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Pesantren that live in the midst of society certainly have a great influence on people's lives. In Law no. 18 of 2019 concerning pesantren that there are three roles of pesantren in the implementation of educational functions, da'wah functions and community empowerment functions. Pesantren with its business entities certainly provide great opportunities and become a forum for community empowerment. The success of this empowerment affects the improvement of people's living standards and can even realize welfare through the roles of pesantren. However, there are several problems experienced such as low human resources, low income, there are some pesantren businesses that are not developing. Therefore, it is necessary to design a strategy to compile a business design systematically balanced with mentoring, training and evaluation. This research uses a qualitative approach with a phenomenological type of research location in a business entity owned by the Salafiyah Syafi'iyah Sukorejo Islamic boarding school, Banyuputih District, Situbondo Regency. Data collection is done through interviews, conservation and documentation. The results of this study show that the strategy of economic empowerment of pesantren in pesantren-owned enterprises is carried out with three strategies including: strategy formulation, strategy implementation, and strategy evaluation. Strategy formulation includes: first, formulation of policy direction for economic development of pesantren. [ABSTRACT FROM AUTHOR]

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]

Tetralogy of Fallot (TOF) is a complex cyanotic congenital heart disease with a survival beyond middle age. Rheumatic and congenital cyanotic heart disease are common causes of hospital admission. However, coexistence of rheumatic heart disease with complex congenital heart disease like TOF is known to occur very rarely. This report presents a case of rheumatic valvular heart disease (AR & MR) with a complex congenital heart disease (TOF with PDA with PLSVC) in a 30 yrs old female. Patient was treated by conservative management and advised for corrective surgery and double valve replacement. [ABSTRACT FROM AUTHOR]

With the advent of next-generation sequencing approaches, there has been a renaissance in the microbiome field. Microbial taxonomy and function can now be characterized relatively easily and rapidly-no longer mandating complex culturing approaches. With this renaissance, there is now a strong and growing appreciation for the role of the microbiome (referring to microbes and their genomes) in modulating many facets of physiology-including overall immunity. This is particularly true of the gut microbiome, and there is now an evolving body of the literature demonstrating a role for gut microbes in modulating responses to cancer treatment-particularly immunotherapy. Gut microbes can modulate immunity and anti-tumor responses via a number of different interactions, and these will be discussed herein. Additionally, data regarding the impact of gut microbes on cancer immunotherapy response will be discussed, as will strategies to manipulate the microbiome to enhance therapeutic responses. These efforts to date are not completely optimized; however, there is evidence of efficacy though much additional work is needed in this space. Nonetheless, it is clear that the microbiome plays a central role in health and disease, and strategies to manipulate it in cancer and overall precision health are being explored. [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: Coronary artery disease is the commonest form of heart disease and the leading cause of morbidity and mortality throughout the world. Electrolytes imbalance can lead to increase in hospital mortality and morbidity in acute coronary syndrome patients. Our objective was to find out and to compare in-hospital outcome of patients presenting with acute coronary syndrome with or without onadmission hyponatremia. Methods: A total of 336 patients were included in this study of which 59 patients were in group A (sodium level <135 mmol/l). Group A was subdivided in Group A1 (Na+-134-130mmol/l), Group A2 (Na+-120-129mmol/l), Group A3 (Na+-<120mmol/l) and 277 patients were in group B (sodium level >135 mmol/l). Results: On-admission hyponatremia was documented in 16.12 %(59) of patients with acute coronary syndrome. Among them, 16 patients with acute anterior STEMI, 19 patients with acute inferior STEMI, 19 patients with NSTEMI and 5 patients with unstable angina. In this study, in hospital complications like acute heart failure (81.4% vs. 29.2%, p<0.05), cardiogenic shock (32.2% vs. 15.5%, p<0.05) and in hospital mortality (6.8% vs. 1.1%, p<0.05) were significantly more in the patients with hyponatremia. The frequency of in hospital mortality, acute heart failure and arrhythmia progressively increased with increasing severity of hyponatremia. Logistic regression analysis showed low plasma sodium level was independently associated with in hospital mortality (â =2.13, P =0.027, OR = 8.388, 95% CI 1.268 - 55.488). Conclusion: In this study on-admission hyponatremia significantly associated with high in-hospital adverse outcome in acute coronary syndrome patients. [ABSTRACT FROM AUTHOR]

