Effect of estradiol valerate on endometrial thickness in polycystic ovary syndrome having ovulation induction with letrozole

Background: PCOS is a common endocrine disorder in women of reproductive age. Letrozole is an orally active aromatase inhibitor and as effective as chlomiphene citrate for induction of ovulation. Estrogen is important in the regeneration and growth of the endometrium prior to ovulation prepare the tissue to respond to progesterone post ovulation in PCOS patients. Aim of the study was to assess the effects of estradiol valerate on endometrial thickness in PCOS having ovulation induction with letrozole. Methods: This randomized controlled study was conducted in the department of reproductive endocrinology and infertility, BSMMU, Dhaka, with 1 year duration. A total 80 diagnosed cases of PCOS patients with subfertility were included in this study. Among them 40 patients received letrozole and estradiol valerate and 40 patients received letrozole and placebo. Results: On day 8, mean endometrial thickness was not statistically significant between two groups (p=0.436). On day of triggering, mean endometrial thickness was significantly higher in intervention group 9.2±1.4 mm than control group 8.2±1.4 mm (p=0.004). Mean changes of endometrial thickness on day of triggering compared with on day 8 was significantly higher in intervention group 3.2±1.5 mm than control group 2.5±1.6 mm (p=0.043). Pregnancy rate was higher in intervention group 13 (38.2%) than control group 8 (22.2%) with relative risk 1.72, 95% CI (0.82-3.63%), that was not statistically significant between two groups (p=0.144). Conclusions: Mean changes of endometrial thickness on day of triggering were significantly higher in intervention group than control group. The pregnancy rate achieved with letrozole+estradiol valerate combination was higher than that achieved with letrozole and placebo group

Effect of D-chiro-inositol on hormonal parameters and insulin resistance in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder among women of reproductive age, characterized by hormonal imbalance and insulin resistance. D-chiro-inositol, a naturally occurring inositol isomer, has been suggested as a potential treatment option for PCOS. This study aimed to investigate the effects of D-chiro-inositol supplementation on hormonal parameters, and insulin resistance in women with PCOS. Methods: This randomized controlled study was conducted among 60 women of PCOS with insulin resistance, who were assigned to either Group A (D-chiro-inositol) or Group B (placebo) for 12 weeks. S. FSH, LH, S. total testosterone, fasting blood glucose, fasting insulin, and insulin resistance (HOMA-IR) were measured at baseline and after 12 weeks of treatment. Statistical analyses were performed using SPSS version 23.0 for Windows. Results: After 12 weeks of treatment, significant reductions in serum luteinizing hormone, serum total testosterone, fasting insulin, and HOMA-IR were observed in the D-chiro-inositol group compared to the placebo group. However, no significant changes were observed in fasting blood glucose levels. D-chiro-inositol was well-tolerated, with no significant differences in side effects between the two groups. Conclusions: D-chiro-inositol supplementation for 12 weeks significantly improved hormonal parameters, and insulin resistance in women with PCOS. The treatment was well-tolerated, suggesting that D-chiro-inositol can be an effective therapeutic option for patients with PCOS

Mifepristone alone versus mifepristone-misoprostol combination regimen for management of intrauterine fetal death

Background: Early pregnancy failure is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination. The study objective was to compare the outcome of Mifepristone alone with the Mifepristone- Misoprostol combination regimen for the management of IUFD.Methods: This was a Prospective clinical trial at the department of obstetrics and gynecology, Chittagong Medical College Hospital, Chittagong. From March 2016 (Actual patient enrolment started after obtaining ethical clearance i.e. March 2018) to September 2018.Results: A subjects delivered earlier than group B and the mean induction delivery interval in Group A is significantly less in comparison to Group B (p=<0.001). Out of 50 women, 2(4%) and 10(20%) women in Groups A and B required oxytocin infusion to establish good contractions, and completion of termination who regarded as a failure. In the mifepristone alone group, the success rate is significantly higher than in the combination group.Conclusions: The efficacy of mifepristone alone was found superior to that of the mifepristone misoprostol combination regimen in the present study.

