Ibrahim Cardiac Medical Journal

Elevated Serum Homocysteine Concentrations in Severe Preeclampsia and Eclampsia

2023-11-13T06:18:33+00:00

Background & objective: Preeclampsia, a pregnancy-specific syndrome, is a major cause of maternal and perinatalmorbidity and mortality all over the world. Several studies have indicated that homocysteine concentrations areincreased in women with preeclampsia. However, there is still conflicting evidence on the extent to which elevatedmaternal homocysteine contributes to this deadly complication of pregnancy. The present study was, therefore,intended to see the association between serum homocysteine and preeclampsia.

Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Dhaka MedicalCollege Hospital, Dhaka over a period of 2 (two) years from July 2007 to June 2009. Pregnant women with gestationalage ranging between 24 – 40 weeks having preeclampsia or eclampsia were considered as cases, while gestationalage-matched pregnant women without preeclampsia and eclampsia were considered as controls. However, pregnancywith diabetes mellitus, known renal or hepatic disease, urinary tract infection, cardiovascular disease, and takinganti-epileptics were excluded from the study. A total of 100 pregnant women – 50 cases and 50 controls were selectedfor the study. Among the cases, 16 had mild preeclampsia, 17 had severe preeclampsia, and 17 had eclampsia.

Result: Two-thirds of the cases and 60% of the controls were in their 3rd decade of life with no significant differencebetween the study groups (p = 0.651). There was no significant difference between the groups in terms of gravidityand gestational age. However, the past history of PE demonstrated its more significant presence in the case group thanthat in the control group (p = 0.030). Out of 50 cases, 30(60%) had severe proteinura (+++), 15(30%) had moderateproteinuria (++) and 5(10%) had mild proteinuria. The mean serum homocysteine level was significantly higher inmild PE (7.2±1.2 μmol/L) than that in normal pregnant women (5.3±1.0 μmol/L). The concentration of homocysteineincreases with the increase in severity of preeclampsia (p = 0.004) and turning preeclampsia into eclampsia (p =0.027). The data show as the grade of proteinuria increases progressively (from mild to severe) the concentrations ofhomocysteine level also increase progressively from 6.3 ± 1.6 μmol/L in mild proteinuria to 11.4 ± 3.7 μmol/L insevere proteinuria.

Conclusion: The serum homocysteine level is significantly elevated in mild PE than that in normal pregnant women.The concentration of homocysteine increases further with the increase in the severity of preeclampsia and ineclampsia.

Ibrahim Card Med J 2022; 12 (2): 10-14

Association between Alopecia Areata and Thyroid Disorders

2023-11-13T06:31:06+00:00

Background & Objective: Alopecia areata (AA) is an autoimmune disorder characterized by patches ofnon-scarring alopecia affecting the scalp and body hair. Previous epidemiological studies suggest a potentialpositive association between alopecia areata (AA) and several autoimmune diseases, including autoimmunethyroid disorders. The present study was therefore undertaken to determine the association between AA andthyroid disorder.

Methods: This cross-sectional case-control study was carried out in the Department of Physiology, Dhaka Medical College, Dhaka over a period of 1 year from July 2021 to June 2022. A total of 40 clinically diagnosed patients of AA (case) of both sexes with age ≥18 years were taken from the Outpatient Department of Dermatology and Venereology, Dhaka Medical College Hospital (DMCH), Dhaka. An equal number (n = 40) of age-matched (withcases) apparently healthy subjects were taken as controls for comparison. In order to assess thyroid functionstatus, five variables were measured. These were free tri-iodothyronine (FT3), free thyroxine (FT4), thyroidstimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb or TmAb).Thyroid disorders were evaluated in terms of hypothyroidism, subclinical hypothyroidism, hyperthyroidism, subclinical hyperthyroidism, etc.

