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Background: The presence of New-onset Atrial Fibrillation (NOAF) during critical illness increases morbidity, mortality, and hospital costs, as well as the incidence of complications such as heart failure and thromboembolic disorders. We aimed to determine the incidence and the risk factors associated with NOAF in Intensive Care Units (ICU). Material and Methods: A nested case control study of patients admitted to ICU was conducted to determine the risk factors associated with NOAF. Occurrence of potential risk factors were noted once in eight hours. Frequency, percentage, and odds ratio were calculated. Multiple logistic regression was done to find the risk factors associated with NOAF. Results: We followed up 271 individuals of both genders, among whom 29 cases of new onset of AF were observed (10.7%). The risk of getting NOAF was higher for those who were on renal replacement therapy (OR: 7.9 (95% CI: 3.2-19.2)), suspected sepsis (OR: 4.2 (95% CI: 1.7-10.2)) and had hypokalemia (OR: 4 (95% CI: 1.2-12.9)). Conclusion: Prompt diagnosis and treatment of hypokalaemia and sepsis may significantly reduce the risk of NOAF in ICU. Other independent risk factors were suspected sepsis and renal replacement therapy.

Abstract Background and Aim Esophagogastroduodenoscopy (EGD) is often performed prior to transesophageal echocardiogram (TEE) to evaluate for esophageal pathologies. Although TEE is a safe procedure, some contraindications exist, such as esophageal varices. The incidence of bleeding with TEE is

Superior mesenteric artery (SMA) aneurysm is caused by degeneration of the visceral arteries. Although a rarely encountered entity, it requires timely management owing to the high mortality rate associated with rupture, particularly when the aneurysm is saccular in nature. As such, urgent treatment is generally indicated. We present five cases of SMA aneurysm arising from the main trunk or branches of the SMA.

Background: Hemodynamic significant Patent Ductus Arterisous (hsPDA) is one of the main complications of preterm birth; however, its management needs further research and development. Ductal stealing results in pulmonary hyperperfusion which potentially causes oxygenation disorders and leads to target organ disruptions (i.e. cerebral, abdominal, and renal). Therefore, monitoring tissue oxygenation is essential for detecting organ disorders. Previous studies revealed that near-infrared spectroscopy (NIRS), as a non-invasive method, showed promising results in monitoring tissue oxygenation. This study aimed to analyze the difference in regional oxygen saturation (rSO2) between premature babies with and without hsPDA.Methods: This cross-sectional study was conducted on preterm infants aged 3-7 days with 24-336/7 weeks of gestation. hsPDA diagnosis was carried out using echocardiography; defined as >1.5 mm diameter of ductus arteriosus and >1.4 left pulmonary artery and aorta (La/Ao) ratio. The cerebral (rcSO2), abdomen (raSO2), and renal oxygen saturation (rrSO2) were measured through NIRS monitoring. The statistical analysis was conducted using SPSS software (Version 21.0).Results: There were 11 out of 52 infants categorized as hsPDA. The mean±SD birth weight, mean±SD gestational age, and mean±SD ductus diameter in hsPDA was determined at 1213±293 gram; 30.72±2.01 weeks, and 2.84±0.93 mm, respectively. There was no significant difference between the hsPDA and non hsPDA groups in terms of rcSO2 (75.27±9.14% and 79.03±9.11%; P=0.238), raSO2 (65.60±11.07% and 67.48±10.17%; P=0.594), and rrSO2 (76.41±14.98% and 82.61±10.41%; P=0.218).Conclusion: Based on the obtained results, the existence of hsPDA doesn’t affect the oxygenation in cerebral, abdominal, and renal tissues in preterm babies. Moreover, the decision should be made regarding the optimal time for ductal closure.

