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Background: Besides conventional risk factors, a novel risk factor hypovitaminosis D may play unique role in the development of coronary artery disease. Evidences suggest that people with low serum vitamin D level is associated with risk of acute MI even after adjusting for the known risk factors. This study was conducted to find out the association between serum vitamin D Level and angiographic severity of coronary artery disease in patients of acute myocardial infarction. Methods: One hundred and four patients of acute myocardial infarction undergoing coronary angiography in DMCH during May 2017 to April 2018 were the study population. The population were divided into 2 groups based on their serum vitamin D level; normal vitamin D (>30 ng/ml) and low vitamin D (d"30 ng/ml). Low vitamin D level again divided into 3 groups; insufficient (vitamin D 21 to 30 ng/ml), deficient (Vitamin D 10-20 ng/ml) and severely deficient having vitamin D <10 ng/ml. Coronary angiogram was done during index hospitalization. The severity of the coronary artery disease was assessed by vessel score and Gensini score. After calculation of Gensini score, 36 points was chosen as an appropriate cut-off value and patients were divided into two groups; those with a Gensini score d"36 points was considered as having absent or mild coronary artery disease and those with a Gensini score >36 points was considered as having moderate to severe coronary artery disease. Association between serum vitamin D Level and angiographic severity of CAD was looked for. Results: Seventy seven (74.0%) of study population had vitamin D level d" 30 ng/ml, while 27(26.0%) patients had normal level. There was no significant association between common cardiovascular risk factors with vitamin D level. Double or triple-vessel CAD were more frequent in those with vitamin D levels d"30 ng/ml as compared to those with normal vitamin D levels (>30 ng/ml) (P<0.05). Majority (48.1%) of patients had double vessel disease (DVD). Among them 4(8%) patients had normal serum vitamin D levels (>30 ng/ml) and 46 (92%) patients had low vitamin D (d"30 ng/ml). Mean Gensini score was found 20.8±5.1 in normal vitamin D (>30 ng/ml) and 48.3±13.3 in low vitamin D (d"30 ng/ml) (p<0.05). Moderate to severe CAD (Gensini score >36) was found in 54.1% of patients with vitamin D insufficiency (21-30 ng/dl) and 83.3% of patients with vitamin D deficiency (10-20 ng/dl) (p<0.05). Moderate negative correlation (r= -0.641; p=0.001) was found between Gensini score and serum vitamin D level of patients with acute myocardial infarction. Conclusion: Low serum vitamin D level is associated with increasing severity of coronary artery disease, docsumented angiographically among patients of acute myocardial infarction. Low serum vitamin D levels may be an emerging, independent, and potentially modiûable cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease is an important medical and public health issue as it is common and leading cause of mortality and morbidity in Bangladesh as it is throughout the world. This study was carried out to determine the existence of seasonal rhythms in hospital admissions due to acute myocardial infarction (AMI) in Dhaka Medical College Hospital. Methods: This cross-sectional observational study was conducted during the period of April 2015 to March 2016 among the patients with AMI admitted at the Cardiology Department of DMCH. 882 patients were enrolled. Results: The highest number of patients were admitted during winter (n=285, 32.3%) followed by post monsoon (n=213, 24.1%) and monsoon (n=194, 22.0%). The lowest number of patients were admitted during summer (n=190, 21.5%). The hospital admission was significantly higher in winter compared to other seasons (p-value versus summer, monsoon and post monsoon was 0.008, 0.011 and 0.042 respectively). Conclusion: A seasonal variation in the hospital admission due to AMI with a peak in winter was clearly demonstrated in the study. Persons admitted to hospital with AMI tend to be all age groups and both sexes present a stronger seasonal variation peak admission in winter. [ABSTRACT FROM AUTHOR]

