Association of Maternal Serum Homocysteine level with Maternal Birth Weight.

A baby's weight at birth is an important predictor of infant growth and survival. Low birth weight leads to an impaired growth of the infant and its attendant risks of a higher mortality and morbidity. Various studies found higher maternal plasma homocysteine level was associated with lower offspring birth weight. Therefore, this study was carried out to find out association between maternal serum homocysteine and birth weight. A cross sectional study was conducted in the Department of Obstetrics and Gynaecology, BSMMU from September 2018 to August 2019. Pregnant women at their third trimester between 37-40 weeks admitted to in patient Department of Obstetrics and Gynaecology, BSMMU were included in this study. Ethical committee clearance was obtained from the institution. After matching eligibility criteria informed written consent were taken from the patients. Data was collected from the patients using the structured design by interview, observation, clinical examination and haematological investigations. The serum homocysteine level of these patients and birth weight of their babies was measured immediately after delivery. Negative correlation was found between maternal serum homocysteine level and neonatal birth weight, (r = -0.419, p<0.05). During regression analysis maternal homocysteine and gestational age was found significant when adjusted with maternal age, parity, maternal BMI and sex of the baby. So, increased maternal serum homocysteine is negatively associated with low birth weight babies.

Chronic Morbidities Overrule Acute Morbidities in Determining Self-Reported Health in Rural Bangladesh.

Self- rated health (SRH) is a valuable screening-level measure of a community's health status. A better understanding of the factors that influence SRH is time-demanding and challenging. This study aims to examine the determinants of SRH by investigating health morbidities, demographic and socio-economic factors in Bangladesh perspective. This cross-sectional study was conducted among 908 adults (aged 18 years and above) in Manikganj district of central Bangladesh from 2nd January to 13th January 2017. Chi-square test was performed to test the association and binary logistic regression was performed to predict the relationship of SRH with all potential variables. The present study reveals the balance of bad health versus good health which was 27.2% and 72.8% respectively. Participants had at least one or more chronic diseases reported 3.40 times (p<0.001) bad health compared to those who did not have any chronic illness. In contrast, acute morbidity was not a significant determinant for SRH (OR=1.379, p=0.063). Older population aged 60 years and above had 3.96 times (p<0.001) higher chance of having self-reported bad health than the younger population. In addition, depression was also found a significant contributor (OR=2.05, p<0.001) to bad health. Chronic morbidity, older age and depression are the significant predictors of SRH. If SRH is used as a screening-level measure for the rural communities then the chronic disease status of rural Bangladesh will be identified quickly and easily.

Physical, Psychological and Social Impact of COVID-19 Pandemic on Healthcare Workers at a COVID Designated Bangladeshi Public Hospital.

The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.

Repeat breeding: prevalence and potential causes in dairy cows at different milk pocket areas of Bangladesh.

The objective of this study was to figure out the prevalence and probable causes of repeat breeding (RB) in dairy cows. Hence, a cross-sectional study was conducted on randomly selected 265 dairy farms in Sirajganj, Bogura, Rangpur, Satkhira, and Munshiganj districts of Bangladesh from December 2018 to February 2019. Data were collected through a direct interview method using a survey questionnaire. The reproductive organs of repeat breeder cows were examined for pathological, infectious, and functional reasons, and genital tract abnormalities. Additionally, the influence of nutrition, season, and age on the frequency of RB was recorded. The prevalence of RB was 28% among the 3824 cows investigated. Among the total repeat breeder cases, 72.54% of RB cases were found in Holstein-Friesian crossbred, 23.90% in Jersey crossbred, 1.50% in Sahiwal crossbred, and 2.06% in indigenous cows. The prevalence of RB was significantly highest (P < 0.01) in Satkhira (44.35%) and lowest in the Munshiganj district (15.87%). Data indicated that a major proportion of cows significantly (P < 0.05) faced RB problems due to functional causes (34.18%), followed by pathological causes (28.01%), genital tract abnormalities (21.32%), and infectious causes (16.49%). Furthermore, the cows were remarkably (P < 0.001) affected in RB during the summer season and nutritional deficient diseases like milk fever (70%). Age (3-7 years) had a significant (P < 0.001) effect on the RB occurrence (90%) in crossbred cows. However, particular focus should be given to systematic breeding, balanced nutrition, artificial inseminator efficiency, and hygienic inseminating tools to reduce RB incidence in high-yielding crossbred cows.

