High-resolution optical coherence tomography in a case of descemetocele managed with amniotic membrane transplantation

Amniotic membrane transplantation is a useful in the management of corneal melts and descemetocele. We describe high-resolution anterior segment optical coherence tomography (OCT) (Optovue) in a patient with descemetocele who was managed surgically with amniotic membrane transplantation. A 60-year-old female presented with a corneal melt in the right eye. She was a case of rheumatoid arthritis and was on systemic treatment with immunomodulators. Slit lamp examination revealed a severe thinning paracentrally. High-resolution OCT was performed at the site of descemetocele. She underwent amniotic membrane transplantation using fibrin glue and bandage contact lens application. At 6 weeks postoperative, the bandage contact lens was removed. The area of thinning healed with scarring. OCT at the healed site revealed stable surface and an increase in stromal thickness to 281 ? this case describes the utility of amniotic membrane in the healing of sterile corneal melts by providing tectonic support and its integration in the stroma. The stromal healing and increased thickness at the site of descemetocele could be delineated on high-resolution OCT imaging.

Lipoma of Tongue: a case report.

Lipoma is the benign tumor occurring at any anatomical site where fat is present. It may be evident for 1 to 5 percent of the entire benign tumor of the oral cavity. Lipoma of the tongue is extremely rare because tongue is totally devoid of fat cell. In this case study we report a case of lipoma of tongue. A 45 years old Bangladeshi female patient presented with this benign tumor at the left lateral border with dorsal and ventral surface of the tongue for which complete tumor excision was done.

Serum calcium and lipid profile in acute ischemic stroke.

Background: Worldwide acute ischemic stroke (AIS) is a major public health problem. Therefore, this study was undertaken to see the association of some biochemical risk factors with AIS in Bangladesh. Methodology: This study was conducted in Biochemistry department of Dhaka Medical College, Dhaka from January 2014 to December 2014. In this study, 50 patients of AIS considered as case and 50 age and sex matched healthy individuals taken as control. Blood sample was collected and tested for serum calcium and lipid profile in case and control. All the parameters then compared statistically between two groups. Results: Study showed that serum calcium was significantly lower (p= 0.001) in cases and serum TChol, TAG, LDL-C significantly higher (p= 0.035, 0.001 and 0.019 respectively) and HDL-C significantly lower (0.001) in cases compared to controls. Conclusions: This study concludes that low serum calcium level and altered lipid profile are significantly associated with AIS.

Central Obesity Plays an Important Role for the Development of Type 2 Diabetes in Bangladeshi Women.

Background: Diabetes mellitus coexists at a greater frequency with hypertension, obesity, central obesity, and dyslipidemia. Obesity has been identified as the most important modifiable risk factor in the aetiology of type-2 diabetes mellitus. Central obesity has been shown to be the most pathogenically important in the causation of metabolic disorders including type-2 diabetes. Aims: To determine the association of central obesity with type 2 diabetes in Bangladeshi women. Subjects and Methods: A total of 60 type 2 diabetic female subjects along with 60 healthy female subjects were recruited in this study. Anthropometric indices were measured using standard techniques. Serum glucose was measured using glucose-oxidase method, insulin was measured using ELISA and thyroid hormones were measured using chemiluminescence based automated Immulite Auto analyzer (DPC, USA). Insulin secretory capacity and insulin sensitivity were estimated using fasting glucose and fasting insulin by HOMA-CIGMA software. Results: Waist circumference of the control (89±8) subjects was significantly (p=0.046) lower than the diabetic (94±11) subjects. Waist-hip ratio of the control subjects was significantly lower compared to diabetic subjects. Fasting plasma insulin level in control sub-jects (7.6±2.2) was significantly (p=0.009) lower compared to diabetic subjects (11.8±9.8). Plasma lipid profile and thyroid hormone status in control and diabetic subjects were not found significantly different. Insulin secretory capacity (HOMA %B) and insulin sensitivity (HOMA%S) in control subjects (93 ±21, 95±39 respectively) were found to be significantly higher com-pared to diabetic subjects (45±32, 67±42 respectively). In age-adjusted binary logistic regression analysis, waist circumference was found to be significantly associated with diabetes. In multiple linear regression analysis TSH was found to be significantly associated with waist circumference. Conclusion: Waist circumference may be an independent indicator for the development type 2 diabetes in Bangladeshi women which may have influenced by thyroid stimulating hormone (TSH). Key Words: wais

Serum Lipid Profile in Ischemic Heart Disease: A Cross-Sectional Analytical Study.

