Short-term Treatment Outcome of Patients with Acute ST-elevation Myocardial Infarction in a Tertiary Care Hospital.

Outcome of acute ST-elevation myocardial infarction patients varies time to time. The present study was intended to find out the short-term treatment outcome of the patients admitted in hospital. This descriptive study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15 January 2014 to 14 July 2014. A total of 100 patients admitted with Acute ST-elevation Myocardial Infarction confirmed on the presence of the (a) Typical chest pain of acute ST-elevation Myocardial Infarction (b) Electrocardiogram (ECG) evidence of ST segment elevation in two or more contiguous leads (c) Raised cardiac marker (Troponin I) were included in the study. Patients were randomly enrolled according to the inclusion and exclusion criteria and observe for one week. Data were processed and analyzed by using computer bases software SPSS version 19.0. Descriptive statistical methods were applied for data analysis. P value was considered as statistically significant when it is less than 0.05. Short-term treatment outcome of acute ST-elevation myocardial infarction include mechanical, arrhythmic, ischemic and inflammatory sequelae, as well as left ventricular mural thrombus. In addition to these broad categories, heart failure, arrhythmia, death are other common complications of AMI. The initiation of the complications usually results in explicit sign and symptoms of the acute MI patients. Learning of the complications in the post infarction period and the clinical syndromes develop with each complication, will allow the health care worker to evaluate and manage the complication appropriately.

Nitrous Oxide versus Medical Air Using in General Anaesthesia During Laparoscopic Cholecystectomy: A Comparative Study.

This study was designed to observe the haemodynamic changes, recovery status and cost effectiveness during anaesthesia in laparoscopic cholecystectomy with medical air in comparison to anaesthesia with nitrous oxide associated with maintain of adequate analgesia and was conducted in the department of Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2017. Nitrous oxide is popularly using as an analgesic in current balanced general anesthesia in addition carrier agent for anesthetic. Intraoperative pain intensity depends on many variables including, type of surgery, surgical stimulation and surgical incision. It is difficult to measure intraoperative pain properly under general anesthesia therefore anesthetist depends on the surrogate marker of inadequate analgesia like raised heart rate, blood pressure, sweating and lacrimation. However, unfortunately, these parameters may changes in same direction with light plane of anesthesia, hypercarbia and ongoing procedural status of the patient.

Effect of pre-bypass methylprednisolone on post-operative renal function following correction of atrial septal defect under cardiopulmonary bypass.

Conventional open heart surgery with cardiopulmonary bypass (CPB) are associated with transient post-operative renal dysfunction which is caused by systemic inflammatory response induced by CPB. Corticosteroids are administered to attenuate the systemic inflammatory response. The purpose of this study was to compare the effects of pre-bypass and post-bypass methylprednisolone on postoperative renal function after correction of ASD under CPB. Forty (40) patients were selected in the University cardiac centre of BSMMU undergoing ASD correction under CPB. Patients were randomized into two group to receive pre-bypass (Group A) or post-bypass (Group B) methylprednisolone 30mg/kg. Markers of glomerular function (BUN, serum creatinine, creatinine clearance) and damage (micro-albuminuria) and tubular function (glucosuria) were evaluated 24 hours after operation. Transient impairment of glomerular and tubular function of kidney was observed in patients those received post-bypass metylprednisolone (Group B) while Group A patients shown no significant difference between baseline and post-operative renal function. Use of pre-bypass methylprednisolone has a protective effect on post-operative renal function after correction of ASD under CPB.

Cervical spinal cord injury due to fall while carrying heavy load on head: a problem in Bangladesh.

STUDY DESIGN: Observational study. SETTING: Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. METHODS: This observational study was conducted on 84 patients of Cervical spinal cord injury (CSCI) due to fall while carrying heavy load on head. They were admitted at the CRP, Dhaka, Bangladesh between January 1999 and December 2001. Relevant personal information, neurological status, types of bony injuries and x-ray findings were noted down in pre-structured questionnaire. In addition, each subject was interviewed to find out the cause of accidental fall while carrying heavy load on head. RESULTS: Age of the studied subjects ranged between 10 to 50 years. All were male of whom 79 (94%) subjects were farmers and/or low cost daily laborers. In all, 72% percent of the subjects were carrying 60-80 kg weight on their head when fall occurred. A total of 48 (57%) subjects had complete neurological lesion. The most common vertebral levels were C5 and C6. So far the mechanism of injury is concerned hyper flexion of the cervical spine predominated (61%) over hyperextension (36%). CONCLUSION: Fall while carrying heavy load on head is a common cause of CSCI in Bangladesh. The victims are mostly young farmers or unskilled day laborers who were not habituated to carry heavy load on head.

