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.

Study of Association of C- Reactive Protein with Coronary Collateral Development.

Background: In vitro studies have shown that C-reactive protein ( CRP ) attenuates nitric oxide production and inhibits angiogenesis, which may result in impaired collateral development. The aim of this study was to investigate the association between CRP levels and the extent of coronary collaterals. Materials and methods: A total of 100 patients who had a stenosis of >95% in any major coronary artery in angiograms were included in the study. The CRP was measured from a venous blood sample with a high- sensitivity assay. Collaterals of the epicardial coronary arteries were then studied and graded in a scale of 0 - 3 according to Rentrop classification. Results: Mean age was 49.6 years and 86% were male. The mean CRP level was found 15.57 ±12.85 mg/L in grade 0 (n =25 ), 11.38± 11.11 mg/L in grade I( n=20 ), 9.22± 10.15 mg/L in grade II ( n=34 ) and 8.97±8.44 mg/L in grade III ( n =21 ) collateral group. The mean CRP values reduced significantly (p<0.05) as the Rentrop collateral grade increased which indicated that patients with a higher grade of collaterals significantly had less CRP. Subjects with a higher grade of collaterals were significantly less likely to have diabetes mellitus [odds ratio (OR): 0.53, 95%; CI: 0.13, 0.91] or acute coronary syndrome [ odds ratio (OR) :0.67 , 95%; CL 0.43, 0.95] or higher CRP values [odds ratio (OR) 0.56 per 10 unit increase, 95%; CL 0.22, 0.92] but they were more likely to have higher number of vessels with significant stenosis [odds ratio (OR) : 1.59 ; 95% CI: 1.34, 1.87]. After adjusting for age, gender, clinical presentation with acute coronary syndrome, diabetes mellitus and the number of vessels with significant stenosis, each 10-unit increase in CRP values corresponded to 39% reduced- odds of having a higher collateral grade ( OR: 0.61, 95%: CL0.1 1,0.68). Conclusion: It may be concluded that elevated levels of CRP are significantly and inversely associated with angiographically visible coronary collateral development assessed by Rentrop classification.

A study of effects of acid activated saw dust on the removal of different dissolved tannery dyes (acid dye) from aqueous solutions.

The effectiveness of acid activated sawdust in absorbing D-Brown EGP and Lurazol Brown PM dyes from aqueous solutions was studied as a function of agitation time and initial dye concentration. The experimental data were fitted to Langmuir and Freundlich isotherm and found that adsorption process follows both the isotherms. The values of Langmuir and Freundlich constants indicate favorable and beneficial adsorption. Saw dust is an excellent low cost adsorbent of colored organic anions and may have significant potential as a color removal from tannery wastewater.