Community empowerment and mental wellbeing: longitudinal findings from a survey of people actively involved in the big local place-based initiative in England.

BACKGROUND: Community empowerment initiatives are receiving increased interest as ways of improving health and reducing health inequalities. PURPOSE: Longitudinally examine associations between collective control, social-cohesion and mental wellbeing amongst participants in the Big Local community empowerment initiative across 150 disadvantaged areas of England. METHODS: As part of the independent Communities in Control study, we analysed nested cohort survey data on mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale-SWEMWBS) and perceptions of collective control and social-cohesion. Data were obtained in 2016, 2018 and 2020 for 217 residents involved in the 150 Big Local areas in England. Adjusted linear mixed effect models were utilized to examine changes in SWEMWBS over the three waves. Subgroup analysis by gender and educational level was conducted. RESULTS: There was a significant 1.46 (0.14, 2.77) unit increase in mental wellbeing score at wave 2 (2018) but not in wave 3 (2020) (0.06 [-1.41, 1.53]). Across all waves, collective control was associated with a significantly higher mental wellbeing score (3.36 [1.51, 5.21]) as was social cohesion (1.09 [0.19, 2.00]). Higher educated participants (1.99 [0.14, 3.84]) and men (2.41 [0.55, 4.28]) experienced significant increases in mental wellbeing in 2018, but lower educated participants and women did not. CONCLUSION: Collective control and social cohesion are associated with better mental wellbeing amongst residents engaged with the Big Local initiative. These health benefits were greater amongst men and participants from higher educational backgrounds. This suggests that additional care must be taken in future interventions to ensure that benefits are distributed equally.

Collective control, social cohesion and health and well-being: baseline survey results from the communities in control study in England.

BACKGROUND: Area-based initiatives (ABIs) are receiving renewed interest as a part of the 'place-based public health' approaches to reducing health inequalities. PURPOSE: Examine associations between collective control, social cohesion and health amongst residents involved in the Big Local (BL) ABI. METHODS: Survey data on general health, mental well-being, perceptions of individual and collective control and social cohesion was obtained in 2016 for 1600 residents involved in the 150 BL ABI areas in England, and 862 responded-a response rate of >50%. Adjusted mean differences and adjusted odds ratios (ORs) were calculated using random effect linear and generalized estimating equation models. Subgroup analysis by gender and educational level was conducted. RESULTS: Mental well-being was positively associated with collective control (mean difference: 3.06 units, 1.23-4.90) and some measures of social cohesion ('people in the area are willing to help each other' [mean difference: 1.77 units, 0.75-2.78]). General health was positively associated with other measures of social cohesion (area-belonging [OR: 4.25, 2.26-7.97]). CONCLUSIONS: Collective control and some aspects of social cohesion were positively associated with better mental well-being and self-rated health amongst residents involved with BL. These positive associations were often greater amongst women and participants with a lower education. Increasing the collective control residents have in ABIs could improve the health effects of ABIs.

Risk factors for non-communicable diseases related to obesity among first- and second-generation Bangladeshi migrants living in north-east or south-east England.

BACKGROUND: Obesity is a global burden, which significantly increases the risk of non-communicable diseases (NCDs). More than a quarter of adults in the United Kingdom are obese, but prevalence varies by ethnicity, and South Asians have the largest burden of NCDs. This paper assesses how sex, generation, and region interplay to vary the predisposition to obesity-related (OR) NCDs among UK Bangladeshis. METHODS: We used National Institute for Health and Care Excellence suggested grading for combining body mass index and waist circumference to define populations at risk of OR-NCDs. Data from 517 adults of Bangladeshi origin from a cross-sectional study (March 2013 to April 2015) were analysed. Male and female participants from London and north-east England were equally sampled including: (1) adult migrants, who came to the UK aged >16 years; (2) child migrants, who came to the UK aged ≤16 years; and (3) second-generation Bangladeshis (who were born and brought up in the UK). A generalised estimating equation using a binomial distribution and a logit link was used to explore the relationship between the binary outcome of being 'at risk of OR-NCDs' and associated factors. RESULTS: Females, married individuals, those living in London, the second-generation, and those of lower self-assessed financial status, with low acculturation status, or who did not walk daily for at least 20 min were more likely to develop OR-NCDs. A striking sex difference was found with more females prone to OR-NCD risk in the north-east than in London. CONCLUSIONS: Our study observed important inter- and intra-regional inequality in OR-NCD risk which worsens the health of ethnic minorities and widens inequality.

