First Cardiac Magnetic Resonance Experience in Bangladesh: A Case of Arrhythmogenic Right Ventricular Dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive degeneration and replacement of the right ventricular (RV) myocardial tissue by fat and fibrosis and produce clinical condition. Desmosome gene mutations are only the causative state for ARVD hereditary disorder. The arrhythmogenic right ventricular cardiomyopathy incidence is about 1/1000-5000. Mostly young people and athletes are bearing the clinical presentations include presyncope, syncope, ventricular tachycardias or ventricular fibrillation leading to cardiac arrest. We report about the first case of Cardiac magnetic resonance (CMR) imaging to diagnose a case Arrhythmogenic right ventricular dysplasia (ARVD) of a 34-year-old male from Savar, Dhaka, Bangladesh who was referred to cardiac emergency for the evaluation recurrent dizzy spells.

Comparison between 2D and 3D Echocardiographic Parameters used for Diagnostic and Therapeutic Purpose in Patients with Rheumatic Mitral Stenosis.

Rheumatic heart disease causes a substantial number of morbidity and mortality in South Asia. With the increasing urbanization & antibiotic availability, it is now in declining trends. The prevalence of Rheumatic Fever and Chronic Rheumatic Heart Disease in Bangladesh is 0.6 and 0.3 per thousand populations, respectively. Mitral valve is mostly involved in the rheumatic process, particularly in the form of mitral stenosis. Treatment options of mitral stenosis depend upon the severity of the disease. Echocardiography has a key role in determining the pattern, extent and severity of the involvement of the mitral valve apparatus. 2D and Doppler echocardiography are conventionally used. 3D echocardiography is more available nowadays. The heart being a complex three-dimensional structure, a 3D evaluation would definitely offer better visualization for accurate assessment of the severity of rheumatic mitral stenosis. There are many echocardiography based scoring systems are available for the assessment of the severity of rheumatic MS. Those are mostly 2DE based; among them, Wilkins is widely practiced. Real-time 3DE based score for mitral stenosis is developed recently. This cross-sectional observational study was done in the University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from May 2012 to October 2012. Considering all ethical issues, data were collected from 50 subjects who underwent transthoracic 2D and 3D Echocardiography for the assessment of the extent and severity of mitral stenosis. Precise measurement of the mitral valvular area is of a pivotal role in the assessment of severity, which is found almost similar by both 2DE (0.98±0.24cm²) and 3DE (0.92±0.23cm²). But in identifying calcification and its extent specifically commissural involvement is better detected by 3DE (p=0.002). Detail assessment of subvalvular involvement particularly chordal adhesion can better be done by 3DE (p<0.001). All of these have important contributions in formulating the most favorable therapeutic roadmap in chronic rheumatic MS. To make an efficient management plan and also for the confident prediction of complications, three-dimensional echocardiography has promising prospects and should be considered as an important adjuvant to the conventional two-dimensional echocardiography.

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis.

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

Coronary angiographic profile in bangladeshi patients with metabolic syndrome and ischemic heart disease.

The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. We evaluated interrelationships between angiographic CAD and the metabolic syndrome, in 478 patients who were referred for coronary angiography to evaluate suspected myocardial ischemia in the department of cardiology of BSMMU between June 2007 and May 2008. We applied the criteria for the metabolic syndrome proposed by ATP III guideline. Study populations were divided into two groups on the basis of presence or absence of metabolic syndrome. Age was similar in both groups. Body mass index (BMI) was higher (26.22 ± 1.94 vs. 22.07 ± 1.55) in metabolic syndrome group (p ≤ 0.0001). All parameters, waist circumference (103.16 ± 10.21 vs. 91.45 ± 7.61) cm, blood pressure both systolic (141.34 ± 21.49 vs. 127.94 ± 13.01) and diastolic (86.8 5 ± 8.42 vs. 79.28 ± 7.77) mm of Hg, serum triglyceride (248.32 ± 77.88 vs. 128.35 ± 19.00)mg/dl, fasting blood glucose (125.40 ± 22.86 vs. 95.65 ± 10.63)mg/dl were significantly higher in metabolic syndrome group (p value=0.0001), whereas HDL (33.10 ± 6.55 vs. 39.30 ± 6.17)mg/dl was lower (p value = 0.0001). More subjects in metabolic syndrome were having type B (55.60% vs. 31.00%) and type C (9.50% vs. 2.70%) lesion as compared to non-metabolic syndrome group. Involvement of left main artery was more (4.80% vs. 0.90%) in metabolic syndrome group. Metabolic syndrome has primary predictive ability for CAD. A metabolic profile should form part of the risk assessment in all patients with coronary disease, not just those who are obese.