Co-infection of Hepatitis A Virus with Salmonella Typhi

Waterborne diseases are very common in developing countries like Bangladesh due to intake of contaminated water from local water supply authority, along with inadequate sewage and water drainage systems. Multiple infections can occur with contaminated water. Viral hepatitis and typhoid fever are endemic in our country. Both are transmitted feco‐orally and are associated with poor sanitation, poor hygiene. Sometimes more than one type of infection along with coexisting febrile illness makes the diagnosis and management a challenging task. We report a case of 10 years young girl came to us with 10 days history of low grade intermittent fever, yellow discoloration of sclera and urine and right upper abdominal pain and final diagnosis was confirmed as co-infection of Hepatitis A and Salmonella typhi infection. KYAMC Journal. 2022;12(04): 250-251</jats:p

Developing a Vaccine for Rheumatic Fever and Rheumatic Heart Disease: Current Research Strategies and Challenges

Rheumatic heart disease (RHD) is the most serious manifestations of rheumatic fever, which is caused by group A Streptococcus (GAS or Streptococcus pyogenes) infection. RHD is an auto immune sequelae of GAS pharyngitis, rather than the direct bacterial infection of the heart, which leads to chronic heart valve damage. Although antibiotics like penicillin are effective against GAS infection, improper medical care such as poor patient compliance, overcrowding, poverty, and repeated exposure to GAS, leads to acute rheumatic fever and RHD. Thus, effort to design a vaccine based on emm gene identification of GAS, M-protein going on for more than 40 years, is unlikely to succeed. M-protein is strain specific. Infection with one strain does not provide immunity from infection with another strain. Based on the emm gene identification, of 250 or more identified strains of GAS, the distribution is heterogenous and keeps changing. The M-protein gene sequence of the organism tends to mutate. A vaccine prepared from available strains may not be effective against a strain following mutation

Using Mnemonics in Teaching-Learning: A Profile of Experiences of the Bangladeshi Anatomy Teachers

Background: Teaching-learning of Anatomy is become challenging due to change in undergraduate medical curricula and reduction of time allotted for studying Anatomy. Moreover, students are never tried of using memory enhancing techniques like mnemonics that results better retention of recalled anatomical knowledge. But teachers’ experiences regarding different aspects of mnemonics are still sketchy. Objective: To analyze the experiences of the Bangladeshi Anatomy teachers’ in using mnemonics on teaching-learning of Anatomy. Material and Methods: A questionnaire-based survey was conducted to analyze the experiences of 63 Bangladeshi Anatomy teachers regarding different aspects of anatomical mnemonics and their suitability in teaching-learning of Anatomy. Results: Most of the surveyed teachers had experience of using anatomical mnemonics as a student (88%). Most (82%) of them used mnemonics in Regional Anatomy and also got the highest number of choices (90%) as the subdivision of Anatomy where mnemonics are likely to be effective. Most of them relate themselves with memory enhancing techniques in Anatomy. Conclusion: Most of the teachers’ used mnemonics as a student, mostly in Regional Anatomy where the use of mnemonics was likely to be more effective than any other subdivisions of Anatomy. KYAMC Journal. 2022;12(04): 226-230</jats:p

A Pregnant Lady with Thyrotoxic Cardiomyopathy and Pulmonary Hypertension

Thyrotoxic cardiomyopathy is potentially life threatening complications of thyrotoxicosis during pregnancy due to its harmful effects both on mother and fetus. We present a case of 32-year-old pregnant lady presented with non-productive cough, palpitation, restlessness, sweating and weakness after minimum exertion with a small swelling on the right side of her neck for three months. There was tachycardia with normal blood pressure, first and second heart sound were soft with pansystolic murmur on mitral and tricuspid area. After all laboratory investigations, she was diagnosed as dilated cardiomyopathy with moderate to severe pulmonary hypertension with toxic multi nodular goiter with 13 weeks of pregnancy.The thyrotoxic cardiomyopathy during pregnancy is rare due to difficulties in diagnosis. However, physicians should be aware of the risk posed by thyrotoxic cardiomyopathy during pregnancy.&#x0D; KYAMC Journal Vol. 11, No.-1, April 2020, Page 54-56</jats:p

