healthcare access for this marginalized group.

Diabetes Distress (DD)—an emotional or affective state arise from challenge of living with diabetes and the burden of self-care—negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward–backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach’s α and discriminative validity through independent t-test and test–retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test–retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

Background and Aims: The increasing prevalence of diabetic complications and tobacco consumption are alarming worldwide. The aim of this study was to assess the association between tobacco smoking and diabetic peripheral neuropathy (DPN) among male smokers with type 2 diabetes. Research Design and Methods: In a matched case-control study, participants were recruited from 2 major hospitals in Sharjah, the United Arab Emirates (UAE). Male patients aged ≥18 years and diagnosed with DPN who had type 2 diabetes mellitus for at least 1 year were recruited. Age-(±3 years)-matched controls with diabetes were recruited for each case. Sociodemographic characteristics and self-reported data on physical activity, and tobacco smoking were collected. Smoking status was assessed as current, past, or never. Medical and clinical data were collected from hospital records. Results: An equal 140 of each cases and controls were included in the analysis, with a mean (SD) age of 63.8 (10.6) and 63.7 (10.5), respectively. Cases were more likely to smoke and had a longer smoking duration than the controls. After adjusting for all potential confounders, the association between tobacco smoking and DPN was significant (past smokers [OR = 4.10; 95% CI = 1.84-9.17], and current smokers [OR = 2.48; 95% CI = 1.06-5.83]). Conclusions: This study found a significant association between tobacco consumption and DPN among males with type 2 diabetes in the UAE. Targeted smoking cessation programmes are urgently needed.

Objective The study aimed to systematically review the evidence on the association between smoking and the risk of diabetic neuropathy, with a particular emphasis on the risk of peripheral neuropathy among individuals with diabetes mellitus. Design and methods MEDLINE, EMBASE, SCOPUS, and CENTRAL databases were searched for studies published before August 2024. Cross-sectional, case–control, and cohort studies that assessed the association between smoking and diabetic neuropathy in individuals diagnosed with diabetes mellitus (type 1 or type 2), reported smoking as an exposure, and any type of diabetic neuropathy as an outcome were included in the study. The risk of bias of the included studies was evaluated using the modified risk of bias in non-randomized studies—of exposures (ROBINS-E). Results Seventy-five articles, including 228,699 individuals with diabetes met the inclusion criteria. Fifty-four cross-sectional, 8 case–control, and 13 cohort studies provided data for the meta-analyses. Cohort studies demonstrated a significantly increased risk of diabetic peripheral neuropathy (RR 1.28; 95% CI 1.05, 1.51), the most prevalent subtype of diabetic neuropathy. Meta-analyses of cross-sectional and case–control revealed an increased risk of diabetic neuropathy (all types combined) among smokers with diabetes ([OR 1.29; 95% CI 1.17, 1.41], [OR 1.48; 95% CI 1.23, 1.72]). Meta-regression showed no statistically significant impact of total sample size and type of effect estimates on pooled effect estimates for cross-sectional, case–control, and cohort studies. Conclusion Smoking is associated with an increased risk of diabetic neuropathy, peripheral neuropathy in particular. Future research should evaluate the precise dynamics of neuropathy pathogenesis among individuals with diabetes to prevent such complications. Systematic review registration PROSPERO CRD42022363380.

Correspondence to Dr Sheikh Mohammed Shariful Islam; shariful.islam@deakin.edu.au Summary box COVID-19 outbreaks and the repeated lockdowns to control its spread have significantly impacted people’s social life, physical and mental health, and the global economy. The introduction of a vaccine passport needs to consider several uncertainties (e.g., duration of immunity, the possibility of reinfection).13 Currently, there are no data on the level and duration of postinfection immunity in people recovered from COVID-19.14 Introducing a vaccine passport for domestic and international travel might promote the further spread of the virus. [...]if the vaccine passport is based on an antibody test, it could be subjected to fraudulence due to the perceived social and economic benefit of a positive result.15 Hence, a vaccine passport might be an incentive for returning to everyday life and eventually opening international travel as the approved vaccines are highly effective in preventing severe disease, hospitalisation and death and reducing transmission.16 They remain largely efficacious against the highly transmissible Delta variant reinforcing ongoing usefulness.17 All this evidence gives confidence in these vaccines as appropriate tools for conferring immunity to the broader population for their unrestricted movement when combined with other public health measures, such as mask-wearing and social distancing. [...]recommencing social life and economic activities within a country cannot wait for an ideal WHO recognised vaccine passport. [...]time, a vaccine passport may be accepted as a valid document among the countries within a particular region (e.g., the EU, the African Union) or under a quarantine free travel bubble agreement. Proof of recovery from infection or a negative test result should not be used as an immunity certificate due to a lack of scientific evidence. [...]a vaccine passport should only be issued after recommended waiting time following the second dose of a vaccine, for example, after 1 week of completing the second dose of Pfizer/BioNTech and 3 weeks of the second dose of the Oxford/AstraZeneca vaccine.22 A vaccine passport can remain valid for a specific period with provision for further renewal as data on the vaccines’ long-term effectivity and the need for subsequent booster dose becomes available and while their ongoing efficacy against mutant variants is closely monitored.

Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh. This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured. There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form, <1% consumed alcohol within the past 30 days, 92% did not consume adequate fruit and vegetables (five servings or more), and 35% had low physical activity level [<600 metabolic equivalent (MET) min per week]. Documented diabetes was found in 4% of the participants. Seventeen percent were overweight [body mass index (BMI) ≥25 kg/m 2 and 21% had abdominal obesity (men ≥94, women ≥80 cm). Overall, 21% people had hypertension (blood pressure ≥140/90 mmHg or medication). Physical inactivity, alcohol intake, hypertension, obesity, and diabetes were more prevalent in urban areas, as opposed to tobacco. Tobacco intake showed a decreasing gradient, but hypertension, obesity, diabetes, and low physical activity showed an increasing gradient across the wealth quartiles. Risk factors are widely prevalent in Bangladeshi people across sexes and across both rural and urban areas of residences. NCD prevention through risk factor control, and early detection and treatment of hypertension and diabetes are warranted.