MyMedR

Endometriosis and infertility: raised iron concentration in the peritoneal fluid and its effect on the acrosome reaction

Arumugam K

Hum Reprod, 1994 Jun;9(6):1153-7.

PMID: 7962392

Endometriosis and infertility are commonly associated. This study investigated the role of accelerated lipid peroxidation of spermatozoa by the peritoneal fluid of patients with endometriosis as a cause for this association. It proposes that the increased iron concentration present in the fluid of these patients acts as a catalyst for the process. Peritoneal fluid from 25 patients with endometriosis and 25 matched controls was obtained at laparoscopy. Spermatozoa were incubated in the fluid from both groups and the subsequent acrosome reaction rates analysed. The relationship between these results and iron concentration in the fluid was examined. A significant decrease in the acrosome reaction rate was seen in the endometriotic group (P = 0.034). Overall, a decrease in the acrosome reaction rate was associated with an increased iron concentration in the fluid (18 of the 25 pairs). In mild disease, (six of 11 pairs), the relationship was not as marked as that in severe disease (12 of 14 pairs). These results suggest that the peritoneal fluid in patients with endometriosis has a detrimental action on the acrosome reaction of spermatozoa in vitro.

Serum prolactin levels in infertile patients with endometriosis

Arumugam K

Malays J Pathol, 1991 Jun;13(1):43-5.

PMID: 1795561

Raised prolactin levels have been implicated as a cause for infertility in patients with endometriosis. This study was done to investigate if serum prolactin levels were significantly raised in infertile patients with endometriosis. Serum prolactin levels were studied in 43 infertile patients with endometriosis. For controls, 36 infertile patients with normal pelvic findings were used. For standardization, blood samples were drawn on day 21 of the menstrual cycle. Analysis was done by radioimmunoassay using reagent kits. The mean prolactin level in the endometriotic group was 372 mIU/l (range 187-752) while that in the controls was 333 mIU/l.(range 124-767). There was no statistical difference (t = 1.12). Furthermore the accepted normal level for serum prolactin in our population is less than 540 mIU/l. These results show that there is no evidence to implicate raised prolactin levels as a cause for infertility in patients with endometriosis.

Perinatal outcome amongst the Malays in an urban hospital

Arumugam K

Asia Pac J Public Health, 1992;6(1):32-4.

PMID: 1304776 DOI: 10.1177/101053959200600109

National data show that the perinatal mortality amongst the Malays is higher than that of the Chinese but less than that of the Indians. These figures include data from both urban and rural areas. In the University Hospital, Kuala Lumpur, however, the perinatal mortality amongst the Malays was found to be the lowest; an odds-ratio of 0.72 (95% confidence limits; 0.59-0.87; P < 0.0005) when compared to the non-Malays. This occurred despite a significantly higher parity amongst the Malays. The Malays in this group of patients however, had a significantly better social class distribution.
Publication year: 1992-1993

Fulltext The polycystic ovarian syndrome and infertility: a metabolic disorder that needs early diagnosis and treatment

Arumugam, K., Majeed, N.A.

JUMMEC, 2011;14(1):6-9.

MyJurnal

We investigated the association between polycystic ovarian syndrome, dyslipidemia and glucose intolerance in a cross sectional analysis comparing 50 patients with polycystic ovary syndrome and 50 patients without the disease (control group) who were attending the Infertility clinic. Variables of interest were their body-mass index (Kg/m2), fasting and blood glucose levels after a 75 gram oral glucose tolerance test and their total cholesterol (mmol/L), total triglycerides (mmol/L), high density cholesterol lipoprotein (HDL) cholesterol (mmol/L) and, low density lipoprotein cholesterol (mmol/L) levels. Except for HDL where significantly lower values were observed, significantly higher levels were detected in patients with PCOS than that of the control group. The difference persisted even when the obesity index were adjusted and matched. We conclude that both glucose intolerance and dyslipidemia were significantly associated with PCOS irrespective of the obesity index.

Emergency cervical circlage for cervical incompetence

Arumugam K, Ratnavale M

J Obstet Gynaecol, 1997 Jan;17(1):49-50.

PMID: 15511765

Twelve patients had emergency cervical circlage for inevitable middle trimester abortion due to cervical incompetence. The mean gestation was 23 weeks (range 15-28 weeks). The median cervical dilatation was 3 cm. In three patients, the cervical dilatation was more than 5 cm. The median prolongation of pregnancy was 3.3 weeks (range 4 days to 10 weeks). Eight of the 14 babies survived. All babies that survived were more than 1000 g. Based on our experience, we advocate an active approach to inevitable middle trimester abortions due to cervical incompetence.

Endometriosis and social class: an Asian experience

Arumugam K, Welluppilai S

Asia Oceania J Obstet Gynaecol, 1993 Sep;19(3):231-4.

PMID: 8250754

The social class distribution in 147 patients confirmed to have endometriosis at laparoscopy was done to see if the disease was associated with affluence. Two hundred and eighty-one patients confirmed not to have endometriosis was used as controls. The patients were derived from a background population for which the social class characteristics was known. Endometriosis was significantly (p < 0.001) associated with social class 1 and 2. However there was no association between social class distribution and the severity of the disease developed.

