The Incidence, Predisposing Factors, Complications and Outcome of Preeclampsia in Diabetic Pregnancy

Introduction: Preeclampsia is a serious complication of pregnancy and common cause of fetal and maternal morbidity as well as mortality worldwide. In diabetic women, the chance of preeclampsia is increased. The incidence of preeclampsia in diabetic pregnancy is approximately 10 to 15 percent, which is associated with poor glycaemic control. Aim: This study was carried out to find the predisposing factors related to preeclampsia and determine the complications of preeclampsia in diabetic pregnancy and also the impact of preeclampsia in infants born to diabetic mothers. Methods: This prospective study was carried out at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. The Patient population consisted of 80 diabetic pregnant women who attended or admitted to BIRDEM hospital during the study period. The women were divided into groups: 50 pregnant diabetic women with preeclampsia were taken as case. 30 pregnant diabetic women without preeclampsia were taken as control. Diagnosis of preeclampsia was made on the basis of the criteria of the Committee on Terminology of the American College of Obstetrician and Gynecologist. Results: Preterm delivery (<37 weeks gestation) was higher among study group (64%) compared to control (33.3%) women. Term delivery was 36.0 vs 66.7 percent among case and control women, respectively. The distribution is statistically significant (P<0.01). 35 percent of Caesarean section was done due to fetal distress in the study group and in control group it was 20 percent. In study group, 22.5 percent Caesarean sections were done due to impending eclampsia and eclampsia, 705 percent due to accidental haemorrhage and 5 percent due to IUGR. Maternal complication in study and control subjects. In the case group, maximum number of the women (16%) showed signs of impending eclampsia, while among control women, maximum number (10%) developed postpartum haemorrhage (PPH). 48 percent neonates were of low birth weight and in controls it was 13.3 percent. Both hyperbilirubinaemia (40%) and hypoglycaemia (30%) were more in study group than controls (16.66% and 20%, respectively). Perinatal outcome among study group and controls. Neonatal survival was 82.0 percent in study group and 86.7 percent in control group. Comparison of Perinatal outcome between the groups is not statistically significant. Most of the perinatal mortality was due to prematurity (8%) and intrauterine death (6%). In control group, most of the perinatal deaths were due to congenital anomalies (6.6%). Conclusion: The higher incidence among study group may be, in part, the result of more preterm birth or shortened gestational duration because early delivery is a consequence of preeclampsia. The higher rate in associated with preeclampsia was due to increased incidence of IUD and prematurity. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12379 Birdem Med J 2011; 1(1): 10-14

Out come of induction of remission in undernourished children with acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is the most common childhood leukaemia. On the other hand under-nutrition is a common problem in our country. This prospective study was conducted to see the outcome of induction of remission in undernourished children with acute lymphoblastic leukaemia. This study was carried out in the department of Paediatric hematology and oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period from November 2002 to October 2004. A total of sixty (60) children who were diagnosed as acute lymphoblastic leukaemia in 1 to 15 years of age were included in this study. But the children with previous history of congenital disease and that of chemotherapy or steroid were excluded from this study. Patients were divided into two groups on the basis of Z score of weight for age. Thirty (30) children those with Z score- 2 or less were classified as undernourished and was labeled as Group A and another thirty (30) patient those Z score above-2 were classified as well nourished and was placed in Group B, After inclusion into the study, completion of induction of remission was monitored by physical examination and laboratory investigations. The result showed that mean age in Group A was 77.16 ± 7.07 months and that in Group B was 74.13 ± 5.09 months with male preponderance in both the groups. Mean body weight in Group A was 14.55 ± 0.76 Kg and that in Group B was 21.40 ± 1.05 kg (p<0.001). Children in Group A required 39.06 ± 0.72 days to complete induction but in Group B it required 31.63 ± 0.17 days (p<0.04). Hospital stay in Group A children was 52.10 ± 1.08 days and in Group B 42.37 ± 0.50 (p<0.002). The result suggested that under nutrition has an influence on the out come of induction of remission in undernourished children with acute lymphoblastic leukaemia. So appropriate measures are essential to improve nutritional status of children for successful management of ALL in children.

