Introduction: Bivalirudin and heparin are the two most commonly used anticoagulants used during Percutaneous Coronary Intervention (PCI). The results of Randomized Controlled Trials (RCTs) comparing bivalirudin versus heparin monotherapy in the era of radial access are controversial, questioning the positive impact of bivalirudin on bleeding. The purpose of this systematic review is to summarize the results of RCTs comparing the efficacy and safety of bivalirudin versus heparin with or without Glycoprotein IIb/IIIa Inhibitors (GPI). Methods: This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA statements for reporting systematic reviews. We searched the National Library of Medicine PubMed, Clinicaltrial.gov and the Cochrane Central Register of Controlled Trials to include clinical studies comparing bivalirudin with heparin in patients undergoing PCI. Sixteen studies met inclusion criteria and were reviewed for the summary. Findings: Several RCTs and meta-analyses have demonstrated the superiority of bivalirudin over heparin plus routine GPI use in terms of preventing bleeding complications but at the expense of increased risk of ischemic complications such as stent thrombosis. The hypothesis of post- PCI bivalirudin infusion to mitigate the risk of acute stent thrombosis has been tested in various RCTs with conflicting results. In comparison, heparin offers the advantage of having a reversible agent, of lower cost and reduced incidence of ischemic complications. Conclusion: Bivalirudin demonstrates its superiority over heparin plus GPI with better clinical outcomes in terms of less bleeding complications, thus making it as anticoagulation of choice particularly in patients at high risk of bleeding. Further studies are warranted for head to head comparison of bivalirudin to heparin monotherapy to establish an optimal heparin dosing regimen and post-PCI bivalirudin infusion to affirm its beneficial effect in reducing acute stent thrombosis.
Objective: To analyse the pregnant women with heart disease and to assess its influence on the fetomaternal outcome. Materials and methods: This observational study was carried out during the period from Jan 2006 to Sept 2007. Fifty pregnant women with cardiac diseases who were admitted in the Fetomaternal Medicine unit of the department of Obstetrics & Gynaecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) were included in the study. Results: Rheumatic heart disease (n-37, 74%) with isolated mitral stenosis (28%) was the predominant cardiac problem among the study subjects while atrial septal defect (16%) was the most common form of congenital heart disease (n-13, 26%). Based on New York Heart Association (NYHA) functional classification, 40(80%) women were in class-I, 7(14%) were in class-II and 3(6%) were in class-III heart disease on presentation. The mean (±SD) gestational age at delivery was 37.50(±2.50) weeks and pregnancy duration was shortened in more advanced classes of heart disease. The rate of cesarean section (90%) was high in the study subjects. The rate of prematurity (55.5%) was high among class II and III and average birth weight of neonates were less among these two classes compared to class I (2.80±0.20 kg in Class-I, 2.30±0.26 in Class-II and 2.10±0.34 in Class-III). No baby was delivered stillborn and there was no neonatal death. Out of fifty, nine patients developed heart failure during the hospital stay. Duration of hospital stay was shorter in class-I (7.50±1.50) and was prolonged in more advanced classes of heart disease (9.50±1.56 in Class-II and 13.80±4.20 in Class-III). Two patients of the study subjects expired. Conclusion: Rheumatic heart disease was the predominant type of heart disease in pregnancy and most of the women were in class I on admission. The neonatal outcome was satisfactory. Two patients in the congenital heart disease group expired during the study period. Key words: Maternal, Fetal, Cardiac disease. doi: 10.3329/bjog.v23i1.3050 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 3-7
Background: Anaemia and Iron-deficiency(ID) often acts synergistically, while intestinal parasitosis (IP) augments in developing nutritional anemia and-iron deficiency(NAID) rampant in resource constraint countries. Since no such study was reported from Bangladesh yet, we conducted this community-based intervention-study in a disadvantaged rural-area. Methodology: Total 168, children(mean age=6.86±2.33years) having intestinal parasitosis and anaemia, were subjected to fortnightly anthropometry and were randomized into 4 groups(Gp):Children from A1 & A2 were dewormed and B1 & B2 were not. Further, A1 and B1 were supplemented with micronutrient and A2 & B2 were not. Haematological indices/micronutrient assay were done for all at baseline. Postintervened blood was re-tested to compare with baseline. Findings: Prevalence of helminths(81.5%) and protozoa(12%)lowered down significantly after intervention in A1, than A2, B1 and B2(p< 0.001). Mean Hb increased in A1, than A2 (p>0.00), B1(p>0.005) and B2 (p>0.001). Mean S. ferittin increased in Gp.A1 than B1 (p< 0.03), and A2 than B1(p< 0.03) and Mean Total Iron-Binding-capacity increased in Gp A1 than A2(p< 0.03) and A2 than B2(p>0.04). While no post-intervened increment in mean height-z-score was observed except in A1 than B2 (p< 0.04), Means weight-z-score was increased in A1 than A2(p< 0.02), B1 than B2 (p< 0.001), A2 than B1(p< 0.05) & A2 than B2 (p< 0.05). Conclusion: Micronutrient supplementation helps parasitic and/or anaemic children in increasing haematological indices and gaining weight if dewormed in prior. It is particularly essential in underdeveloped low-health care budgeted countries in adopting better policies/strategies towards better child survival, through a cost-effective sustainable prevention /control programs against NAID.
