Receptor model-based sources and risk assessment of metals in sediment of the coastal construction-oriented aquatic system in Bangladesh

Metal pollution in sediment from construction areas raises ecological and health concerns, yet source-based sediment pollution in Bangladesh remains understudied. Our investigation focused on fifteen locations in the Kohelia River and the coastal regions near the Matarbari projects (Matarbari Power Plant, Matarbari Deep Seaport), assessing metal concentrations' sources and impacts on ecology and human well-being. Sediment quality indices indicated high Cd and Cr contamination, with sites near Matarbari projects being the most polluted. The positive matrix factorization model identified three anthropogenic sources and mixed sources. Matarbari projects contributed significantly to As (67.9 %), Mn (50.25 %), Cd (48.35 %), and Cr (41.0 %), while ship-breaking yards contributed Fe (58.0 %), Zn (55.5 %), Pb (53.8 %), and Cu (36.1 %). Ecological indices showed different impacts on aquatic life from metal pollution, but cancer risk levels stayed below the threshold set by the US Environmental Protection Agency. These findings underscore the need for targeted measures to address metal pollution.

Sequential mediation analysis of physical activity, healthy diet, BMI, and academic burnout in the Pakistani educational landscape

Research has indicated a negative impact of physical activity on academic burnout among students, however, there is a paucity of evidence about the underlying mechanism of this association in Pakistani students. The present research seeks to investigate the relationship between physical activity and academic burnout by investigating the potential mediating effects of adherence to the Mediterranean diet (MD) and body mass index (BMI). A sample of 596 students using a cross-sectional survey design was gathered from two public universities (Riphah International University and Mohammed Ali Jinnah University) in Rawalpindi, Pakistan from June to July 2022. The study participants were asked to fill out the Physical Activity Rating Scale-3, the Learning Burnout Scale, and the Test of Adherence to MD questionnaires. The study employed descriptive, bivariate, and path analysis through regression utilizing the SPSS software version 27. The findings demonstrated a negative correlation between academic burnout and BMI, physical activity, and adherence to the MD. The relationship between physical activity and academic burnout was mediated by BMI. Physical activity and academic burnout were inversely correlated, with adherence to the MD and BMI interacting as sequential mediators. The outcomes of this research have expanded our knowledge of the association between physical activity and academic burnout and have suggested crucial and appropriate strategies for addressing student academic burnout.

Association of CSF Total Protein with Clinical Heterogeneity, Disease Severity and Electrophysiological Pattern in GBS Patients

Guillain-Barre Syndrome (GBS) is considered as an immune mediated inflammatory disease of peripheral nerves and nerve roots. The significance of CSF total protein (CSF-TP) in subtypes of Guillain-Barre syndrome has not been well established. This observational, cross sectional study's aim was to identify association of CSF total protein with clinical heterogeneity, disease severity and electrophysiological subtypes in GBS patients. This study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2017 to February 2019 on 50 (fifty) admitted GBS patients as per inclusion and exclusion criteria. About 3-5 ml of CSF was taken around 10±2 days from disease onset for detection CSF cell count and protein. Pattern of clinical presentation, disability status by Hughes scale and NCS findings of these patients was documented. Mean CSF-TP were substantially higher for Sensori-motor GBS (195.42 mg/dl) and GBS with cranial involvement (226.12 mg/dl) than that of GBS with motor (134.00 mg/dl) and autonomic involvement (155.21 mg/dl). Mean CSF total protein (CSF-MTP) in severely ill GBS patients (Grade-IV) was 217.04 mg/dl and very severely ill GBS patients (Grade-V) was 138.00mg/dl which was significantly higher than mean CSF total protein in mild GBS patients (CSF-MTP: 99.86mg/dl) and moderately ill GBS patients (CSF-MTP: 172.00 mg/dl). Mean CSF total protein is 245.00mg/dl in AIDP which is also higher than mean CSF total protein of AMAN (153.36 mg/dl) and AMSAN (165.17mg/dl). CSF-TP is thought to be a sensitive test for GBS in the second week after onset, but it may be a reliable predictor of clinical severity. There is a significant association of CSF-TP elevation with demyelinating electrophysiologic pattern.

Serum Uric Acid and Serum Lipid Levels in Patients with Acute Ischemic Stroke Admitted in Mymensingh Medical College Hospital

Stroke is the second-leading cause of death and also a leading cause of combined death and disability. In Bangladesh, stroke prevalence is 11.39 per 1000 population, but highest prevalence of stroke is 14.71 per 1000 population in the Mymensingh division. Hyperuricemia has been reported as an independent risk factor for stroke in different studies and a significant association between serum uric acid and dyslipidemia has also been stated. On the contrary, some studies suggest that uric acid has a neuroprotective role. This cross-sectional study was completed in the Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2021 to January 2023. In this cross-sectional study, 352 adult acute ischemic stroke patients were included from the Medicine Department of Mymensingh Medical College Hospital. Serum uric acid and fasting serum lipid levels were measured within 48 hours of admission. The mean age ±SD of the respondents was 61.9±12.8 years. Hyperuricemia was found among 18.2% of respondents, whose mean ±SD serum uric acid was 5.7±1.9 mg/dl. Dyslipidemia was present in 88.4% of patients. The mean ±SD of the National Institutes of Health Stroke Scale (NIHSS) score was 12.0±5.9. Most of the patients (65.6%) were suffering from moderate stroke, followed by moderate to severe stroke (15.1%), severe stroke (10.8%) and minor stroke (8.5%). After multiple linear regressions, the independent variables age, gender, serum uric acid and total cholesterol were found to be significant predictors of the NIHSS score of the respondents. In conclusion, the majority of acute ischemic stroke patients have an association with dyslipidemia, but only around one-fifth of patients have hyperuricemia. There is a significant association of high serum uric acid and high serum total cholesterol with stroke severity (NIHSS score). But low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and, triglycerides have no association with stroke severity.

Assessing stocks of Mystus tengara (Hamilton, 1822) from three different management systems in Baors (Oxbow lake) of southwest Bangladesh: Implications for sustainable management

This study was conducted to observe the stock assessments of Tengara (Mystus tengara) in three different management systems of Baors (Oxbow lake) such as System-1, System-2, and System-3. In this study, 1806 specimens were sampled using traditional fishing nets to observe growth pattern, population structure, growth parameters, natural mortality (M), fishing mortality (F), total mortality (Z), recruitment pattern, exploitation rate (E), relative yield per-recruit (Y'/R), optimum catchable length, length at first capture, steady state biomass (SSB), and maximum sustainable yield (MSY) from January to December 2021. Digital slide calipers and a digital balance were used to measure each individual's total length (TL) and body weight (BW), respectively. An empirical maximum length-based model was used to calculate size at first sexual maturity (Lm), and optimum catchable length (Lopt) was calculated based on asymptotic length (L∞). The least square linear regression equation was used to determine the regression parameters. The value of regression parameter, 'b' was 3.01 for system-1, 2.78 for system-2, and 2.70 for system-3, indicating that growth pattern of Tengara is isometric in system-1, but negative allometric growth in system-2 and system-3. The highest asymptotic length (L∞) and weight (W∞) of Tengara were found in system-1 (11.19 cm and 13.67 g) in comparison with system-2, (10.98 cm and 12.49 g) and system-3 (9.09 cm and 6.96 g) respectively. The growth coefficient (K) of the von Bertalanffy growth function (VBGF) was 0.72 year-1, 0.72 year-1, and 0.73 year-1 for system-1, system-2 and system-3, respectively. The calculated M, F, Z were 1.72, 1.28, and 3.00 year-1 for system-1, 1.11, 0.67 and 1.78 year-1 for system-2 and 1.12, 0.84 and 1.96 year-1 for system-3 respectively. The calculated life span (tmax) was found 4.19 years for system-1, 4.15 years for system-2 and 4.12 years for system-3. The recruitment patterns showed that the highest relative percentage of recruits were found in July, June and September for system-1, system-2 and system-3 respectively, with the major recruitment peak occurring from April to June for system-1, May to June for system-2 and June to July for system-3. One minor recruitment peak also occurred from August to September in system-1. The exploitation rate was more or less same in all three systems indicating that Tengara is under exploited from all the Baors. The significantly highest SSB and MSY were found in system-1 (22.65 and 12.11 metric tons), compared to system-2 (16.16 and 10.28 metric tons) and system-3 (5.55 and 5.49 metric tons), respectively. Considering the values of regression parameters, recruitment pattern, SSB and MSY, system-1 was found more suitable for Tengara compared to system-2 and system-3 management practices of Baors. Finally, these findings will turn out to be paradigm for the impregnable management of Tengara in Baors of southwest Bangladesh.