Short-term exposure of 4-hydroxynonenal induces mitochondria-mediated apoptosis in PC12 cells

4-Hydroxynonenal (4-HNE) is one of the most reactive aldehydic by-products of lipid peroxidation. The role of 4-HNE in the etiology of various neurodegenerative disorders including cerebral ischemia/reperfusion, Alzheimer’s disease, Parkinson’s disease, etc. has been documented. We and others have reported that long-term toxic insults of 4-HNE triggers apoptotic signals and oxidative stress in various cells. However, the status of apoptosis following short-term exposure and underlying mechanisms has not been explored so far. We studied the apoptotic changes in PC12 cells receiving short-term exposure of 4-HNE. A significant dose-dependent induction in reactive oxygen species (ROS) and early response markers (c-Fos, c-Jun, and GAP-43) were observed in cells exposed to 4-HNE (10, 25, and 50 µM) for 1h. Following the exposure of PC12 cells to 4-HNE, the levels of protein and messenger RNA expressions of P53, Bax, and caspase 3 were significantly upregulated, whereas the levels of Bcl2 was downregulated. We could record the apoptotic signals and ROS generation in PC12 cells receiving 4-HNE exposure for such a short period of time. Induction in the expression and activity of caspase 3 has also indicated the mitochondrial mediation in the apoptosis induction.

Von Hippel-Lindau disease in a pregnant lady

Von Hippel-Lindau disease is a rare genetic disorder characterized by various tumours and cysts in the central nervous system and other viscera. Here a case was described in a young female who was pregnant at the time of initial presentation with the complaints of occasional headache, low back pain and pain in the upper abdomen. After the birth of a healthy baby she was admitted to the hospital and the CT scan of upper abdomen suggested a multiloculated pancreatic cyst. MRI of thoracolumbar spine revealed an intracanalicular extradural mass and CT scan of brain revealed a cerebellar cystic mass. The spinal and cerebellar masses both were diagnosed histologically as haemangioblastoma. After a month she underwent laparotomy with near total pancreatectomy. Microscopically it was a microcystic cystadenoma. Based on the clinical presentation, imaging and histopathology of spinal, cerebellar and pancreatic lesions as well as a family history of her father's death due to brain tumour the final diagnosis was Von Hippel-Lindau disease.

Outcome of pregnancy in patients with congenital heart diseases

This prospective study was conducted to evaluate the outcome of pregnancies in women with congenital heart diseases. In this study 50 pregnant women age between 20-45 years with congenital heart diseases were included. Twenty two (44%) were presented with atrial septal defect, 12(24%) with ventricular septal defect, 5(10%) were with patent ductus arteriosus, 6(12%) with Fallot's tetralogy, 2(4%) with pulmonary stenosis, 2(4%) with Eisenmenger syndrome, 1(2%) with dextrocardia. Shortness of breath (60%) was the main presenting complaint. Normal vaginal delivery (52%) was done in majority of cases. Spontaneous abortion occurred in 16% of pregnancies. Major complications were heart failure 16%, arrhythmias 21%, cardiovascular mortality 4%, preeclampsia 4%, and eclampsia 2%. Premature birth 16%, fetal demise 4%, neonatal death 2% and cardiac anomaly at birth 2% were also observed. The outcome of pregnancy in women with congenital heart diseases is favourable with considerable maternal and neonatal complications.

Hyperlipidemia in childhood idiopathic nephrotic syndrome during initial remission and relapse

The objective of this study was to correlate hyperlipidemia during initial remission of nephrotic child with relapse. This observational prospective study was carried out among 26 children, between 1 to 8 years age with first attack idiopathic nephrotic syndrome, who was seen at Paediatric Nephrology Department of BSMMU and Paediatric Nephrology Department, NIKDU, from December'2005 to August'2006 and were followed-up for at least 6 months after initial attack. Twenty two age and sex matched hospitalized children, suffering from non-renal diseases, were enrolled as controls. Fasting blood samples for lipid profile were taken at the time of diagnosis of both cases and controls and also during remission of cases only. These patients were divided into two groups based on serum lipid profile during remission. Group-I consisted 16 patients who had normal lipid profile during remission and Group-II consisted 10 patients who had abnormal lipid profile during remission. Both Groups I & II had higher mean levels of serum cholesterol, LDL, TG and Lp(a) than those of controls during initial diagnosis. Between two groups on remission, Group-II patients showed higher mean serum cholesterol (332.9±105.19 mg/dL vs. 183.13±16.89 mg/dL; p<0.001), serum LDL (252±101.67 mg/dL vs. 119.19±21.33mg/dL; p<0.001), and serum TG (182.8±73.83 mg/dL vs. 93.31±20.95 mg/dL; p<0.001). Five patients out of 10 patients of Group-II (19% of total case) developed subsequent relapse within 6 months follow-up. Among the relapsers, mean cholesterol (334±46 vs. 232±34 mg/dL; p<0.05) was significantly higher than that of non-relapsers of Group-II patients. On the other hand, no patient of Group-I developed relapse within 6 months follow-up. It may be concluded from this study that hyperlipidemia in general at remission, specifically serum total cholesterol, may be regarded as predictor of relapse in childhood idiopathic nephrotic syndrome.

