Eisenmenger Syndrome - a Case Report.

Eisenmenger syndrome (ES), the most advanced form of pulmonary arterial hypertension associated with congenital heart disease, is a devastating condition that has a considerable impact on patient's life. Patients who develop ES typically exhibit one or more of a range of cardiac defects including ventricular septal defects (VSD), atrial septal defects (ASD) and patent ductus arteriosus (PDA). The nature of the congenital defect underlying ES is important because it has prognostic implications. Early diagnosis & treatment of cardiac defect before development of pulmonary hypertension is the key to definite management, otherwise only supportive management can be offered. Our patient Mr. Abdul Khaleque, 55 years old, businessman, non diabetic, non hypertensive admitted in DAMCH, cardiac unit with the complaints of shortness of breath on exertion since childhood, bluish discoloration of nails and toes for 10 years, headache and vertigo for 2 weeks. Initially it was during severe exertion and relieved by rest. Gradually the severity of breathlessness has increased. Now he has developed NYHA class III. He had history of repeated attacks of cough with expectoration of mucoid sputum with occasional scanty amount of blood which did not foul smell and did not change with posture. We diagnose him as Eisenmenger syndrome secondary to ASD and treat him with only medical measure.

Pulmonary Hypertension: A Review.

Pulmonary hypertension is a relatively common disorder that leads to right heart failure if untreated. Symptoms and signs of pulmonary hypertensionare often subtle and nonspecific. As a result a significant delay between the onset of symptoms and the diagnosis of pulmonary hypertension is common. Recently improved understanding of the pathophysiology of pulmonary hypertension leads to various treatment options that enable us to treat this disorder more efficiently.

High-Density Lipoprotein as a Therapeutic Target: Treatment Strategies.

Coronary artery disease (CAD) is one of the most important causes of morbidity and mortality worldwide despite considerable therapeutic advances that control the risk factors. Numerous clinical trials have shown an inverse association between high density lipoprotein cholesterol levels and the risk of coronary artery disease. So, high density lipoprotein has become a new therapeutic target after low density lipoprotein in the management of risk factors of coronary artery disease. In this review, we explore existing and future treatment strategies along with their benefits and failures which will guide our management strategy. HDL raising therapies showed very promising results in many clinical trials but larger clinical trials are ongoing.

Comparative Study between 12 and 15 Lead Electrocardiograms for Evaluation of Acute Posterior Myocardial Infarction.

Background: The ECG diagnosis of acute posterior infarction has traditionally been based on the presence of ST segment depression on the pericardial chest leads. However, such ST segment depression is neither specific nor sensitive for the diagnosis of a posterior infarction. Detection of ST segment elevation in V7- V9 in 15 lead ECG can help in early diagnosis of acute Posterior myocardial infarction. Method: Total of 100 patients Inferior myocardial infarction was evaluated by Electrocardiography in standard 12 lead and 15 lead. The patients were categorized into group I having posterior/ and or associated changes and group II having without posterior changes in ECG. Echocardiography and LVgraphy was done to evaluate the posterior wall movement. Result: For diagnosis of posterior myocardial infarction, 43.3% sensitivity and 95.1% specificity was found in 12 lead ECG, whereas in 15 lead ECG it was 80.0% sensitivity and 95.1% specificity. Conclusion: 15 Lead ECGs (including V7-V9) more sensitive than 12 lead ECGs in diagnosis of acute posterior myocardial infarction. Patient with inferior myocardial infarction or anterior ischemia developed more complications if associated with acute posterior myocardial infarction. 15 lead ECGs can routinely be used in patients with ischaemic type of chest pain.

Improper Inhalation Technique-A Barrier to Good Asthma Control.

