A Massive Ovarian Mucinous Cystadenoma: A Rare Case Report.

Ovarian mucinous cystadenoma is a benign tumour that arises from the surface epithelium of the ovary. It tends to be huge in size if not detected early. We describe a 32 year old woman (para 1+0) presented with marked abdominal distension, discomfort and vague pain in the abdomen with dyspepsia, anorexia, nausea, vomiting and irregular menstruation for last three months with the suspicion of pregnancy. On examination no findings were in favour of pregnancy, rather an ill defined abdominal mass about 30 weeks pregnancy size was found. Transabdominal USG revealed a big multiloculated ovarian cyst of about 25x20 cm. On laparotomy a huge cystic mass was noticed arising from left ovary. The cyst wall was smooth, intact and without any external projection though adherent with the left fallopian tube and left salpingo-oophorectomy was done. Histopathological examination revealed an ovarian cyst compatible with mucinous cystadenoma. Such giant ovarian tumours have become rare in current practice. This case report emphasizes the significance of thorough evaluation of all women presented with non specific complaints like vague abdominal pain or simple dyspepsia. Although the condition is rare, it is potentially dangerous in the massive form if not timely diagnosed and managed properly. With the increasing awareness of such conditions, more and more cases could be detected and reported early.

Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin.

Background: In recent years the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) in patients of chronic liver disease (CLD) of various origins has gained much attention. This variable is readily available, easy to interpret, and inexpensive and the clinical utility of the AST/ALT ratio in the diagnostic workup of patients with CLD is quite promising. Objective: The present study was designed to find out the link between aminotransferase (AST/ALT) ratio with commonly measured biochemical parameters of liver function tests in CLD of viral origin. Materials and method: This cross sectional study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh. Forty four biopsy proven diagnosed subjects of chronic viral hepatitis without cirrhosis of both sex were selected purposively. With aseptic precaution 5 mL venous blood was collected from each subject and common liver function tests (serum AST, ALT, AST/ALT ratio, alkaline phosphatase, total bilirubin, serum total protein, serum albumin, serum globulin, serum albumin/globulin ratio, prothrombin time) and viral serology (HBsAg, Anti HDV antibody, Anti HCV antibody) were performed. Data were analyzed by SPSS version 19 for Windows. Pearson’s correlation test was done to determine association between AST/ALT with other biochemical parameters. Results: Mean(±SD) age of the study subjects was 32.55±10.55 years (range 20-50 years) with 48 (77.7%) male and 14 (22.6%) female subjects. Pearson’s correlation test was done between AST to ALT ratio with other biochemical parameters and prothrombin time showed significant positive correlation (p <0.01). Conclusion: In our study we found significant positive correlation between AST/ALT with prothrombin time in CLD subjects without cirrhosis.

Acardiac Twin.

Acardiac anomaly is a rare complication of multiple pregnancies. It is a hemodyamically disadvantaged nonviable twin which occurs in association with a twin reversed arterial perfusion sequence (TRAP). In TRAP, blood flows from an umbilical artery of the pump twin in reverse direction into umbilical artery of the perfused (or acardiac) twin via an arterial to arterial (AA) anastomosis. Its blood is poorly oxygenated and results in variable degrees of deficient development of the head, heart, and upper limb structures. The lower half of the body is usually better developed, which may be explained by the mechanism of perfusion. The pump twin is at risk of heart failure and problems related to preterm birth with a reported mortality of 50-75%. We present a case of multiple pregnancy with acardiac twin in a 26 year old lady with gestational diabetes mellitus. During ante natal check up several ultrasonographic (USG) screening showed twin pregnancy with one healthy fetus and the other fetus with inconspicuous anatomy and structure. Repeat USG at 36th week of gestation diagnosed twin pregnancy with acardiac twin. Strikingly the pump twin did not develop the usual complications and was delivered by cesarean section at 37th week of gestation.

Hysterosalpingography in Infertility.

Background: Infertility is a common medical problem. It can be due to problems in either partner, or both. Ovulatory dysfunction, tubal and peritoneal factors comprise the majority of female factor for infertility. Hysterosalpingography (HSG) plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes. Objective: The aim of this study was to evaluate the hysterosalpingographic findings of women with infertility in our setting. Materials and method: This cross sectional study was carried out in the infertility centre at BIRDEM, Dhaka, Bangladesh during the period of September 2002 to February 2003. Out of 100 infertile patients 50 infertile women of reproductive age (21-40 years) indicated for HSG were enrolled in this study. Results: Sixty percent patients had secondary infertility. Majority of the subjects of both primary and secondary infertility (55% and 60%) were in 26-30 years age group. On HSG any sort of uterine pathology was found in 10% cases and unilateral and bilateral tubal block were present in 24% and 20% cases respectively. Conclusion: Hysterosalpingography, a safe, less invasive procedure, has an important role in diagnosing uterine and tubal factors of infertility.

