Comparative Study between Paracervical Block and Non-Steroidal Anti Inflammatory Drug for Relief of Pain during Manual Vacuum Aspiration Procedure.

The incidence of first trimester pregnancy loss is around 10.0-20.0% of registered pregnancies. Manual vacuum aspiration is a safe, effective and acceptable option of treatment for patients diagnosed with first trimester pregnancy loss. Main disadvantage of MVA is the pain caused by manipulation of the cervix, the uterine suction and the cervical dilatation. This study showed the way how the pain and discomfort might be reduced. This was a cross-sectional comparative study was conducted at the obstetrics and Gynecological Department of Sadar hospital, Manikganj, Bangladesh from January 2017 to December 2017. All the consecutive women admitted and diagnosed as incomplete abortion, missed abortion and anembryonic pregnancy (blighted ovum) were included in this study. Sampling technique was purposive sampling. The objective of this study was to compare the effectiveness of paracervical block anesthesia with non-steroidal anti inflammatory drug (NSAID) for relief of pain during the manual vacuum aspiration procedure for the treatment of first trimester pregnancy loss. Total 120 cases were included in this study. Assigned study population were divided into two groups like Group A and Group B. 60 of the study population were included in Group A who were given paracervical block anesthesia 3 minutes before the procedure. Another 60 study population was included in Group B who was given diclofenac 75mg intramuscular injection, 30 minutes before the procedure. Both intraoperative and postoperative pain level was evaluated by using visual analog scale ranged from (0-10 points) 30 minutes after the procedure. At the same time the satisfaction level of the study population were measured by 5 points lickert scale. Regarding clinical profile of the study population it showed no significant difference in case of mean age, mean gestational age and mean duration of the procedure between two groups. The mean intraoperative pain score in Group A was 4.0±1.3, in Group B it was 5.4±1.5 (p=0.001) which was significant. So it showed that paracervical block anesthesia significantly reduced the pain in relation to diclofenac 75mg intramuscular injection. Mean postoperative pain level 30 minutes after procedure in Group A was 2.2±0.4 and in Group B was 2.4±0.4 (p=0.343), where post-operative pain is lower in Group A than Group B. Though this difference is not statistically significant (p=0.343). In Group A 73.0% (n=44) and in Group B 43.0% (n=26) study population were agreed that the procedure was easy. Most common adverse effect was epigastric pain which was 1.7% (n=1) in Group A and 10.0% (n=7) in Group B. Paracervical block significantly reduces intraoperative pain during Manual Vacuum Aspiration (MVA) procedure in the treatment of first trimester pregnancy loss in comparison to intramuscular injection of diclofenac. In conclusion it might be mentioned that regarding paracervical block anesthesia, efficacy is higher and side effects are less. Moreover paracervical block anesthesia is cost effective.

Effect of Meconium Staining Amniotic Fluid on Fetal Outcome.

Meconium-stained amniotic fluid is the passage of meconium by a fetus in utero during the antenatal period or in labour. It has for long been considered to be a bad predictor of fetal distress and meconium aspiration syndrome (MAS). The objective of this study was to find out the fetal outcome of MSAF and clear amniotic fluid. This cross- sectional comparative study was carried out in Upazilla Health Complex, Palash, Narshingdi from July 2016 to June 2017. A total of 100 pregnant women among them 50 women with MSAF and 50 women with clear liquor were studied to see the record of ANC, mode of delivery and fetal outcome by APGAR score. Study showed that among MSAF group 76.0% (n=38) had irregular ANC and 24.0% (n=12) had regular ANC whereas in clear liquor 86.0% (n=43) had regular ANC 14.0% had irregular ANC. Among MSAF (50 cases) thick meconium was in 20 cases (40.0%) and thin meconium was in 30 cases (60.0%). Regarding mode of delivery 52.0% (n=26) MSAF cases had instrumental delivery and Caesarean section compared to 24.0% (n=12) in clear liquor group. Regarding thick MSAF among 40.0% (n=20), (n=14) had low APGAR score and (n=6) had normal score at one minute and (n=9) low APGAR score and (n=11) normal score at five minutes. In clear liquor, among 100.0% (n=50), 20.0% (n=10) had low APGAR score and 80.0% (n=40) had normal score at one-minute and at five minutes 8.0% (n=4) had low APGAR score and 92.0% (n=46) had normal score. Among MSAF 26.0% (n=13) were admitted to SCBU compare to 12.0% (n=6) in clear liquor group. The mean SCBU stay was 3.1 days in MSAF whereas 1.2 days in clear liquor. Among MSAF babies 4.0% (n=2) had MAS compared to no MAS in clear liquor group. Regarding Survivalist 92.0% (n=46) were alive in MSAF whereas 100.0% all (n=50) were alive in clear liquor group.