Background: Patients with acute anterior ST-segment elevation myocardial infarction (STEMI) and right bundle-branch block (RBBB) have high mortality risk, which may be stratified by early ECG changes. Our objective was to find out and to compare in-hospital outcome of patients presenting with acute anterior STEMI with or without complete RBBB. Methods: This prospective cohort study was conducted in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, over a period of one year from March 2016 to February 2017. A total of 184 patients were included in this study of which 32 patients were included in group A (acute anterior STEMI with complete RBBB) and 152 patients were included in group B (acute anterior STEMI without any BBB or fascicular block). Results: RBBB was documented in 17.4% (32) of patients with acute anterior STEMI. Acute LVF (50.0% vs. 26.3%, p<0.05), Cardiogenic shock (31.3% vs. 13.2%, p<0.05) and mortality (21.9% vs 7.9%, P<0.05) were more frequently observed in patients with complete RBBB in comparison to patients without any BBB or fascicular block (FB). Among the AMI patients with RBBB, permanent RBBB was associated with a greater incidence of acute LVF (54.2% vs 37.5%, p>0.05), cardiogenic shock (37.5% vs 12.5%, p>0.05) and mortality (25% vs 12.5%, p>0.05). Conclusion: In this study right bundle branch block accompanying acute anterior STEMI was associated with high in-hospital adverse outcomes. [ABSTRACT FROM AUTHOR]

Understanding the concept of halal tayyiban is a predictor of consumer attitudes towards halal cosmetics so that this attitude can influence the intention to purchase halal cosmetics. In addition, it is important for producers to include halal certification/logos because both Muslim and non-Muslim consumers perceive halalcertified products as tastier, more hygienic and safer. So this shows that the more confident consumers are about the halalness of the product, the greater the consumer's liking (preference) for the product. The research stages in this journal began by distributing questionnaires directly to halal cosmetics consumers at Roxy Square Jember. The number of indicators in this research was 24 so that a sample of 120 respondents was obtained. The sampling method used in this research is non-probability sampling. Sampling used an incidental sampling approach. Data obtained from the results of distributing questionnaires will be processed and presented in quantitative form. The steps taken to convert questionnaire data into quantitative data are by giving a value to each item answered by the respondent [ABSTRACT FROM AUTHOR]

Background: In Bangladesh, each emergency physician faces amitriptyline overdose nearly a day. An acute cardiovascular complication, one of the worst complications is mainly responsible for the mortality in tricyclic overdose. Recently, we managed ventricular tachycardia in a young female presented with an impaired consciousness 10 h after intentionally ingesting 2500 mg amitriptyline. Here, we report it, discuss how the electrocardiography is vital to acknowledge and predict it and its' complications and also the recent update of the management of it. Case presentation: A young married Bangladeshi-Bengali girl, 25-year-old, having a history of disharmony with her husband, came with an impaired consciousness after intentionally ingesting 2500 mg amitriptyline about 10 h before arrival. There was blood pressure 140/80 mmHg, heart rate 140 beats-per-min, temperature 103 ±F, Glasgow coma scale 10/15, wide complex tachycardia with QRS duration of 178 ms in electrocardiography, blood pH 7.36. Initially, treated with 100 ml 8.4% sodium bicarbonate. After that, QRS duration came to 100 ms in electrocardiography within 10 min of infusion. To maintain the pH 7.50-7.55 over the next 24 h, the infusion of 8.4% sodium bicarbonate consisting of 125 ml dissolved in 375 ml normal saline was started and titrated according to the arterial blood gas analysis. Hence, a total dose of 600 mmol sodium bicarbonate was given over next 24 h. In addition to this, gave a 500 ml intravenous lipid emulsion over 2 h after 24 h of admission as she did not regain her consciousness completely. Afterward, she became conscious, though, in electrocardiography, ST/T wave abnormality persisted. So that, we tapered sodium bicarbonate infusion slowly and stopped it later. At the time of discharge, she was by heart rate 124/min, QRS duration 90 ms in electrocardiogram along with other normal vital signs. Conclusion: Diagnosis of amitriptyline-induced ventricular tachycardia is difficult when there is no history of an overdose obtained. Nevertheless, it should be performed in the clinical background and classic electrocardiographic changes and wise utilization of sodium bicarbonate, intravenous lipid emulsion, and anti-arrhythmic drugs may save a life. [ABSTRACT FROM AUTHOR]

