Demographic profile of COVID-19 patients in the Northern part of Bangladesh

Background: It is a new pandemic; the demographic profile of COVID-19patients may be helpful for corona virus patients. Methods: This was a cross-sectional study conducted at the department of cardiology at Rangpur medical college hospital, Rangpur, Bangladesh during July 2020 to December 2020.In total 37confirmed COVID-19patients were selected as the study population. Data were collected from patients or their attendants by using a pre-designed structured questionnaire, after having appropriate consent. The statistical package for the Social sciences (SPSS) version 22.0 was used for data analysis. Results:In this study 70% participants were male whereas 30% were female and the ratio was 2.36:1. The mean±SDage of the participants was 56.57±15.96 years. The highest number of participants were from 51-60 years’ age group which was 27.3%, 2.70%, 18.92%, 16.22%, 13.51%, and 21.62% participants were from 21-30, 31-40, 41-50, 61-70 and >70 years of age group respectively. The majority portion of participants were with normal body-weight (BMI: 18.5-24.9) which was in 57% and 43% were with overweight (BMI: 25.0-29.9). More than half of the patients were from Rangpur district which was 54%. The highest number of patients were with cough as a major symptom, which was 51.35%. The highest number of participants were with IHD (64.86%) as a major comorbidity. Conclusions:As per the findings of this study, we can conclude that, middle aged population are mostly being affected byCOVID-19in Bangladesh. The affected number of males were higher than female.

Spatial Variability and Associated Risk Assessment of Nitrate and Ammonium Concentration in Hail Haor Wetland, Northeastern Bangladesh

Nitrate-nitrogen and ammonium-nitrogen concentration were evaluated to assess the current nutrient condition of an ecologically as well as economically important wetland of Bangladesh. The contamination condition of surface water nitrate and ammonium of Hail Haor wetland was assessed to understand its probable risk to human health using the water samples collected from total-fifty monitoring stations, 25 each for two different seasons within 2018 to 2019. Nitrate concentration was measured using the spectrophotometer by colorimetric method, whereas ammonium was quantified using the micro Kjeldahl's distillation method. Statistical and geo-spatial analysis revealed an extensive understanding of the temporal and spatial variability as well as possible source identification of the nutrients in the studied area. Medium to a low level of nitrate ranging from 0.95 up to 9.25 mg/L and high ammonium with values from 0.32 up to 1.92 mg/L was a sporadic trend observed in wetland water, with low water season having more concentration than that of wet high water season. Hazard quotients (HQ) obtained from wetland water for four individual age groups recognized wetland water to be safe for consumption (HQ<1) based on its nitrate level. Wetlands can provide valuable ecosystem services, conserve the native and exotic wetland inhabitants and mitigate flood along with their purifying properties of nutrient removal to lessen the public health concerns about nitrate-nitrogen in drinking water. Therefore, appropriate rein in measures, incentivizing water use efficiency, and continuous monitoring of water quality will ensure safety for wetland habitats, also may aware of the risks or opportunities associated with using wetland water for both drinking and agricultural use.

Disaster Coping Strategy Practiced by the Affected People for their Livelihood Due to Climate Change