Association between bacterial vaginosis and preterm delivery

Bacterial vaginosis (BV) is one of most common presentation in women of reproductive age, and its prevalence is relatively high in the obstetric population which is responsible for preterm delivery. The present study tried to explore the association of BV with preterm delivery, and included 100 pregnant women aged 15 to 35 years, between 28 36 weeks of gestation, with abnormal vaginal discharge and clinically suspected of BV, attending obstetrics outpatient department of BSMMU were selected for the study, divided into two groups based on Amsel clinical criteria (63 culture negative and 37 culture positive for BV). Mean ± SD age of BV negative and positive subjects was 24.59 ± 5.18 and 23.89 ± 4.77 years respectively (statistically no significant difference). Likewise, socioeconomic status, educational status and gravida did not show statistically any significant difference between groups. Significantly high number of BV positive women delivered prematurely (73%) compared to BV negative (25.4%) (p<0.001). Mean ± SD gestational age also differed significantly 37.49 ± 2.53 vs. 35.24 ± 2.33 weeks (p<0.001). Our study supported that abnormal bacterial colonization, indicative of bacterial vaginosis, is strongly associated with preterm delivery.

A young lady with secondary tuberculosis of breast

Tuberculosis of breast is an extremly rare form of extrapulmonary tuberculosis even in endemic area like Bangladesh and the incidence is 0.25-4.5% of all breast lesions. The diagnosis is difficult because of nonspecific clinical, radiological and histopathological findings. Very often biopsy specimens are inadequate and microscopy or culture is negative. It is usually suspected in a multiparous woman who may be immunocompromised. We report a case of breast tuberculosis in a 26 years old multiparous lady who previously present with two times attack of right sided breast lump and then diagnosed as a case of breast abscess and treated by incision and drainage with antibiotics in a nearby local hospital. During her third time attack she admitted into Mymensingh Medical College Hospital with right sided breast lump with multiple discharging sinuses for one month. Biopsy was taken from the lump and sinus tract and histopathological report confirmed the diagnosis as a case of tuberculosis of breast. Her X-ray chest showed tubercular lesion in lungs. So this is a case of secondary breast tuberculosis. This case highlights how difficult is the diagnosis of a case of breast tuberculosis for which the patient may require even mastectomy at very late case. So this case is reported.

Histological variant of nephrotic syndrome with atypical presentation in children

Aims of the present study were to find out the histological pattern of atypically presenting nephrotic syndrome children and their response with oral corticosteroid therapy. This prospective study was carried out in the Paediatric Nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, for a period of two years, from September 2001 to September 2003. Forty children with nephrotic syndrome with atypical presentations such as gross haematuria, renal impairment, hypertension and hypocomplementaemia were enrolled for the study. For each patient proper investigations were done to screen out infection and necessary treatment was given accordingly. Renal biopsy was done in all cases after treating infection and controlling hypertension and specimen were evaluated by light and immunofluorescence microscopy. All the patients were treated with oral prenisolone 60 mg/m2/day for 4 weeks and response were observed by heat coagulation test. In present study it was observed that mean age of presentation was 8.73+/-4.36 years. Hypertension, gross haematuria, impaired renal function and hypo-complementaemia were observed in 50%, 45%, 19% and 15% cases respectively. When histopathologies were considered, 90% cases had other than minimal change disease (MCD) and Mesangial proliferative glomerulonephritis (MesPGN) was the most common histopathology (47.5%). Regarding steroid therapy only 43.2% patients were responsive to oral prednisolone therapy within 28 days. Atypically presented nephrotic syndrome usually manifested with higher age of onset, gross haematuria, hypertension, renal insufficiency and hypocomplementaemia. Mesangial proliferative glomerulonephritis was the predominant histological type. The majority (56.8%) of these atypically presented nephrotic syndromes were resistant to steroid therapy.

Poverty and infant mortality in the Eastern Mediterranean region: a meta-analysis

OBJECTIVES

To test the hypothesis that poverty is associated with infant mortality in Eastern Mediterranean countries and to measure the strength of the association.