Risk of coronary heart disease and other forms of atherosclerotic vascular diseases, rises with plasma cholesterol concentration and in particular with the rise of ratio of total cholesterol to high density lipoprotein (HDL-C) cholesterol. A much weaker correlation also exists with plasma triglyceride concentration. Extensive large-scale randomized trials have shown that lowering total cholesterol and LDL-C concentrations reduces the risk of cardiovascular events including death, myocardial infarction and stroke and reduces the need for revascularisation.This cross-sectional analytical study was designed to observe association between lipid profile level with chronic ischaemic heart disease and the study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total of 50 cases were selected purposively according to the selection criteria from the patients admitted in the Department of Cardiology, Dhaka Medical College Hospital with chronic ischaemic heart disease (IHD). Diagnosed IHD patients were taken as cases and 50 age- & sex- matched healthy subjects were taken as controls. Serum TC, TG, LDL-C & HDL-C were measured in all study subjects.The mean±SD of serum TC, TG, HDL-C and LDL-C concentration in cases were 314.54±73.72 mg/dl, 288.04±60.45 mg/dl, 36.02±4.12 mg/dl, and 178.62±22.7 mg/dl respectively and in controls were 174.64±18.97 mg/dl, 119.42±12.47 mg/dl, 43.04±2.58 mg/dl & 126.28±11.45 mg/dl respectively. Serum Total Cholesterol, TG & LDL-C were found to be significantly higher in cases than that of controls. Serum HDL-C was found to be significantly lower in cases than that of controls. The present study reveals that the patients with chronic ischemic heart disease is accociated with significantly higher levels of serum TC, TG and LDL-C whereas HDL-C was found to be lower in IHD patients.

Serum Homocysteine Level in Type 2 Diabetes Mellitus with Peripheral Arterial.

Peripheral arterial disease is a macrovascular complication of type 2 diabetes mellitus. Hyper-homocysteinemia is found to be associated with peripheral arterial disease. Homocysteine induced endothelial-cell injury is mediated by hydrogen peroxide. Hydrogen peroxide exposes the underlying matrix and smooth muscle cells of the arteries which, in turn, proliferate and promote the activation of platelets and leukocytes. The present study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011 to observe the association of hyperhomocysteinemia with peripheral arterial disease in type 2 diabetes mellitus. A total of 100 subjects (50 cases and 50 controls) were selected by purposive sampling from Bangladesh Institute of Health sciences (BIHS) and BIRDEM Hospital, Dhaka. Subjects having ankle brachial index <0.9 were considered as cases and those having ankle brachial index 0.9 were considered as controls. Subjects with absent peripheral pulses or nonrecordable ankle brachial index were considered as ankle brachial index <0.9. All study subjects were normotensive, normolipidemic and non- smoker. The study showed a higher level of homocysteine (μmol/L) in cases when compared with that of controls (15.95±1.80 vs. 9.31±2.11; p<0.001). In cases, males had higher proportion of arterial disease (56%) than females. Other variables (age and body mass index) showed no significant difference between two groups.

Study of High Sensitive C-Reactive Protein in Ischemic Heart Disease.

