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.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI).

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Knowledge and Attitude Regarding National Tobacco Control Law and Practice of Tobacco Smoking among Bangladesh Police.

Tobacco is an important public health problem of Bangladesh having both high production and consumption. Police are engaged in enforcement of the tobacco control law. For effective enforcement of national tobacco control law (NTCL), they should have sound knowledge of tobacco control law and their attitude to the tobacco control law must be a positive one. The objective of the study was to explore the status of knowledge and attitude regarding national tobacco control law and practice of tobacco smoking among Bangladesh Police. The descriptive cross sectional study was conducted among 440 members of Bangladesh Police during the period of March 2015 to November 2015. Police personnel of different ranks were interviewed randomly using a semi-structured questionnaire from the selected SP offices, police lines, police stations and police camps. Among the respondents 414(94.1%) were male and 26(5.9%) were female. About half (214, 48.6%) of the respondents never smoked in life, while 226(51.4%) smoked in life even one or two puffs. There was no female among the ever smokers. One quarter (114, 25.9%) of the respondents ever smoked but quitted and 112(25.4%) respondents were currently smoker. Among the current smokers 31(7.0%) were occasional, while 81 (18.4%) were daily smoker. It was observed that there was lack of knowledge among police personnel regarding various rules and clauses of national tobacco control law. Most of the respondents (434, 98.6%) showed positive attitude regarding rationality of prohibition of smoking in public places and public transports. The most of the respondents (418, 95.0%) agreed that there should not be any advertisement of tobacco products in cinema hall, radio and television channel. A highest majority (377, 85.7%) of the respondents gave their opinion that Government should increase taxes on tobacco products. Most of the respondents (433, 94.4%) opined against the selling of tobacco products to the minor. Almost every respondent (436, 99.1%) wanted proper implementation of tobacco control law. Nearly half of the respondents (213, 48.4%) thought that smoking among police was one of the obstacles in effective implementation of tobacco control law. An overwhelming majority of the respondents (435, 98.9%) agreed that police personnel should not smoke tobacco for keeping their health and fitness and thereby for better performance. Almost all respondents (436, 99.1%) gave a positive opinion that police personnel may be a role model for the public by not smoking tobacco. Most of the respondents (427, 97.1%) think that orientation or training program on tobacco control law should be arranged for police personnel. More than one fourth (25.5%) of the police personnel in Bangladesh are currently smokers and this should be intervened. Smoke-free police station initiative is started but not being 100% implemented. Lack of knowledge regarding various rules and clauses of NTCL was sufficient enough to draw intervention in this regard. Positive attitude of police personnel towards NTCL and smoke free police station initiative will help to implement tobacco control law properly.

Clinical Profile and Outcome of Peripartum Cardiomyopathy - A Study in a Tertiary Cardiac Hospital of Bangladesh.

This study was done to evaluate the clinical profile, management and to analysis of pregnancy outcomes of peripartum cardiomyopathy pregnant women. Follow up was done after treatment and to see the prognosis. All patients admitted with peripartum cardiomyopathy from July 2009 to June 2014 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh were considered for this observational study. Seventy two (72) women were evaluated. Primi-paras are 28 (39%) of the total study population. Fifty two patients (72%) were clinically improved and in 35 (48% ) the left ventricular functional status returned to normal with the treatment of Diuretics, selective Beta-blocker, Angiotensin converting enzyme inhibitor(ACEI) or Angiotensin receptor blocker (ARB) and vitamin B complex. Eleven cases (15%) developed persistent cardiomyopathy that is persistent left ventricular dysfunction beyond six months of presentation. Ten women (14%) presented with thromboembolic events and anti coagulant were prescribed for life long for secondary prevention. Maternal mortality was 8 (13%). Among all live births four had intra uterine growth retardation and another three had died during the neonatal period. The patients of peripartum cardiomyopathy were improved symptomatically and prognosis was good with the treatment of diuretic, selective beta-blocker, ACEI or ARB and vitamin B complex. Regular clinical follow up with echocardiography and monitoring of INR if the patients are in Anticoagulant are advised to reduce the morbidity and mortality.

Synchronous bilateral breast cancer in a patient with Klinefelter's syndrome.

Synchronous bilateral male breast cancer (MBC) is rare and only a few cases have been reported in the literature. The majority of MBC patients have no definable risk factors. We describe a case with Klinefelter's syndrome, prior thymic irradiation, testicular surgery, and first degree family history in a 61-year-old male.

Metastatic renal cell carcinoma presenting as a breast lump in a treated breast cancer patient.

Metastatic malignancy in the breast is uncommon. A 68-year-old woman with a past medical history of breast cancer presented with a lump in the opposite breast. A mammogram suggested a possible benign lump. An ultrasonography-guided core needle biopsy was taken to complete the triple assessment. The histology on the breast core biopsy showed it to be a metastatic renal cell carcinoma. Subsequent computed tomography of the abdomen confirmed a renal primary tumour. The patient was referred to the renal oncologist for palliative treatment.

A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis.

BACKGROUND: A diagnostic scoring system such as the modified Alvarado score, combined with selective laparoscopy in adult females, can be used in the assessment of acute abdominal pain suggestive of appendicitis. METHOD: A total of 84 consecutive patients presenting to our surgical team with suspected appendicitis were assessed prospectively using the modified Alvarado score. The definitive management of this study group was instigated according to a set algorithm based on the score. The algorithm included the use of diagnostic laparoscopy in adult female patients with scores suggestive of appendicitis. A negative appendicectomy rate was obtained from those undergoing appendicectomy using this approach and compared to that obtained from the 97 patients that had undergone appendicectomy under the care of the other surgical teams in our unit during the study period. RESULTS: The rate of negative appendicectomy in the study group was 0% compared to 18% in the control group (P < 0.05); 10% of adult female women had negative diagnostic laparoscopies for appendicitis thus saving this group an unnecessary appendicectomy. This was achieved without an increase in total in-patient stay. CONCLUSION: An algorithm combining the modified Alvarado score with selective laparoscopy is recommended for widespread use in the management of suspected acute appendicitis.

Emergency small-bowel resection in a district general hospital.

Small-bowel resection has been identified as a core surgical skill that all general surgical trainees must acquire. Most of these resections are performed by the unsupervised higher surgical trainee on call. Reviewing 51 small-bowel resections performed over a five-year period in a district general hospital we found that, although the operation carried a high mortality rate (18%) and a high morbidity rate (21%), these had less to do with the operative technique than with the nature of the underlying disease and the hazards of emergency surgery in general. We conclude that small-bowel resection per se is relatively safe and remains a good training procedure.