The purpose of the study were to (i) determine the disaster coping strategy practiced by the affected people (ii) assess the socio-economic profile of the respondents, (iii) ascertain the contribution of selected characteristics of the people and (iv) identify the constraints of disaster coping strategy practiced by the affected people. The study was conducted at Gangachara Upazila of Rangpur District. Data were collected from a sample of 302 respondents, randomly selected from disaster affected population. Age, education, family size, farm size, disaster affected land, annual income, training received, extension media contact, knowledge on disaster coping strategy, environmental awareness, household assets, credit facilities, IGAs, water and sanitation condition, risk orientation, awareness about SSNP, perception of Climate Change (CC), perception of disasters and scope of work in vulnerable situation constituted the independent variables, while disaster coping strategy practiced was the dependent variable. For measuring the disaster coping strategy practices, a 4-point rating scale was used against 50 items taking 10 items from each of five components of human needs e.g. 1) food preservation, collection and management, 2) agricultural products protection, 3) maintaining social network, 4) safeguard of health and sanitation, and 5) protection of housing and shelter. Numerical values and scales were used to measure the personal attributes. Regression and path analysis were employed to determine the contribution among the variables. For exploring relationship between the two variables Pearson’s Product Moment Correlation (r) was used. The majority (77.8 per cent) of the respondents had regular coping strategies compared to 22.2 per cent were found to have occasional coping strategies in the study area. Among 19 independent variables 16 were found significant relationship with the dependent variable. Stepwise multiple regression revealed that six variables namely education (23 per cent), participation in IGAs (3.6 percent), awareness of SSNPs (2.9 percent), disaster affected land (1.2 percent), farm size (1.9 percent) and perception of CC (1 percent) were the important contributing variables which combined explained 33.6 of the total variation of practice of coping strategy. Path analysis indicated that disaster affected land (0.589) had the highest positive direct effect while farm size (0.643) had the highest positive indirect effect to the disaster coping strategy practice. The major constraints for practicing disaster coping strategy in the study area were ‘Lack of knowledge and skills of affected people‘, ‘Lack of relief materials during disaster‘, ‘Lack of technologies‘, ‘Weak weather forecasting‘, ‘Less motivation’, ‘Low sanitation & health coverage’ and ‘Lack of communication during disasters’,. To cope up with the challenges of the disasters, the people used reduction of food intake per meal, putting goods above flood level, keeping women and children in safer places, using boiled and tube well water, providing health care support to the sick family members, transfer important documents to the safer places, increasing level of homestead with soil, taking relief, credit, religious fasting, using mosque/temple as campaigning center, borrowing principal food from neighbor, use savings, migration, livestock sell, and social interconnectedness as the major coping strategies to survive the situation and improve their livelihood.

Management of Hepatitis C Virus Infection - New Era Has Been Started.

Hepatitis C virus is a major cause of chronic hepatitis and is responsible for majority of liver transplantation worldwide. It has got no vaccine for prevention. Interferon containing regimen was the only management options for treatment of Hepatitis C virus till last year. Due to side effect profile and treatment cost this treatment options was not reachable for general population. Besides, response rate was not so satisfactory (Genotype 1, 40-50%, Genotype 2 & 3, 70-80%). New oral antivirals were introduced in 2014 which has got little side effect profile as well as good treatment response rate (80-95%). These new drugs with their different combination regimens along with indications, contraindications and treatment monitoring of Hepatitis C virus are discussed briefly in this review.

Metabolic Syndrome in Hypothyroid Patients.

Thyroid functions affect metabolic syndrome (MetS) parameters including blood pressure, fasting plasma glucose, serum triglycerides and HDL-Cholesterol. But the relationship between MetS and thyroid functions is yet to be identified clearly. Metabolic syndrome is a state in which most features of hypothyroidism can be seen. The aim of the present study was to investigate the frequency of MetS in hypothyroid patients. Thirty one patients with overt hypothyroidism, 32 patients with subclinical hypothyroidism (SCH) and 58 euthyroid controls were enrolled in this study. NCEP-ATP III criteria was used to diagnose metabolic syndrome. Majority of the participants were in the age group of 30-40 years. Body mass index and waist circumference, blood pressure, fasting plasma glucose and serum triglycerides were found to be higher in hypothyroid patients compared to that of euthyroid controls (p<0.001). On the other hand serum HDL-C was found to be significantly lower in hypothyroid patients compared to that of euthyroid controls (p<0.001). Prevalence of MetS was 82.5% in the hypothyroid group and 27.6% in eythyroid controls (p<0.001). No significant difference was found between SCH (81.3%) and overt hypothyroid (86.7%) groups in respect to prevalence of MetS (p<0.05). The findings of the study suggest a need to investigate the presence of hypothyroidism during the management of MetS patients.

Effect of Ramadan Fasting on Serum Lipid Profile of Bangladeshi Female Volunteers.

