Coronary Artery Revascularization with the Left Internal Mammary Artery (LIMA) to Diagonal (D) & Left Anterior Descending (LAD) Sequential and LIMA-LIMA "Y" Graft, Our Experiences at National Heart Foundation Hospital and Research Institute

The Left internal mammary artery (LIMA) is considered the conduit of choice for the surgical treatment (CABG, coronary artery bypass grafting) of Coronary artery disease (CAD) due to its superior long term potency than the other conduits. Sequential anastomosis with the LIMA in CABG increases the number of arterial graft and more completeness the arterial revascularization. To increase the number of arterial graft and improved long term potency, an alternative technique is sequential anastomosis of LIMA to Diagonal (D) & left anterior descending artery (LAD) and LIMA-LIMA "Y" Graft play a vital role in patients with tight proximal lesion. Perioperative data were prospectively collected from all patients with isolated CAD with tight proximal LAD lesion, who underwent off-pump CABG from November 2013 to October 2015 at a single Centre. A total of 321 patients had LIMA to D & LAD sequential and LIMA-LIMA "Y" grafts pattern with severe proximal LAD lesion. The mean age was 54.7±8.4 years, male & female ratio was 29.7:7.5. Left main involvement was in 25% & triple vessel disease was 89% with LVEF 53.6±8.6%. Sequential LIMA to diagonal (side to side) & LAD (end to side) done in all 294 cases and LIMA-LIMA"Y" grafts in 27 cases. Thirty days mortality was 0.935% (3 patients). Postoperative myocardial infarction (MI) occurred in 2 patients (0.623%). Two sequential LIMA graft failed and both the diagonal & LAD bypassed coronary arteries were very narrow, about 1mm in diameter. All the patients underwent postoperative NYHA class evaluation at 3-6 months follow up & found normal and none of the patients suffered for angina. Revascularization with skeletonized sequential LIMA anastomosis to D, LAD & LIMA-LIMA "Y" graft is a safe, feasible with improve overall long-term potency and reproducible alternative in the presence of severe proximal LAD lesion to the complete revascularization of the anterior& lateral myocardial wall. Long term follow-up with coronary angiogram is essential to recommend this technique as standard one.

Engineering dendrimers to produce dendrimer dipole excitation based terahertz radiation sources suitable for spectrometry, molecular and biomedical imaging

Two critical nanoscale design parameters (CNDPs); namely, surface chemistry and interior compositions of poly(amidoamine) (PAMAM) dendrimers were systematically engineered to produce unique hyperpolarizable, electro-optical substrates. These electro-optically active dendritic films were demonstrated to produce high quality, continuous wave terahertz radiation when exposed to a suitable pump laser that could be used for spectrometry and molecular imaging. These dendrimer based dipole excitation (DDE) terahertz sources were used to construct a working spectrometer suitable for many practical applications including THz imaging and analysis of encapsulated hydrogen species in fullerenes.

Death in a diarrhoeal cohort of infants and young children soon after discharge from hospital: risk factors and causes by verbal autopsy

Assessing mortality pattern of children after discharge from hospital is important to guide appropriate management policy. We studied young children aged 1-23 months, who were discharged from an urban Diarrhoea Treatment Hospital. Children were enrolled on discharge from the hospital, and followed at home after 6 and 12 weeks to assess post-discharge mortality. Of 500 children, 427 were available for evaluation at home 6 weeks after discharge. The median age of the children was eight months, 77 per cent of whom were less than 12 months of age. Of the 427 children, 30 (7 per cent) died within 6 weeks and two died within 12 weeks of discharge from hospital. The median survival time of the deceased was 11 days. Children less than 6 months of age had a five times greater risk of death compared with those aged 6 months or older. Malnutrition, non-breastfeeding, and lack of immunization were important risk factors for death. As ascertained by verbal autopsy, the underlying causes of death were respiratory diseases and watery diarrhoea. Malnutrition and low birth weight were the main associated causes. Hospitalized children, especially young infants, should be given special attention and need to be followed preferably within a week of discharge.