Modified Snodgrass Urethroplasty for Distal Penile Hypospadias: Our Experience at BSMMU Hospital.

Hypospadias is a developmental defect of male urethra characterized by absence of meatal opening at the tip of glans but is present at the ventral surface of penis anywhere along the shaft, even in the perineum. Usually this defect is associated with ventrally curved penis. Surgery is the single option to correct this birth defect. More than 300 techniques have been developed but none is universally acceptable as because, surgery is usually associated with fistula. Rate of fistula formation varies from technique to technique. Now a day, Snodgrass technique is widely practiced because of its low rate of fistula formation. Many factors are responsible for this post-operative complication. Most important one is developmentally defective ventral penile skin where some local factors like vascular and collagen tissues are insufficient. This observational study was performed to evaluate the role of dorsal vascular flap over the neourethra following urethroplasty by Snodgrass technique in terms of post-operative fistula formation in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2018 to March 2020. A total of 39 patients with distal penile hypospadias were included in this study. All underwent Snodgrass urethroplasty with additional dorsal vascular flap over the neourethra to support this ventrally deficient local factor. The outcome in terms of post operative urethrocutaneous fistula was evaluated. Only two patients (5.15%) developed urethrocutaneous fistula. In conclusion, addition of dorsal vascular flap over the neourethra by Snodgrass technique reduces the rate of the fistula formation.

Short Term Outcome of Therapeutic ERCP in the Management of Biliary Ascariasis in a Tertiary Care Hospital of Bangladesh.

The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.

Delta variant and black fungal invasion: A bidirectional assault might worsen the massive second/third stream of COVID-19 outbreak in South-Asia.

BACKGROUND: Here, we have shortly reported the recent updates on the disastrous progressions of the deadly delta variant and a virulent coinfection or post-COVID-19 infection of black fungus in India and its neighbouring countries. METHODOLOGY: We searched by utilizing appropriate keywords in Google Scholar, PubMed and other scholarly databases alongside several national and international newspapers to collect the latest data regarding the targeted topic. RESULTS: Recently, the delta variant is wreaking havoc in India, UK, and other countries around the globe and has also exhibited successful infections in around 20 to 55% of the people who have already recovered from COVID-19 originating from the different strains. Besides, a significant catch is the prevalence of 85.5% and 64.11% of Mucormycosis infections being co-morbid with COVID-19 and diabetes, respectively in South-Asian regions. CONCLUSIONS: To avert the emergence of an epidemic amid the pandemic, prompt actions from concerned authorities are warranted. Proper education on black fungus infection and associated risks from the COVID-19 and diabetes, adequate public awareness, and sufficient healthcare assistance to battle such fungal infections effectively should be ensured as quickly as possible.

Anorectal Malformations and Associated Anomalies in Children.

Anorectal malformations (ARM) incorporate a broad spectrum of diseases, can affect both sexes, and involve the distal anus and rectum as well as the uro-genital tracts. Defects range from the minor which can be treated easily with an excellent outcome, to those are complex and often associated with other anomalies are difficult to manage with poor functional prognosis. This study was done to observe the hospital incidence of Anorectal malformations, frequency of types, sex distribution and spectrum of associations with ARM. The effects of presence of associated anomalies on morbidity and mortality also observed. Detailed history, clinical examinations and relevant investigations were performed for the primary and as well as the associated anomalies. A total of 80 patients were admitted in the department of pediatric surgery in Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Age of the patients was ranging from 1-180 days with the mean age of 0.49±1.002 months. Male: Female ratio was 1.6: 1. Among them 48(60%) were high and 32(40%) were low variety of ARM. In male 37(46.2%) had high and 13(13.7%) were low variety whereas in female 11(13.7%) were high and 19(23.7%) had low ARM. Associated anomalies were seen in 25(31.2%) patient -18 in males and 7 in females; 20 in high and 5 in low ARM. Associated anomalies were uro-genital 11(13.8%), cardiovascular 10(12.5%), vertebral 4(5%), limb defects 3(3.5%) and others 2(2.5%). Four patients have more than one anomaly. Anorectal malformations occur more in boys than girls. Males were more likely to have high lesions and without fistula was the common defect. Low variety ARM were found more in females with Anovestibular fistula is the commonest defect. The most common associated anomalies were recto urinary fistula (13.8%). Associations were more in high than low ARM but not significant (p>0.05). Post operative complications were more in high ARM in both sexes with associated anomalies. The effects of types and associations on morbidity and mortality were significantly different (p<0.05).