Natural Isatin Derivatives Against Black Fungus: In Silico Studies

During this coronavirus pandemic, when a lot of people are already severely afflicted with SARS-CoV-19, the dispersion of black fungus is making it worse, especially in the Indian subcontinent. Considering this situation, the idea for an in silico study to identify the potential inhibitor against black fungal infection is envisioned and computational analysis has been conducted with isatin derivatives that exhibit considerable antifungal activity. Through this in silico study, several pharmacokinetics properties like absorption, distribution, metabolism, excretion, and toxicity (ADMET) are estimated for various derivatives. Lipinski rules have been used to observe the drug likeliness property, and to study the electronic properties of the molecules, quantum mechanism was analyzed using the density functional theory (DFT). After applying molecular docking of the isatin derivatives with sterol 14-alpha demethylase enzyme of black fungus, a far higher docking affinity score has been observed for the isatin sulfonamide-34 (derivative 1) than the standard fluconazole. Lastly, molecular dynamic (MD) simulation has been performed for 100 ns to examine the stability of the proposed drug complex by estimating Root Mean Square Deviation (RMSD), Radius of gyration (Rg), Solvent accessible surface area (SASA), Root Mean Square Fluctuation (RMSF), as well as hydrogen bond. Listed ligands have precisely satisfied every pharmacokinetics requirement for a qualified drug candidate and they are non-toxic, non-carcinogenic, and have high stability. This natural molecule known as isatin derivative 1 has shown the potential of being a drug for fungal treatment. However, the impact of the chemicals on living cells requires more investigation and research.

Zohra Begum Kazi: Pioneering Bengali female doctor and nationalist representation

This paper aims to elucidate a comprehensive biographical account of Zohra Begum Kazi, the pioneering Bengali female doctor in Bangladesh. Her professional journey commenced during the British colonial time, achieved prominence during the era of Pakistan, and ultimately reached the pinnacle of her life's accomplishments in the independent Bangladesh. Despite her distinguished medical career, her life was significantly shaped by sundry historical discourses, endowing her with the attributes of a philanthropist, a revolutionist, and a nationalist. This study seeks to assess her multifaceted contributions in three distinct dimensions: firstly, her role as a medical doctor; secondly, her engagement in the nationalist movement, and thirdly, her intellectual influence as a moral and social philosopher. Through this multifaceted analysis, we aim to consign her within the annals of Bangladesh's national history as the leading Bengali female doctor.

Anti-diarrheal effect of piperine possibly through the interaction with inflammation inducing enzymes: In vivo and in silico studies

Piperine is a natural alkaloid that possesses a variety of therapeutic properties, including anti-inflammatory, antioxidant, antibacterial, and anticarcinogenic activities. The present study aims to assess the medicinal benefits of piperine as an anti-diarrheal agent in a chick model by utilizing in vivo and in silico techniques. For this, castor oil was administered orally to 2-day-old chicks to cause diarrhea. Bismuth subsalicylate (10 mg/kg), loperamide (3 mg/kg), and nifedipine (2.5 mg/kg) were used as positive controls, while the vehicle was utilized as a negative control. Two different doses (25 and 50 mg/kg b.w.) of the test sample (piperine) were administered orally, and the highest dose was tested with standards to investigate the synergistic activity of the test sample. In our findings, piperine prolonged the latent period while reducing the number of diarrheal feces in the experimental chicks during the monitoring period (4 h). At higher doses, piperine appears to reduce diarrheal secretion while increasing latency in chicks. Throughout the combined pharmacotherapy, piperine outperformed bismuth subsalicylate and nifedipine in terms of anti-diarrheal effects with loperamide. In molecular docking, piperine exhibited higher binding affinities towards different inflammatory enzymes such as cyclooxygenase 1 (-7.9 kcal/mol), cyclooxygenase 2 (-8.4 kcal/mol), nitric oxide synthases (-8.9 kcal/mol), and L-type calcium channel (-8.8 kcal/mol), indicating better interaction of PP with these proteins. In conclusion, piperine showed a potent anti-diarrheal effect in castor oil-induced diarrheal chicks by suppressing the inflammation and calcium ion influx induced by castor oil.

Factors associated with children's cognitive, language, and motor development in deprived urban settings in Bangladesh

BACKGROUND

Children's development is multifactorial. Although there have been several studies exploring the association of children's development with maternal, child, and environmental factors, we are unaware of any study that assessed those factors in children whose mothers were enrolled in a social safety net programme in low- and middle-income countries. This study aimed to identify the factors associated with disadvantaged children's cognitive, language, and motor development at age 6-16 months in deprived settings of urban Bangladesh and to identify relative importance of these factors of children's development. We also explored if there were any gender differences in child development.

METHODS

This cross-sectional study was conducted in a deprived setting of urban Bangladesh. Bayley III was used for assessing children's cognitive, language, and motor development. Multivariable linear regression model was used to find the factors associated with children's development, and dominance analysis was used to explore the relative importance of the factors.

RESULTS

Out of the total 599 mother-child dyads, 303 (50.58%) were girls. The factors associated with children's development were length-for-age Z-score (cognitive: B = 1.21 [95% CI = 0.31, 2.11], P = 0.008; language: 1.67 [0.79, 2.55] P < 0.001; motor: 2.15 [1.01, 3.29] P < 0.001) and home environment (cognitive: 0.58 [0.27, 0.89] P < 0.001; language: 0.59 [0.27, 0.92], P < 0.001; motor: 0.44 [0.09, 0.79] P = 0.013). Girls had higher cognitive (1.90 [0.17, 3.6], P = 0.031) and language (2.53 [0.55, 4.51], P = 0.013) development compared with boys. Families with a higher number of under five children within the households had lower language (-1.57 [-2.78, -0.36], P = 0.011) development. Violence against the mother and the families' food security status were not associated with the children's development. Children's length-for-age Z-score (27%) and home stimulation environment (23%) were the most important factors of cognitive development.

CONCLUSION

Children's nutritional status and home environment are important factors for disadvantaged children's development in deprived urban settings of Bangladesh. Both early child development-focussed parenting and nutrition interventions should be considered when designing child development programmes in urban settings in low- and middle-income countries.

Engineering the surface patchiness and topography of polystyrene colloids: From spheres to ellipsoids

HYPOTHESIS

Colloidal surface morphology determines suspension properties and applications. While existing methods are effective at generating specific features on spherical particles, an approach extending this to non-spherical particles is currently missing. Synthesizing un-crosslinked polymer microspheres with controlled chemical patchiness would allow subsequent thermomechanical stretching to translate surface topographical features to ellipsoidal particles.

EXPERIMENTS

A systematic study using seeded emulsion polymerization to create polystyrene (PS) microspheres with controlled surface patches of poly(tert-butyl acrylate) (PtBA) was performed with different polymerization parameters such as concentration of tBA monomer, co-swelling agent, and initiator. Thermomechanical stretching converted seed spheres to microellipsoids. Acid catalyzed hydrolysis (ACH) was performed to remove the patch domains. Roughness was characterized before and after ACH using atomic force microscopy.

FINDINGS

PS spheres with controlled chemical patchiness were synthesized. A balance between two factors, domain coalescence from reduced viscosity and domain growth via monomer absorption, dictates the final PtBA) patch features. ACH mediated removal of patch domains produced either golf ball-like porous particles or multicavity particles, depending on the size of the precursor patches. Patchy microspheres were successfully stretched into microellipsoids while retaining their surface characteristics. Particle roughness is governed by the patch geometry and increases after ACH. Overall, this study provides a facile yet controllable platform for creating colloids with highly adjustable surface patterns.

Identification of synthetically tractable MERS-CoV main protease inhibitors using structure-based virtual screening and molecular dynamics potential of mean force (PMF) calculations

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a potentially lethal infection that presents a substantial threat to health, especially in Middle East nations. Given that no FDA-approved specific therapy for MERS infection exists, designing and discovering a potent antiviral therapy for MERS-CoV is crucial. One pivotal strategy for inhibiting MERS replication is to focus on the viral main protease (Mpro). In this study, we identify potential novel Mpro inhibitors employing structure-based virtual screening of our recently reported Ugi reaction-derived library (URDL) consisting of cherry-picked molecules from the literature. The key features of the URDL library include synthetic tractability (1-2 pot synthesis) of the molecules scaffold and unexplored chemical space. The hits were ranked based on the docking score, MM-GBSA free energy of binding, and the interaction pattern with the active site residues. A molecular dynamics (MD) simulation study was performed for the first two top-ranked compounds to analyze the stability and free binding energy based on the molecular mechanics Poisson-Boltzmann surface area. The potential mean force calculated from the steered molecular dynamics (SMD) simulations of the hits indicates improved H-bond potential, enhanced conformational stability, and binding affinity toward the target, compared to the cocrystallized ligand. The discovered hits represent novel synthetically tractable scaffolds as potential MERS-CoV Mpro inhibitors.Communicated by Ramaswamy H. Sarma.

