Efficacy and Safety of Repeated Use of Ulipristal Acetate in Uterine Fibroids.

Uterine fibroids are benign tumor of the uterus that often appear during child bearing ages. Medical treatments are considered the first-line treatment to preserve fertility, avoid or delaying surgery. This randomized control study was carried out in OPD of Obstetrics and Gynecology Department of BSMMU, Dhaka, Bangladesh from May 2018 to March 2019 to evaluate the efficacy and safety of ulipristal acetate (5mg) once daily in reproductive women with three months treatment courses. Total 52 samples with symptomatic uterine fibroids for treatment course-1, among them 36 were needed for treatment course-2 which was slow or non-responding in treatment course-1. Main outcome measures were amenorrhea, controlled bleeding, fibroid volume, anaemia, quality of life. Sixty one percent (61.0%) of patients were achieved amenorrheic during both treatment courses. Ninety percent (90.0%) patients were control of bleeding during both treatment courses. In treatment course-1, reductions from baseline in fibroid volume were 62.70%, whereas in course-2, reductions in fibroid volume were 75.33%. Five percent (5.0%) of patients were discontinuing Ulipristal acetate due to adverse effects. Renal and liver function tests were performed before and after each course of treatment. The level of creatinine, SGPT in the blood for both treatment courses had no statistically significant effects. Ulipristal acetate may be an alternative to surgical treatment, the safety profiles and prolong effects with improvement of symptoms, quality of life after cessation of drugs. Repeated use of drugs reduces the size and also improves the patient's condition.

Tuberculosis in Systemic Lupus Erythematosus Patients.

The tubercular infections (TB) are most important cause of morbidity and mortality in SLE patients worldwide and an ongoing alarming issue in developing countries. This observational study was carried out in SLE clinic of BSMMU, Bangladesh from April 2015 to March 2016 after taking ethical clearance from IRB to observe frequency and risk factors of tuberculosis in SLE patients. A total 230 consecutive SLE patients were enrolled. Patient's clinical characteristics, history of TB, SLEDAI score, cumulative doses of immunosuppressants were recorded. In clinically suspected cases tuberculin test, chest X-ray, spot and first morning sputum for AFB, Gene Xpert MTB/RIF, ADA, FNAC and tissue biopsy were requested along with routine tests. The multivariate logistic regressions were done for risk factors. Out of 230 patients TB was documented in 23 (10%) subjects. Among TB cases 16 women and 7 men. Mean age of patients was 27.56±9.3 years and mean duration of occurrence of tuberculosis after SLE diagnosis was 4.26±5.38 years. Present and past TB was observed in 10 and 13 cases respectively. Cough, night sweat, fever, anorexia were significant presenting features. Fifteen and 8 patients had pulmonary and extra pulmonary TB respectively. Organ involvement pattern was multi-lobed lungs, joint, meninges, lymph nodes, peritoneum and pleura. High disease activity disease (SLEDAI score >12), total intake of prednisolone >1000mg were risk factors of TB. Frequency of tuberculosis was high (10%) in SLE patients. Awareness including prevention of flares and judicious use of steroids might reduce the rate of TB.

Estimation of Serum Creatinine and Uric Acid in Bangladeshi Gestational Diabetic Mother Attending in Tertiary Care Hospital.

The hyperuricaemia in Gestational diabetes mellitus has been explained to be a component of the metabolic syndrome which reflects insulin resistance and it has been shown to have a positive correlation with the creatinine levels. Gestational hyperuricaemia was found to be significantly associated with a high rate of maternal and foetal complications along with proteinuria and hypertension. Aimed of this study was to evaluate the serum creatinine and uric acid levels in Bangladeshi women with GDM in their second and third trimester of pregnancy. This descriptive cross sectional study was conducted at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to June 2014. Pregnant women, in their second and third trimester, attending the outpatient department of Obstetrics and Gynecology and the Department of Endocrinology, MMCH, Mymensingh, Bangladesh were enrolled by purposive sampling technique. GDM was diagnosed on the basis of oral glucose tolerance test (OGTT) as outlined in UN agency WHO criteria 2013. Out of 172 participants, 86 had GDM (Case) and 86 were normoglycemic (control). The mean age of GDM and control groups was 28.6±3.2 and 27.3±3.1 years respectively. The BMI was 26.4±1.5 kg/m² and 26.3±1.3 kg/m². In this study we found serum creatinine levels in GDM cases were significantly (p<0.001) increased in both trimesters (1.09±0.16mg/dl and 1.07±0.11mg/dl) compared to those without GDM (0.69±0.16mg/dl and 0.64±0.15mg/dl). Serum uric acid levels in GDM and without GDM in 2nd trimester were (4.47±0.42mg/dl and 4.43±0.63mg/dl respectively) had (p>0.05) no significant difference. Serum uric acid levels in GDM cases were significantly (p<0.001) higher in third trimesters (4.48±0.41mg/dl) compared to those without GDM (3.52±0.74mg/dl). There was distinct alteration of serum creatinine and uric acid levels in GDM compared to normal pregnancy.