Clinico-pathological Study of Malignant Ovarian Tumor in a Tertiary Care Hospital.

Ovarian cancer is considered as one of the foremost gynecological malignancies due to its complex nature, unpredictable behavior and prognosis. Therefore, varying therapeutic strategies are necessitating an accurate diagnosis of this cancer. This study aimed to observe the frequency, age distribution, clinical presentation, gross features and histopathological pattern of the ovarian tumors among the Bangladeshi population. This cross-sectional observational study included 125 participants who were admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU) with histologically proven ovarian cancer from January 2016 to December 2017. The epidemiological data and histopathological analysis of the ovarian cancer were performed. Among the 125 participants examined, the majority were in two age groups between 21-30 and 41-50 years. Histologically, serous adenocarcinoma (50.4%) was the commonest, least common being endometroid variety (0.8%). Furthermore, 40.1% of participants were presented with stage iii disease. Abdominal distention followed by abdominal pain was the main presenting complains. Adenocarcinoma is mostly serous in variety and higher in younger age group.

Clinico-pathological Evaluation of Residual Ovary Syndrome: A Cross Sectional Study.

The residual ovary syndrome (ROS) occurs in patients where one or both ovaries are conserved at the time of hysterectomy. It occurs mostly within 10 years of hysterectomy. Residual ovary syndrome usually requires surgery and histology varies from some physiological cysts to benign or even malignant neoplasms. The objectives of the study were to analyze the etiopathology of re-operation for ROS and to find out their clinical presentations. This cross-sectional observational study was conducted in the department of Obstetrics and Gynaecology, BSMMU during a period of 5 years from January 2014 to December 2018. All consecutive patients admitted with residual ovary syndrome (ROS) at the department of Obstetrics and Gynaecology and also in Gynae-oncology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Total 40 cases were enrolled according to selection criteria and sampling technique was purposive. The mean age of the study populations was 42.20±7.13 years. All of the study populations were parous except one who was nulliparous. The mean age of hysterectomy was 37.25±6.44 years. The indication of primary surgery by hysterectomy was fibroid in 50% of cases; others were abnormal uterine bleeding, pelvic inflammatory disease etc. After primary surgery majority (77.5%) of the study populations presented with chronic pain with or without dyspareunia and 20% presented with lump in abdomen either symptomatic or asymptomatic. Around half (57.5%) of the patients were presented within 5 years and 82.5% within 10 years of hysterectomy. Per-operative findings of secondary surgery for ROS were mainly extensive peri-ovarian and peritoneal adhesions involving surrounding structures. Among them majority (77.5%) of the cases were presented with various types of cystic and complex masses in the ovaries. Histopathological reports of residual ovary were functional cysts 35.0% (n=14), Corpus luteal cyst 12.5% (n=5), endometriotic cyst 12.5% (n=5), benign ovarian tumours 37.5% (n=15) and malignant ovarian tumour 2.5% (n=1). ROS, usually requires surgery which in most of the cases becomes troublesome due to presence of extensive adhesions with surrounding structures. So, decision is crucial whether to remove or conserve apparently healthy ovaries found at hysterectomy in pre-menopausal women. Moreover decision of hysterectomy in premenopausal women should be taken very judiciously as several medicines are available for conservative management. Usually indications of hysterectomy are benign.

Relaparotomy Following Caesarean Section: A Cross Sectional Study.

