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Clinical outcome and risk factors of patients with acute myocardial infarction: A tertiary level hospital-based study in Bangladesh.
Get PDFIntroduction: Coronary Artery Disease (CAD) remains the major cause of mortality and morbidity in mankind. Even though a lot of advances are made in the diagnosis, management, and prevention of the disease. Coronary Artery Disease (CAD) is the leading cause of death in the United States, affecting over 5 million Americans. It is the most common cause of death worldwide.
Aim of the study: The study aimed to evaluate the clinical outcome and Risk Factors of Patients with Acute Myocardial Infarction in a Tertiary Level Hospital-Based Study in Bangladesh.
Methods: This cross-sectional study was conducted in the Department of Cardiology, TMC & RCH, Bogura, Bangladesh from January 2020 to January 2021. The study was conducted after obtaining ethical clearance from the institutional review board of TMC & RCH, Bogura, Bangladesh. The data was collected from the discharge records of the patients admitted to the cardiology department.
Result: A total of 56 patients were diagnosed with myocardial infarction and analyzed in this study. The age distribution of the study was based on STEMI, 22(39.39%) patients suffering from AMI were in the 50-59 years age group, 16(28.57%) patients were from the age group 60-69, 12(21.43%) patients were from the age group 40-49, among the 5(8.93%) patients were from the age group >70 age group and only one patient was from the age group 30-39. the clinical outcomes of the study population; there are 17(30.36%) patients who had a cardiogenic shock, 13(23.21%) patients who were getting well, 12(21.43%) patients who had LVF/Pulmonary edema, 7(12.50%) patients had bradyarrhythmias and both 7(12.50%) patients died within 24 hours of hospital admission, 5(8.93%) patients have had tachyarrhythmias, 4(7.14%) patients had a cardiac arrest and only one patient had a mechanical complication.
Conclusion: There is a need for early detection of risk factors to prevent the progression of coronary heart disease, a need for creating awareness in the community regarding risk factors, symptoms, and signs of acute myocardial infarction so that early referral can be done to the coronary care unit to prevent morbidity and mortality in the community
Recurrent anti-GAD65 limbic encephalitis in a pediatric patient
Get PDFLimbic encephalitis (LE) associated with anti-glutamic acid decarboxylase (GAD) 65 antibodies is an autoimmune condition characterized by signs and symptoms of limbic system inflammation. Herein we present the case of an 8-year-old girl with recurrent anti-GAD65 limbic encephalitis with a past history of viral infection.
 
The impact of Covid 19 in paediatric surgical services in Dhaka Medical College Hospital; A retrospective observational study
Get PDFIntroduction: Since the COVID 19 declared by the WHO on March 11, 2020, all the non-essential services were affected. To control the spread of virus, the Govt of Bangladesh imposed several measures like social distancing, population lockdown, complete curtailment of public transport. The routine paediatric surgical services were declined due to scarcity unknown disease, fear of contagion, engagement of health care resources to COVID 19 patient\u27s care.
Aim: The aim of the study to evaluate the effect of COVID 19 on the paediatric surgical services in our institution.
Material and methods: A retrospective observational study was done to analyze the changes in our out patients visit, total routine admission, total emergency admission, total routine operation, total emergency operation, total day care surgery, mortality and academic activities during the pandemic period when compared to the pre pandemic period. Data were divided in to two groups; Pre pandemic period (March 2019-February2020) and during pandemic (March2020-February2021).
Results: There were 48.4 % reduction in OPD attendance, 40.9% reduction of total admission, 55.1 % reduction of routine admission, 32.2% reduction of emergency admission, 34.2% reduction of total operation, 35% reduction of routine operation, 33.4 % reduction of emergency operation,75.2 % reduction of day case surgery, significant reduction of endo laparoscopic procedure and academic activities. Mortality rate was also affected during pandemic period.
Conclusion: The outbreak of COVID 19 has affected not only individuals with COVID 19 but also patients seeking surgical operation. Understanding the present situation helps the clinician to provide optimal surgical care
Prevalence and antimicrobial susceptibility pattern of pseudomonas aeruginosa isolated from clinical samples in Jashore Medical College Hospital.
Get PDFBackground: Pseudomonas aeruginosa is one of the leading causes of hospital-acquired infections. Increased resistance in this organism continues to pose a significant threat to patient care because of limited therapeutic options. The main objective of this study was to find out the prevalence and current antimicrobial susceptibility pattern of P. aeruginosa isolates obtained from various clinical samples at a tertiary care hospital.