Comparative efficacy of ivermectin and Nigella sativa against helminths in Aseel chickens (Gallus gallus domesticus).

In this study, we evaluated the in vivo comparative efficacy of ivermectin and Nigella sativa extract against helminths in Aseel chickens, and the effects of helminths on blood parameters before and after treatment in Aseel chickens. Forty naturally infected adult Aseel chickens were randomly divided into four groups (n = 10 each): group A (ivermectin at 300 µg/kg); group B (N. sativa extract at 200 mg/kg); group C (ivermectin at 300 µg/kg + N. sativa extract at 200 mg/kg); group D was kept as a positive control to monitor time-related changes. On day 28 post treatment, the mean percentages of faecal egg-count reduction (FECR %) in groups A, B and C were recorded as 93.58, 88.09 and 100.00%, respectively. Further data analysis showed significantly higher efficacy in group C (100 ± 0.00%) than in groups A and B (P < 0.001). Highly significant (P < 0.001) improvements in mean percentage values of packed cell volume (PCV %) were recorded in groups A and C on days 14 and 28 post treatment. Meanwhile, the improvements in mean values of haemoglobin (Hb) concentration in groups A, B and C were highly significant (P < 0.001) when compared to that of group D on day 28 post treatment. The synergistic combination of ivermectin and N. sativa extract possessed greater efficacy than either ivermectin or N. sativa extract used alone. Furthermore, both PCV % and Hb concentration values gradually increased in the treated groups compared to the control group, in which PCV % and Hb concentration gradually decreased throughout the trial.

Phylogeny and comparative modeling of phytochelatin synthase from Chlorella sp. as an efficient bioagent for detoxification of heavy metals.

Phytochelatins (PCs) found extensively in algae and plants are important for detoxification of heavy metals from soil and wastewater, and their synthesis is mediated by an enzyme phytochelatin synthase (PCS). In this study, a phylogram was generated to study evolutionary relationships of PCS from various organisms. It was revealed that PCS from green algae and plants are orthologs as both have evolved from a common ancestor. PCS from cyanobacteria appeared in two different clades showing that they have followed different lineages during evolution. Structural modeling was also carried out by building a 3D model of PCS from Chlorella variabilis using software Modeller v9.16. The predicted structure will be helpful for protein engineering strategies and to understand its interactions with other proteins. The biological biosorption capacity of Chlorella vulgaris (a green alga) was determined to remove Cd, Cu and Pb from industrial effluents. The biosorption of three heavy metals from industrial waste water was investigated under various conditions like pH, biomass concentration, contact time and temperature. Bio-removal of heavy metals was carried out by exposing culture of C. vulgaris to water samples of different heavy metal concentrations. The decrease in Cd, Cu and Pb quantities after 1 to 7 days of incubation period were 83%, 84% and 82.5%, respectively. In view of this, Chlorella spp. could be used on a large scale to detoxify heavy metals and clean up contaminated environments.

Morphokinetic analysis of human embryo development and its relationship to the female age: a retrospective time-lapse imaging study.

Time-lapse imaging technique has provided embryologists with a unique chance of studying the embryo morphokineticsto select the most viable embryos for implantation in the field of IVF (In vitro fertilization).The conventional method of morphological evaluations has proved that maternal age affects the human embryo quality. This retrospective study carried out at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan mainly focuses on the effect of female age on human embryo morphokinetics. A total number of 200 patients undergoing ICSI treatment cycles at the clinic were selected for the study and divided into five age groups (< 26, 26-30, 31-35, 36-40, and > 40 years). Embryo culture was done at 37°C, 6% CO2 and 5% oxygen for 5-6 days. Ten time-points were selected for kinetic analysis. The number of retrieved, matured, fertilized and cleaved oocytes showed highly significant difference (P≤ 0.0001) when compared among different age groups. There was no significant difference in average morphokinetic time-points among young versus old women.Whereas timely cleaved embryos showed significant difference in tPNa i.e. time for pronuclear appearance (P≤ 0.001), t4 and t5 i.e. time for 4 and 5-cell cleavage (P≤ 0.05)among different age groups. The clinical pregnancy rates showed a decline with increasing age. These results indicate the effect of female age on time-lapse embryo morphokinetic parameters. In future the addition of time-lapse analysis in routine IVF can help to improve the success rate by selecting the most viable embryos for uterine transfer.

