Introduction:Percutaneous Coronary Interventions (PCIs) are commonly performed via the femoral route. Frequent bleeding and vascular access site complications with this approach have led to the search for an alternate route. Transradial coronary angiography and intervention has become a popular technique due to reduced local and bleeding complications, easier post-procedural care and patient preference. In certain patients, transradial access may not be possible due to various anatomical reasons.Transulnar arterial access however, has recently been shown to be feasible and safe for both coronary angiography and intervention. The procedural success, advantages and complication rates for this procedure appear similar to those for the transradial approach. The technical success rate is 95-96% through transulnar route. Complications such as local hematoma, ulnar artery perforation and reversible parasthesia can occur in 1% of patients .1In many patients, when the transradial cannulation is not feasible due to anatomical aberration or any other difficulty, the transulnar approach may be tried. Methods:In the forearm, ulnar artery is larger in caliber than the radial artery 2 . The ulnar nerve lies on the medial side of lower two-third of the artery and the palmer cutaneous branch of nerve descends on lower part of vessel to the palm of the hand. It crosses the flexor retinaculum lateral to ulnar nerve and pisiform bone.A study was done in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2012 to August 2012. 15 consecutive patients were included for transulnar coronary angiography. The techniques described for ulnar cannulation and sheath placement are similar to those for radial artery access. In all cases, adequacy of radial collateralization to the hand was checked with the inverse Allen's test or a variation of this based on oxygen plethysmography. Typically, the arm was abducted to approximately 70 degrees with mild hyperextension of the wrist. Local anesthetic is infiltrated in the region just proximal and lateral to the pisiform bone. The Seldinger technique was used to cannulate the vessel. Sheaths between 5 Fr and 6Fr diameter and 11 cm length were used. Coronary angiographies were performed via 5 Fr catheters. We have used intra-arterial glycerine trinitrate (GTN) and verapamil to counter the ulnar artery spasm. Vascular sheath was removed immediately after the procedure and manual compression and pressure bandage was given in all cases. After 3-4 hours, pressure bandage was loosened and on the next day bandage was removed. Results:Out of 15, transulnar coronary angiography was done successfully in 14 (93.99%) patients, 1(6.66%) case was postponed due to failure to canulate the ulnar artery. Of them 11(64.28%) was male and 3(21.42%) was female. 2 (14.28%) of them had significant ulnar artery spasm, for which we had to use higher dose (300 micro gram) of GTN Abstract:For performing Coronary angiogram and PCI Trans ulnar route is a feasible alter...
Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients of cirrhosis of liver. The cause and pathogenesis of PHG in cirrhotic patients is poorly understood. Some studies showed, association of Helicobacter pylori (H. Pylori) with portal hypertensive gastropathy in cirrhosis of liver, but the evidence is not robust. The aim of this study was to assess the association of H. pylori infection and PHG in patients with cirrhosis of liver. This case control study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from April 2016 to August 2018. A total of 230 patients with cirrhosis of liver were included in this study. There were 115 cirrhotic patients with PHG as cases and 115 cirrhotic patients without PHG as controls. Upper gastrointestinal Endoscopy and 13C Urea Breath Test (UBT) was done in both cases and controls. In this study, out of 230 cases, 147 (63.91%) found to have H. pylori infection. Among cirrhotic patients with PHG case, 77 (66.95%) was positive in UBT. Out of these 77 UBT positive cases, 55 had mild PHG whereas 22 cases had severe form of PHG. Among 38 cases of cirrhosis with PHG who had negative UBT, 23 had mild PHG and 15 cases had severe form of PHG. The risk of positive urea breath test was not statistically significant in cirrhotic patients with PHG in comparison with cirrhotic patients without PHG (P=0.337, OR 1.303, 95% CI 0.759-2.235). In this study, statistically significant association was not found between H. Pylori and PHG in cirrhotic patients. Bangladesh Med J. 2021 May; 50(2) : 21-27
Decompensated heart failure is one of the major causes of morbidity and mortality in worldwide. Some of these patients suffer repeatedly after taking optimum medical therapy (OPT). Cardiac resynchronization therapy (CRT) has been shown to be an effective therapy for patients with heart failure and dyssynchrony.
Background Nephrotic syndrome (NS) is one of the most common glomerular disease in children, characterized by massive proteinuria, hypoalbuminemia, dyslipidemia and edema. Steroid-resistant nephrotic syndrome (SRNS) and steroid-dependent nephrotic syndrome (SDNS) present challenges in pharmaceutical management. Patient need several immunosuppressant for optimal control, each of which has significant side effect and difficult to get desired results. Rituximab (RTX) is a monoclonal antibody that targets B cells and has been shown to be effective for patients with SRNS and SDNS. Objective To see efficacy of RTX in pediatric patients with SRNS. Method This retrospective study took place in Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from July 2017 to June 2019. Patients diagnosed with SRNS who were treated with RTX and followed up for 6 months were enrolled in this study. Primary endpoint was achievement of remission after rituximab infusion; secondary endpoint was relapse-free survival rate in 6 months period following rituximab infusion. Results Total 7 patients were recruited in this study. Among them 4 were male. Clinical and lab parameters of all patients before and after RTX were compared. Complete remission achieved in 4/7 patients, partial remission in 2/7 patients and no response in 1/7 patient. Mean number of relapse in 3 patients before RTX infusion was 3.67 (SD 0.57) and after 0.33 (SD 0.00) (P=0.038). Conclusion RTX is a biological agent that is effective and promising drug in children with SRNS. Rituximab is useful to induce and maintain remission.
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