Assessment of Risk Factors of Heart Failure: A Case Control Study

Heart failure (HF) is becoming an increasingly prevalent healthcare problem. Besides, Ischemic heart disease (IHD) and Hypertension (HTN), there is a number of other factors that continue to evolve as risk factors for heart failure. The aim of the study was to identify the different risk factors of heart failure patients. This case-control study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2014 to July 2015. It was included 75 patients of heart failure (cases) and 75 age and sex matched adult individuals (friends and relations of heart failure cases) as controls. The risk factors studied were grouped into demographic, clinical, behavioral and biochemical variables. The age distribution between case and control groups was almost identical with mean ages of either group being 55 years (p=0.922). The sex distribution was also fairly comparable with male being predominant in both the groups (p=0.574). In this study IHD followed by uncontrolled hypertension (p=0.001) are came out to be the predominant risk factors of heart failure followed by smoking and obesity (p<0.001). From the findings of the study, it can be concluded that a number of risk factors are involved in heart failure cases. Of them ischemic heart disease and uncontrolled hypertension are the predominant ones followed by smoking and obesity. The best strategy would, therefore, be to treat and control ischemic heart disease, hypertension, obesity, diabetes and smoking habit in the population. However, as the risk factors in the population continue to change; ongoing surveillance is important to guide right preventive strategy in future.

Limited versus Aggressive Open Discectomy for a Single Level Lumbar Intervertebral Disc Prolapse

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.

Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.

Open-door Laminoplasty for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament (OPLL) using Titanium Reconstruction Miniplate and Screws

To review outcome of 25 patients who underwent open-door cervical laminoplasty for multilevel cervical spondylotic myelopathy (MCSM) and ossification of the posterior longitudinal ligament (OPLL) using titanium reconstruction miniplate and screws. Records of 18 men and 7 women aged 35 to 78 (mean, 62.6) years were reviewed retrospectively from October 2009 and October 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, Bangladesh. Four patients had 5 levels (C3-C7), 21 patients had 4 levels (C3-C6) decompression and 3 patients (12%) performed foraminotomies. A total of 104 laminae were opened, all of them were fixed with a titanium reconstruction miniplates. In 21 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 4 laminae and 4 patients fixed in 5 laminae levels. In most patients, screw fixation was unicortical and no spacer or bone graft was used. Demographic and surgical data were collected and clinical outcomes were assessed with neck pain score, neck disability index and Nurick's grading. Outcome analysis was done using Odom's criteria. The mean follow-up duration was 1.8 (range, 1-5) years. Diagnoses were MCSM (n=20), OPLL (n=5). Mean estimated blood loss (EBL) was 120ml (range: 50-200), mean surgery time was 153 min (range: 75-240). Following Nurick's grading, 23 patients (92%) improved, 2 (08%) had the same Nurick grade. No intraoperative complications were noted and average hospital stay was 6.12 days (range: 5 to 9). Significance improvements in overall NDI scores occurred at 1 year follow up (p<0.002). Radiographic evaluation showed an increase in the mean sagittal diameter from 13.3mm at pretreatment to 19.4mm post surgery. Two patients developed transient C5 palsy. Open-door Laminoplasty technique is safe, easy and achieves a good canal expansion and neurological recovery and can be used as an alternative treatment for cases of MCSM and OPLL patients without instability.

ISOLATION AND DETECTION OF NEWCASTLE DISEASE VIRUS FROM FIELD OUTBREAKS IN BROILER AND LAYER CHICKENS BY REVERSE TRANSCRIPTION–POLYMERASE CHAIN REACTION

The present research work was carried out to isolate and identify Newcastle disease virus (NDV) by using haemagglutination inhibition (HI) test and reverse transcription-polymerase chain reaction (RT-PCR) assay. A total of 160 clinical (blood, tracheal and cloacal swabs) and post-mortem (brain, lung, colon and spleen) samples were collected from chickens of two field outbreaks of Newcastle disease (ND) in 2006, one in a broiler (Cobb-500) farm of Mymensingh district and other one in a layer (Sonali) farm of Gazipur district. All the samples were inoculated onto 10-day-old embryonated chicken eggs through allantoic sac route and in the chicken embryo fibroblasts (CEFs) cell culture. The allantoic fluid (AF) of the dead embryos and the infected culture fluid (ICF) of the CEF were harvested at 48 and 96 hours of post-infection, respectively. The HI and RT-PCR were employed to detect NDV in tissue homogenates of all the clinical and post-mortem samples as well as laboratory samples (AF and ICF). Among the clinical samples, virus isolation rate was found higher from tracheal swab (90%) compared to those of cloacal swab (85%) and serum (65%). On the other hand, among the four different types of post-mortem samples, virus isolation rate was found higher in spleen (100%) compared to those of lungs (80%), colon (60%), and brain (80%) samples. In CEF cell culture system, the rate of virus isolation from all the aforesaid samples was found 100% with the exception of serum samples. The isolation rate of NDV was higher in CEF culture system (93.8%) compared to that of avian embryos (80%). Among the clinical and post-mortem samples, inoculum of only cloacal swab and colon showed HA and HI activities. The anti-NDV hyperimmune serum revealed complete inhibition of the 4 haemagglutination unit of each isolate of viruses isolated from broiler and layer chickens present in the laboratory samples (AF and ICF). The NDV specific primers used in the direct RT-PCR for genome detection of NDV showed equal sensitivity and specificity with the RNA extracted from the clinical, post-mortem and laboratory samples (AF and ICF) as with the genomic RNA of reference NDV. Higher rate of detection of NDV was recorded with RT-PCR assay than HI test. Therefore, the molecular method (RT-PCR) can be introduced for rapid and confirmatory detection of NDV from any form of outbreak of ND in the field level of Bangladesh.DOI = http://dx.doi.org/10.3329/bjvm.v8i2.9618 Bangl. J. Vet. Med. (2010). 8 (2) : 87–92 

Correlation between severity of coronary artery stenosis and perfusion defect assessed by SPECT myocardial perfusion imaging

Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.

Rapid detection of infectious laryngotracheitis virus by standardization of polymerase chain reaction targeting a relatively conserved region of the thymidine kinase gene

Infectious laryngotracheitis is an acute upper respiratory tract infection of chickens caused by infectious laryngotracheitis virus. The study was conducted to standardize the polymerase chain reaction targeting a relatively conserved region of the thymidine kinase gene for the rapid detection of infectious laryngotracheitis virus. The vaccine samples were collected from two renowned company of Bangladesh. DNA was extracted from diluted vaccine samples by using Wizard® Genomic DNA purification kit and thymidine kinase gene was amplified by using PCR system 9600 Thermocycler. Two vaccine samples were positively amplified by polymerase chain reaction. A procedure was developed for rapid detection of infectious laryngotracheitis virus by polymerase chain reaction of the conserved region of viral thymidine kinase gene containing DNA fragments. The results obtained in this study suggested that the polymerase chain reaction procedure could serve as a fast and sensitive method for the detection of vaccine strains of infectious laryngotracheitis viruses.   Key words: Infectious laryngotracheitis virus; viral thymidine kinase (TK) gene; polymerase chain reaction DOI: http://dx.doi.org/10.3329/ujzru.v29i1.9468 UJZRU 2010; 29(1): 61-64