Background: Evidences suggest that heavy physical exertion can trigger the onset of acute myocardial infarction. But there have been no clean cut data in Bangladesh about the risk of myocardial infarction during and after heavy exertion. To address this question the study was conducted. Methods: It was a multicentre cross sectional study was conducted from July 2012 to June 2013 with patient of diagnosed acute myocardial infarction (AMI) admitted in department of cardiology of National Institute of Cardiovascular Diseases (NICVD), Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH). From selected samples, two hours activity prior to onset of symptom of AMI was asked according to standard questionnaire. Activities were quantified on a scale from 1 to 8 metabolic equivalents (METs) according to generally accepted values. Collected data were analyzed by SPSS version 16. Results: In this study 246 patients (74 .4 percent of whom were men; mean age [±SD], 64.68 ± 7.63 years) were interviewed. The study showed that 11.38% patients were engaged in strenuous physical exertion (e" 6 METs) within two hours prior to symptom onset of AMI. Strenuous exertion group of AMI patients were all most all sedentary worker [26 (92.86%) of 28]. Most of the patients (82.14 %) of strenuous group had history of less than 8 hours work per day. Strenuous exertion group had history of longtime exertion (72.57%, 1-2 hours) than non-strenuous group (42.66%, <0.5 hours). Moreover, 67.86% AMI patients of strenuous exertion group had experienced irregular exertion whereas most of the patients (64.22%) of non strenuous group had a history of regular exertion. Conclusions: The result of the study indicates that a period of strenuous physical activity is associated with increased risk of having AMI, particularly among patients of sedentary worker who have dyslipidemia and who exercise irregularly. Those who exercise regularly have lower chances of AMI as shown by the negative correlation. [ABSTRACT FROM AUTHOR]

Background: Hyperhomocysteinemia is known as an independent risk factor of atherosclerosis. But the probable role of Hyperhomocysteinemia in Premature Coronary Artery Disease (CAD) is not well studied. The aim of this study was to assess the role of serum homocysteine on angiographically documented CAD in younger and older ischaemic heart disease (IHD) patients. Methods: Total 120 patients with IHD admitted in the Department of Cardiology, Dhaka Medical College Hospital for CAG were selected by purposive sampling method and divided into two groups. 60 patients in Group-I, d" 40 years of age (Younger); 60 patients in Group-II, >40 years of age (Older). Homocysteine was measured in all patients and other demographical and clinical data were collected. Homocysteine level was correlated with the presence and severity of CAD. Results: Smoking, positive family history of IHD, dyslipidaemia and hyper homocysteinemia were important risk factors in younger IHD patients. Whereas, hypertension, diabetes mellitus and dyslipidaemia were important cardiovascular risk factors in older age group. Obesity was not an important risk factors as evidenced by mean BMI. Serum homocysteine was not well related to presence of CAD or extent of CAD in older IHD patients. However in younger patients hyperhomocysteinemia was related to both presence and severity of CAD. Conclusion: In younger IHD patients hyperhomocysteinemia is an important cardiovascular risk factor. But in older patients it loses its significance. So serum homocysteine level should be screened routinely in younger IHD patients. [ABSTRACT FROM AUTHOR]

