Fermentation optimization of cellulase production from sugarcane bagasse by Bacillus pseudomycoides and molecular modeling study of cellulase

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Isolation of cellulase producing Bacillus pseudomycoides from sugarcane bagasse.

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Fermentation and optimization of different parameters for cellulase production.

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Modeling and validation of cellulase enzyme.

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Interaction dynamics between cellulase and cellulose.

Degradation of cellulosic carbon, the most important natural carbon reservoirs on this planet by cellulase is very essential for valuable soluble sugars. This cellulase has potential biotechnological applications in many industrial sectors. Thus the demand of cellulase is increasing more frequently than ever. Agro industrial byproducts and suitable microbes are of an important source for the production of cellulase. Bacillus pseudomycoides and sugarcane bagasse were used for the production of cellulase and different process parameters influencing the production of cellulase were optimized here. The bacterium showed maximum cellulase production in the presence of sugarcane bagasse, peptone and magnesium sulfate at pH 7, 40 °C in 72 h of incubation. Primary structures of the cellulase is consists of 400 amino acid residues having molecular weight 44,790 Dalton and the theoretical PI is 9.11. Physiochemical properties of cellulase indicated that the protein has instability index 25.77. Seven hydrogen bonds were observed at multiple sites of the cellulase enzyme; His269, Asp237, Asn235, Tyr271, Ser272, Gln309, Asn233. This protein structure may play first hand in further development of exploring cellulase and cellulose interaction dynamics in Bacillus sp. Thus this bacterium may be useful in various industrial applications owing to its cellulase producing capability.

Biochemical and in silico study of leaf and bark extracts from Aphanamixis polystachya against common pathogenic bacteria

Aphanamixis polystachya may be a natural, renewable resource against antibiotic-resistant bacterial infections. The antibacterial activity of A. polystachya leaf and bark extracts was investigated against three antibiotic-resistant bacterial species and one fungus. Methanolic leaf extract showed only limited antibacterial activity but both methanolic and aqueous bark extract showed high antimicrobial activity. In an antioxidant activity test, leaf and bark extracts exhibited 50% free radical scavenging at a concentration of 107.14 ± 3.14 μg/mL and 97.13 ± 3.05 μg/mL, respectively, indicating that bark extracts offer more antioxidative activity than leaf extracts. Bark extracts also showed lower toxicity than leaf extracts. This suggests that bark extracts may offer greater development potential than leaf extracts. The molecular dynamics were also investigated through the simulated exploration of multiple potential interactions to understand the interaction dynamics (root-mean-square deviation, solvent-accessible surface area, radius of gyration, and the hydrogen bonding of chosen compounds to protein targets) and possible mechanisms of inhibition. This molecular modeling of compounds derived from A. polystachya revealed that inhibition may occur by binding to the active sites of the target proteins of the tested bacterial strains. A. polystachya bark extract may be used as a natural source of drugs to control antibiotic-resistant bacteria.

Screening of Potent Phytochemical Inhibitors Against SARS-CoV-2 Main Protease: An Integrative Computational Approach

Coronavirus disease 2019 (COVID-19) is a potentially lethal and devastating disease that has quickly become a public health threat worldwide. Due to its high transmission rate, many countries were forced to implement lockdown protocols, wreaking havoc on the global economy and the medical crisis. The main protease (Mpro) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus for COVID-19, represent an effective target for the development of a new drug/vaccine because it is well-conserved and plays a vital role in viral replication. Mpro inhibition can stop the replication, transcription as well as recombination of SARS-CoV-2 after the infection and thus can halt the formation of virus particles, making Mpro a viable therapeutic target. Here, we constructed a phytochemical dataset based on a rigorous literature review and explored the probability that various phytochemicals will bind with the main protease using a molecular docking approach. The top three hit compounds, medicagol, faradiol, and flavanthrin, had binding scores of −8.3, −8.6, and −8.8 kcal/mol, respectively, in the docking analysis. These three compounds bind to the active groove, consisting of His41, Cys45, Met165, Met49, Gln189, Thr24, and Thr190, resulting in main protease inhibition. Moreover, the multiple descriptors from the molecular dynamics simulation, including the root-mean-square deviation, root-mean-square fluctuation, solvent-accessible surface area, radius of gyration, and hydrogen bond analysis, confirmed the stable nature of the docked complexes. In addition, absorption, distribution, metabolism, excretion, and toxicity (ADMET) analysis confirmed a lack of toxicity or carcinogenicity for the screened compounds. Our computational analysis may contribute toward the design of an effective drug against the main protease of SARS-CoV-2.