Delivery by caesarean section (CS) is the most common obstetric procedure in daily practice and rate is increasing worldwide. In spite of huge appeal for this operation, there is significant rate of short & long term complications. Relaparotomy after caesarean section in early post-operative period is one of the rarest short term complications but the fatality rate is very high. The objective of this study was to find out indications, managements, risk factors and outcomes of patients undergoing relaparotomy after CS. Finally to improve the quality of care for preventing this dreadful complication and to reduce the maternal mortality and morbidity. Purposive sampling was done, all consecutive patients who underwent relaparotomy within 6 weeks of CS in Rajshahi Medical College Hospital (RMCH) during study period from January 2015 to December 2015 has been included for this study. This was a cross-sectional and observational study in a tertiary referral and teaching hospital RMCH. During study period total admitted obstetric patients at RMCH were 12688. There were 9802 deliveries where 53.89% (n=5282) had vaginal delivery and 46.11% (n=4520) underwent caesarean sections. Among these 46.11% (n=4520) CS, relaparotomy was needed 0.18% (n=8) cases. Total relaparotomy was done in 0.39% (n=50) cases out of 12688 obstetric patients. Out of 50 cases 42 had caesarean delivery in other hospitals and clinics outside RMCH. The indications of relaparotomy were secondary post-partum hemorrhage (PPH) 28% (n=14), primary PPH 12% (n=6), haemoperitoneum 22% (n=11), pyoperitoneum 18% (n=9), subrectal hematoma 16% (n=8) and burst abdomen 4% (n=2). Main surgeries performed were subtotal hysterectomy in 44% (n=22) cases, total abdominal hysterectomy in 10% (n=5) cases, re-suturing of uterine incision 8% (n=4), drainage of pus & peritoneal toileting 8% (n=4), ligation of bleeding vessels 6% (n=3), drainage of subrectalhaematoma in 16% (n=8) cases, repair of intestinal injury 4% (n=2) and repair of anterior abdominal wall in 4% (n=2) cases. Case fatality of relaparotomy was high 18% (n=9), majority were preventable. Identification of risk factors, adequate attention, expert decision, prompt intervention & proper management will improve the outcome.

Preoperative Analysis of CA-I25 and its Relation with Histopathological Study in Ovarian Tumours.

Ovarian cancer (OC) is the seventh most common cancer among women in the world. Epithelial OC is the most predominant pathological subtype, with five major histotype. All five subtypes that differ in origination, pathogenesis, molecular alterations, risk factors and prognosis. The clinical presentations of ovarian tumors are variable and not specific. Most of the malignant ovarian tumor seeks medical advice at advanced stage of the disease. At that stage no effective treatment could be possible. There are several researches are going on developing a screening test for ovarian cancer. But there hasn't been much success yet. Clinical examination such as complete pelvic examination together with two investigations is used most often to screen the ovarian cancer. These investigations are transvaginal ultrasound (TVUS) and the blood test CA-125. The measurement of CA-125 level usually in combination with other modalities like bimanual pelvic examination, transvaginal ultrasonography is the proposed modality of early detection of ovarian cancer. The most promising application of this tumor marker is the screening. Therefore this cross sectional and observational study was conducted to observe the relationship of histopathological diagnosis and clinical features with serum CA-125 levels. Study conducted from January 2017 to December 2017 at Sir Salimullah Medical College& Mitford Hospital, Dhaka, Bangladesh. All admitted Gynecological patients having ovarian tumors during study period were included purposively for this study. Sample size was 50. Clinical features and preoperative findings of CA-125 level of these 50 patients were collected. Finally histopathological reports were accumulated after operative treatment. Gastrointestinal & constitutional complain, gynecologic mass and pain in abdomen were the selected symptoms. CA-125 levels were evaluated in relation with histopathological findings. The different findings were correlated with those of studies done at home and abroad. Mean age of the study population was (Mean±SD) 34.25±14.65. Histological findings among the study population showed that benign tumors were 72% (n=36) and malignant tumors were 28% (n=14). In case of benign ovarian tumors among 36 women, 94.4% (n=34) of them showed CA 125 level <35U/ml, other 5.6% (n=2) showed more than normal (>35U/ml) but range was 35-65U/ml. While 14 of the study population having histopathologically proven malignant ovarian tumor, showed the tumor marker level >35U/ml among 71.4% (n=10) and 28.6% (n=4) showed tumor marker <35U/ml. This finding was statistically significant (p=0.001). Histopathological findings revealed that there were significant increases in CA-125 levels in women with malignant serous histotype of serous cyst adenocarcinoma where range of CA-125 level were 2018.88 to 4249.63U/ml. Constitutional symptoms such as weight loss, loss of appetite, symptoms of mass effect such as urinary retention and rapidly progressing tumor were the symptoms of malignant ovarian tumors. Preoperative elevated level of CA-125 is the differentiating points of malignant serous histotype from benign ovarian tumors. This study will put forward some clues about the clinical diagnosis of ovarian tumor which may be utilized for making investigation and management plan. Also it will help for making prompt decision during pre-operative and per-operative procedures.