Background:. COVID-19 is associated with higher morbidity and mortality in patients with chronic liver diseases (CLDs). However, our understanding of the long-term outcomes of COVID-19 in patients with CLD is limited. Methods:. We conducted a multicenter, observational cohort study of adult patients with CLD who were diagnosed with COVID-19 before May 30, 2020, to determine long-term clinical outcomes. We used a control group of patients with CLD confirmed negative for COVID-19. Results:. We followed 666 patients with CLD (median age 58 years, 52.8% male) for a median of 384 (interquartile range: 31–462) days. The long-term mortality was 8.1%; with 3.6% experiencing delayed COVID-19-related mortality. Compared to a propensity-matched control group of patients with CLD without COVID-19 (n=1332), patients with CLD with COVID-19 had worse long-term survival [p

Hepatic encephalopathy (HE) is a reversible brain dysfunction caused by liver insufficiency and portosystemic shunting. Hepatic encephalopathy is a common complication of advanced liver disease and is on a rise with the increasing incidence of non-alcoholic steatohepatitis (NASH). Since partnership with nursing staff is a critical part of successful management of these complex patients, we conducted a survey assessing their knowledge regarding HE.169 nurses participated in the survey. We found that more than 30% of the nurses did not know that ammonia is one of the toxins responsible for causing hepatic encephalopathy. We also found that 20% of the nurses had difficulty answering questions regarding titration of lactulose to bowel movements. Dietary education is a significant area for improvement as 80% of the nurses wanted to restrict fat and carbohydrate intake in these patients. With this simple survey, we identified important knowledge gaps among experienced nurses at our institution. We believe that by improving knowledge through focused lectures, we can improve patient care and reduce the length of hospitalizations in patients with HE.

Large vessel arterial thrombosis has been reported to complicate a subset of cases of coronavirus disease 2019 (COVID-19). Thrombosis of the extracranial carotid arterial system can lead to devastating stroke in some patients with COVID-19. We have presented the case of a patient previously hospitalized with COVID-19 for oxygen supplementation who had presented after discharge with delayed stroke from a right common carotid artery and internal carotid artery thrombosis. The thrombotic occlusion resolved with antithrombotic medications and no invasive intervention. The present report highlights the complicated and heterogeneous nature of COVID-19 and provides one approach to managing the devastating complication of stroke from carotid arterial thrombosis.

The financial services industry of Bangladesh has achieved phenomenal success and advancing day by day for the growth of technology. Bangladesh has long been considered a role model for financial inclusion, first with the emergence of proliferation and prominence of microfinance institutions, especially in rural areas. This paper examines the financial services innovation in Bangladesh by presenting the changes in the industry over the years. The paper also analyses the comparative picture of Bangladesh’s financial inclusion and world financial inclusion. This study is a descriptive study where quantitative data has been collected from secondary sources. The study reflects a very positive picture of financial innovation in Bangladesh. We expect that the study can be used by concerned business people in decision making for the better implication of financial innovation.

The number of beach tourism in the Serang Regency or Anyer beach region and the diversity of the desires of every tourist, then tourists are required knowledge of traveling in terms of choosing the desired tourist location. For tourists who already have the experience of traveling on the Anyer beach, it is not too difficult to determine the desired tourist location, but most tourists who do not have the tourist experience on the Anyer beach will have difficulty being able to determine the expected beach tourism location. This study aims to provide recommendations of 24 Anyer beach tourist attractions to tourists. Recommendations generated using the Simple Additive Weighting (SAW) method using 12 criteria. The results of this study are in the form of applications that can be accessed online. The application can produce appropriate recommendations for tourists in the form of alternative beach tourism along with details such as the name of the beach tour, address, coordinates of Google Maps, photos of the state of beach tourism and the price of admission.