Antiviral peptides against the main protease of SARS-CoV-2: A molecular docking and dynamics study

The recent coronavirus outbreak has changed the world's economy and health sectors due to the high mortality and transmission rates. Because the development of new effective vaccines or treatments against the virus can take time, an urgent need exists for the rapid development and design of new drug candidates to combat this pathogen. Here, we obtained antiviral peptides obtained from the data repository of antimicrobial peptides (DRAMP) and screened their predicted tertiary structures for the ability to inhibit the main protease of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using multiple combinatorial docking programs, including PatchDock, FireDock, and ClusPro. The four best peptides, DRAMP00877, DRAMP02333, DRAMP02669, and DRAMP03804, had binding energies of -1125.3, -1084.5, -1005.2, and -924.2 Kcal/mol, respectively, as determined using ClusPro, and binding energies of -55.37, -50.96, -49.25, -54.81 Kcal/mol, respectively, as determined using FireDock, which were better binding energy values than observed for other peptide molecules. These peptides were found to bind with the active cavity of the SARS-CoV-2 main protease; at Glu166, Cys145, Asn142, Phe140, and Met165, in addition to the substrate-binding sites, Domain 2 and Domain 3, whereas fewer interactions were observed with Domain 1. The docking studies were further confirmed by a molecular dynamics simulation study, in which several descriptors, including the root-mean-square difference (RMSD), root-mean-square fluctuation (RMSF), solvent-accessible surface area (SASA), radius of gyration (Rg), and hydrogen bond formation, confirmed the stable nature of the peptide-main protease complexes. Toxicity and allergenicity studies confirmed the non-allergenic nature of the peptides. This present study suggests that these identified antiviral peptide molecules might inhibit the main protease of SARS-CoV-2, although further wet-lab experiments remain necessary to verify these findings.

Molecular docking and dynamics study to explore phytochemical ligand molecules against the main protease of SARS-CoV-2 from extensive phytochemical datasets

BACKGROUND

The high transmission and pathogenicity of SARS-CoV-2 has led to a pandemic that has halted the world's economy and health. The newly evolved strains and scarcity of vaccines has worsened the situation. The main protease (M^pro) of SARS-CoV-2 can act as a potential target due to its role in viral replication and conservation level.

METHODS

In this study, we have enlisted more than 1100 phytochemicals from Asian plants based on deep literature mining. The compounds library was screened against the M^pro of SARS-CoV-2.

RESULTS

The selected three ligands, Flemichin, Delta-Oleanolic acid, and Emodin 1-O-beta-D-glucoside had a binding energy of -8.9, -8.9, -8.7 KJ/mol respectively. The compounds bind to the active groove of the main protease at; Cys145, Glu166, His41, Met49, Pro168, Met165, Gln189. The multiple descriptors from the simulation study; root mean square deviation, root mean square fluctuation, radius of gyration, hydrogen bond, solvent accessible surface area confirms the stable nature of the protein-ligand complexes. Furthermore, post-md analysis confirms the rigidness in the docked poses over the simulation trajectories.

CONCLUSIONS

Our combinatorial drug design approaches may help researchers to identify suitable drug candidates against SARS-CoV-2.

Designing a multi-epitope vaccine candidate to combat MERS-CoV by employing an immunoinformatics approach