Methods: The study was conducted in the Bacteriology laboratory of the Department of Microbiology, Jashore Medical College Hospital, Jashore, Bangladesh. All clinical samples received from various departments from January 2021 to December 2021. The colonies which were grown on culture media were identified by different standard biochemical tests. Antimicrobial susceptibility testing was done using Kirby–the Bauer disc diffusion method and the results were interpreted according to the CLSI guidelines. Quality control of the test was done by standards ATCC strain of P. aeruginosa 27853.
Result: A total of 167 cultured organisms were recorded and analyzed in this study. Among 167 cultured organisms, there were 37 isolates identified as P. aeruginosa. Among the antibiotic sensitivity patterns of P. aeruginosa, we found that the most sensitive drug was colistin 35 (94.59%), followed by levofloxacin 31(83.78%), cefuroxime axetil 29(78.38%), gentamicin 26(70.27%), and each cefperazone+sulbactum & netilmicin has a percentage of 24(64.86%) On the other hand, we found P.aeruginosa showed resistance towards Ofloxacin 24(64.86%), Piperacillin 23(62.16%), Ceftazidime 21(56.76%), Cefoprazone 20(54.05%), Cefipime 20(54.05%), Aztreonam 19(51.35%), Cefaprazone + sulbactum 16(43.24%) and Gentamycin 17(45.00%).
Conclusion: Most of the P. aeruginosa strains were isolated from sputum, urine, respiratory secretions and pus samples and were found to be MDR. Piperacillin-tazobactam was the most sensitive chemotherapeutic agent followed by Colistin and levofloxacin
Relation of serum prolactin level to systemic lupus erythematosus disease
Get PDFBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organ systems. Prolactin accelerates the breakdown of immune tolerance by promoting the survival, maturation and activation of autoreactive B and T cells, dendritic cells and macrophages and may play a role in the pathogenesis of autoimmune diseases, including systemic lupus erythematosus. Premature cardiovascular disease is the leading cause of morbidity in lupus which may be directly associated with altered lipid metabolism in systemic lupus erythematosus patient.
Objective: To find out the relation of serum prolactin and lipid profile with systemic lupus erythematosus patients.
Methodology: This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from January 2017 to December 2017. In this study, fifty diagnosed patients of SLE (Group A) and fifty apparently healthy individuals (Group B) of both sexes were selected according to the selection criteria from Department of Medicine, Dhaka medical college hospital, Dhaka (Group A) and by personal contact (Group B). Baseline parameters (body mass index, blood pressure and fasting plasma glucose) of both groups were measured. Serum prolactin was estimated by enzyme immune assay.
Results: Out of 100 patients included in our study. Mean ± SD of serum prolactin level was significantly higher (p <0.001) in SLE patients (37.95 ± 18.47) ng/ml when compared to healthy controls (14.82 ± 2.86) ng/ml. Distribution of serum prolactin status in SLE patients shows among 50 patients 37 (74%) has hyperprolactinemia and 13 patients have normal prolactin level. Among age (mean ± SD), gender distribution and duration of disease of study subjects among groups. There were no significant differences in terms of age and gender between SLE patients and healthy subjects show homogenecity of both groups. Shows serum prolactin of the study subjects in both groups. Serum prolactin level was significantly higher in SLE patients than healthy individual. Serum prolactin showed significant positive correlation with SLE (p<0.001). In Group A thirty seven SLE patients had raised serum prolactin & thirteen had normal prolactin level. The correlation of serum prolactin with SLE. There was significant positive correlation of serum prolactin.
