Improvement of Left Ventricular Systolic Function after Percutaneous Coronary Intervention in Diabetic Patients with Non-ST elevated Myocardial Infarction.

Long term mortality is higher in Non-ST-segment elevated myocardial infarction (NSTEMI) patients than STEMI paitents. NSTEMI are a high risk factor for ensuing cardiovascular events in diabetic patients. But, use of drug eluting stents (DES) will further improve outcomes in patients with diabetes suffering early percutaneous coronary intervention (PCI). The aim of the study was to determine the changes in left ventricular (LV) systolic activity after successful PCI in NSTEMI diabetic patients was compared with non-diabetic patients. This comparative clinical study was performed in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2017 to June 2018. Thirty (30) diabetic and 34 non-diabetic patients with NSTEMI undergoing percutaneous coronary intervention were included in the study. In all patients PCI with drug eluting stent was performed successfully. Earlier echocardiography (2-Dimensional) was done, at release subsequent PCI and 3 months afterward to evaluate the LV systolic activity and compare to diabetics and non-diabetics at all levels of evaluation to assess the outcome of intervention. At baseline LVEF was rather lower in diabetic group than non-diabetic group patients. In diabetics patients segments with abnormal wall motion (WMA) was higher than non-diabetics patients. While the LVEDD, LVIDd and LVIDs were significantly larger in the earlier group than those in the latter group, the LVESV was no different in both groups. At release from hospital, no significant enhancement was observed in either group following PCI in terms of LVEF, number of segments with WMA, LVIDd and LVIDs. However, both LVEDV and LVESV reduced successfully in both groups with decrease of LVESV being more marked in non-diabetics compared with diabetics (p=0.018). However, 3 months after PCI, LVEF improved (8.4±1.2%) in diabetics and 7.9±1.2% in non diabetics patients but this improvement between two groups was not statically significant (p=0.631). Similarly baseline to 3 months after PCI LVIDs reduces in diabetics patients (5.7±1.9%) and 4.8±1.1% in non diabetics patients but the difference between both groups was not significant (p=0.201). Diabetic patients more frequently required 2 stents (p=0.30), while stent's diameter and length did not differ between the study groups. This study demonstrated that improvement of the parameters of left ventricular systolic function after using of drug eluting stent in NSTEMI diabetic patients was not lower to the non diabetic group under same condition. So, suggestion of PCI with drug eluting stent may be extended in NSTEMI diabetic patient.

Role of oral clonidine on intraopereative haemodynamic stability for craniotomies of intracranial space occupying lesion.

This was an analytical comparative study. Aim of this study was to observe the effect of oral clonidine on intra operative haemodynamic stability in intracranial space occupying lesion (ICSOL) patients who underwent craniotomy. Total 60 patients were distributed into case and control group. Number of cases was 30 in each study group of this study. Mean age of experimental and control were significantly close to each other. Baseline weight, pulse, systolic blood pressure, diastolic blood pressure and mean pressure also showed a significant similarity between each group. Variable of each group was collected during different events of craniotomy. All variable of pulse, systolic blood pressure, diastolic blood pressure and mean pressure were tabulated by line chart and fluctuation of variable was measured by significance test. The fluctuation of mean pressure was respectively 11.6%, 11.2%, 12.4%, 11.4%, 14.2%, 15.6%, 10% and 9.4% in different events of craniotomy in hemodynamically unstable group and it was respectively 11.1%, 10.9%, 10.4%, 9.9%, 9.2%, 9.4%, 8.6% and 8.7% in hemodynamically stable group. 'P' value was less than 0.05. It was observed that fluctuation of haemodynamic parameters were significantly less in experimental group where oral clonidine was used as premedication.

Neurobehavioral effects of carotid endarterectomy.

OBJECTIVE: Nineteen patients with symptomatic carotid stenosis (>70%) were subjected to carotid endarterectomy in a prospective study to evaluate neurobehavioral changes before and 6 months following the operation. METHODS: All patients were subjected to neurobehavioral rating scale one week before and 6 months after the operation. RESULTS: There were no significant changes in the 27 items of this scale before and 6 months following the operation. Some patients showed no difference at all in some items of this scale before and after operation such as suspiciousness excitement, speech and articulation using Mann-Whitney rank test, P values were (> 0.05) as regards to all items of neurobehavioral rating scale. CONCLUSION: Uncomplicated carotid endarterectomy does not seem to be associated with significant long time neurobehavioral impairment following the operation.

Neurobehavioral effects of carotid endarterectomy.

OBJECTIVE: Nineteen patients with symptomatic carotid stenosis (>70%) were subjected to carotid endarterectomy in a prospective study to evaluate neurobehavioral changes before and 6 months following the operation. METHODS: All patients were subjected to neurobehavioral rating scale one week before and 6 months after the operation. RESULTS: There were no significant changes in the 27 items of this scale before and 6 months following the operation. Some patients showed no difference at all in some items of this scale before and after operation such as suspiciousness excitement, speech and articulation using Mann-Whitney rank test, P values were (> 0.05) as regards to all items of neurobehavioral rating scale. CONCLUSION: Uncomplicated carotid endarterectomy does not seem to be associated with significant long time neurobehavioral impairment following the operation.

Study of awareness during noninhalational anaesthesia.

Forty-five adult patients underwent a noninhalational anaesthetic method for investigation of awareness during surgery and recall of events associated with surgery in postoperative period. All the patients were divided into two groups. The first group of patients were male and had upper abdominal operations. The second group were female and had lower abdominal operations. No significant difference was found between these two groups either in requirements of depth of anaesthesia or in the evidence of per-operative awakefulness. Eighty percent patients of both the groups showed various signs of peroperative awakefulness but did not recall any events associated with surgery in the postoperative period. There was no report of dream either.