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
Background: Preeclampsia is a multisystem disorder, unique to pregnancy that is usually associated with high blood pressure and proteinuria after 20 week of gestation. Abnormal liver function tests occur in 20% to 30% of pregnancies complicated by preeclampsia and are associated with a higher risk of adverse maternal and fetal outcome. Objective: To observe the alteration of hepatic enzymes in preeclampsia. Methods: The present cross-sectional study was carried out in the Department of Biochemistry, Dhaka Medical College, and Dhaka from July 2015 to June 2016. A total number of one hundred pregnant women in third trimester of pregnancy with or without preeclampsia, attending in the outpatient Department of Obstetrics and Gynecology in DMCH, were selected as study subjects. Of them fifty pregnant women in third trimester of pregnancy were with preeclampsia and fifty were normal healthy pregnant women. Estimation of hepatic enzymes like aspartate transaminase, alanine transaminase and gamma glutamyl transferase were done in both preeclampsia and normal pregnant patients and mean values of the variables were compared between them. Results: The mean serum aspartate transaminase level was significantly higher in preeclampsia compared to normal pregnant woman (32.4 ± 15.4 IU/L vs 24.8 ±11.8 IU/L respectively and p 0.007). Serum alanine transaminase level was also significantly higher in preeclampsia than normal pregnancy (38.1±19.9 IU/L vs 18.8±6.95 IU/L, respectively and p < 0.001). Serum gamma glutamyl transferase was also significantly higher in preeclampsia than normal pregnancy (44.7±19.1 IU/L vs 26.6± 6.0 IU/L p < .001). Conclusions: Hepatic enzymes (alanine transaminase, aspartate transaminase, gamma glutamyl transferase) were increased. So routine assessment of these parameters may helpful to prevent worse outcome of preeclampsia patients. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 18-22
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: Statins are the corner stone therapy of atherosclerotic cardiovascular disease (ASCVD). Statins may cause myalgia, myotoxicity, myopathy and rhabdomyolysis along with its lipid lowering properties and pleiotropic effects. Statins associated muscle symptoms (SAMS) are the leading cause of nonadherent and discontinuation. This study was conducted to evaluate and understand the muscle symptoms of high intensity statin therapy (atorvastatin 40 mg and rosuvastatin 20 mg) for a period of three months in individual patient with clinical atherosclerotic cardiovascular disease.Methods: A total of 280 patients with clinical atherosclerotic cardiovascular disease were studied to once daily atorvastatin 40 mg and rosuvastatin 20 mg. It was a randomized controlled single blind trial. The primary end point was muscle symptoms-muscle pain, fatigue, cramp/spasticity and weakness at 4 weeks and in 3 months of study period. Serum creatinine kinase was measured in every patient with muscular symptoms.Results: Patients of atorvastatin group noticed severe pain more than rosuvastatin group at the end of 3 months of treatment period (14.21% vs 4.38%, p <0.05), respectively). Significantly more patients felt extremely bad (12.78% vs 4.38%, p <0.05) and bad (24.66% vs 14.52%, p <0.05) with atorvastatin compared with rosuvastatin. Patients of atorvastatin group showed more marked increase muscle spasm (3.76% vs 1.46%, p <0.05) and slight increase muscle spasm (36.27% vs 16.01%, p <0.05) than rosuvastatin group by spasticity grade. One patient of atorvastatin group developed considerable increase in muscle spasm. Medical research council (MRC) muscle power grade 4 between atorvastatin and rosuvastatin group was observed 20.05% vs 10.90%, p <0.05, respectively. Three patients of atorvastatin group developed grade 3 muscle power. Serum creatine kinase > 1500 U/L was observed more in atorvastatin than rosuvastatin group (14.21% vs 4.38%, p <0.05, respectively). Statin associated muscle symptoms (more severe muscle problem, myositis/myopathy) observed more in atorvastatin than that of rosuvastatin group ( 34.07% vs 13.08% , p <0.05, respectively). Both treatments were well tolerated. No cases of rhabdomyolysis, incident diabetes, hepatic or renal insufficiency were recorded during the study period.Conclusion: Rosuvastatin had better outcome profile of muscle symptoms than atorvastatin in patients with clinical atherosclerotic cardiovascular disease among the Bangladeshi population. Patients in atorvastatin group experienced more muscle pain, fatigue, cramp/spasticity and weakness than rosuvastatin.University Heart Journal Vol. 14, No. 1, Jan 2018; 9-20
Introduction:At the end of twentieth century, the mortality from cardiovascular diseases allocated nearly half of the statistics of mortality in industrial and a quarter of fatalities in developing countries. Among these diseases is "congestive heart failure (CHF)" which is a very important part of cardiovascular diseases and almost all heart diseases can lead to this syndrome. 1 CHF is a debilitating complaint associated with a large number of readmissions. 2 A large body of research has revealed that CHF-related rehospitalization within six months is around 25-30%, which can increase to 40% within 1 year. 3 Another study showed the readmission from CHF range from 27% to 47% within three to six months after initial discharge. 4 One of the study in USA showed, annual readmission rate was 56.6%, median time to Abstract:Background: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The readmission rate within 3-6 months after discharge in these patients is 10-50%.
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