Effect of acetaminophen on sulfamethazine acetylation in male volunteers.

The effect of acetaminophen on sulfamethazine N-acetylation by human N-acetyltrasferase-2 (NAT2) was studied in 19 (n=19) healthy male volunteers in two different phases. In the first phase of the study the volunteers were given an oral dose of sulfamethazine 500 mg alone and blood and urine samples were collected. After the 10-day washout period the same selected volunteers were again administered sulfamethazine 500 mg along with 1000 mg acetaminophen. The acetylation of sulfamethazine by human NAT2 in both phases with and without acetaminophen was determined by HPLC to establish their respective phenotypes. In conclusion obtained statistics of present study revealed that acetaminophen significantly (P<0.0001) decreased sulfamethazine acetylation in plasma of both slow and fast acetylator male volunteers. A highly significant (P<0.0001) decrease in plasma-free and total sulfamethazine concentration was also observed when acetaminophen was co-administered. Urine acetylation status in both phases of the study was found not to be in complete concordance with that of plasma. Acetaminophen significantly (P<0.0001) increased the acetyl, free and total sulfamethazine concentration in urine of both slow and fast acetylators. Urine acetylation analysis has not been found to be a suitable approach for phenotypic studies.

Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

The MURCS Association: Mullerian Duct Aplasia, Renal Hypoplasia and Cervicothoracic Somite Dysplasia - A Case Report.

We report on a 22 years old lady with aplasia of uterus and most of the vagina with normal secondary sexual characteristics, unilateral renal hypoplasia and anomalies of cervico throacic somites (MURCS Association), growth retardation, cardiac defect and congenital urethrovaginal fistula. Although there is a broad spectrum of anomalies described with MURCS association genitourinary fistula is not yet reported and reviewed in published articles. The relevance of this paper is to show the importance of further investigation in cases of primary amenorrhoea with mullerian agenesis to establish that the patient has MURCS association and not simply MRKH (Mayer Rokitansky-Kusterhauser Syndrome) syndrome. Consequently we should provide guidance to the patients and their families about the best way to conduct the case including genetic counseling and family screening.

Metabolic risk factor-profile in patients on treatment with second generation antipsychotics.

The second generation antipsychotic agents, although exhibit superior safety profile, is associated with metabolic adverse effects including weight gain, diabetes mellitus and hyperlipidaemia. These adverse effects are not only the risk factors for cardiovascular disease and diabetes mellitus but may also impair patient's adherence to treatment. However, different member of second generation antipsychotics differ. in their extent of metabolic adverse effects. The aim of the study was to evaluate the association between olanzapine, risperidone or quetiapine treatment and body mass index, blood pressure, diabetes mellitus and hyperlipidaemia in patients with Schizophrenia and Bipolar Disorder. Forty-four cases of Schizophrenia and Bipolar Disorder diagnosed with DSM-IV criteria were selected according to inclusion and exclusion criteria. Body weight, body mass index and blood pressure were measured at baseline, at the end of 4th, 8th and 12th weeks of treatment. Blood samples were collected to measure blood glucose and serum lipid profile at baseline and at the end of 4th, 8th and 12th weeks in the study group receiving treatment (olanzapine 20-30 mg/day, risperidone 4-16 mg/day and quetiapine 300-800 mg/day) after overnight fasting. Therapeutic use of olanzapine and risperidone in Schizophrenia and Bipolar Disorder for a period of 4th, 8th and 12th weeks was associated with significant increase in body weight and body mass index. Quetiapine did not cause significant changes in body weight and body mass index after 4 and 8 weeks. However, after 12 weeks treatment, body mass index increased significantly. Olanzapine, risperidone and quetiapine increased the blood glucose level significantly after 8 and 12 weeks treatment. Olanzapine and risperidone elevated the serum cholesterol, triglyceride and low density lipoprotein levels significantly after 4, 8 and 12 weeks. But quetiapine showed no significant change in lipid profile. However, olanzapine and risperidone significantly increased triglyceride level after 8 and 12 weeks. Amongst three drugs, quetiapine treatment increased high density lipoprotein level. Our study revealed that quetiapine treatment is associated with less risk of dyslipidaemia.

