Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8

Background: Statins are the corner stone therapy of atherosclerotic cardiovascular disease (ASCVD). Statins may cause myalgia, myotoxicity, myopathy and rhabdomyolysis along with its lipid lowering properties and pleiotropic effects. Statins associated muscle symptoms (SAMS) are the leading cause of nonadherent and discontinuation. This study was conducted to evaluate and understand the muscle symptoms of high intensity statin therapy (atorvastatin 40 mg and rosuvastatin 20 mg) for a period of three months in individual patient with clinical atherosclerotic cardiovascular disease.Methods: A total of 280 patients with clinical atherosclerotic cardiovascular disease were studied to once daily atorvastatin 40 mg and rosuvastatin 20 mg. It was a randomized controlled single blind trial. The primary end point was muscle symptoms-muscle pain, fatigue, cramp/spasticity and weakness at 4 weeks and in 3 months of study period. Serum creatinine kinase was measured in every patient with muscular symptoms.Results: Patients of atorvastatin group noticed severe pain more than rosuvastatin group at the end of 3 months of treatment period (14.21% vs 4.38%, p <0.05), respectively). Significantly more patients felt extremely bad (12.78% vs 4.38%, p <0.05) and bad (24.66% vs 14.52%, p <0.05) with atorvastatin compared with rosuvastatin. Patients of atorvastatin group showed more marked increase muscle spasm (3.76% vs 1.46%, p <0.05) and slight increase muscle spasm (36.27% vs 16.01%, p <0.05) than rosuvastatin group by spasticity grade. One patient of atorvastatin group developed considerable increase in muscle spasm. Medical research council (MRC) muscle power grade 4 between atorvastatin and rosuvastatin group was observed 20.05% vs 10.90%, p <0.05, respectively. Three patients of atorvastatin group developed grade 3 muscle power. Serum creatine kinase > 1500 U/L was observed more in atorvastatin than rosuvastatin group (14.21% vs 4.38%, p <0.05, respectively). Statin associated muscle symptoms (more severe muscle problem, myositis/myopathy) observed more in atorvastatin than that of rosuvastatin group ( 34.07% vs 13.08% , p <0.05, respectively). Both treatments were well tolerated. No cases of rhabdomyolysis, incident diabetes, hepatic or renal insufficiency were recorded during the study period.Conclusion: Rosuvastatin had better outcome profile of muscle symptoms than atorvastatin in patients with clinical atherosclerotic cardiovascular disease among the Bangladeshi population. Patients in atorvastatin group experienced more muscle pain, fatigue, cramp/spasticity and weakness than rosuvastatin.University Heart Journal Vol. 14, No. 1, Jan 2018; 9-20

Evans syndrome, a combined clinical condition of autoimmune haemolytic anaemia (AHA) and idiopathic thrombocytopaenic purpura (ITP) and has non-specific pathogenesis. The clinical cases are extremely rare, since only 4% of AHA or ITP are incorporated with Evans. It is distinguished from differentials, such as lupus, IgA deficiency, and acquired immunodeficiency, by peripheral blood film, bone marrow, Coombs test, and coagulation profile. A case of adult female from Pabna, Bangladesh is documented in this report. She complained of high grade intermittent fever, exertional dyspnea, icteric skin and sclera. Other features included mild splenomegaly, dark urine, and profuse sweating after fever. Investigation reports were consistent with AHA and ITP, with normal coagulation and viral profile. However, the patient was treated with corticosteroids, platelet and blood transfusion. And in follow-up visits, there was a pattern of gradual decline in erythrocyte sedimentation rate (ESR) and reticulocyte count, with normalization of haemoglobin, red cell, and white cell count. No association with other diseases was found in this case. Bangladesh Med J. 2018 Jan; 47 (3): 37-40