METHODS

A bibliographic search was conducted. The studies including data regarding deaths during the first year of life, socioeconomic status of the household and/or maternal literacy were selected. Nine studies, conducted in the Eastern Mediterranean region, fulfilled the inclusion criteria. These included seven cross-sectional surveys and two case-control studies. Maternal illiteracy and low socioeconomic status were used to show the level of poverty in each household. Risk estimates for low socioeconomic status and maternal illiteracy were extracted from each study. Meta-analysis was performed for the association between exposure groups of low socioeconomic status and maternal illiteracy and the outcome of death within the first year of life.

MAIN RESULTS

Poverty was associated with an increased risk of infant death (pooled OR 1.52, 95% CI 1.38 to 1.67), significant at p<0.0001. There was a significantly increased risk of infant death among illiterate mothers (OR 1.72, 95% CI 1.42 to 2.08) compared with literate mothers. The meta-analysis OR for an association between low socioeconomic status subgroup and infant death was 1.37 (95% CI 1.25 to 1.49), significant at p<0.0001.

CONCLUSIONS

This meta-analysis indicates that there is a significantly increased mortality risk in infants born in poor households. The results suggest that policies aimed at poverty alleviation and female literacy will substantially contribute to a decrease in infant mortality.

A case of renal transplantation

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.

Urinary tract infection and vesicoureteric reflux in children

A retrospective study of 74 children with Urinary Tract Infection (UTI) were evaluated for the prevalence of vesicoureteric reflux (VUR) at a tertiary hospital in Dhaka, Bangladesh from 2003 to 2006. There were 45 (60%) girls and 29 (40%) boys; 58 (78%) were at an average age between 1-5 years, 11 (15%) were between 0-1 year and five (7%) were more than 5 years of age. All patients were documented to have UTI by history and laboratory investigations. There were 27 (36%) patients who had acute pyelonephritis at the initial clinical presentation and fourty seven (64%) patients had recurrent UTI. Thirty two (43%) patients had vesicoureteric reflux; fifteen (47%) had it bilaterally (VUR); and 13 (41%) had renal scarring. Five (7%) patients who had renal scarring were with- out reflux. Twenty three (72%) of the VUR patients had mild to moderate reflux (grade 1-3) and nine (28%) had severe reflux (grade 4-5). The age of the patients with VUR was below one year in 13 (40%), between 1 and 5 years in 17 (53%) and between 6 and 12 years 2 (7%) patients. There were 9 (33%) patients with acute pyelonephritis who had reflux. Follow-up of the VUR patients showed that reflux disappeared with out surgical intervention in 14 (44%), improved in three (9%) to lower grade and worsened in two (6%) to higher grade. Five (16%) patients underwent ureteral re-implantation; all the patient of VUR had recurrent UTI and were more than one year of age. While on chemoprophylaxis, two of the reimplanted patients developed break-through UTI. None of the study patients developed new scars, hypertension or renal failure during follow-up; the duration of follow-up was from 6 months to 3 years. Children with UTI below 6 years of age have high incidence of reflux and scarring with specially in patients with acute pyelonephritis.

Congenital nephrotic syndrome, an uncommon presentation of cytomegalovirus infection

Cytomegalovirus (CMV) infection is a very rare infection in children as well as in infancy. In CMV infection extra renal manifestations in central nervous system (CNS), eyes and hematological are prominent and common than renal manifestation. We are describing two case reports one at the age of 5 months and another at one month with features of both extra renal and renal manifestations of nephritic syndrome. Our first case presented with predominant features of CNS manifestations like convulsion and spastic monoplegia, sensory type of deafness and absence of light reflexes along with nephritic features. Deafness and absence of light reflex were confirmed by audiometric and ophthalmological examination and brain atrophy was confirmed by CT scan. Our second case had features of hypothyroidism along with nephritic features. Hypothyroid status was confirmed by elevated serum TSH level and reduced T4 level. In both cases nephritic features were confirmed at bed site urine examination by heat coagulation test and other relevant investigations. CMV infection was confirmed in both cases by detecting anti CMV IgM by ELISA method. Both patients were clinically improved with intravenous gangcyclovir therapy. In these two cases reports, clinical, serological and therapeutic observation established the causal relationship between the CMV infection and nephrotic syndrome.