Second trimester sonographic features of fetal chromosomal defects.

Advances in ultrasound technology have dramatically improved the detection of fetal chromosomal defects. Each chromosomal defect has its own syndromal pattern of detectable abnormalities prenataly. Most commonly detectable defects are Trisomies & Triploidies. Although only an invasive test can provide a definitive diagnosis, fetuses with major chromosomal abnormalities have either external or internal defects that can be recognized by detailed ultrasonographic examination at second trimester. These are defined as ultrasound markers for fetal aneuploidy. This article provides an overview and discussion on prenatal sonographic features that may suggest the presence of a common fetal chromosomal defect.

Modulation of oxidative stress by enalapril and valsartan in adrenaline treated rats: a comparative study.

Angiotensin (Ang II) II is known to promote oxidative stress in acute myocardial infarction (AMI). Inhibition of renin angiotensin system (RAS) or blockade of Ang II receptors may therefore be effective in reducing oxidative stress during AMI. The study evaluates and compares the protective effect of Angiotensin Converting Enzyme (ACE) inhibitor and AT1 receptor blocker in adrenaline induced oxidative stress in rats. Rats were treated with two successive injections of adrenaline subcutaneously at a dose of 2 mg/kg administered 24 hours apart. In other two groups of rats enalapril (30 mg/kg) or valsartan (30 mg/kg) were given orally once daily through intragastric tube for 2 weeks and then two injections of adrenaline were administered 24 hours apart. Serum Aspertate Transaminase (AST), plasma Malonde Aldehyde (MDA), erythrocyte GSH and serum vitamin E levels were measured 24 hours after the 2nd injection of adrenaline in all the groups. Administration of adrenaline caused significant increase (p < 0.001) in serum AST and plasma MDA levels and decrease (p < 0.001) in erythrocyte GSH and serum vitamin E levels. Pre-treatment of enalapril or valsartan for 14 days reduced (p < 0.001) serum AST and plasma MDA levels and increased the concentration of erythrocyte GSH in enalapril pre-treated group (p < 0.01) and in valsartan pre-treated group (p < 0.05). Pre-treatment of enalapril or valsartan also increased (p < 0.01) serum vitamin E levels in adrenaline treated rats. However, no significant difference was noted between the effect of enalapril and valsartan on serum AST, plasma MDA, erythrocyte GSH and serum vitamin E levels. It may be concluded that both enalapril and valsartan offered cardioprotection in adrenaline induced oxidative stress, but the protection afforded by valsartan was not superior to enalapril.

Study on oxidative stress and antioxidant level in patients of acute myocardial infarction before and after regular treatment.

In acute myocardial infarction (AMI), lack of oxygen delivery to myocardium leads to generation of reactive oxygen species (ROS) which play an important role in the pathogenesis of AMI. Endogenous anti-oxidants protect the myocardial tissues from the deleterious effect of free radical mediate injury. The study evaluates the extent of oxidative stress and antioxidant status against ROS in AMI patients and amelioration of oxidative stress after regular treatment and also assesses the association between oxidative stress and risk factors for atherosclerosis like dyslipidemia and diabetes mellitus (DM). The study was conducted on 72 AMI patients and age and sex matched 18 healthy controls. Patients were assigned to four groups, AMI without dyslipidemia or DM, with dyslipidemia, with DM and with both dyslipidemia and DM. Plasma malondialdehyde (MDA) and GSH content and vitamin E levels were determined on admission into hospital and on the 5th day of treatment. Plasma MDA level increased significantly (p < 0.001) and erythrocyte GSH and plasma vitamin E levels were decreased (p < 0.001) in all the groups of patients as compared to control. On the 50th day of regular treatment MDA level reduced (p < 0.001) and GSH and vitamin E levels increased (p < 0.001) in patients. The plasma MDA level was significantly higher (p < 0.001) in patients with both dyslipidemia and DM or with only DM in comparison to patients without dyslipidemia and DM. The difference in the GSH level between patients with risk factors and without risk factors was not significant. It may be conclude that an imbalance exists between oxidant and antioxidant molecules in AMI patients which shift towards oxidative side and regular treatment restores this balance. There may be some association between oxidative stress in AMI and risk factors like dyslipidemia and diabetes mellitus.