The study was conducted to evaluate the effects of fasting for a period of one month during Ramadan on the lipid profile of Bangladeshi female volunteers who fasted during the Arabic month of Ramadan, when there occurs a change, both in the pattern and timing of dietary intake. Findings of the study showed that Ramadan fast significantly reduced serum Total cholesterol (TC) (p=0.030) and Low density lipoprotein (LDL-C) (p=0.011). A statistically nonsignificant elevation of triglyceride (TG)) was observed (p=0.598). High density lipoprotein cholesterol (HDL-C) also found to be raised significantly at the end of fasting (p = 0.037). Findings of the study revealed that fasting during the month of Ramadan changes lipid profile pattern in an aniatherogenic direction and may be beneficial to health.

Serum Lipid Profile, Serum Magnesium and Fasting Serum Glucose in Newly Diagnosed Type 2 Diabetic Subjects.

Type 2 diabetes is considered as a major health burden due to its rising prevalence and disabling, life threatening complications. Dyslipidemia, often coexisting with T2DM as a feature of insulin resistance, is hypothesized to be linked with altered magnesium homeostasis. This study was designed to evaluate the serum magnesium levels and its influence on serum lipids in type 2 diabetics. Lipid profile, serum magnesium (Mg) and fasting serum glucose (FSG) were measured in 30 newly diagnosed normotensive type 2 diabetic patients chosen as cases (Group II) just before introducing any treatment, and was compared with that of 30 healthy controls (Group I). The serum magnesium was found to be significantly lower (p<0.001) and LDL-c was found to be significantly higher (p<0.01) in cases. The correlation analysis revealed a significant negative association of FSG to serum magnesium (r= -0.720), total cholesterol (r=-0.483) and a positive correlation to HDL-c (r=-0.440). However, serum magnesium showed a significant positive relation only with serum HDL-c (r =0.372, p<0.05). Serum magnesium and lipid fractions showed wide range of variation within the normal reference ranges in the newly diagnosed T2D subjects. Further large scale studies are needed to elucidate the association of serum magnesium with lipid profile changes. Estimation of serum magnesium level may prove useful in T2DM with normal or abnormal lipid levels or in those who are prone to develop dyslipidemia or certain complications associated with dyslipidemia. Key words: Lipid Profile, Type

Caffeine and Total Polyphenol Contents of Market Tea Cultivated and Processed in Bangladesh

Objective: The aim of this study was to determine the contents of caffeine and total polyphenol in six brands of market tea cultivated and processed in Bangladesh. Methods: Caffeine and polyphenol contents were determined by solvent extraction (AACC) and the International Organisation for Standardisation Method (ISO) 14502-1 respectively. Results: Caffeine contents of the different tea samples ranged between 0.99 ± 0.17% to 2.08 ± 0.16% (g/100g materials), while that of total polyphenol was from 36.90 ± 1.39% to 17.29 ± 2.30% of gallic acid equivalents (GAE). The order of caffeine concentration in tea samples was found as follows: Organic Black Tea > Taaza Tea > Organic Green Tea > Magnolia Tea > Organic Zinger Tea > Organic Tulsi Tea. The polyphenol concentration in the tea samples was highest in Organic Green Tea followed by Taaza Tea and the rest as follows: Magnolia Tea > Organic Black Tea > Organic Zinger Tea > Organic Tulsi Tea. An indicative difference in amounts of caffeine and polyphenols for different tea brand samples is seen in this study. Conclusion: This systematic screening provides information to producers as well as consumers on the quantities of caffeine and polyphenols in commercial tea available in the markets of Bangladesh.

Renal function impairment in Hypothyroidism.

