Modified Bentall procedure with mitral valve replacement in a patient with Marfan syndrome: a case report

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder characterized by fibrillin-1 protein abnormalities, predisposing individuals to cardiovascular complications such as aortic root dilation and mitral valve prolapse (MVP). Management often requires surgical intervention, with the modified Bentall procedure being a standard approach for aortic root replacement. However, managing concomitant mitral valve pathology poses additional challenges due to the complex anatomical relationship between the two valves and the prolonged nature of the procedure. We present a case report of a 35-year-old male with Marfan syndrome who underwent a successful simultaneous modified Bentall procedure and mitral valve replacement for concurrent aortic root aneurysm and mitral valve prolapse. Surgical interventions involved meticulous attention to detail to mitigate risks associated with malpositioned coronary ostial sutures, debridement of the severely calcified mitral valve, and achieving hemostasis. Following surgery, the patient exhibited favorable postoperative outcomes, with evidence of optimal valve function and improved systolic and diastolic parameters, indicative of a successful recovery.

Combination therapy in the treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis: a case series and review of literature

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disease of skin and mucous membrane that are mostly caused by drugs. Many studies have focussed on treatment that modify immunologic responses like corticosteroid, IVIG, cyclosporine, biologics like TNF-? inhibitors etanercept, infliximab etc. But there are few studies available on using two immunomodifier drugs simultaneously. However, no standardized treatment protocol has been established for SJS/TEN patients. We present a case-series of 10 SJS-TEN patients treated with both systemic corticosteroid and cyclosporine. We provide a review of literature on individual systemic corticosteroid, cyclosporine and also simultaneous use of both agents for SJS/TEN, including various outcome measures-stabilization, mortality rate, hospital length of stay and comparison to other systemic agents.

Clinico-pathological profile of breast cancer patients in a radiation therapy centre

Background: The aim of the study was to evaluate the clinico-pathological characteristics of patients with breast cancer at the Radiation Center of Bangabandhu Sheikh Mujib Medical University (BSMMU), a tertiary?care cancer center in Dhaka, Bangladesh. Methods: This descriptive study was conducted from March 2021 to February 2022 where patients receiving radiotherapy for breast cancer were included. Data were collected from face-to-face interviews with patients and from their investigation reports. Data regarding age, presenting symptoms, histological type, tumor size, involvement of regional nodes, hormonal receptor status, and human epidermal growth factor receptor 2 (HER2) amplification were recorded and then analyzed. Results: The mean age of the patients was 52.53 years. Most of the patients (93%) were multiparous and 62.24% were postmenopausal. The most common symptom was breast lump (91.6%). Infiltrating ductal carcinoma and lobular carcinoma were seen in 136 (95.1%) and 7 (4.9%) cases respectively. The TNM stage distribution was stage I, 6 (4.2%); stage II, 52 (36.36%); stage III, 76 (53.15%); and stage IV, 9 (6.29%). Locally advanced breast cancer constituted 42.66% of the cases. Among the patients 90 (62.94%) patients were ER/PR positive and 42 (29.37%) patients were HER2 positive. Triple negative breast cancer (TNBC) constituted 25.17% (36) of the study population. All receptors were positive in 25 patients (17.48%). Conclusions: Majority of our patients receiving breast radiotherapy at our center are middle aged and have advanced disease. TNBC and HER2 positive breast cancer are more common in our population.

Anesthetic management in a challenging case of primary pulmonary synovial sarcoma

Primary pulmonary synovial sarcoma is a very rare tumor. This tumor accounts for less than 0.5% of all lung neoplasia. While synovial sarcomas are commonly reported from periarticular tissues, they are often found in lung or thorax as a metastasis from an extrapulmonary primary. However, rarely they arise primarily from lung tissue. We report a case of primary pulmonary synovial sarcoma which was indenting the right side of the heart. He was managed with neoadjuvant chemotherapy followed by surgical resection. The anesthetic management was challenging. The focus was kept on stringent invasive as well as non-invasive monitoring of cardiac and respiratory parameters. The surgery was uneventful and the patient made a successful recovery.