The impacts of African Swine Fever (ASF) have most frequently been described quantitatively though it is increasingly acknowledged these impacts extend well beyond numbers. During 2020, a multidisciplinary team of researchers developed a framework for Socioeconomic and Livelihood Impact Assessment (SELIA) of livestock diseases in smallholder communities. Two key innovations within this SELIA framework are the integration of sustainable livelihoods concepts to capture rich information beyond financial impacts, and the inclusion of stakeholders across the value chain, beyond farmers. This paper focuses on the findings from one of the first applications of the SELIA framework. In late 2020 the research team applied participatory tools from the SELIA Framework (8 focus group discussions, 14 key informant interviews, and 2 network mapping activities) to gather data to describe the impact of ASF in backyard pig-farming communities and value chains. This was undertaken across two locations in the Philippines, in turn highlighting potential leverage points for intervention. Owing to COVID-19 travel restrictions and risks, modifications to training and field activities were made. Findings from focus groups and interviews revealed the deep, emotional impacts of ASF and the associated control measures. Pigs were considered pets by many farmers and some women described them as being like their children. Animal health-workers (AHWs) also recognised the emotional toll on farmers and were sometimes strongly criticised by community members due to their involvement in depopulation campaigns. Misinformation early in the epidemic also led farmers to hide their animals from AHWs, and to dispose of them inappropriately. While the overall impact of ASF on society was negative, the impacts across different communities, scales of production and different value chain actors varied. The losses experienced by backyard farmers resulted in significant losses to linked value chain actors, such as input suppliers. This trial application of the SELIA framework revealed some complex and varied impacts of ASF. This included significant differences in livelihood and socio-economic impacts amongst different actors within value chains and also among different categories of actors (for example small, medium and large-scale traders). Repeated themes and triangulated findings suggest two leverage points for further consideration. Firstly, it is recommended a One Welfare approach to ASF control in the Philippines is explored. Emphasising careful communication between animal health-workers and farmers, and humane and sensitive pig depopulation practices. Secondly, consideration of ASF support programs tailored to sectoral and specific communities is recommended.

Primary myelofibrosis (PMF) is a chronic myeloproliferative disorder seen in older adults which can present both with hepatosplenomegaly as well as mild nonspecific liver enzyme abnormalities. Mild elevations in bilirubin can occasionally be seen due to both intravascular hemolysis as well as extramedullary hematopoiesis. Marked hyperbilirubinemia as a presenting sign of PMF progression, however, has not been reported. We present the case of a patient with a remote diagnosis of PMF, who presented with marked hyperbilirubinemia with a notable response to ruxolitinib.

Abstract Acute esophageal necrosis (AEN) is a rare presentation of severe esophageal injury. The optimal long‐term management of complications related to AEN, particularly stricture formation, are not well defined. We report a case of AEN in a patient who presented with diabetic ketoacidosis (DKA) and had dysphagia due to refractory stricture formation after mucosal healing occurred. A 62‐year‐old male with diabetes mellitus presented with altered mental status. He was admitted for hypovolemic shock secondary to DKA and treated with vasopressors, fluid resuscitation, and insulin. After resolution of DKA, he reported persistent dysphagia. Upper endoscopy showed circumferential black mucosal discoloration throughout the entire esophagus that spared the gastroesophageal junction. He was diagnosed with AEN and was continued on a proton pump inhibitor and sucralfate with improvement in symptoms. Repeat endoscopy 4 weeks later showed a 10‐cm benign‐appearing stricture in the mid esophagus. He underwent dilation with temporary symptomatic relief; however, recurrence in symptoms has thus far necessitated a total of 10 repeat upper endoscopies, including repeat dilations along with local steroid injection therapy. AEN is a rare presentation of severe esophageal injury and is typically associated with severe hemodynamic compromise. Although most cases resolve with supportive care and mucosal healing, there is little information regarding prognosis and optimal management of complications, such as refractory esophageal strictures. We describe a case of AEN complicated by refractory symptomatic esophageal stricture despite several dilations and intralesional steroid injections and discuss our approach to treatment.

An 84-year-old man has a history of a right hypogastric artery aneurysm that was excluded with endograft several years ago. His course was complicated by a type II endoleak with an enlarging aneurysm that required multiple attempts of coil embolization. Several years later, he presented with gross hematuria and was found to have embolization coils extruding into his bladder and an arteriovesical fistula. As seen in this case, endovascular intervention for a type II endoleak is not benign. We describe a novel complication of an arteriovesical fistula that necessitated a difficult repair and ultimate revascularization.