Background: Hypothyroidism is an important public health problem in Bangladesh. It is associated with increased risk for atherosclerosis and other complications. The frank development of hypothyroidism is associated with metabolic derangements including dyslipidemia- which is an etiopathologic factor for development of renal impairment. This study was to evaluate whether hypothyroidism is associated with impaired renal function. Methods: Using a cross sectional analytical study design, a total of 111 subjects attending Out Patient Department, Center for Nuclear Medicine and Ultrasound, Bogra Medical College during January 2007 to December 2007 were included purposively. Eighty newly diagnosed hypothyroid patients (Group I) and 31 healthy adults (Group II) were enrolled in this study. Serum thyroid stimulating hormone and serum free thyroxine were assayed by radioimmunoassay. Serum fasting lipid profile, serum creatinine and serum uric acid were estimated by enzymatic colorimetric method. Estimated GFR was calculated using MDRD equation. Results: The mean (±SD) age of in Group I and Group II were 35.59 (±6.91) and 37.35 (±2.78) years and were comparable. In Group I, there were 66 females and 14 males. In Group II, there were 16 females and 15 males. The mean BMI was 25.49 ±2.17 kg/m2 in Group I and 24.24 ±1.99 kg/m2 in Group II. The mean (±SD) Serum total-cholesterol, LDL- cholesterol and tryacylglycerol in Group I were significantly higher than that in Group II. Serum HDL cholesterol in Group I was significantly lower than that in Group II (p<0.001). The mean (±SD) serum creatinine was significantly higher in Group I than Group II (P<0.001). The estimated glomerular filtration rate (eGFR) was lower in Group I compared to Group II (p=0.011). In Group I (Hypothyroid), there were significant correlations of BMI, S Total-Cholesterol, S HDLCholesterol, S LDL-Cholesterol, S triglycerides and S creatinine with serum TSH level. In Group I (Hypothyroid), there were significant positive correlations of BMI and TSH with serum creatinine. Conclusions: Hypothyroidism is associated with dyslipidemia, hyperuricemia and impaired renal function. Therefore, patients presenting with these biochemical abnormalities are recommended to be investigated for hypothyroidism and vice versa.

Symphysio Fundal Height (SFH) Measurement as a Predictor of Birth Weight.

Fetal weight is a very important factor to make a decision about labor and delivery. Assuming that in large fetuses, dystocia and other complications like cerebral edema, neurological damage, hypoxia and asphyxia may result during or after the delivery. On the other hand, one of the causes of high perinatal mortality in our country is high rate of low birth weight. Rural people may not have access to ultrasonography which is one of the methods to predict birth weight. For these people alternative easy method is necessary. So we can assess fetal birth weight by measuring symphysio-fundal height. Total 100 consecutive pregnant women of gestational age more than 32 weeks admitted for delivery in the Obstetric and Gynaecology department of Faridpur General Hospital were the subject of this study. After selection of cases, a thorough clinical history was taken and elaborate physical examination was done. Common criteria for collection of data were followed in every case. The fetal weight estimated by Johnson's formula was recorded in the predesigned data sheet and then was compared with birth weight following delivery of the fetus. Collected data were compiled and relevant statistical calculations were done using computer based software. Statistical tests (Correlation) were done between actual birth weight (taken as dependant variable) and fetal weight (found by Johnson's Formula), symphysio fundal height (SFH), pre-delivery weight and height of the patients (taken as independent variables) and the tests revealed that actual birth weight was significantly correlated with fetal weight (found by Johnson's Formula), SFH, pre-delivery weight and height of the patients. Among these fetal weight and SFH had shown highest correlation. Regression analysis showed that SFH, maternal height and maternal weight explained respectively 59%, .011% and .009% of observed variation of birth weight.

Evaluation of Prescribing Pattern of the Private Practitioners in Bangladesh.

A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.

Survey on the awareness of using painkillers among the University students of Bangladesh.

The aim of the study was to determine the Awareness of using Painkillers among the University Students of Bangla-desh. The main objective of this survey was to determine the percentage of young adults using painkillers without prescription. The survey carried out among 300 students of different public and private universities. Data were collected using structured questionnaires containing 5 questions related to the students’ demographics and 15 questions related to the awareness of using painkillers. Descriptive statistics, factor analysis and Chi square test were used for data analysis. A total of 300 questionnaires were completed and collected. Both male and female students studying in different public and private universities completed questionnaires distributed. The most important finding was 69% students are unaware about taking painkillers. The study concluded that the university students are not conscious about using painkiller. A big percentage of students use painkiller without physician’s prescription.

Comparative Efficacy of Dried Fruits of Carica Papaya Linn. and Vitamin-E on Preventing Hepatotoxicity in Rats.

