Glycemic Status among Pregnant Women during 24th to 28th Gestational Age.

Gestational diabetes mellitus (GDM) is a heterogeneous group of metabolic disorder, which result in varying degrees of maternal hyperglycemia and pregnancy associated risk. Glucose intolerance usually returns to normal range within 6 weeks after delivery. This study was undertaken to determine the glycemic status who attended for antenatal care. This study enrolled pregnant women, with their gestational age between 24th - 28th weeks. This analytical cross sectional study was carried out in the department of Biochemistry, BIRDEM General Hospital, Dhaka, Bangladesh from July 2014 to June 2015. Total 135 subjects were selected to evaluate the glycemic status among Bangladeshi pregnant women attending BIRDEM General Hospital. Among them 41 were GDM subjects and 94 were non GDM subjects. The mean fasting plasma glucose values (mmol/L) and 2 hours after 75gm glucose values of GDM were 6.06±1.26 and 9.78±2.74 respectively compared to non GDM patients were 4.82±0.38 and 7.26±0.41 respectively and the mean of HbA1C (%) of GDM and non GDM were 5.87±0.73 and 5.43±0.31 respectively.

Study of Thyroid Disorders among Type 2 Diabetic Patients Attending a Tertiary Care Hospital.

Type 2 diabetes mellitus (T2DM) and thyroid disorders (TD) are the two most common endocrine disorders in clinical practice. Unrecognized thyroid disorders may adversely affect the metabolic control and add more risk to an already predisposing type 2 diabetes mellitus. The objective of the study is to find out the percentage of hypothyroidism and hyperthyroidism in patients with type 2 diabetes mellitus and non diabetic subjects. This cross-sectional study was conducted in the department of Biochemistry and outpatient Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh from July 2014 to June 2015. Total 200 patients were selected by inclusion and exclusion criteria. Among them, 115 were T2DM subjects and 85 were non diabetic subjects. Type 2 diabetes mellitus and normoglycemia were diagnosed according to WHO criteria from previous medical records. All patients were underwent thyroid function tests; free thyroxine (FT4), free tri-iodothyronine (FT3) and S. TSH (thyroid stimulating hormone). Study sample were divided 4 groups: Group 1: Type 2 diabetic subjects with thyroid disorders; Group 2: Non diabetic subjects with thyroid disorders; Group 3: Type 2 diabetic subjects without thyroid disorders; Group 4: Non diabetic without thyroid disorders. Thyroid disorders were categorized into subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism and overt hyperthyroidism. Percentage of thyroid disorders in type 2 diabetes mellitus and non diabetic patients were estimated. Comparison of all demographic characteristics was done among the groups. The percentage of thyroid disorders in type 2 diabetic patients was 23.5%. The most frequent thyroid disorders in type 2 diabetic patients were subclinical hypothyroidism (10.4%) and overt hypothyroidism (6.1%). The percentage of thyroid disorders in non diabetic subjects was 12%. Here, subclinical hypothyroidism is 5.9% and overt hypothyroidism is 3.5% were significantly higher in female, overweight and obese subjects. Patients with thyroid disorders (both type 2 diabetic and non-diabetic) had strong association with family history of thyroid disorders. This study showed that the percentage of thyroid disorders in type 2 diabetes mellitus is very high. Specially hypothyroidism (both subclinical and overt) are most frequent. So it is very necessary to provide regular screening for thyroid disorders in type 2 diabetic patients as well as initiating early treatment. Early treatment thyroid disorders in type 2 diabetic patients will help us to avoid complications and reduce morbidity and mortality of diabetes mellitus and thyroid disorders.

Evaluation of Bcr-Abl Gene Rearrangement among Bangladeshi Chronic Myeloid Leukaemia Patients.