Objetivo. Recolectar información sobre la presencia de parasitosis intestinales en roedores, con énfasis en parásitos de importancia médica en humanos. Materiales y métodos. Se realizó un estudio parasitológico para detectar la presencia de helmintos en roedores en zonas urbanas y rurales de cinco provincias del Ecuador entre el 2014 y 2017. Los roedores fueron capturados y transportados al Centro Referencia Nacional de Parasitología del Instituto Nacional de Investigación en Salud Pública – Guayaquil, para su posterior análisis. Resultados. Se encontraron 125/211 (59.2%) ratas con endoparásitos, 13/20 (65%) R. rattus y 112/191 (58.6%) R. norvegicus. El nemátodo más prevalente fue Nippostrongylus brasiliensis (para ambas especies de roedores), y Heterakis spumosa, seguido por los cestodos: Hymenolepis diminuta, H. nana, Moniliformis moniliformis y Cysticercus fasciolaris. Conclusiones. La presencia de cuatro especies de cestodos zoonóticos en los roedores muestreados que viven cerca comunidades humanas, representan un riesgo potencial de infecciónpara los habitantes, especialmente en el caso de R. norvegicus (presento mayor diversidad de especies parasitarias).Por lo tanto, el control de la población de roedores en las áreas residenciales y las recomendaciones a la población local sobre el riesgo de transmisión de enfermedades a través de roedores parece ser totalmente necesario.

Al-Qur'an is the Holy Book which is the main and first source in Islamic teachings. It is important for us as Muslims to learn about how to read the Qur'an properly. This research uses two method approach namely Multimedia System Development method and learning method used is to use Tartil method. By using this two-method approach it is hoped that it will be more interesting for students to read and be able to accelerate how to read the Qur'an properly. The results of this research are in the form of an android-based application that can help to learn and read the Al-Qur’an properly. This application is tested using the Black Box method that shows all functions are running properly 100% according to what is expected.. The results show 85% progressed after using the application and only 15% did not progress.

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided among chronic kidney disease (CKD) patients. Till now, limited data are available on NSAID use in Egypt, and we aimed to study the prevalence and pattern of NSAID use among CKD patients. Methods A cross-sectional study was done among 350 CKD adult patients presented to the Main Alexandria University Hospital. Those with end-stage renal disease and diagnosed with acute renal injury and pregnant women were excluded. Demographic and clinical data were collected by interviewing eligible patients. Data about the pattern, history of drug-drug interactions, and knowledge about the NSAID side effects were also gathered. Results Of the enrolled patients, 57.1% were hypertensive, 46% were diabetics, 28% had osteoarthritis, and 18.3% had cardiovascular disease. CKD stages were 3.7%, 40.3%, and 56% in stages 2, 3, and 4, respectively. Almost two thirds (65.7%) were NSAID users. Among them, 82.6% were regular users. Headache was the most reported (68.7%) reason of use. The use of drugs which may have drug-drug interaction with the NSAIDs (as diuretics or renin-angiotensin-aldosterone system inhibitors) was reported in 36%. In multiple logistic regression, the odds of NSAID use decreased by 4% (odds ratio (OR) = 0.96, 95% confidence interval (CI) 0.93–0.99, p = 0.01) for every year increase in the patient’s age and decreased by 3% (OR = 0.97, 95% CI 0.95–0.99, p = 0.01) for every 1 ml/min/1.73 m2 increase in glomerular filtration rate. Conclusion Despite the hazards of NSAID use on the kidney, still high proportion of CKD patients are using them for a long period and they are simultaneously using other drugs with possible drug-drug interactions. This study provided important information that would decrease the gap in knowledge about the use of NSAID in Egypt. It is recommended that NSAIDs should be used with caution among CKD patients and patients should be advised about its adverse health consequences.

Background: Breast cancer (BC) has become a health priority due to its increasing incidence. It is curable when detected at an early stage, so there is an urgent need for its early detection. Mammography screening (MS) is the main recommended test for early detection of BC. Objectives: The aim of the study was to assess MS utilization behavior among female employees and to identify some factors based on the Health Belief Model that determines the likelihood of MS utilization behavior in terms of: health beliefs, knowledge about BC and its risk factors, and access and need for MS. Methods: The study was conducted among 400 female employees aged 40 years and older in four workplace sectors in Alexandria using a cross sectional approach. A predesigned interview questionnaire was used to collect socio-demographic data, habits, reproductive history, family history, culture affiliation, access to MS, reproductive health screening behavior, MS utilization behavior, need for MS, knowledge about BC and MS, perceptions towards BC and MS, perceived threat (susceptibility and severity), perceived benefits and perceived barriers to MS, (personal barriers, economic barriers, health care system barriers). Results: More than two thirds of females (69.7%) had bad MS utilization. Seventy two percent of females had poor knowledge about BC protective factors, signs and symptoms and risk factors of BC and about MS. The perception of the studied females was high concerning susceptibility and seriousness of BC and benefits of screening but there were some perceived personal, economic and health care system barriers to MS. Multiple linear regression analysis of the factors predicting MS utilization shows that age, accessibility, perceived need, total knowledge of BC, MS, and occupation sector were the significant predictors. Conclusion: The majority of female employees had poor knowledge about BC and MS. Increasing the females’ knowledge about BC and accessibility to screening areas are important strategies influencing their decisions about whether or not to participate in cancer preventive practices.