Conclusion: From present study it can be concluded that systemic lupus erythematosus is related to increased serum prolactin level and with dyslipidemia
Outcome of medical induction of labour in post-dated pregnancy
Get PDFIntroduction: Post maturity, post-term, Postdate, and prolonged pregnancy is accepted terms by WHO and the International Federation are of Gynecology and Obstetrics to describe pregnancy beyond dates (expected date of delivery). Prolongation of pregnancy complicates up to 10% of all pregnancies and carries increased risk to mother and foetus. Objective: To study of medical induction of labour in post-dated pregnancy. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, 250 Bedded Sadar Hospital, Jhenaidah, Bangladesh from January to June 2022. Fifty (50) patients included in our study. Labour induction in post-dated pregnancy was performed only after appropriate assessment of the mother and foetus. The inclusion criteria were intact membrane, cephalic presentation, singleton pregnancies, low Bishop score in post-dated pregnancies. Absolute contraindications to induction of labour include contracted pelvis, placenta previa, unexplained vaginal bleeding, presentation other than head and previous caesarean section were excluded from the study. This study shows that the main method was oxytocin drip and second method was ARM+oxytocin in drip, some cases induced by using oral prostaglandin and very few cases induced by intra cervical prostaglandin. Results: Total 50 patients included in our study. Among than 32 patients were primigravida and 18 patients were multigravida. They were 18-38 years of age range. 20 patients (40%) were induced by only oxytocin drip and second method was ARM+oxytocin drip applied on 20 patients, some cases-7 patients (20%) were induced by using oral prostaglandin and very few cases-3 patients (10%) were induced by intra cervical prostaglandin. Only oxytocin drip and failure rate was 30%, combined ARM and oxytocin drip applied on 20 patient and failure rate was 20%. 1 patient were induced by using oral prostaglandin and failure rate was 14.2% and very few cases-3 patients were induced by intra cervical prostaglandin and failure rate was 0.0% Among spontaneous vaginal delivery was 70 %, 14% assisted vaginal delivery. Among them Forceps covers 6% and Ventouse covers 8%. 12% Caesarean section was done for foetal distress, 4% for cervical distocia and 4% for hyper stimulation. Among them healthy baby was born 70%. 26% distress baby and 4% Still birth. Conclusion: The timely onset of labour is an important determinant of perinatal outcome. Confirmation of diagnosis of postdatism is very important. In management of postdatism a careful advice and proper monitoring can alleviate maternal anxiety and untoward complications. It is a routine practice in many centers of our country to terminate most of the post-dated pregnancy by caesarean section due to limitations of foetal monitoring system and oxytocin titration Induction of labour in the presence of a ripe cervix and favorable fetal presentation appears to carry little risk to mother or foetus
Dermatoglyphic traits in Calpainopathy: A Case Report
Get PDFCalpainopathy is a Limb Girdle Muscular Dystrophy due to calpain deficiency caused by genetic mutations in CAPN 3 gene. It results in progressive, symmetrical weakness of proximal muscles. Other clinical features include tiptoe walking, difficulty in running, scapular winging, waddling gait, scoliosis, calf hypertrophy and Achilles’ tendon tightness. Dermatoglyphics or the study of skin patterns in hand and feet, can be used to predict the diseases caused by the genetic factors, due to the common ectodermal origin of the skin and the nervous system. This study attempts to observe any characteristic dermatoglyphic findings on the hands of a 24 year old female with Calpainopathy.An electronic flatbed scanner was used to obtain the finger and palm prints which were analysed using the classification given by Cummins and Midlow. It was observed that ulnar loop patterns were the dominant patterns found with the a-b ridge count from 39 to 41 in both the hands. It can be concluded that there is a need of large sample studies to generalize the fiding to this population
Epidemiology, incidence, etiology, complications and outcome of Acute Pancreatitis in Kashmiri Population: A retrospective hospital based single centre study.
Get PDFIntroduction: Acute pancreatitis is an inflammatory disease of the pancreas. It can be initiated by several factors, including gallstones, alcohol, trauma, infections and hereditary factors. About 75% of pancreatitis is caused by gallstones or alcohol. According to the physical examination, radiological findings and laboratory results the etiology of the acute pancreatitis is diagnosed as biliary or non-biliary.
Aims and Objectives: The present study aimed to study the clinical profile (incidence, etiology and outcome) of Kashmiri patients with acute pancreatitis.
Material and Methods: This was a hospital based retrospective study conducted in Srinagar for a period of 2 years w.e.f. September 2017 to September 2019 on 650 patients of all age groups with clinical/Laboratory/imaging findings suggestive of acute pancreatitis.
Results: Our data revealed gallstone as most common etiological agent followed by idiopathic acute pancreatitis. Mild, moderately severe acute pancreatitis constitutes 48.61%, 24.61% and 26.76% of patients respectively. There is statistically significant association between high body mass index >25 Kg/m2, waist circumference >100 cm, high blood sugar >200 mg /dl, hematocrit >44, CRP >150 mg/d and worsening of acute pancreatitis.
Conclusion: The present study concluded that the Kashmir valley has increased number of cases of acute pancreatitis in recent years which is one of the major causes of admission in gastroenterology ward.
Key words: Acute Pancreatitis, Inflammatory disease, Gallstone, Clinical profile and Severity of pancreatitis.