Atrial infarction is a very rare diagnosis. Though available literature suggests, the condition per se may have been not so rare. Over the past few decades, atrial infarction have been reported several times, even some case series have been reported, but there is no consensus on the diagnosis of this condition, and its true importance also has not been understood completely. Previous works have shown that this condition is associated with several serious complications; hence recognition of this condition in early period is important, which is at the same time not so easy due to subtlety of the known features and less availability of information. We report a case of 70 year old Muslim, Bengali, male suffering from acute coronary syndrome, in whom, right atrial infarction was recognized by electrographic features, which is very rarely diagnosed with confidence in ante-mortem patients. Since, in Bangladesh, post-mortem autopsy to find out causes behind cardiac death is not done routinely and in the light of possibility of serious life-threatening complications, ante-mortem diagnosis of atrial infarction is necessary. So, Cardiologists should be aware of this uncommon condition. [ABSTRACT FROM AUTHOR]

Every one of us has heard about tragic and sudden death of a healthy young person and which is often stated as 'inexplicable'. The current case report focuses on a 20 year old young man with hypertrophic cardiomyopathy facing premature death with history of similar sudden premature death of his grandmother, father and brother. Hypertrophic cardiomyopathy is the commonest cause of sudden cardiac death in young adults and is also an important substrate for heart failure disability at any age. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome is a cardiac emergency. It is increasingly common in younger peoples. Management of elderly peoples is difficult due to their associated comorbidity. This study tried to compare the in-hospital outcome of the younger and older patients with acute coronary syndrome. Methods: The study was a comparative cross sectional study. Clinical and biochemical evaluation was done in hospital settings. A total number of 120 patients were included in the study and divided into two groups according to distribution of age. In group I there were elderly groups of aged >60 yrs. and in group II there were patients within the age 40 to 60 yrs. All the data were collected systematically in a preformed data collection form. Results: Group I populations had more in hospital stay and more complications than group II. Conclusion: The study revealed significant association with age and outcome of Acute coronary syndrome patients. Complications of acute coronary syndrome increase as the age of the patients increases. [ABSTRACT FROM AUTHOR]

Background: Due to socio-economic improvement and changes in the life style, ischeamic heart disease is becoming a major burden to our health care system. In recent years, the incidence is increasing among younger age groups as well. Methods: A total of 120 patients with ischeamic heart disease admitted for coronary angiogram were included in the study and were divided into two groups. Among them, 60 younger patients were in Group-I (d" 40 years of age); 60 older patients in Group-II (>40 years of age). We compared demographic profiles, different risk factors and angiographic profiles between two age groups. Results: Among the common risk factors, smoking (63.3% vs 40%, p=0.011) & family history of ischeamic heart disease (21.7% vs 8.3%, p=0.040) were more common in younger group. Whereas, hypertension (41.7% vs 65.0%, p=0.010) and DM (18.3% vs 36.7%, p=0.024) were more common in older patients. Serum Homocysteine level was found significantly higher in younger patients (30.0% vs 13.3%, p=0.026). In group-I. coronary angiography revealed normal coronaries in 15 patients (25%), single vessel disease in 29 (48.3%) and multi-vessel disease in 16 patients (26.6%). Whereas, 40(66.6%) patients in group-II were found to have multi-vessel disease and 2 of them had significant left main coronary disease. However, young patients who had high serum homocysteine level showed more angiographic severity than older patients. Conclusion: There are significant differences in the clinical, biochemical and angiographic profile of young patients with ischeamic heart disease as compared to older patients. Young patients with ischeamic heart disease has got less angiographic severity, except in those with high serum homocysteine level. [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 Graves' disease, a well-known cause of hyperthyroidism, is an autoimmune disease with multi-system involvement. More prevalent among young women, it appears as an uncommon cardiovascular complication during pregnancy, posing a diagnostic challenge, largely owing to difficulty in detecting the complication, as a result of a low index of suspicion of Graves' disease presenting during pregnancy. Globally, cardiovascular disease is an important factor for pregnancy-related morbidity and mortality. Here, we report a case of Graves' disease detected for the first time in pregnancy, in a patient presenting with bi- ventricular heart failure, severe pulmonary hypertension and pre- eclampsia. Emphasis is placed on the spectrum of clinical presentations of Graves' disease, and the importance of considering this thyroid disorder as a possible aetiological factor for such a presentation in pregnancy. Case presentation A 30-year-old Bangladeshi-Bengali woman, in her 28th week of pregnancy presented with severe systemic hypertension, bi-ventricular heart failure and severe pulmonary hypertension with a moderately enlarged thyroid gland. She improved following the administration of high dose intravenous diuretics, and delivered a premature female baby of low birth weight per vaginally, twenty four hours later. Pre-eclampsia was diagnosed on the basis of hypertension first detected in the third trimester, 3+ oedema and mild proteinuria. Electrocardiography revealed sinus tachycardia with incomplete right bundle branch block and echocardiography showed severe pulmonary hypertension with an estimated pulmonary arterial systolic pressure of 73 mm Hg, septal and anterior wall hypokinesia with an ejection fraction of 51%, grade I mitral and tricuspid regurgitation. Thyroid function tests revealed a biochemically hyperthyroid state and positive anti- thyroid peroxidase antibodies was found. 99mTechnetium pertechnetate thyroid scans demonstrated diffuse toxic goiter as evidenced by an enlarged thyroid gland with intense radiotracer concentration all over the gland. The clinical and biochemical findings confirmed the diagnosis of Graves' disease. Conclusions Graves' disease is an uncommon cause of bi-ventricular heart failure and severe pulmonary hypertension in pregnancy, and a high index of clinical suspicion is paramount to its effective diagnosis and treatment. [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]