C-reactive protein (CRP) is a sensitive marker of inflammation, and elevated levels have been associated with future risk of myocardial infarction (MI). Even elevated CRP in healthy men and women can predict the future coronary events. This cross-sectional analytical study was undertaken to observe association between high hsCRP level with chronic ischaemic heart disease and was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total 50 cases were selected purposively according to the selection criteria form the patients admitted in the Department of Cardiology, Dhaka Medical College Hospital with chronic ischaemic heart disease (IHD). Diagnosed IHD patients were taken as cases; age- and sex-matched 50 healthy subjects were taken as controls. Serum hsCRP and serum TC, TAG, LDL-C and HDL-C were measured in all study subjects. The mean serum hsCRP concentration in cases and controls were 11.22±7.64 mg/dl and 1.72±0.98 mg/dl respectively. Serum hsCRP, Total Cholesterol, TAG and LDL-C were significantly higher in cases than control subjects. Serum HDL-C was significantly lower in cases than control subjects. The present study reveals that the patients of chronic ischemic heart disease have been found to have close association of increased level of hsCRP.

Iron Status in Pre-Eclampsia: A Case-Comparison Study.

Preeclampsia is one of the most leading causes of maternal mortality in developing countries. Many studies have demonstrated the relation between alteration of iron status and preeclampsia. The aim of the study was to assess the status of iron in preeclampsia. This case control study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total number of 100 pregnant women in the third trimester of pregnancy attending the Obstetrics & Gynaecology Department of Dhaka Medical College Hospital were selected purposively as study subjects. Among them 50 diagnosed cases of preeclampsia were selected as cases and 50 normal healthy pregnant women as controls. Serum ferritin and serum iron concentration were measured in all study subjects. The mean serum ferritin concentration in cases and controls were 95.06±50.07 μg/l and 45.56±27.44 μg/l respectively. Mean serum iron concentration in cases was 121.78±41.93 μg/dl and that in controls was 61.04±24.18 μg/dl. The present study showed significant differences of mean serum ferritin and serum iron between cases and controls. The study revealed presence of significantly higher level of serum ferritin and serum iron in preeclamptic group.

A Study of Serum Zinc level in Cirrhosis of Liver.

Cirrhosis is a consequence of chronic liver diseases. Zinc is a micronutrient that plays an important role in the function of liver. This cross-sectional study was carried out in the Department of Biochemistry, Dhaka Medical College, from July 2010 to June 2011 to observe the association of serum zinc level with liver cirrhosis. A total of 100 adults, both males and females with age range of 18-60 years, of which 50 were healthy subjects and 50 adult hospitalised cirrhotic patients were selected purposively for the study according to selection crieteria. Fasting serum zinc level was measured with atomic absorption spectrophotometer. Serum zinc level was found to be low in 72% patients. Mean ±SD of serum zinc levels (μg/L) were 610.32 ± 169.60 and 827.66 ± 267.32 in cases and controls respectively. In cirrhotic patients serum zinc level was significantly lower than that of healthy controls (P<0.001). Though, it is difficult to draw any definite conclusion from this study, because of reduced level serum of zinc found in cirrhotics, Zn may be supplemented to them with a hope of better treatment response.

Serum and Erythrocyte Magnesium levels in Offsprings of Essential Hypertensive Parents.

Hypertension is an important public health challenge worldwide, 95% of which are primary or essential hypertension, where the exact causes are not known. It has been thought that magnesium level has an association with hypertension and plays role in the pathogenesis of essential hypertension. Several evidences suggested that decreased magnesium level may be a significant modifiable risk factor for developing essential hypertension. To explore the relationship between serum and erythrocyte magnesium level with blood pressure, this case control study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), during the year 2006. Thirty offsprings of essential hypertensive parents were taken as cases and 30 age and sex-matched offsprings of normotensive parents were taken as controls. Serum & erythrocyte magnesium were measured by colorimetric Calmagite method. Significantly lower serum magnesium level (mg/dl) was found in cases than that of controls (1.90±0.210 vs 2.13±0.366, p<0.01) and erythrocyte magnesium (mg/dl) was also found to be lower in cases when compared with that of controls (4.46±0.699 vs 5.43±0.775, p<0.001). Mean systolic and diastolic blood pressure were found to be significantly higher (p<0.01) in cases as compared to controls. Though it is difficult to draw any definite conclusion, it may be assumed that, a hereditary predisposition to hypertension may be related to magnesium metabolism and magnesium deficiency might have a role in the future development of hypertension in the offsprings of essential hypertensive parents.

