Abstract

Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 52-58

Background: Epidemiologic studies have identified hyper-homocysteinemia as a possible risk factor for atherosclerosis. The aim of my study was based on evaluation of relationship between homocysteinemia with carotid artery stenosis in ischemic stroke patients.Methods and materials: It was a prospective observational study conducted in the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka. Thirty six consecutive patients with ischemic stroke were analyzed by serum total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and extracranial Doppler ultrasonography and vascular risk factors were recorded. Equal number of controls of same ages were compared with the case group.Result: Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL had a positive correlation with serum homocystine (p=0.001). Serum High density lipoprotein (HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89 ± 9.38 ìmol/l and control group was 12.31 ± 3.27 ìmol/l, (p=0.001). Elevated fasting homocysteine level was found in 75.0% of the ischemic stroke patients and in 16.67% of healthy controls (p=0.001).On the basis of clinical evaluation and results of imaging studies, etiological classification of the ischemic stroke patients were made, where 36.1% cases were small artery disease, 38.9% large artery disease, 8.3% cases cardioembolic and in 16.7 % other causes. Among the cases, carotid duplex study was found normal in seven cases (19.4%), Group 1 findings in seven cases (19.4%), group 2 findings in eight cases (22.2%), group 3 findings in thirteen cases (36.1%) and group 4 findings in one case (2.8%). All abnormal carotid duplex findings were significantly higher among cases with elevated level of homocysteine (p=0.001, 0.001, 0.001).Conclusion: The incidence of hyperhomo-cysteinemia is higher in ischaemic stroke cases than that in age-sex matched healthy controls. Hyperhomocysteinemia in ischaemic stroke patients has been determined as vascular risk factor in our study. Significant correlation has been found between homocysteine concentration and intraluminal thickness and carotid artery stenosis.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 1-9

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Objective: The study was intended to determine the angiographic profile (severity, site, and type of lesion) based on the level of cardiac troponin-I (cTn-I) in patients of unstable angina. Methods: The present cross-sectional study was conducted in the Department of Cardiology, Sir Salimullah Medical College & Mitford Hospital (SSMCH). Data were collected at Ibrahim Cardiac Hospital & Research Institute and SSMCH. A total of 81 patients with unstable angina were selected over a period of 1 year. Based on the level of cTn I at admission, the patients were divided into high risk (troponin-I level 0.06-0.6) and low-risk (0-<0.06) groups. Thus 47patients fell into high risk group (Group-I) and 34 patients into low-risk group (Group-II). The angiographic characteristics of the two groups of patients were then compared. Results: Over three-quarter (77%) of the patients in Group-I had significant coronary lesions compared to 26% in Group-II. Significant stenosis was commonly observed in Group-I than that in Group-II (p < 0.001). Number of vessels involved like single vessel (SVD), double vessel (DVD), and triple vessel diseases (TVD) were higher in Group-I compared to Group-II (30% vs. 20%; 34% vs. 3% and 12% vs. 3%). Site of lesions in LAD (left anterior descending) were compared between the study groups, proximal and mid lesions were found significantly higher in Group-I (45% vs. 9% and 49% vs. 18%, respectively), while distal lesion was almost identically distributed (5% vs. 6%). Type-B land type C lesions were higher in Group-I (30% vs. 3.0%) and (47% vs. 14%) while type-A lesion was higher in the Group-II (20% vs.8%). Majority (77%) of the patients who developed significant coronary artery lesion had raised cTnI. Conclusions: Patients of unstable angina with raised serum troponin-I had more severe coronary lesions (in terms of number of vessels significantly affected and site and type of lesions) than those with low serum troponin-I.