Low dose-extended letrozole versus double dose-short letrozole protocol for ovulation induction in polycystic ovary syndrome

Background: Letrozole, an aromatase inhibitor has been regarded as the first line drug for ovulation induction in anovulatory PCOS patients because of its monofollicular growth and there is no chance of hyperstimulation by letrozole. Traditional protocol of letrozole includes administration of letrozole for 5 days in first half of follicular phase which induces ovulation in 61.7% cases. Few recent studies have shown that extended letrozole protocol causes more follicles to grow and induces more ovulation than the traditional protocol. The aim was to compare the effects of low dose-extended letrozole protocol and double dose-short letrozole protocol for ovulation induction in infertile PCOS patients.Methods: A randomized controlled trial (RCT) was conducted in the department of reproductive endocrinology and Infertility at Bangabandhu Sheikh Mujib Medical University (BSMMU) on seventy infertile polycystic ovary syndrome patients. Low dose-extended letrozole group or experimental group received tablet letrozole 2.5 mg daily for 10 days and double dose-short letrozole group or control group received tab. Letrozole 5 mg daily for 5 days starting from the 2nd day of menstrual cycle or withdrawal bleeding. The ovarian response was assessed by folliculometry on day 12 of menstrual cycle by transvaginal sonography for measurement of total number of growing follicles, biggest follicle size and endometrial thickness. Mid luteal serum progesterone was measured on day 21-23 to confirm ovulation.Results: The mean number of growing follicle was 1.44±0.95 versus 0.99±0.65 in low dose-extended letrozole group and double dose-short letrozole group respectively generating p value of 0.001. The mean size of the dominant follicle at day 12 was greater in low dose-extended letrozole group than the other displaying 17.69±3.63 mm and 16.6±3.49 mm respectively but the difference was not statistically significant. The number of ovulating patients was greater in low dose-extended letrozole group (76.5% versus 71.9%), but without significant statistical difference. Pregnancy rate was insignificantly greater in low dose-extended letrozole group (23.5% versus 18.8%) as well.Conclusions: Low dose-extended letrozole protocol produces more multifollicular growth and larger size dominant follicle with a trend to raise the ovulation rate and pregnancy rate, though insignificantly

Association of kisspeptin in patients with poly cystic ovarian syndrome

Background: Poly cystic ovarian syndrome (PCOS) is a complex multifactorial disorder, affecting millions of women worldwide. Kisspeptin, a hypothalamic peptide encoded by the KISS1 gene, is widely reported as a key factor in the regulation of luteinizing hormone (LH)/follicular stimulating hormone (FSH) secretion, which may be potentially involved with the development of PCOS. The aim of the study was to estimate the serum kisspeptin level in PCOS patients and evaluate the association of kisspeptin with other biochemical, and hormonal parameters in women with PCOS. Methods: This case-control study was conducted at the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from August 2020 to July 2021. A total of 90 patients between age 18-30 years were enrolled in this study. Data was collected on variables of interest by using the structured questionnaire designed for interview, observation, clinical examination, and biochemical investigation of the patients and analyzed by using the t-test, non-parametric test (Mann-Whitney U test) and chi-square test as appropriate. Results: We found no significant difference between PCOS & control group, but acanthosis nigricans (AN), waist hip (W:H) ratio were statistically significant in PCOS group. We found serum LH (11.98±6.29 mIU/ml), LH: FSH (1.71±0.92), AMH (10.09±3.8 ng/ml), fasting insulin (26.53±28.34 µU/ml), ovarian volume (16.91±4.57), was significantly higher in PCOS patients. Kisspeptin value in PCOS patients was 85.92±56.59 pg/ml and control group was 63.74±43.16 pg/ml. In the PCOS group, there was a positive correlation between kisspeptin and LH, AMH, and ovarian volume. Conclusions: Serum kisspeptin levels were similar in women with or without PCOS but positively correlated with ovarian volume, serum LH and AMH in PCOS patients

Effects of metformin plus myo-inositol compared to metformin alone as pre-treatment of ovulation induction in polycystic ovary syndrome with insulin resistance

