Homocysteine as a predictor and prognostic marker of atherosclerotic cardiovascular disease: a systematic review and meta-analysis.

OBJECTIVE: Hyperhomocysteinemia is a well-known marker that is associated with an increased risk of atherosclerosis due to its toxic effect on endothelial cells. This, in turn, leads to cardiovascular injury and increases morbidity. Different studies have shown alterations in the levels of homocysteine with respect to multiple disease states. Whether this non-traditional marker is associated with cardiovascular injury or not is subject to conflicting results. The purpose of this systematic review is to evaluate the role of homocysteine in the formation of atherosclerotic cardiovascular disease in young adults and children. MATERIALS AND METHODS: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). A search was done using specific keywords, including "homocysteine", "coronary artery disease", and "atherosclerosis", amongst several others, from the databases of PubMed, COCHRANE, and EBSCO. The data items included the diseased sample population along with the intervention used, or investigations carried out and the findings of the studies. Finally, 35 eligible studies were included. RESULTS: Young patients with atherosclerotic cardiovascular disease were more likely to have elevated levels of homocysteine compared to elderly patients. Elevated levels of homocysteine have been observed with several genetic, nutritional deficiencies, and autoimmune states such as rheumatoid arthritis. On the other hand, decreased levels of homocysteine have been observed after certain intervention treatments, such as oral contraceptive pills, L-thyroxine, and even the adoption of certain diets. In the majority of studies, whenever homocysteine levels were higher than normal, this was reflected by an increased carotid intima-media thickness. CONCLUSIONS: Homocysteine has a high correlation with atherosclerotic cardiovascular disease in young and overweight patients. In addition, the relationship of homocysteine with smoking, genetic polymorphism, specific hormonal and renal disorders, nutritional deficiencies (vitamin B12 and folic acid), and the use of specific medicines are among the other recurring findings. Given that many of these studies focus only on women, the relationship between homocysteine and atherosclerotic cardiovascular diseases in males is still unclear. Whether males are more prone to hyperhomocysteinemia needs to be assessed. Still, precise processes underlying variations in homocysteine in relation to all influencing factors are unclear and need further studies.

Identification of Variants and Mutational Analyses of Cardiac Myosin-binding Protein C (MYBPC3) Gene of Adult Bangladeshi Patients with Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic hereditary cardiomyopathy characterized by sudden cardiac death. Mutations in the MYBPC3 gene are often the most prevalent genetic abnormality in HCM with a prevalence ranging from 20.0 to 42.0%. The mutation spectrum is available for different countries, but such studies are lacking in the Asian population including Bangladeshi patients. A cross-sectional descriptive study was conducted for mutation analysis of the whole MYBPC3 gene on a cohort of 75 HCM Bengali Bangladeshi probands through Next Generation Sequencing at the Genetic Research Lab of Bangabandhu Sheikh Mujib Medical University from 2016 to 2019. The structural and functional impact of the mutations was further analyzed by in silico process. We analyzed the data and found 103 variants in 102 locations in the MYBPC3 gene. Variants were identified in both the coding region and the non-coding region. We found one possibly novel variant in the MYBPC3 gene. The findings of this research will help to develop a genetic database of HCM which will help in the early diagnosis and proper management of HCM patients in Bangladesh. One pathogenic splice donor variant (47356592 C >T) was found in the intronic region. Among the variants in the coding region, one missense mutation was pathogenic (NP₋000247.2: p.Asp770Asn) which was found in seven patients and another one is of conflicting interpretations of pathogenicity (NP₋000247.2: p.Ser217Gly) which was found in two patients. We have identified one in-frame deletion (NP₋000247.2: p.Ala433del) that is possible a novel variant responsible for the development of HCM.

A Case of Congenital Coronary Ostial Stenosis with Systemic Lupus Erythematosus.

Congenital coronary ostial stenosis or atresia (COSA) is a spectrum of rare developmental conditions with different pathophysiologic mechanisms and clinical implications. Although COSA includes various entities, these entities have two features in common. First the defect is congenital, although it may progress during pre-natal and post natal life. Second the developmental defect may cause ostial or proximal coronary obstruction (that is stenosis or atresia). Coronary ostial stenosis or atresia affects the left coronary (L-COSA) more frequently than it does the right coronary artery. Systemic Lupus Erythematosus (SLE) is not an uncommon disease in young female, but combination of congenital coronary ostial stenosis with systemic lupus erythematosus make the case very rarer. Here we presented A 17 years old girl got admitted to Bangabandhu Sheikh Mujib Medical University, Bangladesh for evaluation of on and off chest pain of CCS-III to CCS-IV for 1 day on 17 September 2019.