Factors associated with safe preparation and home use of sugar-salt solution

The use of oral rehydration salts is frustratingly low, mostly because one must visit a health care provider to procure the packets. Mothers are advised to use sugar-salt solution (SSS) and other home-based fluids as first fluid replacement during diarrhoea. However, the use rate of SSS is also not encouraging and few mothers can prepare it correctly. We conducted an observation study on mothers who reported to the diarrhoea treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh during September 1990 through to December 1992. At quarterly intervals, 240 mothers were recruited randomly to elicit their knowledge and ability to prepare SSS. Most (94.6%) of the mothers knew about the solution, but only 62% of them used the solution at home. The use rate was higher when mothers came to know about the solution through interpersonal communication (e.g. community health workers, doctors, friends, neighbours and relatives) and from multiple sources (72%) than when they learned about it from the media or from a single source (54%). As many as 85.4% of the mothers could prepare the solution within the safe limits of sodium concentrations (30 to 100 mmol/l). The figure rose to 95.8% after practical instruction as to how to prepare the solution. This improvement was dependent neither on the literacy level of mothers nor on their knowledge and use of the solution earlier. To increase interpersonal communication and to improve mothers' behaviour in using and correctly preparing SSS, every contact with health care providers should be utilised for organising sessions on the use and preparation of the solution.

Trends of immunisation status of the children and women attending an urban diarrhoea hospital in Bangladesh

Since October 1988 the International Centre for Diarrhoeal Disease Research, Bangladesh has been offering immunisations to children less than 2 years old and women of reproductive age (15 to 45 years) who report for treatment at its Dhaka-based treatment centre. A survey conducted during October 1989 to June 1992 has revealed that 22.5% of these targeted children (n = 4,456) and 21.7% of the women (n = 5,266) had not received any immunisations. Only 23.2% of the children had completed an immunisation schedule, whereas 70.1% of the women had received 2 doses of tetanus toxoid. The percentage of women receiving both doses of tetanus toxoid vaccine increased significantly from 55.2% to 80.5% during the survey period (Chi Square = 9.47, p = 0.002). However, the percentage of children receiving all doses of vaccines against the six communicable diseases increased only from 15.8% to 23.4% (Chi Square = 1.13, p = 0.29) during the reporting period. Our observation shows that it is possible to cover a significant percentage of women with at least 2 doses of tetanus toxoid vaccine. However, immunisation services need to be intensified utilising all the health centres to improve immunisation coverage for the children.

Compliance with diphtheria, tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups

OBJECTIVE

To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation.

DESIGN

Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated.

SETTING

Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh.

SUBJECTS

136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died.

INTERVENTIONS

All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose.

MAIN OUTCOME MEASURE

Rate of non-compliance with advice to return child for second vaccination.

RESULTS

46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose.

CONCLUSIONS

Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.

Immunisation in a curative setting

OBJECTIVE

To study the uptake of vaccination offered to women and children attending a curative health facility.

DESIGN

Prospective survey over eight months of the uptake of vaccination offered to unimmunised women and children attending a diarrhoeal treatment centre as patients or attendants.

SETTING

The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.

SUBJECTS

An estimated 19,349 unimmunised women aged 15 to 45 and 17,372 children attending the centre for treatment or accompanying patients between 1 January and 31 August 1989.

MAIN OUTCOME MEASURES

The number of women and children who were unimmunised or incompletely immunised was calculated and the percentage of this target population accepting vaccination was recorded.

RESULTS

7530 (84.2%) Of 8944 eligible children and 7730 (40.4%) of 19,138 eligible women were vaccinated. Of the children, 63.8% were boys, 75.9% were aged under 1 year, and 23.0% were aged 1 to 2 years. The estimated number of missed opportunities for vaccination was 716 among the children (8.0% of the target population) and 11,408 among the women (59.6% of those eligible).

CONCLUSION

It is possible to establish immunisation services at a health facility treating acutely ill patients.