Aggressive salivary duct carcinoma with widespread dissemination: a case report

Salivary duct carcinoma is a rare and aggressive salivary gland malignancy with a poor prognosis. Due to the paucity of literature, very little is known about this neoplasm. We have described such a case in this case report and highlighted the clinical and histopathological features associated with this disease. A sixty-year old male patient reported in the outpatient department of a regional dental college and hospital with a circular firm growth in the mandibular anterior region and mobility of adjacent mandibular teeth. An array of investigations including radiographic, tomographic, ultrasonographic as well as histopathological were performed. It was diagnosed as invasive salivary duct carcinoma with distant metastases in the shoulder joint, ribs as well as pelvic bones. Currently, no National Comprehensive Cancer Network guidelines for the specific treatment of salivary duct carcinomas exist. National Comprehensive Cancer Network guidelines recommend complete surgical excision of tumors for major salivary gland tumors without nodal involvement (N0) with or without neck dissection for high-grade and T3/T4 salivary gland tumors.

Sarcomatous transformation of florid cemento-osseous dysplasia: a case report

Florid cemento-osseous dysplasia (COD) represents a rare group of benign fibro-osseous disorders, while osteogenic sarcoma (OS) on the other hand, is a malignant tumour of ominous prognosis. The malignant transformation of a benign fibro-osseous lesion of the jaw is quite uncommon and has few reported cases. The clinico-radiological findings and histopathological analysis of a lesion present in all four quadrants of the jaw of a patient who reported at the outpatient department of a regional dental college is presented here. The lesion underwent sarcomatous transformation over two months and the findings were confirmed by histopathological evaluation. Although florid cemento-osseous dysplasia is a benign lesion of the jaw with a very low propensity for malignant transformation, it should be closely monitored in patients with tumour predisposition syndromes. Further research and molecular studies are required for better understanding of inadvertent changes.

Ball valving laryngeal masses: a difficult “ball” in the anaesthetists’ court

Dynamic airway obstruction (also called ball-valve effect) is a serious condition often seen in glottic lesions. This is an anesthetic challenge as total airway obstruction can occur after the induction of general anesthesia. We present a case of a middle aged female who had a large laryngeal mass which was showing ball-valve effect. The patient had refused for tracheostomy despite it being the safest procedure in the circumstances. We then performed videolaryngoscopy and managed to intubate the patient with the help of some improvisation. The patient underwent a succesful and uneventful surgery.

Safety and efficacy of del Nido cardioplegia in adult cardiac surgery: experience in NICVD

Background: Cardioplegia is used to induce and provide a depolarized diastolic cardiac arrest to provide a motionless surgical field. Del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This observational study was performed to assess the safety and efficacy of del Nido cardioplegia in adult cardiac surgery patients. Methods: Total 140 adult patients selected for cardiac surgical procedure i.e., coronary artery bypass grafting (CABG), valve surgery, or CABG with valve surgery no need requiring cardiopulmonary bypass (CPB) were purposively allocated into two groups: a) del Nido cardioplegia (n=70) and b) blood cardioplegia (n=70). Primary outcomes assessed myocardial preservation. Results: The study compared del Nido (A) and blood cardioplegia (B) groups. Mean ages were 49.5±7.86 and 48.9±6.79 years, respectively (p=0.5641). BMI (26.98±2.3 vs 27.2±2.14 kg/m2, p=0.4846) and comorbid factors, including smoking (48% versus 51%) were similar. Differences were lower hemoglobin in A (males: 11.7±1.18 versus 13.6±0.55; females: 10.2±0.58 versus 12.2±0.21, p<0.0001) and CPB/ACC times for isolated CABG (A: 112.40±15.75/78.45±11.65 versus B: 123.8±18.55/86.28±15.26 minutes, p=0.0001). Post-operatively, more blood loss occurred in A, but they had shorter mechanical ventilation, ICU stay, and hospital stay durations. Other variables, like 30-day mortality, were similar. Conclusions: Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.

