Mycotic Aneurysm of Aorta Following Mitral Valve Replacement – A Case Report.

The term mycotic aneurysm refers to aneurysm associated with infection by microorganism. Sir William Osler first coined the term mycotic aneurysm in 1885 by disclosing the relation between abnormal cardiac valves and infection with micrococci not with fungi. An 11 years old female from Feni presented with asymptomatic vascular swelling in abdomen referred by a cardiologist. CT angiogram revealed fusiform aneurysm in distal part of abdominal aorta involving ostioproximal part of both common iliac arteries and saccular aneurysm of distal part of superior mesenteric arteries suggestive of mycotic aneurysm. Patient underwent vascular operation aorto biilliac bypass by PTFE graft with excision and ligation of aneurysm of superior mesenteric arteries .Mycotic aneurysm in bacterial endocarditis is rare. It is a challenging job for the cardiologists, infectious disease specialists and vascular surgeon. Time appropriate skilled prompt surgical management can bring smile for both patients and physicians.

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.

Effect of Pleurotomy During Internal Mammary Artery Harvest on Pulmonary Function.

Background: Pulmonary function after coronary artery bypass graft surgery using harvested Internal mammary artery(IMA) were assessed in this prospective case control Clinical study comparing two groups of Patients with or without pleurotomy. Method: we conducted this Study at National Institute of Cardiovascular Diseases (NICVD), Dhaka, in the Department of Cardiovascular Surgery.A total of 60 consecutive patients undergoing CABG with use of IMA between july 2005 to June 2007 were reviewed. Study population were divided into Group A (n=30,undergone CABG with pleurotomy during IMA harvestion).Group B (n=30,undergone CABG with intactpleura during IMA harvestion). Results: in lung function spirometry revealed FEV1 significantly decreased in group A than B (56.81±17.76% Vs 79.85±7.7%; p=0.035)and when FEV1correalated with inspiratory vital capacity the advantage of intact pleura were confirmed at 6th postoperative day (78.02 ±12.17; B, 82.08 ±11.72 p=0.045). Vital capacity was significantly decreased in-group A than B at 3 months postoperatively (A 88.79 ± 14.38%;B 98.11±30.25%; p=0.009), but not on 6th Postoperative day. Pleuropulmonary complication like atelectasis, pleural effusion insignificantly higher in groupA than B(16.7 %VS6.7%) and (10% vs. 6.7%)at 6th postoperative day but not at 3months postoperatively. Conclusions: These results demonstrate that pleurotomy during Internal mammary artery harvesting significantly deteriorated pulmonary function variably than intact pleura group of patients.

Patients with Left Ventricular (LV) Dysfunction: Is OPCAB Advantageous over Conventional CABG in our settings.

Objective: Off-pump CABG (OPCAB) is a well established surgical procedure in Bangladesh now. Majority of Bangladeshi patients having CABG are undergoing OPCAB procedures these days. Patients with left ventricular dysfunction are known to be particularly at risk of complications after surgical coronary revascularization. Off-pump procedure can be considered in these patients, avoiding the potentially damaging effect of cardiopulmonary bypass (CPB). Patients with left ventricular dysfunction are thus thought to be ideal OPCAB candidates. This study is undertaken to check the advantage of OPCAB over conventional CABG of Bangladeshi patients with left ventricular dysfunction. Methods: This is a prospective clinical trial done in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2006 to Dec 2007. Among the 52 patients 26 patients underwent OPCAB with preoperative ejection fraction (EF) 35.2±3.2% and rest 26 patients had conventional bypass (CCABG) with preoperative EF 33.4±3.8%. Different variables were evaluated and compared. Echocardiography was used both pre and postoperatively to assess the LVEF, LVIDd and LVIDs and regional wall motion abnormality and to assess the presence or absence of ischemia or infarction. Data were collected by interview schedule and checklist. Data were analyzed by standard statistical methods. Results: In this small series of patients with left ventricular dysfunction, off-pump CABG was carried out with good early outcome; with low mortality and morbidity and significant improvement in postoperative left ventricular function. There was no significant difference between the groups in terms of change in EF, LVIDd and LVIDs. Conclusion: From this study it can be concluded that both the surgical strategies improved the myocardial function and early outcome in patients with left ventricular dysfunction. However OPCAB surgery has a somewhat better result regarding ventilation time and ICU stay. Thus both OPCAB and on pump surgery can be performed safely and effectively in patients with left ventricular dysfunction with good results and low mortality.

Clinical Significance Of Serum HbeAg Among HbsAg Positive Patients.

