Topsy turvy in the line of fire

In literature there are several schools of thoughts regarding the tooth present in line of fracture. Some supports the preservation to tooth and others in contrast against to the preservation of the tooth. A case of mandibular fracture with a tooth in the fracture line is presented in this paper. Removal of tooth done followed by reduction under G.A with 1 month postoperative follow-up. Different authors supporting different treatment plan for tooth in fracture line. It depends on case whether to remove the tooth or preserve. There are several pro and cons for both the treatment plan discussed in this paper.

Assessing the prevalence of hypocalcemia after total thyroidectomy at a tertiary care hospital

Background: Thyroidectomy is a common surgical procedure for various thyroid disorders, but it often leads to complications such as hypocalcemia. Understanding the prevalence and predictors of hypocalcemia post-total thyroidectomy is crucial for improving patient outcomes. Methods: This prospective cross-sectional study was conducted at a tertiary care hospital with 100 patients undergoing thyroid surgery, including total thyroidectomy, completion thyroidectomy, and thyroidectomy with neck dissection. We analyzed the incidence of transient and permanent hypocalcemia, examining correlations with surgery type, demographic variables, and postoperative day of onset. Data were collected through patient records and postoperative follow-ups. Results: The study revealed that 30% of patients experienced hypocalcemia postoperatively. Hypocalcemia was most prevalent among patients undergoing thyroidectomy with neck dissection (58.33%), compared to those undergoing total thyroidectomy (18.18%) and completion thyroidectomy (40.00%). The majority of hypocalcemia cases (66.67%) occurred on the second postoperative day. Most hypocalcemia instances were transient (86.67%), with a smaller fraction being permanent (13.33%). Conclusions: Hypocalcemia remains a significant complication following thyroid surgery, particularly in surgeries involving neck dissection. Early identification and management of at-risk patients could mitigate the severity of this complication. Our findings underscore the importance of vigilant monitoring and tailored postoperative care to minimize the impact of hypocalcemia on patient recovery and quality of life.

Association of plasma fibrinogen level with the severity of obstructive sleep apnoea patients in a tertiary care hospital

Background: Obstructive sleep apnoea syndrome (OSAS) is a common sleep-related breathing disorder of multi-risk factorial pathogenesis and is characterized by recurrent, partial or complete upper airway obstruction resulting in intermittent hypoxia during sleep. It has been implicated in both cardiovascular and cerebrovascular diseases. Objective of the study was to determine the association of Plasma Fibrinogen levels with the severity of OSA patients in a tertiary care hospital. Methods: This cross-sectional observational study with group comparison was conducted among all the patients attending in the Department of Respiratory Medicine, BSMMU with suspicion of OSA within one year after the clearance of institutional review board (IRB) using STOP-BANG questionnaire and Epworth sleepiness scale (ESS) and confirmed by polysomnography. Plasma fibrinogen was measured in all OSA and non-OSA patients. Data were analyzed with the help of statistical package for the social sciences (SPSS) version 26. Results: Sociodemographic analysis found no significant differences in age, gender, area, occupation, or smoking between OSA and non-OSA groups (p>0.05). However, witnessed apnoea (p=0.002), breathlessness (p=0.005), higher ESS (p<0.001), and STOP-Bang scores (p<0.001) were associated with OSA. Plasma fibrinogen levels were significantly higher in OSA (319.2±63.7 mg/dl versus 242.5±20.33 mg/dl, p<0.001), positively correlating with AHI (r=+0.876, p=0.001). Positive correlations were also found between fibrinogen levels and daytime sleepiness (r= +0.393, p=0.002), waist circumference (r =+0.346, p=0.007), and BMI (r =+0.297, p=0.021) in OSA patients. Conclusions: In conclusion, this study establishes a notable connection between plasma fibrinogen levels and the severity of OSA. Elevated fibrinogen levels correlate with increased OSA severity, indicating a link between OSA, inflammation and coagulation.