Neuroendocrine regulation of prolactin secretion in adult female rhesus monkeys during different phases of the menstrual cycle: role of neuroexcitatory amino acid (NMA)

The present study attempts to examine the role of N-methyl-D, L-aspartate (NMDA) receptors in the central regulation of prolactin (PRL) secretion, which may be involved in ovarian function and its alteration by glutamate in various phases of the menstrual cycle of female rhesus monkeys (Macaca mulatta). The results suggest that the glutaminergic component of the control system, which governs PRL secretion by utilizing NMDA receptors, may have an important role in regulating changes in PRL secretion. The response of PRL during the luteal phase of the cycle was different from that observed in follicular and menstrual phases. Steroids may influence the NMDA-dependent drive to release PRL. N-methyl-D-aspartic acid (NMA) involvement in the regulation of PRL secretion may occur through activation of the PRL-stimulating system depending on the physiological state or steroidal milieu. It is possible, therefore, that the NMA-induced release of PRL-releasing factors (PRF) and PRL are enhanced in the presence of ovarian feedback.

Increased concentrations of plasma neuropeptide Y in patients with eclampsia and preeclampsia

OBJECTIVE

Epinephrine and norepinephrine are associated with the hyperstimulation of the sympathetic nervous system. Neuropeptide Y is a potent vasoconstrictive substance that is released in response to sympathetic nerve stimulation.

STUDY DESIGN

The concentrations of plasma neuropeptide Y in pregnant patients with eclampsia (n = 8), preeclampsia (n = 8), and normotension (n = 8) were measured by radioimmunoassay on admission and 6 days after delivery. Correlations between plasma concentration of neuropeptide Y and mean arterial blood pressure were also evaluated in these patients on admission and 6 days after delivery.

RESULTS

The plasma level of neuropeptide Y in women with eclampsia (P <.001) and preeclampsia (P <.003) was found to be significantly elevated with respect to that in normotensive pregnant women. At 6 days after delivery the concentration of plasma neuropeptide Y was significantly decreased in women with eclampsia, women with preeclampsia, and women with normotensive pregnancies compared with the value measured on admission (P <.0001, P <.0001, and P <.002, respectively). At admission the plasma neuropeptide Y level was positively correlated with mean arterial blood pressure in women with eclampsia and preeclampsia. However, no significant correlations were observed between plasma neuropeptide Y concentration and mean arterial blood pressure both at admission and 6 days after delivery in normotensive pregnant women and 6 days after delivery in women with eclampsia and preeclampsia.

CONCLUSION

We have concluded that the level of neuropeptide Y in plasma is increased in women with eclampsia and preeclampsia. Elevated plasma neuropeptide Y levels may play a key role in the development of eclampsia and preeclampsia.

Modified preparation and rapid quality control test for technetium-99m-tetrofosmin

OBJECTIVE

The objectives of this study were to: modify the preparation of 99mTc-tetrofosmin by using twice the amount of 99mTcO4- recommended by the manufacturer; evaluate the use of miniaturized rapid paper chromatography (MRPC) for quality control (QC) testing; and determine the in vitro stability of the modified preparation using MRPC.

METHODS

Two preparations of 99mTc-tetrofosmin were made: one with 4.4-8.8 GBq (120-240 mCi) and the other with 13.9-17.6 GBq (380-480 mCi) 99mTcO4-, referred to as regular and modified preparations, respectively. Routine QC tests were performed using MRPC and instant thin-layer chromatography/silica-gel (ITLC/SG) systems. The preparations were injected into 58 patients. Planar and SPECT images of stress and rest studies were obtained. The technical quality of the SPECT images was graded visually by four observers. Heart-to-lung and heart-to-background ratios were calculated from the planar images.

RESULTS

The QC testing procedure took 4.18 +/- 0.15 min with MRPC and 54 +/- 5.3 min with ITLC/SG systems. The percent labeling efficiency, as determined by both techniques, ranged from 95.6 +/- 1.6 to 97.2% +/- 0.8%. Both preparations were stable up to 6 hr after reconstitution. There was no difference between the cardiac-to-lung and cardiac-to-background ratios of the two preparations.

CONCLUSION

The results indicate that MRPC is a faster and effective chromatographic technique for routine QC testing of 99mTc-tetrofosmin. Doubling the amount of 99mTcO4- used in preparing 99mTc-tetrofosmin did not affect its in vitro stability, its efficacious use in patients or the technical quality of the images.