Introduction: Chronic heart failure with reduced ejection fraction is a major complication of diseases involving myocardium. Despite numerous pharmacological interventions and invasive therapeutic techniques, therapeutic options for end stage heart failure remain limited to left ventricular assist device & organ transplantation. Regenerative medicine may bring hope here. Method: This pilot study was carried out at the Department of cardiology in collaboration with department of haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from October 2017 to March 2018. Considering inclusion & exclusion crieteria ten (10) patients were taken in stem cell group and ten (10) patients in control group. Patients in the control arm received standard of care in accordance with practice guidelines for heart failure management (GDMT). Patients in the cell therapy arm received, in addition to standard of care, bone marrow–derived cardiopoietic stem cells (G-CSF) meeting quality release criteria. Baseline clinical and echocardiographic data were obtained and recorded in pre-formed data sheet. Close liaison was maintained with all patients and followed up after 30 days & after 3 months and for any complication. The absolute change in 6 MWD from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But significant improvement was found at 6 months follow up of 6MWD between the two groups (300±28 vs 375±25, p= 0.04). Baseline BORG scale was similar in the control group and the SCT group (8.1±0.56 and 8.3±0.67 respectively, P= 0.45). The absolute change in BORG scale from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But improvement was not statistically significant in between the two groups (p= 0.32, 0.45, 0.23 respectively). Echocardiographic observation also revealed a similar baseline LVIDd, LVEF level in the control group and the SCT group which was not statistically significant (p = 0.45, 0.52 respectively). Gradual improvement in LVIDd were found at 30 days, 3 months, 6 months follow up observation but statistically significant absolute change was found only at 6 months follow up in between groups (62.4±1.8 vs 56±2.4, p=0.03). Baseline LVEF were less than 30% in both control & SCT group (29.5±0.8% & 28.7±1.3% respectively). The echocardiographic evaluation also revealed a significant increase in LVEF at 6 months (34% ±1.6 and 40% ± 2.5%, p = 0.04) of follow-up in between group but not at 30 days & 3 months follow up. University Heart Journal Vol. 16, No. 2, Jul 2020; 52-58
These cases may go unrecognized, and even among those who are known to be hypoxemic, some do not use supplemental oxygen. During air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate in patients with lung disease despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. Each year worldwide, more than 2.75 billion passengers travel by air, 736 million in the United States alone1. One study reports that over an approximately 3-year period, there were 11,920 In-flight medical emergency calls made by airlines to a medical communications Center; this was estimated to represent almost 1 medical emergency for every 600 flights2. Respiratory symptoms accounted for 12% of this in-air emergencies. The development of respiratory symptoms during flight was associated with an increased risk of hospitalization after air travel (odds ratio [OR], 2.13), second only to possible stroke (OR, 3.36). A previous study reported an average of 72 in-flight deaths per year3, from a population representing approximately 50–60% of the total estimated number of worldwide passengers for that period. Of those deaths, 69% occurred in passengers with no known previous medical illness3 as such, a thorough assessment of patients with chronic lung disease and cardiac disease who are contemplating air travel should be performed. Central Medical College Journal Vol 5 No 2 Jul 2021 PP 116-125
Back Ground: Hypertrophic cardiomyopathy is genetically transmitted primary cardiac disease and an important cause of morbidity and sudden death in young people, including competitive athletes.Objectives: The study was designed to compare the CAG findings between normal subject and hypertrophic cardiomyopathy patients who required CAG.Methods: HCM was diagnosed by using diagnostic criteria (clinical, electrocardiography and echocardiography) defined by Western Working group. The study was carried out on 60 subjects of which 30 had hypertrophic cardiomyopathy, 30 age and sex control (normal subjects).Results: In comparison of control it was observed that HCM cases had significantly larger proximal left anterior descending (3.81+-0.64 vs 2.49+-0.61 P < 0.001), proximal left circumflex (3.29+-0.46 Vs 2.39+-0.60, p < 0.001) and proximal right coronary artery (3.15+-0.47 vs 2.49+-0.42, P < 0.001). Coronary artery stenosis were found in 5 cases of HCM and among them, single vessel disease was present in 3, double vessel disease in I and triple vessel disease in I cases.Conclusion: Coronary artery disease (CAD) associated with hypertrophic cadiomyopathy (HCM) is a complex clinical syndrome, difficult to diagnose clinically, that can reliably be recognized by coronary arteriography.University Heart Journal Vol. 11, No. 2, July 2015; 71-78
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