Antiplatelet Therapy in Patients with Acute Coronary Syndrome: An Update

Antiplatelet therapy is the cornerstone in the treatment of acute coronary syndrome. Aspirin is the most widely used antiplatelet agent followed by P2Y12 inhibitors. Glycoprotein (GP) IIb-IIIa antagonists are also gaining popularity as an antiplatelet agents during peri-PCI period. This review article summarizes the indications, duration of dual antiplatelet therapy (DAPT) in ACS setting. Antiplatelet therapy in special situations like atrial fibrillation and thrombocytopenia are discussed here. Issues like switching between P2Y12 inhibitors and genetic testing of antiplatelet agents are also mentioned in this article&#x0D; University Heart Journal Vol. 17, No. 1, Jan 2021; 66-70</jats:p

EVALUATION OF INTRARENAL RESISTIVE INDEX BY DUPLEX COLOR DOPPLER ULTRASONOGRAPHY IN PATIENTS WITH DIABETIC NEPHROPATHY – COMPARISON BETWEEN HEALTHY ADULT CONTROL SUBJECTS

Background: Renal Doppler Ultrasonography (USG) has become a useful adjunct to gray scale sonography in the evaluation of renal function in various pathophysiological conditions like diabetic nephropathy. We can diagnose diabetic nephropathy by serum creatinine level and creatinine clearance rate. But early stage diagnosis of diabetic nephropathy is not always possible. In this study we have focused on resistive index of interlobar arteries of kidney to see changes of renal parenchyma for early stage diagnosis of diabetic nephropathy.&#x0D; Objectives: To observe the difference between values of intrarenal resistive  index measured by duplex color Doppler USG in type 2 diabetic  patients having diabetic nephropathy and in healthy adult control subjects.&#x0D; Materials and methods: This cross sectional observational study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler Ultrasonography of interlobar artery was carried out in both groups to measure the peak systolic velocity, the end diastolic velocity and arterial Resistive Index.&#x0D; Results: The Resistive Index of interlobar artery of left kidney in control group was 0.58±0.08 and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53. The difference of Resistive index of interlobar artery of left kidney in the two groups were statistically significant and the RI of right kidney of control &amp; that of case groups were 0.60±0.09 and 0.76±0.03 respectively. In between control and case groups the RI of right kidney were statistically significant. So, resistive index of interlobar artery was increased in type 2 diabetic nrphropathy patients compared to control group.&#x0D; Conclusion: It can be concluded in present study that resistive index remains significantly higher in patients with diabetic nephropathy than in controls. Thus Duplex Doppler ultrasonography allows the rapid, noninvasive evaluation of the intrarenal vasculature and can be used as an easily available parameter of the evolution and a predictor in patients with clinical diabetic nephropathy.&#x0D; Keywords: Doppler Ultrasonography, Intrarenal Resistive Index, Diabetic Nephropathy</jats:p

Echocardiographic Assessment of Myocardial Viability and Prediction of Left Ventricular Functional Recovery after Acute Myocardial Infarction Using Strain and Strain Rate

Background: Extent of viable myocardial tissue has been recognized as a major determinant of recovery of left ventricular (LV) function after myocardial infarction. The present research was aimed at assessment of myocardial viability and prediction of left ventricular functional recovery in patients after acute anterior ST-elevated myocardial infarction using Tissue Doppler strain.&#x0D; Methods: In this prospective observational research, 47 patients admitted into the hospital with acute anterior ST-elevated myocardial infarction were included. All patients underwent two-dimensional and strain echocardiography within 48-72 hours of admission. Follow up two-dimensional echocardiography had performed at 6 months after baseline examination.&#x0D; Results: Total 47 patients (mean age, 57±5 years) underwent two-dimensional and strain echocardiography within 48-72 hours of admission. Significant relations were observed between baseline global systolic lengthening strain and wall motion score index (r=0.67), change in left ventricular ejection fraction (LVEF, r= -.844), Global Ses (r=.441) and on admission troponin I (r =0.397). At 6-months follow-up, LV ejection fraction was reassessed. Patients with absolute improvement in LV ejection fraction ≥5% at 6-months follow-up (n=24; 51%) had a higher (more negative) baseline global Ses strain (P&lt;0.001) and lower global systolic lengthening (P&lt;.001). A cutoff value for baseline global systolic lengthening strain of 7.6% yielded a sensitivity of 83% and a specificity of 87% to predict LV functional recovery at 6-months follow-up.&#x0D; Conclusions: Global Left ventricular strain (Ses and Systolic lengthening) early after acute anterior ST-elevated myocardial infarction reflects myocardial viability and predicts recovery of LV function at 6-monts follow-up.&#x0D; University Heart Journal Vol. 17, No. 1, Jan 2021; 22-30</jats:p