Hepatitis B Virus (HBV) infection is a menace worldwide as a major cause of morbidity & mortality through its consequences viz. acute hepatitis, chronic active, or persistent hepatitis, cirrhosis of liver and primary hepatocellular carcinoma. A total of 127 'HBsAg positive' patients were studied for 'HBeAg' by serum ELISA. Patient's aged between 11 to 60 years with a mean age 27.11. Out of 127 'HBsAg positive' cases 19 (14.96%) were 'HBeAg positive', of which maximum (21.43%) were among <20 years age group. Among 106 male patients 15 (14.155) & among 21 female patients 4 (19.055) were 'HBeAg positive'. Often the initiation of therapeutic approach remains a dilemma in absence of laboratory assessment of viraemic load or presence of HBV DNA through PCR or other DNA hybridization techniques. In such situations, alternatively, a significantly serum 'HBeAg' among 'HBsAg positive' patients may be taken as a surrogate marker for acute viral replication, and, thus apply justifying the initiation of antiviral chemotherapy without delay.

Knowledge And Awareness About The Risk Of HIV/AIDS Among Truck Drivers Of A Selected Area.

This cross- sectional study was conducted among the truck drivers at Daulatdia Ghat, Goalanda, Rajbari district. The objective of this study was to find out the knowledge and awareness about the risk of HIV/AIDS transmission among the truck drivers .Out of 226 respondents, 37.3% were within the age group 25 to 35 years. Most of the respondents (74%) were married and 44% were educated up to primary level. Half of the respondents (50%) had monthly income from taka 10,000 to taka 15,000 per month. From this study, it was found that 97% respondents had heard the name of HIV/AIDS, 61.8% had known about HIV/AIDS from media and newspaper. In respect of the route of HIV transmission, 39.8% of respondents thought that HIV is transmitted by sexual activities and 58.7% thought the disease is transmitted by syringe, transfusion. About 47.8% respondents thought that HIV can be detected from blood and 76% knew the fate of HIV/AIDS is death. Majority (82.5%) of the respondents obtained correct knowledge about HIV/AIDS transmission and 13.2% of them knew the place where test of HIV can be done.

Status And Utilization Of Maternal Health Care Services In A Selected Rural Area Of Bangladesh.

Improvement of maternal health care services is regarded as an important component for achieving targets of MDGs by the year 2015. A cross-sectional community based study was carried out to find out the status and utilization of maternal health care services in Pangsa Upazilla of Rajbari District among 517 mothers who had at least one child up to 1 year of age. The study was conducted from June to August in the year 2008. Data were collected through face-to-face interview using purposive sampling technique. Most of the respondents were in the age group of 20-29 years (69.05%) and 35.01% of them had received primary education. Sixty seven percent of them had average monthly income of Taka 3001-5000. Eighty percent of the respondents were at the age group of 15-19 years when they got married. Most of the mothers (71.57%) got antenatal care during their last pregnancy and more than 80% of them had completed their TT vaccination schedule during pregnancy period. More than 80% of the deliveries were taken place at home. Eighty five percent of the deliveries were normal delivery and most of them (77.76%) were attended by the untrained traditional birth attendants (TBA). Hemorrhage was found to be the highest reported obstetric complication (37.50%). This study offered a picture of the maternal health care services in rural Bangladesh and detected the need for future work in this area.

Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting.

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner.

Comparison of haematological values among different groups of low birth weight babies and normal birth weight babies.

This prospective cross sectional study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. This study was undertaken to compare the haematological value (reference range) among Small for gestational age-low birth weight (SGA-LBW), Appropriate for gestational age-low birth weight (AGA-LBW) and Normal birth weight (NBW) babies. Total 90 (ninety) newborn babies were enrolled in this study. They were ultimately divided into three groups as a) Group I (SGA-LBW), b) Group II (AGA-LBW), c) Group III (NBW). Study period was one year (December 2003 to December 2004), Relevant informations were collected from the guardian of the babies before inclusion in the study. In group I, 19(63.3%) were preterm and 11(36.7%) were term. In group II, 30(100%) were preterm and in group III, 30(100%) were term. Mean Hb, and HCT levels were highest in group I (SGA-LBW) and the value was 17.14+/-1.41 gm/dl (Hb) and 0.51+/-0.04 (HCT) respectively. Mean Hb and HCT value were lowest in group II (AGA-LBW) and the value was 14.57+/-1.78 gm/dl (Hb) and 0.43+/-0.05 (HCT) respectively. In between value was found in group III (NBW) and the value was 16.14+/-1.09 gm/dl (Hb) and 0.48+/-0.04 (HCT) respectively. Differences were statistically significant. On the contrary, MCV Values were highest in group II (AGA-LBW) and the value was 103.23+/-4.99 (fl). Lowest MCV value was in group III (NBW) and the value was 98.13+/-3.93 (fl). In between result of MCV value was found in group I (SGA-LBW) and the value was 99.27+/-10.73 (fl). Differences were also statistically significant. MCH and MCHC level was also highest in group I (SGA-LBW). Difference was also statistically significant. No significant differences of TC of WBC and platelet counts were not found among different groups. Hb and HCT level had significant positive correlation with gestational age. Other parameters had no Positive correlation with gestational age.