Association of serum alpha-1 antitrypsin level with the severity of COPD

Background: Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder linked to early onset COPD, notably the emphysema variety, but often goes undetected. Low serum AAT levels may impact lung function and correlate with COPD severity. The aim of the study was to detect possible associations of serum AAT level with the severity of COPD patients on the basis of post bronchodilator FEV1 in Bangabandhu Sheikh Mujib Medical University (BSMMU). Methods: A cross-sectional study was conducted at the Department of Respiratory Medicine, BSMMU, Dhaka, from October 2022 to September 2023. Adult patients (?18 years) of both genders diagnosed with COPD based on spirometry were included. COPD was defined per GOLD guidelines, with a post-bronchodilator FEV1/FVC ratio <70%. Severity was categorized based on post-bronchodilator FEV1% predicted. Association between serum AAT level and COPD severity was analyzed using SPSS version 26, with significance set at p <0.05. Results: The study involved 80 COPD patients, with 1.25% showing low serum AAT levels and 98.75% normal. No significant differences in age, sex, or smoking status were observed among severity groups. Mean serum AAT levels varied across severity groups but were not statistically significant (p=0.377). Smoking was prevalent (66.3%), with common comorbidities like hypertension (26.3%), IHD (16.3%), and diabetes mellitus (15.0%). Shortness of breath (95.0%) and cough (92.5%) were common symptoms, with most patients having moderate disease severity (42.5%). Conclusions: The study indicates a weak association between serum AAT levels and COPD severity, with only 1.25% of 80 patients exhibiting low AAT levels.

The impact of surgical closure of atrial septal defect on the pulmonary hypertension: a prospective observational study

Introduction: The most prevalent congenital disease is atrial septal defect. Atrial septal defects that have a left to right shunt result in persistent volume overload in the pulmonary vasculature. So histological changes occur in pulmonary vasculature leads to pulmonary hypertension. Without surgery, both life expectancy and functional ability are reduced. The aim of this study was to observe the impact of surgical closure of atrial septal defect on pulmonary hypertension. Methods: This observational study was done in the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University from June 2020 to June 2022. Sample size was 24 Patients were evaluated preoperatively, postoperative day of operation through a clinically, ECG, color doppler echocardiography. The statistical analysis was performed by using SPSS version 26.0 for windows software. Results: In my study, the mean age of the patients was 33.33±11.3 years, male female ratio was 1:2. The mean pulmonary artery systolic pressure got decreased from 57.54±7.9 mmHg to 53.29±8.30 mmHg on postoperative day. 75% patients improved into New York heart association class 2 on post operative day. Significant improvement was seen in functional capacity of the patients. 29.2% patients had atrial fibrilation preoperatively, after surgery on post-operative day it became 25%. Conclusions: This study concludes that surgical closure of atrial septal defect leads to a significant reduction in pulmonary hypertension.

Hypospadias with cryptorchidism presented as ambiguous genitalia and its management with surgery

Background: The incidence of hypospadias with cryptorchidism is about 6-31.6%. Current management recommendations are that undescended testis beyond three months needs surgery between 6-12 months of age. Proximal hypospadias and cryptorchidism overlap with disorders of sex development and endocrine problem. The aim of this study was to assess the outcome of surgical management of hypospadias with cryptorchidism, at selected centers in Dhaka, Bangladesh.Methods: This prospective study was conducted in the Department of Pediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from January, 2018 to January, 2022. In this study, we included 70 diagnosed cases of hypospadias with cryptorchidism presented as ambiguous genitalia who underwent surgery.Results: Mean age at surgery was 4.6�4 years and majority (91.4%) were male. Associated renal anomalies were absent in 81.4% cases, symptomatic renal anomalies were present in 11% cases, severe chordee was 62.9%. Abnormal hemiscrotum was 98.6% and normal hemiscrotum was 1.4%. Hernia with cryptorchidism was present in 30 % cases. Testosterone was normal in 94.3% patients, estrogen and progesterone was elevated in 5.7% patients. After operation, male was 94.3% and female was 2.9%, chordee condition was corrected in 81.4% and urine passed through tip of penis in 84.3% patients.Conclusions: We found that surgery is simple, safe, and effective in the treatment of patients with hypospadias and cryptorchidism with satisfactory functional results, normal physical health status, improved quality of life, satisfying psychological support and probably less pain.