Causes for infertility: a comparative study

Arumugam K, Urquhart R

Ann Acad Med Singap, 1991 May;20(3):351-2.

PMID: 1929177

A representative group of 204 infertile couples from Kuala Lumpur, Malaysia were compared to a similar group of 633 couples from Aberdeen, UK in an attempt to study if there was any regional difference in the pattern of infertility seen. The protocol for investigation and diagnostic criteria for both centres were standardised. A significant difference (X2 = 63.43; p less than 0.001) was seen. The reasons for these differences are discussed.

Physical, psychological and sexual effects in multi-ethnic Malaysian women who have undergone hysterectomy

Wong LP, Arumugam K

J Obstet Gynaecol Res, 2012 Aug;38(8):1095-105.

PMID: 22540215 DOI: 10.1111/j.1447-0756.2011.01836.x

The postoperative effects on Asian women after hysterectomy have not been fully explored. This study was undertaken to investigate the physical, psychological and sexual functioning effects in multi-ethnic Malaysian women who have undergone hysterectomy.

Menstrual characteristics associated with endometriosis

Arumugam K, Lim JM

Br J Obstet Gynaecol, 1997 Aug;104(8):948-50.

PMID: 9255089

This case-controlled study investigates whether the presence of menstrual characteristics, which may increase the exposure of the peritoneal cavity to retrograde menstruation, increases the risk of developing endometriosis. The menstrual characteristics considered were 1. age at menarche of less than 12 years, 2. duration of menstrual flow greater than five days and 3. menstrual cycle lengths of < 28 days. The frequency with which these menstrual characteristics occurred in 305 women with proven endometriosis was compared with their frequency in 305 age-matched women without endometriosis. Adjusting for the confounding factors of parity, age at first childbirth and social class, the only menstrual characteristic that was significantly associated with endometriosis was menstrual cycle lengths of less than 28 days (odds ratio 1.83; 95% confidence intervals 1.60-2.55). There was insufficient evidence to conclude that the presence of menstrual characteristics which may increase the exposure of the peritoneal cavity to retrograde menstruation, increase a women's risk of developing endometriosis. The association of short menstrual cycle lengths with endometriosis may have been consequential rather than causal.

Endometriosis and infertility: the role of exogenous lipid peroxides in the peritoneal fluid

Arumugam K, Dip YC

Fertil. Steril., 1995 Jan;63(1):198-9.

PMID: 7805914

OBJECTIVE: To determine if lipid peroxides were raised in the pelvic peritoneal fluid of patients with endometriosis.

DESIGN: Control study involving patients with and without endometriosis.

METHODS: The lipid peroxide (malondialdehyde) levels in the pelvic PF of 12 patients with moderate-to severe endometriosis, 15 patients with minimal-mild endometriosis and 13 patients with normal pelvises were compared.

RESULTS: The level of lipid peroxides were not affected by the presence nor the severity of endometriosis.

CONCLUSION: Accelerated lipid peroxidation does not appear to play a role in the causal relationship between endometriosis and infertility.

De novo formation of adhesions in endometriosis: the role of iron and free radical reactions

Arumugam K, Yip YC

Fertil. Steril., 1995 Jul;64(1):62-4.

PMID: 7789581

OBJECTIVE: To show that raised iron levels in the peritoneal fluid (PF) of patients with endometriosis catalyze free radical reactions that results in the tissue destruction and fibrosis seen in these patients.

DESIGN: A case-controlled study of the iron levels (microgram/mL) in the pelvic PF of 12 patients with moderate-to-severe disease, 15 patients with minimal-to-mild disease and in 17 women with normal pelvises were compared. As an index of free radical reactions through lipid peroxidation, the levels of malondialdehyde levels (ng/mL) were assessed simultaneously in the same specimens.

RESULTS: Controlling for the phase of the menstrual cycle, significantly higher levels of iron were seen in patients with endometriosis, the levels being correlated with the severity of the disease. However no such corresponding relationship was seen in the malondialdehyde levels in the PF.

CONCLUSIONS: These results suggest that raised iron levels in the PF do not play a role in catalyzing free radical reactions as judged by the degree of lipid peroxidation.

The use of the semen analysis in predicting fertility outcome

Arumugam K, Omar SZ

Aust N Z J Obstet Gynaecol, 1992 May;32(2):154-7.

PMID: 1520202

The study investigates the use of the various parameters of the semen analysis in predicting the fertility outcome in 82 infertile couples. The sperm density, % progressive motility, % normal morphology were divided into 'normal' and 'abnormal' based on the criteria proposed by WHO. The subsequent cumulative pregnancy rates were then calculated according to this criteria. A life-table method of analysis was used. All female related fertility factors were excluded. With the exception of a sperm density of less than 20 x 10(6) per ml the other parameters showed no significant correlation with the cumulative pregnancy rates at 12 months or 24 months respectively. We concluded that the semen analysis does not predict the probable outcome of the subsequent rates even when female fertility related factors were excluded apart from a sperm density less than 20 x 10(6) per ml.