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive-age women. Insulin resistance (IR) is a common disorder, which may impair female fertility by causing ovulatory dysfunction. Lifestyle modification and insulin sensitizers are commonly used in the management of IR. This study aimed to compare the effects of metformin plus myo-inositol versus metformin alone as pre-treatment in ovulation induction in polycystic ovary syndrome with insulin resistance.Methods: This prospective quasi-experimental study was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 52 insulin-resistant infertile PCOS women were included in this study, who were allocated into two groups by using odd-even numbers and given two different treatments.Results: Mature follicles and mid-luteal serum progesterone levels were significantly higher in metformin plus myo-inositol group (60.9% versus 28.0% and (73.9% versus 44.0%) respectively. The ovulation rate was significantly higher in metformin plus myo-inositol group (73.9% versus 44.0%), and the pregnancy rate was higher in metformin plus myo-inositol group (26.92% versus 11.54%), but the difference was not statistically significant.Conclusions: Ovulation rate was significantly higher in metformin plus myo-inositol group than metformin alone group. The pregnancy rate was higher in metformin plus myo-inositol group but no significant difference was found between the two groups

Solid-state Synthesis of Phase Pure CuBi2O4 by Sequential Ball Milling

Bismuth-based metal oxides are an intriguing class of photoelectrode materials that can potentially enable large-scale solar hydrogen production via photoelectrochemical (PEC) water-splitting. For realizing such PEC devices, Kusachiite (copper bismuth oxide) is one of the most promising photocathode materials for high solar to hydrogen efficiency. Here we attempt to synthesize phase pure copper bismuth oxide (CuBi2O4) nanopowders using a facile solid-state reaction technique subsequently sintered at 750 0C for 4 h in air. These CuBi2O4 (CBO) powders have been further sequentially ball milled (SBM) up to 25 h to elucidate the milling duration effect on the optical bandgap of the ball milled CuBi2O4 (SBM-CBO). The structural, optical, and Raman studies suggest that phase pure tetragonal CBO could be grown from raw CuO and Bi2O3 powders. The variations in morphology and chemical composition of CBO with increasing milling hours were examined using field emission scanning electron microscopy (FE-SEM) and Energy Dispersive X-ray (EDX) microanalysis, respectively. The optical bandgap was measured in the range of 1.70 - 1.85 eV from the UV-VIS-NIR Diffuse reflection data of SBM-CBO powders. The CBO photocathode materials with variable structural and optical properties could be a promising candidate for self-sustained PEC generation of hydrogen fuel.Comment: 4 pages, 5 figures, 2022 4th International Conference on Sustainable Technologies for Industry 4.0 (STI

Screening for cervical cancer (By VIA Test) among selected garments worker in Chattogram, Bangladesh

Background: Bangladesh is a densely populated country of South East Asia with low resource setting where cervical cancer is the 2nd leading cause of female cancer. In more than 80% cases are diagnosed at advanced and inoperable stage. Regarding socio demographic context of this country VIA has been introduced as a screening method for cervical cancer which is most simple, cost effective, and acceptable test for all women. In Bangladesh among 3 million garment workers more than 80% are women. The objective of this study was to identify prevalence of VIA positive cases among garment workers. So that it can reduce the incidence of cervical cancer in Bangladesh. Methods: It was a cross–sectional observational study conducted in some selected garment factories in Chattogram city of Bangladesh from January 2021 to July 2021, where we enrolled 534 female workers for VIA test. Results: Among all the respondents 56% were 30 years or younger, 38% were aged between 31 to 40 years. Among 534 participants, 44.9% completed primary education, 37.3% were smoker and 34.5% had their children at early age. Majority (86.7%) had excessive whitish discharge. Post coital bleeding and irregular bleeding was 2.6% and 2.2% respectively. Considering awareness, 61.8% had idea about cervical cancer, only 1.1% had undergone VIA test in the past. In our study we found 2.4% of participants were VIA positive cases. Conclusions: It is important to include the garment workers, while making public health policies and implementation of cervical cancer control program

Effect of nonpharmacological interventions on dietary practices, energy expenditure and biochemical parameters of hypercholesterolemic type 2 diabetic subjects