In the absence of an effective treatment in modern medicine, efforts are being made to find suitable herbal remedies for hepatitis. This prospective experimental study was conducted in the department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka from July 2006 to June 2007 to evaluate the hepatoprotective effects of Carica papaya against carbon tetrachloride (CCl4) induced hepatotoxicity and compared it with that of vitamin-E. Total 36 adult rats were used and they were divided into six equal groups namely A, B, C, D, E and F. All the rats were fed with normal diet and 2ml distilled water orally for 7 days. In addition, Group D received Carica papaya extract, Group E received olive oil and Group F received vitamin E orally per day for 7 days. On the seventh day CCl4 was administered to all the rats except Group A and was sacrificed on 8th day of experiment. Serum bilirubin, alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase and hepatic histopathology were done thereafter. Carica papaya and vitamin E showed significant hepatoprotection against CCL4 induced hepatotoxicity but Carica papaya showed more significant changes in ALP level than vitamin E. Prevention of hepatic necrosis and fatty degeneration were also observed in Carica papaya and vitamin E pretreated rats but there is no significant difference.

Effects of Methanol Extract of Piper chaba Stem Bark on Acute Inflammation in Rats.

The plant Piper chaba Hunter (Piperaceae), a climbing glabrous shrub grows in plenty in southern Bangladesh. Popularly known as 'Choi' it is used as spices and believed to have medicinal value in a wide variety of disease conditions including arthritis, asthma, bronchitis and piles. In the present study, effect of methanol extract of Piper chaba stem bark on acute inflammation has been reported. The anti-inflammatory effect was studied in rats by injecting 0.1ml of 1% carrageenan suspension into the planter surface, where oedema of the rat's hind paw was used as an index of acute inflammation. Methanol extract of Piper chaba stem bark given orally 1 hour before injection at doses of 125 and 250 mg/kg body weight, produced significant (p< 0.05) anti inflammatory effect compared to control and the percentage of inhibition of oedema formation was 33% and 35% respectively, which however was less compared to aspirin (46%) and hydrocortisone (56%). The result suggest that in case of acute inflammation, Piper chaba stem bark possess mild to moderate anti inflammatory effect compared to that of aspirin and hydrocortisone.

Risk Factor for Relapse in Childhood Nephrotic Syndrome - A Hospital Based Retrospective Study.

Nephrotic Syndrome (NS) is a common childhood illness characterized by massive proteinuria, hyperlipidemia, hypoalbuminemia & edema. NS is a disease of relapse and it is a major problem to manage the cases with frequent relapse. So it is very important to find out such children who are prone to develop frequent relapse. This retrospective study was conducted in the paediatric department of Dhaka Medical College Hospital (DMCH) from January to December 2005.Total 100 children with relapsed NS of them 50 had Frequent Relapse NS (FRNS) and 50 had Infrequent Relapse NS (IFRNS) were included in the study with a view to find out the risk factors for relapse. Data were collected from previous medical and hospital records. Data were analyzed by using SPSS program. Chi-squared test and Student's t-Test were used as statistical test and p value < 0.05 was taken as significant. NS was more common among 2-6 years of age (67%) with male to female ratio roughly 2:1. Most of patient with frequent relapse had age <5 years, came from rural area and belongs to poor social class compared to that of infrequent relapse. The mean age at first onset was significantly less in frequent relapse group than that of infrequent relapse group. Majority of atopic child belongs to frequent relapse cases. Low serum albumin level, low serum total protein level, culture positive Urinary Tract Infection (UTI) at initial attack were observed to be statistically significant in case of frequent relapse group.

Relationship between Baseline White Blood Cell count and C-reactive protein with Angiographic severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome.