Currently, no approved vaccine is available against the Middle East respiratory syndrome coronavirus (MERS-CoV), which causes severe respiratory disease. The spike glycoprotein is typically considered a suitable target for MERS-CoV vaccine candidates. A computational strategy can be used to design an antigenic vaccine against a pathogen. Therefore, we used immunoinformatics and computational approaches to design a multi-epitope vaccine that targets the spike glycoprotein of MERS-CoV. After using numerous immunoinformatics tools and applying several immune filters, a poly-epitope vaccine was constructed comprising cytotoxic T-cell lymphocyte (CTL)-, helper T-cell lymphocyte (HTL)-, and interferon-gamma (IFN-γ)-inducing epitopes. In addition, various physicochemical, allergenic, and antigenic profiles were evaluated to confirm the immunogenicity and safety of the vaccine. Molecular interactions, binding affinities, and the thermodynamic stability of the vaccine were examined through molecular docking and dynamic simulation approaches, during which we identified a stable and strong interaction with Toll-like receptors (TLRs). In silico immune simulations were performed to assess the immune-response triggering capabilities of the vaccine. This computational analysis suggested that the proposed vaccine candidate would be structurally stable and capable of generating an effective immune response to combat viral infections; however, experimental evaluations remain necessary to verify the exact safety and immunogenicity profile of this vaccine.

Plant-Based Phytochemical Screening by Targeting Main Protease of SARS-CoV-2 to Design Effective Potent Inhibitors

Currently, a worldwide pandemic has been declared in response to the spread of coronavirus disease 2019 (COVID-19), a fatal and fast-spreading viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The low availability of efficient vaccines and treatment options has resulted in a high mortality rate, bringing the world economy to its knees. Thus, mechanistic investigations of drugs capable of counteracting this disease are in high demand. The main protease (Mpro) expressed by SARS-CoV-2 has been targeted for the development of potential drug candidates due to the crucial role played by Mpro in viral replication and transcription. We generated a phytochemical library containing 1672 phytochemicals derived from 56 plants, which have been reported as having antiviral, antibacterial, and antifungal activity. A molecular docking program was used to screen the top three candidate compounds: epicatechin-3-O-gallate, psi-taraxasterol, and catechin gallate, which had respective binding affinities of -8.4, -8.5, and -8.8 kcal/mol. Several active sites in the targeted protein, including Cys145, His41, Met49, Glu66, and Met165, were found to interact with the top three candidate compounds. The multiple simulation profile, root-mean-square deviation, root-mean-square fluctuation, radius of gyration, and solvent-accessible surface area values supported the inflexible nature of the docked protein-compound complexes. The toxicity and carcinogenicity profiles were assessed, which showed that epicatechin-3-O-gallate, psi-taraxasterol, and catechin gallate had favorable pharmacological properties with no adverse effects. These findings suggest that these compounds could be developed as part of an effective drug development pathway to treat COVID-19.

Prospective Role of Peptide-Based Antiviral Therapy Against the Main Protease of SARS-CoV-2

The recently emerged coronavirus (SARS-CoV-2) has created a crisis in world health, and economic sectors as an effective treatment or vaccine candidates are still developing. Besides, negative results in clinical trials and effective cheap solution against this deadly virus have brought new challenges. The viral protein, the main protease from SARS-CoV-2, can be effectively targeted due to its viral replication and pathogenesis role. In this study, we have enlisted 88 peptides from the AVPdb database. The peptide molecules were modeled to carry out the docking interactions. The four peptides molecules, P14, P39, P41, and P74, had more binding energy than the rest of the peptides in multiple docking programs. Interestingly, the active points of the main protease from SARS-CoV-2, Cys145, Leu141, Ser139, Phe140, Leu167, and Gln189, showed nonbonded interaction with the peptide molecules. The molecular dynamics simulation study was carried out for 200 ns to find out the docked complex’s stability where their stability index was proved to be positive compared to the apo and control complex. Our computational works based on peptide molecules may aid the future development of therapeutic options against SARS-CoV-2.

Efficacy of Phytochemicals Derived from Avicennia officinalis for the Management of COVID-19: A Combined In Silico and Biochemical Study