Spectrum of valvular lesions in newly diagnosed rheumatic heart disease

Background: Rheumatic heart disease (RHD) is the most common acquired heart disease among young adults and an important health problem in developing countries. There is much scarcity of information about echocardiographic evaluation of valvular involvement of RHD in Bangladesh. Objective of this study was to analyze the clinical spectrum and pattern of cardiac valvular lesions in newly diagnosed RHD patients. Methods: This cross-sectional study was conducted from April 2019 to May 2021 in National Center for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD), Dhaka, Bangladesh. Newly diagnosed 160 RHD patients irrespective of age and sex were enrolled. Medical history was obtained, physical examination was carried out, several investigations were done and standard color Doppler echocardiography was performed. Diagnosis of RHD was made following 2012 World Heart Federation criteria. Results: More than 60% of newly diagnosed patients of RHD were female; mean age of patients was 24.29±9.17 years and 77.5% of patients were between 15-34 years of age. Detected valvular lesions were mostly isolated (65%) and mitral valve involvement was 88.7%. Isolated mitral regurgitation was detected among 56.3% patients and was higher in female. Combination of mitral regurgitation and mitral stenosis were reported in 12.5% cases whereas mitral regurgitation with aortic regurgitation was present in 10.6% cases. Overall, 14 (6.4%) of the newly diagnosed patients were detected with severe forms of cardiac valvular lesion. Conclusions: RHD were common in young adults. Mitral valve was predominantly involved, particularly presenting as isolated mitral regurgitation.

Robotic intraoperative tracheal repair during retrosternal malignant goiter excision: an anesthetic challenge

Thyroidectomy is the treatment of choice for large retrosternal goiters. These tumors often are large enough to require thoracotomy. Robotic surgery can help in avoiding thoracotomy and its associated post operative complications. Rarely, such tumors and their surgery can be complicated by tracheal tears. Such tears, especially those near the carina are difficult to repair and often require open thoracotomy. We described such a case where we avoided open thoracotomy and instead performed a minimally invasive robotic repair of tracheal tear. The maintenance of ventilation during this robotic repair was critical. A combination of several airway devices was used to allow the complex surgical repair to be executed without affecting ventilation.

Correlation of fine needle aspiration cytology and cell block study of category III, IV, and V (TBSRTC-2017) thyroid lesions with special reference to cytokeratin-19 immunohistochemical staining

Context: Ascertaining the role of cytokeratin-19 (CK19) and its staining pattern helps to differentiate papillary carcinoma from other thyroid lesions. Aims: To correlate fine needle aspiration cytology (FNAC) and cell block study of equivocal cases (Category III, IV, and V) with the role of CK19 staining in it. Settings and Design: A hospital-based cross-sectional observational study was designed and conducted at North Bengal Medical College and Hospital, Shusrutnagar, Darjeeling. Methods and Material: The FNAC performed and reported as per TBSRTC-2017.50 cases of Category III, IV, and V was selected for cell block study and CK19 staining followed by immunohistochemical scoring. Results: Out of 50 cases, 17 were follicular neoplasm, 21 papillary carcinoma, 6 lymphocytic thyroiditis, 1 Hürthle cell adenoma, 1 medullary carcinoma, 1 lymphoma, and 3 undifferentiated carcinomas. Among cases of papillary carcinoma, 10 showed 4+ positivity, 9 showed 3+ positivity, 2 showed focal 1+ and 2+ positivity. In the case of follicular neoplasm, 1 showed 3+ positivity, 3 cases had 1+ 2+ positivity, and 13 cases revealed negative staining. Conclusion: Role of CK19 in distinguishing papillary carcinoma of thyroid from other lesions in cytologically diagnosed Category III, IV, and V (TBSRTC-2017) cases can be demonstrated.

Zero Budget Natural Farming in India: Aiming Back to the Basics

Crisis of Indian agriculture is very pertinent at this moment as green revolution is gradually losing its hope. Excessive, pointless exploitation of broods of green revolution has left bad footprints on country’s food security and environmental safety. With the motto to ensure food security by reviving Indian agriculture in environmentally safe way as well as to release farmers from debt cycle and suicides, zero budget natural farming (ZBNF) has come in the picture, which discards uses of all the chemical farming inputs and relies on natural way of farming i.e. rejuvenating soil and crop health through its own practices (Jivamrita, Bijamrita, mulching, soil aeration, intercropping, crop diversification, bunds, bio-pesticides etc.). ZBNF movement right now is the most popular agrarian movement which begun in 2002 in Karnataka and later successfully spread in many states (specially, of South India) of the nation through numbers of trainings, demonstrations and various promotional activities. Successful outcomes from farmers’ fields of south Indian states like Andhra Pradesh, Karnataka etc. are encouraging and grabbing attention of farmers, public and private organisations towards ZBNF in recent times. Yet, various controversies regarding its transparency, inadequate information, efficacy, practices, idealisms, even the term ‘zero budget’ etc. have agglutinated around ZBNF over the years since it debuted. Critics in fact have cited several references of drastic yield reductions with ZBNF practices in many places. Adequate scientific evaluation or monitoring of ZBNF’s successes or failures through multi-locational trials is now therefore the needful before allowing or restraining its run in Indian agriculture.