The COVID-19 pandemic has forced museum communities around the world to rapidly re-examine their approach to safe visitor engagement. In an atmosphere of uncertainty, increased attention to hygiene and social distancing, the following is a reflection by 'SparkLab' Sciencentre in the Queensland Museum, Australia, two months after reopening. It highlights the key lessons learnt and strategies adopted, as they continue to reshape and reassess their approach to safe hands-on visitor engagement. This reflection also emphasises the overarching importance of agile planning, open communication, and continued monitoring of COVID-Safe operations, visitor engagement and staff wellbeing.

Virus Epstein Barr (VEB) ha sido relacionado con una serie de tumores malignos de origen epitelial y linfoide. Existe una clara correlación entre este virus y enfermedades linfoproliferativas como Linfoma de Burkitt (LB), Linfoma Hodgkin (LH), Linfoma no Hodgkin (LNH) y carcinoma gástrico. Se han desarrollado diversas técnicas para la detección de VEB en células tumorales: hibridación in situ (RISH) que detecta RNAs (ácido ribonucleico) pequeños codificados para VEB (EBERs) en las células con infección latente, considerado el estándar de oro para la identificación del virus; la reacción en cadena de la polimerasa (PCR) que permite la detección de la cepa viral y representa un ensayo importarte en el diagnóstico del virus. Se realizó un estudio retrospectivo a partir de muestras de tejidos en parafina de pacientes con linfoma y se buscó al virus mediante PCR y RISH. La prevalencia del virus fue de 58,82%, el género más afectado fue el masculino y el grupo más afectado fue el de 31/40 años. La presencia del virus fue similar en ambos tipos de linfoma: Hodking y No Hodking. La técnica de RISH se mostró más eficiente para detectar la presencia del virus. Abstract Epstein Barr Virus (EBV) is linked to a number of malignant tumors of epithelial and lymphoid origin. There is a strong correlation between this virus and lymphoproliferative diseases such as Burkitt's lymphoma (BL), Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL) and gastric carcinoma. There are various techniques developed to detect EBV in tumor cells: in situ hybridization (ISH) detects small coded RNAs (ribonucleic acid) to VEB (EBERs) in latently infected cells. This is considered the gold standard for virus identification. The polymerase chain reaction (PCR) allows the detection of the viral strain and represents an important fact in the virus diagnose. We conducted a retrospective study in paraffin from tissue samples of patients with lymphoma and we sought the virus through PCR and RISH. The virus prevalence was 58.82%, the most affected gender was male and the most affected group was 31/40 years. The virus was similar in both types of lymphoma: Hodgkin and non-Hodgkin. RISH technique seemed to be more efficient to detect the virus.

With the widespread adaptation of the Internet of things (IoT), we are already witnessing a deluge of IoT data analytics applications. IoT data analytics can be defined as a process to control and optimize decision making in real time, by analyzing huge chunks of IoT sensor data. Moreover, data analytics stands on the shoulders of sensor data aggregation that includes data pre-processing and routing. This paper envisions two open problems of data aggregation, first, raw IoT sensor data is highly uncertain, second, the traditional algorithms are not fit for processing highly uncertain sensor data. This is formally known as data veracity problem. This paper proposes a data aggregation scheme for highly uncertain raw IoT sensor data collected using the device to device communication. The approach initially reconstructs the subspace using sample data and then it iteratively tracks down the low-rank approximation of the dominant subspace in the presence of high uncertainties at the fog server. Later, the robust dominant subspace is used to estimate a more reliable true sensor data matrix from the highly uncertain raw IoT sensor data traffic matrix. Moreover, the proposed scheme achieves the aforementioned tasks while processing the raw IoT sensor data without any prior information, i.e., in a fully unsupervised fashion. The existing literature based on sampling, approximation, and data reduction either causes random data reduction or destruction of global characteristics of the raw data. However, unlike the existing solutions, the proposed method removes the uncertainties while preserving the global characteristics of the raw data. Performance evaluations conducted using both the real world sensor data and synthetic data injected with noise, outliers, and missing values. Experimental results show that the proposed approach can estimate a reliable true sensor data matrix in the presence of high uncertainties and the energy efficient device to device communication-based data delivery mechanism can accommodate a large number of IoT devices.