Clinical presentation of hypothyroidism: a study of 50 cases

Background: When the thyroid gland does not produce and release enough thyroid hormone into your circulation, it is known as hypothyroidism. Your metabolism becomes slower as a result. Hypothyroidism, also known as an underactive thyroid, can make you feel exhausted, put-on weight, and have trouble with cold weather. In utero, throughout infancy, during youth, or even during maturity, it may begin to develop. The frequency of unanticipated overt hypothyroidism varies from 1 to 18 cases per thousand persons when accompanied by biochemical and clinical symptoms of hypothyroidism. The aim of the study was to observe the various clinical presentations of hypothyroidism Methods: This cross-sectional observational case-based study was conducted at the institute of nuclear medicine, Dhaka medical college hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2005 to July 2005. A total of 50 patients attended at the study place during the study period who were biochemically hypothyroid were included in the study. Results: The age range of the patients was 13 months to 54 years with a mean age of 29.5 years in this series. The majority of the patients were between 20 to 49 years of age. Female comprises 80.0% in comparison to 20.0% of male cases of hypothyroidism. Spontaneous primary (idiopathic) hypothyroidism (90.0%), post-radioiodine therapy, and post-ablative hypothyroidism were the most important causes of hypothyroidism in this series. Most typical symptoms and signs of hypothyroidism were found in this study. The most common symptoms were generalized weakness, lethargy, slowness of activities, impairment of memory, loss of scalp hair, somnolence, dry skin, puffiness of the face, constipation, weight gain, hoarseness of voice, swelling of the body, decreased sweating and paraesthesia. Cases of idiopathic hypothyroidism and other types had similar symptoms. The mean duration of symptoms before medical consultation was 2.9 years. Dry and coarse skin topped the list of physical findings and was present in 60.0% of the cases. Other findings in order of frequency include goiter (56.0%), puffiness of the face (38.0%), cold and thick skin (44.0%), thick tongue (24.0%), peripheral edema (24.0%), Anemia (20.0%), pallor of the face (12.0%), bradycardia (08.0%), thick lips (4.0%), ascites (2.0%) and pericardial effusion (2.0%). Conclusions: Although in the present series a limited number of patients were included, it encompassed varieties of cases. Moreover, an attempt was made to evaluate the common presentation, age incidence, sex distribution, and laboratory status of hypothyroidism in our country, giving more emphasis on clinical findings.

A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

Biodiesel Fuel Production from Palm, Sunflower Waste Cooking Oil and Fish Byproduct Waste as Renewable Energy and Environmental Recycling Process.

Significant of the Study: Biomass is renewable, organic, plant and animal derived source of biomaterial that can be converted into different forms of biofuel, bioplastic, bio-solvent, and bioenergy using different biotechnological procedures. Biomass derived bio-fuel is biodegradable, nontoxic, sustainable and substitute for fossil fuel as well as capable to reduce greenhouse gas emission. It is renewable and outstanding energy resource for the creation of steam and electricity, transportation fuel, manufacturing industries. Biomass derived from animal and plants like, fruits, vegetable, crops, fish, chicken and other animal byproducts or waste biomass which can be used for bioenergy production like biofuel and nano-catalyst for biofuel. Aim: The purpose of this study was to compare and investigate the suitable biodiesel properties produced from waste fish byproducts, palm and sunflower oil which were more economically viable. Results: There was a total of 7, 5 and 4 types of fatty acid methyl esters presence in the fish, palm and sunflower biodiesel, respectively. The quality of biodiesel such as viscosity, total acid number, fuel consumption and emission rate was evaluated. The kinematic viscosity was maintained ASTM standard in case of all produced biodiesel. However, sunflower biodiesel was slightly viscous compared to palm and fish biodiesel. Metal elements such as phosphorus, magnesium, and calcium were present moderately in all biodiesel but it was limited range in fish oil. In the engine tests, the emissions of unburned hydrocarbons, oxides of nitrogen and carbon monoxide were lower in palm biodiesel than in sunflower and fish biodiesel. Fuel consumption was higher in palm biodiesel. Fish biodiesel had the lowest fuel consumption than that of palm and sunflower biodiesel. Conclusion: It can be concluded that waste palm oil and fish oil can be considered as a great potential source for commercial biodiesel.

Circadian Variation in Frequency of Stroke in Bangladesh: a Hospital Based Cross Sectional Study.