Prospects and Constraints of Transplanted Maize, Wheat, Sorghum and Pearl Millet: A Review

Cereal crops such as maize, wheat, sorghum and pearl millet are important for human consumption due to their nutritional benefits. These cereals play pivotal roles to meet world’s food demand. However, maintenance of food security particularly in the circumstance of changing climate, constantly urges for modification of agro-techniques and one such modification is the incorporation of transplanting technique in these cereals as an alternative under a non-practicable situation of direct sowing. Transplanting is a method of transferring seedlings grown in nursery or others to the field. It has been already found to shorten the crop duration and improve germination, plant stand, seed and seedling quality parameters, growth, yield and economic profitability of these cereals. Besides, research findings are also available stating that transplanting helps these cereals to cope up with vagaries of weather and to exhibit greater radiation and water use efficiencies and suppression of weeds. Outcomes of transplanting are however dependent on various factors like methods of nursery raising, the variety used, mode of planting, age of seedlings etc. In spite of these prospects, transplanting technique is not so popular in these cereals due to poor dissemination, discouraging research findings, pest and disease problems, lack of suitable package of practices etc. Therefore, focuses are to be given in conducting more and more research trials to confirm its location and situation wise efficacy and also in developing and disseminating a suitable package of practices of transplanting accordingly.

Growth, Yield, Seed and Seedling Quality Parameters of Rapeseed-mustard Varieties under Different Seed Priming Options

Rationale: Crop production and quality of produce get affected by drought, stand establishment and low availability of nutrients. Apart from various prevailing methods, seed treatment through priming now-a-days has been found to noticeably improve crop establishment for increasing seed yield and quality. Aim: To study the effect of various seed priming options on rapeseed-mustard varieties. Place of Study: A field experiment was conducted at AB Block Farm, Bidhan Chandra Krishi Viswavidyalaya, Kalyani, Nadia, West Bengal, India during winter season of 2017-2018. Methodology: Experiment comprised six rapeseed-mustard varieties (Anushka, Sanchita, TBM-143,TBM-204, Kranti and Pusa Bold) in main plot and five seed priming options (KH2PO4 @ 0.15 mol 100 ml water-1 5 g seeds-1, KNO3 @ 0.1 mol 100 ml water-1 5 g seeds-1, PEG 6000 @ -0.3 MPa 100 ml water-1 5 g seeds-1, hydro priming @ 100 ml 5 g seeds-1 and control) in subplot, replicated thrice in a split plot design. Observations on growth and yield contributing parameters were recorded from the field. Further, various quality parameters of seed and seedlings were evaluated in the laboratory. Data on all the parameters were finally statistically analyzed. Results: Among the varieties, Pusa Bold performed better in terms of growth, yield contributing parameters and seed yield under seed priming through either KH2PO4 @ 0.15 mol 100 ml water-1 5 g seeds-1 or PEG 6000 @ -0.3 MPa 100 ml water-1 5 g seeds-1. Seed and seedling quality parameters such as root and shoot lengths, seedling fresh and dry weights, germination % and vigour index were also improved under the same. Conclusion: Cultivation of mustard variety, Pusa Bold by seed priming through any of those two chemicals (KH2PO4 or PEG 6000) can be recommended for New alluvial zone of West Bengal, India.

Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases

Introduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma. Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%). Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

A Comparative Analysis of Rapid Immunochromatographic Card Test with MAC –ELISA Used in Detection of Dengue at a Tertiary Care Hospital in Jamshedpur, Jharkhand

Introduction: Dengue virus transmitted by mosquitoes iswidely distributed throughout the tropics and subtropics. It isone of the most rapidly spreading mosquitos borne viraldisease in the world. In India specially, dengue has emergedas a matter of major concern because of its epidemicproportions. Therefore, early diagnosis for dengue is called for,to reduce the mortality and morbidity attributed to it.Aims and Objective: There are numerous methods for thediagnosis of dengue of which the serological tests play asignificant role. Various rapid ICT tests are being used in thelaboratories for the early diagnosis of dengue these days. Thepresent study aims to evaluate the performance of rapid ICTwith reference to MAC-ELISA for its role in diagnosis ofdengue.Methods and Materials: In the present study 305 suspectedsamples of dengue were collected during the month of October2017 to December 2017. All the samples were collected byaseptic techniques.Results: 92 samples were positive by Mac Elisa IgM Ab test.The prevalence of the disease was 30.16 %. When ICT IgM Abtest was compared with Elisa IgM capture Ab test a sensitivityof 95.65 % and specificity of 98.59 % was observed.Conclusion: The high sensitivity and specificity makes itsuitable to be used in acute diagnosis of dengue but Mac ElisaIgM capture Ab test combination will make it more reliable andconfirmatory.

Quality indicators for eye bank

Purpose: The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. Methods: Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions – “result quality” and “process quality.” The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011–2016. Results: Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. Conclusion: These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.

Crop Co-efficient Values of Sunflower for Different Growth Stages by Lysimeter Study.

The experiment was conducted on sunflower (variety BARI Surjomukhi-2) crop during the month of mid-November, 2014 to mid-March, 2015, in a lysimeter (dimension:1 m X 1 m X 1 m size) to measure crop evapotranspiration (ETc) and determine crop coefficient (kc) values at Irrigation and Water Management Division, Bangladesh Agricultural Research Institute, Gazipur. The study was examined by applying four irrigation at an interval of 10, 15, 20, and 25 days allowing drainage within and adjacent the tank. Results reveals that irrigation at 15 days interval produced the highest yield and was considered suitable for estimating ETc and kc. Seasonal total ETc was found as 270.89 mm. The kc values of sunflower under different ET0 methods for initial, development, mid-season and late season ranged from 0.34 to 0.48, 0.80 to 1.10, 1.06 to 1.55, and 0.27 to 0.36, respectively. Among different methods, P-M method gave relatively higher value than those of other methods and also FAO recommended value. Therefore, this information would be a helpful tool for crop water requirement and irrigation scheduling for similar semi-arid climates.

Association between anthropometry, cardiometabolic risk factors, & early life factors & adult measures of endothelial function: Results from the New Delhi Birth Cohort.

Background & objectives: Abnormal endothelial function represents a preclinical marker of atherosclerosis. This study was conducted to evaluate associations between anthropometry, cardiometabolic risk factors, and early life factors and adult measures of endothelial function in a young urban Indian cohort free of clinical cardiovascular disease. Methods: Absolute changes in brachial artery diameter following cuff inflation and sublingual nitroglycerin (400 μg) were recorded to evaluate endothelium-dependent and -independent measures of endothelial function in 600 participants (362 men; 238 women) from the New Delhi Birth Cohort (2006-2009). Data on anthropometry, cardiometabolic risk factors, medical history, socio-economic position, and lifestyle habits were collected. Height and weight were recorded at birth, two and 11 yr of age. Age- and sex-adjusted linear regression models were developed to evaluate these associations. Results: The mean age of participants was 36±1 yr. Twenty two per cent men and 29 per cent women were obese (BMI > 30 kg/m2). Mean systolic blood pressure (SBP) was 131±14 and 119±13 mmHg, and diabetes prevalence was 12 and 8 per cent for men and women, respectively. Brachial artery diameter was higher for men compared with women both before (3.48±0.37 and 2.95±0.35 cm) and after hyperaemia (3.87±0.37 vs. 3.37±0.35 cm). A similar difference was seen before and after nitroglycerin. Markers of increased adiposity, smoking, SBP, and metabolic syndrome, but not early life anthropometry, were inversely associated with endothelial function after adjustment for age and sex. Interpretation & conclusions: The analysis of the current prospective data from a young urban Indian cohort showed that cardiometabolic risk factors, but not early life anthropometry, were associated with worse endothelial function.