Introduction: Meconium staining amniotic fluid is associated with lots of adverseoutcome and has long been considered to be a bad predictor of fetal outcome.Objective: This prospective observational study was undertaken to find out immediatefetal outcome in meconium stained liquor.Materials and Methods: This study was conducted in Obstetrics and Gynecologydepartment of Dhaka National Medical Collage Hospital from July to December 2008.The pregnant women with yellow, brown and thinly stained amniotic fluid in labour withgestational age 37 completed weeks were enrolled in the study. Their babies weretaken as case and followed upto 7 days after delivery in National Medical CollageHospital and in Dhaka Shishu Hospital after admission when required. Babies bornwithout meconium stained liquor were taken as a control.Results: Total 80 cases were enrolled in the study as case and 80 cases wereenrolled as control. Mean gestational age was 39.3±1.5 weeks in cases and 38.5±1.3weeks in control. There was 13.8% pregnancy induced hypertension in case groupand 3.8% in control group. Pre-eclampsia were present 10% in case group and 1.1%in control group (p<0.05). Caesarean deliveries were high (75%) in cases and it wasmuch higher with thick meconium (75%) as compared to the thin meconium (25%,p<0.001). Apgar scores in first minute and fifth minute were also low in cases. Birthasphyxia was more in cases (20%). Meconium Aspiration syndrome (25%) andConvulsion (3.8%) were developed only in cases. Admission in neonatal ward wasmore (22.5%) in cases (p<0.05) as compared to control. Neonatal mortality was high(3.8%) in cases than control (1.3%).Conclusion: Meconium stained amniotic fluid were associated with higher rate ofcaesarian delivery, increased need for neonatal resuscitation, increased rate of birthasphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome,hospital admission and mortality.Key words: Meconium stained liquor; foetal outcome.DOI: 10.3329/bjch.v33i2.5675Bangladesh Journal of Child Health 2009; Vol.33(2): 41-45

Background: Coronary collateral circulation is an alternative source of blood supply to the myocardium in coronary atherosclerotic disease. They provide adequate flow to the major epicardial branches of the coronary artery. Indicator of cardiac ischemia like stable angina pectoris may determine the presence of coronary collateral circulation.Methods and results: In this prospective observational cross sectional study, 150 patients with stable angina pectoris with or without MI (myocardial infarction) and or coronary intervention were enrolled. Presence of coronary collaterals in coronary angiogram was defined as Rentrop grade > 1. Patients were divided into two groups. Group A patients having Rentrop grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3. Patients are compared in these groups. Total (63%) patients with stable angina were in Group B with coronary collateral circulation and only (37%) patients with stable angina pectoris were in Group A without collaterals.Conclusions: The incidence of development of coronary collaterals was significantly higher in patients with stable angina pectoris. DOI: 10.3329/uhj.v6i2.7245University Heart Journal Vol. 6, No. 2, July 2010 pp.61-64

The antioxidant N-acetyl Cysteine prevents contrast induced nephropathy in patients with impaired renal function who undergo coronary angiogeaphy. However its role in Bangladeshi population is not clear. This study was done determine whether oral acetylcysteine prevents contrast induced nephropathy in high risk patients.100 patients with mild to moderate renal insufficiency who are undergoing elective coronary angiography with or without intervention.50 patients were randomy assigned to receive oral N acetyl cysteine (600mg) twice daily on the day before and on the day of procedure. All patients received low osmolar contrast agent.10 (20%) control patients (no premedicationgroup) and none of acetyl cysteine (0%) group developed a more than 25% increase in serum creatinine level within 48 hours after contrast exposure. Acetyl cysteine prevents contrast induced nephropathy.

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

Chikungunya virus (CHIKV) is an RNA alphavirus of the Togaviridae family that produces an acute febrile illness in humans followed by Joint pain, Itchy rash and leg swelling. This emerging virus has caused several large outbreaks in parts of Africa, Asia, and the Indian Ocean Islands and more recently in the Caribbean. This study was done from December 2015 to November 2016 on 24 confirmed Chikungunya patients with leg swelling. Peripheral vascular duplex study was done in every patients to find out the cause of leg swelling. Unilateral leg swelling 83% and Bilateral leg swelling 17%. Lower limb vascular Duplex was done in all patients. Moderate resersible lymphatic oedema in subcutaneous tissue of lower limb was found in 22 patients only. 2 patients had cellulites with mild lymphatic swelling. DVT was absent. There was mild reduction of peak systolic arterial flow in 13 patients which is secondary to pressure effect of lymphedema and leg swelling. 16 patients had non tender lymphadenopathy (>1cm in diameter), 2 had tender lymphadenopathy in inguinal region and no enlarged lymph glands was observed in rest of the 6 patients. 6 patients had neutropenia and 8 had lymphopenia. Gradual improvement of symptoms was observed with conservative treatment. Lymphedema is reversible and conservative therapy is appropriate. And Non tender lymphadenopathy does not require treatment.University Heart Journal Vol. 13, No. 1, January 2017; 13-16