Cardiovascular Risk Scoring of Hospitalized Chronic Kidney Disease Patients by Framingham Risk Score.

Patients with chronic kidney disease (CKD) are more likely to have complications due to cardiovascular diseases (CVD). This cross sectional descriptive study was conducted in the Department of Medicine and Nephrology, Chittagong Medical College (CMC), Chittagong, Bangladesh from June to December, 2014 and was performed to estimate the risk of cardiovascular events according to Framingham's Risk Score of CKD patients. In this research, 100 patients who was diagnosed as CKD and admitted in the Chittagong Medical College Hospital were enrolled. Estimated glomerular filtration rate (eGFR) was calculated with the MDRD formula. Cardiovascular risk factors were analyzed by Framinghams criteria and after compilation data were analyzed by SPSS-18.0. Among 100 patients, most of patients were under 60 years of age where males (56.0%) were more than females (44.0%). Framingham Cardiovascular Risk Score revealed that most of the male were at high risk group compared to female. Regarding different components of lipid profile with Framingham risk score, higher risk group had high mean total cholesterol (212.17mg/dl) and also low mean HDL level (38.58mg/dl). Patient with different stages of CKD with cardiovascular risk showed stage 5 CKD was 80%, stage 4 was 15.0% and rest 5 was at stage 3 and most were in low risk group (56.0%). There were significant positive correlations found in between age and serum total cholesterol level with the cardiovascular risk scoring but not with HDL and eGFR. The predominant cardiovascular risk factors were age, male gender, smoking and high serum total cholesterol.

Successful pregnancy outcome with coexisting primary epithelial ovarian carcinoma.

Maternal epithelial ovarian cancer (EOC) is rare. EOC is reported to occur in 1:12,000 to 1:50,000 pregnancies. We report a case of Stage IA epithelial ovarian cancer detected in the first trimester managed by laparotomy at 13 weeks followed by left sided salpingo-oophorectomy and infra-colic omentectomy. Histopathology revealed papillary mucinous cystadenocarcinoma (well differentiated with negative peritoneal cytology for malignancy). Chemotherapy was not warranted due to early stage disease and she had an uneventful gestation ending in vaginal delivery of a 2.5 kilogram male baby at term. During the period of follow up she developed no clinical or biochemical evidence of tumour recurrence or relapse.

Pregnancy in sick sinus syndrome with pacemaker - two cases.

Sick sinus syndrome is a generalized abnormality of cardiac impulse formation that may be caused by extrinsic causes or by intrinsic disease of the sinus node making it unable to perform pace making function. It can be manifested for the first time in pregnancy. First case was diagnosed as sick sinus syndrome at 8 weeks of gestation having Mobitz type I heart block (Wenckebach block), and needed temporary pacemaker during caesarean section. Second case was diagnosed at 24 weeks of gestation having complete heart block and needed permanent pacemaker at 38 weeks of gestation due to exaggeration of the symptoms. Both the cases were dealt successfully by caesarean section under general anesthesia in close collaboration with cardiologists and anesthesiologists.

Antibacterial Effects of Chloroform Henna (Lawsonia inermis) Leaf Extracts against Two Nosocomial Infection Causing Pathogens: Gram-positive Staphylococcus aureus and Gram-negative Klebsiella pneumoniae: A Comparative Study.