Microalbuminuria as a Predictor of Short-Term Mortality in Acute Ischemic Stroke.

Stroke is one of the major causes of morbidity and mortality all over the world. Microalbuminuria is one of the predictors of mortality. Available published data has suggested that microalbuminuria is a potential new risk factor for ischemic stroke. This study was carried out in the Department of Biochemistry, Dhaka Medical College during the period from July 2009 to June 2010. In this study, we enrolled 120 patients of ischemic stroke. 60 of them were with microalbuminuria (MA) and 60 were without MA. Among the MA +ve group, 38 (63.3%) were males and 22 (36.7%) were females. On the other hand those belonging to MA -ve groups 52 (36.7%) were males and 8 (13.3%) were females. Age range of the subjects in MA +ve group was 45-70 years and in MA-ve group was 50-70 years. In patients with microalbuminuria mortality was 26.7% and in patients without MA mortality was 11.7% (p<0.05). The study showed significantly higher mortality in patients with microalbuminuria than that of the patients without microalbuminuria.

Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus.

Background- People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome. People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes. We investigated the prevalence of metabolic syndrome in patients with newly diagnosed diabetes mellitus. Methods- It was a cross sectional study. The study was conducted in Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet & Diabetic Hospital, Sylhet. The study was conducted From July 2008 to June 2009 among 200 patients with newly diagnosed type 2 diabetic patients with age >20 years. Along with blood glucose, different components of metabolic syndrome was assessed, i.e. serum triglyceride level, serum HDL level, blood pressure and waist circumference. Results- Prevalence of metabolic syndrome was 73.5% according to NCEP-ATP III criteria, 81.0% according to modified NCEP-ATP III criteria, 82.5% according to modified WHO criteria and 61.0% according to IDF criteria. All variables other than waist hip ratio and fasting blood sugar had statistically significant higher mean values among patients with metabolic syndrome than patients without metabolic syndrome. Conclusion- It may be concluded that prevalence of metabolic syndrome is considerable in newly diagnosed type 2 diabetic patients in our population. The considerable prevalence of metabolic syndrome in our population is implicative of an alarming risk of cardiovascular disease in future.

Performance of Plasma B-Type Natriuretic Peptide as a Diagnostic Biomarker in Heart Failure.

Background: Accurate diagnosis of heart failure (HF) is essential for its proper management and logical drug therapy to reduce morbidity and mortality. On this perspective researcher are in search of a good biomarker as complementary to the clinical parameters to improve the performance of HF diagnosis. B-type natriuretic peptide (BNP) secreted by cardiac ventricles in HF has emerged as a new promising biomarker in this regard. Objective: To evaluate the performance of plasma BNP as a diagnostic biomarker in HF. Methods: In a cross sectional study 180 clinically suspected HF patients were selected. Their plasma BNP were measured and then subjected to echocardiogram. Patients were categorized as HF and without HF on the basis of echocardiogram and against this information the performance of plasma BNP of study subjects were evaluated as a diagnostic biomarker of HF considering 100 pg/ ml as its cut off point. Results: Sensitivity, specificity, accuracy, PPV, NPV, PLR and NLR of plasma BNP for diagnosis of HF found to be 88 %, 63.8 %, 77.2 %, 75.2 %, 81.0 %, 2.4 and 0.2 respectively. Conclusion: Plasma BNP concentration increases in HF. Based on 100 pg/ml as cut off point, plasma BNP shows good performance in diagnosis of HF.

Correlation between serum bilirubin and serum ferritin Level in thalassaemia patients.

