Objective: To evaluate in-hospital and 1-year outcomes of primary percutaneous coronary intervention (PPCI) in elderly patients with ST-elevation myocardial infarction (STEMI). Methods: All patients aged ≥ 65 years presenting with STEMI and undergoing PPCI at Ibrahim Cardiac Hospital & Research Institute, Bangladesh from January 2015 to August 2017 were consecutively included in the study based on predefined eligibility criteria. Data pertaining to angiographic characteristics, procedural variables, in-hospital and 1-year outcome variables were recorded and analyzed with the help of descriptive statistics and Chi-square Test. Results: The mean age of the patients was 69.2 ± 5.2 (range: 65-85) years with male to female ratio being 4:1. The patients were predominantly diabetic (78%) followed by hypertensive (74%) and dyslipidaemic (70%) smoker (54%). Half of the patients presented with anterior myocardial infarction (MI), 30% had inferior MI, 12% with right ventricular (RV) extension and 8% with inferolateral extension. About one-quarter (24%) had arrhythmia with complete heart block (CHB). The culprit arteries were LAD (50%), followed by RCA (42%) and LCx (8%). Nearly half (46%) had single vessel disease, 34% double and 20% triple vessel disease. Majority (80%) received a single stent and 20% required two stents with mean diameter and length of the stents were 2.9 ± 0.4 mm and 27.3 ± 7.9 mm respectively. Intracoronary eptifibatide was used in 20% cases. In terms of left ventricular ejection fraction (LVEF), 58% and 28% had mild and moderate LV systolic dysfunction respectively. The mean duration of hospital stay was 4.0 ± 1.9 days. About 18% required repeat hospitalization. Overall, 7(14%) patients died (4 during their stay in the hospital due to cardiac cause and 3 during follow up due to non-cardiac causes). At 1 year follow up, in-stent restenosis was seen in 1 case followed by target vessel revascularization (TVR). The Association between age and outcome revealed that advanced age (age ≥ 75 years) was an important predictor of in-hospital and one-year outcome with Relative Risk (RR) of having unfavorable outcome was > 5-fold (95% CI: 1.6-19.5) in patients of advanced age than that in patients of age < 75 years (p = 0.008). Conclusion: Primary PCI is a feasible treatment option for elderly Bangladeshi patients presenting with STEMI with fewer in-hospital and 1-year follow up deaths. Adverse cardiovascular events are even less. Advanced age (age ≥75 years) is an important determinant of adverse cardiovascular events including mortality, probably because of more medical co-morbidities associated with advanced age. Ibrahim Card Med J 2020; 10 (1&2): 18-26

Background & Objective: Non-communicable diseases, particularly diabetes, hypertension and ischemic heart diseases have created an epidemic situation worldwide. Bangladesh is also in the grip of the menace. The only way to get rid of the menace is prevention of these diseases which demands awareness against the diseases. This study was undertaken to assess the level of knowledge of adult people of Puthia Upazila regarding prevention of the seclected non-communicable diseases (NCDs). Methods: The study was carried out in the Department of Community Medicine Rajshahi Medical College, Rajshahi over a period of 2 months from April 2018 to May 2018. All adult people (18 years onwards) residing in the rural area of Puthia Upazila were the respondents (study population) in this study. The survey invited the adult individuals to participate in the study. A total of 1001 individuals voluntarily responded to participate in the study. Of them 648(64.7%) were free from the NCDs and were interviewed to assess their level of knowledge on prevention of selected NCDs. A self-administered questionnaire containing the variables of interest for evaluating knowledge was used. Result: Two-thirds (68.2%) of the respondents were 30–50 years old with mean age of the respondents being 44.3(range: 25-90) years. Males outnumbered females by 11:9. Over half (54%) informed that they had little knowledge and 10.7% were familiar with the NCDs. Around half held the view that diabetes, hypertension, ischemic heart diseases and stroke were NCDs/chronic diseases. Approximately 70% told that the NCDs were on a rising trend. Regarding causes of chronic diseases, the respondents told excess intake of fat and sedentary life-style (67.9%), intake of excess CHO (54.2%), indulgence in smoking (68.2%), less intake of vegetables and fruits (57.4%), excess or additional salt intake (50.5%) and family history of NCD (44.1%). Regarding prevention of NCDs, around 70% were in favor of adopting healthy dietary behaviour and avoiding too much fatty food, followed by regular exercise (71.2%), avoiding or giving up smoking (70.8%) and avoiding or giving up taking extra salt (57.9%). Conclusion: The study concluded that the people of Puthia Upazilla are aware more or less about the selected NCDs (diabetes, hypertension, ischemic heart diseases and stroke). They are also aware that these diseases are increasing. Around two-thirds of the people are aware about the risk factors of these non-communicable diseases and the ways to prevent them. Ibrahim Card Med J 2020; 10 (1&2): 27-32