Detection of 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR at Mymensingh Medical College, Mymensingh, Bangladesh.

The coronavirus disease (COVID-19) is highly pathogenic viral infection caused by SARS-CoV-2. Currently, COVID-19 has caused global health concern. WHO has declared COVID-19 as a pandemic disease on March 11, 2020 and characterized by fever, dry cough, fatigue, myalgia and chest pain with pneumonia in severe cases. The virus has spread to at least 213 countries and more than 9093827 confirmed cases and 471490 deaths have been recorded. In the beginning, the world public health authorities tried to eradicate the disease in China through quarantine but are now transitioning to prevention strategies worldwide to delay its spread. There are some newly developed and promising methods for detection of SARS-CoV-2, in order to facilitate the development of novel approaches for early diagnosis. Nucleic acid based tests currently offer the most sensitive and early detection and confirmation for SARS-CoV-2 infection. Among them Real-time reverse transcription polymerase chain reaction (rRT-PCR) is the most popular and the "gold standard" testing method for the detection of SARS-CoV-2. The present study was carried out to detect 2019-Novel Coronavirus (2019-nCoV) by rRT-PCR method at Mymensingh Medical College, Mymensingh, Bangladesh from 1st April, 2020 to 31st May, 2020. A total of 14356 samples were tested from four districts of Mymensingh division namely, Mymensingh, Jamalpur, Sherpur, Netrokona and some parts of Sunamganj for rRT-PCR. Among them 1086 (7.5%) patients were positive for SARS-CoV-2. Out of 1086 positive cases 716(65.9%) were male and 370(34.1%) were female with a Mean±SD age 34.1±12 years. Maximum positivity was found in Mymensingh district followed by Netrokona, Jamalpur, Sherpur and Sunamganj respectively. This is the first base line study for genetic detection of 2019-nCoV in Mymensingh division which may reflect the total scenario of Bangladesh situation. We hope this paper will help the researcher to increase the availability, accuracy, and speed of widespread COVID-19 testing throughout the world in this crisis moment.

Comparison of High Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh, Bangladesh.

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Early rearing enrichments influenced nest use and egg quality in free-range laying hens.

In Australia, free-range egg production pullets are typically reared indoors, but adult layers get outdoor access. This new environment may be challenging to adapt to, which could impair egg production and/or egg quality. Adaptation might be enhanced through rearing enrichments. We reared 1386 Hy-Line Brown® chicks indoors with three treatments across 16 weeks: (1) a control group with standard litter housing conditions, (2) a novelty group providing novel objects that changed weekly, and (3) a structural enrichment group with custom-designed structures to partially impair visibility across the pen and allow for vertical movement. Pullets were transferred to a free-range system at 16 weeks of age with daily outdoor access provided from 25 until 64 weeks. Daily egg production at different laying locations (large nests, small nests and floor), weekly egg weights and egg abnormalities were recorded from 18 to 64 weeks old. External and internal egg quality parameters of egg weight, shell reflectivity, albumen height, haugh unit, yolk colour score, shell weight and shell thickness were measured at 44, 52, 60 and 64 weeks. There was a significant interaction between rearing treatment and nest box use on hen-day production from weeks 18 to 25 (P < 0.0001) with the novelty hens laying the most eggs and the control hens the fewest eggs in the nest box. Similarly, from 26 to 64 weeks, the novelty hens laid more eggs in the large nest boxes and fewer eggs on the floor than both the structural and control hens (P < 0.0001). Egg weight and abnormalities increased with age (P < 0.0001), but rearing treatment had no effect on either measure (both P ≥ 0.19). Rearing treatment affected shell reflectivity and yolk colour with the control hens showing paler colours across time relative to the changes observed in the eggs from enriched hens. The novelty hens may have established nest box laying patterns as they were more accustomed to exploring new environments. The differences in egg quality could be related to stress adaptability or ranging behaviour. This study shows that enriching environments during rearing can have some impacts on production parameters in free-range hens.