Induction by Misoprostol In Case of Intra Uterine Fetal Death: A Cross Sectional Study.

The objective of this study was to find out the effectiveness and safety of vaginal misoprostol in delivering the dead fetus in cases of intrauterine fetal death (IUFD). This cross sectional study was undertaken among all consecutive patients admitted at the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh, from October 2012 to September 2013, were included for this study. Vaginal misoprostol was applied in 50 cases that were admitted and diagnosed as a case of IUFD. After taking informed written consent from patients 50µgm of tablet misoprostol was introduced per vaginally into the posterior fornix. Doses were repeated in every 4 hours up to effective contraction to a maximum 6 doses. Follow up was done in hourly interval. Those who did not respond, decision for other methods like oxytocin infusion or LUCS were done. Study showed 60% (n=30) patients belonged to age group of 18-24 years. Among study population 44% (n=22) of the patients belonged to 22-32 weeks of gestation, 30% (n=15) were 33-37 weeks and 26% (n=13) were 38-42 weeks. The causes of intrauterine death were unidentified among 60% (n=30) of cases. Regarding antenatal check up 54% (n=27) had no checkup, 26% (n=13) were irregular and 20% (n=10) were regular. 60% (n=30) of the patients had less Bishop Score <3. Ninety six percent (96%) (n=48) patients responded with vaginal misoprostol and only 4% (n=2) were non responder group. Most 84% (n=42) of the cases needed 2-3 doses, only 8% (n=4) cases needed single dose and 8% (n=4) cases needed 4 to 6 doses. The induction delivery interval varied from 6 to 23 hours and maximum 52% (n=26) of the patients delivered within 12 hours. Adverse effects such as uterine hyper stimulation, tachysystole were not detected. The major complications observed like postpartum hemorrhage 4% (n=2), reduced platelet count 2% (n=1), and chorioamnionitis 4% (n=2). However minor complications like nausea, shivering and mild fever also observed in few cases. Study showed successful induction of labor by misoprostol in a shorter time with significantly less side effects.

Scar Endometriosis - A Rare Entity: Case Series.

Endometriosis is a condition where there are functional endometrial glands and stroma in sites other than uterine mucosa. It is a unique condition which is benign but has a tendency of invasion and extension locally. Scar endometriosis is a rare entity where there is presence and proliferation of endometrial gland and stroma in the scar of the previous surgery. It is estimated to be only 0.03 to 0.15% of all cases of endometriosis. Because of its deceptive nature and lack of specific diagnostic tools, scar endometriosis is often difficult to diagnose. It is also a challenge for the clinicians as this condition is difficult to treat because it is nonresponsive to hormonal treatment and excision is often the only effective treatment. Here we present two cases of scar endometriosis that we have encountered in BIRDEM general hospital, Dhaka, Bangladesh in last five years.

Antibacterial Activities of Clove (Syzygium aromaticum) Extracts Against Three Food Borne Pathogens: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.

