Samsad Jahan

Gender differences in serum leptin concentrations from umbilical cord blood of newborn infants born to nondiabetic, gestational diabetic and type-2 diabetic mothers.

To investigate gender differences, if any, in leptin concentrations from umbilical cord blood of new born infants of mothers with type 2 diabetes mellitus (DM), gestational diabetes mellitus (GDM), and Non diabetic (ND) at delivery. Serum leptin concentrations were measured in 105 newborns (53 males and 52 females in the three groups). Blood was taken from the umbilical cord of the babies at delivery. Maternal anthropometric measurements were recorded within 48 hours after delivery. Pearson correlation coefficient was used to explore the relationship between serum leptin concentrations and anthropometric measures of the fetus and their mother. Both Serum leptin level and serum C-peptide was measured by chemiluminescence based ELISA. The median range of leptin concentration in cord blood was ND group: Male [13.91 (3.22 – 47.63)], Female [16.88 (2 – 43.65)]; GDM group: Male [32 (7 – 76.00)], Female [36.73 (4.80 – 81.20)]; DM group: Male [20.90 (2 –76.00)], Female [32 {2.58 – 80.67)]. Cord serum leptin levels correlated with birth weight(r=0.587, p=0.0001), ponderal index (PI) (r=.319, p=0.024)of the babies and body mass index (BMI) (r=−0.299, p=0.035) of their mothers but did not correlate with gestational age, cord serum C-peptide concentration or placental weight at delivery. Leptin concentrations were higher in the female fetus in comparison to the male fetus. Birth weight of the female fetuses were also higher than that of male fetus. We found that there are very strong associations between cord leptin concentrations at delivery and birth weight, ponderal index of the baby, body mass index of the mothers with Type 2 DM. We also found that high leptin levels could represent an important feedback modulator of substrate supply and subsequently for adipose tissue status during late gestation or adipose tissue is the major determinant of circulating leptin levels.

Influence of maternal diabetes on serum leptinemic and insulinemic status of the offspring: A case study of selected patients in a tertiary care hospital in Bangladesh

INTRODUCTION Leptin is now known to be an important hormone affecting intrauterine fetal growth. Since growth of fetus is also affected by the glycemic status of the mother. Serum leptin of infant is influenced by the maternal diabetic state. Investigation of cord blood leptin in babies of DM (Diabetes Mellitus) and GDM (Gestational Diabetes Mellitus) mothers (controlled blood glucose levels) may provide some indication about involvement of genetic factor in the development of leptin abnormalities in fetus. AIM The study was taken to investigate whether cord blood insulin, c-peptide and leptin levels correlate with birth weight in offspring of DM mother. METHODS Blood was drawn from umbilical cord of 30 babies from GDM mothers (GDM-babies), 45 babies from Type 2 DM Mothers (DM-babies), and 30 babies from ND (Nondiabetic) mothers (ND-babies) of term pregnancy. Weight, blood glucose, placenta, serum leptin and c-peptide of the babies were measured. RESULTS Birth weight of GDM and DM babies were significantly higher compared to ND-babies. Glucose level in GDM babies was significantly higher than ND and DM babies. Leptin levels in GDM babies were significantly higher than that of ND and DM babies. Serum c-peptide in GDM babies was significantly higher than DM and ND babies. However, there was no significant difference in leptin-glucose ratio among the three groups. Irrespective of degree of hyperglycemia leptin is a major determinant of fetal growth. CONCLUSIONS DM mother produces different insulinemic and leptinemic responses in the fetus indicating a possible genetic involvement.

Laparoscopic hysterectomy in large uteri: Experience from a tertiary care hospital in Bangladesh

The purpose of this study was to examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy for uteri weighing more than 500 g as compared to uteri weighing less than 500 g in benign gynecological diseases.

A comparative study between laparoscopically assisted vaginal hysterectomy and vaginal hysterectomy: Experience in a tertiary diabetes care hospital in Bangladesh

Objective: The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery. Materials and Methods: A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon. Results: There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively. Conclusions: LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.

Pre-pregnancy Body Mass Index and the Risk of Adverse Pregnancy Outcome in Two Thousand Type 2 Diabetes Mellitus Bangladeshi Women

Background: The aim of the present study were to evaluate the frequency of maternal complications and adverse fetal outcomes in a group of singleton pregnant women with type 2 diabetes mellitus to compare the outcome in three groups (lean, normal and overweight). Materials and Methods: The women were categorized into three groups: lean 25.0-29.9 kg/m2. The effect of pre-pregnancy BMI was analyzed by comparing the frequencies of various outcomes in three BMI groups. The results were expressed as odds ratio (ORs) and the corresponding 95% confidence intervals (CIs) & p values. Results: The risk of late fetal death was consistently increasing with BMI (ORs were 1.2 (0.9-1.7), 1.6 (1.1-2.3) & 2.6 (1.7-3.8) for lean, normal & overweight respectively). The risk of early neonatal death was also higher among women with higher BMI (ORs was 1.6 (1.1-2.3) for overweight). The rate of preeclampsia is higher among women with lean and overweight BMI in compares to normal BMI (the values were 2.5%, 1.8%, & 7.0% for lean, normal & overweight respectively). Hypertensive disorders was also more common among lean (3.8%) and overweight (3.6%) compared to normal (1.6%). The risk of preterm delivery was significantly increased for overweight group (4.2%) and lean (2.4%), as compare to normal. The risk of SGA was significantly more in lean (2.7%) compared to normal weight (1.5%) & overweight group (1.9%). Conclusion: Pre-pregnancy overweight increases the risk of late fetal death and perinatal mortality.

Kallmann's Syndrome: A Rare Cause of Primary Amenorrhoea

Kallmann syndrome is a very rare hereditary disease. It is characterized by hypogonadotropic hypogonadism in association with anosmia ot hyposmia, both of which occur as a result of impairment of olfactory axon development and failure of migration of gonadotropin-releasing hormone (GnRH) neurons. Mode of inheritance can be autosomal dominant, autosomal recessive, or X-linked. We report a case of Kallmann syndrome in an 18 year old girl who presented with primary amenorrhoea, poor sexual development with poor sense of smell and colour blindness. Plasma levels of LH, FSH and oestradiol were very low. The patient’s other pituitary hormone levels were normal. Chromosome analysis showed 46, XX karyotype. USG of lower abdomen confirmed presence of uterus and ovaries. MRI of brain showed olfactory bulbs to be present and there was no pituitary or hypothalamic lesion. We present this case for its very rare occurrence in the eastern part of the world and the typical feature being normal MRI brain with functional defect of the olfactory pathway. Treatment was started with cyclic conjugated oestrogen and progestin. Our patient is now on regular follow-up to monitor response to treatment.