Growth, structural, thermal, and optical characteristics of L-asparagine monohydrate doped magnesium sulphate heptahydrate semiorganic crystals

A novel semi-organic crystal has been grown using slow evaporation technique by doping organic compound L-asparagine monohydrate (C4H8N2O3·H2O) with inorganic material Magnesium sulphate heptahydrate (MgSO4·7H2O). The crystallographic parameters like strain, dislocation density and crystallite size were calculated by powder X-ray diffraction method. Functional groups were identified and bond length, force constants were calculated from FT-IR spectroscopy. Energy dispersive X-ray (EDX) analysis was used to identify the constituent elements of the crystal. Kinetic and thermodynamic parameters, such as, activation energy Ea, change in Gibb's free energy (ΔG) and change in enthalpy (ΔH) have been determined by thermogravimetric analysis (TGA) analysis. Ea, ΔH and ΔG show positive values and change in entropy (ΔS) shows negative ones. The thermal degradation behavior of the crystals has been analyzed by differential scanning calorimetry (DSC) analysis. Various optical constants such as optical band gap, lattice dielectric constant, absorbance, extinction coefficient, the ratio of free charge carrier concentration to the effective mass, Urbach energy, optical and electrical conductivities were estimated from UV-vis transmittance data. High optical conductivity (1010 s-1) justifies the good photo response nature of the semi-organic crystal.

Effect of Milk Intake and Calcium-Vitamin D Supplementation on Serum Vitamin D Status

Vitamin D is important for health and disease. Milk is a good natural source of it, and calcium-vitamin D supplements are widely available over-the-counter and prescribed in clinical practice. But the effect of milk intake and calcium-vitamin D supplementation on serum vitamin D status is not known. This cross-sectional study was done to see the relationship between vitamin D status and milk intake or oral calcium-vitamin D supplementation using a structured questionnaire and carried out in a private consultation centre of Dhaka city, the capital of Bangladesh from July 2017 to March 2018. Serum 25-hydroxyvitamin D [25(OH)D] level was measured by radioimmunoassay. Out of 259 patients, 64.1% had vitamin D deficiency defined as serum 25(OH)D level <20ng/mL. Sixty one percent of those who had serum 25(OH)D level <20ng/mL did not take milk or milk products, while 53.0% of those having 25(OH)D level ≥20ng/mL did not take milk. Approximately 89.0% of those who had serum 25(OH)D level <20ng/mL did not take oral calcium-vitamin D, whereas 72.0% of those having 25(OH)D level ≥20ng/mL did not take oral calcium-vitamin D (p=0.001). In the multiple logistic regression analysis, there were significantly increased odds of vitamin D deficiency for females as compared to males [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.34-4.56] and not taking oral vitamin D as compared to taking oral vitamin D (OR 3.56, 95% CI 1.74-7.28). Vitamin D deficiency is widely prevalent. Lack of milk intake and calcium-vitamin D supplementation are more commonly associated with serum vitamin D deficiency, and calcium-vitamin D supplementation is specially important in females.

Role of Rehabilitation Exercise on Myofascial Pain Syndrome Causing Upper Back Pain

Upper back pain is as painful or troublesome as the pain in the lower back or the neck. Myofascial pain syndrome which is most common cause of upper back pain is characterized by localized musculoskeletal pain and tenderness in association with trigger points. The aim of the study was to correlate the improvement of myofascial pain syndrome patients with proper and timely physical therapy. This quasi experimental study was conducted in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from 1st January 2008 to 31st August 2008 to see the role of rehabilitation exercise on myofascial pain syndrome causing upper back pain. Sixty (60) patients of myofascial pain syndrome causing upper back pain were randomly assigned for treatment; out of which 23(38.33%) were male and 37(61.66%) were female. The male and female ratio was 1:1.6. The patients selected for the trial were divided into two groups: Group A and Group B. In group A (n=28) the patients were treated with thermotherapy- Microwave diathermy, non-steroidal anti inflammatory drugs and activities of daily living instructions and in Group B (n=32) with same interventions in addition to rehabilitation exercises. Treatment duration was 6 weeks. The difference of treatment improvement was statistically significant (p<0.05) from 1st week up to 6th week. After complete course of treatment 67.86% patients in Group A and 78.13% patients in group B reported improvement. So rehabilitation exercises can be a valuable adjunct to other modalities of treatment of myofascial pain syndrome causing upper back pain.

Evaluation of Serum Iron Profile in Patients with Pulmonary Tuberculosis

Approximately 10.0% of tuberculosis (TB) Infected individuals develop clinical disease in the absence of immune suppression suggests that individual factors may play a role in the response to infection. Body's immune function is boosted by micronutrient and also plays a major role in response to tubercular infection. Someone, may argue that cell mediated immunity is compromised in iron deficiency before anemia becomes apparent. This descriptive observational study intended to assess serum iron profile in patients suffering from pulmonary tuberculosis. This study included 56 newly diagnosed sputum smear positive and negative pulmonary tuberculosis patients as per inclusion and exclusion criteria and was conducted at the department of the Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh with the collaboration of the Biochemistry department, BSMMU, Bangladesh from February 2017 to January 2018. Collected data were recorded in a structured questionnaire and compiled and appropriate analyses were done by using computer-based software Statistical Package for Social Sciences (SPSS) version 23.0. Out of 56 patients, majority was young and at reproductive age, male was predominant (78.6%) with a male to female ratio of 3.7:1. More than three fourth 43(81.0%) patients were found to have low serum iron concentration. Majority 45(80.4%) patients had normal serum TIBC, 6(10.7%) had low serum total iron binding capacity (TIBC) and 5(8.9%) had high serum TIBC. Almost two third 36(64.3%) patients had low serum transferrin saturation and 20(35.7%) had normal serum transferrin saturation. Majority 31(55.4%) patients had normal serum ferritin, 2(3.6%) had low serum ferritin and 23(41.1%) had high serum ferritin. Serum iron concentration and serum ferritin were significantly associated with chest x-ray abnormalities (p<0.01). Half of the patients were smear positive for acid fast bacilli (AFB) (50.0%). No significant association was found between sputum positive for AFB with iron profile status. In smear positive pulmonary tuberculosis patients, more than three fourth (78.6%) patients had low serum iron concentration at baseline and majority 20(80.0%) patients had normal serum iron concentration after 2(two) months. Mean serum iron concentration was 41.8±17.6mcg/l in baseline and 70.4±29.7mcg/l in at 2(two) month. More than sixty percent (60.7%) patients had low serum transferrin saturation at baseline and 20(80.0%) patients had normal serum transferrin saturation after 2(two) months. Mean serum transferrin saturation was 18.1±7.6% at baseline and 31.2±19.4% in at 2(two) months. After 2(two) months follow up serum iron concentration and serum transferrin saturation had significant improvement (p<0.05). Significant iron deficiency status occurred in pulpmonary tuberculosis and which improved after anti-tubercular treatment without iron supplementation.

Prevalence of Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting: A Single-Centre Study in Bangladesh

Coronary artery disease (CAD) is one of the important causes of mortality worldwide. South Asians, notably Indians are unduly prone to develop CAD with its incidence being doubled in the last three decades among both rural and urban settlers. CAD prevalence of in Bangladesh is not known. There are merely a limited number of small-scale epidemiological studies are existing. Recent data indicates CAD prevalence in our country to lie between 1.85-3.4% in rural and 19.6% in an urban sample of working professionals. Despite marked disparity in values, the disease seems to be in rising trend. Patients with concomitant CAD and carotid artery disease are at increased risk of developing peri-operative neurological events including stroke. By far, the prevalence of carotid artery disease in candidates of CABG has not yet been determined in our country. There is a lack of pre-operative guidelines as well for the necessary vascular investigations that should be performed on CABG candidates before they go to the operation table. Pre-operative non-invasive carotid Doppler ultrasonography is a useful screening tool for carotid artery disease in all patients undergoing CABG. This was a cross-sectional observational study, was conducted in the Radiology & Imaging department of Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2017 to June 2017. The present cross-sectional study was intended to determine the prevalence of concurrent occurrence of carotid and coronary artery disease in elderly patients undergoing CABG. Total 210 elderly (from 60 & above) patients scheduled for CABG taken as study population. There was bilateral carotid atherosclerotic plaque in 15(12.2%) patients. Right carotid plaque was in 69(56.0%) patients, left carotid plaque in 54(43.9%) patients. Carotid stenosis grading was done in percentage (%). There was significant (>50.0%) stenosis of right carotid system in 12 patients (17.4%) and significant stenosis of left carotid system in 18 patients (33.3%). Right carotid system & bulb was the most common site of plaque formation. We can conclude from this study that a substantial proportion of patients after a particular age possess carotid artery disease simultaneously with coronary artery disease, routine evaluation of carotid arteries of the elderly patients scheduled for CABG is strongly suggested.