Microbial transformations of hypolipemic E-guggulsterone

Biotransformation of E-guggulsterone (pregna-4,17(20)-cis-diene-3,16-dione) (1) by Aspergillus niger resulted in the formation of four new hydroxyl derivatives identified as 7 beta-hydroxypregna- 4,17(20)-trans-diene-3,16-dione (2), 7 beta-hydroxypregna-4,17(20)-cis-diene-3,16-dione (3), 7 beta- hydroxypregn-4-ene-3,16-dione (4), and 7 beta,15 beta-dihydroxypregn-4-ene-3,16-dione (5). The biotransformation of 1 with Cephalosporium aphidicola also resulted in the formation of four new steroidal derivatives as 11 alpha-hydroxypregna-4,17(20)-trans-diene-3,16-dione (6), 11 alpha- -hydroxypregna-4,17(20)-cis-diene-3,16-dione (7), 11 alpha,15 beta-dihydroxypregna-4,17(20)-trans-diene- 3,16-dione (8), and 11 alpha,15 beta-dihydroxypregna-4,17(20)-cis-diene-3,16-dione (9). The structures of these compounds were elucidated on the basis of 1D and 2D NMR spectroscopic techniques.

Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia

We measured plasma catecholamine concentrations on admission (after eclamptic fit) and after 6 days of delivery in 21 eclamptic patients and on admission in 15 normotensive pregnant women in Bangladesh. Plasma epinephrine and norepinephrine concentrations in eclamptic patients were significantly higher on admission than those of normotensive pregnant women (P < 0.0001). Plasma catecholamine concentrations and mean arterial blood pressure had return to be almost normal as normotensive pregnant women after 6 days of delivery, resulting in no correlation between mean arterial blood pressure and plasma catecholamines. On admission (after eclamptic fit) mean arterial blood pressure was positively correlated with plasma epinephrine (r = 0.626, P < 0.002) and norepinephrine (r = 0.553, P < 0.008) concentrations in patients with eclampsia. The amount of proteinuria was also significantly correlated with plasma epinephrine (r = 0.515, P < 0.02) and norepinephrine (r = 0.606, P < 0.003) concentrations. Number of convulsions was significantly correlated with concentrations of plasma epinephrine (r = 0.514, P < 0.02), norepinephrine (r = 0.521, P < 0.01) and mean arterial blood pressure (r = 0.535, P < 0.01). A positive correlation was found between time passed after convulsion with plasma epinephrine (r = 0.515, P < 0.02) and norepinephrine (r = 0.570, P < 0.006) concentrations. These suggested that the increased plasma levels of epinephrine and norepinephrine in eclamptic patients were well correlated with the severity of the clinical features of eclampsia.

Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia

We measured plasma catecholamine concentrations on admission (after eclamptic fit) and after 6 days of delivery in 21 eclamptic patients and on admission in 15 normotensive pregnant women in Bangladesh. Plasma epinephrine and norepinephrine concentrations in eclamptic patients were significantly higher on admission than those of normotensive pregnant women (P < 0.0001). Plasma catecholamine concentrations and mean arterial blood pressure had return to be almost normal as normotensive pregnant women after 6 days of delivery, resulting in no correlation between mean arterial blood pressure and plasma catecholamines. On admission (after eclamptic fit) mean arterial blood pressure was positively correlated with plasma epinephrine (r = 0.626, P < 0.002) and norepinephrine (r = 0.553, P < 0.008) concentrations in patients with eclampsia. The amount of proteinuria was also significantly correlated with plasma epinephrine (r = 0.515, P < 0.02) and norepinephrine (r = 0.606, P < 0.003) concentrations. Number of convulsions was significantly correlated with concentrations of plasma epinephrine (r = 0.514, P < 0.02), norepinephrine (r = 0.521, P < 0.01) and mean arterial blood pressure (r = 0.535, P < 0.01). A positive correlation was found between time passed after convulsion with plasma epinephrine (r = 0.515, P < 0.02) and norepinephrine (r = 0.570, P < 0.006) concentrations. These suggested that the increased plasma levels of epinephrine and norepinephrine in eclamptic patients were well correlated with the severity of the clinical features of eclampsia.