Fetomaternal Outcome of Pregnancy in Women with Tetralogy of Fallot.

This prospective study was done to determine fetomaternal outcomes of pregnancy in women with Tetralogy of Fallot (TOF) and carried out in two centres especially in the care of patients with adult congenital heart disease (CHD) from January 2005 to December 2009. Clinical, haemodynamic and obstetric data were reviewed for pregnant women with TOF. Ten (10) pregnant women were identified in the age range 18 to 47 years. Most of the patients were in the age group of 18 to 27 years, 34 to 36 weeks gestational age (in week) and primi gravida (60%). Right-sided aortic arch (20%) and major anomalies of pulmonary collaterals (30%) were common anomalies anatomical association. Normal vaginal delivery was the mode of delivery (70%) in the majority of the patients. Spontaneous abortions were occurred in 3(30%) patients. Primary maternal cardiac events complicating pregnancies were congestive heart failure (20%), arrhythmias and cardiovascular events (10%). Premature labor (40%) was the most common obstetric complication. Premature birth (40%), fetal demise (20%), neonatal death (10%) and cardiac anomaly at birth (10%) were the offspring complications in the study. Women with TOF can go through pregnancy with a low risk to themselves with frequent treatable complications, but there is a high incidence of miscarriage, premature births and low birth weight. An incidence of congenital anomaly in the fetus is higher than that found in the normal population.

Crossbreeding effect of double-muscled cattle on in vitro embryo development and quality.

Nowadays, several developing countries have started to breed double-muscled cattle to their autochthonous cattle to improve meat production. However, the developmental competence of the resultant crossbreeding embryos is unknown. The objective of this study was to evaluate the effect of crossbreeding double-muscled (Belgian Blue; BB) semen with beef (Limousin; LIM) and dairy (Holstein-Friesian; HF) derived oocytes on embryo development and quality, using purebred BB as a control (BB oocytes fertilized by BB sperm). A single ejaculate of a BB bull was evaluated by Computer Assisted Sperm Analysis before using for in vitro fertilization. Ovaries from each breed were collected at the local slaughterhouse (n = 1,720 oocytes). All statistical analyses were performed using R-core (P < 0.05). Embryo quality was evaluated via differential-apoptotic staining of day 8 blastocysts. Cleavage (48 h post insemination) and day 8 blastocyst rates were greater (P < 0.05) for LIM (82.9 ± 6 and 27 ± 4.3%, respectively) than for BB (69.8 ± 8.5 and 19.6 ± 3.1%, respectively) and HF (45.1 ± 10 and 12.3 ± 2.2%, respectively). Holstein-Friesian presented lower cleavage and day 8 blastocyst rates than BB (P < 0.05). Limousin blastocysts presented a higher number (P < 0.05) of inner cell mass cells (ICM; 68 ± 7.8) than HF (40.4 ± 8.2). In conclusion, crossbreeding double-muscled cattle by in vitro fertilization with LIM oocytes yielded better embryo compared with the purebred combination, while the combination with HF oocytes produced the lowest rate of blastocysts.

Practical methods to assess the effects of heat stress on the quality of frozen-thawed Belgian Blue semen in field conditions.

The increased exportation of semen and embryos of double-muscled beef breeds to tropical and developing countries makes it important to investigate the reproductive capacity of these breeds in adapting to tropical conditions. The aim of this study was to evaluate the quality of Belgian Blue semen collected after there is heat-stress (HS; as a mimic of tropical condition) compared with non-heat stressed (NHS; as their comfort zone), using practical spermatozoa staining methods such that prevail in developing countries. There was screening of semen kinetics using CASA and evaluation of their DNA-, acrosome, plasma membrane-integrity, and mitochondrial activity. For each staining technique, there was evaluation of 12 frozen-thawed semen samples from six Belgian Blue bulls collected after there were HS and NHS conditions in Belgium. Mixed linear regression models were used to assess the effects of HS for each CASA variable and staining method outcome using the replicate nested with bull as a random effect. There were differences (P < 0.05) in values when there were semen collections following HS and NHS conditions for several post-thawing kinetic variables. Furthermore, the mean percentages of DNA-, acrosome-, and plasma membrane-integrity, as well as mitochondrial activity were greater (P < 0.05) when semen was collected following NHS compared with HS conditions. Conclusively, results indicated that when there was collection of semen following HS conditions, there were detrimental effects on the viability and quality of Belgian Blue semen which is an important consideration for the semen collection, processing, and evaluation in tropical countries.

