Use of Anticoagulant Warfarin in Patients Presenting With Atrial Fibrillation in a Tertiary Level Hospital

Atrial fibrillation (AF) is the most common sustained arrhythmia in the World, occurring in approximately 0.4% of the general population. The purpose of the present study was to see the trend of use of warfarin in hospital admitted patients with atrial fibrillation. It was conducted in the department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2008 to January 2009. A total of 150 patients with atrial fibrillation were enrolled in this study. Out of them, male were 60(40%) and female 90(60%); age range 22-79 years. Most common presenting symptoms were palpitation (80%) & dyspnoea (70%). Chronic rheumatic heart disease (Mitral stenosis) (33%) was found in most cases followed by IHD (22%), hypertension (21%). According to CHADS₂ score, most of the patients belonged to moderate risk group (47%) and 32% in low risk group. Anticoagulation with warfarin was used in 40% cases of valvular AF & 25% patients with non valvular AF. Among non valvular AF, it was prescribed for 38% in high risk group, 34% in moderate risk & 3% in low risk group. The study states that warfarin is underused in both valvular & non valvular AF.

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

Aetiology and risk stratification of patients presenting with atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia in the World, occurring in approximately 0.4% of the general population. The purpose of the present study was to see the aetiology, presenting symptoms and risk stratification of hospital admitted patients with atrial fibrillation. It was conducted in the department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2008 to January 2009. A total of 100 patients with atrial fibrillation were enrolled in this study. Out of them, male were 40(40%) and female 60(60%); age range 22-79 years. Most common presenting symptoms were palpitation (80%) & dyspnoea (70%). Chronic rheumatic heart disease (CRHD) (63%) was found in most cases followed by IHD (13%), hypertension (11%). Among CRHD, mitral stenosis was 50%, and mixed mitral valve disease was 8%. Risk stratification of patients with AF for future thromboembolism revealed high risk factors were present in 60% cases, moderate in 25% cases, and weaker risk factors in 15% cases. According to CHADS2 score, most of the patients belonged to moderate risk group (47%) and 32% in low risk group. Chronic rheumatic heart disease is one of the major causes of atrial fibrillation in hospital admitted patients & risk stratification revealed that most of the patients were in risk for future stroke.