Background: Epidemiological transition which is taking place in every part of the world, among all races, ethnic groups and cultures has resulted in the global rise in cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality throughout the world. We tried to assess the pattern of cardiac disease at coronary care unit (CCU) of tertiary care hospital. Methods: A cross sectional study conducted among the patients admitted at CCU of Dhaka Medical College Hospital (DMCH) during the period of 1st January 2010 to 31st December 2010. A total of 2415 patients were included in the study. Results: A total 2415 patients in the year 2010, were admitted at CCU of DMCH, among them 56% (n=1346) were male and 44% (n=1069) were female. Out of total admitted patients 220 (9%) were below 30 years of age and 588 ( 24%) & 1607 (67 %) were the age group of 31 to 44 years and 45 years and above age group respectively. Among the disease group ischemic heart disease( IHD) (45%) was the most common cause of hospitalization followed by heart failure (HF) (16%) valvular heart disease (9%), hypertension (7%) and arrhythmia (2%). Acute myocardial infarction (30 %) was the leading cause of IHD followed by unstable angina (15%). Conclusion: This study has found that almost three-quarters of cardiac disease were due to IHD, HF and valvular heart disease in decreasing order of frequency. Countries like Bangladesh can be able to spend very little resources to address those cardiovascular diseases. Along with public as well as private sector efforts, public awareness about the risk factors for cardiovascular diseases should be improved to reduce this sort mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background To determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population. Methods This cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ⩾7) and group-B (coronary score <7) depending on Gensisni score. Result There were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ⩾25 and waist to height ratio (⩾0.55) than Group B which showed a statistically significant association (p < 0.001). Though a significant positive correlation (r = 0.296, p = 0.006) was observed between BMI and Coronary artery disease score in group A patients, scenario was reverse fro group B (r = 0.076, p = 0.659). The statement was also true for Waist-to-height ratio and Waist-toheight ratio with BMI. Multivariate analysis also yeilded that a patient with BMI ⩾25 kg/m2 and waist-to height ratio of ⩾0.55 are 3.06 times and 6.77 times, more likely to develop significant coronary artery disease respectively. Conclusion The waist-to-height ratio showed better correlation with the severity of coronary artery disease than the BMI. [ABSTRACT FROM AUTHOR]

Arsenic contamination of ground water has been found in Rajarampur village in the Nawabgonj district of north-western Bangladesh. A recent survey has indicated that 11% of tubewell water contains arsenic in the range 0.01 mg/l to 0.05 mg/l, and 29% above the WHO maximum permissible limit of 0.05 mg/l. None of the water samples from tubewells of less than 60 ft depth showed arsenic levels above 0.05 mg/l. Of the 1273 people exposed to this contaminated water supply 7.5% showed clinical manifestations of arsenicosis. The majority of these (59.4%) were female. There were no cases below 7 years of age. The most frequently seen clinical manifestations were melanosis (98.9%), keratosis (92.7%), hyperkeratosis (45.8%), depigmentation (29.2%), anorexia (26.0%) and cough (25.0%). Hepatomegaly was detected in 3.2% of the population and there was one case of squamous-cell carcinoma. The article also describes the use of a validated field test for the detection of arsenic in water. [ABSTRACT FROM AUTHOR]

Since its introduction in 1977, Percutaneous Coronary Intervention (PCI) i.e. coronary angioplasty and/or stenting have gained increasing importance in the treatment of coronary artery disease. PCI has reduced the need for coronary artery bypass graft (CABG) surgery and are performed more and more frequently worldwide including Bangladesh. Though Dhaka Medical College Hospital (DMCH) is the pioneer institute for medical education in this country, the facilities for PCI and other cardiac intervention were previously not available in this institute. Recently, however, PCI has been introduced in DMCH. We are here reporting the first regular successful case of PCI done in DMCH. [ABSTRACT FROM AUTHOR]

Protein C is one of the most important factors that prevent blood from clotting. Protein C deficiency usually leads to venous thrombosis. We intend to report a male of 38 years admitted in coronary care unit of Dhaka Medical College Hospital, who suffered recurrent episodes of myocardial infarction, whose traditional risk factors were well controlled. Ultimately he was diagnosed with protein C deficiency, which is not commonly implicated in arterial thrombosis. Protein C deficiency can rarely cause severe life threatening arterial thrombosis, like myocardial infarction. Many more cases are reported in recent literature. It can happen sporadically. A high degree of suspicion should be maintained if traditional risk factors are absent in instances of arterial thrombosis, to look for protein C deficiency.

Background: To determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population., Methods: This cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score <7) depending on Gensisni score., Result: There were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ≥25 and waist to height ratio (≥0.55) than Group B which showed a statistically significant association (p < 0.001). Though a significant positive correlation (r = 0.296, p = 0.006) was observed between BMI and Coronary artery disease score in group A patients, scenario was reverse fro group B (r = 0.076, p = 0.659). The statement was also true for Waist-to-height ratio and Waist-to-height ratio with BMI. Multivariate analysis also yeilded that a patient with BMI ≥25 kg/m2 and waist-to height ratio of ≥0.55 are 3.06 times and 6.77 times, more likely to develop significant coronary artery disease respectively., Conclusion: The waist-to-height ratio showed better correlation with the severity of coronary artery disease than the BMI.