Successful Multi-vessel Percutaneous Coronary Intervention for Recent Myocardial Infarction in a Patient with Dextrocardia and Situs Inversus.

Dextrocardia with situs inversus is a state which is characterized by abnormal positioning of the heart and other internal organs. It is a rare congenital anomaly and the exact cause is not known. More than 60 recognized genes are significant for the proper positioning and patterning of the organs in the body. However, a specific genetic cause of dextrocardia with situs inversus has not been identified and inheritance prototypes have not been established in the majority cases. There are partial available case reports of successful percutaneous coronary intervention (PCI) in these patients who have atherosclerotic coronary artery disease, especially when presenting with myocardial infarction. PCI is technically difficult because of dextrocardia. We hereby describe a 51-year-old male, who had a recent inferior wall myocardial infarction and underwent successful coronary angiography and PCI at a tertiary level hospital in Dhaka, Bangladesh.

Study of Angiographic Relationship between Peripheral Arterial Diseases with the Involvement of Specific Coronary Artery Lesion.

The purpose of this study was to investigate magnitude, pattern and involvement of previously unheralded coronary artery disease in patients suffering from clinically significant peripheral artery disease of lower limbs. This cross sectional study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2014 to February 2015. Total 58 patients with clinically diagnosed peripheral arterial disease of lower limb undergoing angiographic evaluation. Selective CAG in addition to peripheral arteriography was performed in all the study population as per ACC/AHA guidelines for CAG (class IIa recommendation).In this study, it was documented that the proportion of coronary arterial disease was highest in LAD (63.9%) followed by LCX (55.6%), RCA (52.8%), and lowest LM (11.1%) in lesion with aorto-iliac segment. But the proportion of coronary arterial disease was highest in LCX (41.9%) followed by LAD (38.7%), RCA (35.5%), and lowest LM (12.9%) in lesion with femero-popliteal blood vessels. Similarly, the proportion of coronary arterial disease was highest in LCX (36.4%) followed by RCA (27.3%) and equal percentage in LAD and lowest in LM (9.1%) in tibioperoneal segment. Patients of peripheral arterial disease (PAD) having no symptoms of coronary artery disease (CAD) are more likely to have severe coronary artery involvement. Coronary angiogram should be done in patient with PAD to detect previously undetected CAD and pattern of PAD reflects the severity and involvement of coronary arteries.

Pericardial Tumor Presenting As Recurrent Pericardial Effusion--A Case Report.

Pericardial tumors are unusual and may be difficult to characterise with imaging. They manifest as large, non-contractile, solid masses within the pericardium. Presenting symptoms include heart failure, arrhythmias, sudden death, cyanosis and chest pain. But it can also present as recurrent pericardial effusion misdiagnosed as tuberculosis and other infectious causes. Accordingly a patient with pericardial mass (tumor) presented with recurrent pericardial effusion as a rare case.

Fungal fermentation of whey incorporated with certain supplements for the production of proteases.

The pattern and the extent of formation of proteases and secretion varied with the fungus, age and/or the nature of the co-supplement. Addition of yeast extract induced the best yield of proteases from both Aspergillus niger and A. terreus. Proteases from A. niger were highly induced by glutamic acid, alanine or albumin, with minor differences, whereas gelatin, peptone, aspartic acid, casein or acetamide stimulated the accumulation of proteases in the culture medium of A. terreus. Galactose stimulated the yield of the enzyme particularly with A. terreus while most C-supplements inhibited such processes, more prominently in the presence of cellulose or starch. Incorporation of nicotinic acid and wheat bran initiated the maximum productivity of proteases from A. niger and A. terreus, respectively. Co+2 and Cu+2 highly stimulated the output of proteases from A. niger and A. terreus, respectively. Co+2 and Ca+2 stimulated the enzyme activity of alkaline and acid proteases from A. terreus and acid proteases from A. niger. The other six cations and DTT inhibited variably the three proteases particularly alkaline proteases from A. terreus indicating that proteases from various sources even from closely related species showed different properties.

Childhood brucellosis: a study of 102 cases.

One hundred two children, 45 days to 14 years of age, with proven brucellosis were studied to illustrate the epidemiologic, clinical and laboratory findings and to assess the outcome of antimicrobial therapy. The main source of infection was the consumption of raw milk in 80% of the patients. The predominant presenting symptoms and signs were fever, arthralgia, malaise, weight loss, arthritis, hepatosplenomegaly and lymphadenopathy. Brucella melitensis was isolated from 75% of 87 patients. Diverse hematologic and biochemical abnormalities were found. Different durations and combinations of trimethoprim-sulfamethoxazole or tetracycline plus streptomycin or rifampin were used for therapy. Eight-five patients were followed for an average of 14 months. Twelve (85.7%) of 14 patients treated with two-antibiotic combinations for 3 weeks relapsed, as did 5 (8%) of 62 patients treated for at least 6 weeks (P less than 0.001). No relapses occurred in 9 patients treated with trimethoprim-sulfamethoxazole and rifampin for 8 to 12 weeks plus streptomycin for the first 3 weeks. Longer duration and combination of antibiotic therapy seem warranted to improve outcome and to prevent relapses.