The recent coronavirus disease 2019 (COVID-19) pandemic is a global threat for healthcare management and the economic system, and effective treatments against the pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus responsible for this disease have not yet progressed beyond the developmental phases. As drug refinement and vaccine progression require enormously broad investments of time, alternative strategies are urgently needed. In this study, we examined phytochemicals extracted from Avicennia officinalis and evaluated their potential effects against the main protease of SARS-CoV-2. The antioxidant activities of A. officinalis leaf and fruit extracts at 150 µg/mL were 95.97% and 92.48%, respectively. Furthermore, both extracts displayed low cytotoxicity levels against Artemia salina. The gas chromatography-mass spectroscopy analysis confirmed the identifies of 75 phytochemicals from both extracts, and four potent compounds, triacontane, hexacosane, methyl linoleate, and methyl palminoleate, had binding free energy values of -6.75, -6.7, -6.3, and -6.3 Kcal/mol, respectively, in complexes with the SARS-CoV-2 main protease. The active residues Cys145, Met165, Glu166, Gln189, and Arg188 in the main protease formed non-bonded interactions with the screened compounds. The root-mean-square difference (RMSD), root-mean-square fluctuations (RMSF), radius of gyration (Rg), solvent-accessible surface area (SASA), and hydrogen bond data from a molecular dynamics simulation study confirmed the docked complexes' binding rigidity in the atomistic simulated environment. However, this study's findings require in vitro and in vivo validation to ensure the possible inhibitory effects and pharmacological efficacy of the identified compounds.

Virtual screening and molecular dynamics simulation study of plant-derived compounds to identify potential inhibitors of main protease from SARS-CoV-2

The new coronavirus (SARS-CoV-2) halts the world economy and caused unbearable medical emergency due to high transmission rate and also no effective vaccine and drugs has been developed which brought the world pandemic situations. The main protease (Mpro) of SARS-CoV-2 may act as an effective target for drug development due to the conservation level. Herein, we have employed a rigorous literature review pipeline to enlist 3063 compounds from more than 200 plants from the Asian region. Therefore, the virtual screening procedure helps us to shortlist the total compounds into 19 based on their better binding energy. Moreover, the Prime MM-GBSA procedure screened the compound dataset further where curcumin, gartanin and robinetin had a score of (-59.439, -52.421 and - 47.544) kcal/mol, respectively. The top three ligands based on binding energy and MM-GBSA scores have most of the binding in the catalytic groove Cys145, His41, Met165, required for the target protein inhibition. The molecular dynamics simulation study confirms the docked complex rigidity and stability by exploring root mean square deviations, root mean square fluctuations, solvent accessible surface area, radius of gyration and hydrogen bond analysis from simulation trajectories. The post-molecular dynamics analysis also confirms the interactions of the curcumin, gartanin and robinetin in the similar binding pockets. Our computational drug designing approach may contribute to the development of drugs against SARS-CoV-2.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Association of Stress Hyper-Glycaemia on Outcomes of Hospitalized Non Diabetic Patients with First Attack of Acute ST Elevated Myocardial Infarction Underwent Thrombolysis

Coronary heart disease (CHD) is the most common cause of heart disease and serious cause of early death in developed countries around the world. Stress hyper-glycaemia has a bad prognostic implication in hospital outcomes in acute ST elevated myocardial infarction patients. It serves as a marker of myocardial damage, provides information about complications of acute MI and bad prognosis. The aim of this cross-sectional descriptive study was to find out prognostic implications of Stress hyper-glycaemia in non diabetic patients with first attack of acute ST elevated myocardial infarction underwent thrombolysis and conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2017 to May 2018. Total 249 first attack of Acute STEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic stress hyper-glycaemia (Blood sugar >7.8mmol/L and HbA1c <6.5), Group II: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic normo-glycaemia (Blood sugar <7.8mmol/L and HbA1c <6.5). In this study, in non diabetic Stress hyperglycemic patients' death was 5.7% and in non diabetic normo-glycemic patients death was 0.6%. It was statistically significant (p<0.05). In non diabetic stress hyperglycemic patients, heart failure was 78.31% patients and in non diabetic normo-glycemic patients, it was 21.6%. It was statistically significant (p<0.01). Echocardiography showed that patients with non diabetic Stress hyper-glycaemia had mean ejection fraction (LVEF) was 44.01±4.93 and patients with non diabetic normo-glycaemia had mean ejection fraction (LVEF) was 47.70±5.71. It was statistically significant (p<0.01). In this study, in non diabetic Stress hyperglycaemic patients, cardiogenic shock was 16.1% and in non diabetic normo-glycemic patients, it was 3.7%. It was statistically significant (p<0.05). Mean duration of hospital stay, in non diabetic Stress hyperglycaemic patients was 5.07±0.566 and in non diabetic normo-glycemic patients, it was 3.52±0.850. It was statistically significant (p<0.001). In conclusion, the incidence of death, heart failure, cardiogenic shock and hospital stay were higher in non diabetic Stress hyperglycaemic patients than non diabetic normo-glycemic patients who admitted with first attack of acute ST elevated myocardial infarction.

