Heart in Heart: A Case Report of Giant Left Atrial Appendage Aneurysm

Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly. The cause mostly due to congenital, but can be acquired also. Patient may remain asymptomatic or may present with variable symptom. It can predispose to hazardous adverse events, including atrial fibrillation, myocardial infarction, cardiac dysfunction and life-threatening systemic thromboembolism. Simple imaging, electrocardiography and echocardiography can diagnose this rare cardiac anomaly. We are reporting a case who presented to us at 5 years of age with palpitation, chest pain and dizziness with arrythmia that developed one month back; he visited our outpatient department of the National Heart Foundation Hospital & Research Institute Hospital, Dhaka, Bangladesh on 13th February 2020. We diagnosed left atrial appendage aneurysm with mitral valve prolapse with atrial arrhythmia thereafter surgical resection of aneurysmal part along with mitral valve annuloplasty done by mid sternotomy and maze therapy. Postoperative period was uneventful and discharged after 6th post operative day.

Cross-Sectional Analytic Study to Compare the Efficacy Between of Clinical Skill Learning (CSL) and Multimedia Lecture as Teaching Tool in Case of Endotracheal Intubation

Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.

Electrostatic rogue waves in double pair plasmas

A nonlinear Schrödinger equation is derived to investigate the modulational instability of ion-acoustic (IA) waves (IAWs) in a double pair plasma system containing adiabatic positive and negative ion fluids along with super-thermal electrons and positrons. The analytical analysis predicts two types of modes, viz., fast ( ω f ) and slow ( ω s ) IA modes. The possible stable and unstable parametric regions for the IAWs in the presence of external perturbation can be observed for both ω f and ω s . The number density of the negative ions and positrons plays a vital role in generating the IA rogue waves in the modulationally unstable region. The applications of our present work in astrophysical environments [viz., D-region (H + , O 2 - ) and F-region (H + , H - ) of the Earth's ionosphere] and in laboratory plasmas [viz., pair-ion fullerene (C + , C - )] are pinpointed.

Heavy ion-acoustic rogue waves in electron-positron multi-ion plasmas

The nonlinear propagation of heavy-ion-acoustic (HIA) waves (HIAWs) in a four-component multi-ion plasma (containing inertial heavy negative ions and light positive ions, as well as inertialess nonextensive electrons and positrons) has been theoretically investigated. The nonlinear Schrödinger (NLS) equation is derived by employing the reductive perturbation method. It is found that the NLS equation leads to the modulational instability (MI) of HIAWs, and to the formation of HIA rogue waves (HIARWs), which are due to the effects of nonlinearity and dispersion in the propagation of HIAWs. The conditions for the MI of HIAWs and the basic properties of the generated HIARWs are identified. It is observed that the striking features (viz., instability criteria, growth rate of MI, amplitude and width of HIARWs, etc.) of the HIAWs are significantly modified by the effects of nonextensivity of electrons and positrons, the ratio of light positive ion mass to heavy negative ion mass, the ratio of electron number density to light positive ion number density, the ratio of electron temperature to positron temperature, etc. The relevancy of our present investigation to the observations in space (viz., cometary comae and earth's ionosphere) and laboratory (viz., solid-high intense laser plasma interaction experiments) plasmas is pointed out.

Pattern of congenital heart diseases

This prospective observational study was done to find out the frequency of various forms of congenital heart disease (CHD) diagnosed by echocardiography. During the study period (January 2002 to December 2005) 2050 patients were screened by echocardiography. All patients were evaluated by cardiologists and had chest radiograph, electrocardiogram and echocardiography. Total 2050 patients were studied and among them 1071 had congenital heart disease. Male was 561(52.38%) and female was 510(47.62%). Atrial septal defect (ASD) was 374(34.92%), ventricular septal defect (VSD) was 318(29.69%), patent ductus arteriosus (PDA) 83(7.75%), pulmonary stenosis (PS) 58(5.42%), tetralogy of Fallot 162(15.13%), transposition of great vessels (TGA) 16(1.49%), Ebstein anomaly 5(0.4%), coarctation of aorta 1(0.09%) and single ventricle 2(0.19%). This distribution is more or less similar to that reported in studies at home and abroad. In this study atrial septal defect (ASD) was the commonest in acyanotic CHD and tetralogy of Fallot was the commonest cyanotic CHD.

Indoor air pollution and its impact on children under five years old in Bangladesh

Indoor air concentrations of volatile organic compounds (VOCs), carbon monoxide (CO), carbon dioxide (CO2), nitrogen dioxide (NO2), and dust particles were measured for 49 biomass and 46 fossil fuel users in urban slums of Dhaka, Bangladesh. The health impacts of these pollutants were assessed on 65 and 51 children under five years old from families who use biomass and fossil fuel as main source of energy, respectively. Mean concentrations of CO were found to be significantly higher in biomass fuel users (P = 0.010), while geometric mean concentrations of benzene, xylene, toluene, hexane, total VOCs, and NO2 were significantly higher (P < 0.01) in the fossil fuel users. Symptoms such as redness of eyes, itching of skin, nasal discharge, cough, shortness of breath, chest tightness, wheezing, or whistling chest were found to be associated with the choice of biomass fuel, with the odds ratio ranging from 4.0 to 6.3. No significant association of use of biomass fuel with respiratory diseases, eczema, diarrhea, or viral fever was observed after adjustment for potential confounders. These results suggest a significant association between the biomass fuel-using population and respiratory symptoms. These symptoms may not be due to the pollutants only, as some other underlying causes may be present.