Prevalence of iron deficiency in Saudi children from birth to 15 months of age.

A cross-sectional study was carried out to determine the prevalence of iron deficiency among healthy Saudi children from birth to 15 months of age. The groups studied were: newborns, 3-4 months, 5-6 months, 7-8 months, 9-10 months and 12-15 months of age. The age groups were dictated by the vaccination schedule. Serum ferritin was measured and transferrin saturation calculated in each subject. The lower limits of normal were taken as a transferrin saturation of less than 10% and a serum ferritin of less than 12 micrograms/l. A total of 333 serum samples was adequate for analysis. None of the newborns or the 3-4-month-old infants had evidence of iron deficiency. At 5-6 months only 3.3% of subjects had iron deficiency. In the subsequent older age groups the prevalence of iron deficiency increased significantly with age from 9.3% to 12.7% and reached 14.5% in the oldest age group. Screening for iron deficiency in children attending well-baby clinics and hospitals at ages of 12-15 months is recommended.

Allelopathic effect of alfalfa (Medicago sativa) on bladygrass (Imperata cylindrica).

Greenhouse and laboratory experiments were conducted at the Agricultural and Water Resources Research Center Station, Baghdad, in 1985 and 1986 to investigate the possible allelopathic potential of alfalfa (Medicago saliva L.) and its decomposed residues on bladygrass (Imperata cylin-drica L. Beauv.), a noxious weed in Iraq, and to isolate, characterize, and quantify possible allelopathic agents in alfalfa residues and root exudates. Results indicated that decomposed alfalfa roots and their associated soil produced a 51-56% reduction in bladygrass seed germination. Root and shoot length of bladygrass seedlings were reduced by an average of 88%. Decayed and undecayed mixtures of alfalfa roots and soil at 0.015∶1 (w/w) inhibited bladygrass seedlings reproduced from rhizomes by 30 and 42%. It was found that root exudates of alfalfa seedlings caused significant reduction in shoot and root dry weights of bladygrass seedlings when alfalfa and bladygrass were grown together in nutrient culture. Caffeic, chlorogenic, isochloro-genic,p-coumaric,p-OH-benzoic, and ferulic acids were detected in alfalfa root exudates and residues. The highest amount (126 fig phenolic acids/g soil) of these compounds was found in alfalfa root residues after six months of decomposition in soil.

Evaluation of some weed extracts against field dodder on alfalfa (Medicago sativa).

Experiments were conducted to evaluate the effectiveness of some weed extracts against field dodderCuscuta campestris Yunck. on alfalfa (Medicago stiva L.) and to identify and quantify the phytotoxic agents of these extracts. All concentrations of aqueous extract of every weed showed significant effectiveness on dodder when compared to the untreated plant under lath house and field conditions. Control percentages of the (0.5 g) of Bermuda grass (Cynodon dactylon) and wall goosefoot (Chenopodium murale) ranged between 83 and 96, and the same concentration caused injury to alfalfa foliage up to 43% when applied in the field. Phytotoxic agents were identified as phenolic compounds such as chlorogenic, isochlorogenic,p-coumaric acids, and scopoletin. Their quantities varied with species; Bermuda grass had the highest content (32.2 µg/g dry weight) followed by Johnson grass (Sorghum halepense), well goosefoot, and tumble pigweed (Amaranthus albus). These results might aid in screening for effective alternate approaches for controlling dodder on alfalfa planted for seeds.

Fever in children: diagnosis and management by nurses, medical students, doctors and parents.

Thirty-six nurses, 18 final year medical students, 24 doctors and 36 parents were questioned about their understanding and management of the symptom "fever". There was an obvious tendency to over-diagnose fever by the nursing and medical staff. Antipyretics and sponging were unnecessarily prescribed. Most parents do not have a thermometer and have minimal understanding of fever and its management, and 37% regard fever as a cause of brain damage. Their main sources of information on the subject derive from relatives and friends: only 9% mentioned nurses or doctors as their source of information. Medical students receive little teaching on fever. It is recommended that more time should be devoted to teaching nurses, medical students and junior doctors about fever and they in turn should educate parents on the subject.