Inflammation has been shown to play a role in atherosclerosis and acute coronary syndrome. This study was carried out to evaluate the relationship between baseline white blood cell (WBC) count and C-reactive protein (CRP) with angiographic severity of coronary artery disease in patients with acute coronary syndrome and to identify those subsets of patients with acute coronary syndrome who may need to undergo invasive or conservative strategies. Method: A total of 100 patients with acute coronary syndrome including unstable angina, non-ST elevated myocardial infarction & ST elevated myocardial infarction were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to correlate angiographic findings, C-reactive protein and WBC count. Results: This study observed that either raised WBC count or raised CRP independently and combination of both WBC count and CRP elevation were significantly associated with more severe coronary artery disease. Either raised WBC count or raised CRP or combination of raised WBC count and CRP were significant predictor of multivessel disease and high stenosis score. Conclusion: Elevation of WBC count and CRP in patients with acute coronary syndrome are associated with severe coronary disease. WBC count and CRP can be used as a new and even simpler tool for risk stratification in acute coronary syndrome.

Survey on the awareness of using painkillers among the University students of Bangladesh.

The aim of the study was to determine the Awareness of using Painkillers among the University Students of Bangla-desh. The main objective of this survey was to determine the percentage of young adults using painkillers without prescription. The survey carried out among 300 students of different public and private universities. Data were collected using structured questionnaires containing 5 questions related to the students’ demographics and 15 questions related to the awareness of using painkillers. Descriptive statistics, factor analysis and Chi square test were used for data analysis. A total of 300 questionnaires were completed and collected. Both male and female students studying in different public and private universities completed questionnaires distributed. The most important finding was 69% students are unaware about taking painkillers. The study concluded that the university students are not conscious about using painkiller. A big percentage of students use painkiller without physician’s prescription.

Study of Serum Insulin Level in Hypertensive Patients.

Background and aims: Hypertension is a frequent and almost ubiquitous health disorder, prevalent both in developed and developing countries. Hyperinsulinemia and insulin resistance have been suggested to be closely associated with the pathogenesis of essential hypertension. However there is considerable controversy in this regards. The present study was designed to explore the relationship between serum insulin and serum ionized calcium in non diabetic and diabetic hypertensive subjects. Subjects and Methods: A total of 57 hypertensive and diabetic hypertensive patients attending out patients department of the BIRDEM and NICVD were included in the study. Fasting serum glucose was measured by glucose oxidase method, lipid profile was measured by enzymatic method. Serum insulin was measured by Enzyme Linked Immunosorbent assay (ELISA) method and serum ionized calcium by the Ion Sensitive Electrode (ISE) technique. Results: Glucose-insulin ratios were calculated as the index for insulin. Serum insulin (pmol/ml), Mean ± SD, 147 ± 48 in DC and 170 ± 80 in DH groups vs 118 ± 21 in NC and 120 ± 41 in EH groups, p= 0.023 and p= 0.031 respectively. Although, from the serum insulin results, the diabetic groups seemed to have insulin resistance, the glucose-insulin ratios in the two groups were significantly lower compared to nondiabetic groups (Glucose-insulin ratio, mmol/pmol, 0.066 ± 0.025 in DC, 0.074 ± 0.025 in DH vs 0.044 ± 0.11 in NC, 0.043 ± 0.012 in EH, p= 0.005 - 0.0001). The serum ionized calcium in the healthy subject, first time reported in the country by an up to date method (1.17 ± 0.05 M ± SD), were within the range found in healthy subjects of the other populations. No significant difference in the serum Ca2+ could be found between any of the study groups. Also, serum Ca2+ did not correlate with blood pressure, glucose or insulin in any of the study groups or with all the patients as a whole. Serum total cholesterol, triglyceride, HDLc and LDLc levels in the DC, EH and DH group did not show any significant difference compared to NC group and among the groups. The lipid abnormality as reflected by the mean LDL-HDL cholesterol ratios was the highest in the DH group but the differences were not statistically significant compared to the NC, DC and EH group. Conclusions: The data suggest the following conclusions: a) Serum ionized calcium level in our population is similar to that reported for other population. b) Serum glucose and insulin by themselves do not have any direct influence on serum ionized calcium. c) Non obese diabetes mellitus subjects in our population do not show insulin resistance as the primary defect. Rather, there is significant decompensation of the insulin secretory capacity in the subjects. d) Insulin resistance should be measured directly in relation to blood pressure and Ca2+ in appropriate groups of subjects to explore the relationship between insulin resistance, hyperinsulinemia and serum ionized calcium.