A hospital based cross sectional study was carried out to analyze diurnal variation of stroke and their association to sleep awake cycle. Four hundred and two patients of stroke admitted in different Medicine Units of Faridpur Medical College and Dhaka Medical College Hospitals from July 2012 to June 2013 were chosen using purposive sampling technique. Enrolled patients were with their first stroke, subsequently proved by CT scan of brain. The initial clinical diagnosis of stroke was made from history and examination obtained from the patient himself or from his/her attendant. The time of onset of stroke was recorded by attending doctor at the time of assessment and recorded on a fixed proforma. Patient who could not give history properly or had no responsible attendant and who had history of head injury, intracranial space occupying lesion or bleeding disorder were excluded from the study. Age ranged from 25 years to 98 years with mean age of 62.02 years (+_SD 11.75 years). Out of 402 patients 59.7% suffered from ischemic stroke. Highest incidence of stroke (26.9%) occurred between 4:01am to 8:00 am and lowest (7.5%) between 8:01 pm to 12:00 am. Among the subtypes, ischaemic stroke has shown a single peak incidence at 4:01 to 8:00 am and lowest between 8:01 pm to 12:00 am. 50 % of ischaemic stroke cases developed between 0:01 am to 8:00 am. In this study, maximum number of patients developed hemorrhagic stroke between 4:01 am to 8:00 am (25.9%) and lowest number developed hemorrhagic stroke between 12:01 pm to 4:00 pm (9.3%). This study confirms the diurnal variation of both hemorrhagic and ischaemic stroke in Bangladesh and most of them occurs in early morning after wakening.

Role of CT scan in the Evaluation of Lung Tumor with Cytopathilogical Correlation.

Lung cancer is an important & widespread disease that contributes a major health problem worldwide. Lung cancer kills over 1 million people per year. Cigarette smoking is the major cause of lung cancer. CT scan is the principal radiological examination adjunct to X-Ray chest examination in diagnosis & management of lung cancer. The main Objective of the study was to assess the diagnostic usefulness of CT scan in evaluating & characterize the different types of lung tumors and to correlate CT findings of lung tumors with that of cytopathology. This study was carried out in the department of Radiology & Imaging, Dhaka medical college hospital, Dhaka during the period from 1st January 2007 to March 2008. It was a cross sectional study. Total 51 patients were selected conveniently, detailed history particularly symptoms related to lung tumors was carefully elicited to obtain maximum possible information regarding the illness. Possible diagnosis was established by the combination of history, physical examination, laboratory & radiological investigations. Then patients were underwent CT examination of lung. Cytopathological sample were obtained from the lesion by guided aspiration. Collected FNAC samples were send for cytopathology & collected reports were compared with CT scan reports. Sensitivity of CT to diagnose lung tumor was 97.4%, specificity 76.9% & accuracy 92.2 %.

Low-grade dorsal spinal cord astrocytoma presented with paraplegia following minor trauma

Although they constitute about one third of spinal cord glial neoplasms, low-grade astrocytomas can present variably. Post-traumatic neurologic dysfunction due to low-grade spinal cord gliomas is an uncommon event. The authors report a case of paraplegia following minor traumatic event in an 18-month-old boy where subsequent imaging was directed to exclude intracranial hemorrhage. Upon further investigations which included spine-computed tomography and magnetic resonance imaging, a hemorrhagic intraspinal neoplasm was discovered and confirmed to be a low-grade astrocytoma. This case illustrates an instance of significant neurological deficit caused by intratumeral hemorrhage and swelling

Aorto-bi-Femoral Bypass for Juxtarenal Aortic Occlusion in a Patient with Multiple Co- Morbidities: Report of a Challenging Case.

Aorto-bi-femoral bypass for aorto-iliac occlusive disease is a fairly common procedure in vascular surgical practice. The procedure, despite its extensive nature, is generally well tolerated particularly by those having an infrarenal type of aortic occlusion. Patients having a juxtarenal aortic occlusion require a considerably more expeditious surgery necessitating maneuvers to protect the renal arteries. Surgical risk increases significantly in those having multiple co-morbid conditions. We report here a successful case of aorto-bi-femoral bypass for juxtarenal aortic occlusion in a patient having multiple co-morbid conditions like ischemic heart disease, occluded right renal artery with chronic kidney disease, severe malnutrition, hypertension and chronic obstructive pulmonary disease

Serum Proinsulin in Bangladeshi Subjects with Impaired Glucose Tolerance.

