Background: EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy and patient with EF< 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anaesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death.Objectives: The aim of this study was to find out the characteristics of patients, identifying of the risk factors, better understanding of pathophysiology, pre-operative optimization of the patients, uses of stable drugs & anesthetic techniques, reduces intraoperative or early postoperative complications & perioperative morbidity, mortality.Methods: In this retrospective study we described our experiences of 236 cases of very low ejection fraction (20% - 35%) from 1st July 2014 - 30th June 2017. We reviewed their medical history and noted age, sex, type of operation & anesthesia, pattern of operation either elective or emergency, preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.Results: General anaesthesia was performed in 176 (74.58%) cases and rest of 60(25.42%) cases were regional where spinal 42(17.80%) cases & epidural 18(7.62%) cases. The age of the patients were in the range of 20 to 70 years, with majority of the patients were in 60 to 69 years age group. The majority of the patients about 46.19% were in LVEF 26 - 30% group, 36.01% patients were in 31 - 35% group and rest of 17.80% patients were in 20 - 25% group. Average duration of operation incase of general anesthesia 66.5(±2.28SD) min and incase of regional 44.2(±3.25SD) min. The mortality rate only 1.27%.Conclusions: Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care have contributed to the success of very low ejection fraction patients in our hospital.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 114-120

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137

Background Hyperlinear palms are described as a feature of loss-of-function (LoF) variants in Filaggrin (FLG). Objective To explore the phenotype of participants (age &lt;31 years) with atopic eczema of Bangladeshi ancestry from East London and investigate which factors best associate with LoF FLG variants. Methods A cross-sectional study with participants recruited between May 2018 and March 2020. Patterns of palmar linearity were categorised and modelled with Eczema Area and Severity Index (EASI), transepidermal water loss (TEWL), skin hydration (SH) and LoF FLG variants. Results Five hundred and six complete cases were available. Five palm patterns were noted. The ‘prominent diamond’ pattern associated best with EASI (marginal effects [ME], 2.53, 95% CI 1.74-3.67), TEWL (ME 1.32, 95% CI 1.11-1.62) and SH (ME 0.85, 95% CI 0.78-0.96). Using five palm patterns had some ability to discriminate LoF FLG variants (area under the receiver operator characteristic [AUROC] 76.07; 95% CI 71.58-80.57), improving in subgroup analysis with only fine perpendicular/prominent diamond patterns and SH (AUROC 89.11%; 95% CI 84.02-94.19). Limitations Single centre study design with humans classifying clinical patterns. Stability of temperature and humidity not guaranteed across TEWL and SH measurements despite using a climate controlled room. Conclusion Palm patterns associate with EASI and TEWL. The fine perpendicular/prominent diamond patterns are markers to detect absence/presence of LoF FLG variants respectively.