Intravascular embolization of bullets and other foreign bodies is a rare complication of penetrating trauma. It can represent a diagnostic challenge because it may present in various and unexpected ways. We report the case of a 65-year-old male who sustained shotgun pellet emboli to left ulnar artery following a right and left upper extremity gunshot injury. Pulse volumel.11 January-December 2018-2019 p.33-37

Introduction: Endotracheal intubation using video laryngoscopy causes less cardiovascular response and less airway morbidity compared to classic direct laryngoscopy, in cardiac surgery. A comparison of the cardiovascular responses to endotracheal intubation using both indirect video laryngoscopy and direct laryngoscopy within the same patient has not yet been described. Materials and methods: This comparative randomized controlled clinical trial on 110 patients undergoing elective CABG. Data were expressed as mean ± SD and statistically analyzed using analysis of variance (ANOVA) and paired “t”-test over time and software SPSS-19.00. Results: Total intubation time was significantly higher in Video laryngoscopy group than direct laryngoscopy group (Table 2). The mean effective airway time were 6.15±4.92 in Video laryngoscopy group and 11.32(±9.11) in direct laryngoscopy group which was statistically significant (Table 3). The relative increase of the Rate Pressure Product (RPP) at intubation was significantly smaller (i.e. 27%, P < 0.001) using video laryngoscopy compared to the classic direct laryngoscopy. Cardiovascular responses were blunted by an additional 10. 2% (P = 0.029), when the patient was on beta blockade (Table 4). Conclusion: Study observed that less hemodynamic responses during endotracheal intubation using indirect video laryngoscopy compared to classic direct laryngoscopy. Even if the patient is on beta-blocker therapy, diminished cardiovascular responses at intubation were recorded after indirect laryngoscopy compared to direct laryngoscopy. Bangladesh Crit Care J March 2022; 10 (1): 52-56

Background: Stroke is a global health problem, leading cause of death all over the world. It accounts for chronic illness and disability in a large segment of population. It imposes a great loss on economy of the nation due to loss of service of the workforce during illness and extended hospitalization they require during recovery. Stroke continues to have a great impact on public health. It is associated with multiple risk factors and co-morbid conditions. Objective: To find out the hospital outcome of acute stroke patients associated with various risk factors and co-morbidities. Materials and methods: This is a cross sectional observational study, carried out in the department of Medicine and Neurology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh for a period of 6 months. One hundred patients presented with acute stroke diagnosed on clinical & investigational background fulfilling the inclusion and exclusion criteria were enrolled in the study. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) score. Patients’ symptoms, degree of disability or dependence in the daily activities and clinical outcome were evaluated and measured by the modified Rankin Scale (mRS). Result: This study showed that a majority of patients (49%) were in the 51-60 years age group, mean age was 56.81 years. Male and female ratio was 1.38:1. Among all all-risk factors, hypertension is the most common, present in 72% cases; the next most common risk factors were DM (59%), smoking (47%), heart disease (35%), and migraine (14%). About 72% of patients had a mild stroke, 17% of patients had a moderate stroke and 11% of patients had a severe stroke according to NIHSS score at admission. Seventy-four (74%) of them had infarction and the rest had hemorrhage. The study showed that 62% of the patients recovered (mRS score 0 to 2) and among them the maximum were ischemic stroke. 29% had poor outcomes, disabled and they were discharged on request or risk bond (mRS score 3 to 5). 9% expired during hospital stay (mRS score 6). Logistic analysis revealed that age >50 years, hypertension, diabetes mellitus, heart disease, hyperlipidemia, family history of CVD, CAD, past history of stroke / TIA, migraine and peripheral vascular disease were associated with poor stroke outcome. Conclusion: This study shows that the main risk factors & the comorbid conditions for a stroke were hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and smoking. People suffering from a stroke with these risk factors have poorer outcomes than those with no risk factors & comorbidities. Identifying characteristics of people at high risk of recurrence has important implications for planning secondary prevention strategies to reduce the disease burden. Early detection and prevention of the risk factors can reduce health care burden and disability. Bangladesh Crit Care J March 2022; 10 (1): 15-18