Thalassaemia is the most common hereditary disorder in the world including Bangladesh. Beta thalassaemia major and Hb-E thalassaemia both are common in our country. Iron overload causes most of the mortality and morbidity associate with thalassaemia. To assess the iron over load and liver function a cross sectional comparative study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka in collaboration with Thalassaemia Center and Department of Pathology, Dhaka Shishu Hospital, Dhaka during the period of July 2006 to June 2007. The study was carried out with the patients who visited regularly in Dhaka Shishu Hospital Thalassaemia Centre (DSHTC) and had multiple transfusions (more than five) and age more than 2 years. To compare the state of liver function with normal healthy individuals' normal healthy persons were also included. Total 70 subjects were included in this study. The study subjects were distributed into two groups, the group - A (cases, n=40) and group - B (healthy controls, n=30). According to the major types of thalassaemia present in our country, group -A again divided into two, group - AI b-thalassaemia major (n=12) and group - AII of Hemoglobin E b-thalassaemia (n=28). The mean of serum Bilirubin in group - A and group - B were (2.04 ±0.70) mg/dl and (0.67±0.15) mg/dl respectively. Group - A had higher serum bilirubin than group -B in p value <0.001.The mean level of serum bilirubin in group - AI was (1.70±0.70)mg/dl and the mean of bilirubin in group AII was (2.18±0.66) mg/dl. Group -AI had lower serum bilirubin than group AII in p value <0.05. Pearson's correlation between serum bilirubin and serum ferritin had r value -0.26 was statistically not significant. Mean level of serum ferritin in the total was (2729.40 ± 1935.87) ng/ml, minimum level was 304 ng/ml and maximum was 7256ng/ml. Mean level of serum ferritin in the patients of b - thalassaemia major was (4098.67 ± 1598.63) ng/ml, minimum level was 1212ng/ml and maximum was 7560ng/ml. Mean level of serum ferritin in the patients of HbE b - thalassaemia was (2232.57± 1598.63) ng/ml, minimum level was 304ng/ml and maximum was 630ng/ml. Group AI had higher level of serum ferritin than group AII in p value <0.05.

Role of Serum Total PSA (Prostate Specific Antigen) and Free to Total PSA Ratio in the Diagnosis of Carcinoma Prostate.

The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra- sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA 4 ng/ml and only 3 have total PSA 4 ng/ml. 18 of these 20 have free to total ratio 0.16 and 02 have f/t ratio 0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA 4 ng/ml and 20 of BPH have tPSA 4 ng/ml. 38 of 40 BPH patient have f/t ratio>0.16 and 2 of 40 patient are f/t ratio 0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of>4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA.

Cystatin C: A Better Predictor of Kidney Function in Diabetic Patients .

Serum cystatin C is a new promising marker of renal function. The aim of this study was to analyze serum cystatin C as a better predictor of renal function in diabetic nephropathy. In 60 diagnosed diabetic patients, serum cystatin C and serum creatinine were assessed. Glomerular filtration rate was estimated based on the cystatin C concentration according to Cockcroft- Gault formula and based on serum creatinine concentration according to Larsson formula. DTPA-GFR (Diethylenetriamene pentaacetate Renogram) was done as reference standard. The cross tabulation of DTPA-GFR was done with eGFR- creatinine and eGFRcystatin C. The calculated sensitivity, specificity and accuracy of eGFR- creatinine were 85%, 87.2% and 85% respectively. The eGFR- cystatin C showed higher sensitivity, specificity and accuracy than eGFR- creatinine in studied diabetic subjects. The cystatin C showed more significant correlation, r=0.78, p<0.001 than serum creatinine, r=0.59, p<0.001 with DTPA-GFR in diabetic patients. This study demonstrates that serum cystatin C may be used for early prediction for renal function impairment in diabetic kidney disease.

Study of serum non-HDL cholesterol in cerebrovascular disease.

