Bioabsorbable Vascular Scaffolds Eluting with Everolimus: for Percutaneous Coronary Intervention of Patients with de-novo Coronary Artery Lesion: Our Experiences at a Tertiary Hospital.

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention (PCI) of de-novo coronary artery lesion by using Bioabsorbable Vascular Scaffold (BVS) ABSORB stents eluting Everolimus. Methods: Total 16 patients were enrolled in this very preliminary study of BVS absorb. Among them, Male: 11 and Female: 5. Total 20 stents were deployed. Mean age were for Male: 56 yrs, for Female: 60 yrs. Associated coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history (FH) for CAD and Smoking. Patients were followed up clinically. Results: Among the study group; 13 (81%) were Dyslipidemic, 10(62.5%) were hypertensive; 6 (37.5%) patients were Diabetic, FH 3(18.75%), and 2(18%) were all male smoker. Female patients were more obese [Body Mass Index (BMI) M 25: F 27] and developed CAD in advance age. A common stented territory was for left anterior descending artery (LAD): 6 (37.5%), left circumflex artery (LCX) 5 (25%), right coronary artery (RCA) 6(37.5%). One patient had both LCX and LAD stenting. Total 3 patients had double/overlapping stent in RCA lesion. Territory wise distributions of BVS ABSORB stent were for LAD 6(30%), RCA 9 (45%), and LCX 5 (25%). There was no periprocedural or postprocedural complication. Conclusion: BVS ABSORB Everolimus eluting vascular scaffold showed favorable clinical outcome without any major cardiac events (acute or late stent thrombosis, MI or death) over a period of 9 month. Thus, BVS ABSORB would be favorable alternative to other available drug eluting metallic stents.

Patency of Multiple stents/Overlapping Stents in Single Artery Territory in Bangladeshi Patient: An Updated Single Center Experiences.

Background: Coronary artery disease (CAD) in Bangladeshi population is diffuse in nature with small caliber arteries. Now a day, these are treated, by PCI with stent deployment, often multiple in a single coronary artery. However, long term data on In-stent re-stenosis (ISR) in multiple or overlapping stent in single coronary artery in these patients is not yet available. Therefore, the aim of our present study was to assess long-term outcome of stent patency or the development of ISR of varieties stent in single vessel territory. Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the 3-36 months preceding the study for the quantifying period of 2007-2011. Total 51 patients (male: 42, Female: 9) who had multiple stents in one coronary artery were included in this study. Average age was Male: 57; Female:61. Average study period was 3.1 ± 2.4yrs. Results: Our results show that, among the total studied population 82.4% (42) were male and 17.6% (9) were female. Total 114 stent were deployed in 54 vessels of 51 patients. Territory wise distribution of deployed stent was LAD 52(45.6%), RCA 42 (36.8%) and LCX 20(17.5%). Stent used were BMS 45(39.5%), DES 69(60.5%). Re-look Coronary Angiogram (CAG) revealed that Significant ISR (ISR>60%) developed in BMS 8(17.8%) and DES 8(11.5%). Among the different DES the development of significant ISR were in Sirolimus 1(3.2%), Paclitaxel 4(16%), Everolimus 3 (30%). Conclusion: Our study has shown that deployment of multiple stents in a single artery territory (either separately or as overlapping) is safe and has reasonably lower degree of ISR, even when BMS was used. As a whole BMS shows higher degree of ISR than to DES for an average period of follow up of 3.1 yrs.

Tran-Radial Percutaneous Coronary Intervention (PCI) is Safe and Alternative to Conventional Trans-Femoral Approach: Our Experiences at Apollo Hospitals Dhaka.

Background: Aim of the study was to assess the safety of the trans-radial Percutaneous coronary intervention (PCI) than conventional Trans-femoral approach by using either Bare-metal stents (BMS) and or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent. Also to see its safety in regards of procedural time, quick mobilization, less complication and less radiation exposure. Methods: Total 117 patients were randomized from a total of 538 patients who had PCI at our center in the quantifying period. Total 130 stent deployed in 117 patients. Among the patients, Male: 100 and Female:17 . Mean age were for Male: 55yrs, for Female:57yrs . Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Our study shows 21.7% had trans-radial PCI. Among the study group; 72 (61.5%) were Dyslipidemic, 75 (64.1%) were hypertensive: 47(40.2%) patients were Diabetic, FH 29 (24.8%) and 33(33%) were all male smoker. Female patients were more obese (BMI M 27: F 29) and developed CAD in advance age. Common stented territory were LAD 51 (43.6%) followed by RCA 41 (35%) and LCX 27(23%). Average length and diameter of stented vessel were almost same in all territory. Territory wise multiple or overlapping stenting was done in LAD 3 (6 stents), RCA 1(2stents), LCX 4 (10 stents). Stent used: BMS 37 (28.5%), Sirolimus 41(31.5%), Paclitaxel 27 (21%), Everolimus 22 (16.9%), Biolimus 2 (1.5%) and Zotarolimus 1(0.75%). Less Procedural time, reduced radiation exposure, no procedural complication and overall better patient comfort were observed. Conclusion: Our study has revealed that trans-radial PCI is safe with reduced radiation exposure, quick mobilization of patient and no procedural complication in all the case, indicates it can be done routinely as an alternative to conventional Trans-femoral approach.