A miniaturized rapid paper chromatographic procedure for quality control of technetium-99m sestamibi

A miniaturized rapid paper chromatographic technique (MRPC) for quality control of a technetium-99m sestamibi preparation was developed and compared with the manufacturer's and Hung et al. techniques. The MRPC system involves the use of 6.0x0.5cm Whatman 3MM paper strip developed in ethyl acetate. The procedure was completed within 3min while that of the manufacturer and Hung techniques took 30-35 and 4min respectively. The Rf range of 99mTc-sestamibi using MRPC was 0.55-0.75 while that of the other two techniques was 0.9-1.0. The results indicate that MRPC can be used to separate 99mTc-sestamibi from any 99mTc contaminant that migrates with the solvent front. The MRPC is a fast and effective chromatographic technique for routine quality control testing of 99mTc-sestamibi preparation.

Possible modulation of N-methyl-D,L-aspartic acid induced prolactin release by testicular steroids in the adult male rhesus monkey

N-methyl-D,L-aspartic acid (NMA), an agonist of the neurotransmitter glutamate has been shown to acutely stimulate the release of prolactin (PRL) in intact rats and monkeys. To further investigate the role of neuroexcitatory amino acids in PRL secretion, the effects of NMA administration were examined on PRL release in long term orchidectomized adult rhesus monkeys, in both the absence and presence of testosterone. Intact and long term castrated adult male monkeys weighing between 8-13 kg, were implanted with a catheter via the saphenous vein for blood withdrawal and drug infusion. Blood samples were collected at 10 min intervals for 50 min before and 70 min after administration of the drug or vehicle. Plasma PRL concentrations were estimated using radioimmunoassay. Whereas a single iv injection of NMA (15 mg/kg BW) induced a prompt discharge of PRL in intact monkeys, an identical dose had surprisingly no effect on PRL secretion in orchidectomized animals. On the other hand, plasma PRL increases in response to a challenge dose of thyrotropin releasing hormone (TRH; 6 micrograms/kg BW, iv) were similar in magnitude in the two groups of monkeys. Testosterone replacement in orchidectomized animals by parenteral administration of testosterone enanthate (200 mg/wk) reinitiated the PRL responsiveness to acute NMA stimulation. These results indicate that N-methyl-D-aspartic acid (NMDA) dependent drive to PRL release in the adult male rhesus monkey may be overtly influenced by the sex steroid milieu.

Cerebral perfusion changes in schizophrenic patients using Tc-99m hexamethylpropylene amineoxime (HMPAO)

Tc-99m hexamethylpropylene amineoxime (HMPAO) was used to image cerebral perfusion changes in 20 patients with chronic schizophrenia (19 male and 1 female, aged 22-48, at an average age of 29.0). All were being given neuroleptic drugs. Twelve had electroconvulsive therapy. In addition, all had abnormal studies except one, who was normal and had a poor response to treatment. Ventricular dilatation and cerebral atrophy was seen in eleven patients, and 77 focal lesions were detected. Forty-two lesions demonstrated increased HMPAO retention, which was distributed as follows: 26 in the basal ganglia in 14 patients (12 bilateral, 2 unilateral); 10 along the sylvian fissure in the parietotemporal region; and 3 in the frontal and 1 in each of the temporal, parietal, and occipital regions. Thirty-five focal lesions exhibited decreased perfusion: ten parietal, eight frontal, seven temporal, six cerebellar, and four occipital lobes. This study demonstrates the potential value of Tc-99m HMPAO in schizophrenia and other psychiatric disorders.

Role of thallium-201 in the diagnosis of solitary bone lesions

Thallium-201 is known to accumulate in malignant tumours. In this work we are evaluating the role of thallium in differentiating benign from malignant solitary bone lesions in 28 patients with solitary bone lesions on 99Tcm-MDP bone scans. Lesions' uptake of 201Tl was evaluated using visual assessment and lesion to background ratio. We found significant uptake with a mean lesion to background ratio of 4.27 in malignant lesions and no or faint uptake with a mean lesion to background ratio of 1.37 in benign lesions.

Effect of dexamethasone on the estrous cycle length in Black Bengal goats (Capra hircus )

In an experiment to examine the relationships between adrenals and reproductive cycle, 10 mg dexamethasone (a synthetic glucocorticoid) were injected intramuscularly twice daily for 10 d to four Black Bengal goats, beginning on Day 11 of the synchronized estrous cycle. The extended length of the sexual cycle was monitored by the clinical signs of anestrus. Laparotomy was performed to examine the status of the ovary of an 8, 9, 10 and 8 d extended cycle, respectively. The length of the next cycle was normal. Endogenous cortisol values were suppressed for 11, 13, 20 and 24 d, respectively. It is thought that dexamethasone caused prolonged luteal function either by the suppression of prostaglandin F(2)alpha synthesis or by the suppression of pituitary stimulation of follicular growth.