Result: In the present study, the baseline demographic and clinical characteristics were almost similar between cases and controls. The male-to-female ratio of AA patients was 1:1. The mean age was 29.9 ± 10.5 years for thecase group and 29.9 ± 10.4 years for the control group. Most of the patients with AA had mild disease (45%)followed by moderate (42.5%) and severe (12.5%) diseases. The study demonstrated the prevalence of thyroiddys function to be significantly higher in the case group (20%) than that in the control group (5%) with a risk of developing thyroid disorder in patients with AA being 4.7(95% CI = 0.9 – 23.9) times higher than that in the control group (p = 0.043). There were significant differences between cases and controls in terms of levels of TSH,FT3 and FT4. The present study demonstrated a significant difference between cases (AA patients) and controlswith respect to thyroid auto-antibodies (Tg-Ab, TPO-Ab) as well. Tg-Ab and TPO-Ab were also found positive in 12euthyroid alopecia areata patients.

Conclusion: The prevalence of thyroid disorders is comparatively high in alopecia areata patients as opposed to healthy individuals of similar age and sex. The serum levels of TSH, TPO-Ab and Tg-Ab are significantly elevated, and the levels of free T3 and free T4 are significantly dropped in patients of alopecia areata compared to theirhealthy counterparts. However, Tg-Ab and TPO-Ab may be present in euthyroid alopecia areata patients.

Ibrahim Card Med J 2022;12(2):15-20

Coarctation of the Aorta in Infants : A Diagnostic Challenge

2023-11-13T06:41:40+00:00

Coarctation of the aorta (CoA), usually occurring in the thoracic and rarely in the abdominal aorta, remains an under diagnosed disease entity in the majority of neonates & infants with a misdiagnosis rate being more than62%. It is an earnest need to diagnose CoA in them at the earliest possible time to provide appropriate management. We retrospectively analyzed data of 6 infants with CoA at Ibrahim Cardiac Hospital & Research Institute to provide clues for the diagnosis of CoA, describe their echocardiographic and computed tomography aortopulmonary angiogram to match them with the diagnosis of CoA and analyze their prognosis.

Ibrahim Card Med J 2022; 12 (2): 21-26

Study on Serum Calcium, Magnesium and Uric acid Levels in Preeclamptic and Healthy Pregnant Women - A Comparative Study

2023-11-13T06:50:17+00:00

Background & Objective: Pre-eclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Various dietary deficiencies or excesses have previously been linked to preeclampsia. Many studies have documented that the changes in the concentration of minerals like calcium, magnesium, and uric acid have a link to the etiopathogenesis of preeclampsia. The present study was undertaken to find the associations of serum calcium, magnesium, and uric acid with preeclampsia.

Methods: This cross-sectional comparative study was carried out in the Department of Physiology in collaboration with the Department of Biochemistry, Rajshahi Medical College, Rajshahi over a period of one year between July 2018 to June 2019. Pre-eclamptic and healthy pregnant women aged 18-35 years with single-tone pregnancies having agestational age of 28-32 weeks were the study population. While preeclamptic pregnant women were included as cases, healthy pregnant women were included as controls. A total of 100 cases (pre-eclamptic women) and an equalnumber of controls (healthy pregnant women) were included. Serum calcium, magnesium, and uric acid levels of the subjects were compared between the case and the control groups to evaluate their association with preeclampsia.

Result: The findings of the study revealed that cases were older and heavier than the controls. However, both groups were alike in terms of gestational age. Both systolic and diastolic blood pressures were much higher in the case group than those in the control group. The serum calcium was significantly decreased in the case group than that in the control group (p < 0.001). The serum magnesium was also significantly dropped in the case group compared to the control group (p < 0.001). However, the serum uric acid was dramatically raised in the former group than that in the latter group (p < 0.001).

Conclusion: The study concluded that serum calcium and magnesium levels are significantly decreased and serum uricacid levels significantly increased in preeclamptic women.

Ibrahim Card Med J 2022; 12 (2): 27-31

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

2023-11-13T07:01:21+00:00

Background & objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE.

Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (< 140mmHg and > 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT).

Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, & MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio < 0.73 and mean DceT >178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference.

Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function.