PRACTICAL IMPLICATIONS

The health of children under five years old in Bangladesh, especially those living in poor socioeconomic conditions, is considered to be worsening because of indoor air pollution. It is commonly suggested that biomass fuel should be replaced by fossil fuel, as pollution levels are believed to be higher with biomass fuel. Our findings, however, suggest that pollution can be higher with fossil fuels, and indicate that a switch in fuel from biomass to fossil does not necessarily improve the children's health. Awareness programs should therefore be undertaken to avoid the unnecessary use of gas. Clean fuels and clean stoves should also be ensured to reduce emissions of indoor air pollutants.

Does rheumatic fever occur usually between the ages of 5 and 15 years?

It has long been considered that rheumatic fever usually occurs in children between the ages of 5 and 15 years. However, supporting data from the developing countries are insufficient. It is important to know the age of occurrence of rheumatic fever for clinical and public health purposes. To describe the age distribution of Bangladeshi subjects, we have reviewed the records of all patients who attended with acute rheumatic fever in the outpatient department of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, during June 1990 through November 1995. During this period 630 subjects were diagnosed to have acute rheumatic fever defined by the revised Jones criteria. Of them, 535 (84.9%) presented with first attack. Their age ranged from 3 to 30 years, and a skewness to the right of the age distribution was observed. Thus, we used percentile distribution to determine reference range of age. The 2.5 and 97.5 percentiles were 5 and 22 years, respectively. Their mean (standard deviation) and median age were 12.7 (4.4) and 12 years, respectively. Slightly more than 22% of subjects were older than 15 while less than 1% were younger than 5 years. This finding was supported by multiethnic data from other developing countries. The current analysis warrants reevaluation of the prevailing conviction for age of occurrence of rheumatic fever. In conclusion, the age reference range for occurrence of rheumatic fever in Bangladesh should be considered to be 5 to 22 years but not 5 to 15 years.

Decomposition analysis of binary polyfunctional urethane monomer mixtures

Thermal decomposition in three binary monomer mixture systems containing an experimentally synthesized monomer (EXP3) and a commercial polyfunctional urethane monomer (U-4TXA) was examined in terms of differential thermal analysis (DTA) and simultaneous thermogravimetry (TG) analysis when a sample was heated to 800 degrees C. The binary EXP3/U-4TXA monomer mixtures were visible light-cured (VLC) resins which included CQ (camphorquinone=0.5 wt%) and DMAEMA (dimethylaminoethyl methacrylate=0.5 wt%) as the photoinitiator. Their DTA curves showed that thermal decomposition initiated at around 300 degrees C and finished at around 500 degrees C. TG curves showed complete weight loss at 800 degrees C during thermally induced decomposition: the decomposition reaction at weight losses of 5 to 50% was calculated from the slope of the (1/T) versus log10(Hr) diagram, because the exothermic decomposition temperature shown on DTA curves increased with increasing heating rate from 2 to 20 degrees C/min. Thermal decomposition analysis showed that a decomposition with weight change had exothermic heats ranging from 0.38 to 1.07 kJ/g for the EXP U1 mixture, 1.06 to 1.76 kJ/g for EXP U2 and 1.74 to 2.02 kJ/g for EXP U3. Activation energy ranged from 1.42 to 1.89 kJ/mol at weight losses of 5 to 50% in the three binary EXP3/U-4TXA monomer mixture systems.

Dental application of binary urethane monomer mixtures:strengthened resin matrix

The strengthened resin matrices in six experimental binary visible light-cured (VLC) urethane monomer mixtures were examined in terms of mechanical strength. A 60 wt% bis-GMA/40 wt% binary monomer mixture was used as a control sample. A dry state (1 day in air at 37 degrees C) and a wet state by immersion in distilled water (7 and 30 days at 37 degrees C) were investigated. The compressive strength and diametral tensile strength of urethane monomer samples had values equivalent to, or greater than those of a control sample in the dry state, but had increased values in the wet state. The nano-indentation hardness values in experimental urethane monomer mixtures were greater than that in a control sample in the dry state, showing that immersion in water gave increased strength (maximum increase was about 2.5 times) in six binary urethane monomer mixtures. The compressive strength of the samples in the dry and wet states exhibited linearly increasing elastic modulus values for the resin matrix in the range about 50 to 2600 MPa. The toughened resin matrix had smaller amounts of residual monomer in the urethane monomer mixtures (0.41 to 5.03 wt%) compared with that of the binary 60bis-GMA/40TEGDMA mixture (0.71 to 6.26 wt%). This study has revealed that resin matrices are strengthened by the use of four-functional urethane monomers in experimental binary urethane monomer mixtures.

