Correlation of Serum Anti-Mullerian Hormone with Clinical, Metabolic and Hormonal Parameters in Bangladeshi Women with Polycystic Ovary Syndrome: A Cross-sectional Study

Metabolic dysfunctions are common in polycystic ovary syndrome (PCOS). Alongside its utility in PCOS diagnosis, anti-Mullerian Hormone (AMH) is emerging as a metabolic risk marker in PCOS. Data relating to the metabolic importance of AMH in Bangladeshi women with PCOS are lacking. This study aimed to evaluate serum AMH in newly diagnosed women with PCOS and correlate the AMH levels with their clinical, hormonal, and metabolic parameters. This cross-sectional study evaluated 150 newly diagnosed women with PCOS attending a tertiary hospital in Bangladesh from January 2020 to December 2020. Alongside clinical assessment, blood glucose, lipids, total testosterone (TT), thyroid-stimulating hormone (TSH), prolactin and AMH were measured. The median age of the study subjects was 21.5 years (interquartile range 18.0-26.0 years); the median AMH level was 5.09ng/dL (interquartile range 3.64-7.73ng/dL) and 52.0% had metabolic syndrome. Age, body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, plasma glucose 2 hours after oral glucose tolerance test, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, TT, TSH, and prolactin levels and the frequencies of hirsutism and metabolic syndrome were similar across the quartiles of AMH. AMH correlated with none of the variables except TT, with which a strong positive correlation was found. Participants with PCOS phenotype A had the highest AMH levels, and the difference in AMH across the phenotypes was statistically significant.

Etiology of Chronic Abnormal Uterine Bleeding According to the FIGO's PALM-COEIN Classification in Bangladeshi Women of Reproductive Age: A Cross-Sectional Study

Chronic abnormal uterine bleeding (AUB) is common, but there is a lack of standardized methods for investigating and etiological categorization of AUB. The PALM-COEIN classification system of AUB is getting important to overcome this issue. This cross-sectional study was conducted from January 2019 to December 2019 at Mymensingh Medical College Hospital, Mymensingh, Bangladesh, to determine the causes of AUB in women of the reproductive age group and categorize the causes of AUB as per the PALM-COEIN classification. A total of 380 women with chronic AUB were evaluated. The distribution of PALM-COEIN causes of AUB were AUB-P (1.8%), AUB-A (9.2%), AUB-L (13.2%), AUB-M (5.8%), AUB-C (1.1%), AUB-O (24.7%), AUB-E (1.6%), AUB-I (6.6%), and AUB-N (36.1%). The participants' mean age was 29.6 (±10.5) years, the majority (78.2%) of them was married, only a few (9.5%) had comorbid diseases, including hypertension (HTN) (1.1%), diabetes mellitus (DM) (5.3%), and hypothyroidism (8.7%). Women in the AUB-M classification had higher age than others; anemia was more prevalent in the AUB-P group, the AUB-O group had the highest TSH levels and hypothyroidism frequency. The PALM-COEIN classification helps ascertain the cause of AUB practically and should be used in routine clinical practices to manage these patients better.

Study of Bacterial Pathogens in Urinary Tract Infection and their Antimicrobial Sensitivity Pattern in the Setting of Gynecology Outpatient Department

Urinary tract infection (UTI) is commonly encountered in both community and hospital settings and is often associated with significant morbidity. The inappropriate administration of antibiotics to treat UTI increases the development of antimicrobial resistance to antibiotics. This cross-sectional study was conducted at the gynecology outpatient department (OPD) of Mymensingh Medical College Hospital, Bangladesh, from January 2018 to November 2019 to determine the frequency of causative micro-organisms of UTIs and their antibiotic resistance pattern. Four hundred eight women presenting with the symptoms of UTI referred with a diagnosis of UTI based on a urine routine examination, culture, and sensitivity reports to the OPD were included in the study. Antibiotic sensitivity testing was done in the microbiology department of the hospital following the Kirby-Bauer disc diffusion method. E. coli was the most common (48.5%) organism isolated, followed by Proteus (21.6%), Klebsiella (15.0%), Enterococcus spp. (4.7%), S. aureus (3.9%), Acinetobacter spp. (3.9%), and Pseudomonas (2.5%). The distribution of the causative organisms in various age groups of the patients was similar. Overall, most (>80%) of the organisms were resistant to Erythromycin (93%), Ampicillin (92%), Amoxycillin (90%), and Cefuroxime (84%); the highest sensitivity was found for Meropenem (85%), Amikacin (81%), Gentamycin (79%), and Nitrofurantoin (71%). The highest sensitivity of E. coli was found for Meropenem (90%), Amikacin (83%), Gentamycin (83%), and Nitrofurantoin (76%). E. coli were resistant to Ampicillin (100%), Amoxycillin (100%), and Erythromycin (100%), Cephalexin (85%), and Cefuroxime (85%). Proteus was highly sensitive to Meropenem (90%) and Gentamycin (82%), whereas highly resistant to most of the antibiotics. Klebsiella was found sensitive to Amikacin (90%), Gentamycin (77%), Meropenem (74%), and Ciprofloxacin (74%) and resistant to Ampicillin (100%), Erythromycin (87%), Cefixime (80%), and Cefuroxime (76%). The results of this study showed that resistance is likely to be against the most commonly used antibiotics. Most of the uropathogens showed sensitivity to injectable antibiotics, namely Meropenem, Gentamycin, and Amikacin.

