Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. Percutaneous recanalization of occluded coronary artery is one of the treatment options and reinfarction and restenosis negatively affect the outcome following procedure. Although various factors including fibrinogen are suspected as risk factors for this but its role in adverse outcome after stent implantation is controversial. The aim of this study was to determine the impact & relation of periprocedural fibrinogen level on outcome after coronary stent implantation. This prospective study was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Hospital, Dhaka over a period of one year between July 2016 to June 2017. Total 53 patients of chronic stable angina (CSA) undergoing elective PTCA followed by stenting were included in this study as per inclusion and exclusion criteria. Plasma fibrinogen level was measured by collecting venous blood samples at three timed points in relation to stenting – 24 h before, 24 h after and 72 h after stenting. Recurrence of angina, myocardial infarction, repeat revascularization (either PCI or Cardiac surgery), and death were considered as adverse outcome during follow up at 1, 3 and 6 months after intervention. During the 6 months follow up period 1 (one) patient developed UA (at 1 month), 2 developed MI (1 at 3 month and 1 at 6 month) and 2 died (1 at 3 month and 1 at 6 month). Patients were grouped on the basis of four outcomes: favorable outcome (those who did not develop any of the four outcomes) and unfavorable or adverse outcome (those who developed any of the four outcomes). The mean age of study population was 53.92 years and 39 (73.6%) were male. Regarding cardiovascular risk factors, 43.4% patients had diabetes mellitus, 88.6% had dyslipidaemia, 56.6% were non-smokers. Baseline plasma fibrinogen level were significantly higher in patients who developed complications following PCI than those who did not develop the complications (394.4 ± 16.0 Vs 271.5 ± 21.8 mg/dl) & remained high after 24 hours and 72 hours following PCI (p < 0.001). Angiographic profiles of the study population reveals 84.9% LAD, 16.9% RCA & 15% LCX involvement but there was no association of post-PCI adverse outcomes with vessels involved, number of stents deployed and types of stents used (p > 0.05). Study showed that the risk of developing unfavorable outcome following PCI in patients with pre-PCI & post-PCI high serum fibrinogen was estimated to be 5.7 times & 12 times higher than those who have had serum fibrinogen lower than 350 mg/ dl respectively (p = 0.023 & 0.025 respectively). High serum fibrinogen can therefore be used as a marker for predicting adverse outcome following PCI. University Heart Journal Vol. 17, No. 2, Jul 2021; 122-127
Studies regarding clinical characteristics of stroke involving the posterior circulation territory of the brain in Bangladesh are rare although large number of patients were found in hospital admission and with a high morbidity and mortality. Study for better understanding of the clinical features, risk factors and aetiologies of posterior circulation stroke (PCS) may be very helpful for early diagnosis, treatment, and also for setting primary and secondary prevention strategies. The objective of the study was to identify clinical features and short-term outcome of PCS. Adult patients admitted in Dhaka Medical College Hospital with clinical features consistent with posterior circulation stroke involving brain stem or, cerebellum or thalamus or occipital area and confirmed by computer tomography (CT) scan of brain were the the cases as respondents. Few cases were needed MRI of brain to confirm diagnosis. This was a hospital based prospective observational study with descriptive and analytical component. Sample was selected from the study population by purposive type of non-probability sampling technique. Sample size was 30. A semi-structured questionnaire was prepared containing patients’ profile as well as stroke patients’ reporting form which included all the essential information regarding clinical profile of PCS as well as short term outcome. Analysis was done using Statistical Package for the Social Sciences (SPSS) software. Thirty consecutive cases of strokes involving posterior circulation territory were included in the study according to inclusion and exclusion criteria. Male female ratio was 1.7:1. Most of the patients in both sexes were affected after the age of 50 years. Hemorrhagic PCS was significantly higher than ischaemic PCS. Among hemorrhagic PCS common symptoms were decreased level of consciousness and motor disturbances. Most common clinical sign in ischemic PCS is impaired consciousness which was present in 55.6% of the total ischemic PCS cases. Whereas this sign was present in all the cases of hemorrhagic PCS (100%). Like presenting symptoms, most of the clinical signs were also more common in hemorrhagic PCS. But few clinical signs were more common in ischemic strokes, such as cranial nerve involvement and nystagmus. Commonest predisposing factors were tobacco abuse, hypertension and dyslipidemia. Mortality was higher in hemorrhagic PCS than ischemic PCS within 7 days of follow up. Bangladesh Med J. 2021 Sept; 50(3): 20-25
