Echocardiographic Assessment of Valvular Involvement in Chronic Rheumatic Heart Disease in BSMMU, Bangladesh.

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years especially in the developing county like Bangladesh. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of sub-clinical disease. It has a progressive course and patients usually may require valve repair/replacement in future. Echocardiography is an easily available, non-invasive, widely used, standard tool for diagnosis and evaluation of RHD. But there is scarcity of echocardiographic study of Valvular Involvement in Chronic Rheumatic Heart Disease (CHRD) in Bangladesh. This study was aimed to utilize echocardiography as a tool to evaluate patients of CRHD in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This observational study was conducted in the Department of Cardiology, BSMMU from September 2018 to August 2019. Echocardiography was done in each patient only once with VividE9®machine. Among 1350 echocardiography, 101 patients (7.5%) were diagnosed as RHD including post valve replacement patients. The mean age of the patients was 40±14 years and 64.34% were female. Mitral stenosis (MS) was the commonest lesion in 84.15% followed by mitral regurgitation (MR) in 66.33%, tricuspid regurgitation (TR) in 57.43%, aortic regurgitation (AR) in 49.51%, aortic stenosis (AS) in 26.74% and pulmonary regurgitation in 10.89%. The frequency of complications like pulmonary hypertension, heart failure, atrial fibrillation (AF), LA thrombus, stroke and infective endocarditis was 67.33%, 61.05%, 18.81%, 6.93%, 3.96% and 0.99% respectively. History of Rheumatic fever was present only in 10.89% patient. Mitral stenosis was the commonest lesion seen mostly in female and most common complication was pulmonary hypertension. Mean age of patients in this study was higher than other contemporary studies and frequency as well as severity of complications was also more in female.

Assessment of the impacts of vehicular pollution on urban air quality.

Air quality crisis in cities is mainly due to vehicular emissions. Owing to the expanding economic base Indian cities are growing at a faster rate. Transportation systems are increasing everywhere and the improved technology is insufficient to counteract growth. The effect of vehicular emission on urban air quality and human health has been described. A survey has been conducted in an Indian mega city to evaluate the status of air pollution at traffic intersections and the unique problem arising out of vehicular emissions in the study area has been narrated. Approach for the selection of the air monitoring stations, methodology adopted for data collection and the results have been discussed. Vulnerability analysis (VA) has been carried out to identify the zones at what pollution stress. Options for reducing mobile source emission have been discussed and a strategic air quality management plan has been proposed to mitigate the air pollution in the city.

Improvement in pulsed wave Doppler echocardiographic assessment of pulmonary artery pressure.

Non invasive estimation of pulmonary artery pressure (PAP) is of paramount importance in various form of cardiac, respiratory and intensive care medicine practice. Using pressure gradient between different chambers enables a reliable estimation of PAP and are being largely practiced. In absence of these pressure gradient, various time interval or the ratios of pulmonary blood flow velocity curve (PBFVC) in pulsed wave doppler echocardiography (PWDE) can predict the PAP. But there is lack of general agreement as which parameter should be used. We hypothesized that using separate time interval or their ratios of PBFVC for different group of patient may improve the PWDE prediction of PAP. Forty-six consecutive patients with different cardiac diseases and 20 consecutive control persons underwent PWD echocardiographic examination. Pulmonary blood flow velocity curve derived time intervals--the time intervals--time to peak velocity (TPV), Pre-ejection period (PEP) and right ventricular ejection time (RVET) and their ratios were measured. The Doppler derived measurements were compared with cardiac catheterization (CC) measured PAP in 46 patients in whom CC were done. PBFVC derived time interval TPV and the ratio PEP/TPV correlated well with CC measured systolic PAP (r=-0.78 and r=0.77 respectively). For congenital left to right shunt disease the ratio PEP/TPV improved the prediction (r=-0.87) while the same measure showed weak correlation in patients with left sided heart disease. Only TPV could predict mean PAP in patients with left sided heart disease (r=-0.60). We concluded that the use of separate PBFVC derived time interval or their ratio from PWDE may improve the prediction of PAP with different pathological group of disease.