Background: Takayasu Arteritis is a vasculitis occurring mostly in young females which may present in diverse ways. Here we report a teenager with Takayasu Arteritis who presented with uncontrolled hypertension. This case depicts an atypical presentation of this disease where the girl visited many physicians for controlling the level of hypertension and put a diagnostic dilemma about the underlying etiology of young hypertension. Case presentation: A 13 year old girl presented with epistaxis, persistent headache and uncontrolled hypertension. Her clinical examination revealed normal radial, very feeble femoral and absent other lower limb pulses. There was a blood pressure discrepancy of 50/40 mm of Hg between two arms. There were bruits over multiple areas including the abdominal aorta. She had features of left ventricular hypertrophy. Her Arch aortogram showed hugely dilated arch of aorta which became abruptly normal just after origin of left subclavian artery. There was ostio-proximal stenosis of right bracheocephalic artery, left common carotid and left subclavian artery with post stenotic dilatation of all the vessels. Abdominal aortogram revealed critical stenosis of abdominal aorta above the origin of renal arteries with a pressure gradient of 80/11 mm of Hg. Conclusion: Takayasu's Arteritis should also be kept in mind while searching for the cause of uncontrolled hypertension in the young age group. [ABSTRACT FROM AUTHOR]

Objectives To assess whether assistance with and/or advice on the UK Universities & Colleges Admissions Service (UCAS) application process by undergraduate medical and dental students increases the offer rate to applicants from educational institutions situated in areas of socio-economic deprivation for medical and dental courses. Methods A sample of 42 students making 172 applications in 2001 and another sample of 40 students making 158 applications in 2002 from 4 further education and sixth form colleges across East London were entered into the study. Applicants were either offered advice and assistance with writing their personal statement and extra curricular activities, such as work experience (group A) or advice only on the importance of the personal statement and extra curricular activities (group B). Applicants were also assisted with or advised to submit their applications early. All applicants were offered mock interviews. Main outcome measures The number of offers made to applicants by medical and dental schools and the dates of offered interviews. Results The total offer rate rose from 9% (preceding 4 years) to 38% (CI 25–51%, P < 0.05) in 2001 and 44% (CI 27–61%, P < 0.05) in 2002, confirming a rising trend in offers to applicants in group A. Applicants who were only advised on the importance of the personal statement and extra curricular activities (group B) showed smaller increases, ranging from 10% to 29% for 2001 and from 28% to 37% for 2002. The dates for the offered interviews were earlier in group A than group B. Conclusions Undergraduate students can help applicants to medical and dental schools from socio-economically deprived areas submit earlier, improved UCAS applications and provide interview practice, all of which are associated with a higher offer rate. Applicants benefit from advice on activities such as work experience, community work and personal interests, but assistance in organising such activities increases the offer rate more. The study was conducted during a period of time when there was an increase in the number of medical school places available. Therefore, more research is needed to confirm that such assistance can increase applicants' offer rates elsewhere, particularly applications from students who traditionally would not apply for medicine or dentistry. [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]