Mechanistic inhibition of gastric cancer-associated bacteria Helicobacter pylori by selected phytocompounds: A new cutting-edge computational approach

Background

Helicobacter pylori (H. pylori) is a persistent bacterial inhabitant in the stomachs of approximately half the global populace. This bacterium is directly linked to chronic gastritis, leading to a heightened risk of duodenal and gastric ulcer diseases, and is the predominant risk factor for gastric cancer - the second most common cause of cancer-related deaths globally. The increasing prevalence of antibiotic resistance necessitates the exploration of innovative treatment alternatives to mitigate the H. pylori menace.

Methods

Initiating our study, we curated a list of thirty phytochemicals based on previous literature and subjected them to molecular docking studies. Subsequently, eight phytocompounds-Glabridin, Isoliquiritin, Sanguinarine, Liquiritin, Glycyrrhetic acid, Beta-carotin, Diosgenin, and Sarsasapogenin-were meticulously chosen based on superior binding scores. These were further subjected to an extensive computational analysis encompassing ADMET profiling, drug-likeness evaluation, principal component analysis (PCA), and molecular dynamic simulations (MDs) in comparison with the conventional drug, Mitomycin.

Results

The natural compounds investigated demonstrated superior docking affinities to H. pylori targets compared to the standard Mitomycin. Notably, the phytocompounds Diosgenin and Sarsasapogenin stood out due to their exceptional binding affinities and pharmacokinetic properties, including favorable ADMET profiles.

Conclusion

Our comprehensive and technologically-advanced approach showcases the potential of identified phytocompounds as pioneering therapeutic agents against H. pylori-induced gastric malignancies. In light of our promising in silico results, we recommend these natural compounds as potential candidates for advancing H. pylori-targeted drug development. Given their potential, we strongly advocate for subsequent in vitro and in vivo studies to validate their therapeutic efficacy against this formidable gastrointestinal bacterium.

Assessment of Serum Homocysteine Level to Predict Early Prognosis of Ischaemic Stroke

Cerebrovascular disease is the third most familiar cause of mortality worldwide and in Bangladesh. The reported prevalence of stroke in Bangladesh is 0.3%. Age, high serum glucose, elevated admission blood pressure, fever, large infarction size, and hyperhomocysteinemia has been reported to be risk factor for early post-stroke neurological deterioration. Early serum homocysteine level estimation can predict the early prognosis of ischemic stroke. In a developing country like Bangladesh, an earlier stroke outcome prediction for guiding therapeutic approach is essential. This study aimed to specify the role of estimating serum homocysteine during the early phase of acute ischemic stroke to assume an early prognosis that would guide- a management plan, the need to stay in the hospital and the need for intervention. This cross-sectional descriptive study was performed at the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from October 2021 to April 2022. Radiologically confirmed all ischemic stroke patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, during the study period fulfilling the inclusion and exclusion criteria were included in this study. Non-probability purposive sampling technique was used. Data was collected using a pre-designed case record form. Quantitative data were represented as mean and standard deviation and qualitative data as frequency and percentage. The comparison was made by Chi-square test and independent samples t-test using SPSS (version 26.0). During the study period, among 716 stroke patients, 59 ischemic stroke patients were included in this study. The mean age of the patients was 64.0±11.72 years. After 72 hours of supportive treatment, early neurological outcomes were observed using NIHSS scoring. Out of 59 patients, the condition of 45(76.0%) patients improved or remained stable (END-) and the state of 14(24.0%) patients worsened (END+). Elderly age-raised temperature and elevated blood glucose level are known to increase infarction size, but only elevated temperature (p value 0.009) has statistical significance in this study. The mean homocysteine level ±SD was 20.22±6.95μmol/L, which is above the normal (<15μmol/L). The level was above average for both outcome groups. Serum homocysteine level was significantly higher in END(+) group (31.59±2.98μmol/L) than END(-) group (16.69±2.66μmol/L) and p value was <0.001.

Community Based Rehabilitation for Accessibility of Disable Person in a Low and Middle-income Country like Bangladesh

Not Available.

Pick and place process for uniform shrinking of 3D printed micro- and nano-architected materials

Two-photon polymerization lithography is promising for producing three-dimensional structures with user-defined micro- and nanoscale features. Additionally, shrinkage by thermolysis can readily shorten the lattice constant of three-dimensional photonic crystals and enhance their resolution and mechanical properties; however, this technique suffers from non-uniform shrinkage owing to substrate pinning during heating. Here, we develop a simple method using poly(vinyl alcohol)-assisted uniform shrinking of three-dimensional printed structures. Microscopic three-dimensional printed objects are picked and placed onto a receiving substrate, followed by heating to induce shrinkage. We show the successful uniform heat-shrinking of three-dimensional prints with various shapes and sizes, without sacrificial support structures, and observe that the surface properties of the receiving substrate are important factors for uniform shrinking. Moreover, we print a three-dimensional mascot model that is then uniformly shrunk, producing vivid colors from colorless woodpile photonic crystals. The proposed method has significant potential for application in mechanics, optics, and photonics.

Selective deconstruction of mixed plastics by a tailored organocatalyst

Plastic represents an essential material in our society; however, a major imbalance between their high production and end-of-life management is leading to unrecovered energy, economic hardship, and a high carbon footprint. The adoption of plastic recycling has been limited, mainly due to the difficulty of recycling mixed plastics. Here, we report a versatile organocatalyst for selective glycolysis of diverse consumer plastics and their mixed waste streams into valuable chemicals. The developed organocatalyst selectively deconstructs condensation polymers at a specific temperature, and additives or other polymers such as polyolefin or cellulose can be readily separated from the mixed plastics, providing a chemical recycling path for many existing mixed plastics today. The Life Cycle Assessment indicates that the production of various condensation polymers from the deconstructed monomers will result in a significant reduction in greenhouse gas emissions and energy input, opening a new paradigm of plastic circularity toward a net-zero carbon society.

Hirsutine, an Emerging Natural Product with Promising Therapeutic Benefits: A Systematic Review

Fruits and vegetables are used not only for nutritional purposes but also as therapeutics to treat various diseases and ailments. These food items are prominent sources of phytochemicals that exhibit chemopreventive and therapeutic effects against several diseases. Hirsutine (HSN) is a naturally occurring indole alkaloid found in various Uncaria species and has a multitude of therapeutic benefits. It is found in foodstuffs such as fish, seafood, meat, poultry, dairy, and some grain products among other things. In addition, it is present in fruits and vegetables including corn, cauliflower, mushrooms, potatoes, bamboo shoots, bananas, cantaloupe, and citrus fruits. The primary emphasis of this study is to summarize the pharmacological activities and the underlying mechanisms of HSN against different diseases, as well as the biopharmaceutical features. For this, data were collected (up to date as of 1 July 2023) from various reliable and authentic literature by searching different academic search engines, including PubMed, Springer Link, Scopus, Wiley Online, Web of Science, ScienceDirect, and Google Scholar. Findings indicated that HSN exerts several effects in various preclinical and pharmacological experimental systems. It exhibits anti-inflammatory, antiviral, anti-diabetic, and antioxidant activities with beneficial effects in neurological and cardiovascular diseases. Our findings also indicate that HSN exerts promising anticancer potentials via several molecular mechanisms, including apoptotic cell death, induction of oxidative stress, cytotoxic effect, anti-proliferative effect, genotoxic effect, and inhibition of cancer cell migration and invasion against various cancers such as lung, breast, and antitumor effects in human T-cell leukemia. Taken all together, findings from this study show that HSN can be a promising therapeutic agent to treat various diseases including cancer.

Molecular Biomarker Identification Using a Network-Based Bioinformatics Approach That Links COVID-19 With Smoking

The COVID-19 coronavirus, which primarily affects the lungs, is the source of the disease known as SARS-CoV-2. According to "Smoking and COVID-19: a scoping review," about 32% of smokers had a severe case of COVID-19 pneumonia at their admission time and 15% of non-smokers had this case of COVID-19 pneumonia. We were able to determine which genes were expressed differently in each group by comparing the expression of gene transcriptomic datasets of COVID-19 patients, smokers, and healthy controls. In all, 37 dysregulated genes are common in COVID-19 patients and smokers, according to our analysis. We have applied all important methods namely protein-protein interaction, hub-protein interaction, drug-protein interaction, tf-gene interaction, and gene-MiRNA interaction of bioinformatics to analyze to understand deeply the connection between both smoking and COVID-19 severity. We have also analyzed Pathways and Gene Ontology where 5 significant signaling pathways were validated with previous literature. Also, we verified 7 hub-proteins, and finally, we validated a total of 7 drugs with the previous study.