Risk Factors for Hypertension in Young Adults of Bangladesh

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.

Association of Diastolic Dysfunction with N-terminal Pro-B-type Natriuretic Peptide Level in Heart Failure Patients with Preserved Ejection Fraction

Heart failure is a major public health issue with a current prevalence of over 23 million worldwide. Epidemiologic studies suggest that nearly one-half of patients with heart failure have a normal ejection fraction that is now termed HFpEF. Prevalence of HFpEF is approximately 50% (range 40-71%). Most pathophysiologic abnormalities in patients with HFpEF are related to diastolic function. Doppler echocardiography is the choice of investigation for evaluation of Diastolic function. Tissue Doppler Imaging is a new dimension in this concept. Natriuretitic peptides are widely accepted biomarker in HFrEF patients. Now a days, it is also considered for HFpEF patients for diagnostic & prognostic purpose. Aim of this study was to find out the association of Diastolic dysfunction with N-terminal Pro B-type Natriuretic Peptide level in HFpEF patients. This cross-sectional analytical study was conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2016 to September 2017. Total 120 HFpEF patients were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I: HFpEF patients with normal Diastolic function. Group II: HFpEF patients with diastolic dysfunction in this study mean NT-pro BNP value of Group I and Group II were 104.07±7.2pg/ml and 943.19±112.51pg/ml respectively, which was statistically significant (p value <0.05). Among the echocardiographic parameters LV hypertrophy, Left atrial volume index (LAVI), TDI derived mitral annular velocity, e' septal velocity, E/e' (septal) ratio, Decelaration time were statistically significant. In this study, it was also shown that the levels of NT-proBNP had positive correlation with Doppler parameters. Statistically significant moderate positive correlation was observed between NT-proBNP level and LAVI value, correlation coefficient (r=0.553, p=0.001) suggesting that the higher the level of NT Pro BNP level, the higher value of the LAVI value. Statistically significant moderate positive correlation was also observed between NT-proBNP level and E/e' (septal), correlation coefficient (r=0.526, p=0.001) suggesting that the higher the level of NT Pro BNP level, the Higher value of the E/e' (septal) value in HFpEF patients with diastolic dysfunction. In subgroup analysis of Group II ,mean NT-proBNP level showed affirmative relation with severity of diastolic dysfunction grades ranging from grade I (340.76±24.42) to grade III (3727.83±306.50) Diastolic dysfunction is associated with elevated NT-proBNP level in HFpEF patients & NT-proBNP value rises with gradual deterioration of Diastolic dysfunction among the HFpEF patients.

Short Term Outcome of Cardiac Resynchronization Therapy on Functional Recovery of Patients with Congestive Heart Failure in Bangladeshi Population

Cardiac resynchronization therapy (CRT) reduces symptoms and improves left ventricular function in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We analyzed the clinical and echocardiographic outcome of CRT in heart failure patients. Thirty five (35) heart failure patients were included in this prospective observational study, conducted from February 2015 to February 2016 in the Department of cardiology, National Institute of Cardiology & Vascular Disease (NICVD) hospital, Dhaka, Bangladesh. Patients underwent CRT-P (BiV pacemaker) or CRT-D (defibrillator) implantation and were followed up. Clinical, electrocardiographic and echocardiographic study were performed before and 3 months after CRT implantation. After 3 months of BiV pacing, New York Heart Association functional class has improved from 3.3±0.44 to 1.7±0.60; (p<0.001). Left ventricular end diastolic diameter was reduced from 67.9±5.20 to 61.9±5.90mm; (p<0.001) and left ventricular end systolic diameter was reduced from 56.4±6.50 to 50.5±7.20mm; (p<0.001). Ejection fraction was significantly increased from 27.5±4.3% to 38.8±6.7%; (p<0.001). The average grade of mitral regurgitation was decreased from 1.49±0.65 to 0.43±0.61; (p<0.001). The number of hospitalization was also significantly reduced from 2.51±1.44 to 0.11±0.32; (p<0.001). Among the study patients, 71.4% patient was responders, 17.1% super responders and 11.4% non-responders. Although the study was performed on a small number of patients, it can be considered that CRT had favorable hemodynamic and clinical results and reduced the need for hospitalization in our heart failure patients.