Estimation of Serum Zinc, Copper and Magnesium Levels in Bangladeshi women with Gestational Diabetes Mellitus Attending in a Tertiary Care Hospital.

Zinc (Zn), Copper (Cu) and Magnesium (Mg) are essential trace elements for normal embryogenesis and fetal growth. Alteration of Zn, Cu and Mg concentrations in blood has been observed in normal pregnancy as well as in gestational diabetes mellitus (GDM). Aim of this study was to evaluate the serum Zn, Cu and Mg levels in Bangladeshi women with GDM in their second and third trimester of pregnancy. This descriptive cross sectional study was conducted at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2013 to June 2014. Pregnant women, in their second and third trimester, attending the outpatient department of Obstetrics and Gynecology and the Department of Endocrinology of MMCH were enrolled by purposive sampling technique. GDM was diagnosed on the basis of oral glucose tolerance test (OGTT) as defined in WHO criteria 2013. Out of 172 participants, 86 had GDM (Case) and 86 were normoglycemic (control). The mean age of GDM and control groups was 28.6±3.2 years and 27.3±3.1 years respectively. The BMI was 26.4±1.5kg/m² and 26.3±1.3kg/m². In this study we found serum Zn levels in GDM cases were significantly (p<0.001) low in both trimesters (43.93±5.48µg/dl and 46.86±3.12µg/dl) compared to those without GDM (67.30±7.81µg/dl and 67.58±9.12µg/dl). On the contrary, serum Cu levels in GDM cases were significantly (p<0.001) higher in both trimesters (224±3.8µg/dl and 243.91±6.9µg/dl) compared to those without GDM (220.1±7.6µg/dl and 234.9±4.6µg/dl). There was significant (p<0.001) increase of serum Cu levels in 3rd trimester compared to 2nd trimester in both GDM and non GDM cases. Serum Mg level was significantly low (p<0.001) in 2nd and 3rd trimesters in GDM cases (1.39±0.26mg/dl and 0.93±0.15mg/dl) compared to control group (1.67±0.30mg/dl and 1.67±0.31mg/dl). There was distinct alteration of serum Zn, Cu and Mg levels in GDM compared to normal pregnancy.

Serum albumin and creatinine clearance rate among smear positive pulmonary tuberculosis patients in Bangladesh.

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College 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 albumin & creatinine clearance levels in smear positive Bangladeshi pulmonary tuberculosis patients as a means to monitor the possibility of management of these patients as these levels decrease significantly. Serum albumin level was investigated in TB patients for monitoring the nutritional status of TB patients and also for the adjustment of serum calcium level. Creatinine clearance rate was investigated in TB patients for monitoring the impairment of renal function and nutritional depletion in 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 albumin was estimated by colorimetric principle. Serum creatinine was also estimated by colorimetric principle & creatinine clearance rate was estimated from serum creatinine by Cockcroft- Gault equation. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of serum albumin in Group II (3.74±0.44gm/dl) was significantly lower (p<0.001) than that in Group I (4.85±0.31gm/dl). Mean±SD of creatinine clearance rate in Group II (35.36±8.29ml/min) was also significantly lower than that in Group I (84.16±20.20ml/min). It is evident from the study that serum albumin & creatinine clearance rate levels significantly decrease in smear positive Bangladeshi pulmonary tuberculosis patients.

Sensitivity, specificity and predictive values of immunochromatographic strip test in diagnosis of childhood kala-azar.

In Bangladesh, the total population at risk for kala-azar exceeds 20 million (18%) living in 88 Thana (19%) of 27 districts (42%). A confirmatory diagnosis of visceral leishmaniasis (kala-azar) is done by demonstration of the parasite (LD body) in organ aspirates or tissue biopsy sample, an invasive procedure with relatively low sensitivity. To assess the diagnostic usefulness of ICT for antibody against the leishmanial antigen rK39 & its feasibility for use under field conditions (rural areas). An experimental study conducted during January, 2003 to July, 2003 in pediatrics department of MMCH including 60 confirmedly diagnosed KA cases & 60 controls having diseases other than KA. One drop of peripheral blood is applied to the nitrocellulose strip & 3 drops of test buffer is added to the dried blood. Observing 2 visible bands indicates presence of IgG anti-K39. The rK39 strip test was positive in 57 out of 60 confirmed KA case diagnosed by LD body demonstration in splenic or bone marrow aspirate. The estimated sensitivity was 95%. One control diagnosed as other than KA had positive strip test but negative aspirate smear. The estimated specificity of the strip test was 98.3%. The predictive value of a positive result is 98.3% & that of a negative result is 93.5%. rK39 strip test is highly sensitive & specific in our situation & it can be used as a simple & the best method for diagnosis of KA in rural areas.