Ibrahim Card Med J 2022; 12 (2): 32-39

Thyroid Function Status of Female Nurses Working Night-shift at a Tertiary Care Hospital

2023-11-13T07:13:54+00:00

Background & objective: Night shift work has well-known adverse effects on health like sleep disturbances and other medical conditions including thyroid diseases. Various studies have revealed that the effect of night shift work on healthis mainly related to its interference with circadian rhythm, which can also influence thyroid hormone levels in accordance with sleep patterns. Therefore, night work can modify thyroid function and increase the risk of thyroid disorders. The present study was therefore conducted to evaluate the impact of the night shift work on the thyroid function status of female nurses in a tertiary care hospital.

Methods: This case-control study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka over a period of 1 year from January 2021 to December 2021. All female nurses (in the age range of 25-50 years) working at Dhaka Medical College in different shifts were the study population. Of them, the case group consisted of 90 female nurses who worked the night shift in different wards from 8.00 pm. to 8.00 am and the control group consisted of 90female nurses who worked the morning shift in the Outpatient Department (OPD) from 8.00 am to 2.00 pm. However, nurses with a personal or family history of sleep disorder, taking medications that may interfere with sleep, history of diabetes mellitus, bronchial asthma, or diagnosed with any kind of thyroid disease, such as Hashimoto’s thyroiditis, and pregnant nurses were excluded from the study. While the exposure variable was shift-work, the outcome variable was thyroid function status, evaluated in terms of serum FT4, FT3, and TSH and the presence of thyroid disorders.

Results: The cases and controls were almost alike in terms of age, BMI, and blood pressure. The mean age of the case and the control groups were between 34 and 35 years with no significant difference between the groups. While serum levels of free thyroxine (FT4) and free triiodothyronine (FT3) were somewhat reduced in the case group than those in the control group, the serum TSH was significantly elevated in the former group than that in the latter group – a picture typical of subclinical hypothyroidism. Overt hypothyroidism was also higher in the former group than that in the latter group. Subclinical and clinical hyperthyroidism was found in 2(2.2%) and 3(3.3%) subjects of the control group only. Overall, 60% of the cases had some form of thyroid disorders as opposed to 15% of the controls with the risk of having thyroid disorders in night shift nurses being > 8(95% CI = 4.1 – 17.5) times higher than that in morning shift nurses(p < 0.001).

Conclusions: The study concluded that night shift nurses may have a higher risk of developing subclinical hypothyroidism due to significantly higher levels of TSH and normal FT3, and FT4 levels. About two-fifths of the nurses working night shifts are at increased risk of having thyroid disorders, primarily subclinical hypothyroidism.

Ibrahim Card Med J 2022; 12 (2): 40-45

Level of Satisfaction of Geriatric People about Services Provided by an Old Home at Gajipur, Bangladesh

2023-11-13T07:22:23+00:00

Background & objective: With increased life expectancy and an increased proportion of older people, the demand for old-age homes is increasing. A satisfactory quality of service provision from old age homes can enhance the overall quality of life of an old person. This study aims to assess the level of satisfaction of geriatric people, with the services provided by the Bayaska Punarbasan Kendroy (an old home), situated at Gajipur, Bangladesh.

Methods: This descriptive study was designed to evaluate the level of satisfaction of the residents of the Bayaska Punarbasan Kendro about the services provided there. The study was carried out at the Department of Community Medicine, Rajshahi Medical College, Rajshahi over a period of 1 year from January 2019 to December 2019. A total of 200 respondents (residents) were consecutively included in the study based on predefined enrollment criteria. To determine the level of satisfaction of the residents of the Bayaska Punarbasan Kendro about the services provided there, the respondents’ opinion was sought about how well they were satisfied with each of those services. The responses given to each discrete question were scored from 0-4 using Likert Scale, where 0 meant “highly dissatisfied”, and 4 meant “highly satisfied”, with 1 “dissatisfied”, 2 “neither dissatisfied nor satisfied”, and 3 “satisfied” in between them. The scores obtained thus were then summed up to find an integrated score, which ranged from 0-32. The total score was then subdivided into five categories as scores 0-6 (highly dissatisfied), scores 7-12 (dissatisfied), scores13-18 (neutral), scores 19-25 (satisfied), and scores 26-32 (highly satisfied).

