Minimally invasive Coronary ArteryWe discussed the procedure with the patient, who was enthusiastic and well-motivated to accept the technique.On the day prior to the elective surgery, a thoracic epidural catheter was inserted at the T1 and T2 level under local anesthesia using an 18-gauge. Tuohy needle with the patient in sitting position. The epidural space was identified by hanging-drop technique. The catheter was directed cephaled and advanced 3cm into the epidural space. The block level was tested by a test dose of 3ml Lignocaine (2%).On the day of surgery, early in the morning the patient was pre-medicated with 7.5 mg Midazolam orally. At 8:30am in the operating room, 10 ml of 0.25% Bupivacaine + 5 ml of 1% Lignocaine was administered through the epidural catheter as a bolus and the level of block was tested by pin-prick discrimination. The upper level of block was C6 and the lower level was T10. After skin incision weinfused a solution of 25ml 0.5% Bupivacaine + 25ml distilled water + 50µg Fentanyl by syringe pump at the rate of 5ml per hour. The patient breathed 5 litres of oxygen per minute using a face mask.The patient was continuously monitored by Intra Arterial Blood Pressure (IABP), CVP, ECG, pulse oxymetry, ETCO 2 , and ABCT. The maximum
The advent of new technology has opened opportunities to the computer users to consider alternate ways for humans to interface with machines. Research groups are looking to use computer interfaces that can allow users to communicate with devices in a subtle way and allow virtual reality environments to create an immersing experience. Electromyography based wearable input device can interface with mobile devices in a subtle way. Electromyography can also be used for interactive computer gaming as well as to control flights through virtual joysticks and controllers. This study provides a brief review on various ways for humans electromyography (EMG) signal to interface with machines. Therefore, the crux of this study is to overview the up to date developments and research related to the EMG interface with the wearable devices. This study further opens up a passage for researchers and end users to advocate an excellent understanding of EMG interfacing with mechanical devices.
Introduction: Tuberculosis (TB) is highly prevalent in Bangladesh. The affection of the central nervous system(CNS) is one of the most dangerous manifestations of extrapulmonary tuberculosis. This may take the form of either tubercular meningitis (TBM), tuberculoma, or spinal arachnoiditis. CNS tuberculosis (CNS-TB) carries high morbidity and mortality among all forms of TB. The diagnosis is difficult and often delayed due to the varied and non-specific presentation. Aside from clinical indicators, cerebrospinal fluid (CSF) diagnostic indicators include mononuclear pleocytosis, low sugar levels, and high protein concentrations. It is possible to confirm Mycobacterium tuberculosis in CSF using staining, culture methods, and molecular analysis, but it is difficult. Advanced radiological imaging techniques can often be very helpful in making presumptive diagnoses, but they do not always yield confirm diagnoses. Aim: In our case series, we aimed to highlight the spectrum of presentation of CNS tuberculosis, diagnostic challenges, and initial response to anti-TB drugs. Material and Methods: We report a case series of six patients with CNS tuberculosis admitted to the neurology department between 2022 and 2023. Four of them were prospectively reviewed and two retrospectively. Data on presentation, diagnostic workup, and treatment were analyzed. Result: We presented six cases of CNS TB from 2022 to 2023. Four cases among six had only TBM, two cases had concomitant intracranial tuberculoma and two cases had tuberculosis in the extracranial site. The most common presentation were fever, altered consciousness level, and constitutional symptoms. CSF study was done and revealed increased total protein in all six cases, lymphocytic pleocytosis in 66.67% of cases, a low sugar level in 50% of cases, and raised ADA level in 66.67% of cases. MTB was detected in a polymerase chain reaction (PCR) in one case and was none positive for AFB stain and culture. MRI with contrast showed meningeal enhancement in all six cases, hydrocephalus in 66.67% of cases, and infarction and tuberculoma in 33.33 % of cases. Brain biopsy for histopathological confirmation was not done. All of them had an anti-tubercular therapy and reported good clinical responses at 21-day-follow up. Conclusion: CNS TB should be diagnosed primarily based on compatible clinical features, morphological findings on brain MRI, and CSF findings. In Bangladesh, CNS TB should always be considered an important differential diagnosis in patients with prolonged fever and headache, as well as altered consciousness level, and treatment should be initiated immediately on the basis of strong clinical suspicion, rather than waiting for laboratory confirmation.
Background & objective : Myocardial revascularization in diabetic patients is challenging. Off pump coronary artery bypass (OPCAB) surgery has been widely used for the treatment of coronary artery disease. The goal of this study was to compare outcomes of OPCAB in diabetic patients relative to non diabetic patients. Methods:The present prospective study was conducted between January 2014 to June 2017. During the period a total of 193 patients (of whom 70 had diabetes and 123 patients were non-diabetics) were included in the study. All of them underwent coronary artery bypass grafting (CABG) without cardiopulmonary bypass surgery. The early clinical outcomes of OPCAB were evaluated during the postoperative hospital stay. Result: Over three-quarters of the patients in both diabetic and non-diabetic groups were ≥ 50 years old with no significant intergroup difference (p = 0.825). Majority(90%) of the patients in either group was male (p = 0.786). Nearly half (48.5%) of the patients in diabetic and 45% in non-diabetic group were overweight or obese (p = 0.557). The smokers weremuch higher in non-diabetic group than that in the diabetics (p = 0.009). The average number of grafts needed was considerably higher in the diabetic group (p = 0.079). All the postoperative outcome variables like pneumonia, stroke, arrhythmia, renal failure requiring dialysis and postoperative mortality in both the groups were almost identical (p > 0.05). Conclusion: Off-pump coronary artery bypassis the preferred choice of revascularization for multi-vessel coronary artery disease in diabetic patients. However, continuous, strict glycemic control is essential to have a good postoperative outcome. Ibrahim Card Med J 2018; 8 (1&2): 10-16
DOI: http://dx.doi.org/10.3329/icmj.v2i1.17381 Ibrahim Cardiac Med J 2012; 2(1): 8-11
Ruptured Valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired, a coexisting cardiac lesion might be present. The presentation may range from an asymptomatic murmur to cardiogenic shock. Most of these cases were earlier diagnosed using echocardiography and conventional angiography. But with the availability of advanced imaging modalities like cardiac CT this condition can be accurately assessed noninvasively. The high spatial resolution of cardiac CT provides anatomical details of the aneurysm by depicting a jet of contrast materials extending from the aneurysm and adjacent cardiac chamber. We report a case of ruptured aneurysm arising from the non-coronary sinus with a fistulous track connecting the sinus with the right atrium. This case was evaluated by 32 slice cardiac MDCT (Multi detector computed tomography) imaging. This was later confirmed peroperatively. Ibrahim Cardiac Med J 2014; 4(2): 64-67
Here we present a case involving a middle aged male patient suffering from ruptured left Sinus Of Valsalva (SOV) and attendant complications. The rarity of the condition presents a clinical dilemma in the diagnosis and treatment of the same. Occurrences are so rare that not much comprehensive guideline is available for the medical team to proceed with treatment. We describe how we arrived at the diagnosis by correlating the various investigations done and also the surgical correction done resulting in a satisfactory outcome. DOI: http://dx.doi.org/10.3329/uhj.v7i2.10850 University Heart. Journal Vol. 7, No. 2, July 2011
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