Silicosis - A Case Report.

Silicosis is not an uncommon disease in Bangladesh as a good number of people are exposed to silica dust in their working places. Again pulmonary tuberculosis is also common here, the risk of which is increased by about 30 folds in silicosis. In the reported case, a young stone cutter of 40 years was admitted to Faridpur Medical College Hospital with progressive dyspnoea, dry cough and radiological appearance of multiple small and a large nodular pulmonary mass. Two of his brothers, also stonecutter, died of similar disease. In this context the patient was diagnosed as a case of chronic complicated silicosis and treated symptomatically as there is no curative treatment. A good number of people are engaged in stone cutting in our country including Faridpur district and are vulnerable to this progressive and non-curable disease. To aim of this case report is to make those people to be aware about the condition, so that they can protect themselves by taking appropriate measures (i.e. using protective mask) and should monitored their condition by regular chest x-ray. If early signs of silicosis is detected the worker should changed their job.

Efficacy and Safety of Fluvastatin Sodium XL 80mg in Treatment of Hypercholesterolemic Patient with Risk Factor of Cardiovascular Disease.

Back ground: Reduction of coronary heart disease (CHD) risk through the modification of risk factors has a strong effect on clinical practice. The introduction of 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductase inhibitors (statins) has significantly advanced the treatment of hypercholesterolemia and in reduction of cardiovascular events and total mortality rates. Among the available statins, Fluvastatin is a newer, synthetic, second generation, potent lipid lowering agent and widely accepted in diverse population. However the safety profile and efficacy was not assessed in Bangladeshi population, a population significantly different from Caucasian population where most studies were done. Current study aimed at evaluating the safety and efficacy of fluvastatin in the specified population. Methods: The study is an open-label, multicenter, quasi experimental study conducted among 162 adult patients suffering from hypercholesterolemia. After through baseline evaluation, the patients were given with Fluvastatin 80 mg once daily for 3 months. All the patients were assessed twice, before and after treatment. Data on demography, of relevant medical history and of physical examination were collected in the both the visit along with data on relevant lipid parameters (Total Cholesterol, LDL-C, HDL-C and TG) were collected at final visit. Safety was assessed by evaluating adverse events, as well as laboratory abnormalities, including liver aminotransferases. Results: Serum total cholesterol was found to be significantly reduced and across two assessments the reduction was 51.2 units (P<.001). Average reduction in LDL-cholesterol was around 40 units (P<.001). Most significant reduction (140.0±305.8 units) was seen in serum LDL cholesterol (P<.001). However; no statistically significant reduction was seen in HLD cholesterol. Safety of fluvastatin was assessed by evaluating the adverse events, as well as through laboratory abnormalities, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Comparison of aminotransferase level was done before and after treatment through paired t test, Neither ALT nor the AST showed statistically significant rise after 3 months treatment of fluvastatin (P>.05). Out of 162 study participant 4.3% had their treatment interrupted, of which 1 (0.62%) had to cease treatment due to lack of efficacy, 1 (0.62%) experienced adverse event, 2 (1.24%) didn’t return to follow-up and 3 (1.86%) patients requested their physician to cease the treatment. Conclusion: Three month treatment with Fluvastatin XL 80 mg reduces most of lipid parameter of lipid profile (Total cholesterol, Triglyceride and LDL) significantly. The drug is found to be well tolerated with minimal adverse event during the course of treatmen

Different modalities of management for ischemic mitral regurgitation

Mitral regurgitation [MR] resulting from prior myocardial infarction is now recognized as an important clinical sequel that directly impacts the long-term outcome of patients.' Defining Ischemic MR. Carpentier's pathophysiologic triad I defines the relationship between etiology, lesion[s] [pathological changes in the valve], and dysfunction [abnormalities of leaflet motion] that results in MR. Carpentier's classification of leaflet dysfunction is based on the motion of the margin of the leaflet in relation to the annular plane. Often authors use an etiologic definition for ischemic MR such as "mitral regurgitation resulting from prior myocardial infarction associated with normal mitral valve leaflets and chordae. In terms of defining ischemic MR it is important to note that the majority of patients have an etiologic basis of prior myocardial infarction, not an acute myocardial infarction or papillary ischemic event. Resulting wall motion abnormalities and left ventricular remodeling leading to lateral and apical displacement of papillary muscles are the key pathophysiologic events. The predominant mitral valve lesion, therefore, is leaflet tethering, mainly of the posterior-medial scallop of the posterior leaflet [P-3] adjacent to the posterior commissure area, particularly in the setting of posterior infarction. Mitral annular dilatation often accompanies leaflet tethering as an associated lesion. The leaflet dysfunction resulting in the most common form of ischemic MR is Type IIIb. with restricted motion of the margin of the leaflet[s] in systole. Therefore for the majority of patients ischemic MR is defined by the presence of the following [a] prior history of myocardial infarction [b] tethering of predominantly the posterior-medial scallop of the posterior leaflet, and [c] Type III b Carpentier dysfunction with restricted leaflet motion in systole. Other forms of ischemic MR are less common. Type I dysfunction without leaflet restriction [normal leaflet motion] and isolated annular dilatation can occur in the setting of isolated basilar rnyocardial infarction Some patients with ischemic MR have Type II dysfunction [excess leaflet motion], resulting from either an acute [ruptured papillary muscle] or chronic [fibrotic and elongated papillary muscle] myocardial ischemic event. It should be emphasized that the prior concept of "acute ischemia with papillary muscle dysfunction" that would reverse with revascularization is now recognized to be valid in only a small percentage of patients with ischemic MR. This review will concentrate on ischemic MR with restricted leaflet motion that is most frequently seen in clinical practice

Coronary artery bypass grafting on beating heart. does it provide superior myocardial preservation than conventional technique?

To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting [CABG]. A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients [15 patients in each of 3 sub-groups] who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a] conventional technique, b] off-pump technique, and c] on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band [CKMB] levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. This study indicates that the off-pump technique provides better myocardial preservation than other methods