Short-term Treatment Outcome of Patients with Acute ST-elevation Myocardial Infarction in a Tertiary Care Hospital

Outcome of acute ST-elevation myocardial infarction patients varies time to time. The present study was intended to find out the short-term treatment outcome of the patients admitted in hospital. This descriptive study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15 January 2014 to 14 July 2014. A total of 100 patients admitted with Acute ST-elevation Myocardial Infarction confirmed on the presence of the (a) Typical chest pain of acute ST-elevation Myocardial Infarction (b) Electrocardiogram (ECG) evidence of ST segment elevation in two or more contiguous leads (c) Raised cardiac marker (Troponin I) were included in the study. Patients were randomly enrolled according to the inclusion and exclusion criteria and observe for one week. Data were processed and analyzed by using computer bases software SPSS version 19.0. Descriptive statistical methods were applied for data analysis. P value was considered as statistically significant when it is less than 0.05. Short-term treatment outcome of acute ST-elevation myocardial infarction include mechanical, arrhythmic, ischemic and inflammatory sequelae, as well as left ventricular mural thrombus. In addition to these broad categories, heart failure, arrhythmia, death are other common complications of AMI. The initiation of the complications usually results in explicit sign and symptoms of the acute MI patients. Learning of the complications in the post infarction period and the clinical syndromes develop with each complication, will allow the health care worker to evaluate and manage the complication appropriately.

Haematohidrosis: A Case Series of Five Patients

Haematohidrosisis manifested by sweating mixed with blood. It is a rare disease and there are scarce literature regarding case report. We are describing five cases of haematohidrosis in different age group here in this case series. In case 1- a 20 year old woman was admitted with history of recurrent haemorrhage from various sites without any trauma or anticoagulant or antipletlet medication. There was no evidence of local trauma. Physical examination was unremarkable. Her blood workup came out insignificant. In case 2- a 10 year old boy was admitted with epistaxis, conjunctival bleeding, haematuria and per rectal bleeding without any history of injury. He had no history of medicine which would cause bleeding. Physical examination and laboratory profile were insignificant. In case 3- a 15 year old boy presented with recurrent haematuria and conjunctival haemorrhage without any trauma. No history of medication that would cause the bleeding. His systemic examination and laboratory profile was unremarkable. In case 4- a 25 year old woman presented with bleeding from ear, nose and eyes without any local trauma. She was not on any medication that would cause bleeding. Her systemic inquiry and laboratory profile was unremarkable. In case 5- a 20 year old woman presented with bleeding from eyes, ears and umbilicus. There was no evidence of self-inflicted injury. She had features of anxiety disorder. Other systemic examination and laboratory profile was unremarkable. All the cases were labelled as haematohidrosis and treated with propranolol with successful outcome. We report this case series to build up awareness and disseminate clinical knowledge.

Comparison of Recurrent Laryngeal Nerve Injury during Thyroidectomy with and Without Routine Identification of the Nerve Peroperatively

Thyroidectomy is one of the commonest operative procedures performed in the neck and injury to recurrent laryngeal nerve (RLN) is not uncommon. It results in hoarseness to serious respiratory distress depending on the extent of the injury. The incidence of RLN injury varies widely and is multifactorial depending on the extent of surgical procedures, experience and expertise of the surgeons, nature of the thyroid diseases and a wide range of anatomical variations. Peroperative routine identification of the nerve during thyroidectomy can be a way to prevent injury. Despite recommendation for identification of the RLN peroperatively in thyroid surgery, a debate still exists whether the nerve to be identified peroperatively or not, to avoid its inadvertent injury. The aim of this study was to compare the incidence of RLN injury between two groups where RLN was identified peroperatively in one group and the nerve was not attempted for identification in the other group in thyroid surgery. A comparative cross-sectional study was carried out in the department of surgery and otolaryngology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2018 to November 2019, on patients who underwent elective thyroid surgery. Patients were included in RLN identified group and in RLN not identified group, by individual surgeons' preference to identify or not to identify the RLN peroperatively. Peroperative identification of the nerve was done by direct visualization. All cases were evaluated for vocal cord palsy preoperatively, during extubation and postoperatively. Patient's particulars, other parameters and perioperative data were recorded. A total of 80 cases were included in this study, 40 cases (50.0%) in the peroperative RLN identified group and 40 cases (50.0%) in the RLN not identified group. Unilateral RLN palsy was encountered in 2.5% (2 cases) in the RLN identified group and 6.3% (5 cases) in the nerve not identified group (p value 0.192). Transient unilateral RLN palsy was seen in 7.5% (6 cases) of patients; 2.5% (2 cases) in the RLN identified group and 5.0% (4 cases) in the RLN not identified group. And 1.3% (1 case) of permanent unilateral RLN palsy was encountered in this study, which was in the RLN not identified group; there was no permanent palsy in the RLN identified group. We did not encounter any bilateral RLN palsy. There was no statistically significant difference in the incidence of RLN injury between the peroperatively RLN identified group and no attempt to identify the nerve group despite recommendation for peroperative RLN identification in thyroid surgery to avoid its inadvertent injury. However, from this study, we recommend peroperative RLN identification in thyroid surgery to enhance surgical skill.

Comparison of Serum Zinc in Children of Wilson Disease and Non-Wilsonian Volunteers in Bangladesh

Wilson disease (WD) is an autosomal recessive disorder of copper metabolism with diverse clinical manifestations. Zinc (Zn) has been used for treatment of WD. Recent studies showed low serum zinc level in patients suffering from WD than the normal. This cross-sectional analytical study has been designed to compare the serum zinc level between paediatric patients suffering from WD but yet not started treatment and children who have normal ALT level. This study was carried out at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from July 2018 to June 2019. Total 51 children were included in this study. Among them 27 were diagnosed case of WD aged between three to eighteen years and 24 children of same ages who were suffering from other than liver disease having normal ALT were included as volunteers. The patients of WD were divided into four groups according to their presentation as acute hepatitis, chronic liver disease (CLD), acute liver failure & neuropsychiatric manifestation. Informed written consent was obtained from all patients and volunteers for participation in this study. Along with other physical findings and laboratory investigations 3 ml of venous blood were collected for estimation of serum zinc level. After estimation of serum zinc level results were analyzed statistically. The difference in serum zinc levels were compared between the groups. Serum zinc level was significantly lower in Wilson disease patients (43.8±19.7μg/dl; range: 13-83) compared to volunteers group (67.8±11.8μg/dl; range: 47-97) p<0.001. Among the diseased group, serum zinc level were significantly lower in 18 CLD (38.4±17.4μg/dl) and in 4 acute liver failure (33.1±3.7μg/dl) compared to 4 acute hepatitis (71.8±4.3μg/dl) (p=0.001) and (p<0.001) respectively. Mean serum zinc level was low in 4 Wilsonian acute liver failure (33.1±3.7μg/dl), which was significant compared to those (23) who presented as Wilson disease non acute liver failure (45.7±20.8μg/dl) (p=0.013). Serum zinc level was significantly lower in Wilson disease children compared to the volunteers. Zinc level was also found significantly low in Wilson disease presented as CLD and acute liver failure in comparison to Wilson disease presented as acute hepatitis.

Nanoscale Porosity in Microellipsoids Cloaks Interparticle Capillary Attraction at Fluid Interfaces

Anisotropic particles pinned at fluid interfaces tend toward disordered multiparticle configurations due to large, orientationally dependent, capillary forces, which is a significant barrier to exploiting these particles to create functional self-assembled materials. Therefore, current interfacial assembly methods typically focus on isotropic spheres, which have minimal capillary attraction and no dependence on orientation in the plane of the interface. In order to create long-range ordered structures with complex configurations via interfacially trapped anisotropic particles, control over the interparticle interaction energy via external fields and/or particle engineering is necessary. Here, we synthesize colloidal ellipsoids with nanoscale porosity and show that their interparticle capillary attraction at a water-air interface is reduced by an order of magnitude compared to their smooth counterparts. This is accomplished by comparing the behavior of smooth, rough, and porous ellipsoids at a water-air interface. By monitoring the dynamics of two particles approaching one another, we show that the porous particles exhibit a much shorter-range capillary interaction potential, with scaling intriguingly different than theory describing the behavior of smooth ellipsoids. Further, interferometry measurements of the fluid deformation surrounding a single particle shows that the interface around porous ellipsoids does not possess the characteristic quadrupolar symmetry of smooth ellipsoids, and quantitatively confirms the decrease in capillary interaction energy. By engineering nanostructured surface features in this fashion, the interfacial capillary interactions between particles may be controlled, informing an approach for the self-assembly of complex two-dimensional microstructures composed of anisotropic particles.

Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients with ST-Elevation Myocardial Infarction

CHADS₂ and CHA₂DS₂-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA₂DS₂-VASC-HSF score promote atherosclerosis and associated with severity of CAD. Objective of the study was to find out the association of the CHA₂DS₂-VASC-HSF score with the severity of CAD in patients with ST elevation myocardial infarction (STEMI). One hundred (100) patients with STEMI were enrolled in this study after considering inclusion and exclusion criteria over a one year period from October, 2017 to September, 2018 in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Coronary angiogram was done within index hospitalization and coronary artery disease severity was assessed by SYNTAX score system. Patients were divided into two groups on the basis of SYNTAX score. Patients with SYNTAX score ≥23 assigned as Group I and SYNTAX score <23 assigned as Group II. The CHA₂DS₂-VASC-HSF score was calculated. Cut-off value of high CHA₂DS₂-VASC-HSF score was ≥4.0. In this study mean age of study population was 51.8±9.8, male patients were predominant (79.0%). Among the studied patients, highest percentage had history of smoking followed by hypertension, diabetes mellitus and family history of CAD in Group I patients. It was found that DM and family history of CAD and history of stroke/TIA were significantly higher in Group I than Group II. An increasing trend of SYNTAX score was observed according to the CHA₂DS₂-VASc-HSF score. SYNTAX score was significantly higher in CHA2DS2-VASc-HSF score ≥4 than CHA₂DS₂-VASc-HSF score <4 (26.3±6.3 vs. 12.1±7.7, p<0.001). Patients with CHA₂DS₂-VASC-HSF score ≥4 had severe coronary artery disease than CHA₂DS₂-VASC-HSF score <4 assessed by SYNTAX score with 84.4% sensitivity and 81.9% specificity (AUC:0.83, 95% CI: 0.746-0.915, p<0.001). CHA₂DS₂-VASc-HSF score was positively correlated with the severity of CAD. This score could be considered as a predictor of coronary artery disease severity.

A Modified Approach for Harvesting Non Vascularized Fibular Graft for Pediatric Age Group

The conventional technique of harvesting free non-vascularized fibular grafting is associated with different scale of morbidity and usually a long scar. We follow a technique that causes minimum interference to the surrounding soft tissues to harvest the desired length of fibula. This prospective study was performed at Department of Orthopaedics, Dhaka Medical College Hospital from January 2018 to December 2018. Thirty patients of average age 10.5 years (range 8 to 14 years) were taken up for the study. The fibula was harvested by two separate incisions, 1 cm each at proximal and distal extent of proposed length of graft after elevating the periosteum circumferentially using a periosteum elevator. Compression bandage and above knee plaster immobilization was applied that help to reduce hematoma formation. The mean follow up is 12 months. The patients were evaluated clinically and by radiology. Twenty nine patients showed good results. One patient had delayed wound healing resulting in fair result. This modified approach of harvesting fibula reduces donor site morbidity and is safer and easier than conventional approach.

Serum Electrolyte Status of Patients with Acute Stroke Admitted in a Tertiary Care Hospital

Stroke, usually a focal rather than global neurological deficit resulting from vascular origin with sudden onset, may be with cerebral infarction or intracerebral haemorrhage. It results in brain oedema following vascular injury and electrolyte imbalance. A descriptive cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during March 2016 to May 2018 to assess the electrolyte levels among 220 purposively selected patients with stroke confirmed by CT scan. Data were collected by the principal investigator himself by using interview schedule and case record form after attaining consent. Blood samples were collected from the patients to carry out biochemical and haematological tests and to assess serum electrolyte levels. Data were cross-checked for completeness, consistency and relevancy, and were analyzed by computer software SPSS 20.0. Age was significantly higher in haemorrhagic stroke (64.88±13.00 years) than ischaemic stroke (60.92±13.96 years). Male (55.91%) were predominant than female (44.09%). One hundred nineteen (54.09%) patients had ischaemic stroke and 101(45.91%) patients had haemorrhagic stroke. The serum concentration of Na+, K+, Cl- and HCO₃- were measured during acute period of stroke. Imbalance in serum Sodium, Chloride, Potassium and Bicarbonate level were observed in 37.27%, 29.55%, 23.18% and 6.36% patients respectively. Hyponatremia, hypokalemia, hypochloremia and acidosis were most common electrolyte imbalance in both ischaemic and haemorrhagic strokes. In ischaemic stroke hyponatremia was 35.29%, hypernatremia was 3.36%, hypokalemia 19.33%, hyperkalemia 0.84%, hypochloraemia 30.25%, hyperchloraemia 3.36%, acidosis was in 6.72% and alkalosdis in 1.68% patients while in haemorrhagic stroke hyponatremia 33.66%, hypernatremia 1.98%, hypokalaemia 22.77% hyperkalemia 3.96%, hypochloremia 19.80%, hyperchloraemia 4.95%, acidosis 2.97% and alkalosis was in 0.99% of patients. Mortality was more in hyponatremic, hypokalemic and in hypochloremic patients.

Role of Intra-arterial Nitroglycerin (Post Procedural, Prehemostasis) to Reduce Radial Artery Occlusion after Transradial Catheterisation: A Doppler-guided Study

The study was intended to evaluate efficacy of Intra-arterial nitroglycerin through the sheath at the end of a transradial procedure to preserve the patency of the radial artery. This prospective observational study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2017 to April 2018, by including a total 200 patients undergoing coronary procedures (CAG and / or PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Doppler study. In this study 102 patients (Group I) received 200 mcg intra-arterial nitroglycerine, prior to trans-radial sheath removal. Another 98 patients (Group II) did not receive intra-arterial nitroglycerine prior to trans-radial sheath removal. Conventional haemostatic compression methods were applied (average 2 hours) in both groups of patients. Evaluation of radial arterial arterial blood flow by colour Doppler study was done on next day after the procedure in both groups. Results of this study in which RAO was determined by vascular doppler study showed that frequency of radial artery occlusion were 13.5% one day after transradial coronary procedures. We found the incidence was 8.8% vs. 18.4%, (p=0.04) in Group I and Group II respectively. The incidence of RAO was significantly lower in post procedural nitroglycerine group. From multivariate logistic regression analysis diabetes mellitus (p = 0.02), hemostatic compression time for more than 02 hours after sheath removal (p = <0.001) and procedure time (p = 0.02) was predictors of RAO. So, the administration of nitroglycerin at the end of a transradial catheterization reduced the incidence of RAO, as shown by 1 day after the radial procedure by doppler ultrasound.

A Case Report of Porphyria Cutanea Tarda with Hepatitis-C Virus Co-infection

Porphyria cutanea tarda is a rare disorder of heme metabolism due to deficiency of the enzyme uroporphyrinogen decarboxylase which is manifested as some typical dermatological features and hepatic dysfunction. The Hepatitis-C virus co-infection is common and it can be aggravated by other environmental factors. We report a case of porphyria cutanea tarda in a 37-year-old woman, who presented with recurrent skin blisters and has concomitant Hepatitis-C virus infection. She was taking oestrogen containing oral contraceptive pill for a long duration. The diagnosis of porphyria cutanea tarda was considered on the basis of clinical features and high level of urine porphyrin level. She was put on hydroxychloroquine and combination drugs for Hepatitis-C virus with significant improvement after 3 months of therapy.

Local and Nonlocal Transport Spectroscopy in Planar Josephson Junctions

We report simultaneously acquired local and nonlocal transport spectroscopy in a phase-biased planar Josephson junction based on an epitaxial InAs-Al hybrid two-dimensional heterostructure. Quantum point contacts at the junction ends allow measurement of the 2×2 matrix of local and nonlocal tunneling conductances as a function of magnetic field along the junction, phase difference across the junction, and carrier density. A closing and reopening of a gap was observed in both the local and nonlocal tunneling spectra as a function of magnetic field. For particular tunings of junction density, gap reopenings were accompanied by zero-bias conductance peaks (ZBCPs) in local conductances. End-to-end correlation of gap reopening was strong, while correlation of local ZBCPs was weak. A model of the device, with disorder treated phenomenologically, shows comparable conductance matrix behavior associated with a topological phase transition. Phase dependence helps distinguish possible origins of the ZBCPs.

A 60-year-old Man Presented with Relapsing Polychondritis with Haemophagocytic Lymphohistiocytosis

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

Procalcitonin versus C-Reactive Protein as a Biomarker for Prediction of Bacterial Infection in Children with Febrile Neutropenia in Acute Leukemia

Febrile neutropenia (FN) is a frequently occurring treatment-related complication with significant morbidity and mortality for childhood acute leukemia. Early diagnosis and assessment of severity are essential steps for early comprehensive treatment to reduce FN-related morbidity and mortality. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can be used to assess and predict the bacterial infection in children with febrile neutropenia. The objective of the study was to determine the role of procalcitonin and CRP as a biomarker for prediction of bacterial infection in children with FN in acute leukemia. This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2020 to July 2021. Total 58 Children with acute leukemia aged 1 to <18 years with FN were analyzed in this study. A proper history and thorough physical examination were carried out. The blood sample was sent for biomarkers (Procalcitonin and CRP) within 24 hours of the onset of FN and other investigations, such as Complete blood count, Blood C/S, Urine R/E and C/S. Metabolic workup (SGPT, Serum Creatinine, Serum Electrolytes, Serum Ca+) was also done in every patient. Stool R/E & C/S, Chest X-ray, Wound swab for C/S were done when the patient presented with diarrhoea, cough, respiratory distress and focal sepsis respectively. In this study, the mean age of the patients was 6.62±4.07 years (1.10-16.0 years) and 34 patients (58.6%) were male. In 65.5% of patients, localizing signs of infection were not identified. Of the 58 patients, 12 patients (20.7%) showed positive blood culture and 2 patients (3.4%) showed positive urine culture. Klebsiella spp (41.0%) was the most frequent organism isolated followed by Acinetobacter (17.0%), Pseudomonas (17.0%) and E. coli (17.0%). The median PCT levels were significantly higher in patients with bacterial infection than patients without bacteremia (26.10μg/l versus 0.78μg/l, p=0.002) and PCT level >2μg/l was significantly associated with bacteremia. The median CRP levels in the bacteremia and without-bacteremia patients were 137.4mg/L and 54.17mg/L, respectively (p=0.036). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.797 (95% CI 0.651-0.943) for PCT and 0.697 (95% CI 0.54-0.855) for CRP in predicting the bacterial infection. PCT and CRP both are useful biomarkers for the prediction of bacteremia, but PCT may be a superior early biomarker as compared to CRP to predict bacterial infection in children with febrile neutropenia in acute leukemia.