Chronic Myeloid Leukaemia (CML) is a clonal myeloproloferative disorder. Presence of molecular translocation t (9; 22) in CML patients can be confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Among haematological malignancies CML is the commonest leukaemia of adults in Asia. Despite this, there are very few studies published from Bangladesh, documenting the frequency of bcr-abl fusion transcripts. So, we would like to perform this observational study to evaluate bcr-abl fusion transcripts and demographic status among RT-PCR positive chronic phase CML patients at BIRDEM & other two centers of Dhaka city, Bangladesh where patients admitted from different districts of Bangladesh in the period of January 2010 to June 2012. Twenty patients from three centers willing to perform RT-PCR test and showed positive PCR result, were enrolled under written consent before starting treatment with targeted molecular therapy. The age range of the sample was 18 to 52 years, with mean age of 34.80 and male - female ratio of 4:1. This study showed among chronic phase CML patients bcr-abl transcript rearrangement frequency was b3a2 (e14a 2) 45% while b2a2 (e13a2) was 55% by RT-PCR testing method. Cytogenetic and molecular analysis has become mandatory in order to make a correct diagnosis and monitoring response to newer molecular targeted treatment modalities. So our health sector should be enriched with laboratories with modern technology to diagnose haemato-oncological diseases as per WHO guideline.

Comparison of Low Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh Region of Bangladesh.

Altered metabolic and hormonal status of the body in pregnancy leads to changes in lipid profile. High Lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the Department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh during the period from July 2011 to December 2012 to compare the changes in low density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hrs. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has being found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum Low Density Lipoprotein (LDL) cholesterol increases in third trimester (174.83±13.78 mg/dl) than second trimester (156.77±7.96 mg/dl) of pregnancy. Therefore, lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Challenges in HbA1C Level as a Diagnostic Tool of Diabetes and Pre-Diabetes in Middle-Aged Population: The Bangladesh Study.

Worldwide prevalence of diabetes is found to be the human health at an alarming rate. However, large numbers of patient remain undiagnosed. Oral glucose tolerance test (OGTT) still is regarded as gold standard in diagnosis of blood glucose abnormality. Although the less number of bodies are considering measurement of HbA1C as an alternate tool to identify risk group. This study was undertaken to evaluate the role of measurement of HbA1C in the diagnosis of diabetes and pre-diabetes in middle-aged Bangladeshi subjects and carried out in the department of Biochemistry, BIRDEM from July 2013 to June 2014. A total 177 subjects of age within the range of 30-45 years were selected for the purpose and classified into healthy control (n=62) pre-diabetes (n=69) and diabetes (n=46) groups based on the values of OGTT. Middle aged Bangladeshi subjects attending Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, the HbA1C values were 5.0-5.6% in control group, 5.6-6.2% in pre-diabetes and 8.1-9.7% in diabetes group (95% CI). The optimal cut-off value of HbA1C related to pre-diabetes diagnosed by OGTT was 5.6%, which showed the sensitivity 47.8%, specificity 74.2%, positive predictive value 67.3% and negative predictive value 58.5%. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1C measurements. So measurement of HbA1C may not be used as an alternate tool of OGTT to identify people of diabetes and pre-diabetes in certain situation.

Challenges in HbA1c Analysis and Reporting in Patients with Variant Hemoglobins.

Hemoglobin A1c (HbA(1)c) is a well-established indicator of mean glycemia. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA(1)c measurements. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The objective of our study is to compare the HbA(1)c values measured on high performance liquid chromatography (HPLC) and Turbidimetric Inhibition Immunoassay (TINIA) in diabetic patients with variant hemoglobins including HbE. A total of 7595 diabetic patients receiving treatment at BIRDEM General Hospital were analyzed for HbA(1)c results within a period of two months from December 2013 to January 2014. Seventy two cases out of 7595 (0.95%) had either undetectable or below normal HbA(1)c levels (males-33 and females-39; ratio = 0.82:1) by HPLC method. In 34(0.45%) cases, HbA(1)c value was undetectable by HPLC method but was in the reportable range by TINIA method. In the other 38 (0.55%) cases, HbA(1)c levels were below the reportable range (<4%) by HPLC method but were in the normal or higher range by TINIA method. TINIA method did not agree with HPLC method on Bland Altman plot in the 38 cases with below normal HbA(1)c levels, [Mean bias -5.2(-9.3 to 1.0), 95% CI] but agreed very well [mean bias -0.21 (-0.84 to 0.42), y=1.1037+0.776X; r(2)=0.30, p<0.01] in controls. In control group mean MCV was 83.80±7.48 and in study group was 73.65±10.44. Alkaline electrophoresis confirmed the variant hemoglobin to be HbE. The fasting blood sugar levels of all the 72 cases correlated strongly with TINIA method (r(2) =0.75, p<0.0001) but not with HPLC (r = 0.24, p=0.13). In our regions where populations have a high prevalence of Hb variant, proper knowledge of hemoglobin variants which affect the measurements HbA(1)c level is essential. MCV of 80fl or below may serve as a rough guide to select samples that require analysis by TINIA method. Moreover, HPLC may be a convenient and inexpensive tool for screening of hemoglobinopathies especially among diabetic population in Bangladesh. It may therefore be helpful in improving management of complications related to both anaemia and iron overload.