Introduction: Neurocryptococcosis is an opportunistic fungal infection that represents a high cost in human lives and for the economy of countries. Its causative agent, the Cryptococcus neoformans/Cryptococcus gattii species complex, has a sexual and an asexual phase, four major serotypes and seven molecular varieties with phenotypic, clinical-epidemiological and antifungal susceptibility differences. Objective: To characterize by molecular methods clinical isolates of C. neoformans from Guayaquil, Ecuador. Materials and methods: We determined mating types, serotypes and molecular varieties by PCR and RFLP in 27 yeast isolates previously identified as C. neoformans by conventional methods. The isolates were recovered from cerebrospinal fluid of HIV seropositive patients with neurological syndrome admitted at “Dr. José Daniel Rodríguez Maridueña” Hospital from December, 2013, to January, 2015. Results: We established a wide prevalence of C. neoformans serotype A, MATα and genotype VNI among the studied isolates. Conclusions: These data are similar to those obtained in other countries and the first identified by molecular characterization in Guayaquil, Ecuador. Therefore, they constitute an important contribution to the knowledge on cryptococcosis in this country.

To meet the rapid growing requirement of data services and offload the heavy base station load, device-to-device (D2D) communication is proposed as one of the key technologies for future cellular network, which can enable users to communicate directly and thus effectively improve the bearing capacity of the network. However, when D2D users transmit packets in the manner of cooperative communication, the cooperative users with non-cooperative behavior, such as the selfishness of user, may lead to a sharp decline in network performance. For this reason, in our paper, a trust-oriented partner selection mechanism (TPSM) is proposed to avoid choosing those users with non-cooperative behavior. In particular, the related psychological researches show that the psychology structure of users can be divided into three aspects: cognition, emotion, and behavior. Considering the psychology structure of users, we build multi-dimensional trust relationships between sending users and cooperative users by evaluating the cognition trust, emotion trust, and behavior trust. Furthermore, aiming at the multi-dimensional trust relationships between sending users and cooperative users, we classify the cooperative users into three categories, namely reliable users, observed users, and unreliable users, by combining the decision-theoretic rough sets based on Naive Bayes. Finally, based on different cooperative transmission scenarios, an optimal partner selection mechanism is proposed in this paper. The optimal partner can be chosen from the reliable cooperative users, according to the different scenarios and factors. The numerical results show that the proposed TPSM can effectively identify the selfish users and notably enhance the packet delivery rate.

El objetivo del presente estudio ha sido analizar la estructura financiera de 162 empresas iberoamericanas empleando información acerca de sus estados financieros en el periodo 2009 – 2015, para determinar mediante regresiones econométricas cuáles son las variables que explican la estructura de endeudamiento de las empresas de los principales sectores económicos en 7 países iberoamericanos: Argentina, Brasil, Chile, Colombia, España, México, y Perú. Los resultados obtenidos apoyan mayoritariamente la teoría del equilibrio estático.