Endometriosis and race

Arumugam K, Templeton AA

Aust N Z J Obstet Gynaecol, 1992 May;32(2):164-5.

PMID: 1520204

The pelvic findings of 202 infertile women undergoing diagnostic laparoscopy in Kuala Lumpur, Malaysia were compared to that of 464 infertile women undergoing diagnostic laparoscopy in Aberdeen, United Kingdom. Endometriosis was significantly more common in the women from Kuala Lumpur (51% against 22%, p less than 0.001). There was however no significant difference seen in the severity of the disease (AFS Classification, 1985). These findings confirm our clinical impression that endometriosis is more common in Asian women when compared to Caucasian women.

Fulltext Combined pregnancy--a case report

Kumarasamy S, Arumugam K

Med J Malaysia, 1991 Sep;46(3):252-4.

PMID: 1839921

A case of combined intra- and extra-uterine pregnancy is reported. Awareness of this condition, a high index of suspicion, the proper interpretation of physical signs and ultrasound findings together with early resort to laparoscopy resulted in a favourable outcome.

Uterine leiomyomata in pregnancy

Hasan F, Arumugam K, Sivanesaratnam V

Int J Gynaecol Obstet, 1991 Jan;34(1):45-8.

PMID: 1671020

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Return of fertility after long-term use of the intrauterine device

Arumugam K, Tai FM

Med Sci Res, 1991 Mar;19(6):183.

PMID: 12343753

Endometriosis and social class

Arumugam K, Templeton AA

Med J Aust, 1990 Nov 05;153(9):567.

PMID: 2233493

Hysterosalpingography -- a Malaysian experience

Arumugam K, Ng KB

Malays J Reprod Health, 1987 Dec;5(2):85-8.

PMID: 12315186

Fulltext Glycated haemoglobin is a good predictor of neonatal hypoglycaemia in pregnancies complicated by diabetes

Arumugam K, Abdul Majeed N

Malays J Pathol, 2011 Jun;33(1):21-4.

PMID: 21874747 MyJurnal

We investigated the usefulness of a single value of maternal HbA1c in late pregnancy as a predictor for neonatal hypoglycaemia and secondly, to find the appropriate threshold value. A prospective analysis of the HbA1c concentration between 36 to 38 weeks of gestation in 150 pregnant mothers with either pre-existing or gestational diabetes was performed. At delivery, glucose levels in the cord blood were analysed. Neonatal hypoglycaemia was defined as a blood sugar level of < 2.6 mmol/l. Receiver operator characteristic curve was constructed to evaluate the value of HbA1c concentration in predicting hypoglycaemia. There were 16 foetuses who were hypoglycaemic at delivery. The area under the ROC curve for predicting neonatal hypoglycaemia was 0.997 with a 95% confidence interval of 0.992 to 1, a very good prediction rate. The optimal threshold value for HbA1c in predicting hypoglycaemia in the foetus was 6.8% (51 mmol/mol). HbA1c level in late pregnancy is a good predictor for hypoglycaemia in the newborn.

Screening for colorectal neoplasias with fecal occult blood tests: false-positive impact of non-dietary restriction

Roslani AC, Abdullah T, Arumugam K

Asian Pac J Cancer Prev, 2012;13(1):237-41.

PMID: 22502676

OBJECTIVE: Screening for colorectal cancer using guaiac-based fecal occult blood tests (gFOBT) is well established in Western populations, but is hampered by poor patient compliance due to the imposed dietary restrictions. Fecal immunochemical tests (FIT) do not require dietary restriction, but are more expensive than gFOBT and therefore restrict its use in developing countries in Asia. However, Asian diets being low in meat content may not require diet restriction for gFOBT to achieve equivalent results. The objective of this study was to evaluate and compare the validity and suitability of gFOBT and FIT or a combination of the two in screening for colorectal neoplasias without prior dietary restriction in an Asian population.

METHODS: Patients referred to the Endoscopic Unit for colonoscopy were recruited for the study. Stool samples were collected prior to bowel preparation, and tested for occult blood with both gFOBT and FIT. Dietary restriction was not imposed. To assess the validity of either tests or in combination to detect a neoplasm or cancer in the colon, their false positive rates, their sensitivity (true positive rate) and the specificity (true negative rate) were analyzed and compared.

RESULTS: One hundred and three patients were analysed. The sensitivity for picking up any neoplasia was 53% for FIT, 40% for gFOBT and 23.3% for the combination. The sensitivities for picking up only carcinoma were 77.8% , 66.7% and 55.5%, respectively. The specificity for excluding any neoplasia was 91.7% for FIT, 74% for gFOBT and 94.5% for a combination, whereas for excluding only carcinomas they were 84%, 73.4% and 93.6%. Of the 69 with normal colonoscopic findings, FOBT was positive in 4.3%, 23.2 %and 2.9% for FIT, gFOBT, or combination of tests respectively.

CONCLUSION: FIT is the recommended method if we are to dispense with dietary restriction in our patients because of its relatively low-false positivity and better sensitivity and specificity rates.

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