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media.

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

High Wall Motion Score Index after Acute Myocardial Infarction is Associated with Worse In-Hospital Outcome.

Myocardial Infarction is a major cause of death and disability worldwide. The incidence of coronary heart disease is high and second most cause of death after cancer. This prospective study conducted on 100 patients admitted with first attack of acute myocardial infarction in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2012 to June 2013 who were observed 3 to 8 days of hospital stay without doing further echocardiography and evaluated the relationship between echocardiographic wall motion score index (WMSI) assessed within 24 hours of admission and in-hospital outcomes. Mean age was 53.24±10.17 years in WMSI <2 and 55.58±12.68 years in WMSI ≥2 groups; difference was statistically non-significant (p>0.05). In both groups, males were predominant sufferer. Male-female ratio was 3.55:1 and the difference was statistically non-significant (p>0.05). As a risk factor, smoking was significantly higher in both groups but the difference was not statistically significant (p>0.05) between groups. Hypertension was 34(49.28%) cases in WMSI <2 and 13(41.93%) cases in WMSI ≥2 group; difference was not statistically significant (p>0.05). Diabetes mellitus was 13(18.84%) cases in WMSI <2 and 16(51.61%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Dyslipidemia was 28(40.58%) cases in WMSI <2 group and 23(74.19%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Site of involvement of MI in WMSI <2 group were 39(56.52%) cases AMI (Anterior) and 30(43.48%) cases AMI (Inferior). In WMSI ≥2 group, AMI (Anterior) were 29(93.55%) and AMI (Inferior) were 02(6.45%). It revealed that AMI (anterior) was significantly higher in WMSI ≥2 group and AMI (Inferior) was significantly higher in WMSI <2 group. Heart failure class (Killip class) increases with the increasing of WMSI. In Killip class-I, 4(5.80%) were WMSI <2 and 01(3.23%) was WMSI ≥2 (p>0.05). In Killip class-II, 8(11.59%) were WMSI <2 and 02(6.45%) were WMSI ≥2 (p>0.05). In Killip class-III, 4(5.80%) were WMSI <2 and 13(41.94%) were WMSI ≥2 (p<0.05). In Killip class-IV, 2(2.89%) were WMSI <2 and 05(16.13%) were WMSI ≥2 (p<0.05) that was statistically significant. Arrhythmia was 14(20.29%) cases in WMSI <2 group and 13(41.94%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Death was 2(2.90%) cases in WMSI <2 and 07(22.58%) cases in WMSI ≥2 group that was statistically significant (p<0.05). Early mortality rate was greater in patients with both WMSI ≥2 and a higher Killip's class. The higher the WMSI determined within 24 hours of admission, the worse the in-hospital outcome. Echocardiography is an affordable and readily available technique, which may be used to identify and stratify the risk following acute MI.

Association of Metabolic Syndrome with Hyper Apolipoprotein B status in Young People with Acute Coronary Syndrome.

Prevalence of Metabolic Syndrome (MetS) and acute coronary syndrome (ACS) in young people is progressively increasing. This was originally a case control study to predict the risk of ACS with hyper apolipoprotein B (Hyper apoB) status in young people, with 50 cases of 18-45 years of age of both sex with first attack of acute coronary syndrome admitted in Coronary care unit of Mymensingh Medical College Hospital from June 2009 to May 2010 and for comparison, equal number of age and sex matched healthy controls were chosen. In present study only cases were analyzed regarding their anthropometric, fasting blood glucose, blood pressure and lipoprotein lipid profiles. Regarding anthropometric measurement, body mass index (BMI), Waist Circumference (WC) and Waist-to Hip ratio (WHR) was calculated. Thirty one cases had increased and 19 had normal WHR, of them 28 cases had hyper and 3 had normal ApoB and 14 cases out of 19 with normal WHR had hyper ApoB and hyper ApoB status was significantly found to be present in ACS patients with increased waist-hip ratio (p=0.03). In this study WHR, instead of WC was used by the author to define abdominal obesity for the diagnosis of MetS along with other criteria according to IDF (International Diabetic Federation) consensus worldwide definition of Mets. Out of 50 young ACS cases 14 cases had metabolic syndrome of those 12 had hyper ApoB status and was statistically significant (p=0.04).