Multiple/Overlapping Stents in a Single Artery Territory in Bangladeshi Patient Population with Diabetes Mellitus (DM)-Sirolimus Eluting Stent (Cypher) shows better Patency and Reduced ISR: A Single Center Experience.

Background: Data of stent patency or the development of ISR in multiple or overlapping stent in a single vessel territory of Bangladeshi diabetic (DM) patient population is not yet available. Therefore, the aim of our present study was to assess primarily the long-term stent patency of varieties of stent in patient with Diabetes Mellitus (DM) and Non-diabetes Mellitus (NDM). Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the e”36 months preceding the study for the quantifying period of 2007-2011. Total 51 (11%) patients (male: 41, Female: 10) from a total 461 patients were included in this study who has multiple or overlapping stent in single vessel territory. Total 32 (62.7%) patients included into the DM group with an average age of 57 yrs and in the NDM were 19 (37.3%) with 58 yrs. Average ISR period was 3.1 ± 2.4 yrs. Results: Our result shows that total 70 stent were deployed in 33 vessels of DM patient and 44 stent in 21 vessel of Non-DM patient. Territory wise total number of deployed stent in patient of DM: NDM were in LAD 34 (48.6%): 18(41%), RCA 16 (22.8%): 4 (9%) and LCX 20(28.6%): 22(55%). Stent used in DM: NDM; were BMS 21 (30%): 22(50%), Sirolimus 24(34.3%): 10(22.7%), Paclitaxel 17(24.3%):8(18.2%), Everolimus 6(8.6%):4(9.1%)%). Re-look coronary angiogram (CAG) revealed that increased number of in-stent restenosis occurred more in patient with Diabetes [DM 10(31.3%) vs NDM 5(26.3%)]. Significant ISR (ISR>60%) in DM patient treated with for BMS were 4 (36.4%), for Paclitaxel 3(42.3%), for Sirolimus 1(9.1%). Average stent size and length were almost same in both groups for any coronary territory. Conclusion: Our study has revealed that increased number of ISR were more in patient with diabetes (DM) in a single artery territory when multiple stents were used either separately or as overlapping. Among the stent used, Sirolimus shows better patency with reduced ISR than Paclitaxel and other limus eluting stent for an average period of follow up of 3.1 yrs.

Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy.

Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. A young man presented with epigastric pain and bilous vomiting followed by haematemesis 15 years after vagotomy & gastrojejunostomy for chronic duodenal ulcer. At presentation the patient was in shock and an emergency laparotomy was done after resuscitation. At laparotomy a retrograde type II JGI was found and managed by resection of the affected segment and partial gastrectomy and jejuno - jejunostomy with closure of the duodenal stump. Postoperative recovery was uneventful. Retrograde JGI is a rare condition and only less than 200 cases have been reported since its first report. Clinical picture of acute intestinal obstruction with suspicion about the condition in patients having a past history of gastrojejunostomy makes the elusive diagnosis definite and demands early surgery to reduce the grave consequences of the disease.

Vaccination coverage survey in Dhaka District.

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Pattern of aerobic bacteria with their drug susceptibility of surgical inpatients.

The pattern of aerobic bacteria with their antibiotic susceptibility isolated from infected patients in one of the surgical units at Mymensingh Medical College Hospital during the period from September to November' 2000 were reported in the present study. Out of 74 clinical samples, 52 were wound swabs, 18 were pus and 4 were urine. Bacterial growth was yielded in 43 samples and the distribution of isolates was as follows: Pseudomonas spp 16, Esch.coli 13, Staphylococcus aureus 08, Klebsiella spp. 03 and others 03. Majority (61.5 %) of culture positive results were found in wound swabs. Antibiotic susceptibility pattern showed considerable variation within Gram negative bacterial isolates. All the Esch.coli and Klebsiella isolates were resistant to amoxicillin. Ceftriaxone (65.6% and 100% respectively) and ciprofloxacin (71.4% and 100%) still appeared to be highly sensitive for both species. Over 93% strains of Pseudomonas were sensitive to Ceftazidime and aztreonam. Whereas, over 43% of same strains were resistant to ciprofloxacin. Over 87% strains of Staph.aureus were resistant to penicillin but sensitive to erythromycin. Whereas, 100% of those strains were sensitive to cloxacillin. Over 50% of all isolates were sensitive to gentamicin but resistant to cefalexin and cotrimoxazole. It was suggested to be careful regarding selection of antibiotic regime in surgical cases to minimize incoming higher magnitude of drug resistance among bacteria in near future.

