Objective Evidence of Inducible Ischemia in Patients with Ischaemic Heart Disease by Global Longitudinal Strain During Dobutamine Stress Echocardiography

Background: Operator dependent two-dimensional (2D) echocardiography is a noninvasive test to assess myocardial hypokinesia. Inter observer variability is more as it is subjective. Objective evidence of 2D global longitudinal strain (2D GLS) and strain rate imaging are getting popularity. Methods: This cross sectional study was done on 20 patients who came for dobutamine stress echo (DSE) in the department of cardiology of BSMMU, Dhaka from 1st February 2019 to 31st July 2019. 2D GLS was done before and just after DSE. Results: DSE findings revealed 6 patients had viable LAD, 9 had viable LCX and 6 had viable RCA, 9 had nonviable LAD, 2 had nonviable LCX and 3 had nonviable RCA territories. Difference in Post-systolic strain rate (SRps) in myocardial segments supplied by LAD at baseline peak stress in patients who had normal and nonviable LAD (-21% to. -23%, p=0.98) and (-6%to – 7%, p= 2.87) which were not significant. At peak exercise there was a trend towards greater SRps in viable territory of LAD in compared with baseline and peak stress (-1% to -16%, P = 0.05) which was significant. SRps in myocardial segments supplied by LCX at baseline and peak stress in patients who have normal and nonviable LCX (-20% to. -21%, p=0.82) and (-5%to – 5%, p=1.18) which had similar result as LAD territory. At peak exercise there was a trend towards greater SRps in viable territory of LCX compared with baseline and peak stress (-12% to -15%, P = 0.06). There was no significant difference in SRps in myocardial segments supplied by RCA at baseline and peak stress in patients who had normal and nonviable RCA (-23% to. -24%, p=1.72) and (-4%to – 5%, p=2.10). At peak exercise there was a trend towards greater SRps in viable territory of RCA compared with baseline and peak stress (-10% to -15%, P = 0.04). Conclusion: Results of subjective interpretation of DES has compared with objective evidence 2D GLS on peak stress which has similarity. It was a small study. Future large study is needed to establish these findings.

In-Hospital Outcomes of Patients with Acute Kidney Injury Following Acute Coronary Syndrome in a Tertiary level Hospital

Background: Acute Kidney Injury (AKI) is a strong predictor of in-hospital adverse outcomes, which is a common complication of acute coronary syndromes (ACS). ACS patients with renal impairment during hospitalization are associated with adverse outcomes like heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality. Objective: To compare ACS patients with or without AKI has significant risk of in-hospital adverse outcomes. Methods: This prospective comparative study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period of July 2017 to June 2018. A total of 70 eligible patients were included in this study. Electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, RBS, 2-D echocardiography along with serum troponin, CK MB and electrolytes were done for all patients. Results: It was observed that mean age was 58.0±8.5 years in group A (ACS with AKI) and 55.6±12.3 years in group B (ACS without AKI). Male population was predominant in both the groups (85.7% and 74.2%, respectively). Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively). Arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Conclusion: This study showed adverse outcomes including longer duration of hospital stays were more common in the patients with AKI (group A) than in the patients without AKI (group B).

Analysis of Bangladeshi Medical Undergraduates Ability to Retain Anatomical Information by Using Mnemonics

Anatomy forms the fundamental base for the medical undergraduates during the earlier period of MBBS course. It is a vast subject and it always needs some specialized approach to teaching-learning. For easier retrieval of recalled anatomical information, medical undergraduates use different mnemonics. But the effectiveness of different mnemonic techniques like ‘Rhyme’ and ‘Storytelling’ has not been addressed systematically. Methods: This cross sectional analytical study was conducted in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2017 to February 2018 and sample was collected from two public medical colleges in Dhaka City. Total 93 first year medical undergraduates of both sex were selected and divided into three groups (‘Rhyme’, ‘Storytelling’ and control) in the ‘memory tests’ on Neuronantomy. The effectiveness in memorizing anatomical information was determined and differences between effectiveness detected by comparing the performances of medical undergraduates. Results: Judging by the performances of the medical undergraduates, ‘Rhyme’ was found significantly more effective in memorizing anatomical information than ‘Storytelling’ and control group. Conclusion: The idea regarding the effectiveness of specific mnemonic techniques should be helpful in deciding on where and how to use or avoid the use of mnemonics according to their actual potentials.

Developing a Vaccine for Rheumatic Fever and Rheumatic Heart Disease: A Review of Current Research Strategies and Challenges

Rheumatic heart disease (RHD) is an auto immune sequelae of rheumatic fever (RF) caused by Group A Streptococcal (GAS) pharyngitis, rather than the direct bacterial infection of the heart, which leads to chronic heart valve damage. Although antibiotics like penicillin are effective against GAS infection, improper medical care such as poor patient compliance, overcrowding, poverty, and repeated exposure to GAS, leads to acute rheumatic fever and RHD. Thus, effort to design a vaccine based on emm gene identification of GAS, M-protein going on for more than 40 years, is unlikely to succeed. M-protein is strain specific. Infection with one strain does not provide immunity from infection with another strain. Based on the emm gene identification, of 250 or more identified strains of GAS, the distribution is heterogenous and keeps changing. The M-protein gene sequence of the organism tends to mutate. A vaccine prepared from available strains may not be effective against a strain following mutation.