Lipid profile in women receiving depot medroxyprogesteron acetate as contraceptive.

The study was conducted to estimate the serum lipid levels in women using depot medroxyprogesterone acetate (DMPA). A total of 90 Bangladeshi married women of age group 15-40 years attending the Model Family Planning Clinic, Mymensingh Medical College Hospital, Mymensingh, from July 2010 to June 2011. Patients were classified into three groups comprising those using the drug for 3 months (n=30), 1 year (n=30), and 2 years (n=30), respectively, compared to a control group (n=30) of married non-hormonally treated women of similar ages. Their age, weight, height, BP and BMI were recorded; all the subjects were clinically examined. Blood samples were collected for biochemical assay of serum lipid profiling parameters, such as total cholesterol, HDL-C, TAG and LDL-C. Data were collected and processed according to the design and objectives of the study. A significant (p<0.01) decrease in serum total cholesterol was observed up to 1 year of using DMPA, but a sharp increase was observed in 2 years group. Likewise total cholesterol, HDL-C was significantly (p<0.01) decreased in the 1 year group and rapidly increased in the 2 years group. A significant (p<0.01) reduction in TAG level was observed throughout the study tenure when compared with control group. No significant (p>0.05) difference in LDL-C level was observed among the treatment groups. The study concludes that DMPA induced significant alterations in lipid profiling parameters of the studied population and prolong use does not have risk of atherosclerosis; however, further study with a larger sample size is suggested for a general recommendation.

Prospective MRI assessment for invasive lobular breast cancer. Correlation with tumour size at histopathology and influence on surgical management.

AIM: To evaluate the performance of breast magnetic resonance imaging (MRI) in determining the size of invasive lobular carcinoma (ILC) compared to histopathology, and its influence on breast surgical management. MATERIALS AND METHODS: Prospective evaluation was undertaken of standardized contrast-enhanced MRI images of 51 consecutive women over an 18 month period with pure ILC or with lobular features as the dominant subtype on breast core biopsy. Image interpretation was performed by one consultant radiologist (M.H.). The lesion size at MRI was compared with the size at final histopathology after surgical excision using a Bland-Altman agreement plot. RESULTS: Of the 51 prospectively imaged consecutive women, seven were excluded as they had diffuse ILC. The remaining 44 patients had a mean histological tumour size of 34.9 mm (range 4-77 mm). MRI underestimated tumour size in 26 (59.1%) cases. In 21 (47.7%) patients, this discrepancy was small, ranging up to 16 mm. The largest underestimation occurred in five (11.4%) cases with a difference ranging between 31 and 48 mm. Fifteen (34.1%) tumours were overestimated by MRI where the discrepancy ranged up to 22 mm. In three (6.8%) patients MRI and histological size matched. The Bland-Altman agreement plot demonstrated that in 95% of cases the size at histopathology will be between 0.36 and 2.31 times the MRI size at extremes. MRI correlated better with histopathology in tumours up to T2 (<5 cm) size leading to a change in surgical management for nine of the 44 (20.5%) patients. CONCLUSION: MRI enables surgical management decisions to be made with increased confidence in patients with ILC up to T2 size.

Serum calcium level among normal pregnant and pre-eclamptic women in a sub urban area of Bangladesh.