Complement-inhibiting activity of human seminal plasma and semen quality

Human seminal plasma (SP) contains potent complement inhibitors. This study examined the complement-inhibiting activity of individual SP samples from 118 patients with infertility and analyzed them in relation to various semen parameters. When 25% complement-inhibiting activity was considered the cut off value, less than 1 SD unit from the mean percentage of inhibition of SP samples with normal semen quality, 32 samples (27%) showed low inhibiting activity. Among the lower group, incidences of patients with asthenozoospermia (66%) and oligozoospermia (31%) were significantly (p < .01) higher than those (36 and 10%) in the group whose SP showed significant inhibiting activity. Partial characterization revealed that the component responsible for complement inhibition was heat labile, trypsin resistant, high molecular weight (>10 kD) glycoprotein that can inhibit alternative as well as classical complement pathways. Furthermore, since in the majority of SP samples the anticomplementary activity was blocked by monoclonal antibody against membrane cofactor protein (MCP) or decay accelerating factor (DAF), the complement-inhibiting factors that were identified are likely to be MCP and/or DAF, which are known to be present in human SP. These results suggest that complement-regulatory proteins in SP such as MCP and DAF may protect sperm cells against complement attack in the male reproductive tract.

Study of complications in hypertensive patients having irregular treatment

One hundred cases of hypertensive complications due to irregular drug-therapy were studied in medicine units of Dhaka Medical College Hospital for the period of one year from February 7, 1989 to February 6, 1990. Among those stroke had headed the list (48%) manifesting in various ways e.g. cerebral haemorrhage with focal neurological signs--hemiplegia, hemiperesis, aphasia etc. Hypertension associated with varying degrees of cardiac ischaemias and heart failure was seen in 14% and 10% cases respectively. Highest incidence of complications was seen in 1-5 years after detection of hypertension with mean age of 55 +/- 18.70 years. Out of 48 cases of strokes, smoker were 41 (75.92%). Regarding reasons of noncompliance of drugs, personal carelessness was the prominent one (47%). Among the risk-factors for atherosclerosis family history tops the list (66%). Diabetes coexists with hypertension in 13% cases. Ocular complications were seen in 06% cases of malignant hypertension with variable retinal changes.

Metabolic and hormonal profile of the offsprings of conjugal diabetics

Oral glucose tolerance response to blood glucose, serum immunoreactive insulin (IRI) and plasma free fatty acid (FFA) levels were studied on 159 offsprings of both parent diabetics (connubials). Fasting serum cholesterol, triglyceride, phospholipid and total lipids were also measured in these subjects. We detected 6 diabetics out of 159 connubials at the time of our study. FFA level in 6 diabetic connubials were higher all time intervals than 153 non-diabetics connubials. Fasting and one hour post glucose response were less in 6 diabetic connubial but two hours post glucose IRI response to both 6 diabetic connubials and 153 non-diabetic connubials were same indicating a delayed insulin secretion in response to oral glucose level in 6 diabetic connubials.

Hypertension in Secretariate population of Bangladesh

A total of 8,172 persons constituting 98.6% of the total Secretariate Population of Bangladesh were screened for elevated blood pressure. One thousand and ninety cases (13.3%) showed diastolic blood pressure of 90 mmHg or above. Those with diastolic blood pressure of 95 or above constituted 3.7% of the population. More than two-thirds of the latter group (71.6%) remained undetected indicating that vast majority of our hypertensive population remains undiagnosed and untreated. It is recommended that the misconception regarding symptomatic hypertenson should be removed by adequate emphasis on the preventive value of the control of hypertension on cardiovascular and cerebrovascular complication. A plea has also been made for a large-scale survey to determine the extent of the problem in Bangladesh.

Mebendazole and pyrantel pamoate as broad-spectrum anthelmintics

The efficacy of mebendazole and pyrantel pamoate was studied in two groups of 59 and 58 cases, respectively, of patients with polyparasitosis. Mebendazole had a cure rate of 96%, 82.2%, 71.4% and 66.6% in A. lumbricoides, hookworm, T. trichiura and S. stercoralis, respectively, while the corresponding figures for pyrantel pamoate were 92.6%, 85.7%, 19.4% and 0%. Pyrantel pamoate is considered to have no significant effect on T. trichiura and S. stercoralis. None of the drugs had any effect on T. saginata. Both drugs have been found to be equally effective against enterobiasis by various authors. It is recommended that pyrantel pamoate be the drug of choice in cases of multiple parasitic infections excluding T. trichiura and S. stercoralis whereas those with one or both of these in addition to others should be treated with mebendazole. Mebendazole can be prescribed for patients with clinical evidence of helminthic infections even where stool examination is not possible as it covers almost the whole range of common helminthic infections. The only limitation for poorer patients however is its cost. Pyrantel pamoate has a wider applicability for the poorer patients in spite of the fact that it is ineffective against trichurids and S. stercoralis.