Hyperproinsulinemia is commonly present in subjects with impaired glucose tolerance. The present study was undertaken to investigate the proinsulin level in Bangladeshi IGT subjects and to explore its association with insulin resistance. This observational study was conducted under a case-control design with IGT subjects (n=50) and controls (n=44). IGT was diagnosed following the WHO Study Group Criteria. Serum glucose was measured by glucose-oxidase method, serum lipid profile by enzymatic method and serum insulin and serum proinsulin were measured by ELISA method. Insulin secretory capacity (HOMA%B) and insulin sensitivity (HOMA%S) were calculated from fasting serum glucose and fasting serum insulin by homeostasis model assessment. The study subjects were age- and BMI- matched. Mean (±SD) age (yrs) of the control and IGT subjects were 40±6 and 40±5 respectively (p=0.853). Mean (±SD) BMI of the control and IGT subjects were 23±3 and 22±2 respectively (p=0.123). Fasting glucose was not significantly higher in IGT subjects, but serum glucose 2 hours after 75 gm glucose load was significantly higher in IGT subjects. Median (Range) value of fasting serum glucose (mmol/l) of control and IGT subjects were 5.3 (3.8-6) and 5.2 (4-12) respectively; (p=0.297). Median (Range) value of serum glucose (mmol/l) 2 hours after 75 gm glucose load of control and IGT subjects were 6.1 (3-7.8) and 7.9 (5- 21) respectively; (p=0.001). Fasting TG was significantly higher in IGT subjects and LDL-c was significantly lower in IGT subjects. Serum Total cholesterol and HDL-c were not significantly different between the IGT and control subjects. Median (Range) value of fasting serum TG (mg/dl) of control and IGT subjects were 119 (51-474) and 178 (82-540) respectively; (p=0.001). Median (Range) value of fasting serum T chol (mg/dl) of control and IGT subjects were 180 (65-272) and 186 (140-400) respectively; (p=0.191). Median (Range) value of fasting serum HDL-C (mg/dl) of control and IGT subjects were 29 (19-45) and 31 (15-78) respectively; (p=0.914). Median (Range) value of fasting serum LDL-C (mg/dl) of control and IGT subjects were 117(29-201) and 111(41- 320) respectively; (p=0.001). Fasting serum proinsulin was significantly higher in IGT subjects. Median (Range) value of fasting serum proinsulin (pmol/l) of control and IGT subjects were 9.2(1.8-156) and 17(3-51) respectively; (p=0.001). Insulin secretory capacity (HOMA%B) was higher but insulin sensitivity (HOMA%S) was significantly lower in case of IGT subjects. Median (Range) value of HOMA%B of control and IGT subjects were 97(46-498) and 164(17-300) respectively; (p=0.001). Median (Range) value of HOMA%S of control and IGT subjects were 68(19-270) and 39(15-110) respectively (p=0.001). In multiple regression analysis a significant negative association was found between fasting proinsulin and insulin sensitivity (p=0.037). The data led to the following conclusions: a) Insulin resistance is the predominant defect in Bangladeshi IGT subjects. b) Basal proinsulin level is significantly increased in IGT subjects. c) Insulin resistance is negatively associated with serum proinsulin in IGT subjects.

Treating Asthma in Pregnancy - An Update.

Asthma is one of the most common chronic medical conditions affecting the lungs during pregnancy. At any given time, up to 8% pregnant women have asthma. During pregnancy, asthma not only affects the woman, but it can also cut back on the oxygen to fetus. But this does not mean that having asthma will make pregnancy more difficult or dangerous to fetus. Pregnant women who have asthma that is properly controlled generally have normal pregnancies with little or no increased risk to pregnant women or their developing babies. Currently available national guidelines for the treatment of asthma during pregnancy emphasize the objective measurement of control, patient education, motivation, caution and medication adherence. The article reviews the available literature highlighting the appropriate selection of medications in the treatment of asthma during pregnancy, and to identify those factors which may influence the asthma care provider's ability to successfully manage this condition, and also illustrate that maintaining asthma control with long term medications in pregnancy is safer than the risk of uncontrolled asthma or untreated exacerbations for both the mother and the fetus. Women's drug treatment during pregnancy should be regularly assessed in the light of asthma control criteria.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study.