Evaluation of the in vitro antibacterial activity of aqueous and ethanolic extracts isolated from Clove (Syzygium aromaticum) buds against three food borne pathogens, gram-positive Staphylococcus aureus and gram-negative Escherichia coli & Pseudomonas aeruginosa. This interventional study was carried out during the period of July 2018 to June 2019 in the Department of Pharmacology and Therapeutics with the collaboration of Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. The antibacterial activity was tested at different concentrations of both extracts of spice by using disc diffusion & broth dilution method. The extracts were prepared by using solvents aqueous & ethanol. The test microorganisms were also tested for their activity against a standard antibiotic Gentamicin (80mg) by broth dilution method and the result was compared with that of Aqueous and Ethanolic extracts. Aqueous and ethanolic extracts of clove had inhibitory activity against the test bacteria. Among different concentrations of the ACE, 500µg/ml & above concentration showed inhibitory effect against Staphylococcus aureus & Escherichia coli and 700µg/ml & above concentration showed inhibitory effect against Pseudomonas aeruginosa. In case of ECE, 500µg/ml & above concentration showed inhibitory effect against aforesaid bacteria. In disc diffusion method, S. aureus was found to be most susceptible to ACE (30.5mm) & Pseudomonas aeruginosa was found to be most susceptible to ECE (38mm). Minimum inhibitory concentrations (MIC) of ECE were lower than ACE for the test bacteria except Staphylococcus aureus where MICs of ACE & ECE were the same. This result was also compared against a standard antibiotic Gentamicin where the MICs of Gentamicin were lower in comparison to MICs of ACE & ECE. The present study showed that aqueous and ethanolic extracts of Clove demonstrated antibacterial effects against food borne pathogens.

Assessment of Quality of Life of Chronic Kidney Disease Patients Receiving Hemodialysis with Kidney Disease Quality of Life™-36 Scale.

Chronic kidney disease and the methods of its treatment play an important part in shaping the Quality of Life QOL of patients receiving dialysis. KDQOL™-36 is the most widely used instrument to evaluate health related quality of life of chronic kidney disease patients. The aim of the study was the subjective assessment of the quality of life (QOL) of patients treated with hemodialysis and also to understand the distribution of component scores of the scale with distribution of responses to individual items of the scale among the selected sample. This cross sectional study was conducted among randomly selected 151 patients of chronic kidney disease receiving hemodialysis with pre-dialysis proper education at Inpatient Department in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh during the period of June 2018 to December 2018. The instrument to measure the QOL was Kidney Disease and Quality of Life Bangla version 36 (KDQOL™-36). Recruited patients were interviewed with questionnaire technique to collect data with the scale which is a structured questionnaire comprised of four subscales. Mean scores ±SD of the domain of the physical and mental component summary, burden of kidney disease, symptoms and problems of kidney disease and effects of kidney disease subscales were 29.3±16.03, 16.93±13.0, 81.09±13.14 and 61.67±13.84 respectively. The mean ±SD of the combined score for all the four domains was 47.24±11.52. The rate of those with impaired QOL (mean score <66.7) was 96.7%. The most bothersome domain was burden of the kidney disease domain, where the mean scores of all the items were below 66.7. The study provides information that regular pre-dialysis attendance helps to provide the patient with proper education and thereby achieve better QOL among patients of chronic kidney disease receiving hemodialysis. By using the KDQOL™-36 scale this study finds that the domain of symptom of the kidney disease appeared to have least effect on the quality of life as the mean scores ranged higher from other subscales and in most cases the scores were above 66.7.

Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study.

