Background: Type 2 diabetes mellitus (T2DM) is the most common metabolic disorder and its pathogenesis is characterized by a combination of peripheral insulin resistance and impaired insulin secretory capacity of pancreatic β cell. Genetic predisposition interacts with environmental factors including diet, physical activity, and age leading to the development of diabetes. Objective: To determine the proportion of overweight and obese persons with type 2 diabetes and to compare the fasting blood sugar, fasting serum insulin, insulin resistance and β-cell function in G972R carrier and non-carrier overweight and obese persons with type 2 diabetes. Methodology: One hundred overweight and obese patients with T2DM were recruited from persons with diabetes attending the Diabetes Outpatient Department of Yangon General Hospital. History taking and physical examination were done and blood samples were collected. Plasma glucose level was determined by the glucose oxidase method and fasting serum insulin was measured by enzyme linked immunoassay (ELISA) kit method. Polymerase chain reaction and Restriction Fragment Length Polymorphism were done for genetic polymorphism. Results: Among 100 overweight and obese subjects with T2DM, 81 patients were of homozygous (G/G) genotype, 18 patients were of heterozygous (G/A) and only one patient of homozygous (A/A) genotype. There was no statistically significant difference in the proportion of genotypes between overweight and obese subjects with T2DM.There was no significant difference in fasting blood sugar (FBS), fasting serum insulin, HOMA-IR, β-cell function, lipid parameters between IRS-1 (G972R) carriers and non-carriers. There is significant negative correlation between insulin resistance and TG level (r2=0.0529, p=0.01). Conclusion It was concluded that IRS-1 G972R polymorphism was not important in insulin resistance, β-cell function and lipid parameters in overweight and obese T2DM. There could be a number of candidate genes in the pathophysiology of diabetes mellitus, genetic sequencing of IRS-1 and other genes in the insulin signaling pathway, and finding out the alteration in their genetic patterns would provide clues for the association of the site-specific polymorphisms of these genes with insulin resistance in T2DM.
Insulin Resistance

Introduction: Uterine sarcomas are rare but aggressive malignant tumours of the smooth muscle or supporting tissues of the uterus. Currently, there are no published data available in Brunei Darussalam. This study was done to evaluate the demographic profile, risk factors, diagnostic issues and the clinical outcome of patients with uterine sarcomas in the Raja Isteri Pengiran Anak Saleha (RIPAS) hospital, a tertiary hospital in Brunei Darussalam. Patients and Methods: All patients with uterine sarcoma reg- istered in the Department of Obstetrics and Gynaecology during a period of ten years (2001 to 2010) were studied. Cases were identified through the Gynaecology Oncology registry and the case notes were retrospectively reviewed. Results: Over this period, there were 156 cases of uterine tumour and of these, 37 cases (23.7%) were uterine sarcoma. The majority were local (n=34, Bruneian 81.1%; 30 Malays and four Chinese) with a mean age of 47.8 years. High risk factors were identified in 29 (78.4%) patients. Abnormal uterine bleeding and mass per abdomen were the most common clinical presentations. A preoperative diagnosis was possible only in five cases (13.5%) and in two patients (5.4%) the diagnosis was suspected during surgery and confirmed by frozen section. At the completion of a five-year follow up in the first five year group (2001 to 2005) 62.5% patients are alive and disease free. There were six deaths from the disease during the entire study period. Conclusion: A high pro- portion of uterine tumours were uterine sarcoma. The majority of the patients (78.4%) had one or more risk factors. Unlike endometrial carcinoma a preoperative diagnosis is difficult in uterine sarcoma. At the time of this study 70.3% of patients with uterine sarcoma were alive and disease free.

Carcinoma of the vagina is uncommon and only constitutes two percent of malignant neoplasms of the female genital tract. Malignant melanoma of the vagina is rarer and accounts for only 3.2% of all vaginal cancers. It presumably arises from melanocytes found in the vagina of three percent of normal women. It is a very aggressive tumour and the overall prognosis is poor despite the treatment. We report the case of an 81-year-old woman who presented with per vagina bleeding secondary to a malignant melanoma of the vagina. She was treated with radiotherapy as her disease was locally extensive and she was not a candidate for pelvis exenteration. This is the first recorded case of malignant melanoma to be diagnosed in Brunei Darussalam.