Objective: The objective of the present study was to see the effect of magnesium in preventing cardiac arrhythmias in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: This study was carried out in the Department of Anesthesia, Analgesia and Intensive Care Medicine (Cardiac Anesthesia Wing) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka who underwent CABG surgery under general anaesthesia. A total of 60 patients scheduled for CABG were consecutively selected and were randomly divided into study group and control group. Patients aged 35-70 years irrespective of sex, ASA grade I & II, NYHA functional class I & II and ejection fraction 35-65% were included in the study. The study group was treated by vecuronium, fentanyl and magnesium sulphate infusion, while the control group was treated by vecuronium and fentanyl infusion. The demographic variables, preoperative clinical characteristics, peroperative variables and haemodynamic findings were observed at different time intervals. Results: The mean ages of the study and control groups were 51.0 ± 6.9 years and 53.8 ± 6.2 years respectively. Males demonstrated their predominance in both magnesium (83.3%) and control (76.7%) groups. The distribution of preoperative confounding factors like diabetes, previous MI, hypertension and ejection fraction were not statistically different between the study groups. Two-thirds (67.7%) of the patients in magnesium group and 53.3% in the control group required 3 grafts. Number of 4 grafts in magnesium and control groups was 20% and 30% respectively and that of 2 grafts was 13.3% and 16.7% respectively. In the study group, out of 30 patients, 3(10%) developed arrhythmia, while in the control group out of 30 patients, 5(16.7%) developed arrhythmia (p = 0.353).The haemodynamic parameters in patients receiving magnesium were more stable during the whole period of observation. Conclusion: The findings of the study suggest that magnesium could reduce the development of arrhythmia to an acceptable level in patients undergoing beating heart CABG surgery. However, further study with large sample is recommended to achieve a conclusive remark. Ibrahim Card Med J 2017; 7 (1&2): 37-43

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In this case study the persistence of hypertension in a patient after successful coronary angioplasty was assessed. Pulse and blood pressure were recorded twice daily for 33 days at random interval. The results show the patient had high blood pressure for a total of 17 days in the 33 days of study period after Coronary Angioplasty and Stenting. The patient's blood pressure never excided above 170/90 and pulse remained normal through the study period. In the case study multiple drugs failed to control blood pressure adequately. Other external factors may play a role in failure of management of BP. Indeed the patient's lack of lifestyle modification as per advice of the physician may play a significant role in the persistence of hypertension. The patient should seek further medical assistance from specialists and drugs should be altered to control blood pressure adequately. Further investigation might be considered to rule out secondary causes of persistent hypertension.

Acute appendicitis is the most common surgical emergency, with16% of the population undergoing appendectomy. Burst appendix is one of the complications of acute appendicitis and occurs 25% cases that is associated with increased morbidity and mortality and hence regarded as a surgical emergency.1 This study focuses on the pattern of presentation, risk factors, accuracy of clinical diagnosis, morbidity and mortality of patients managed for perforated appendicitis in DMCH. This observational study was carried out in the department of surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to December 2012.Total 200 cases of suspected burst appendicitis were included in this study. Among the 200 cases of suspected burst appendix patients, majority of the cases 48% were of 25 – 34 years age group. Most of the cases 71% were male and 29% were female. Higher income group of patients are less sufferer 8%, origin of pain from umbilicus 74.50% and from RIF 25.50%, nausea in 71.89%, vomiting in 64.05%, anorexia in 32.67%, fever in 50.32%, diarrhea in 5.22% and abdominal distension in 8.49% cases. Tenderness over RIF was present in 100%cases, rebound tenderness was present 80.39% cases, rigidity over RIF was 84.96% patients, Cough test was positive 54.90% cases, Diffuse abdominal tenderness in 87.58% cases, Abdominal distention in 13.07% cases and absent of bowel sound in 40.52% cases. Maximum number of patients reported after 3-4 days of onset of symptoms. Ultrasonogram shows normal findings in 55.56% and suggesting ruptured appendicitis in 44.44% cases. Operative findings of those patients, 33.33% cases presented with only burst appendix without local sequel and 35.29% cases present with generalized peritonitis, 13.73% cases present with localized peritonitis, 10.46% cases present with localized abscess, 5.23% cases present with periappendiceal fluid collection and extraluminal appendolith present in 1.96% cases. Burst appendix present a challenge to the clinicians because it can be delay in diagnosis, result in delay in operation and can be developed fatal complication. So we emphasize on careful history taking and physical examination in such cases can make the difference between life and death.