Correlation of Heart Rate Variability and 24- hour Mean Heart Rate with TIMI Risk Score in Acute ST-Segment Elevation Myocardial Infarction.

Background: Thrombolysis In Myocardial Infarction (TIMI) risk score, heart rate variability (HRV) and 24hour mean heart rate all are important predictor of prognosis after ST segment elevation myocardial infarction(STEMI). Correlation among these factors has not been studied thoroughly. Methods: This study was conducted in NICVD (National Institute of Cardiovascular Diseases), Dhaka, from July 2008 to June 2009. Total 105 STEMI patients were included in the study. TIMI risk score were calculated and each patient under went 24hour Holter monitoring. SDNN for HRV and mean RR interval for mean heart rate were recorded. Results : Ninety one patients (mean age 53.9 ± 10.8 years), 86.7% were males and 14( mean age 59.8 ± 8.8 years), 13.3% were female. Stratification of subjects by TIMI risk score shows that nearly 60% had risk score in the range of 3 – 7, 17. % between 0 – 2 and 24% 8 or more than 8.SDNN and RR interval stratified by TIMI risk score demonstrates that both the variables decreases significantly with the increase of TIMI risk score. Among the TIMI risk groups SDNN values were 120.0 ± 19, 871.0 ± 20.5 and 40.9 ± 6.4 msec in mild, moderate and high risk group respectively(p=<0.001). Mean RR were 836.8 ± 121.0, 776.7 ± 130.3 and 649.7 ± 75.5 msec in low, intermediate and high risk group respectively(p<0.001). There was a significant correlation between depressed SDNN and high TIMI risk score (r=.893, p=.001). High TIMI risk score also showed a negative correlation with mean RR interval (r=-574, p<0.001). Mean RR and SDNN show a perfect linear relationship (r = 0.657, p < 0.001). Conclusion: It was observed that depressed heart rate variability and increased 24-hours mean heart rate correlates with high TIMI risk score after acute ST-elevation myocardial infarction.

Study of Association of C- Reactive Protein with Coronary Collateral Development.

Background: In vitro studies have shown that C-reactive protein ( CRP ) attenuates nitric oxide production and inhibits angiogenesis, which may result in impaired collateral development. The aim of this study was to investigate the association between CRP levels and the extent of coronary collaterals. Materials and methods: A total of 100 patients who had a stenosis of >95% in any major coronary artery in angiograms were included in the study. The CRP was measured from a venous blood sample with a high- sensitivity assay. Collaterals of the epicardial coronary arteries were then studied and graded in a scale of 0 - 3 according to Rentrop classification. Results: Mean age was 49.6 years and 86% were male. The mean CRP level was found 15.57 ±12.85 mg/L in grade 0 (n =25 ), 11.38± 11.11 mg/L in grade I( n=20 ), 9.22± 10.15 mg/L in grade II ( n=34 ) and 8.97±8.44 mg/L in grade III ( n =21 ) collateral group. The mean CRP values reduced significantly (p<0.05) as the Rentrop collateral grade increased which indicated that patients with a higher grade of collaterals significantly had less CRP. Subjects with a higher grade of collaterals were significantly less likely to have diabetes mellitus [odds ratio (OR): 0.53, 95%; CI: 0.13, 0.91] or acute coronary syndrome [ odds ratio (OR) :0.67 , 95%; CL 0.43, 0.95] or higher CRP values [odds ratio (OR) 0.56 per 10 unit increase, 95%; CL 0.22, 0.92] but they were more likely to have higher number of vessels with significant stenosis [odds ratio (OR) : 1.59 ; 95% CI: 1.34, 1.87]. After adjusting for age, gender, clinical presentation with acute coronary syndrome, diabetes mellitus and the number of vessels with significant stenosis, each 10-unit increase in CRP values corresponded to 39% reduced- odds of having a higher collateral grade ( OR: 0.61, 95%: CL0.1 1,0.68). Conclusion: It may be concluded that elevated levels of CRP are significantly and inversely associated with angiographically visible coronary collateral development assessed by Rentrop classification.