Nonpharmacological interventions play an important role in the management of diabetes and its complications. This study analyzed the effect of nonpharmacological interventions on dietary practices, energy expenditure and management outcome in terms of glycemic and lipidemic status of type 2 diabetic subjects with hypercholesterolemia. These interventions included dietary advice, leaflets, televised lectures, booklets, posters and a bimonthly publication in Bangla. Eighty newly diagnosed type 2 diabetic subjects (male: female ratio 47:33, age 46 ± 8 years) with hypercholesterolemia (fasting serum total cholesterol >200 mg/dl) were selected from BIRDEM by purposive sampling. The first interview was taken before any intervention while the second interview was taken after a minimum interval of 8 weeks. The daily intake of macro- and micro- nutrients was assessed by 24-hr recall method. Energy expenditure of the subjects was calculated by factorial method using physical activity level (WHO/FAO/UNU 1985). After intervention, the proportion of carbohydrate, protein and fat intake of the study subjects did not differ significantly compared to values before intervention. The daily intake of micronutrients also did not differ compared to those before intervention. No significant difference was found between pre and post intervention values of per day energy intake (kcal, 1621 ± 426 vs 1645 ± 623). Total energy expenditure after intervention was significantly higher (1649 ± 340) compared to before intervention (1519 ± 353, p<0.002). After intervention, fasting serum glucose level (7 ± 1.43 mmol/l), serum glucose 2 hrs after breakfast (11 ± 4.1 mmol/l) and total cholesterol (217 ± 35 mg/dl) were significantly reduced compared to before intervention values (9 ± 4, 16 ± 7, 231 ± 32 respectively; p=0.001 for FSG, p=0.001 for SGABF, p<0.001 for total cholesterol). Nonpharmacological intervention was found to be effective in improving the management of diabetes and its complications. Ibrahim Med. Coll. J. 2009; 3(2): 75-7

Original Article EFFECT OF NONPHARMACOLOGICAL INTERVENTIONS ON DIETARY PRACTICES, ENERGY EXPENDITURE AND BIOCHEMICAL PARAMETERS OF HYPERCHOLESTEROLEMIC TYPE 2 DIABETIC SUBJECTS

Nonpharmacological interventions play an important role in the management of diabetes and its complications. This study analyzed the effect of nonpharmacological interventions on dietary practices, energy expenditure and management outcome in terms of glycemic and lipidemic status of type 2 diabetic subjects with hypercholesterolemia. These interventions included dietary advice, leaflets, televised lectures, booklets, posters and a bimonthly publication in Bangla. Eighty newly diagnosed type 2 diabetic subjects (male: female ratio 47:33, age 46 ± 8 years) with hypercholesterolemia (fasting serum total cholesterol&gt;200 mg/dl) were selected from BIRDEM by purposive sampling. The first interview was taken before any intervention while the second interview was taken after a minimum interval of 8 weeks. The daily intake of macro- and micro- nutrients was assessed by 24hr recall method. Energy expenditure of the subjects was calculated by factorial method using physical activity level (WHO/FAO/UNU 1985). After intervention, the proportion of carbohydrate, protein and fat intake of the study subjects did not differ significantly compared to values before intervention. The daily intake of micronutrients also did not differ compared to those before intervention. No significant difference was found between pre and post intervention values of pe

Development of ceramic grade red iron oxide pigment from waste iron source

Ceramic grade red iron oxide (α-Fe2O3) nanoparticles pigments have been synthesized from waste condensed milk containers which contain a prominent amount of iron (93.2%). The synthesis method comprised of two steps: in the first step ferrous sulfate was prepared following an acid leaching method; while the second step was oxidation and calcination of ferrous sulfate to produce desired α-Fe2O3 in nano form. The structure, functional groups, chemical state, morphology, particle size, surface area, elemental, thermal analysis and magnetic properties of the samples were investigated using XRD, FTIR, XPS, SEM, BET, EDS, TG-DT and VSM respectively. Pure hematite (α-Fe2O3) phase was confirmed by XRD and the average crystal sizes were in the range 34–126 nm have been performed by Debye-Scherer's formula, which are consistent with the results as achieved from SEM images. Agglomerated irregular spherical nanoparticles (45–149 nm) were found in SEM image. The surface chemistry and the chemical state (Fe3+) of the hematite nanoparticles was also confirmed by XPS. The mesoporous nature of the nanoparticles with high surface area were measured by BET and it has been revealed that the BET specific surface area (33.55 m2/g) was marginally higher than the commercial one. The magnetic nature of the nanoparticles was portrayed by VSM and the nanoparticles showed the ferromagnetic behavior. Moreover, particle size distributions and zeta potential values have been also measured by DLS