Paroxysmal Nocturnal Hemoglobinuria in Systemic Lupus Erythematosus: A Rare Manifestation

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells. The occurrence of PNH in a patient with systemic lupus erythematosus (SLE) is even rarer. One such presentation was seen in a 19 years old woman who presented with fever, multiple joint pain, photosensitivity, oral ulcer, hair loss and was diagnosed as a case of SLE and was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 7th February 2019. Subsequently she developed progressive anaemia and passing of dark colored urine. Flow cytometry analysis showed PNH clone within red cells. We report this case so that clinicians are aware about this association between PNH and SLE. Informed written consent was obtained from the patient for the publication of this case report, the copy of which is available with the authors.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

Melt State Reinforcement of Polyisoprene by Silica Nanoparticles Grafted with Polyisoprene

We systematically vary the nanoparticle (NP) dispersion state in composites formed by mixing polyisoprene homopolymers with polyisoprene grafted silica particles, and demonstrate how creep measurements allow us to overcome the limitations of small amplitude oscillatory shear (SAOS) experiments. This allows us to access nearly 13 orders in time in the mechanical response of the resulting composites. We find that a specific NP morphology, a percolating particle network achieved at intermediate graft densities, significantly reinforces the system and has a lower NP percolation loading threshold relative to other morphologies. These important effects of morphology only become apparent when we combine creep measurements with SAOS re-emphasizing the role of synergistically combining methods to access the mechanical properties of polymer nanocomposites over broad frequency ranges.

A candidate multi-epitope vaccine against Lumpy skin disease

Lumpy skin disease (LSD) is a fulminant infectious disease that mostly affects cattle and causes considerable economic loss throughout the globe. This study was conducted to develop a new multi-epitope-based vaccine against LSD that can elicit immunological responses using an in silico reverse vaccinology approach. Initially, three antigenic proteins, protein E5, E3 ubiquitin-protein ligase LAP and 62 kDa protein, were manipulated to recognize potential T-cell and B-cell epitopes. To identify superior epitopes, a variety of bioinformatic techniques including antigenicity testing, transmembrane topology screening, allergenicity assessment, conservancy analysis, and toxicity evaluation were used. Finally, three new subunit vaccines (construct V1, V2 and V3) were developed employing the most effective epitopes, suitable adjuvants, pan HLA DR-binding epitope (PADRE) and linkers. Then, based on the antigenicity, solubility, and validation score of the 3D structures, construct V2 was chosen as one of the best candidate vaccines. The results of the molecular dynamic simulation and disulphide engineering indicated that the vaccine (construct V2) was stable. Additionally, the immunological simulation findings supported the vaccine candidate's ability to trigger humoral and cellular immune responses. Further validation of the proposed vaccine candidate may necessitate additional in vitro and in vivo investigations.

Rehabilitation of Persons with Spinal Cord Injury in Bangladesh

There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the health and rehabilitation system of Bangladesh, it's demographic characteristics, accessible resources and rehabilitation challenges. Information for this narrative report was acquired through a structured questionnaire, which was supplemented by an online search of agencies, government websites, rehabilitation-related organizations and published papers during the period of March 2020 to April 2021. Bangladesh is a developing country with a vast population and a developing health care system. Representative government and non-government rehabilitative care settings a total of sixteen survey replies (n=16) were obtained. During the year 2019, a total of 1035 people with SCI were seen. The majority of patients with SCI were hospitalized by a non-government facility (38.65%), whereas the two main public general hospitals consulted roughly 30.0% of people with SCI. The rehabilitation team leader in the majority of the facilities (93.75%) was a physiatrist, but just a few had a full complement of rehabilitation professionals and only 12.5% of settings provide community care. Indoor rehabilitation facilities, equipment and a competent rehabilitation staff are not available at many of the tertiary care facilities including National Trauma Institute (NITOR), where most of the SCI report first after the trauma. A consistent and nationwide data source is unavailable and the majority of the available SCI research publications are hospital-based demographic studies in Bangladesh. SCI was commonly due to work-related trauma in young male manual laborers due to fall from height or road traffic accidents. The country faces multiple challenges in rehabilitation of people with SCI regarding triage, a referral system development, infrastructure and shortage of expert human resources in addition, currently there is no three-tier rehabilitation care continuum available. Keeping pace with the transition to a developed country by 2041, the Bangladesh health sector also has to be oriented to face the focused challenge of caring for people with SCI. As recommended by WHO Rehabilitation 2030 initiatives, establishment of an SCI dedicated national institute and escalation of number of related specialists such as trauma and orthopedic surgery, spinal neurosurgery and physical rehabilitation medicine, skilled professionals such as rehabilitation nurses, therapists, case managers and social workers to work in a team required for specialized care of SCI.

Quality of Life Assessment by SF-36 among the Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) patients have substantial functional disability which poses a significant impact on the quality of life (QoL). So, this study aims to assess the QoL of RA patients by the Short Form Health Survey-36 (SF-36) questionnaire. Total sixty-two (62) rheumatoid arthritis patients were included in this cross-sectional observational study and were performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2018 to September 2019 according to selection criteria. A Bengali validated version of Medical Outcomes Study-36: Item Short Form Health Survey (SF-36) questionnaire was used to assess QoL. Among the sixty-two (62) patients, mean age was 44.18±12.14 years with female preponderance (77.4%). About one-fifth of the patients (19.4%, n=12) were illiterate and the majority (71.0%, n=44) were housewives. Amongst all, 53.2% (n=33) had monthly family income >20,000 taka. Forty percent (n=25) had a disease duration of 1 to 5 years. According to Disease Activity Score Sheet 28 (DAS-28), 36(58.1%) patients had moderate disease activity and 26(41.9%) patients had high disease activity. Among the 8 domains, the mental health domain had the highest score (42.77±13.78) and the role physical domain had the lowest (35.89±15.43). Male, literate patients with higher income had relatively better QoL. Patients with prolonged disease, high disease activity and irregular taking of Disease Modifying Anti-Rheumatic Drugs (DMARDs) had poor quality of life. A significant negative correlation was present between SF-36 scores and the DAS-28 scores (r = -0.803, p<0.001). Rheumatoid arthritis had a relatively poor quality of life regarding both physical and mental health components, but the physical health component was predominantly affected.

Association of Diastolic Dysfunction with Angiographic Severity of Coronary Artery Disease in patients with Non-ST Elevation Myocardial Infarction

In recent years, diastolic dysfunction is an evolving context. Presence of left ventricular diastolic dysfunction (LVDD) indicates a poor prognosis in patients with an ACS and chronic coronary artery diseases. This study evaluated the association of LVDD and angiographic severity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI). This cross-sectional analytical study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, during the period of April 2017 to March 2018. A total of 120 NSTEMI patients undergoing coronary angiogram (CAG) during index hospitalization were included in the study. All patients underwent transthoracic echocardiography before they underwent CAG on different days. Presence (Group I, n=65) and absence of LVDD (Group II, n=55) was established by echocardiography. Severity of CAD was assessed by Vessel score and Leaman score. Association of traditional risk factors (smoking habit, hypertension, diabetes mellitus, dyslipidemia and family history of CAD) with severity of CAD was investigated. Vessel score showed coronary artery obstruction (CAO) was present in 62(95.4%) patients in Group I and 35(63.6%) patients in Group II, single vessel was involved in 17(27.4%) patients while multi vessel in 45(72.6%) patients was found in Group I. On the contrary 27(77.1%) single vessel patients and 8(22.9%) multi vessel patients were found in Group II. Positive Leaman score was significantly higher in Group I, 62(95.4%) than that of Group II, 35(63.6%) which is statistically significant (p<0.001). This study showed a positive correlation between LVDD and CAD severity in terms of vessel score and Leamanscore. This study also demonstrates that the severity of vessel score and Leaman score was higher in the higher grade of diastolic dysfunction. The present study concludes that LVDD is associated with angiographically severe CAD in patients with NSTEMI.