Association of Prolonged QTc Dispersion with Diastolic Dysfunction of the Left Ventricle in Patients with Non ST Segment Elevation Myocardial Infarction

Diastolic function usually declines before systolic function, and this precedes clinical signs in patients with acute coronary syndrome. Therefore, diagnosis of diastolic dysfunction is very important for early diagnosis, follow-up, treatment, and prognostic evaluation in heart failure with preserved ejection fraction (HFpEF) patients. The main objective of the study was to find out association between prolonged QTc dispersion and left ventricular diastolic dysfunction in Non ST Segment Elevation Myocardial Infarction (NSTEMI) patients in HFpEF. This cross sectional analytical study was conducted in the Department of Cardiology and 60 patients were included as study population from August 2015 to July 2016. Then the study population was divided into two groups, each group consisted of 30 patients. NSTEMI patients with prolonged QTc dispersion treated as Group I and NSTEMI patients with normal QTc dispersion treated as Group II. The study shows 20.0% vs. 26.6% patients had detected as Grade I in Group I and Group II respectively with statistically insignificant association (p=0.16). On the contrary, 30.0% vs. 13.4% patients had detected as Grade II in Group I and Group II respectively with statistically significant association (p=0.001). Again, 40.0% vs. 10.0% patients had detected as Grade III in Group I and Group II respectively with statistically significant association (p=0.001). QTc dispersion was found sequentially significant increased (p=0.007) among 3 grades of LVDD (63.6±4.9 vs. 79.4±8.6 vs. 98.2±28.8). QTc dispersion in surface ECG which is a cheap, non-invasive, easily available tool can help us predicting left ventricular diastolic dysfunction in patients with NSTEMI.

Pattern of Disease among Patients Attending Cardiology Outpatient Department of a Private Hospital of Mymensingh, Bangladesh

Epidemiologic transition is taking place in every part of the world. Cardiovascular diseases became the most common cause of death accounting for 30% of deaths worldwide, with 80% of the burden now occurring in developing countries. The objective of the study was to assess the Pattern of disease among patients attending Cardiology outpatient department of a private hospital. The cross sectional descriptive type of observational study was conducted among 550 patients attending Cardiology outpatient department (COPD) of Sodesh Hospital, Mymensingh, Bangladesh from March 2016 to June 2016. All the new patients attending COPD of Sodesh Hospital were selected purposively for the study. Data were collected by interview, physical examination and laboratory investigations of patients using a case record form. Mean age of the patients was 45.1 years with a SD of 15.6 years. Among the patients male were 291(52.9%), a bit higher than the female 259(47.1%). It was observed that more than half of the patients (281, 51.1%) visited cardiologist with non-cardiac problems. Less than one third of the patients (169, 30.7%) attended with cardiac problems and 100(18.2%) patients visited with both cardiac and non-cardiac problems. Among the cardiac diseases and symptoms hypertension was on the top of the list 176(65.4%). Ischemic heart diseases was present in 35(13.0%) and palpitation was in 30(11.1%) patients. On the other hand among the non-cardiac diseases or presentations, 121(43.1%) patients had non-specific chest pain, 63(22.4%) had shortness of breath and 17(6.1%) had diabetes mellitus. Hypertension was found the most frequent cardiovascular disease (65.4%) followed by ischemic heart disease (13.0%). More than half (51.1%) of the patients visit cardiologist with non-cardiac problems. Screening at the level of general practitioner (GP) and appropriate referral system can reduce extreme burden of patients to the cardiologists in the Cardiology outpatient department.

