Low Cardiac Output Syndrome: Incidence after Mitral Valve Replacement with or without Preservation of Mitral Valve Apparatus.

Standard mitral valve replacement in patients with chronic mitral valve regurgitation and mitral valve stenosis consistently results in a decrease in early postoperative left ventricular ejection performance. Some studies showed that preservation of mitral valve leaflet and subvalvular apparatus can reduce postoperative left ventricular dysfunction. On the basis of the concept, this randomized clinical trial comparing mitral valve replacement with preservation of mitral subvalvular apparatus and conventional mitral valve replacement performed in National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, in the period of July 2010 to December 2011. We included 60 patients of mitral regurgitation and mitral stenosis, among them 30 patients underwent mitral valve replacement with preservation of mitral subvalvular apparatus (Group A) and 30 patients underwent conventional mitral valve replacement (Group B). There was no significant difference between two groups in terms of peri-operative variables. But there was significant higher incidence of Low cardiac output (LOS) syndrome [36.7% vs. 6.9% (p<0.05)] and congestive heart failure in Group B than Group A. The duration of ICU stay was also significantly higher in conventional mitral valve replacement group [113.23±11.30 hours vs. 96.23±20.02 (p=0.001)]. Additionally, there was significantly less fall of left ventricular ejection fraction in preservation of mitral subvalvular apparatus group [preop 65.27±5.45, at discharge 54.31±3.78, after 3 months 58.28±5.20 (p<0.0001)] than conventional group [preop 66.43±4.58, at discharge 46.43±3.87, after 3 months 46.55±3.63 (p<0.0001)]. In this study left ventricular ejection fraction was used as measure of left ventricular function. We postulate that, this relative preservation of left ventricular ejection fraction was likely the result of preservation of mitral subvalvular apparatus.

Hepatoprotective activity of the methanolic extract of Fagonia indica Burm in carbon tetra chloride induced hepatotoxicity in albino rats

Objective: To investigate hepatoprotective activity of the methanolic extract of Fagonia indica Burm. on CCl4 induced hepatotoxicity in albino rats. Methods: Animals in Group 1 served as vehicle control, Group 2 served as hepatotoxin (CCl4 2ml/kg, s.c) treated group, Group 3 served as standard (Silymarin 50mg/kg, p.o.) treated group. Group4 and 5 served as methanolic extract of Fagonia indica (MEFI) in different doses (200 mg/kg and 400 mg/kg b.w., p.o).The degree of protection was determined by measuring levels of biochemical marker like SGOT, SGPT, ALP, Bilirubin (Total & Direct) and Cholesterol. The histopathological studies also show the hepatic protection of the test extracts. Results: The levels of the biochemical parameters such as SGPT, SGOT, ALP, Total bilirubin, Direct bilirubin and Cholesterol were significantly increased in CCl4 treated rats when compared with the normal group (P<0.05), but the MEFI (400 mg/kg, bw) treated rats showed maximum reduction of SGOT (114.83±1.51), SGPT (164.33±1.25), ALP (154.83±1.53), Total bilirubin (1.55±0.01), Direct bilirubin (0.65±0.009) and Cholesterol (193.00±1.06) in a significant manner. Histopathological studies also reveal the hepatoprotection property of MEFI in a dose dependent manner. Conclusions: These results suggest that MEFI in different doses showed significant hepatoprotective activity against CCl4 induced hepatotoxicity and this might be due to the presence of flavonoids and tannins. Further research is sought to explore the exact mechanism of action and phytoconstituents responsible for the pharmacological response.

Alendronate induced femur fracture complicated with secondary hyperparathyroidism.

Alendronate is considered to be the gold standard drug for the treatment of postmenopausal osteoporosis. A 75 years old female presented with diaphyseal fracture following trivial fall. Though this fracture pattern was reported in the western world its presence among the population of this subcontinent is very rare. Radiographs showed a transverse fracture in diaphyseal area with lateral cortical thickening and medial spiking. History confirmed that patient was on long term bisphosphonate therapy. Opposite femur also showed lateral cortical thickening at the same level as was seen on fractured side. Biochemical picture was complicated with secondary (Vitamin-D deficiency) hyperparathyroidism. Fracture was fixed with Locking Compression plate and allogenic bone grafting was done. Prophylactic nailing was done on the contralateral side. Vitamin-D and calcium deficiency was corrected and subcutaneous Teriparatide was started. Radiographic evidence of callus formation is present but confirmation of union is uncertain.

Emergence periodicity of Phlebotomus argentipes annandale and brunetti (Diptera: psychodidae): A laboratory study.

Phlebotomus argentipes Annandale and Brunetti (Diptera: Psychodidae) is the vector for visceral leishmaniasis in India. The aspects of its biology such as feeding and man vector contact are associated with emergence periodicity of the adult. Hence, the present study was made to find out the actual emergence period of P. argentipes. Wild caught P. argentipes were confined in the rearing pots inside laboratory. The newly emerged adults were collected at hourly intervals and released in to separate polythene bags and were held at 4°C till death. Sand flies were segregated sex-wise after the death under a microscope. The emergence of adult was observed throughout the day. However, the male preferred dawn emergence and the female the dusk. Two peaks of emergence were found in a day; first one in the morning (0900h) and the second one in the evening (1800h). The ratio of both sexes was found to be about equal. The emergence of adult was found to be 77% out of total eggs laid, which was completed within 7-10 days from the 1st day of emergence under laboratory conditions (25°C to 31°C and 70% to 75% relative humidity). This study has important bearings to find out the actual time for personal protection against biting of sand flies to prevent the transmission of Kala-azar.

Osteochondrosis of the humeral capitellum.

Seven cases of osteochondrosis of the capitellum occurring in five high performance female gymnasts between the ages of 11 and 13 are presented. Two of the patients were treated by surgical excision of the loose osteochondral fragment in three elbows. Four of the five gymnasts, including the two who underwent surgical treatment, were able to return to full workouts without recurrence of symptoms within the 3 year followup. All conditions in gymnasts were detected after symptoms had presented. A survey of 37 actively competing gymnasts at a nationally known gymnastics academy was performed, including a detailed history and physical examination and radiographic examination. No other cases of osteochondrosis were detected. It was postulated that this condition represents a lateral compression injury because of repetitive valgus overload. Investigation of the capitellar blood supply indicates that the common factors in osteochondrosis of the capitellum are repetitive or prolonged trauma to a vulnerable epiphysis on a basis of vascular interruption. Gymnastics maneuvers require forceful weight-bearing through the upper extremities. Medical personnel and coaches associated with gymnastics need to be aware of the condition of osteochondrosis of the capitellum so that any gymnast who presents with a painful, tender, swollen or locked elbow is appropriately investigated and treated.