Background: Many stroke patients develop swallowing difficulty and require nasogastric feeding for the maintenance of nutrition. Objectives: The purpose of the present study was to evaluate the complications of nasogastric tube feeding practice on stroke patients. Methodology: This cross-sectional study was conducted from April 2014 to September 2014 in the Department of Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh. Adult patients aged between 18 to 70 years with stroke was enrolled in the study. The diagnosis of stroke was established by the clinical presentation and neuroimaging. Patients requiring nasogastric tube feeding was included in the study and were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. Results: Of the 100 patients studied, most common age group for stroke was 51 to 60 years (53.0%). Male to female ratio was 2.22:1. In this study population, 63.0% patients had ischaemic stroke; 26.0% had haemorrhagic stroke; 9.0% population had subarachnoid haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39.0%). Other common indications were semi-consciousness (26%), unconsciousness (22.0%), inability to maintain feed (10.0%). Around 71.0% of the patients had complications from NG tube feeding. Out of them, 53.0% of the patients had nasal irritation, 40.0% patients developed aspiration pneumonia. 38.0% of the patients developed diarrhea, 53.0% had tube blockage. 43.0% of the patients had electrolyte imbalance and tube displacement, 18.0% of the patients were malnourished. Conclusion: In conclusion nasogastric tube feeding is associated with various complications which can increase the morbidities in stroke patients. Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):136-142
Naphthalene is a chemical substance which is widely used as moth repellent, insecticide and deodorizer. Naphthalene mothballs are potent hemolytic agents specially for pediatric group and Glucose 6 phosphate dehydrogenase (G6PD) deficient individuals. Our patient, a 14-year-old boy got admitted in our institution with progressive pallor, jaundice, hematuria and oliguria. He used to chew naphthalene mixed flavored raw rice for the last six months. On investigation he was found to have features of intravascular hemolysis and AKI necessitating hemodialysis with blood transfusion. His G6PD activity was below normal. After seven sessions of Hemodialysis (HD) his renal function recovered and discharged accordingly. One month post discharge follow up was normal. J Dhaka Med Coll. 2021; 29(1): 123-126
Hepatitis B virus infection is a major public health problem worldwide and it causes not only hepatic diseases but also extra hepatic manifestations particularly HBV-associated Glomerulo- nephritis (GN). HBsAg has been observed in the glomeruli of some patients with glomerulonephritis. HBV related glomerulo- nephritis may be found in HBV seropositive as well as sero- negative patients. HBV may present in the renal tissue of such patients. In most cases detection of HBsAg in the renal tissue by renal biopsy and immunohistochemistry can establish the etiology. To find out the relationship of HBsAg and Kidney biopsy marker with HBV related glomerulonephropathy, this cross sectional study was done in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), during the period of July 2015 to June 2016. A total number of 53 cases who fulfilled the inclusion and exclusion criteria were selected as sample. Samples were selected by purposive sampling technique. HBsAg antigen in renal tissue was found in 2 patients among 7 patients who were seropositive for both HBsAg and Anti HBc(total), 2 patients among 8 patients who were HBsAg seronegative but Anti HBc (total) seropositive, 2 patients among 38 patients who were seronegative for both HBsAg and Anti HBc(total). There were no patients in this study who was HBsAg seropositive but Anti HBc (total) seronegative. Total 11.3% (6 patients) of renal biopsy specimens were found to have HBsAg deposits which included 3 cases of Membrano- proliferative GN and one of each of Membranous nephropathy, Mesangial proliferative GN and IgA nephropathy. The high rate of HBsAg deposits found in renal tissue indicates that detection of HBsAg deposition should be done for all histological varieties of GN. Antiviral therapy may be used to stop progression of HBV associated nephropathy. Bangladesh Med J. 2021 Sept; 50(3): 1-6
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