Association of Metabolic Syndrome with Hyper Apolipoprotein B status in Young People with Acute Coronary Syndrome

Prevalence of Metabolic Syndrome (MetS) and acute coronary syndrome (ACS) in young people is progressively increasing. This was originally a case control study to predict the risk of ACS with hyper apolipoprotein B (Hyper apoB) status in young people, with 50 cases of 18-45 years of age of both sex with first attack of acute coronary syndrome admitted in Coronary care unit of Mymensingh Medical College Hospital from June 2009 to May 2010 and for comparison, equal number of age and sex matched healthy controls were chosen. In present study only cases were analyzed regarding their anthropometric, fasting blood glucose, blood pressure and lipoprotein lipid profiles. Regarding anthropometric measurement, body mass index (BMI), Waist Circumference (WC) and Waist-to Hip ratio (WHR) was calculated. Thirty one cases had increased and 19 had normal WHR, of them 28 cases had hyper and 3 had normal ApoB and 14 cases out of 19 with normal WHR had hyper ApoB and hyper ApoB status was significantly found to be present in ACS patients with increased waist-hip ratio (p=0.03). In this study WHR, instead of WC was used by the author to define abdominal obesity for the diagnosis of MetS along with other criteria according to IDF (International Diabetic Federation) consensus worldwide definition of Mets. Out of 50 young ACS cases 14 cases had metabolic syndrome of those 12 had hyper ApoB status and was statistically significant (p=0.04).

Risk of Acute Coronary Syndrome is Better Predicted by Apolipoprotein B in Young People than Dyslipidemic Parameter of Conventional Lipid Profile

The traditional lipidic parameters when present and clusters within reference range, often fails to predict the risk of acute coronary syndrome in young population in this region. Measurement of Apolipoprotein B (Apo B), a parameter of the lipoprotein-lipid profile, provides a method of quantifying the concentration of lipoproteins, rather than their cholesterol content. Present study aimed to quantify the risk of acute coronary syndrome (ACS) in young people with having none to less number of traditional lipidic parameters for dyslipidemia. This is a case control study among 50 cases of first attack of ACS among 18-45 years of age of both sexes, admitted in coronary care unit of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2009 to May 2010. Data was recently reanalyzed. Out of five sub-sets of lipid profile, namely TC, TG, HDL-C, LDL-C and non-HDL-C, 16(32%) cases were dyslipidemic by 0 (none) parameter, 13(26%) cases by one parameter, 7(14%) cases by two parameters, 4(8%) cases by three cases, 7(14%) cases by four parameters and 3(6%) cases by all five parameters. It was found that none to lesser the number of dyslipidemic parameters, greater the percentage of ACS cases and they are having hyper ApoB with statistically significant association (p<0.05).

Comparison between retrograde and transeptal approach in radiofrequency catheter ablation of left accessory pathways

To study a series of patients submitted to radiofrequency catheter ablation (RFA) of left accessory pathways (AP) using the transeptal approach (TSA) as compared to the conventional retrograde arterial approach (RAA). Sixty consecutive patients (44 male; mean age of 35.60±11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RAA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p=0.103), fluoroscopy time (p=0.565) and total time (p=0.1917). Three patients in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p=0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%.The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation.

Correlation of platelet count and acute ST-elevation myocardial infarction

The study was conducted in the Department of cardiology, NICVD Dhaka during the period January 2006 to December 2007 to assess the impact of platelet on ST-elevation myocardial infarction (STEMI). To perform this prospective study 200 patients with STEMI within 72 hours of chest pain of both sexes were randomly selected and were evaluated by clinical history, physical examination and with the help of ECG, Echocardiography and others cardiac risk factors analysis. Heparin therapy before admission, previously documented thrombocytopenia (<140,000/cmm), history of previous or current haemostatic disorder, renal impairment (Creatinine >1.6mg/dl) and history of PCI & CABG were excluded in this study. Patient of Platelet count (PC) ≤200000/cubic millimeter (cmm) in Group I and patient of Group II, platelet counts were PC >200000/cmm. Follow up period was 3 days to 7 days after hospital admission. Primary outcome heart failure (any Killip class) was significantly more in Group II than Group I (40.0% vs. 23.0%; p=0.009). Though the incidence of Killip class I and cardiogenic shock were not significant between these two groups but Killip class II (18.0% vs. 8.0%; p=0.036) and Killip class III (15.0% vs. 6.0%; p=0.037) heart failure were significantly more among the patient with higher platelet counts. In-hospital mortality, one of the primary outcomes of this study, was significantly higher in Group II (13.0%) than Group I (5.0 %) and p value was 0.048. Re-infarction was more in patient with higher platelet counts group (Group II) than patients with lower platelet count (Group I) but statistically was not significant (16.0% vs.11.0%; p=0.300).