Bronchial Asthma (BA) is a chronic airway disorder with significant morbidity and mortality but due to recent advances in the field of medicine most patients with BA can have complete symptom control and live a normal life. There are various routs of drug delivery for asthma control but among them aerosol inhalation is considered the optimal route. A number of pressured Metered Dose Inhalers (MDI) & Dry Powder Inhalers (DPI) are available for this purpose. However inhalation of therapeutic aerosols is not without difficulty, it requires precise instructions on the inhaler maneuvers, which is different from spontaneous normal breathing. Also, the characteristics of the inhaler device have to be suitable for the user. Available data indicate that, lack of knowledge demonstrated by health professionals & patients on the inhalation maneuvers & handling of inhalers resulting in a reduction of therapeutic benefit. The paper reviews the literature concerning the fundamental aspects of inhaler devices, inhalation maneuvers & device selection, in an attempt to increase the knowledge of and to optimize the clinical use of therapeutic inhalers. As a result of which Asthmatics can be kept under good control.

Demographic Profile, Clinical Presentation & Angiographic Findings in 637 Patients with Coronary Heart Disease.

Cardiovascular diseases are the commonest cause of death globally and are the major contributor to the burden of premature mortality and morbidity. This study analyses various clinical presentations, conventional risk factors, pattern and severity of coronary heart disease on angiography among 637 patients with coronary heart disease and adult congenital heart disease who underwent cardiac evaluation at National Institute of Cardiovascular Disease (NICVD), Dhaka between January 2007 to December 2008. Among them 547 (85.9%) were male and 90 (14.1%) were female. All of them were between 22 to 76 years of age with mean age 50.15±8.8. One hundred sixty nine (25.9%) patients had chronic stable angina & 398 (62.48%) patients subjected for coronary angiography for acute coronary syndrome and or old myocardial infarction and 74 (11.62%) patients with vascular and adult congenital heart disease prior to surgical treatment. Most prevalent risk factors were smoking (60%) and dyslipidaemia (60%). Thirty five percent patients were hypertensive and 10% patient had diabetes. Normal epicardial coronaries were documented in 25.59% patients which includes the patients who underwent coronary angiography prior to surgical treatment. Ninety three (14.6%) had single vessel disease, 119 (18.68%) had double vessel disease, 259 (40.66%) had triple vessel disease and 3 (0.47%) had isolated left main disease.

" Lutembacher's Syndrome " - A Case Report.

Lutembacher's Syndrome is a rare heart disease comprises ASD (congenital) secundum with Mitral stenosis (Rheumatic origin). The patient Md. Mosharraf Hossain, 72 years old man, non diabetic, non hypertensive, smoker admitted in FMCH on 10.10.2010 with the complaints of respiratory distress and chest pain for 10 days. He had a previous history of Rheumatic fever in early childhood. There was history of recurrent attack of Rheumatic fever. Subsequently he developed MS from Rheumatic carditis. ASD was congenital in origin. If diagnosis could be done earlier, surgical closure of ASD with replacement of mitral valve bears a good prognostic value. Our patient is in elderly age and already developed pulmonary hypertension, operative procedure is not suitable. So the patient should be kept in conservative treatment.

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.

Ventricular Tachycardia – Life Threatening Cardiac Arrhythmia – A Case Report.

Ventricular tachycardia (VT) & ventricular fibrillation (VF) are the most common immediate life threatening complications after acute myocardial infarction. These complications occur in about 5-10% of patients who admitted in hospital and are thought to the major causes of death who die before reaching hospital and to take medical attention. Immediate defibrillation will usually restore sinus rhythm. Prompt pre-hospital resuscitation and defibrillation can save many more lives. Our patient, Mr. Abdul Malek, aged about 55years, hailing from west Naodoba, Jajira, Sariotpur, non-hypertensive, non-diabetic, smoker was admitted in MMW, FMCH on 23/03/10 with the complaints of chest discomfort, shortness of breath, sweating and vomiting. During admission his pulse and BP was non-recordable, ECG shows VT. Immediately the patient was transferred to CCU from MMW. Patient was kept in cardiac monitor and arranged for DC shock. After giving 200 joules DC shock patient reverted to sinus rhythm .His pulse was recordable and reasonable blood-pressure was regained. Then the patient was treated with antiplatelets, anti-coagulant, nitrates and prophylactic iv Lignocaine. Subsequently oral anti-arrhythmic drug Amiodarone was started. The recovery of the patient was un-eventful and was discharged after 10 days without any further complication.