Pattern of bacteria and their antimicrobial susceptibility isolated from inanimate objects and hospital personnel.

Different inanimate samples collected from surgery wards and general operation theatre (GOT) as well as animate samples from surgery personnel were subjected to aerobic culture with the aim of identifying source of infections in surgical cases. The pattern of aerobic bacteria with antibiotic susceptibility isolated from those samples were reported in the present study. Out of 91 such samples, 53 and 26 were from different locations in general wards and OT respectively and 12 were comprising of hand swabs, throat swabs and nasal swabs from surgery personnel. Pathogenic bacteria were isolated from 34 samples having Pseudomonas spp. (18/34) in the top of the list followed by Esch. coli (14). Among the Esch.coli isolates resistance to cotrimoxazole, amoxicillin and doxycycline were 78.7%, 71.4% and 57.1% respectively, whereas sensitivity to aztreonam, ceftazidime, gentamicin and ciprofloxacin were 100%, 85.8%, 78.7% and 71.4% respectively. Ceftriaxone yielded intermediate sensitive results in 21.4% strains. Isolates of Pseudomonas spp. also showed very high sensitive results to aztreonam, ceftazidime and ceftriaxone (94.7%, 94.7% and 84.2% respectively). Ciprofloxacin and gentamicin were sensitive in 68.4% and 57.9% respectively. Susceptibility pattern showed well correlation with clinical response in infected cases.

Lipid profile and its relation to fasting insulin level in non-insulin dependent diabetes mellitus (NIDDM).

Atherosclerotic cardiovascular disease is the major cause of morbidity and mortality in NIDDM patients. But the exact pathophysiology of accelerated atherosclerosis seen in NIDDM is not completely understood. Hyperinsulinemia and hyperlipidemia frequently coexist in these subjects. Present study was undertaken to demonstrate relationship of serum insulin with atherogenic lipids in 92 (male = 62, female = 30) newly diagnosed, middle-aged, nonsmoking, uncomplicated and untreated NIDDM patients with normal body mass index (BMI). Fourty (male = 20, female = 20) non-diabetic healthy subjects with a negative family history of diabetes served as control. After an overnight fasting, venous blood was collected for plasma glucose, serum insulin and lipid profile. ECG and oral glucose tolerance test (OGTT) were done in all subjects. Diabetes mellitus was diagnosed by WHO criteria. Total cholesterol, LDL-c, LDL/HDL ratio, TG (p always < 0.001) and fasting serum insulin (p = 0.033) were significantly higher and HDL-c was significantly lower (p = 0.001) in NIDDM than control subjects. Fasting serum insulin was inversely related to the degree of hyperglycemia in NIDDM subjects (r = -0.1867; p = 0.037). NIDDM with hyperinsulinemia (n = 18) had a strong negative correlation (r = -0.449, p = 0.031) with HDL-c. Neither total cholesterol nor LDL-c had any significant correlation with insulin. The results indicate that diabetic state itself is associated with atherogenic lipid disorder.

The relationship between blood pressure and serum insulin response in glucose intolerant subjects.

One hundred newly diagnosed IGT and type 2 diabetic subjects both normotensive and hypertensive and of age between 40-55 years were studied by oral glucose stimulation. Serum insulin concentrations were measured in the fasting and at 30, 60 and 120 minutes after glucose administration. Postglucose serum insulin responses were found to be significantly higher in the hypertensive subjects with FPG < 7.8 mmol/l (p < 0.05 at 30, 60 and 120 minutes) as compared with the corresponding values of the normotensive subjects with comparable fasting hyperglycemia. No significant difference in insulin responses between hypertensive and normotensive subjects was found in those with FPG > 7.8 mmol/l. A positive correlation was observed between diastolic blood pressure and 2 hour postglucose serum insulin concentration in those with FPG < 7.8 mmol/l (P < .05). The results suggested that hyperinsulinemia is a feature of hypertensive subjects with mild glucose intolerance and not of those with severe glucose intolerance. The absence of elevated insulin response in hypertensive subjects with advanced type 2 diabetes might be due to severe B cell decompensation. It appears that insulin resistance is somehow associated with essential hypertension and hyperinsulinemia is not necessary for the maintenance of raised blood pressure.

HBsAg amongst unscreened operated patients.

Prevalence of asymptomatic Hepatitis B carrier state varies in different countries. Surgical procedures are an important mode of dissemination of Hepatitis B virus infection. Five hundred patients whose HBsAg status was not known and had undergone a major operative procedure in the Dhaka Medical College Hospital were screened for HBsAg. Of these, 43 (8.6%) were found to be HBsAg positive. Age, sex, and previous history of jaundice didn't show any relationship with the HBsAg status. But the HBsAg positivity was found to be positively related to the past history of blood transfusion, hospitalization and injections.