Result: About two-thirds of the residents of the Bayaska Punarbasan Kendro were Muslim and in their 7^th decade of life. More than 55% had already lost their spouses. Fifty percent of the residents came from rural regions. Half of the respondents did not have any income source and the rest half were facing economic hardship. About one-quarter (24.5%) of the respondents were illiterate, nearly two-fifths (37.5%) were primary-level educated and 9% were graduate-level educated. Day labourers comprised almost one-third followed by housewives and service holders. Residents of the old homes were invariably suffering from some sort of physical and mental illnesses concurrently with42% having multiple physical ailments. The major chronic disease was CHD followed by diabetes and osteoarthritis. Nearly half (47%) of the respondents were satisfied with the services provided by the old home, 25.5% were dissatisfied and the rest 27.5% were neither satisfied nor dissatisfied. Probing about the status of living of the old home residents revealed that over one-third (35.5%) had been residing there for < 1 year, 28.5% for 1-3 years, 30% for 3-5years, and only 5.5% for 5 years or more. More than one-third of the respondents had been residing there for < 1 year and only 5% for 5 years or more. Over three-quarters never communicated with their family members since they were admitted to the Bayaska Punarbasan Kendro. However, their children, spouses, or siblings communicated with the moccasionally. They passed their leisure time working (22%), gossiping (29%), watching TV (35.5%), and hangout orreading books (13.5%). Regarding the level of satisfaction, less than half (47%) of the respondents were satisfied with the overall services. The respondents’ level of dissatisfaction was highest with healthcare facilities (37%), followed by accommodation (28%), food service (21%), clothing (17.5%), and leisure time activities (10.5%). The majority (95%) of the respondents was satisfied with the security system and the social media services.

Conclusion: The study concluded that the old-home residents time and again miss their family members and are not happy living there. Nearly one-third of the old-home residents are forced to stay there by their family members and half live there for none of their children or close relatives live in the country and one-quarter do not have any residence to live. None of them has any interest to live there. Almost half are satisfied with the services provided by the old home, over one-quarter are dissatisfied and another one-quarter are neither satisfied nor dissatisfied. The respondents’ level of dissatisfaction is mostly with healthcare facilities.

Ibrahim Card Med J 2022; 12 (2): 46-52

Changes in Lipid Profile in Preeclampsia

2023-11-13T08:23:18+00:00

Background & objective: Preeclampsia is an age-old pregnancy-specific disorder. Numerous theories and ideas have been advanced on its etiology, pathophysiology, and complications, but commendable progress in preventing this long-standing disorder has not yet been made. The relationship between altered blood lipid levels and preeclampsia is currently a topic of discussion. The present study was to ascertain whether serum lipid levels are associated with preeclampsia.

Methods: The present case-control study was carried out at the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital and Department of Obstetrics & Gynaecology, BSMMU, Dhaka over a period of one year between January 2011 to December 2011. Pregnant women in their 3rd trimester with preeclampsia were included as cases, while normal pregnant women at term without preeclampsia were included as controls. An equal number of cases (n = 75) and controls (n = 75) were selected consecutively. While the exposure variable was preeclampsia, the outcome variable was dyslipidaemia, which was defined as either total cholesterol:HDL ratio>4.5 or triglyceride:HDL ratio > 3.5.

Result: The cases and the controls were almost identical in terms of age. The gestational age was also comparable between groups. The preeclamptic patients were predominantly primigravidae (57.3%) and overweight or obese (85.3%). Past history of PET was found in 12% cases as opposed to none in the controls. The prevalences of elevated serum total cholesterol (TC), LDL-C, and triglycerides (Tg) were considerably higher in the case group than those in the control group, although the differences were not statistically significant. However, the prevalence of low HDL-C was significantly higher in the former group than that in the latter group (56% vs. 14.7%, p < 0.001). The incidences of raised total cholesterol and HDL ratio > 4.5 and raised triglyceride and HDL ratio > 3.5 were observed to be significantly higher in the case group than those in the control group(p< 0.001 and p < 0.001 respectively). The likelihood of having raised TC:HDL ratio was estimated to be 10.1(95% CI = 4.2 - 23.9) times higher and that of raised TG:HDL ratio was 3.7(95% CI = 1.9 - 7.4) times higher in the case group than those in the control group.