Knowledge, Attitude and Practice of Hypercholesterolemic Type 2 Diabetic Subjects on Dyslipidemia

This study was undertaken to assess the knowledge, attitude and practice (KAP) of hypercholesterolemic type 2 diabetic subjects on dyslipidemia and to analyze the influence of some demographic and socioeconomic factors on the level of KAP.It was a descriptive cross-sectional survey. One hundred eleven newly diagnosed type 2 diabetic subjects (male 61%, female 39%, age 45±9 years, BMI 24±4.8 Kg/m2) with hypercholesterolemia (fasting plasma total cholesterol >200 mg/dl) were selected from the out patient department of BIRDEM by purposive sampling method. Data were collected by a pre-designed, pretested, interviewer-administered questionnaire. Three categories were defined on the basis of the score obtained by each subject namely low, medium and high as follows: knowledge-score 60%; attitude-score 80%; and practice-score 70% respectively. The levels of knowledge were low in 42%, medium in 35% and high in 23% of the study subjects. The corresponding attitude levels were low in 1%, medium in 31% and high in 68%, and the levels of practice were low in 80%, medium in 14% and high in 6% of the subjects. The knowledge score was higher in secondary and graduate (53.4±8.9%, and 54.9±10.1%) groups compared to illiterate-primary group (48.9±9.9%). Practice score of illiterate-primary group (34.5±16.8%) was lower than secondary and graduate (43.1±13.9% and 46.7±18.1%) groups, but they did not differ on attitude. The various income groups did not differ on knowledge. Attitude score of high-income group (78.7±8.4%) was better than low-income group (70.9±11.8%). Practice score in high-income group (44.7±16.0%) was better than medium income and low-income groups (31.3±14.5% and 28.6±15.0%). Knowledge and practice score in Bangladeshi hypercholesterolemic type 2 diabetic subjects are not satisfactory although they have fairly good attitude levels. Education and income status are the major determinants of knowledge, attitude and practice regarding dyslipidemia in diabetes. A coordinated policy is required to promote knowledge and attitude on healthy lifestyle and to translate those into practice. Ibrahim Med. Coll. J. 2011; 5(2): 37-4

Environmental remediation by hydroxyapatite: Solid state synthesis utilizing waste chicken eggshell and adsorption experiment with Congo red dye

This study reports the adsorption efficacy of hydroxyapatite (HAp) for removing Congo Red (CR) dye from aqueous solution. HAp was synthesized utilizing chicken eggshell as a precursor of Ca source. Solid state synthesis method was implemented which comprised calcination at 950 °C (E-HAp950). XRD analysis confirmed the formation of bi-phasic HAp with 15.5% of β-TCP. Elemental composition was evaluated by XPS and EDX analysis. FESEM analysis revealed the particles are of plate and spherical shaped also confirmed by the TEM images. DLS particle size, zeta potential, BET surface area and point of zero charge were also evaluated. Adsorption efficacy of E-HAp950 for removing CR was evaluated by batch adsorption experiment. Maximum adsorption capacity (qmax) was found to be 9.64 mgg−1 which was best explained by the non-linear fitting (R2 = 0.98) of Langmuir isotherm. Adsorption kinetics profusely followed pseudo second order kinetic model (R2 = 0.999) with qe (experimental) being very much closer to qe (calculative) for this model. Thus, hydroxyapatite prepared by utilizing eggshell waste through solid state method has the potential to remove toxic dyes