Silicosis - A Case Report.

Silicosis is not an uncommon disease in Bangladesh as a good number of people are exposed to silica dust in their working places. Again pulmonary tuberculosis is also common here, the risk of which is increased by about 30 folds in silicosis. In the reported case, a young stone cutter of 40 years was admitted to Faridpur Medical College Hospital with progressive dyspnoea, dry cough and radiological appearance of multiple small and a large nodular pulmonary mass. Two of his brothers, also stonecutter, died of similar disease. In this context the patient was diagnosed as a case of chronic complicated silicosis and treated symptomatically as there is no curative treatment. A good number of people are engaged in stone cutting in our country including Faridpur district and are vulnerable to this progressive and non-curable disease. To aim of this case report is to make those people to be aware about the condition, so that they can protect themselves by taking appropriate measures (i.e. using protective mask) and should monitored their condition by regular chest x-ray. If early signs of silicosis is detected the worker should changed their job.

Outbreak Of Nipah Encephalitis In Greater Faridpur District.

Nipah viral encephalitis is one of the fatal re-emerging infections especially in southeast Asia. After its outbreak in Malaysia and Singapore; repeated outbreaks occurred at western part of Bangladesh especially in Faridpur region. Besides, sporadic attacks appear to occur in the country throughout the year. Here two Nipah outbreaks in greater Faridpur district in 2003 and 2004 are described along with brief review on transmission of the virus. Where the history of illness among patients are very much in favour of man to man transmission. Moreover the death of an intern doctor from Nipah encephalitis who was involved in managing such patients in Faridpur Medical College Hospital strongly suggests man to man transmission of this virus. So, aim of this review article to make the health personnel and general people be aware about man to man transmission of virus, so that they can adapt personal protection equipment (PPE) for their protection against this deadly disease.

Profile Of Clinically Suspected Encephalitis Patients Admitted To Faridpur Medical College Hospital, Bangladesh.

Encephalitis is a relatively common clinical diagnosis of admitted patients in Faridpur Medical College Hospital. This is significant because there was an outbreak of Nipah Virus (Ni-V) encephalitis in Faridpur district in 2004 with 34 cases including 26 deaths. Recent death of an intern doctor of FMCH from Ni-V encephalitis further emphasizes the gravity of situation. In this study a total number of 100 cases of clinically suspected encephalitis patients were studied for different clinical parameters. This is a retrospective study using data from hospital records. Majority of patients presented with neurological features (85%), 6% with pulmonary, 7% with combined neurological and pulmonary, and 2% with other features. 5-18 years age group comprises the highest number 44%, followed by >18 years age group 34%. Male-female ratio was 33:17. July to November was the period of maximum number of admission, the highest being in August. Patient from all upazillas of Faridpur were admitted, the highest being from Sadar Upazilla. 48% of the patients recovered, 19% expired and 7% were referred. In this context, further prospective study is urgently required to find out the epidemiological characteristics of Nipah virus encephalitis in Faridpur region.

Prevalence Of Hematological Disorder: A Bone Marrow Study Of 177 Cases In A Private Hospital At Faridpur.

Bone marrow examination of 177 cases of suspected hematological disorders was carried out in a private hospital at Faridpur from May 2007 to August 2009. Among the malignant hematological disorders, Acute Myeloid Leukemia (AML) was the most common disorders (27.69%) followed by Acute Lymphoblastic Leukemia (9.04%), MDS (7.91%), CML (7.34%) and Multiple Myeloma (1.69%). Among the non-malignant hematological disorders, Combined (both iron and folic acid and /or Vitamin B12) deficiency anemia was the most common disorders (24.87%) followed by Aplastic anemia (10.74%), ITP (6.21%), and Kala-azar (2.82%).