Background & objective: Coronary Artery Disease (CAD) is a devastating life-threatening condition which varies with respect to age and sex. In Bangladesh a large number of patients currently undergoes coronary angiography for a variety of indications. Due to physiological changes after menopause, the females are more prone to develop CAD. So, the risk factors and pattern of CAD in female are subject change with changing ages. The objective of this study was to compare the risk factors and pattern of CAD in female patients of different age groups. Methods: This cross-sectional analytical study was conducted at Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh between September 2005 to August 2016. All female patients (n = 7,627) who underwent coronary angiography during the period were included. They were identified from ICHRI dedicated Cath-lab Database. The patients were divided into three groups based on their age (Group-I ≤45 years, Group-II from age 46 to age 60 and Group-III from age 60 years onwards). A stenosis of ≥ 70% in any of the three major coronary arteries like Left Anterior Descending (LAD), Right Coronary Artery (RCA) and Left Circumflex Artery (LCX) was considered as significant stenosis, while a stenosis of ≥ 50% in left main stem (LMS) was considered significant for left main disease. The data pertaining to their risk factors and angiographic profile were compared among the three age groups to find the association of risk factors and angiographic pattern of the CAD at different age groups. Result: All the risk factors (diabetes, hypertension, dyslipidaemia and CKD) demonstrated their significant presence in Group II and III compared to those in Group I, while they were almost identical between Group II and III. More than 40% of the patients were overweight in all age groups and around 20% were obese including a negligible proportion with morbid obesity. ST-segment elevation MI, NSTEMI (Non-ST-elevation myocardial infarction), prior MI (Myocardial infarction), and ALVF (Acute left ventricular failure) were significantly higher in Group III than the two other groups had. However, unstable angina was significantly higher in age-group I & II and atypical chest pain in Group I. Incidence of Single vessel disease (SVD) was considerably higher in group II. Double vessel diseases DVD), Triple vessel disease (TVD), LM disease was significantly higher in group III compared to two other groups. Normal CAG (Coronary angiography) finding was higher among group I, although it was not significantly different from other two groups. Conclusion: The study concluded that the prevalence of conventional risk factors including overweight/obesity is almost similar between middle-aged and elderly women, while they are significantly lower in early middle-aged group. The elderly women usually present with STEMI (ST-elevation myocardial infarction), non-STEMI, stable CAD, ALVF, while middle-aged women commonly present with UA (Unstable Angina) and early middle-aged women with atypical chest pain. Severe CAD including and LM disease is relatively common in elderly women than those in their early middle-aged and middle-aged cohorts. Coronary artery disease advances with advancing age. Health-care providers should not underestimate the cardiac health of women. Ibrahim Card Med J 2019; 9 (1&2): 60-66

Objective: The present study was undertaken to determine the risk factors for Gestational Diabetes Mellitus (GDM) presented at Bangladesh Institute of Research in Diabetes, Endocrine & Metabolic Disorders (BIRDEM). Materials & methods: The present case-control study was conducted at BIRDEM Hospital, Dhaka over a period of 6 months from July to December 2011. A total of 100 pregnant women (20 cases and 80 controls) were consecutively enrolled in the study. Pregnant women who developed diabetes at their 3rd trimester were cases (n = 20), while pregnant women free from diabetes at their 3rd trimester were controls (n = 80). The diagnosis of GDM was made using a two-step approach. Pregnant women were initially screened by measuring the plasma glucose concentrations 1 hour after a 50 gram of oral glucose challenge. A diagnostic oral glucose tolerance test was performed on the subset of women whose plasma glucose concentrations exceded the threshold value for glucose (> 140 mg/dl). Result: The study showed that older patients (≥ 25 years) were predominant in both case and control groups. The groups were almost comparable in terms of socioeconomic status and occupation. The distribution of gestational age was also similar between groups (33.1 ± 6.3 vs. 34.2 ± 3.9 years, p = 0.476). Majority (85%) of the cases had family history of diabetes (p < 0.001). Thirty five percent of cases were nulipara and 65% multipara compared to 51.3% and 48.7% respectively of the control (p = 0.076). No significant difference was observed between the groups in terms of preterm labour and PROM (p = 0.690 and 0.220 respectively). Forty percent of cases had past history of GDM compared to 3.8% of controls (p < 0.001). The fasting plasma glucose and plasma glucose 2 hrs after 75 g of glucose ingestion were significantly higher in pregnant women having GDM than those in normal pregnant women (8.3 ± 3.1 vs. 4.1 ± 0.5 mmol/L, p < 0.001;12.9 ± 4.8 vs. 5.9 ± 1.2 mmol/L, p < 0.001 respectively). Conclusion: The study concluded that none of the sociodemographic characteristics like age, socioeconomic status and occupation was found to be associated with GDM. However, pregnant women with family history of diabetes are at risk of developing GDM significantly more than those without GDM. Multipara tend to develop GDM more frequently than the primipara does. Past incidence of GDM increases the risk of GDM in the subsequent pregnancy. Ibrahim Card Med J 2015; 5 (1&2): 49-53

Background & objective: Rapid urbanisation in the 20th century has been accompanied by the development of slums. Nearly one-third of the world’s population and > 60% of urban populations in the least developed countries including hundreds of millions of children live in slums. Slums are areas of broad social and health disadvantage to children and their families due to extreme poverty, overcrowding, poor water quality and sanitation, substandard housing, limited access to basic health and education services. The objective of this study was to assess the demographic and nutritional status of working slum children in Dhaka city. Methods: This descriptive cross-sectional study was conducted at Moghbazar slum, situated in Dhaka city from July to December, 2013. A total of 200 slum children aged 6 to18 years whose parents’ (either father or mother) voluntarily consented to allow their children participate in the study. Result: Out of 200 slum children, 57(28.5%) were in the age group of 12-14 years, among them 110(55.0%) were male. More than 50% never attended any kinds of formal school. Forty five percent children lived with their parents. Over half (26%) of the slum children were engaged in beggary, 23% were van/rickshaw puller, 22% were rag-picker (Tokai), 10% were cooli. Three-quarters of the children had medium work-load and 80% did 5-8 hours work per day sixty percent of the children had monthly income of Taka 1000-1500. In terms of BMI, one-third (33.5%) was severely under-nourished, 55% were of normal BMI and 11.5% were overweight and obese. Conclusion: The study presented a gloomy picture (in terms of nutritional status) of working children in a selected slum within Dhaka city. Therefore, health related programmes should focus to improve the overall wellbeing of the working slum children. Ibrahim Card Med J 2019; 9 (1&2): 49-53