Risk of Acute Coronary Syndrome is Better Predicted by Apolipoprotein B in Young People than Dyslipidemic Parameter of Conventional Lipid Profile.

The traditional lipidic parameters when present and clusters within reference range, often fails to predict the risk of acute coronary syndrome in young population in this region. Measurement of Apolipoprotein B (Apo B), a parameter of the lipoprotein-lipid profile, provides a method of quantifying the concentration of lipoproteins, rather than their cholesterol content. Present study aimed to quantify the risk of acute coronary syndrome (ACS) in young people with having none to less number of traditional lipidic parameters for dyslipidemia. This is a case control study among 50 cases of first attack of ACS among 18-45 years of age of both sexes, admitted in coronary care unit of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2009 to May 2010. Data was recently reanalyzed. Out of five sub-sets of lipid profile, namely TC, TG, HDL-C, LDL-C and non-HDL-C, 16(32%) cases were dyslipidemic by 0 (none) parameter, 13(26%) cases by one parameter, 7(14%) cases by two parameters, 4(8%) cases by three cases, 7(14%) cases by four parameters and 3(6%) cases by all five parameters. It was found that none to lesser the number of dyslipidemic parameters, greater the percentage of ACS cases and they are having hyper ApoB with statistically significant association (p<0.05).

B-type Natriuretic Peptide Assay in Differentiating Congestive Heart Failure from Lung Disease in Patients Presenting with Dyspnea.

This cross-sectional analytical study was conducted in Cardiology & Medicine Department of Mymensingh Medical College Hospital. After fulfilling the exclusion & inclusion criteria, B-type natriuretic peptide concentrations were measured in a convenience sample of 100 predominantly male (94%) dyspnic patients who got admitted in Cardiology & Medicine Department of Mymensingh Medical College & Hospital from November 2013 to October 2014. The diagnosis of Congestive Heart Failure (CHF) was based on generally accepted Framingham criteria with corroborative information including hospital course (response to diuretics, vasodilators, inotropes or hemodynamic monitoring) and results of further cardiac testing, including echocardiography. Patients with right heart failure from cor pulmonale were classified as having CHF. Pulmonary disease was confirmed by using the following diagnostic tools: i) A chest X-ray without signs of heart enlargement or pulmonary venous hypertension or a chest X-ray with signs of chronic obstructive lung disease, ii) Normal heart function as seen by echocardiography, iii) Abnormal pulmonary function tests or follow-up results and iv) A positive response to treatment with steroids, nebulizers or antibiotics in hospital. Patients with CHF (n=50) had mean BNP level 1146.72pg/ml (range 103 to 5000pg/ml), which is significantly higher than the group of patients with a final diagnosis of pulmonary disease (n=50) whose BNP was 34pg/ml (range 10 to 90pg/ml) (p<0.05). In conclusion, it was found that B-type natriuretic peptide is an important biomarker for differentiating congestive heart failure from lung disease in patients presenting with dyspnea.

Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh.

Coronary Angiogram (CAG) has been used to detect coronary artery disease in myocardial infarction (both STEMI and NSTEMI) patients. The purpose of this study was to compare the degree of coronary artery disease among STEMI and NSTEMI patients. Among acute coronary syndrome in NSTEMI we found more widespread coronary artery disease other than STEMI. Lack of documentations encouraged us to perform this study in our center. In this retrospective observational study we summarized all myocardial infarction (MI) patients who underwent coronary angiography (CAG) from August 2013 to August 2014 at Enam Medical College Hospital, Dhaka, Bangladesh and data of degree of coronary artery disease were recorded. Data of 100 consecutive MI patients who underwent CAG during that period were recorded. Among them 50 patients having STEMI as Group I (male 45, female 5) & other 50 patients sustained NSTEMI as Group II (male 38, female 12). Among NSTEMI patient group 80% were having multi-vessel disease and in STEMI patient group 80% having single vessel disease and remaining having multi-vessel disease. The degree of coronary artery disease is extensive in NSTEMI patients than in STEMI group. Coronary angiogram can visualize the degree of coronary artery involvement and is a useful screening modality to compare disease extent in MI patients.