Diabetic Retinopathy and Homocysteine in Newly Diagnosed Type 2 Diabetes Mellitus.

Background: Diabetic retinopathy is the commonest complication that occurs from the very beginning in patients with diabetes mellitus (DM). DM itself leads to increased homocysteine (Hcy) level. It is postulated that hyperhomocysteinaemia causes retinal vascular damage as Hcy is an established vasculotoxic agent and auto-oxidation of Hcy leads to oxidative stress, endothelial dysfunction, platelet activation and thrombus formation. Objective: The aim of the study was to evaluate the serum Hcy in newly diagnosed type 2 diabetic subjects with diabetic retinopathy. Materials and method: A case control study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period of January 2006 to December 2007. Total 85 newly diagnosed type 2 diabetic subjects were included in this study, 40 were case having retinopathy and 45 were age and sex matched control without retinopathy. Serum Hcy was measured and compared between case and control. Results: Serum Hcy level in cases was significantly higher (p<0.05) compared to that of control (15.11±5.49 μmol/L vs. 12.59±4.01 μmol/L). Odds ratio was also determined for hyperhomocysteinemia (OR=2.23; CI 0.9-5.45). Conclusion: Hyperhomocysteinaemia is associated with diabetic retinopathy in newly diagnosed type 2 diabetes.

Insulin Resistance and Hypogonadism.

Backgound: The number of hypogonads is increasing day by day. It may be due to sedentary life style with increased obesity, increased tension or stressed lifestyle among all groups of populations. Visceral obesity is associated with insulin resistance, diabetes mellitus and also with hypogonadism. Objective: This study was carried out to determine the proportion of insulin resistance among male subjects with hypogonadism in different age groups along with status of erectile quality among diabetics and non diabetics. Materials and method: This cross sectional study among 161 adult male subjects aged ≥ 20 to ≤ 60 years were purposively selected from Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh between May 2009 to September 2010. Glycemic status and insulin resistance (by HOMA-R) were done and relevant history were documented. Results: The highest proportion (38.9%) of hypogonadism was in ≥ 50 years age group whereas highest proportion (39.6%) of the eugonads was in the age group of 40 to 49 years. More than half of the hypogonad subjects had weak erectile quality (54.0%) which were followed by absent erectile quality in 32.7% and 13.3% subjects had normal erectile quality. Among the eugonad subjects 41.7% had normal erectile quality, 41.6% subjects had weak erectile quality and 16.7% subjects had no erectile quality. More than ninety percent of the hypogonad subjects and about 60% of the eugonad subjects had insulin resistance. The average HOMA-R was more in the subjects with hypogonadism with diabetes which was highly significant (p-value < 0.001). Conclusion: Hypogonadism is associated with insulin resistance.

Serum Lipids and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetic Subjects.

Background: Diabetic retinopathy is the commonest and usually the first observable vascular complication of diabetes mellitus. Along with hyperglycaemia, dyslipidaemia is a contributing factor for the occurrence of diabetic retinopathy. It is postulated that dyslipidaemia results in formation of hard exudate by increasing blood viscosity and altering the fibrinolytic system. A case control study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of January 2006 to December 2007 to evaluate the serum lipid profile in newly diagnosed type 2 diabetic subjects with diabetic retinopathy. Materials and Methods: Total 85 newly diagnosed type 2 diabetic subjects were included in this study, 40 were cases having retinopathy and 45 were age and sex matched controls without retinopathy. Serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were compared between cases and controls. Unpaired t-test and chi-square test were done between groups as tests of significance. Results: All the parameters of lipid profile showed dyslipidaemic trend both in cases and controls. In the cases TG was significantly higher and HDL-C was significantly lower than that of controls (p < 0.05) whereas no significant difference was found between cases and controls with respect to serum TC and LDL-C. Conclusion: It can be concluded that high TG and low HDL-C are associated with diabetic retinopathy in newly diagnosed type 2 diabetes.