In Bangladesh incidence rate of breast cancer was about 22.5 per 100000 females. Breast cancer has been reported as the highest prevalence rate (19.3 per 100,000) among Bangladeshi women between 15 and 44 years of age. For this prevailing situation a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Bangladesh towards breast cancer at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2013 to June 2014. All female participants attending at outpatient department of BSMMU having age more than 20 years and education at least JSC, purposively selected until the sample size achieved 500. Only applying simple cost free method like self breast examination (SBE) and clinical breast examination (CBE) one can asses her breast. Thereby awareness develops regarding her breast so any mass newly appear can be assessed by the lady herself. Early diagnosis of the breast cancer will reduce the burden of treatment cost, mortality & morbidity. Research and development strategy of the project is to enhance the awareness of the community people about breast cancer prevention. Mean age of the study population was 36.16 years. Regarding education nearly 30% (n=150) of them studied up to Junior School, 16% (n=80) respondents completed masters and above remaining in between. Regarding occupation, almost 60% (n=300) were house wife, 32% (n=160) were service holder and only 8% (n=40) of them were students. Knowledge about common female cancer 60% (n=300) were aware about the cervical cancer, 24% (n=120) mentioned breast cancer, 4% (n=20) mentioned ovarian cancer, and 12% (n=60) don't know anything regarding common women cancer. Knowledge about early symptoms of breast cancer, majority of the respondents 66% (n=330) were aware that mass in the breast is the main symptom, 2% (n=10) mentioned pain in breast, 32% (n=160) mentioned that they don't know anything regarding the early symptoms. About the cause of breast cancer 60% (n=300) mentioned that, they don't know anything regarding the cause of breast cancer, 36% (n=180) were aware that non lactation is a cause of breast cancer. About 4% (n=20) of the study population mentioned others, like due to some ones bad did cancer occur as punishment. Knowledge about risk factor of breast cancer, 65% (n=325) have no idea about the risk of breast cancer, 32% (n=160) mentioned few risk factors which have relation with breast cancer and 3% (n=15) did not mention anything. Regarding diagnosis of cancer breast 72% (n=360) mentioned they don't know anything, 16% (n=80) by doing ultra sonogram of breast, 6% (n=30) mentioned about Mammography and 6% (n=30) MRI & others. Regarding screening for prevention of breast cancer 60% (n=300) mentioned that they don't know anything regarding screening. Thirty percent (n=150) were aware that there is screening method but they are not aware specifically regarding this method and they also not aware that breast cancer is a preventable disease. 10% (n=50) were fully aware about screening method like CBE & SBE. About the cause of not seeking medical advice for prevention of Breast cancer, majority of the respondents 40% (n=200) mentioned expenditure problems, 32% (n=160) they don't have any knowledge about this type of medical advice, 8% (n=40) mentioned communication problems and 20% (n=100) others. Regarding Practice of CBE & SBE 68% (n=340) never practice CBE & SBE, 30% (n=150) occasionally practiced CBE & SBE. Only 2% (n=10) mentioned that they were regularly practicing CBE & SBE.

Ovarian Endometrioid Adenocarcinoma Arising in Endometriosis: A Case Report.

Malignant transformation of ovarian endometriosis was first described in 1925 by Sampson; later on it has been described in extragonadal regions by few authors also. Ovarian endometrioid and clear cell carcinoma are highly associated with endometriosis. Here we present a case of malignant transformation of ovarian endometrioma into endometrioid adenocarcinoma and review the clinical and pathological features of these tumors. A 45-years old infertile woman diagnosed as a case of bilateral chocolate cyst with pelvic endometriosis underwent total hysterectomy with bilateral salpingo-oophorectomy. A solid portion was also identified in the right sided cyst, histology of which revealed a well-differentiated endometrioid adenocarcinoma grade-II with foci of squamous morules and keratin pearls. Her pre-operative CA-125 level was within normal range. Women with endometriosis should be considered at an increased risk for the development of ovarian cancer even with normal CA-125 level.

Erratum: N'-[Bis(benzyl-sulfan-yl)methyl-idene]benzo-hydrazide. Corrigendum.

[This corrects the article DOI: 10.1107/S1600536812019472.].

Surgical Management of Desmoid Tumor of the Female Pelvis: A Case Report.