Left Ventricular Diastolic Dysfunction is More Common in Patients of Uncontrolled Diabetes Mellitus.

There is a relationship between the left ventricular diastolic dysfunction with uncontrolled diabetes mellitus. A cross sectional study was designed to see the association of uncontrolled diabetes mellitus with diastolic dysfunction of the heart. The study was conducted from April 2012 to March 2013 in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh. Sixty cases were selected as study population; twenty one patients were in Group I with good glycaemic controlled of HbA1C <7% and 39 patients were in Group II with poorly controlled diabetes mellitus having HbA1C ≥ 7%. In the study population male were 43(71.70%) and female were 17(28.30%). Mean age in the two groups were 49.05 ± 6.34 years vs. 53.64 ± 5.38 years, which was not significant difference. Duration of diabetes was <10 years and ≥ 10 years in two groups. Glycaemic status (percentage of HbA1C) was 6.55 ± 0.29% vs. 8.72 ± 1.01% in controlled and uncontrolled diabetic patient groups respectively which was significant difference. Diastolic dysfunction was found more in uncontrolled diabetic patient (patients having HbA1C% ≥ 7%) than controlled diabetic patients (HbA1C <7%). Grade I diastolic dysfunction was in uncontrolled and controlled glycaemic status were 33(84.60%) and 04(19.00%). The difference was statistically significant. Diastolic dysfunction in type 2 diabetic subjects was significantly higher as compared to the well control group (p<0.001). And this study concluded as - Diastolic dysfunction is more common in patient with poorly controlled diabetes mellitus.

Association between elevated B-type Natriuretic Peptide levels with extent of coronary artery disease in patients with unstable angina and NSTEMI.

The study was undertaken to find out the correlation of elevated B-type Natriuretic Peptide (BNP) levels with the severity of coronary artery disease in patients with unstable angina and NSTEMI. This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during a period of August 2011 to June 2012. A total of 100 consecutive patients with unstable angina and NSTEMI undergoing coronary angiography were included in the study. BNP assay was done by Architect system, a chemo luminescent microparticle immunoassay (CMIA). CAG was done by conventional method within 14 days of index hospital admission. Study patients were divided into two groups on the basis of BNP levels. In Group I, BNP Levels were ≤80pg/ml and in Group II, BNP levels were elevated >80pg/ml. with 50 patients in each group. Angiographic severity of CAD was assessed by vessel score and Friesinger score. Vessel score showed single vessel was involved in 21(47.7%) patients while multi vessel in 23(52.3%) patients was found in Group I. On the contrary 11(22.4%) single vessel patients and 38(77.6%) multivessel patients were found in Group II. There was significant association between vessel involvement (p=0.01). Friesinger score revealed that less severe CAD was found in 22(44%) patients and significant severe CAD in 28(56.0%) patients in Group I. On the contrary 7(14.0%) less severe CAD patients and 43(86.0%) severe CAD patients were found in Group II. There was significant difference between severity of CAD among the study groups (p=0.01). There was linear correlation between BNP pg/ml and coronary artery disease severity in terms of Vessel score (r=0.38, p=0.01) and Friesinger score (r=0.51, p=0.01). The present study concluded that increased BNP level >80pg/ml was significantly associated with the presence and severity of CAD in patient with UA and NSTEMI.

Neonatal uterine prolapse - a case report.

Uterine prolapse is commonly seen in the geriatric age group. Congenital vaginouterine prolapse is a rare condition occurring in neonates and is usually associated with spinal cord malformations in about 85% of cases. Several modalities of treatment have been described for neonatal uterine prolapse. Conservative treatment in the form of simple digital reposition, use of pessary or other self-retaining device is usually sufficient to treat this condition, which is self-limiting and regressive. Here we report our first case of neonatal uterine prolapse, managed successfully with simple digital reposition.