Burkholderia pseudomallei is a Gram-negative bacterium found in soil and the causative agent of a severe disease in humans and animals known as melioidosis. It is intrinsically resistant to many antibiotics and has been reported resistant to the drugs of choice; ceftazidime. Microbial communities in soil in the presence and absence of B. pseudomallei were investigated using metagenomics approach. The variation in bacterial species diversity was significantly higher in soil samples without B. pseudomallei. Abundances of phyla Actinobacteria and Firmicutes were found significantly higher in B. pseudomallei-negative soils. Bacillus amyloliquefaciens KKU1 in phylum Firmicutes was discovered from negative soil and its secondary metabolites could inhibit clinical, environmental and drug resistant isolates of B. pseudomallei, together with some pathogenic Gram-negative but not Gram-positive bacteria. The antimicrobial activity from KKU 1 against B. pseudomallei was abolished when treated with proteinase K, stable in a wide range of pH and remained active after heating at 100 °C for 15 min. Precipitated proteins from KKU1 were demonstrated to cause lysis and corrugated surfaces of B. pseudomallei. The minimum inhibitory concentrations and minimum bactericidal concentrations of the precipitated proteins from KKU1 against B. pseudomallei were 0.97 μg/ml and 3.9 μg/ml. Interestingly, Native SDS-PAGE showed small active compounds of less than 6 kDa, along with other information collectively suggesting the properties of antimicrobial peptides. For the first time, culture-independent information in melioidosis endemic area could lead to a suspected source of metabolites that may help defense against B. pseudomallei and other pathogenic Gram-negative bacteria. [ABSTRACT FROM AUTHOR]

This study examined the potential for green microalgae to produce lipid that could be used for biodiesel production from wastewater substrate. Green microalgae has the potential to be used in the production of biodiesel because it accumulates 5.3211 g of lipid in 39.2246 g of centrifuged and oven-dried algae biomass, accounting for 13.57% of its dry cellular weight. This was obtained with wastewater substrate under open-culture growth conditions. The wastewater substrate contained phosphate, nitrate, nitrite, ammonia, and sulfate at relatively optimal concentrations for culturing algae. The algae assimilated 95% of these nutrients on average for growth until the stationary phase was reached in 13 days. The most rapid cell doubling time observed was 192 h, and the maximum biomass production rate observed was 0.00057 mg/mg/day, reaching a peak algae weight fraction of 0.00926 mg/mg in 13 days. This study also examined and presented the scale-up of growing green microalgae in an open raceway culture system for obtaining maximum lipid yield from a wastewater substrate. The cost-benefit analysis of designing and building such a system was also presented in this study. The open raceway system described and modeled in this study measured 8 m * 3 m * 0.6 m and had a capacity of 10,000 liters, yielding 0.45 kg of biocrude lipid for each cycle of green microalgae culture harvested. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Non-HDL Cholesterol versus LDL Cholesterol as a CVD risk factor in diabetic subjects," by Muhammad Saiedullah and colleagues in the October 2014 issue.

Background: Diabetes mellitus is one of the most important risk factors of coronary artery disease. Admission hyperglycemia adversely influences the outcome of acute coronary syndrome patients. The study was conducted to compare the various diagnostic methods for the detection of undiagnosed diabetes mellitus in acute coronary syndrome patients with admission hyperglycaemia in Bangladeshi population. Methods: It was a cross sectional comparative study involving 157 patients with admission blood glucose level e"7.8 mmol/l. Fasting plasma glucose, Glycated haemoglobin, pre-discharge oral glucose tolerance test was measured in all subjects and comparison of performance of different methods was done. Results: Oral glucose tolerance test revealed that in spite of admission hyperglycaemia, 57 (36.3%) patients were diabetic and 52 (33.12%) patients had impaired glucose homeostasis and 48 (30.57%) patients had normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with admission plasma glucose, fasting plasma glucose or HbA1c alone (area under the ROC curve 0.589, 0.825 and 0.852 respectively). Conclusion: Admission hyperglycaemia does not diagnose diabetes reliably in a stressful condition like acute coronary syndrome. Although neither admission plasma glucose, fasting plasma glucose, nor HbA1c level were as good as oral glucose tolerance test in detecting true diabetes, but combined fasting plasma glucose & HbA1c were found to be more sensitive & specific screening tool for detecting unknown diabetes in acute coronary syndrome patients with admission hyperglycaemia. [ABSTRACT FROM AUTHOR]