A 25 years married women having one child delivered vaginaly presented in the department of Obs & Gynae, Bangabandhu Sheikh Mujib Medical University, Bangladesh on April 2013 with pelvic pain and discomfort. No history of previous pelvic trauma was present. Patient examination showed a isolated mass in the right lower abdomen, right adnexa, extending to the pelvic wall upto lower end of ureter. Tumor markers were within normal limit. Intravenous pyelogram (IVP) showed mild right hydroureter and hydronephrosis with obstruction at the lower end of ureter. She was diagnosed as a case of adnexal mass with mild hydroureter & mild hydronephrosis and it was decided to operate on the patient. The surgical approach was transabdominal. On laparotomy a pseudocystic lesion 12×10cm in size was found over the right paracolic gutter and extending down into the pelvis involving the right parametrium. No abnormality was found in the uterus or tubes. The histological examination revealed a desmoid tumor of the pelvis. The patient's recovery was uneventful.

CRP (C-reactive protein) in Early Pregnancy Predictor for Development of GDM.

This case-control study was done to find out whether elevated serum CRP in early pregnancy is a predictor of GDM and conducted under joined supervision of Obstetrics & Gynecology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital and Biomedical Research Group (BMRG), BIRDEM, from August 2005 to November 2007. Pregnant mothers at their first 16 weeks of gestation without any medical disorder of pregnancy were included in the study. For the purpose of this study blood samples were again collected for OGTT at their 16weeks, 24-28 weeks and 32 weeks of pregnancy to detect GDM. After confirmation of GDM, C-reactive protein and C-peptide were done from the preserved fasting serum sample at the end of this study to compare GDM with control group. A total of 297 patients were included in this study. Among them 145(48%) patients completed follow up, 59(20%) lost from follow-up and 11(4%) patients had abortion; 82(28%) are due for follow up 31(10%) pregnant patients developed GDM subsequently. Finally 28 GDM patients were taken as cases and 71 were control matched for their gestational age and parity. At earlier weeks of gestation, hsCRP could predict (PPV) development of GDM in 59% with NPV 84%, sensitivity 61% and specificity 83%. C-peptide in the 50th percentile could predict (PPV) development of GDM in 58% with NPV 96%, sensitivity 72% and specificity 93%. The present data indicates that hsCRP and C-peptide both is sensitive markers in predicting GDM.

Anti-Bacterial effect of Aqueous Garlic Extract (AGE) determined by Disc Diffusion Method against Escherichia coli.

The study was performed to determine the antibacterial effect of aqueous extract of garlic (Allium sativum) against standard strain of Escherichia coli ATCC 25922. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. Antibacterial effect of AGE was determined by disc diffusion method. Sensitivity of AGE determined in disc diffusion and the zone of inhibition (ZOI) was 4 mm, 10 mm and 20 mm at 25 µg/10 µl, 50 µg/10 µl and 100 µg/10 µl concentrations respectively. From the findings it is clearly determined the extract has definite antibacterial effect upon Escherichia coli. Further studies are required to detect and isolate the active ingredients present in the Garlic extract as well as detail steps of mechanism responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account.

Hypothyroidism and its Effect on Menstrual Pattern and Fertility.

Hypothyroidism is one of the most common endocrine disorders encountered in clinical practice. Thyroid disorder is very common among the female. The aim of this study was to evaluate the effects of hypothyroidism on menstrual pattern and sub-fertility. This cross-sectional comparative study was carried out in the Department of Obstetrics and Gynecology with collaboration of endocrine department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2006 to June 2008, cases were collected from the thyroid clinic of this hospital. Total study subject were 139, among them hypothyroid cases were 79 and euthyroid were 60. Among the hypothyroidism group 62.0% (n=49) had normal menstrual cycle, 21.5% (n=16) had oligomenorrhoea, 10.1% (n=8) had polymenorrhoea and 6.3% (n=6) had amenorrhoea. On the contrary in euthyroid group 86.7% (n=52) had normal menstrual cycle, 6.7% (n=4) had oligomenorrhoea, 5.0% (n=3) had polymenorrhoea and 1.7% (n=1) had amenorrhoea. Proportion of abnormal menstrual history was found to high among hypothyroid group almost 34% (n=27) compared to euthyroid group 13.4% (n=8) and the difference was statistically significant (p<0.001). The proportion of primary subfertility in hypothyroid 11.4% (n=9) whereas in euthyroid cases 1.7% (n=1) and secondary subfertility in hypothyroid 7.6% (n=6) where as in euthyroid cases 5.0% (n=3). So, sub-fertility was higher among hypothyroid group compared to euthyroid group but the difference was not statistically significant (p>0.05). Overall sub-fertility was 13.7% (n=10) and it was 6.7% (n=4) among the euthyroid group. Among total hypothyroid group 60.7% (n=48) are the overt hypothyroid and 39.20% (n=31) are the sub-clinical hypothyroid group. The effect of hypothyroidism is significant on menstrual pattern and on fertility. Hypothyroid women had more menstrual disorders and also suffering from sub-fertility.