Congenital absence of the mammary gland

Tc-99m pertechnetate is known for its uptake and excretion by the mammary gland. Generally, lactating women are not advised to have any radioisotopic studies. If it is necessary to have one, it is recommended that they do not breast-feed their children for at least 24 hours. Congenital absence of the mammary gland is a rare condition. This case was accidently discovered. Nuclear medicine physicians should be aware of the value of clinical examination of patients, and that not every absent or asymmetric breast shadow is due to surgical resection.

Liver metastasis from embryonal carcinoma of the ovary with complete situs inversus. First reported case and review of literature

Embryonal carcinoma of the ovary in a 17-year-old Saudi girl with complete situs inversus is reported. According to reports since 1936, this is the sixteenth case of cancer associated with complete situs inversus, the second ovarian cancer, the first embryonal carcinoma of the ovary, and the youngest cancer case to be reported in association with this congenital anomaly.

Nutritional Profile of Some Tropical Fruits in Bangladesh: Specially Anti-Oxidant Vitamins and Minerals

Objective: Fruits and vegetables are important for the daily diet as these contain micronutrients, fiber, potassium, folate, Vitamin C, vegetable proteins, carotenoids and polyphenols, which act as antioxidants within the body as well as bio-functional components. The aim of the study is to establish nutritional profile specially antioxidant vitamins and minerals of tropical fruits in Bangladesh. Methodology: Nutritional composition and physico-chemical properties, such as pH, titratable acidity, moisture, total soluble solid, crude fibre, total carbohydrate, total protein, total fat, total energy, vitamin C, beta-carotene, ash, sodium, potassium, iron, zinc, copper, manganese, phosphorus, calcium and magnesium content of ten tropical fruits namely Blackberry, Java apple, Jack fruit, Pineapple, Carambola (Star fruit), Golden apple, Mango, Melon, Monkey jack, Star gooseberry were determined according to standard methods. Results: Results of this study suggest that the tropical fruits of Bangladesh were excellent source of antioxidant vitamins and minerals like vitamin C, beta- carotene, iron, zinc, copper and manganese. These fruits were also good source of potassium, phosphorus, calcium and magnesium but poor source of protein and fat and sodium. Conclusion: Present study strongly suggests that star gooseberry, monkey jack, pineapple and golden apple were antioxidant vitamins and minerals enriched tropical fruits. Key words: Antioxidant vitamins and minerals; micronutrients; tropical fruits. DOI: http://dx.doi.org/10.3329/bjms.v10i2.7804 Bangladesh Journal of Medical Science Vol.10 No.2 Apr’11 pp.95-103

Leptin Concentrations in Maternal and Umbilical Cord Blood in Relation to Maternal Weight, Birth Weight and Weight of the Placenta

Objective: Leptin is a hormone which regulates adipose tissue mass of the body. Substantial increase of leptin during pregnancy and detection of leptin and leptin receptor in placenta have led to the speculation that leptin is a gestational hormone with a possible role in regulation of fetal growth. The study was done to find out whether maternal and cord blood leptin correlate with birthweight and weight of the placenta. Materials and methods: A prospective cross sectional study was undertaken in the Department of Obsterics and Gynecology, Bangabandhu Sheikh Mujib Medical University from January 2005 to June 2005. The study was carried out on 39 pairs of mothers and newborns. Maternal venous blood was sampled just before delivery. Cord blood was obtained, birth weight and placental weight measurements were taken just after delivery of the baby. Serum leptin levels were measured by enzyme linked immunosorbent assay. Results: Maternal serum leptin was 24.50 ng/ml (range- 13.15-45.60 ng/ml) and cord serum leptin was 6.50 ng/ml (range- 2.02-12.30 ng/ml). There was no correlation between maternal leptin and birth weight or between maternal leptin and placental weight. Cord leptin was significantly correlated with birth weight but not with placental weight. There was no correlation between maternal and cord blood leptin. There was no significant gender differences in cord blood leptin concentrations. Conclusions: There may be an important role of leptin in regulation of fetal growth and development. Placenta may not be a major source of leptin in maternal and feto-placental circulation. Maternal leptin cannot be a reliable marker of fetal growth. Keywords: Serum leptin, birth weight, placental weight   doi: 10.3329/bjog.v23i1.3049 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 3-7