Serum Uric Acid and Its Association with Coronary Artery Disease.

Background: Few studies have assessed the relation of uric acid level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid levels with the presence and severity of CAD. Materials and Methods: This study was designed as an observational cohort study. The study was composed of 180 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high uric acid (hyperuricemia) were defined as serum uric acid concentration >7.0mg/dl or >420 μmol/L in men and >6mg/dl or >360 μ mol/L in women. The presence of CAD has been defined as the Gensini score being >1. Results: There was a statistically significant difference between the mean uric acid levels of patients with and without CAD (358.23±71.11 μmol/l vs251.32±54.92 μmol/l respectively, p<0.001). There was a statistically significant difference between ejection fraction of patients with and without CAD (54.50±9.25 vs. 63.16±6.56 respectively, p<0.001). Spearman correlation analysis demonstrated a positive correlation between the serum uric acid level and the severity of CAD (p=<0.001, r=0.39). When patients were classified into four groups according to their Gensini score, mean serum uric acid level was found to be significantly increased across the tertiles, and a statistically significant difference was detected between the tertiles (p= <0.001). Conclusion: In conclusion, a significant association has been found between serum uric acid level and the presence and severity of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of uric acid level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients.

Evaluation of total hip replacement.

This prospective study was made to asses the results of total hip replacement done primarily at Dhaka Medical College Hospital by the surgical team from its orthopaedic department. Eight patients were selected randomly from April/2005 to December/2005. Six patients were male and two females. Age of the patients was ranging from 22 to 67 years with average of 37.4+/-5.12 (mean+/-SE) years. Majority of the patients (75%) were diagnosed as Aseptic necrosis of femoral head with secondary osteoarthritis. The femoral head was replaced by metallic component with C-stem and the acetabular cup made up of Ultra-High density Polyethylene. Both the components were cemented (methylmethacrylate) by hand-packing. The patients were followed-up for 7.75+/-6.1 months (mean+/-SE) ranging from 4 months to 1 year. The results were evaluated on the basis of Harris Hip Score(2). 75 % had good to excellent and 12.5% had fair results. One patient complicated with dislocation and ultimately had poor result. The quality of life in seven patients (87.5%) improved much for which they were grateful.

Dermatoglyphic pattern in some connective tissue diseases

In an attempt to describe a new clinical sign in some connective tissue diseases termed round finger print sign, [this term refers to disappearance of the peaked contour of the normal finger print and replacement with a hemisphere like finger print contour], the finger prints in 85 patients and 50 controls were studied. They were classified as follow. Group I: 30 patients with systemic lupus erythematosus [28 females and 2 males, their mean age was 22.32 +/- 2.3 years]. Group II: 40 patients with rheumatoid arthritis [31 females and 9 males, their mean age was 25.81 +/- 6.79 years]. Group III: 15 patients with scleroderma [12 females and 3 males, their mean age was 35. +/- 2.1 years]. Group IV: 50 healthy subjects as controls [45 females and 5 males, their mean age was 30 +/- 8.1 years. Full history taking and examinations were done. Investigations were done to all patients and controls included rheumatoid factor, ANA, platelets count. ect. Then finger prints were studied using magnifying lense with light source, and the permanent finger prints were recorded by ink method. The results of this study showed that, positive round [whorl] finger print sign in 44% of systemic lupus erythernatosus patients [SLE], 54% of rheumatoid arthritis [RA] patients and 93% of progressive systemic sclerosis [PSS]patients with significant statistical differences between all patient groups and control [P < 0.05, < 0.05 and < 0.001 respectively]. This sign is seemed to be anew and useful clinical marker for these connective tissue diseases and may help in early diagnosis

Avicenna's approach to cardiac diseases.

Abu Ali el Husain Bin Abdullah Bin Sina (980-1037 A.D.) known as 'Sheik et Rayees, Ibne-e-Sina' in Arab countries and 'Avicenna' in Western countries, was the first man who considered the psychology and emotions of human beings from physiological point of view, and gave the then, possible explanation of different emotional states and their effects on human body. He related psychology with medicine and proved that all emotional states e.g. pleasure, grief, anger and worry and the others are deeply concerned with the shape of the heart, types of blood and body fluids (humours). Not only he proved this but has also described the management and treatment of these conditions, and was the pioneer in this field. He discussed the action of drugs on heart and mentioned their indications and contra-indications. He based the morality and behaviour of a person on the temperament of the heart and spirit. According to him, appraising the particular characteristic behaviour of a person, information may be obtained about the temperament of the heart and spirit. He is of the opinion that different attributes of a person, e.g. boldness, cowardliness, misery, benevolence, happiness, sorrowfulness, worries and anger, etc. can be controlled and managed medically. Nobody, before him, had shed any light on this subjet.