Phlebectomy versus Sclerotherapy in Varicose Vein Patients: A Comparative Study.

Varicose veins are part of the spectrum of chronic venous disease and include spider telangiectasias, reticular veins, and true varicosities. It may present without advanced signs of chronic venous insufficiency. Sclerotherapy is a treatment choice for patients with varicose veins of lower extremity; it uses the intravenous injection of chemical drugs to achieve the goal of inflammatory occlusion. Phlebectomy, a minimally invasive procedure usually used for higher diameter of varicose veins at the surface of the skin. Objective of the study was to compare the outcome of Phlebectomy and Sclerotherapy in varicose vein patients. It was a quasi experimental study was conducted in the Department of Vascular Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of June 2019 to May 2020. Patients admitted with varicose vein and varicosity of the lower limbs with valves and perforator incompetence in the Department of Vascular Surgery, BSMMU, Dhaka, Bangladesh. During this period 60 patients were selected purposive randomly. Patients were divided to 30 patients were treated with Phlebectomy (Group I) 30 patients were treated with Sclerotherapy (Group II). Data were collected according to the pre-designed semi-structured data collection sheet. After editing data analysis were carried out by using the Statistical Package for Social Science (SPSS) version 22.0 Windows software. This study shows average age 40.73±15.50 years in Phlebectomy (Group I) and 38.43±11.08 years in Sclerotherapy (Group II). Males are more commonly involved than females between two groups which was 76.7% in Phlebectomy (Group I) and 70.0% in Sclerotherapy (Group II). The change CEAP improved to 93.3% in patients who underwent phlebectomy when compared to 83.3% in patients who underwent sclerotherapy. During the follow-up with duplex at treated veins showed 93.3% complete occlusion of treated veins in the phlebectomy group, while only 70.0% of the patients in the sclerotherapy group showed evidence of complete occlusion. In phlebectomy group recurrence of leg varicosities were found 6.7% of the patients, while 26.7% of the patients in the sclerotherapy group. The difference was statistically significant between two groups (p=0.038). This study shows phlebectomy to be much better option than sclerotherapy for the treatment of varicose veins and hence can be used routinely. Both phlebectomy and sclerotherapy not only revealed minimal time taken for return to normal activity but also proved to be safer with regard to complications.

Echocardiographic Evaluation of Cardiac Changes in Patients with Hypothyroidism and the Response to Treatment.

Thyroid hormone acts on heart and peripheral vascular system in multiple ways. Most of the cardiac manifestations are reversible with adequate and timely thyroid therapy. Echocardiographic changes are present in patients with untreated hypothyroidism and the changes are reversible with treatment. Aim of the study was to evaluate the structural and functional changes of the heart in hypothyroid patients and its response to treatment. This prospective observational study was performed in the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2012 to April 2013. The study included 35 cases and 35 control based on their thyroid hormonal status. The cases were previously untreated for hypothyroidism. By 2D and M-mode echocardiography LV septal wall and posterior wall thickness, LVIDD, LVIDS, LA and Aortic diameter and ejection fraction were measured. Mitral inflow pattern was observed through pulse wave Doppler and peak E velocity, a velocity and E/A ratio were noted. All the observations were noted both in cases and controls and in cases after normalization of hypothyroid status. Echocardiographic variables showed that septal wall and posterior wall thickness, LVIDD and LVIDS were higher in the cases than those in the control group. Left ventricular ejection fraction was lower in case group compared to control group. Of the mitral inflow parameters, a velocity was higher and E/A ratio lower in cases than those in control group. Following treatment of >3 months the septal wall and posterior wall thicknesses were reduced significantly (p<0.001 and p<0.001 respectively) and Left ventricular ejection fraction was also improved significantly (p<0.001) from its baseline status. Of the mitral inflow parameters, E-velocity was significantly increased, A-velocity significantly decreased and E/A ratio significantly increased from their baseline figures (p=0.016, p=0.032 and p<0.001 respectively). Cardiovascular complications of hypothyroidism increase the morbidity of the patients. Results of our study showed importance of early diagnosis and prompt treatment reversed the condition and that will diminish the extent of cardiac complications.

Thrombocytopenia in Late Onset Neonatal Sepsis and Its Relationship with Specific Organism in A Tertiary Care Hospital.

Late onset neonatal sepsis (LONS) is a common complication in the Neonatal Intensive Care Unit (NICU) especially in premature infants, in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is an important complication of sepsis. The objective of the present study was to identify the organism-speci?c platelet response in neonate with culture proven LONS. In this retrospective study all the infants with blood culture positive LONS in the neonatal intensive care unit (NICU) at Square Hospitals Ltd., Dhaka, Bangladesh from January 2012 to June 2016 were included in this retrospective observational study. Multiple hemograms with platelet counts, blood culture which also revealed growth of fungus along with growth of bacterial organism were conducted. Duration of thrombocytopenia in relation to type of organism and mortality with respect to degree of thrombocytopenia were also studied. Out of 87 patients with culture-proven nosocomial sepsis, 59(67.8%) patients developed thrombocytopenia (platelet count <150×109/l). In our study, Acinetobacter was the most frequently isolated organism (22/87; 25.3%) the incidence of thrombocytopenia was high among patients who had gram negative sepsis, concurrent bacterial and fungal sepsis (4/4, 100%) and also isolated fungal sepsis (11/11; 100%). The mean platelet count in Gram negative sepsis was significantly lower than gram positive infection (p<0.0001) and also in fungal sepsis in compares with gram positive bacterial causes of sepsis (p=0.0085). Also, the mean duration of thrombocytopenia in patients with Gram-positive sepsis was significantly less than that of both Gram-negative and fungal sepsis (p<0.0001). In this study, about 1.15% cases presented mild, 21.84% moderate and 36.78% severe thrombocytopenia. The mortality rate was higher in thrombocytopenic group. LONS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gram negative sepsis were frequently associated with a decreased platelet count. The mortality rate was higher in sepsis associated with thrombocytopenia.