Background: Non-HDL cholesterol is a potential newer risk factor for cerebrovascular diseases (CVD). Objective: To explore the association of non-HDL cholesterol with cerebrovascular disease. Methods: This case control study was carried out in the Department of Biochemistry, BSMMU, Dhaka during the period of January to December 2007 to evaluate the association of non-HDL cholesterol with CVD in Bangladeshi population. A total number of 135 subjects of both sexes were grouped as Group-􀇿 (CVD cases) and Group-II (Healthy controls). Group-I include 85 cases of which 59 were ischaemic cerebrovascular diseases (ICVD) and 26 were haemorrhagic cerebrovascular diseases (HCVD). By taking the history and doing clinical examination and laboratory investigations, diabetes mellitus, malignant disease, renal disease, liver disease and diuretic medication were excluded from study subjects. Serum non-HDL cholesterol was measured in all study subjects. Statistical analysis was performed by using SPSS for windows version 12.0. Mean values of the findings were compared between groups. One way ANOVA test and multiple comparison (Bonferroni‘t’) test were used to see the level of significance. Results: Serum non-HDL cholesterol found significantly increased in CVD, ICVD and HCVD cases in comparison to control subjects. But ICVD and HCVD cases did not differ with respect to serum non-HDLcholesterol. Conclusion: The result shows that elevated non-HDL cholesterol is associated with CVD. Prospective study with large sample size is required to evaluate the elevated Non-HDL cholesterol as a risk factor of CVD.

Association of Serum Calcium and 24 Hours Urinary Excretion of Calcium in Patients of Preeclampsia.

Preeclampsia is a leading cause of fetal growth retardation, infant morbidity, mortality and maternal death. Several biochemical changes occur during the course of the disease, among them serum total calcium and 24 hr urinary calcium excretion rate have drawn remarkable attention. A case control study was designed to see the association of serum calcium and 24 hours urinary excretion of calcium in patients of pre- eclampsia. The study was done from July 2008 to June 2009 in the Department of Biochemistry, Dhaka Medical College, Dhaka. Total 60 subjects were selected as study population. Among them 30 were diagnosed case of preeclampsia and 30 were age- and sex-matched normal pregnant female healthy control. It was found that the mean measured serum calcium level in case group were 1.96 ±0.17 ( mean±SD ) mmol / l and that of control group were 2.34±0.12 (mean±SD) m mol/ l respectively. The mean 24 hr urinary calcium excretion level were 94.40 ±10.68mg/24 hr (mean±SD) in case group and that of control group were 154.35±66.68 (mean ±SD) mg / 24 hr respectively. The study suggests that low level of serum calcium and urinary excretion of calcium was associated with Pre-eclampsia.

Association of Hypertension and Smoking with Ischaemic Stroke.

Hypertension is one of the most important modifiable risk factors for ischemic stroke. Cigarette smoking is a risk factor for atherosclerotic disease. There is a strong relationship between hypertension and cigarette smoking with ischaemic stroke. A case control study was undertaken to see the association of hypertension and cigarette smoking with ischaemic stroke. The study was done from January to December 2009 in the Department of Biochemistry, Dhaka Medical College, Dhaka. A total of 60 subjects were selected as study population. Among them 30 were diagnosed case of ischaemic stroke and 30 were age-and sex-matched control subjects. It was found that 60% patients of case group and 20% respondents of control group were hypertensive and diffrence was significant. Study showed that 56.66% of cases and 53.33% of controls were smoker and the findings were insignificant. The mean duration of smoking was 27.41 ± 2.98 years in cases and 15.63 ± 2.85 years in controls which was significant. The study suggests that hypertension is significantly associated with ischaemic stroke and longer duration of smoking also associated with ischaemic stroke.

Outcome of pregnancy in women 35 years of age and above.

Pregnancy outcome among women in the age group of 35 years and more are considered to be less favorable than those of younger women. To observe those, this case control study was conducted in the department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital during the period of 1st June 2003 to 31st May 2004. The study includes 100 patients of 35 years of age or above and 100 controls of 20-30 years of age. Observed complications during the pregnancy and delivery were increased incidence of placenta previa, malpresentation, intrauterine death, preterm labour, obstructed labour ruptured uterus etc. Pregnancy related complications were found significantly high (p<0.001) in case group (80%) compared to control group (51%). Rate of caesarian section was also more among the cases. Post delivery maternal complications were more in case group (53%) compared to control (30%) (p<0.001). Perinatal morbidity and mortality was significantly high. Cause of late fetal death in older women include, failure of the uterine vasculature in older women to adapt sufficiently to the increase haemodynamic demands of pregnancy, reduced fetal oxygenation with maternal age and also a rise in the frequency of preexisting hypertension with age. Maternal age is an important and independent risk in pregnancy outcome.