Feasibility and Safety of Distal Transradial Access in the Anatomical Snuffbox for Coronary Angiography and Intervention.

Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve. The study was aimed at proving feasibility and safety of distal transradial access in the anatomical snuffbox. A total of 100 patients were assigned to perform coronary angiogram or intervention through distal transradial access in the anatomical snuffbox from January 2018 to June 2018 in this unit of the University Cardiac Center (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All of them had normal pulse in their distal radial artery. Both right and left distal radial artery were used and demographic features & complications were recorded during hospital stay. Statistical analysis was done through SPSS version 19. The overall feasibility was 98%, greater than expected in this early clinical experience, with 98 successful accesses out of 100 patients. There was failure to access of distal radial artery in two cases which may be due to hypoplastic/vasospastic distal radial artery. Despite all it can be said that it was very much safe as there was no hand ischemia, hematoma, numbness or proximal radial arterial occlusion. Distal transradial access in the anatomical snuffbox for coronary angiography and intervention is a safe and feasible option for both patients and operators.

Transcatheter Closure of Post Infarction Subacute Ventricular Septal Defect: A Case Report.

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.

Comparison between Glyceryl Trinitrate and Trimetazidine in Ischaemic Cardiomyopathy Patients.

Ischaemic cardiomyopathy (ICM) remains a major health problem, both in developed and developing countries like Bangladesh where it causes a significant number of morbidity and mortality. The treatment and outcome of ICM chiefly depends on the presence and extent of hibernating myocardium. In this regard addressing anginal symptoms is the key to patients' comfort as well to achieving the goal of treatment. Glyceryl trinitrate (GTN) and trimetazidine (TMZ) are two widely used drugs for relieving angina. This pilot study was designed to answer some of the confusions and controversies regarding their use and to bring precision in decision making in the treatment of ICM. Here, comparison of GTN and trimetazidine were done by assessing the symptoms by NYHA and CCS class following their use in ICM patients, admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15th October, 2015 to 15th April, 2016, who were randomly placed in two groups in a prospective manner. Most of the patients were in age group 51-60 years and were male in both the groups. It was observed that there was no significant difference in NYHA and CCS class at base line and at discharge between two groups (p>0.05). But statistically significant (p<0.05), improvement noted at 6 weeks and 12 weeks in GTN group in comparison to trimetazidine group. GTN stood out to be a better option than TMZ in the treatment of ICM. Moreover GTN is a cheaper option than TMZ.

Antiulcerogenic and antiinflammatory studies with shilajit.

In folk medicine, shilajit has been used to treat diverse clinical conditions ranging from peptic ulcer to bone healing. The present study was conducted to evaluate the possible antiulcerogenic and antiinflammatory activities of shilajit obtained from the rocky mountains of Zarlek, Badekshan, Afghanistan. Shilajit increased the carbohydrate/protein ratio and decreased gastric ulcer index, indicating an increased mucus barrier. Shilajit was found to have significant antiinflammatory effect in carrageenan-induced acute pedal oedema, granuloma pouch and adjuvant-induced arthritis in rats. The results of the present study thus substantiate the use of shilajit in peptic ulcer and inflammation.