Crystal structure of 4-methyl-benzyl N'-[(thio-phen-2-yl)methyl-idene]hydrazinecarbodi-thio-ate.

In the title compound, C15H16N2S3 {systematic name: [({[(4-methyl-phen-yl)meth-yl]sulfan-yl}methane-thio-yl)amino][1-(thio-phen-2-yl)ethyl-idene]amine}, the central CN2S2 residue is almost planar (r.m.s. deviation = 0.0061 Å) and forms dihedral angles of 7.39 (10) and 64.91 (5)° with the thienyl and p-tolyl rings, respectively; the dihedral angle between these rings is 57.52 (6)°. The non-thione S atoms are syn, and with respect to the thione S atom, the benzyl group is anti. In the crystal, centrosymmetrically related mol-ecules self-associate via eight-membered {⋯HNCS}2 synthons. The dimeric aggregates stack along the a axis and are are consolidated into a three-dimensional architecture via methyl-C-H⋯π(benzene) and benzene-C-H⋯π(thien-yl) inter-actions.

Crystal structure of benzyl 3-(3-methyl-phen-yl)di-thio-carbazate.

In the title compound, C15H16N2S2, the central CN2S2 residue is almost planar (r.m.s. deviation = 0.0354 Å) and forms dihedral angles of 56.02 (4) and 75.52 (4)° with the phenyl and tolyl rings, respectively; the dihedral angle between the aromatic rings is 81.72 (5)°. The conformation about the N-N bond is gauche [C-N-N-C = -117.48 (15)°]. Overall, the mol-ecule has the shape of the letter L. In the crystal packing, supra-molecular chains along the a axis are formed by N-H⋯S(thione) hydrogen bonds whereby the thione S atom accepts two such bonds. The hydrogen bonding leads to alternating edge-shared eight-membered {⋯HNCS}2 and 10-membered {⋯HNNH⋯S}2 synthons. The chains are connected into layers by phen-yl-tolyl C-H⋯π inter-actions; the layers stack along the c axis with no specific inter-actions between them.

Crystal structure of 2-((1E)-{2-[bis-(2-methyl-benzyl-sulfan-yl)methyl-idene]hydrazin-1-yl-idene}meth-yl)-6-meth-oxy-phenol.

In the title compound, C25H26N2O2S2, the central CN2S2 atoms are almost coplanar (r.m.s. deviation = 0.0058 Å). One phenyl ring clearly lies to one side of the central plane, while the other is oriented in the plane but splayed. Despite the different relative orientations, the phenyl rings form similar dihedral angles of 64.90 (3) and 70.06 (3)° with the central plane, and 63.28 (4)° with each other. The benzene ring is twisted with respect to the central plane, forming a dihedral angle of 13.17 (7)°. The S2C=N, N-N and N-N=C bond lengths of 1.2919 (19), 1.4037 (17) and 1.2892 (19) Å, respectively, suggest limited conjugation over these atoms; the configuration about the N-N=C bond is E. An intra-molecular O-H⋯N hydrogen bond is noted. In the crystal, phen-yl-meth-oxy C-H⋯O and phen-yl-phenyl C-H⋯π inter-actions lead to supra-molecular double chains parallel to the b axis. These are connected into a layer via meth-yl-phenyl C-H⋯π inter-actions, and layers stack along the a axis, being connected by weak π-π inter-actions between phenyl rings [inter-centroid distance = 3.9915 (9) Å] so that a three-dimensional architecture ensues.