An Eight-year Study Report on Arsenic Contamination in Groundwater and Health Effects in Eruani Village, Bangladesh and an Approach for Its Mitigation

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.</p> <p>Methods</p> <p>This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. <it>Pearson's </it>chi-square test, <it>t</it>-test and Mann-Whitney test were performed.</p> <p>Results</p> <p>The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.</p> <p>Conclusions</p> <p>Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.</p

Occurrence of antibiotic resistant bacteria in pond water associated with integrated poultry-fish farming in Bangladesh

The use of antibiotics in poultry feed can cause antibiotic resistance in integrated poultry-fish farming pond environment. Therefore, the goal of this study was to monitor the prevalence of drug-resistant bacteria in pond water associated with poultry-fish farming in Bangladesh. The results showed that the prevalence rate of tetracycline (TC) and ampicillin (AMP) resistant bacteria were 0.24 to 2.59% and 0.16 to 1.0%, respectively. The higher prevalence rate of TC and AMP-resistant bacteria was found in site 3 followed by site 4 and 2 compared with control site 1. Site 2, 3 and 4 were adjacent to the integrated poultry farm. On the other hand, higher TC and AMP-resistant bacteria were found in the rainy season than in the winter. The minimum inhibitory concentration result showed quite high level of TC and AMP-resistant bacterial distribution in the pond water. Seven genera of resistant bacteri¡a were identified in pond water samples by 16S rRNA gene analysis. Among them Acinetobacter sp. was predominant followed by Enterococcus sp., Pseudomonas sp., Bacillus, Staphylococcus sp., Enterobacter sp. and Brevibacillus sp

Underutrition and Adiposity in Children and Adolescents: A Nutrition Paradox in Bangladesh

Many studies reported a high prevalence of undernutrition in the under-5 children in Bangladesh. But very few information are available about undernutrition and adiposity among school children and adolescents in Bangladesh. This study addressed the prevalence of undernutrition and obesity among school going children and adolescents. A total of 15 secondary schools were purposively selected from rural, suburban and urban areas. The teachers were detailed about the study protocol. Then the teachers volunteered to register the eligible (age 10 – 18y) students for the study. Each student’s parent was interviewed for family income. Height (ht), weight (wt), mid-upper arm circumference (MUAC) and blood pressure were taken. Fasting blood samples were collected for fasting plasma glucose, total cholesterol (Chol), triglycerides (TG), high-density lipoproteins (HDL). Body mass index (BMI) was calculated (ht/wt in met. sq) for diagnosis of undernutrition (BMI 25.0). A total of 2151 (m-1063, f-1088) students volunteered the study. Of them, the poor, middle and rich social classes were 25.4, 53.1 and 21.5%, respectively. Overall, the prevalence of underweight, normal, overweight and obesity were 57.4%, 35.0%, 4.9% and 2.7%, respectively. For gender comparison, there has been no significant difference of BMI between boys and girls. By social class, the prevalence of underweight was significantly higher in the poor than in the rich (62.2% v. 43.6%) and obesity was higher in the rich than in the poor (6.1% v. 1.2%) [for both, p<0.001]. Logistic regression showed that the participants from urban (OR 1.51, 95% CI 1.03 – 2.22) and the rich (OR 2.03, 95% CI 1.24 – 3.33) social class had excess risk for obesity. The risk for undernutrition was found just reverse. Undernutrition was found most prevalent among the rural students and among the poor social class; whereas, prevalence of overweight and obesity appears to be increasing with urbanization and increasing family income. Thus, the study showed a nutrition paradox – adiposity in the midst of many undernourished children and adolescents in Bangladesh. Further study may be undertaken in a large scale to establish diagnostic criteria for age specific nutrition assessment in Bangladesh. A prospective children cohort may help assessing the cut-offs for unhealthy sequels of undernutrition and adiposity. Ibrahim Med. Coll. J. 2012; 6(1): 1-