Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I² = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.

Background: Wound healing is a dynamic process which is divided into four phases; haemostasis, inflammatory, proliferation and tissue remodelling phases, that encompasses inflammatory cells, cytokines and growth factors. Interleukin-6 (IL-6), Vascular Endothelial Growth Factor (VEGF) and Matrix Metalloproteinase 9 (MMP-9) involve at the different phases of wound healing. Channa striatus (C.striatus) is a fresh water fish that is believed to have natural properties to promote wound healing. Currently, the effects of C.striatus on the cytokines and growth factors are not available. Objective: This study was conducted to evaluate the wound healing biomarkers; IL-6, VEGF and MMP-9 on post Lower Segment Caesarean Section (LSCS) women consuming oral C.striatus extract. Methods: This was a randomised, double-blinded study amongst LSCS women consuming C.striatus extract versus a placebo at Universiti Sains Malaysia Hospital and Raja Perempuan Zainab II Hospital from May 2011 to January 2013. After randomization, the treatment group received freeze dried C.striatus extract 500 mg daily while the placebo group received maltodextrin 500 mg daily for 6 weeks. Blood samples for IL-6, VEGF and MMP-9 were taken from both groups post-operatively at day 3, week 2, week 4 and week 6. The data were analysed using SPSS version 22. Results: A total of 39 patients from C.striatus and 34 patients from placebo group were included in this study. Within C.striatus group, the results of IL-6, MMP-9 and VEGF showed significant differences (P<0.05) for all the study period. Between group comparison showed significant difference (P<0.05) on week 4 and week 6 for IL-6 and MMP-9 whereas VEGF showed significant difference (P<0.05) on day 1, day 3, week 4 and week 6. The trend of IL-6 and MMP-9 exhibit decreasing trend in both groups however, VEGF in C.striatus group exhibit increasing trend till week 6 compared to placebo group. Conclusion: This study showed C.striatus extract had effects on IL-6, VEGF and MMP-9 in post LSCS women. Bangladesh Journal of Medical Science Vol.19(3) 2020 p.520-526

Breast cancer is the most common diagnosed cancer and the leading cause of cancer-related deaths among women globally. This study examined the impact of insulin-like growth factor binding protein-3 (IGFBP-3) A-202C polymorphism (rs2854744) on breast cancer risk and its association with insulin-like growth factor-1 (IGF-1) and IGFBP-3 serum levels among Palestinian women in the Gaza Strip. Understanding these genetic variants could guide the development of early detection strategies and personalized interventions for breast cancer in underrepresented populations. A case-control study involved 112 women with newly diagnosed breast cancer and 222 healthy controls. Genotyping of the IGFBP-3 A-202C polymorphism was performed using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP), and serum IGFBP-3 and IGF-1 levels were measured. The CC genotype of IGFBP-3 A-202C was observed in 70.5% of cases and 20.7% of controls, conferring a 16-fold increased breast cancer risk (OR=16.237; 95%CI 7.904, 33.356, p ≤ 0.001). The AC genotype was found in 19.6% of cases and 32.4% of controls, also associated with ~ 3-fold increased risk (OR=2.889; 95%CI 1.319, 6.325, p = 0.008). The CC genotype conferred a 28-fold increased risk in premenopausal women (OR=28.050; 95%CI 10.281, 76.527, p ≤ 0.001) and 5-fold in postmenopausal women (OR=5.333; 95%CI 1.711, 16.620, p = 0.004). Women with the CC genotype had the highest mean serum IGF-1 levels (116.49 ng/mL, p ≤ 0.001) and IGFBP-3 levels (3.76 µg/mL, p = 0.006) compared to those with the AA genotype. Positive correlations were observed between IGFBP-3 polymorphism and serum IGF-1 (r_s= 0.175, p ≤ 0.001) and IGFBP-3 levels (r_s = 0.164, p = 0.003). The IGFBP-3 A-202C polymorphism, especially the CC genotype, is strongly associated with elevated serum IGFBP-3 and IGF-1 levels and increased breast cancer risk, highlighting its potential as a biomarker for breast cancer screening and risk stratification. Further studies are needed to validate these findings in diverse populations.

Glycated hemoglobin (HbA1c) is used to monitor the long-term management of diabetes and reflects the average blood glucose level over the past three months. Hb J is an alpha-globin gene variant that occurs less commonly but can interfere with the HbA1c result. This case report presents two cases of abnormally high HbA1c in patients with Hb J using the high-performance liquid chromatography (HPLC) method and repeated value using the capillary electrophoresis (CE) method. The first case was a 26 years old female Malay patient, presenting at 25 weeks gestation with diabetes mellitus (DM). Her HbA1c results from HPLC showed persistently high level (> 18.5%, > 179 mmol/mol) despite optimum diabetic control (fasting blood sugar (FBS) range 4.0–6.1 mmol/L). The second case was a 62-year-old female Malay with type 2 DM. Her HbA1c results from HPLC was also persistently high (> 18.5%, > 1;79 mmol/mol) despite good diabetic control (FBS average 5.0–7.0 mmol/L). Both patients’ hemoglobin analysis reports were suggestive of Hb J. Repeated HbA1c using CE were 6.0% (42 mmol/mol) and 8.1% (65 mmol/mol), respectively, and supported the presence of the Hb J variant peak. HbA1c measurement in patients with a variant should be interpreted with caution to avoid misdiagnosis and mismanagement in these kinds of patients.

Haemoglobin A1c (HbA1c) is used to monitor glycaemic control and predict diabetic complications. Measurement of HbA1c can be interfered by haemoglobin (Hb) variant and other Hb derivatives include carbamylated Hb and elevated labile A1c. This study is to determine the percentages and type of interferences during HbA1c analysis and the percentages of non- reportable HbA1c results. This is a cross-sectional study using retrospective data of HbA1c. The HbA1c is measured on Biorad D10 using the ion-exchange high-performance liquid chromatography method. The data were analyzed using descriptive statistics. A total of 26,560 patients were included. The result showed the presence of interferences of 2269 (8.56%). The most common causes of the interferences were the Hb variant (8.48%) followed by carbamylated Hb and labile A1c (0.03% each). The non-reportable HbA1c results were 0.46% with the Hb variant contributed most of the causes. By knowing the presence of interferences particularly the Hb variant, the HbA1c results hopefully are interpreted with caution and correct management can be given to the patients.

Objectives: Acute appendicitis is one of the most common surgical emergencies. Perforated appendicitis can result in increased morbidity and mortality. Thus, early identification of perforation can reduce the impact on patient and improve outcome. Apart from total white cell count (TWCC), serum total bilirubin (SB) has been shown to indicate perforation in appendicitis. The aim of this study was to assess the usefulness of serum total bilirubin (SB) as the preoperative indicator for perforated appendicitis. Materials and Methods: This was a retrospective study of all appendicectomies cases done in Hospital Universiti Sains Malaysia (HUSM) over a one-year period in 2014. Only patients with histopathologically confirmed appendicitis with available liver function tests and total white blood cell count preoperatively were included in the study. These appendicitis cases were further divided into perforated and non-perforated based on histopathological reports obtained. Results: A total of 245 patients had appendicectomy done in 2014 between January to December 2014. Out of 110 from these 245 patients met the inclusion and exclusion criteria. SB was significantly higher (p<0.001) in patients with perforated appendix compared to non-perforated. Conclusion: In conclusion, this study showed that preoperative SB is a useful laboratory parameter for perforated appendicitis to improve clinical decision-making by the clinician. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.233-237