Closed-loop additive manufacturing of upcycled commodity plastic through dynamic cross-linking

A sustainable closed-loop manufacturing would become reality if commodity plastics can be upcycled into higher-performance materials with facile processability. Such circularity will be realized when the upcycled plastics can be (re)processed into custom-designed structures through energy/resource-efficient additive manufacturing methods, especially by approachable and scalable fused filament fabrication (FFF). Here, we introduce a circular model epitomized by upcycling a prominent thermoplastic, acrylonitrile butadiene styrene (ABS) into a recyclable, robust adaptive dynamic covalent network (ABS-vitrimer) (re)printable via FFF. The full FFF processing of ABS-vitrimer overcomes the major challenge of (re)printing cross-linked materials and produces stronger, tougher, solvent-resistant three-dimensional objects directly reprintable and separable from unsorted plastic waste. This study thus offers an imminently adoptable approach for advanced manufacturing toward the circular plastics economy.

Effect of telephone-monitored home-based cardiac rehabilitation exercise on functional capacity and quality of life in heart failure patients in a lower-middle-income country

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic heart failure (CHF) prevails as one of the major cardiovascular diseases in lower-middle-income countries (LMICs) like Bangladesh. Home-Based Cardiac Rehabilitation (HBCR) is a cost-effective method of secondary prevention of chronic heart failure which, if provided, might not only improve the health status of the patients but might also reduce the financial and hospitalization burden on the health care system of these countries. The study aims to assess the scope and benefits of HBCR in such low resource settings.

Purpose

The study evaluates the effect of telephone-monitored HBCR exercise programme in improving the functional capacity and quality of life (QoL) in patients of CHF with reduced ejection fraction due to ischemic heart disease (IHD).

Method

This self-controlled interventional study was conducted from August 2019 to July 2020 at a heart failure clinic, a tertiary healthcare centre in Bangladesh. A total of 115 patients of CHF with ejection fraction &lt;40% and in NYHA class II and III were included in the study according to selection criteria. The functional capacity of the patients was evaluated by NYHA classification and 6-minute walk test. The quality of life of the patients was evaluated by Minnesota Living with Heart Failure Questionnaire (MLHFQ). All patients were advised to perform HBCR exercise as per recommended guideline and were telephone-monitored 2-weekly. After the 3-months study period, the participants were divided into compliant and partial compliant groups based on their adherence to the guideline. Repeat evaluation of patients' condition was carried out. Results were then compared within the groups and data was analyzed through appropriate statistical methods.

Results

Significant improvement of NYHA class (p&lt;0.05), and 6-minute walk test distance (6MWTD) (1102.01±215.90 feet vs 1243.30±217.86 feet; p&lt;0.001) were noticed after the rehabilitation programme. Improvement of total MLHFQ score was also observed (35.53±14 vs 28.22±12.84; p&lt;0.001) at 3-months follow up. The functional capacity and quality of life of the patients in both the compliant and partially compliant groups showed significant improvement after the rehabilitation programme (p&lt;0.001); though no difference was found in the indicators when compared between compliant vs partially compliant groups after rehabilitation except for 6MWTD (1302.86±219.61 feet vs 1230.71±212.284 feet, p&lt;0.001).

Conclusion

From the results, it can be concluded that any amount of routine exercise tends to improve quality of life and symptoms in patients of chronic heart failure with reduced ejection fraction. However, to achieve the best effect in functional capacity and overall health status, the addition of a structured exercise programme like HBCR can be beneficial for proper rehabilitation in low resource settings. Further validation of the results is recommended through randomized control trials in larger study groups.

Genomic Insights Into the Mechanism of Carbapenem Resistance Dissemination in Enterobacterales From a Tertiary Public Heath Setting in South Asia

SUMMARY

10.6% patients were CRE positive. Only 27% patients were prescribed at least 1 antibiotic to which infecting pathogen was susceptible. Burn and ICU admission and antibiotics exposures facilitate CRE acquisition. Escherichia coli ST167 was the dominant CRE clone.

BACKGROUND

Given the high prevalence of multidrug resistance (MDR) across South Asian (SA) hospitals, we documented the epidemiology of carbapenem-resistant Enterobacterales (CRE) infections at Dhaka Medical College Hospital between October 2016 and September 2017.

METHODS

We enrolled patients and collected epidemiology and outcome data. All Enterobacterales were characterized phenotypically and by whole-genome sequencing. Risk assessment for the patients with CRE was performed compared with patients with carbapenem-susceptible Enterobacterales (CSE).

RESULTS

10.6% of all 1831 patients with a clinical specimen collected had CRE. In-hospital 30-day mortality was significantly higher with CRE [50/180 (27.8%)] than CSE [42/312 (13.5%)] (P = .001); however, for bloodstream infections, this was nonsignificant. Of 643 Enterobacterales isolated, 210 were CRE; blaNDM was present in 180 isolates, blaOXA-232 in 26, blaOXA-181 in 24, and blaKPC-2 in 5. Despite this, ceftriaxone was the most commonly prescribed empirical antibiotic and only 27% of patients were prescribed at least 1 antibiotic to which their infecting pathogen was susceptible. Significant risk factors for CRE isolation included burns unit and intensive care unit admission, and prior exposure to levofloxacin, amikacin, clindamycin, and meropenem. Escherichia coli ST167 was the dominant CRE clone. Clustering suggested clonal transmission of Klebsiella pneumoniae ST15 and the MDR hypervirulent clone, ST23. The major trajectories involved in horizontal gene transfer were IncFII and IncX3, IS26, and Tn3.

CONCLUSIONS

This is the largest study from an SA public hospital combining outcome, microbiology, and genomics. The findings indicate the urgent implementation of targeted diagnostics, appropriate antibiotic use, and infection-control interventions in SA public institutions.

Physician's Perception about the Use of PPE, COVID-19 Prevention and Management in Bangladesh

This study aims to explore physician's perceptions about the use of Personal Protective Equipment (PPE), COVID prevention, and management during the COVID pandemic since knowledge on these might explain the reason behind infection and death of physicians in Bangladesh at an unexpected rate. This cross-sectional study was conducted based on an online questionnaire on 346 physicians (n=346) by the Department of Gastroenterology of Mymensingh Medical College Hospital, Bangladesh from 15th July 2020 to 14th September 2020. Physicians of different health care facilities across Bangladesh were invited to take part. Knowledge on specific points of the questionnaire was evaluated, scored, and compared between different groups by Independent sample t-test. Mean knowledge score between the respondents working up to 8 hours and beyond 8 hours per day was 17.28±1.28, 16.90±1.40 respectively (p=0.03). Mean knowledge score observed between graduate and post-graduate physicians and work experience of 5 years and beyond 5 years were 17.26±1.36 vs. 17.16±1.27; (p=0.40), 16.87±1.75 vs. 17.27±1.21; (p=0.11) respectively. Physician's safety should be first concern that is highlighted through proper use of PPE and prevention of COVID. Patient management skills would be better if physicians are trained well on infection prevention and control which in turn will reduce infection and death of physicians.

Adverse In-Hospital Outcome of Transradial PCI in Comparison to Transfemoral PCI in NSTEMI Patients during Index Hospitalization: A Single Center Study in Bangladesh

NSTEMI patients, in comparison to STEMI patients, are more at risk of bleeding, access site complication and MACE after PCI during index hospitalization. Because they get, multiple adjuvant anti-thrombotic agents before PCI than do the STEMI patients undergoing primary PCI. Transradial access (TRA) is proven to decrease those adverse in-hospital outcomes compared to transfemoral access (TFA) in STEMI patients. But very few studies were conducted in this regard considering NSTEMI patients. We observed prospectively the adverse in-hospital outcomes of total 180 NSTEMI patients who had undergone PCI through TRA (Group I = 80) and TFA (Group II = 100) during index hospitalization between October 2017 to September 2018 in National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh. Samples were selected purposively. Patients were followed up 2 hours after PCI and thereafter every day until discharge. Demographic and risk factor variables were almost same in both groups. TRA, compared with TFA, yielded less major bleeding (0% versus 3%, p=0.12) which was statistically non-significant. Minor bleeding was significantly less in Group I (2.5% versus 13.0%, p=0.04). Overall bleeding was also significantly less in Group I (2.5% and 10.0%; p=0.002). Access site complication was non-significantly less in Group I (0% versus 1%, p=0.91). TRA caused non-significant reduction in MACE (2.5% versus 5%; p=0.38) but significant reduction of total adverse in-hospital outcome (5% versus 20%, p=0.006%). In this study TRA seems to have less adverse in-hospital outcome than TFA in NSTEMI patients undergoing PCI during index hospitalization.