Arterial stiffness is an independent risk factor for cardiovascular disease. There are a number of techniques and devices that have been developed and utilized to capture the information pertaining to the elasticity of the blood vessel. Almost all the available indices of arterial stiffness are known to increase with advancing age and are elevated in the presence of hypertension and coronary heart disease. It is not known how closely these different measures of arterial stiffness are related to each other. Available evidence indicates that arterial stiffness indices that share a homogeneous methodology appear to demonstrate good correlations. However, there are no significant associations between some measures. These overall results may be surprising considering that all the indices are supposed to reflect the same property of the arterial wall (i.e., arterial elasticity). Interestingly, no or weak correlations between indices of vascular function are not confined only to arterial stiffness and can be extended to endothelial function and vascular reactivity measures.

Objective: Aim of our study is to analyze the surgical outcome of total laparoscopic hysterectomy (TLH) in our patient perspective of Apollo Hospitals Dhaka.Methods: This is a retrospective, observational study where we have reviewed demographic data, intraoperative and postoperative outcomes, and morbidity data on 100 women who underwent TLH between January 2011 and December 2012.Results: Total 100 patients were studied. Among them five patient required conversion to laparotomy due to presence of severe adhesion. The major and minor complication rates were 2% (bladder injury-2 cases) and 0% respectively. The average operating time was 148 ± 40 minutes and the mean length of hospital stay was 3±1 day. The average uterine size was 10 ± 4 weeks. In our cases operating time and duration of hospital stay were very similar with lower procedural complications to other published data elsewhere.Conclusion: We have observed that TLH is a safe and acceptable alternative procedure to standard hysterectomy from the patients perspective at Apollo Hospital Dhaka.Pulse Vol.8 January-December 2015 p.21-29

Health care delivery is no longer a simple process of examining the patient and giving him a prescription. Over the years there has been rapid expansion in the various branches of health care services. As part of this expansion process and explosion of scientific medical knowledge, laboratory diagnosis has gained tremendous importance in today’s practice. Especially in our country since the beginning of 80’s we have been witnessing significant growth in laboratory services. Through quality management process the laboratory can ensure that the result being issued by the laboratory is reliable to allow decisions to be taken with confidence. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. By utilizing quality control practices, a laboratory is able to find and correct flaws in the analytical processes of a lab before potentially incorrect patient results are released.Pulse Vol.8 January-December 2015 p.62-65

Age changes the vascular structure and function in the normal population, but it has a different effect on wave reflection and pulse wave transmission [1,2] .Many longitudinal studies have found that arterial stiffness measurement among hypertensive patients, diabetic patients, healthy elderly, and people with high cardiovascular (CV) risk will better evaluate arterial health and predict CV events.European guidance for arterial stiffness measurements described in the European consensus document (2006) [3] , the publication of the international reference standards (2010) [4] and the American Heart Association (AHA) scientific statement on arterial stiffness measurements in the USA (2015) have standardized arterial measurement [5] , and thus arterial stiffness measurements have been more widely used in clinical settings.The question now is which measurement of arterial stiffness is more accurate to precisely predict future CV events.Most of the guidelines designated aortic pulse wave velocity (PWV; carotid-femoral PWV) as the golden standard (especially in the Western society) [6] , but in Japan, where arterial stiffness is the most widely used and where they achieved a great amount of data on brachial-ankle PWV and cardio-ankle vascular index (CAVI) [7] , studies found a relationship between organ damage and future CV events.Townsend's [8] brief review on recommendations and standardization of PWV measurements also justified its clinical and scholarly use.The articles from Korea [9] and Thailand [10] describe CV risk factors and outcomes using the CAVI.The modified RAMA-EGAT score from Thailand combined the conventional risk prevention model with arterial function.It would be helpful to have age-and genderstratified values of the CAVI in healthy Koreans and in high-risk patients of a metabolically risky condition.The study from Thailand developed its own risk prediction model called the RAMA-EGAT score, which proved to be accurate in the prediction of CV risk in patients with intermediate atherosclerotic risk factors in the Thai population [11] , and a further modification of the RAMA-EGAT score with the CAVI enhanced its accuracy.Now they are conducting a long-term prognosis study in patients with diverse risk conditions.The Framingham-CAVI

Noninvasive vascular function measurement plays an important role in detecting early stages of atherosclerosis and in evaluating therapeutic responses. In this regard, recently, new vascular function measurements have been developed. These new measurements have been used to evaluate vascular function in coronary arteries, large aortic arteries, or peripheral arteries. Increasing vascular diameter represents vascular remodeling related to atherosclerosis. Attenuated vascular elasticity may be a reliable marker for atherosclerotic risk assessment. However, previous measurements for vascular diameter and vascular elasticity have been complex, operator-dependent, or invasive. Therefore, simple and reliable approaches have been sought. We recently developed a new automated oscillometric method to measure the estimated area (eA) of a brachial artery and its volume elastic modulus (V_E). In this review, we further report on this new measurement and other vascular measurements. We report on the reliability of the new automated oscillometric measurement of eA and V_E. Based on our findings, this measurement technique should be a reliable approach, and this modality may have practical application to automatically assess muscular artery diameter and elasticity in clinical or epidemiological settings. In this review, we report the characteristics of our new oscillometric measurements and other related vascular function measurements.

Despite improvements in hypertension awareness and treatment, the blood pressure (BP) control rate still remains at around 50%. One of the major determinants of low BP control results from therapeutic inertia of the physician and suboptimal compliance of the patients. Home BP self-measurement and monitoring improves patients' awareness and helps the management of hypertension. Recent technological advances are allowing for accurate measurement and telemonitoring of home BP, with a number of randomized clinical trials demonstrating the efficacy of telemonitoring for BP control. Home BP telemonitoring combined with self-adjustment based on prespecified treatment algorithms has been shown to improve BP control. Additionally, telemonitoring with active intervention by medical professionals has been shown to improve drug compliance and increase the target BP achievement rate. Although nothing can replace the tried and tested doctor-patient relationship in the office, telemonitoring of home BP will be an important tool for treating hypertension in the future.

Objective: To know effect of hematoma and perihematomal edema volume on Glasgow Coma Scale (GCS) at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage.Methods: this cross sectional study was conducted in Neurosurgery department, BSMMU to observe effect of hematoma and perihematomal edema volume on GCS at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage. The duration of study period was from November 2005 to April 2007.Results: a total 48 patients were included in the study and the variables that were analyzed included site of hematoma, volume of hematoma, perihematomal edema and the initial GCS score. Associations between the hematoma and perihematomal edema, site of hemorrhage and perihematomal edema, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission were evaluated. Level of consciousness (GCS) at the time of admission is the key factor in predicting outcome and neurological deterioration. In our study we found significant association between- hematoma and perihematomal edema volume, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission. But there was no significant association found between hemorrhage site and perihematomal edema.Conclusion: more the volume of hematoma more was the volume of perihematomal edema. More the volume of hematoma less was the GCS. More the volume of perihematomal edema less was the GCS. But we found no significant association between site of hemorrhage and perihematomal edema volume. GCS is an established predictor of outcome in patients with SICH (spontaneous intracerebral hemorrhage). Accurate prediction of the outcome in ICH patients is important for several reasons: a reliable prognosis must be given to patient and relatives as soon as possible, realistic rehabilitation goals should be set and resources should be allocated in the most efficient way.Pulse Vol.7 January-December 2014 p.22-28