ABSTRACT

Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients. Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative elevated level of HbA1c. Methods: This prospective study was done in National Institute of Cardiovascular Diseases (NICVD). Patients of coronary artery disease (CAD) with DM referred for CABG were enrolled for the study. Total 60 patients were allocated into two groups. Among them 30 patients with preoperative HbA1c of <7% and another 30 patients with preoperative HbA1c of > 7 % underwent CABG surgery from January, 2009 to December, 2010. The early postoperative outcomes were compared between two groups. Both groups were matched with no significant difference that could influence the postoperative outcome. Results: In-hospital mortality was high in patients with preoperative elevated level of HbA1c. An elevated hemoglobin A1c level predicted in-hospital mortality after CABG surgery. Our study revealed that HbA1c greater than 7 % was associated with increase in mortality. For each unit increase hemoglobin A1c , there was a significantly increase risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure, cerebrovascular accident and deep sternal wound infection occurred more commonly in patients with elevated hemoglobin A1c. Morbidity, infections and the composite outcomes occurred more commonly in patients with elevated HbA1c. Conclusion: Elevated HbA1c is strongly associated with adverse events after coronary artery bypass graft surgery. Preoperative HbA1c measurement may allow for more accurate risk stratification in patients undergoing coronary artery bypass graft surgery. Bangladesh Heart Journal 2019; 34(2) : 92-99

Tubal rupture following an ectopic pregnancy is usually associated with profound hemorrhage which can lead to an unstable hemodynamic state that can risk the life of the patient. To explore the pattern of ruptured ectopic pregnancy in a secondary level healthcare facility, this Cross-sectional study was conducted among 100 ruptured ectopic pregnancy cases at 250 Bedded General Hospital, Tangail from January to November 2017. Cases were diagnosed by taking history (short period of amenorrhoea, acute lower abdominal pain and per-vaginal bleeding), clinical examination and relevant investigations (per-abdominal ultrasonography, TVS, CBC, serum ß-hCG level). Postoperatively, all the patients were followed up meticulously till discharge. The mean age of patients was 33.5(±7.8) years and the highest incidence (43%) was recorded in the age group of 26-30 years. All the patients were managed surgically with no record of case fatality. The most common site for the extra-uterine pregnancy was the tubal area (80%), 13% were ovarian pregnancy, 2% were abdominal and 5% were in other sites (rudimentary horn of uterus, cessarian scar). Chronic pelvic inflammatory disease was the most common risk factor (70%). Other risk factors such as, H/O receiving subfertility treatment (assisted reproduction/ ovulation inducing drugs), previous ectopic pregnancy, developmental errors of uterus, caesarean scar pregnancy and unknown cause were 10.0%, 6.0%, 3.0%, 3.0% and 8.0% respectively. The rise of serum ß-hCG level was found ≤1500 IU/L in 72% and >1500 IU/L in 28% of patients. Tubal area found to be the most common site of ruptured ectopic pregnancy in this study and chronic pelvic inflammatory disease was the most common risk factor followed by undergoing subfertility treatment.  Surgical intervention was the choice of treatment in all cases with zero fatality recorded. Bangladesh Med J. 2019 May; 48 (2): 20-23

Background: Eclampsia is defined as the development of seizures that cannot be attributed to other causes and /or unexplained coma during pregnancy or puerperium in a woman with pre-eclampsia. The purpose of this hospital based observational study is to evaluate the extent of the problem and to estimate the associate of foetal and maternal complications Methodology: The observational study was carried out Department of Obstetrics and Gynaecology in 250 bedded general Hospital Tangail from January 2015 to November 2017. All on the diagnosed patients of eclampsia were included in this study. Results: Regarding types of eclampsia 187(62.3%) patients had antepartum eclampsia, 78(26.0%) had postpartum eclampsia and 35(11.7%) had intrapartum eclampsia. Majority (57.0%) patients had 5-9 times of convulsion, 65(21.7%) had >10 times and 64(21.3%) had <5 times of convulsion. Most (95.0%) patients had cesarean section and 15(5.0%) had normal vaginal delivery (NVD). Maternal alive was found 293(97.7%) and death was 7(2.3%). Male baby was found 203(67.7%) and female baby was 97(32.3%). More than three fourth (75.7%) babies had weight 2.5-4.0 kg. Alive babies were found 282(94.0%), neonatal death was 8(2.7%) and intrauterine death was 10(3.3%). Conclusion: Improving ante-natal and emergency obstetric and neonatal care is mandatory to improve the outcome. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 11-15

To find out the safety, effectiveness and outcome of colpocleisis in advanced pelvic organ prolapse in elderly women. A prospective study was conducted in Sheikh Hasina Medical College,Tangail (250 beded general hospital,tangail) among 75 female patients aged 60 years and above with diagnosed cases of Pelvic Organ Prolapse (POP) during the period from February 2014 to February 2018 who had no desire in coital function. Patient information were recorded pre-operative, per-operative and post-operative period. Urodynamic investigation (uroflometry and post void residual urine) were done during pre-operative  and early postoperative period. Follow up was done at 6 week, 3 month and then annually. Main outcome measures were relieving symptoms, recurrence of prolapse and development of urinary incontinence. Patient satisfaction (Subjective outcome) measured by interview during follow up. Colpocleisis was performed in 75 patients. Mean (age of the patients was 66.69 SD ±5.9 years, mean BMI 18.12 SD ±1.69 kg/m2 and mean parity 5.56 SD ±1.9. Majority of operation done under saddle block, only 21.31% was done under local anaesthesia. Mean operation time was 36.16 SD±6.23 minutes, mean blood loss was 41.61 SD±8.34 ml and mean hospital stay was 2.24 SD ±0.49 days. Objective and subjective outcome were same 98.7% only 1.3% patient developed recurrent prolapse (Failed operation) and 1.3% patient developed urinary urge incontinence. The mean differences were significant for the pre and postoperative maximum urinary flow rate, voided volume, post void residual urine (P value is 0.001). Colpocleisis is safe, effective with high success rate in the management of advance pelvic organ prolapse, who do not wish to preserve coital function. So it can be considered as one of surgical option for treating advance pelvic organ prolapse. Bangladesh Med J. 2018 May; 47 (2): 17-22