Background: In epidemiological studies and clinical trials renal function has been shown to be an independent predictor of coronary artery disease (CAD). We conducted this study to find out the association between creatinine clearance rate (CCr) and coronary angiographic severity in patients with (CAD). Method: It was a cross sectional study carried out in the department of Cardiology, Dhaka Medical College Hospital, Dhaka during the period of April, 2011 to March, 2012. All the patients with Ischaemic heart disease (IHD) admitted in the department of Cardiology who fulfill the inclusion and exclusion criteria and underwent coronary angiogram were taken as sampling population. Sampling technique was purposive and sample size was 118. By Cockcroft-Gault formula, CCr was estimated from serum creatinine. Coronary angiographic severity of coronary artery disease was assessed by vessel score and stenosis score. Statistical analysis was carried out by descriptive statistics, correlation coefficient test and one way ANOVA test. Level of significance was set at 0.05. Results: Mean CCr among study subjects was 72.57 ± 17.78 ml/min. Vessel score showed 18.6% had normal coronaries, 37.3% single vessel disease, 31.4% double vessel disease and 12.7% triple vessel disease. There was significant positive relationship between serum creatinine and vessel score, and also negative relationship between CCr and vessel score. The study also showed significant negative correlation between CCr and stenosis score. Conclusion: Angiographic severity of coronary artery disease is associated with degree of renal dysfunction. Decreased creatinine clearance is associated with more extensive CAD. [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]

Background The majority of studies that provide insights into the influence of the microbiome on the health of hematologic malignancy patients have concentrated on the transplant setting. Here, we sought to assess the predictive capacity of the gastrointestinal microbiome and its relationship to infectious outcomes in patients with acute myeloid leukemia (AML). Methods 16s rRNA-based analysis was performed on oral swabs and stool samples obtained biweekly from baseline until neutrophil recovery following induction chemotherapy (IC) in 97 AML patients. Microbiome characteristics were correlated with clinical outcomes both during and after IC completion. Results At the start of IC, higher stool Shannon diversity (hazard ratio [HR], 0.36; 95% confidence interval [CI],.18–.74) and higher relative abundance of Porphyromonadaceae (HR, 0.36; 95% CI,.18–.73) were associated with increased probability of remaining infection-free during neutropenia. A baseline stool Shannon diversity cutoff of <2 had optimal operating characteristics for predicting infectious complications during neutropenia. Although 56 patients received therapy >72 hours with a carbapenem, none of the patients had an infection with an extended spectrum β-lactamase–producing organism. Patients who received carbapenems for >72 hours had significantly lower α-diversity at neutrophil recovery (P =.001) and were approximately 4 times more likely to have infection in the 90 days following neutrophil recovery (HR, 4.55; 95% CI, 1.73–11.93). Conclusions Our results suggest that gut microbiome evaluation could assist with infectious risk stratification and that improved targeting of antibiotic administration during IC could decrease subsequent infectious complications in AML patients. Baseline microbiome diversity is a strong independent predictor of infection during acute myeloid leukemia induction chemotherapy (IC) among clinical and microbiome covariates. Higher baseline levels of Porphyromonadaceae appear protective against infection, while carbapenem use is associated with consequences to the microbiome and infection susceptibility post-IC. [ABSTRACT FROM AUTHOR]