Conclusion: The total cholesterol:HDL ratio and triglyceride:HDL ratio increase significantly in preeclamptic women compared to that in normal pregnant women. However, the alteration is presumably caused by a significant lowering of HDL cholesterol, the total cholesterol and triglyceride do not experience any significant change.

Ibrahim Card Med J 2022;12(2):53-58

Prevalence of Gallbladder Malignancy in Gallstone Diseases

2023-11-13T08:29:44+00:00

Background & objective: Carcinoma (Ca) of the gallbladder is a rare disease. But its prognosis is poor. Early diagnosis of Ca gallbladder, though important, is rarely achieved due to lack of symptoms and physical signs. However, it is frequently associated with gallstone diseases. It is, therefore, of utmost importance to do a routine histopathological examination of all gallbladder specimens after cholecystectomy is done for gallstone diseases. The present study was undertaken to find the prevalence of Ca gallbladder in gallstone diseases.

Methods: This descriptive study was conducted in the Department of Surgery, BSMMU Hospital, and in the Public Medical College Hospitals of Dhaka over a period of eight months from July 2011 to February 2012. A total of 1012specimens of gallbladder were taken from the patients who underwent either laparoscopic or open cholecystectomy for gallstone diseases in the above-mentioned hospitals during the study period. Following the operation, the resected specimens or the biopsies taken from the gallbladder were collected in 10% formaldehyde solution and were sent to the Histopathology Departments of the respective hospitals, for confirmation of diagnoses as well as for histological grading and typing.

Result: Of the 1012 cases of operated gallbladder for cholelithiasis, 28(2.7%) cases were histopathologically diagnosed as having Ca gallbladder. The age incidence of Ca gallbladder varied from 43 – 71 years. The highest incidence was observed in the 6th decade (53.6%) followed by the 5th decade of life (28.5%). Out of 28 cases of Ca gallbladder, 15(53.6%) exhibited increased wall thickness. All 28 cases were adenocarcinoma; of them, 25(89.3%) were poorly differentiated and 3(10.7%) were well-differentiated carcinoma. Non-squamous cell carcinoma or other variants were found. The majority (82.1%) of the cases was of infiltrative scirrhous (a hard slow-growing malignant tumor having a preponderance of fibrous tissue) type and the rest (17.9%) fungating type. Staging of the disease stratified 4(14.3%) cases as Stage-IV, 3(10.7%) cases as Stage-Ill, 8(28.6%) cases as Stage-II, and 13(46.4%) cases of Stage-I.

Conclusion: The study concluded that the prevalence of malignancy in gallstone disease is rare. The incidence is highest in the 6th decade of life and females are more often affected than males. As older people with gallstone diseases are at increased risk of having gallbladder malignancy, it is imperative that older patients with gallstone diseases should be routinely examined for evidence of carcinoma.

Ibrahim Card Med J 2022; 12 (2): 59-63

Journal Scan: Updates from Important Trials in Cardiology of 2022 (4th quarter of 2022)

2023-11-13T08:39:11+00:00

Abstract not available

Ibrahim Card Med J 2022; 12 (2): 67-71

Scientific Misconduct in Scientific Publications

2023-11-13T06:10:05+00:00

Abstract not available

Ibrahim Card Med J 2022;12(2):5-9

Unilateral Orbital mass in a 3-Year-Old Boy of Acute Lymphoblastic Leukemia : A Rare Presentation

2023-11-13T08:34:45+00:00

Background & objective: We report a case of a 3-year-old boy who presented with left eye swelling, low-grade fever, pallor, and generalized lymphadenopathy. He was diagnosed with a case of B-cell acute lymphoblastic leukemia (ALL) on the basis of morphology and immunophenotyping of bone marrow. Orbital manifestation is rarely seen in ALL; rather it is more common in acute myeloid leukemia (AML). Knowledge regarding the unusual presentation of ALL will help timely diagnosis and treatment which is crucial for preserving the eye as well as the vision.

Ibrahim Card Med J 2022; 12 (2): 64-66