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% .

Detection of Coronary Artery Diseases: Comparative Study of Multidetector Computed Tomography Angiogram (64 slice scanner) and Conventional Angiogram.

Methods: It was cross sectional comparative study conducted in National Institute of Cardiovascular Diseases and Bangabandhu Sheikh Mujib Medical University. Total 80 patients were included in the study who underwent MDCT and coronary angiogram. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for single vessel disease were 87.5%, 96.4%, 91.3%, 94.7% and 93.75% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for double vessel disease were 84.0%, 94.5%, 87.5%, 92.85% and 91.25% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy or efficacy for triple vessel disease were 69.5%, 91.22%, 76.19%, 88.13% and 85.0% respectively. Conclusion: Coronary angiography is a promising technology that already appears to have high performance to assess patient base, vessel base and segment base sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detecting coronary artery stenosis.

Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh.

A hospital based cross sectional study was carried out to analyze prevalence of risk factors for stroke in hospitalized patient in a medical college hospital. 100 patients were chosen using purposive sampling technique. Highest incidence of stroke was between the 6th and 7th decade. Patients came from both urban (54%) and rural (46%) areas and most of them belong to the low-income group (47%). In occupational category; service holder (28%) and retired person (21%) were the highest groups. Most of the study subjects were literate (63%). CT scan study revealed that the incidence of ischaemic stroke was 61% and haemorrhagic stroke 39%. Analysis indicated hypertension as major risk factor for stroke (63%) and major portion of the patients (42.85%) were on irregular or no treatment. Twenty four percent of the patients had heart diseases and out of 24 patients 45.83% were suffering from ischaemic heart disease. The present study detected diabetes in 21% patients. Fifty three percent of the study subjects were smoker, 39% patients had habit of betelnut chewing. Out of 26 female patients, only 23% had history of using oral contraceptives. Majority of the patients were sedentary workers (46%). Thirty seven percent of the stroke patients were obese. Among the stroke patients 9% had previous history of stroke and 3% had TIA respectively. Most of the patients (21%) were awake while they suffered from stroke and the time of occurrence was mostly in the afternoon (46%). This study found that hypertension, cigarette smoking, ischaemic heart disease and diabetes mellitus are the major risk factors prevalent in our community while other risk factors demand further study.

Socio-demographic, Clinical Characteristics and Status of Hypertension Control among Rural Hypertensive Patients.

Hypertension is an important independent predictor of cardiovascular disease, cerebrovascular accidents and death. The prevalence of cardiovascular diseases and hypertension is rapidly increasing in developing countries. A cross sectional study was conducted among 103 hypertensive patients during December 2009 to June 2010 in Goshair Hat Upazilla of Shariatpur District to determine the socio-demographic, clinical characteristics and status of control of hypertension in rural population. Respondents were distributed more or less equally among males and females. The mean +_ SD and median age of the respondents were calculated as 59.97 +_ 11.12 years, with 64% of them were included in the age group of 51 to 70 years. More than half of the respondents were housewives (51.5%), which were followed by businessmen (21.4%). Every three of five patients were over weight, while 22.3% respondents were obese. One third of the respondents were also diabetic (33%). None of the 103 patients had achieved the target for SBP (Systolic blood pressure) control (<140mm of Hg) and only 21.4% of the patients had achieved the target for DBP (Diastolic blood pressure) control (<90 mm of Hg). Again none of the diabetic hypertensive patients had achieved the target for SBP control (<130mm of Hg) and only one patient had achieved the target for DBP control (<80 mm of Hg). Overall five patients were found to have uncontrolled and severe hypertension (BP >180/110 mm of Hg), all of whom were female. From this study control of hypertension was found poor among rural hypertensive population. For effectively combating the burden of hypertension in this population, education and awareness about hypertension needs to be given priority.

A Case of Severe Tricuspid Stenosis of Rheumatic Origin.

Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. It’s relatively a rare condition. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis.Other rare causes include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma and congenital tricuspid atresia. Here we describe a patient with history of prior CMC presented with severe Tricuspid Stenosis with Tricuspid Regurgitation (Grade-IV), Mitral Restenosis (Severe), Mitral Regurgitation (grade-1+), Aortic Stenosis (Mild) and Aortic Regurgitation (Grade-2).