Role of B Type Natriuretic Peptide in the Early Diagnosis of Left Ventricular Diastolic Dysfunction in High Risk Subjects.

Background: Brain natriuretic peptide (BNP) reflects left ventricular pressure. It increases in systolic dysfunction. Our aim was to evaluate role of plasma BNP level in early diagnosis of left ventricular isolated diastolic dysfunction. Methods: We studied 60 patients (male=18, female=42) with hypertension, diabetes mellitus, ischemic heart disease, dyslipidemia. The Doppler parameters used for evaluation of diastolic dysfunction are: isovolumetric relaxation time (IVRT), Transmitral flow velocities (E/A) ratio, deceleration time (DT) & pulmonary vein Doppler findings. 49 patients (group-1) had diastolic dysfunction whereas 11 patients (group-2) had normal flow patterns. Plasma BNP level was done in all patients. Results: Mean plasma BNP levels were 40.41±6.82 pg/ml in individuals with normal filling patterns and 183.36±25.28 pg/ml in subjects with abnormal diastolic dysfunction (p<0.001).The accuracy of BNP in detecting diastolic dysfunction was assessed with receiver-operating characteristic(ROC) analysis. The area under the ROC curve for BNP test accuracy in detection of any abnormal diastolic dysfunction was 0.928 (95% CI, 0.861 to 0.994;p<0.001).A BNP value of 63 pg/ml had the sensitivity of 89.9%,specificity of 91.9% and accuracy of 90.3%.PPVwas 97.8% and NPV-66.7% for detecting diastolic dysfunction. Conclusion: Raised plasma BNP level is useful for early diagnosis of isolated left ventricular Diastolic dysfunction.

Timing of Spontaneous Birth and the Risk of Adverse Perinatal Outcome

The study aspired to assess the impact of time of birth on spontaneous onset of labour and delivery. A retrospective descriptive study was conducted from the Empangeni Hospital delivery registry on 9;397 infant births between January to December 2005; weighing more than 1;000 g. Logistic regression; adjusting for birth weight and for gender was used to estimate the relationship between spontaneous birth and timing of birth. A higher proportion of births (59) occurred between 10h00 and 22h00 of the day. Estimating the hourly births; we found that the daytime peak is 5.3and occurred at 10h00 while the night-time peak is 4.9and occurred at 20h00. Maternal age was significantly associated with the timing of spontaneous births (p 0.05). A higher proportion of preterm babies was born during the day (6.4) and early night (3.4) compared to late night births (1.6). There were significant differences between multiple births and low birth weight infants born during the day (1.1; 6.9) and night (0.8; 6.3). However; low birth weight babies were born mostly during early night rather than late night (4vs. 2.3; p 0.05). Adverse pregnancy outcome; measured by estimating the perinatal mortality rate; was the same for day and night and was equally distributed between early and late night. Timing of birth of infants did not influence the negative outcomes of pregnancy among this study population

Self-assessment of confidence of internee doctors in performing common surgical operations.

A total of 140 internee doctors who had just completed or were about to complete their internship training from four leading Medical College Hospitals of Bangladesh were asked to fill up a pre-tested structured questionnaire. Of them 115 were male and 25 were female. All the participants had 6 months compulsory training in Medicine, 123 had 6 months training in Surgery and 17 had 6 months training in Obstetrics-Gynecology. Over 50% doctors expressed lack of confidence in performing ligation, vasectomy, splinting simple fractures, venesection, episiotomy, hydrocele operation, circumcision, proctoscopy and inguinal herniorrhaphy and expressed the need for further training in those procedures. Only 10% and 1.43% internees stated that they were confident about performing ligation and vasectomy independently. Internees from Chittagong Medical College Hospitals expressed their inability to perform ligation and/or vasectomy independently. So it was recommended that surgical training should be made mandatory for all internee Doctors with extension of the Internship period by at least 6 months. Emphasis should be laid on training in vasectomy and ligation. A pre-registration evaluation test may be introduced at the end of their training period.