Background: The subvalvular apparatus arrangementcan causeventricular torsion& deformation during cardiac cycle and interruption of papillary annular complex. As a result there was impairment of normal left ventricular strain pattern. [2] In patients with mitral stenosis, the left ventricle is small. Preservation of subvalvular apparatus thus become important in moderation of left ventricular volume in long term in patients with mitral stenosis undergoing mitral valve replacement. Methods: This cross sectional study was performed on the 32 consecutive subjects in department of cardiac surgery and cardiology of BSMMU with rheumatic mitral stenosis undergoing MVR from Jan 2013 to June 2014.Mode of surgery was determined by morphology of subvalvular apparatus which dictated the extent of the preservation. The patients were divided into two groups-Group I-With preservation of subvalvular apparatus &Group II-No preservation-where SVA was completely excised. In 2D and M Mode echocardiographic measurements:Mid-wall circumferential end systolic LV stress as calculated for ellipsoid, LV mass, the mid wall circumferential end systolic LV stress is calculated by mirsky's formula.9,10 Results: Patients with sub valvular apparatus resection (group I) had deterioration with postoperative ejection fraction in compare to group-II. Left ventricular circumferential wall stress analysis showed increased wall stress in group II after MVR. Conclusion: The increased left ventricular wall stress is responsible for poor outcome in nonpreserved group after MVR. The wall stress increases further in midterm follow up which may explain the mechanism of long term poor out come in patients with mitral stenosis.

Like many other developing countries rheumatic heart disease still poses a great threat to the health system of this country due to its devastating outcome in inappropriately treated cases. PTMC remains a prime treatment option in suitable cases of rheumatic mitral stenosis. But there are controversies and discrepancies in the conventional 2-D echo assessment for proper selection of patients for PTMC. With the advent of newer technologies like 3-D echo with newer options, better assessments are naturally expected. This 3-D echo system raised the hope to fill the shortcomings of 2-D Wilkins’ score. To facilitate this 3-D echo with its scoring system it has to be testified against an established, widely accepted and well-understood existing scoring system that has its limitations. Thus it creates a fertile ground whereupon many studies are being done as it is chosen here. In this study, considering all ethical issues, data were collected from 50 mitral stenosis patients who were scored by means of 2-D Wilkins’ and RT3DE scoring systems prior to PTMC and reassessed echocardiographically to define post PTMC outcome and then from this result to compare the two scoring systems as predictors of outcome of PTMC. This study showed a clear female preponderance (78%) of mitral stenosis patients most of whom belonged to the age group 31-40 years. According to Wilkins’ score all are in the ‘mild’ or ‘moderate’ group but RT3DE scored 24% as severe. Both the 2-D mild and moderate groups had good number of suboptimal outcomes (34% and 24% respectively) although the moderate group had comparatively more optimal outcomes (76% in comparison to 66%) than the mild group (although the difference is not statistically significant), that is, the 2-D score is less consistent. On the other hand the RT3DE score showed a gradual fall of optimal outcome in an ascending order of the score from mild to severe and the differences in outcomes among different groups was statistically significant. This showed a clear superiority of the 3-D scoring system over the 2- D in terms of accuracy and consistency. In the 3-D ‘severe’ group percentage of suboptimal outcome was very high(91.7%). This is the group of patients that were not correctly detected by 2-D echo and as a result the outcome assessment was far from accurate. Due to the higher accuracy and consistency 3-D echo is likely to be more reproducible than the 2-D, 3-D echocardiography was more accurate and consistent than 2-D echocardiography in assessing outcome of PTMC. So, the RT3DE scoring system can be a good supplement to the existing 2-D scoring systemUniversity Heart Journal Vol. 9, No. 2, July 2013; 74-79

HCM is a relatively common genetic mediated primary cardiac disease which may cause sudden death in the young including competative athlets.PTSMA is an alternative therapeutic option for surgical septal myomectomy who are high risk for surgery and presented with severe disabling symptoms due to marked LV outflow obstruction. PTSMA is performed by injection of 1 to 4 ml of 96% to 98% ethanol into the target artery in 0.5 to 1.0 ml aliquots at 1 ml/min. Selection of patients for PTSMA includes those with severe symptoms refractory to maximum medical management associated with LV outflow gradient > 50 mm Hg and basal septal thickness > 18 mm. Successful outcome following septal ablation by LV outflow gradient often reduced to < 20 mm of Hg and improved from symptomatic standpoint. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16083 University Heart Journal Vol. 8, No. 2, July 2012