Introduction: Backache and sciatic pain are routinely seen in day-to-day practice. In all urban settings with changed lifestyle, lack of exercise, bad posture, excessive use of vehicles, and disturbed nutrition; problem of discogenic backache and sciatica is on the rise. The treatment modalities vary from conservative to surgical methods, but they predominantly provide relief to leg pain and not back pain. Nerve root block acts at these inflammatory processes, by the action of the steroid and thus decreasing the chemical irritation to the nerve roots. Furthermore, there is a decrease in sensitization of dorsal horn neurons by bupivacaine. Aims and Objectives: To evaluate diagnostic and therapeutic efficacy of root block procedure. To study relief in terms of pain alleviation, activities of daily living, and straight leg raising (SLR) restriction. Materials and Methods: Retrospective study of fifty patients of sciatic radiculopathy between the ages of 20 and 60 years were evaluated under this study at Dr. D. Y. Patil Medical College and Research Centre, Pune. All the patients of different age and sex had radicular pain with or without back pain, restricted spinal mobility, positive active and passive SLR test, and other nerve tension signs. Results: Out of fifty patients selected after thorough clinical and radiological examination, 45 (90%) had enjoyed complete pain relief and 31 (62%) of which were completely symptom-free at the end of 1 year. Conclusion: Spinal nerve root block may provide lasting therapeutic benefit, allowing the patient to participate in physical therapy and early return to routine activities saving working manpower hours.

Using theoretical techniques, the interactions between adenosine (AD) and minoxidil sulfate (MS) were studied using the DFT/M06-2X/aug-cc-pVDZ level of theory. The formation of the complex was thermodynamically favorable, so we carried out further studies. Frontier molecular orbital analysis shows that the HOMO-LUMO- gap is high (6.81 eV), which means that the complex is kinetically stable. The global reactivity parameters were also calculated to get insight about the chemical reactivity of the complex. Molecular electrostatic potential and charge analyses were carried out for the optimized complex. To study the charge transfer and inter- and intramolecular interactions present in the complex molecule, we employed natural bond orbital analysis. Noncovalent interaction (NCI) analysis along with IGMH and IRI analyses further helped us find the weak interactions. The presence of hydrogen bonds between the N atom (N 27 ) of MS and H atom (H 66 ) of AD and O atom (O 32 ) of MS and H atom (H 46 ) of AD was the main finding of these analyses. QTAIM investigation also supports this finding. EDA analysis was carried out to further study the intermolecular interactions present within the complex. Thus, the present investigation unveils the existence of weak NCIs in the complex.

Cardiofacial syndrome is associated with facial abnormality with congenital heart disease. Here, we report a case of cardiofacial syndrome having anotia and facial nerve palsy on the right side in combination with infundibular pulmonary stenosis and patent ductus arteriosus which is a rare presentation of cardiofacial syndrome. A 6 years old girl presented to department of Cardiac surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of shortness of breath on exertion since 2 years of age. Her physical examination revealed right sided anotia and facial nerve palsy associated harsh ejection systolic murmur in upper left parasternal area. Echocardiography showed critical infundibular pulmonary stenosis with a small patent ductus arteriosus. She underwent ligation of patent ductus arteriosus and excision of infundibular muscular bands and discharged to home without any complication. Any child presented with facial abnormality should be checked for any cardiac abnormality for early intervention and better management of the patient.

Here, we report a case of a right atrial myxoma attached to the lateral wall, which is seen in only 10% cases, impinging upon the tricuspid valve. A 57 year old male normotensive, non-diabetic, nonsmoker patient was presented to us on 5th of August 2018 with the complaints of cough, dyspnea and orthopnea for the last two years. This type of presentation is very rare. After excision of myxoma, there was a significant improvement in the signs and symptoms of the patient. In this report, we emphasize the rarity of myxoma in the Right Atrium, and its difficulty in diagnosis because of its uncommon location and atypical presentation, surgical management has shown to quickly alleviate the majority of symptom and expectant sequeale.

Ectopic parathyroid are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland. Ectopic parathyroid glands are a major cause of persistent and recurrent Hyperparathyroidism. We report a case of 65-year-old female was referred from Surgical Endocrine department to the department of Cardiac Surgery on 20 September, 2017 in Bangabandhu Sheikh Mujib Medical University with parathyroid crisis due to an ectopic mediastinal parathyroid adenoma with her serum calcium and PTH markedly increased in short time. Computed tomography of the chest and lower neck showed an ovoid soft tissue density area measuring about 25×20×15mm in the anterior mediastinum. Technetium-99m-sestamibi (MIBI) scintigraphy scan showed positive and detected localized parathyroid adenoma/hyperplasia in superior mediastinum. Ectopic parathyroid adenoma resection was performed via median sternotomy approach. But after 4 hours patient developed the color change of the left arm due to acute left upper limb ischemia of unknown cause for which the patient was rushed to operation theatre suspecting it to be embolic occlusion and managed by both surgical and medical therapy.