Frequency and Correlates of Albuminuria in Adult Bangladeshi Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is associated with various metabolic risks imparting a higher risk for cardiovascular diseases (CVD) in affected women. Urinary albumin excretion (UAE) is a marker of endothelial leakiness and reflects early endothelial damage; thus is used as an important cardiovascular (CV) risk marker. UAE as a CV risk marker in PCOS patients is less well established. This cross-sectional study was done in a tertiary hospital of Bangladesh from January to December 2018 and 95 consecutive adult PCOS patients were screened for UAE. Clinical and anthropometric data were collected, and oral glucose tolerance test (OGTT), fasting lipid profile, serum creatinine, urine routine examination, total testosterone, prolactin, and TSH were measured. The urine albumin-to-creatinine ratio (UACR) was measured in a random single-voided urine sample. UACR cutoff ≥30mg/g was used to define albuminuria. The mean age of the subjects was 22.5±5.0 years; 72.6% were overweight/ obese; 68.4% had abdominal obesity; 94.7% had dyslipidemia and 40% of them had metabolic syndrome. Albuminuria was observed in 21.1% of the subjects. A higher frequency of metabolic syndrome was observed in albuminuric subjects than non-albuminuric ones (45% vs. 38.7%), though the difference was not statistically significant (p=0.617). Albuminuric subjects had higher plasma glucose (PG) value at 2 hours of OGTT and a higher frequency of acne. Other clinical, biochemical and hormonal parameters were similar in the two groups. PG 2 hours after OGTT and serum triglyceride (TG) showed positive correlations and LDL cholesterol showed a negative correlation with UACR. Our study emphasizes the need for screening PCOS women for UACR which may be helpful in identifying those subjects with future high risk of CVD.

Association of Vitamin D Status with Metabolic Syndrome and its Components in Polycystic Ovary Syndrome

Metabolic syndrome (Met-S) and vitamin D deficiency (VDD) are common in polycystic ovary syndrome (PCOS) and hypovitaminosis D in PCOS was found to be associated with Met-S and its components. This cross-sectional study evaluated 110 newly diagnosed women with PCOS randomly recruited from the Endocrinology outpatient department of Mymensingh Medical College Hospital, Bangladesh from January to December 2018 to assess vitamin D status and to explore the relationship of vitamin D status with Met-S and its components. Met-S was diagnosed by using the International Diabetes Federation (IDF) criteria applicable for South Asian women. Serum 25(OH)D was measured by using chemiluminescence immunoassay (CLIA) method and vitamin D status was determined as per The Endocrine Society cut points. Out of 110 PCOS women studied, 44(40%) had Met-S and 72 (65.5%) had vitamin D deficiency. Subjects with Met-S had higher body mass index (BMI), waist circumference (WC), systolic blood pressure (BP), diastolic BP, fasting plasma glucose (FPG), plasma glucose 2 hour after oral glucose tolerance test (PG 2H-OGTT), triglyceride (TG), total and LDL-cholesterol. The mean vitamin D level was lower in Met-S subjects than those without (17.25±5.71 vs. 20.09±7.02, p=0.027). The frequency of VDD was also higher in Met-S group (75% vs. 59.1%, p=0.227). Vitamin D level showed significant positive correlations with PG 2H-OGTT, TG, total and LDL-cholesterol. Age, BMI, WC, systolic BP, diastolic BP, Ferriman Galway score, FPG, HDL cholesterol, testosterone, prolactin, and TSH had no correlations with vitamin D level. Vitamin D may be associated with Met-S in PCOS as Met-S subjects had lower vitamin D level and higher frequency of vitamin D deficiency, and also correlated with some components of Met-S.

Thyroid Dysfunction and Autoimmunity in First Trimester of Pregnancy, Single Center Experience in Bangladesh

Study on thyroid function and thyroid autoantibody status in pregnancy considering the trimester specific range, is scarce in Bangladesh. This cross sectional study done in Bangabandhu Sheikh Mujib Medical University, Bangladesh from August 2012 to June 2013 encompassed 186 pregnant women of first trimester for study of thyroid function (TSH, FT₄) and anti-thyroid antibodies (anti-TPO, anti-TG). Age of the subjects was 25.4±4.9 years (mean±SD), median gestational age was 9 weeks. Applying the trimester-specific normal reference range set by American Thyroid Association (ATA), 48(25.8%) of the women were found to have thyroid dysfunction; 40(21.5%) subclinical hypothyroid (SCH), 1(0.5%) overt hypothyroid (OH) and 7(3.8%) hyperthyroid; 40(21.5%) women had goiter. If non-pregnant adult normal rage is used, 22 of SCH women as per ATA criteria will be labeled as normal and 19 normal women as per ATA cut off will be labeled as hyperthyroid. There was statistically significant disparity for functional status defined by these two references cut off value (p<0.001). 29(15.6%) women had thyroid autoimmunity and the autoantibody positivity was more frequent in women with thyroid dysfunction than euthyroid women (22.92% vs. 13.04%, p<0.001). Even though universal screening for thyroid dysfunction is not yet a recommendation, it should be considered in our population.

Feasibility and Safety of Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Thalassemia in Bangladesh

Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia. All CVS are done at Fetal Medicine Centre, Family Foundation, Green Road, Dhaka, Bangladesh from June 2013 to December 2016. A total of 236 couples who were referred for prenatal diagnosis of thalassemia (Beta thalassemia & Hb-E beta thalassemia) were studied. Transabdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. Most procedures were done between 11 and 13 weeks (range 11-14 weeks). All CVS were performed with the "2 operators" technique. The samples were sent for prenatal diagnosis by genetic analysis. Results were recorded and analyzed for descriptive statistics. Out of 236, 123 (52.1%) fetuses were diagnosed as trait (Beta trait or HbE trait), 64 (27.1%) as healthy fetuses and 49 (20.7%) as affected fetuses. A total of 236 CVSs were performed as outdoor basis. Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% & 1.3% respectively which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Transabdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis of beta thalassaemia in early pregnancy without significant risk to the mother and the fetus.