Physical training induced resting bradycardia and its association with cardiac autonomic nervous activities.

Regular physical exercise causes resting bradycardia. This exercise-induced resting bradycardia may be associated with exercise-induced changes in Cardiac autonomic nervous activities (CANA). Power Spectral Analysis (PSA) of Heart rate variability (HRV) is one of the most promising new techniques to quantify CANA. Regular physical exercise induced bradycardia is associated with exercise-induced adaptation in CANA. To observe the HRV parameters by frequency domain method (PSA), in male adolescent athletes in order to find out the influence of regular physical exercise on resting heart rate (HR) and CANA. The cross sectional study was carried out on 62 adolescent male athletes aged 12-18 years (group B), in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University from 1st July 2007 to 30th June 2008. For comparison 30 age, sex and socioeconomic condition matched apparently healthy sedentary subjects (group A) were also studied. The study group was selected from the BKSP (Bangladesh Krira Shikka Prothistan, Savar, Dhaka) and the control from a residential school of Dhaka city. HRV parameters were assessed by Polygraph (Polyrite D, version 2.2). For statistical analysis Independent-Samples t-test was done as applicable. Resting mean HR was significantly (p<0.001) lower in the athletes. The mean value of Total (variance), VLF, LF and HF power was significantly (p<0.001) higher in athletes than that of non-athetes. Regular physical exercise-induced resting bradycardia is associated with exercise-induced adaptation in cardiac autonomic nervous activities.

Variation between CT scan findings and histological diagnosis of intracranial glioma.

A total of 45 cases were studied to elucidate the variation between CT scan findings and histological diagnosis of intracranial glioma. They were operated and histopathological examination of all cases was studied. The mean age of the patients were 35+/-2.37 years and ranged from 01 to 65 years. The highest incidence of glioma was found in age group between 40-50 years. The incidence of glioma was more in male 36(80%) in comparison to female 9(20%). The main presenting complaints were headache in 42(93.3%), vomiting in 34(75%), limb weakness in 28(62.2%) and blurring of vision were in 26(57.8%) patients. Other symptoms were convulsion in 29(64.4%) patients and altered consciousness 24(53.3%) patients. By CT scan, diagnosis was made as informed gliomas in all cases. Histopathological examination showed 41(91.1%) cases were gliomas and 3(6.7%) were meningiomas and 1(2.2%) was brain abscess. So there were little variations between CT scan findings and histopathological diagnosis.

Operative management of rigid congenital club feet in Bangladesh.

We report the early results of the surgical treatment of 59 rigid congenital clubfeet in 42 patients. All the feet were operated on in the same hospital by using a one-stage posteromedial release in 41 patients. The patients were divided into two groups as 24 patients (32 feet) had come to the hospital from rural areas, whereas 18 patients (28 feet) all came from the local semi-urban area. After an average of 2 years and 3 months 44 feet were graded either excellent or good, 7 were fair, and 8 had not been adequately corrected. The best results were seen in children who were operated on between the ages of 1 and 3 years. Those from the semi-urban area and who received adequate long-term postoperative care were slightly better.

Spinal cord lesions in Bangladesh: an epidemiological study 1994 - 1995.

OBJECTIVES: Spinal Cord Lesions are a major public health problem in Bangladesh. This epidemiological study was undertaken in order to identify the causes of spinal cord lesions and thus to allow prevention and control programs to be developed. MATERIALS AND METHODS: The records of 247 patients with spinal cord lesions admitted to The Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka from January 1994 to June 1995 were reviewed retrospectively. Comparisons were made with the reports of studies from other countries, both developing and developed. RESULTS: The most common cause of traumatic lesions was a fall from a height followed by falling when carrying a heavy weight on the head and road traffic accidents. Most of the patients were between 20 - 40 years old and the overall age group ranged from 10 - 70 years. The male:female ratio was 7.5 : 1.0. Among the traumatic spinal cord lesions, 60% were paraplegics and 40% tetraplegics. Among the non-traumatic spinal cord lesions cases 84% were paraplegics and 16% tetraplegics. The leading cause of death resulted from respiratory complications and these deaths occurred in the very early period of admission. CONCLUSION: From the results it can be deduced that the high incidence of spinal cord lesion as a result from falls from a height, and from falling when carrying a heavy weight on the head, can be explained by the mainly agricultural based economy of Bangladesh. The most common age group (10 - 40 years) of patients reflects the socio-economic conditions of Bangladesh. The male:female ratio (7.5 : 1.0) of patients with a spinal cord lesion is due to the socio-economic status and to the traditional culture of the society.