The present experimental study was carried out as an experimental study in the department of Cardiac Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2011 to May 2013 to see which preservation techniques give us morphologically and histologically suitable xenograft heart valve for clinical use. We reviewed 20 bovine aortic valves in 2 years. Each of 10 samples was grouped as glutaraldehyde (1.5%) preservation and cryopreservation (-180°C). After collecting each specimen, sterilization of valve was done in low concentration of sterile antibiotic solution (CLPVA). Then 10 dissected valves were immersed each in 250ml of 1.5% glutaraldehyde solution at 4°C. Another 10 dissected valves were placed in a solution of 100ml 10% DMSO and suspended in vapor phase of liquid nitrogen at -180°C. Then after 4 weeks, the valves were examined for naked eye (color change, shrinkage, swelling, pliability, stiffness of leaflet) and histological (endothelial cells, leaflet extracellular matrix preservation, fibroblast preservation, inflammation, necrosis and other pathological conditions on valve leaflet) examination. Statistical analysis showed that morphological changes were not significant in both groups but in histological examination, cryopreservation showed effective preservation of fibroblast and extracellular matrix than glutaraldehyde preservation.

Functional ischemic mitral regurgitation is strongly associated with poor outcomes in patient with coronary artery disease. The best management for mitral regurgitation at the time of coronary revascularization remains controversial. We report, a case of 58 years-old men admitted to GKNM hospital, Coimbatore, Tamil Nadu, India with chest pain and respiratory distress for last 6 hours during my fellowship training in that hospital. ECG showed acute antero-septal MI. The transthoracic echocardiogram revealed severe left ventricular dysfunction with moderate mitral regurgitation. Coronary angiogram revealed triple vessels disease. We planned for early CABG. But the patient suddenly developed severe respiratory distress with ventricular tachycardia. Patient managed with the support of invasive ventilation and IABP. After that, CABG along with mitral valve repair was done under cardiopulmonary bypass. The patient showed excellent symptomatic improvement during his early post-operative period. Mitral valve repair along with CABG may be a preferable treatment option for patient with Ischemic heart disease with moderate mitral regurgitation.

In the age of stent deployment after balloon angioplasty. In stent restenosis (ISR) has become a major concern. Various coronary interventional measures and coronary artery bypass graft (CABG) has employed to manage the ISR. Although CABG seems to offer advantages over other coronary intervention methods in patients with multi vessel ISR; lack of appropriate graftable vessels often make the surgery difficult and end up with incomplete revascularization. Coronary endarterectomy with stent removal mitigated some of the limitations of CABG but initial results of this surgical measure were not favorable. Later, with improvement of surgical technique and meticulous anticoagulant therapy along with CABG showed promising result but till date only few cases have been reported. Here, we are reporting a case of 65 years old lady who underwent CABG along with endarterectomy with stent removal after she had developed stent restenosis in three vessels. This diabetic and hypertensive patient presented with chest pain and shortness of breath which was developed within three months of PCI with stent deployment in three vessels. Angiogram done prior to admission in the cardiac surgery department reveals restenosis in all the three stented vessels. CABG was done and three grafts given in LIMA to LAD, RSVG to OM and RCA. Endarterectomy done on LAD and RCA with stent removal from RCA. Postoperative anticoagulant therapy was strictly maintained. Patient's postoperative period remained eventless other than superficial wound infection. With skilled hand capable of handling highly technique demanding surgery and postoperative anticoagulation maintenance; endarterectomy along with CABG seems to be safe solution for multi vessel ISR with diffuse coronary artery disease.

A study was conducted to find out the effect of different concentrations of Methyl parathion, an organophosphorus pesticide on soil bacterial population, soil respiratory activity and dehydrogenase activity, under laboratory conditions for a definite time period. The higher concentration (100 ppm) of Methyl parathion application, considerably reduced bacterial count, CO2 evolution and enzyme activity in soil but the microbial activities seemed to recover several weeks following pesticide application.