Objective: This cross sectional study was conducted in the dept. of clinical pathology in collaboration with dept. of cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Bangladesh Institute of Research & Rehabilitation of Diabetes Endocrine and Metabolic Disorders (BIRDEM) to evaluate the role of platelet distribution width (PDW) in diagnosing acute coronary syndrome (ACS). Patients & Methods: A total of 142 patients were selected for the study. Of them 79 were cases (patients with acute coronary syndrome) and 63 were controls (patients with non cardiac chest pain). The cardiologist established the diagnosis by clinical examination, ECG and biochemical markers especially troponin I. A structured questionnaire was used which addressed all the variables of interest. Blood samples of the selected patients were taken to investigate their platelet distribution width level and to find its association with ACS. The blood samples was taken properly and processed in a Haematology auto analyzer within 2 hours of collection, which again rechecked manually by peripheral blood film. Statistical analyses were done using mean± standard deviation (SD), t-test, Chi-square (x2) with 95% confidence interval. Test of validity done by receiver operative characteristic curves.Result: In the present study, platelet counts were 273.1±50.15 x 109/L in patients with ACS and 290.78±74.86 x 109/L in control subjects. Platelet counts were slightly low in patients with ACS compared to control subjects. There were no statistical significant differences between the groups in unpaired t- tests. MPV was 12.48±1.17 fl and 10.45±0.66 fl in patients with ACS and control subjects. PDW was 16.23±2.56 fl and 11.89±1.42 fl in patients with ACS and control subjects. Both MPV and PDW were statistically significant between the groups (P<0.001) in unpaired t-test. Patients with acute coronary syndrome the sensitivity, specificity, positive predictive value and negative predictive value of platelet counts, MPV and PDW were obtained by ROC curve and compared with control subjects. The best cut off value of platelet count, MPV & PDW were >225 x 109/L, > 10.7 fl and >12.7 fl respectively. The sensitivity, specificity, accuracy, positive and negative predictive value of platelet counts, MPV and PDW were 83%, 28.1%, 42.3%, 37.6%, 64%; 90.6%, 49.4%, 64.8%, 51.6%, 89.8%; and 94.3%,52.8%, 69%,54.9%, 94.1% respectively. In our study, we found that PDW had higher sensitivity and specificity in contrast to MPV. These PDW are used as predictor for early detection of ACS and risk stratification when other cardiac biomarkers are negative.Conclusion: The PDW is an early indicator to diagnose ACS and correlates with the prognosis of ACS. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19430 University Heart Journal Vol. 9, No. 1, January 2013; 3-8

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No Abstract Available.DOI: http://dx.doi.org/10.3329/uhj.v9i1.19431 University Heart Journal Vol. 9, No. 1, January 2013; 9-12

BACKGROUND:Insulin resistance has been proposed to be the most likely phenotypic trait that could represent a genetic link between low birth weight and type 2 diabetes, especially in Southeast Asia. Insulin resistance can persist for many years, even decades, before the manifestation of overt diabetes. There have been many studies suggesting a strong genetic basis in the etiology of type 2 diabetes mellitus. There is also ample evidence providing a link with low birth weight and type 2 diabetes in later life. Hence, parental insulin sensitivity could well serve as a representation of the offspring's future insulin resistance state. Association between maternal insulin sensitivity and the incidence of type 2 diabetes mellitus in low birth weight babies is confounded by many factors and hence, has limited value in the determination of any genetic origin of the disease. Therefore, the present study was done to investigate the relationship between paternal insulin sensitivity and the growth parameters of the foetus to determine a genetic link between poor early growth and the increased risk of type 2 diabetes mellitus in later life.MATERIALS AND METHODS:The study was performed on 30 healthy fathers and their babies born from nondiabetic mothers. Each father underwent a low-dose short insulin tolerance test (ITT) as a measure of insulin sensitivity. Placental weight was recorded and a blood sample was collected from the placental side of the umbilical cord at birth for measurement of insulin. Measurement of birth weight, length, and head circumference were recorded and ponderal index was calculated from the formula: weight (kg)/ length (cm)3. Individual parameters of insulin resistance syndrome were measured in the fathers.RESULTS:The degree of insulin sensitivity, Km (constant for insulin tolerance test) did not correlate with the fetal growth parameters (Ponderal Index r = 0.031, P = 0.870; weight of baby r = 0.010, P = 0.959; length of baby r = 0.087, P = 0.464; head circumference r = 0.280, P = 0.142) or with the fathers' anthropometric measures: body mass index (BMI), blood pressure, fasting glucose, insulin, and lipid profiles.CONCLUSION:The data suggest that the mechanism linking insulin resistance with low birth weight is not a genetically determined defect.

The infant had an extrathoracic heart covered only by visceral pericardium (complete thoracic ectopia cordis).The sternum was completely splitted with an inter-ridge distance of 5-6 cm, through which the heart was protruding for 4-5 cm and the apex pointing anteriorly.Since her birth, her activities are normal in relation to any other newborn infants including breast feeding, hands and feet movements etc. Her urinary and bowel systems were functioning normal.Initially her heart was covered with saline-soaked gauze pads& systemic antibiotics were given.Direct echocardiography showed single ventricle, grade-111 tricuspid regurgitation with severe pulmonary arterial hypertension (PASP-78).On her 3 rd day of birth at the National Institute of Cardiovascular Diseases, there was bleeding from her visceral pericardium for 5 minutes and she lost approximately 200ml of blood.After 15 days again bleeding occurred followed by a loud scream and cry in the beginning but this time bleeding lasted for 15 minutes and loss of around 400ml of blood. After her blood loss she became very weak and pale. Nutritional support was given by parenteral nutrition.Her complete blood count showed normal at that time. After 1 hour she was haemodynamically stable and began to intake breast milk of a very low quantity. She resumed her normal activities like before after a total of 6 hours approximately.Her parents were poor & her condition was very critical. Unfortunately the baby died on her 20 th days of birth. Ectopia Cordis Abstract:Ectopia cordisis characterized by partial or complete displacement of the heart out of the thoracic cavity The defect is a rare congenital abnormality, occurring in 5.5 to 7.9 per 1 million live births. 1 CASE REPORTS

Patients of acute inferior myocardial infarction, in addition to the ST segment elevation in inferior leads often have ST segment depression in the precordial leads. This study was performed to observe the incidence of these 'reciprocal' ST changes. One hundred consecutive acute inferior myocardial infarction patients were included in the study. They were further allocated to two electrocardiographic groups. Group 1 consisted of patients of acute inferior myocardial infarction with precordial ST segment depression & Group 2 consisted of patients of acute inferior myocardial infarction without precordial ST segment depression. Among the 100 consecutive patients, a large number of patients were included in group 1 (76%). Significant number of patients of group 1 belonged to the age group of above 60 years compared to group 2 (27.6% vs. 4.2% ; p < .02). Conversely significantly higher number of younger patients < 40 years belonged to group 2 ( 41.7% vs. 11.9% ; p < .01). Mean ST segment elevation (mm) was also significantly higher in group 1 than group 2 (4.07 + 1.93 vs. 2 + 0.78; p <.001). The patients of acute inferior myocardial infarction thus show a significant number of ST segment depression in their precordial leads. In different studies these subset of patients showed increased morbidity and mortality.

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