Background: Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve.Objectives:This study sought to compare the feasibility, safety and complications of coronary angiogram and intervention betweenthe distal transradial in the anatomical snuffbox and conventional transradial access.Methods: In this cross sectional studya total of 100 patients were assigned to perform coronary angiogram or intervention through conventional transradial accessand distal transradial in the anatomical snuffboxfrom November 2017 to April 2018 in theDepartment of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU). We divided the total patient in two groups, with 50 patientsin each group. All of them had normal pulse in theirradial and dorsal radial artery.One group was subjected toconventional right transradial accessand another to rightdistal transradial in the anatomical snuffbox.Demographic features &complications were recorded.Results: The overall procedural success was 98% which was greater than expected in our early clinical experience for distal transradial access with 48 successful accesses out of 50 patients and for conventional radial approach it was also 98%.There was failure to access of distal radial artery in two casesthat may be due to hypoplastic/vasospastic distal radial artery and for conventional radial artery radial artery spasm was the cause. Patients of conventional radial access had more spasm, hematoma, numbness and hospital stay (p< 0.001) than distal radial access. Considering all, it may be said thatdistal transradialaccess was very much effective and safe as there was less spasm, more comfortable to the patient, no hand ischemia, hematoma, numbness, and early hospital discharge.Conclusion: Distal transradial access in the anatomical snuffbox for coronary angiogram and intervention is abetter alternative, safe and feasible option to conventional transradial access for both patients and operators.University Heart Journal Vol. 13, No. 2, July 2017; 40-45

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Coronary artery disease is the major cause of mortality world wide. The potentially modifiable risk factors for coronary artery disease were increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, hypertension, hyperglycemia, and smoking. This cross sectional study which included all UGC employees was conducted in the department of cardiology of BSMMU between January 2007 and December 2007. Detailed clinical history, family history, lifestyle, smoking habit, diabetes mellitus, and hypertension, regular use of any medication or any previous cardiac intervention was taken. Physical examination, Blood pressure measurement, ECG, Echocardiography, fasting blood sugar and fasting lipid profile was done to all subjects.163 subjects (all UGC employees), mean age 44.8±8.3 years were included in this study. (20.9%) presented with angina pectoris, 3.7% were having palpitation, and 8.6% were having shortness of breath and 5.5% with nonspecific chest pain. 16.6% subjects presented with hypertension, 12.3% with diabetes mellitus, and 20.9% with dyslipidemia. 3.1% subjects had previous myocardial infarction. ECG shows 8.0% subjects had inferior ischemia, 6.1% had anterior ischemia and 2.5% had bundle branch block. Echocardiography shows 4.9% subjects were having regional wall motion abnormalities Prevalence of risk factors for CAD is increasing, and with the clinical and cost burdens mounting, identifying and treating those at risk remains a national priority. Abbreviations UGC, University Grants Commission, BSMMU, Bangabandhu Sheikh Mujib Medical University   doi: 10.3329/uhj.v5i1.3436 University Heart Journal Vol. 5, No. 1, January 2009 20-23

The present study was undertaken to evaluate the morphological anatomy of cerebral vessels in patients of aneurysmal subarachnoid hemorrhage. The cross-sectional observational study was carried out in the Department of Neurology, Dhaka Medical College Hospital, Dhaka from January 2013 to June 2013. Adult patients of spontaneous subarachnoid haemorrhage (SAH), diagnosed clinically and confirmed by CT scan of the head were included in the study. However, patients who are not capable financially of undergoing Digital Subtraction Angiography (DSA), traumatic subarachnoid haemorrhage, intracerebral haemorrhage and patients taking antiplatelet and anticoagulant drugs and with comorbidities were excluded. A total of 30 subjects meeting the above eligibility criteria were selected consecutively from the study population. The present study demonstrated that 80% of the patients were 50 or younger than 50 years old (mean age 45.0 ± 9.4 years) with a male preponderance (60%). Sudden headache accompanied by vomiting was invariably complained by the patients at onset of Athe disease. On admission two-thirds (66.7%) of the patients were unconscious. 4 out of 30(16.65%) patients exhibited neurological deficit. Of the risk factors, hypertension and smoking demonstrated their significant presence (around 45%) among the patients studied. Based on Glasgow Coma Scale, 7(23.3%) patients out of 30 in the present study were in grade-v. Our data showed that the common site of aneurysm was anterior communication artery (36.7%) followed by middle cerebral artery (26.7%) and posterior communicating artery (23.3%). Saccular aneurysms formed the main bulk (93%) of the cases irrespective of anatomical distribution of aneurysm. In aneurysmal subarachnoid haemorrhage, aneurysms are mainly located in anterior communicating and middle cerebral arteries and of medium-sized. Majority are saccular type and narrow-necked.Bangladesh Med J. 2015 Sep; 44 (3): 125-129

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

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

Clinicians continue to face the challenges of identifying and treating the idiopathic dilated cardiomyopathy to improve symptoms and survival. A study on idiopathic dilated cardiomyopathy was done in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2004 to December 2009. The aim of this study was to examine clinical profile of patients with idiopathic dilated cardiomyopathy. The age range was 18 to 65 years and 70% subjects were male. Most common symptom was dyspnea (86%) and cough (75%). 75% subjects had sinus tachycardia, 42% had ventricular ectopics and 40% had left bundle branch block. Mean diastolic dimension was 60±9 mm, ejection fraction was 28±8%, left atrial dimension was 40±6 mm and 36% were having mitral regurgitation. Left ventricular failure (75%) and various type of arrhythmias (62%) were the main complications. 8% subjects were died during hospital stay. Hence the clinical presentation of idiopathic dilated cardiomyopathy varies from patient to patient, but most patients present later, i.e. at some point in the spectrum of heart failure.

Coronary artery disease (CAD) is one of the leading causes of death in the world and also in Bangladesh. This study was carried out to evaluate that Serum uric acid is a prognostic tool in acute myocardial infarction. In this study, 108 AMI cases were enrolled. All the patients were treated and managed identically by conventional standard management protocol. During hospital stay, patients were assessed for any kind of clinical outcomes e.g good recovery, mortality and morbidity (acute LVF, cardiogenic shock, arrhythmia and heart block). Patients with higher serum uric acid (SUA>6.5mg%, Group-II) were compared with Patients with lower serum uric acid (SUA<6.5mg%, Group-I). In Group I (n=66), good recovery, morbidity and mortality were found in 43 (65.2%), 21 (31.8%), 2(3.0%) patients and in Group II (n=42), good recovery, morbidity, mortality were 13 (31%), 23 (54.8%) and 6 (14.3%) patients respectively. In group II patients having high Serum uric acid concentration had low good recovery but high morbidity and mortality compared to group I patients. In group I (n=66), good outcome and bad outcome was found in 43(65.2%), and 23 (34.8%) patients and in group II (n=42), those were in 13 (31%) and 29 (69%) patents. Logistic regression analysis of serum uric acid concentration of study subjects were done considering uric acid as independent variable but outcome as dependent variable. It was shown that the odds ratio of mortality was 5.38(95% CI p<0.007), odds ratio of morbidity was 4.10(95% CI p<0.001) and odds ratio of bad outcome was 4.67(95% CI p<0.001). This findings indicates a patient having high uric acid had 5.38 times increased mortality, 4.10 times increased morbidity and 4.67 times increased bad outcome than patients having low serum uric acid concentration.University Heart Journal Vol. 12, No. 1, January 2016; 8-11