Pre-eclampsia along with its complications seems to be one of the major causes of maternal morbidity and mortality. Despite numerous studies, the etiology of pre-eclampsia has not yet been fully elucidated. The present study prospectively determines and evaluate whether maternal serum levels of calcium has any association with pre-eclampsia. It was a cross sectional study carried out in the department of Biochemistry, Mymensingh Medical College from July 2009 to June 2010. A total of 76 subjects were selected with the duration of pregnancy from 28th wks to term. Among them 42 were normal pregnant women and 32 were pre-eclamptic, admitted in the department of obstetrics and gynaecology Mymensingh Medical College Hospital. The mean±SD serum calcium of normal pregnant women and that of the pre-eclamptic were 7.62±0.24 and 7.32±0.28mg/dl respectively. There was significant (p<0.001) decrease in serum calcium in subject with pre-eclampsia in comparison to that of the normal pregnancy. So, level of calcium may be significantly decreased in pre-eclampsia.

Serum calcium level among smear positive pulmonary tuberculosis patients in Bangladesh.

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum calcium level in smear positive Bangladeshi pulmonary tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control; n=60) apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) people with smear positive pulmonary tuberculosis. Serum calcium was estimated by colorimetric principle. Serum calcium was adjusted by serum albumin concentration. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of adjusted serum calcium in Group II (2.41±0.15mmol/L) was significantly higher (p<0.001) than that in Group I (1.85±0.11mmol/L). It is evident from the study that serum calcium level significantly increases in smear positive Bangladeshi pulmonary tuberculosis patients.

Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy.

In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/-FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer. Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47-64%) and 90% (84-93%) for US alone, and 76% (61-87%) and 100% (65-100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%. All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/-FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%. In this study, a positive pre-operative US+/-FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure.

Intra-operative assessment of excision margins using breast imprint and scrape cytology.

Local recurrence in breast cancer surgery is related to the completeness of excision. Histological analysis of excision margins is time consuming and impractical for use intra-operatively. Our group evaluated breast imprint and scrape cytology (ISC) for the assessment of excision margins in a feasibility study in 1993-4, with 10 year clinical follow-up. Twenty-six consecutive women undergoing 27 wide local excisions for breast cancer had excision margins prospectively assessed with intra-operative ISC blinded to histology. All ISC results were ready (range 22-30 min) before surgery was completed. ISC agreed with histology in 21/27 (=78%) and disagreed in 6/27 (=22%) of the cases. In two cases with local recurrence, histology was positive in one case, whereas ISC margins were positive in both. Intra-operative ISC is reliable and could help the surgeon to excise more tissue to prevent a second (re-excision) operation. ISC margins may predict clinical outcome, although a larger interventional follow-up study is required.

Intra-operative specimen analysis using faxitron microradiography for excision of mammographically suspicious, non-palpable breast lesions.

Recent advances in digital imaging have made Faxitron microradiography an attractive alternative to intra-operative conventional specimen radiography (CSR) for the excision of wire-localized breast lesions. Faxitron specimen analysis time, usefulness of digital image manipulation and re-excision rates were evaluated in comparison to CSR in 299 consecutive wire-localized excisions for mammographically suspicious non-palpable breast lesions (172 procedures with Faxitron, 127 with CSR) in a non-randomized study. The corresponding mean operation times were 34.7 vs. 42.7 min and the respective re-excision rates were 19.8% vs. 31.5% (no significant difference on chi analysis P < 0.1). Faxitron digital image manipulation led to cavity biopsies in 50% (60/121) of the cancer excisions. In 19 of these (16%), histological excision margins were converted from incomplete to complete. The shorter Faxitron mean operating time enables an additional wire-localized operation per theatre list. Digital imaging guides the surgeon for additional cavity biopsies, resulting in re-excision rates as good as CSR.

The treatment of fasciolopsiasis with niclosamide and dichlorophen.

Niclosamide and Dichlorophen have been tried in infection with F. buski in an endemic area of Bangladesh. Niclosamide is the commonly used agent for this condition, but was found to reduce the ova count by about 48.5% only and repeat treatment did not improve the result. Dichlorophen is advocated for tape worm, but was found to reduce the ova count by 83.3% and repeat treatment completely eradicated infection with F. buski.