Tetralogy of fallot and cor-triatriatum a rare association: a case report.

A 24 yrs young housewife with Tetralogy of fallot (TOF) associated with cor-triatriatum was referred to our institution for investigation of cardiac murmur. The laboratory examination confirmed the diagnosis TOF and cor-triatritum. The patient was advised for total corrective surgery and referred to cardiac-surgical department. Here we report the case.

Role of exercise tolerance test (ETT) and gated single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) in predicting severity of ischemia in patients with chest pain.

This was an observational study carried out in the department of cardiology. Bangabandhu Shikh Mujib Medical University (BSMMU), Dhaka in collaboration with Institute of Nuclear Medicine (INM), Shabag, Dhaka during the period October 2002-March 2003. A total of 54 patients presenting with Canadian Cardiovascular Society (CCS) class I-II severity of chest pain with mean +/-SD age 49.88 +/- 8.44 yrs and having male to female ratio 5.75:1 were included in the study. The main objective of the study was to predict severity of myocardial ischemia by Exercise Tolerance Test (ETT) determined by Duke Treadmill Score (DTS) and by perfusion pattern observed following Single-Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI). All patients underwent ETT and then SPECT-MPI scan using Tc-99m-tetrofosmin in one-day stress and rest protocol. Coronary angiogram (CAG) was done with in six months of the perfusion study. After performing ETT, patients were categorized by DTS and myocardial perfusion studies were also stratified according to severity of perfusion defect. The formula used to calculate the score was: Exercise time- (5 x ST segment deviation)-(4 X Treadmill angina index). The angiographic findings (significant >50% stenosis) and perfusion defects in MPI were compared with the severity of DTS. There were 31 patients who had CAG proven (>50% luminal diameter narrowing) CAD and 23 patients free of CAD. After ETT patients were categorized by Duke Treadmill Score into high DTS 12 (22.22%) patients, intermediate DTS 20 (37.03%) patients low DTS 22 (40.74%) patients. In high DTS group 91.66% patients had perfusion defect, whereas in intermediate and low risk group it was 60% and 40.9% respectively. In high DTS group 91.66% of patients had angiographicaly proven CAD, 58.33% of them had triple vessel disease (TVD) while in intermediate and low risk groups angiographically proven CAD were 65% and 22.72% of whom TVD only in 15% & 0% respectively. The results of ETT using DTS score were satisfactorily correlated with SPECT-MPI scanning in high DTS subsets of patients only. It is therefore, suggested that patient of high risk DTS do not need for myocardial perfusion imaging study and should undergo CAG for further evaluation. But the intermediate and low risk groups were needed myocardial perfusion imaging study to guide for further evaluation.

Assessment of the impacts of vehicular pollution on urban air quality.

Air quality crisis in cities is mainly due to vehicular emissions. Owing to the expanding economic base Indian cities are growing at a faster rate. Transportation systems are increasing everywhere and the improved technology is insufficient to counteract growth. The effect of vehicular emission on urban air quality and human health has been described. A survey has been conducted in an Indian mega city to evaluate the status of air pollution at traffic intersections and the unique problem arising out of vehicular emissions in the study area has been narrated. Approach for the selection of the air monitoring stations, methodology adopted for data collection and the results have been discussed. Vulnerability analysis (VA) has been carried out to identify the zones at what pollution stress. Options for reducing mobile source emission have been discussed and a strategic air quality management plan has been proposed to mitigate the air pollution in the city.

Improvement in pulsed wave Doppler echocardiographic assessment of pulmonary artery pressure.

Non invasive estimation of pulmonary artery pressure (PAP) is of paramount importance in various form of cardiac, respiratory and intensive care medicine practice. Using pressure gradient between different chambers enables a reliable estimation of PAP and are being largely practiced. In absence of these pressure gradient, various time interval or the ratios of pulmonary blood flow velocity curve (PBFVC) in pulsed wave doppler echocardiography (PWDE) can predict the PAP. But there is lack of general agreement as which parameter should be used. We hypothesized that using separate time interval or their ratios of PBFVC for different group of patient may improve the PWDE prediction of PAP. Forty-six consecutive patients with different cardiac diseases and 20 consecutive control persons underwent PWD echocardiographic examination. Pulmonary blood flow velocity curve derived time intervals--the time intervals--time to peak velocity (TPV), Pre-ejection period (PEP) and right ventricular ejection time (RVET) and their ratios were measured. The Doppler derived measurements were compared with cardiac catheterization (CC) measured PAP in 46 patients in whom CC were done. PBFVC derived time interval TPV and the ratio PEP/TPV correlated well with CC measured systolic PAP (r=-0.78 and r=0.77 respectively). For congenital left to right shunt disease the ratio PEP/TPV improved the prediction (r=-0.87) while the same measure showed weak correlation in patients with left sided heart disease. Only TPV could predict mean PAP in patients with left sided heart disease (r=-0.60). We concluded that the use of separate PBFVC derived time interval or their ratio from PWDE may improve the prediction of PAP with different pathological group of disease.

Prevalence of toxoplasmosis in Calcutta and suburbs--a hospital based study for three years.

A total of 752 subjects were tested randomly for detection of antitoxoplasma antibody and its titre. Of these 752 subjects, 170 i.e. 22.6% showed seropositivity for antitoxoplasma antibody. However the titre varied between 1:2 to 1:1024, but in most cases its was 1:128.

Prediction of recovery of Bell's palsy from clinical manifestations.

Sixty patients of Bell's palsy aged between 8 and 72 years, comprising 31 males and 29 females, were studied clinically to find out a method of prediction of recovery in early stage. It was found that young patients with incomplete palsy, unaccompanied by postauricular pain, loss of taste sensation over anterior 2/3rds of tongue hyperacusis and dry eye and recovery beginning within 4 weeks of onset of palsy are likely to make complete recovery, while older patients with complete palsy accompanied by severe postauricular pain, loss of taste sensation, hyperacusis and dry eye and beginning of recovery after 4 weeks of onset of palsy are most likely to have incomplete recovery.

An ELISA method for quantitation of tubulin using poly-1-lysine coated microtiter plates.

A new, sensitive and convenient ELISA method has been developed for quantitation of tubulin using poly-1-lysine (PLL) coated multiwell microtiter plates. Binding of tubulin to untreated plastic surface of microtiter plates was extremely poor. Coating of wells with PLL enhanced the binding and facilitated quantitation by ELISA. Binding of tubulin was followed by stepwise additions of rabbit anti-tubulin IgG, HRP-conjugated goat anti-rabbit IgG and colour reagent. The method has been successfully applied to quantitate the tubulin content of extracts from rat brain and liver as evident from the excellent correlation of the results with those obtained from 3H-colchicine binding assay. The detection limit is as low as 5 ng, which is relatively better than that of the previous RIA methods. The ELISA method does not involve the use of any radioactive compound and all reagents required for this assay are commercially available.

Microtubule associated proteins of goat brain.

The microtubule associated proteins of goat brain were separated from tubulin on the basis of their thermostability and then fractionated by chromatography on Sepharose 4B column. Analysis of the fractions by SDS-Polyacrylamide gel electrophoresis and assay of their tubulin-assembly-promoting activity indicate that this activity resides primarily in the tauproteins (mol. wt. 55,000-70,000) and a class of even lower molecular weight (25,000-35,000) proteins. Electrophoresis of the microtubule associated protein fractions separated from tubulin by phosphocellulose chromatography are in agreement with the results obtained from fractionation on Sepharose 4B columns.