Impact of metabolic syndrome in acute myocardial infarction at hospital

The study was aimed to find out the impact of metabolic syndrome in patients with acute myocardial infarction during hospital stay. This prospective study was carried out in coronary care unit, Mymensingh Medical College Hospital from August 2009 to May 2010. Patients were followed up for minimum 3 days to maximum 6 days after admission. Variables of this study were age, sex, smoking, anterior AMI, inferior AMI, Non STEMI, hyperglycemia, low high density lipoprotein (HDL), raised blood pressure, high triglyceride (TG), waist circumference, recurrent non fatal MI, heart failure (Killip class), arrhythmia (VT, VF), ejection fraction (EF), family history of cardiovascular (CV) risk factors. Considering inclusion and exclusion criteria total 100 patients were included and divided into two groups, Group A - Acute Myocardial Infarction (AMI) with Metabolic Syndrome (MS) and Group B - Acute Myocardial Infarction (AMI) without Metabolic Syndrome (MS). Investigations included ECG, FBS, fasting lipid profile, cardiac enzyme (troponin I) and echocardiography (2D & M mode). The data were analyzed by computer software SPSS version 12. Chi-square test, t test, ANOVA test was used as test of significance. Among the study population (n=100), female were 12.0%. Mean age of study population was 53.3±10.6 years vs. 47.5±11.3 years. Distribution of metabolic syndrome components in study population, High TG (?150mg/dl) was more prevalent (81.1% vs. 25.8%). Heart failure (Killip class) was significantly more in metabolic syndrome patients than those without metabolic syndrome (46.0 % vs. 20%). LV ejection fraction also lowers in metabolic syndrome patients (46.76±8.34 vs. 50.45±7.50) with MI. Among the components of metabolic syndrome, hyperglycemia had strongest association for development of heart failure (OR 3.05; 95% CI 0.80-12.14).

Demographics and cell types of bronchial carcinoma of a tertiary care hospital in Bangladesh

Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style such as smoking have been noted to influence the occurrence of bronchial carcinoma. We conducted this study to document the frequency of various histological types of bronchial carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out among admitted patient with the suspicion of Bronchial carcinoma from January 2010 to January 2011 in medicine units of Mymensingh Medical College Hospital, Mymensingh. Among those only 30 consecutive histopathologically &/or cytological confirmed cases of Bronchial carcinoma were included in the study. No age, gender, environmental or occupational limits were applied for the selection of patients. Patients already diagnosed by some other hospital presenting to our unit with complications were not included in the study. Age rang were 26-70 years. Majority of patients i.e. 63.33% (n=19) were found to be in their fourth and sixth decade of life. Males were 86.66% (n=26) as compared to females 13.44% (n=4) and male to female ratio were 6.5:1. The majority of the patients were belonged to urban areas 63.34% (n=19), while 36.66% (n=11) came from the Rural population. In this study smokers were 86.66% (n=26) and nonsmokers were 13.33% (n=4). In Occupational distribution farmers were 33.33% (n=10), service holders were 20% (n=6), businessman were 16.66% (n=5), all the female were house wife 13.33% (n=4). Specimens for histopathological study were collected by trans-thoracic needle aspiration under CT or ultrasono-guided. The results of cell types in histopathologically proven 30 Bronchial carcinoma patients were; 10(33.36%) adenocarcinoma, 7(23.33%) squamous cell carcinoma, 6(20%) small cell carcinoma, 4(13.33%) large cell carcinoma and 3(10%) non-small cell carcinoma.

Metabolic syndrome is a risk factor for development of heart failure in acute myocardial infarction

There is a relationship between metabolic syndrome with heart failure. A case control study was designed to see the association of metabolic syndrome with heart failure. The study was conducted from August 2009 to May 2010. Hundred cases were selected as study population which was taken from Department of Cardiology Mymensingh Medical College, Mymensingh. Among them 50 were in Group A, 50 were in Group B. Group A was the patient with acute myocardial infarction (AMI) with metabolic syndrome. Group B was the patient with AMI without metabolic syndrome. It revealed that 23(46%) in Group A and 10 (20%) in Group B developed heart failure. Which is statistically significant (p<0.05). The study concluded that metabolic syndrome is significantly associated with heart failure.