Central venous (CV) lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. Our patient is an 85 years old hypertensive, diabetic female presenting with post COVID fibrosis with aspiration pneumonia with septic shock. After admissions in ICU, CV line was inserted through right sub-clavian venous route for administration of essential medications including inotropes. However, forceful backflow of blood was noticed after insertion of CV line raising the suspicion of arterial insertion. It was later confirmed by CXR, ABG and duplex arterial study. Taking appropriate precautions, we were able to remove the CV line safely without any complications. Sometimes minor and easy things like CV like insertion can become life threatening. But with proper knowledge and planning we can overcome any complications. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. The worldwide prevalence and incidence rates of heart failure (HF) are approaching epidemic proportions, as evidenced by the relentless increase in the number of HF hospitalizations, the growing number of HF-attributable deaths, and the spiraling costs associated with the care of HF patients. Worldwide, HF affects nearly 23 million people. In the United States, HF affects approximately 4.7 million persons (1.5 to 2 percent of the total population), with approximately 550,000 incident cases of HF diagnosed annually. Heart failure patients have various presentations and different etiologies. So, this study aimed to see the different clinical presentations of hospitalized heart failure patients. Methods: This study was done to see Clinical Presentation of Heart Failure Patients admitted in National Institute of Cardiovascular Diseases, Dhaka. Total 2112 patients were enrolled for this study during the period of August 2006 to July 2011. Results: Most of the patients (65%) were of 51-70 years age group. 75% (1584) patients were male. 98% patients presented with SOB, 95% patients had basal crepitation, 74% had orthopnoea, 59% had Paroxysmal Nocturnal Dyspoea (PND), 40% had leg edema and 25% had raised JVP. Average heart rate was 85 beats/min, average systolic B.P. was 118 mm Hg and average diastolic B.P. was 73 mm Hg. 45% population had hypertension, 29% patients had diabetes and 27% had concomitant respiratory illness. Average EF was 38%. Ischemic Cardiomyopathy was the commonest (39%) cause of heart failure, acute coronary syndrome was the second leading (29%) cause and valvular heart disease is the third common cause. Conclusion: Most of the heart failure patients are elderly age group. Most of the patients presented with shortness of breath and bilateral basal creps. Most patients had co-morbid other illness that influences the natural course of heart failure patients. Most common causes are ischemic cardiomyopathy, a sequel of ischemic insult of the heart. So, patients of acute or chronic ischemic heart diseases should be treated and follow up with care, considering their socioeconomic condition also. [ABSTRACT FROM AUTHOR]

Fecal microbiota transplantation (FMT) aims to cure Clostridioides difficile infection (CDI) through reestablishing a healthy microbiome and restoring colonization resistance. Although often effective after one infusion, patients with continued microbiome disruptions may require multiple FMTs. In this N-of-1 study, we use a systems biology approach to evaluate CDI in a patient receiving chronic suppressive antibiotics with four failed FMTs over two years. Seven stool samples were obtained between 2016-18 while the patient underwent five FMTs. Stool samples were cultured for C. difficile and underwent microbial characterization and functional gene analysis using shotgun metagenomics. C. difficile isolates were characterized through ribotyping, whole genome sequencing, metabolic pathway analysis, and minimum inhibitory concentration (MIC) determinations. Growing ten strains from each sample, the index and first four recurrent cultures were single strain ribotype F078-126, the fifth was a mixed culture of ribotypes F002 and F054, and the final culture was ribotype F002. One single nucleotide polymorphism (SNP) variant was identified in the RNA polymerase (RNAP) β-subunit RpoB in the final isolated F078-126 strain when compared to previous F078-126 isolates. This SNV was associated with metabolic shifts but phenotypic differences in fidaxomicin MIC were not observed. Microbiome differences were observed over time during vancomycin therapy and after failed FMTs. This study highlights the importance of antimicrobial stewardship in patients receiving FMT. Continued antibiotics play a destructive role on a transplanted microbiome and applies selection pressure for resistance to the few antibiotics available to treat CDI. • This patient level investigation used microbiologic and genomic techniques to investigate FMT failure. • A single C difficile strain was noted for the majority of the entire study period. • One single nucleotide polymorphism (SNP) variant was identified in the RNA polymerase (RNAP) β-subunit RpoB. • This SNV was associated with metabolic shifts but phenotypic differences in fidaxomicin MIC were not observed. • Microbiome differences were observed over time during antibiotic therapy and after failed FMTs. [ABSTRACT FROM AUTHOR]