 
Effect of dyslipidemia and its association with coronary artery disease on angiographic findings
Get PDFIntroduction: Dyslipidemia is an abnormal amount of lipids in the blood which act as a most common risk factor for CAD. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin levels can also lead to dyslipidemia. Objective: To assess the effect of dyslipidemia and its association with coronary artery disease on angiographic findings. Methods: This was a retrospective cross-sectional study was carried out at Cardiology Department, Bangladesh Medical College Hospital, Dhaka, Bangladesh from January to December 2021. Information was gathered from medical records of patients admitted for coronary angiography in our Hospital. During the study period 112 consecutive patients, suffering from CAD were examined. Coronary angiography was performed in the catheterization laboratory of the institute and interpreted by interventionist cardiologists. Reporting was done regarding the stenosis percentage of the main epicardial coronary arteries, and the extent of CAD was categorized as one-vessel, two-vessel, or three-vessel disease, according to the number of affected vessels. Statistical analysis was performed with SPSS version 20 (SPSS, Inc., Chicago, IL, USA) statistical software. Results: During the study period, we identified 112 patients who were subjected to coronary angiography. The mean age of patients were 54.40 years (±SD 8.78 years), where the minimum age was 28 and maximum age was 75. Majority of the patients were young, with around 40.1% (45) of the patients age 46-55 years. The study consisted predominantly of males as represented by 84.82% of the patients, while 15.17% were females. The lipid profile analysis revealed that the mean total cholesterol was 182.60 ± 54.41 mg/dl, mean low-density lipoprotein cholesterol (LDL-C) was 105.46 ± 40.85 mg/dl, mean high density lipoprotein cholesterol (HDL-C) was low, 34.26 ± 7.234 mg/dl and mean triglyceride level was high, 207.64 ± 151.20 mg/dl. The mean levels of different lipids. the patients where dyslipidemia were present in 75.89% patients. Distribution of types of myocardial infarction among the patients. Among 112 patients there were patients of inferior MI 33%, anterior MI 22%, extensive anterior MI 10%, anteroseptal MI 18.5%, Inferolateral MI 9%, lateral MI 4%, high lateral MI 2% and anteroinferior 1.5%. In patients according to clinical findings where mean ± SD of systolic blood pressure was found 134.75 ± 19.25 and random blood sugar was found in 223.81 ± 72.18 mg/dl as well as gallop rhythm was found in 11% patients, those are remarkable. In this study, the most frequent form of dyslipidemia among the patients with significant CAD was found to be low levels of HDL-C (<40mg/dL) at 86.3%, followed by high TG levels (≥150mg/dL) to be 63.2%, high levels of total cholesterol (≥200mg/dl) at 31.6%, and high LDL-C (≥130mg/dL) to be 27.4%. In hospital stay of the patients where mean ± SD of hospital stay of the study patients was 6±0.88 days. 57.1% patients got improved with better outcome and discharged after treatment. 
Progression of left ventricular ejection fraction after acute myocardial infarction
Get PDFIntroduction: A significant proportion of deaths in patients with chronic ischemic cardiomyopathy are due to heart failure or sudden cardiac death (SCD) [1]. Numerous clinical trials have confirmed the benefit of implantable cardioverter-defibrillator (ICD) treatment in patients with reduced left ventricular (LV) function after an acute myocardial infarction (AMI). Objective: To measure and compare Left Ventricular Ejection Fraction (LVEF) after acute anterior wall and inferior wall myocardial Infarction and correlate LVEF with clinical findings in the patients. Methods: It was a prospective observational echocardiography based study which was carried out in the Dept. of Cardiology, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from March to October 2022. A total of 60 (sixty) patients of (anterior or inferior) Acute Myocardial infarction (AMI) were included in the study. Patients were divided in two groups on the basis of anterior myocardial wall MI (AWMI) or inferior myocardial wall MI (IWMI). Echocardiography was done on all cases and ejection fraction was calculated by applying Simpson’s Rule and patients were examined at the same time to see the presence of signs of left ventricular failure (LVF). (LVEF) was correlated with the findings of LVF in these patients. Results: Out of 30 patients of anterior wall MI, 18 (60%) were male and 12 (40%) were female. In inferior wall MI, 28 (93.3%) were male and 2 (6.7%) were female. In all 60 patients (76.7%) patients were male and (23.3%) were females. In anterior wall MI, (6.7%) were in 30 to 40 years of age, (33.3%) were in 41 to 50 years of age, (33.3) were in 51 to 60 years of age, (20.0%) were in 61 to 70 years of age, and (6.7%) were in 71 to 80 years of age. Minimum age was 39 years; maximum was 72 years, with mean of 54.57 and SD of 9.22. In patients with LVF mean ejection fraction (EF) was 37.13 with standard deviation (SD) of 8.4 %. In patients without failure the mean EF was 56.29% with SD of 3.75. In 30 patients of IWMI, mean EF was 54.93% with SD of 6.86. In 30 patients of AWMI it was 46.07% with SD of 11.72. In all 60 patients minimum EF was 30% and maximum was 60% with a mean of 50.50 with SD of 10.52. In AWMI, 53% patients had signs of left ventricular failure. In patients of IWMI, 13.3% had signs of LVF. Conclusions: AWMI causes more decrease in LVEF. LVF is more commonly associated with AWMI than IWMI. There is statistically significant difference in LVEF of patients with and without LVF