Evaluation of the in vitro antibacterial activity of Chloroform extracts isolated from Henna (Lawsonia inermis) leaf against two nosocomial infection causing pathogens, gram-positive Staphylococcus aureus and gram-negative Klebsiella pneumoniae. This interventional study was carried out for the period of January 2021 to December 2021 in the Department of Pharmacology and Therapeutics in collaboration with the Department of Microbiology, Mymensingh Medical College, Bangladesh. The antibacterial activity was tested at different concentrations of Chloroform Henna leaf extracts by using disc diffusion and broth dilution method. The extract was prepared by using solvents chloroform and 0.1% Dimethyl sulfoxide (DMSO). The test microorganisms were also tested for their activity against a standard antibiotic Ciprofloxacin by broth dilution method and the result was compared with that of Chloroform extracts. Chloroform Henna Extracts (CHE) were used initially in nine different concentrations (2.5, 5, 10, 20, 50, 100, 200, 500 and 1000 mg/ml). Among different concentrations of the CHE, 100mg/ml and above concentrations showed inhibitory effect against Staphylococcus aureus and Klebsiella pneumoniae. The MIC for Staphylococcus aureus and Klebsiella pneumoniae were 100 and 200mg/ml in CHE respectively. The MIC of Ciprofloxacin was 1µg/ml against Staphylococcus aureus and 1.5µg/ml against Klebsiella pneumoniae. The MIC of Ciprofloxacin was the lowest in comparison to MICs of CHE for the test organisms. This study showed that Chloroform Henna extracts demonstrated antibacterial effects against food borne pathogens. It is clearly observed that there is definite antibacterial effect of the Chloroform extract of Henna leaves (Lawsonia inermis) against Staphylococcus aureus and Klebsiella pneumoniae.

Successful pregnancy in a woman after repair of bladder exstrophy.

Exstrophy of bladder is a rare congenital anomaly. Pregnancy following surgical correction of bladder exstrophy occurred in this woman. Improved techniques in urinary diversion operation have enabled a large number of patients with bladder exstrophy to achieve urinary control. They can live fairly normal lives and some have achieved pregnancy. Case reports of such exist in the literature. The present case is based on the experience of a 28 years old lady who had successful pregnancy and delivery following curative repair of this defect one and a half year ago. A living healthy male baby was delivered by elective cesarean section.

Experience of early breast milk feeding in preterm very low birth weight infants.

Although human milk is generally accepted as the gold standard for the feeding of term infants, its use in the preterm and very low birth weight (VLBW) infants particularly in the initial period of birth has been more controversial. Little is known about the risks and benefits of early introduction of breast feeding on preterm VLBW infants. The primary object of this study was to evaluate the safety and benefit of early breast milk feeding in preterm VLBW newborns during their initial hospitalization periods. Therefore a prospective observational study was conducted among 37 preterm VLBW infants who were admitted to the Neonatal ward of Sir Salimullah Medical College and Mitford Hospital during the period of February 15th to July 25th, 2003. Oral feeding with breast milk was started within one hour of birth, and weight gain, feeding tolerance, nosocomial infection rate as well as other associated problems of pre-maturity, and postnatal growth curve were recorded upto 16th postnatal day. Seventy three percent of the newborns tolerate breast milk well from the very beginning, and the rest did not tolerate initially but all of them tolerate within 24 hours of birth. Infants had less initial weight loss (20 ± 10 gm) and faster recovery of birth weight. They regained their birth weight at 12th postnatal day. Hyper-bilirubinaemia was found in only 22% cases, and was observed in the group who initially didn't tolerate breast milk and was on intravenous fluid. Nobody developed symptomatic hypoglycemia or necrotizing enterocolitis (NEC). Two cases of sepsis and another two cases of minor infection like conjunctivitis and oral thrush have occurred. In conclusion it can be said that early breast milk feeding is safe in preterm VLBW infants and it helps to promote growth and reduce the need for intravenous line.

Clinical and angiographic profile of congenital anomalous origin of coronary arteries.

Coronary artery anomalies were found in 24(0.6%) patients undergoing coronary arteriography at University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka from 2004 to 2007. Of the 24 patient, 21(87.5%) had anomalies of origin and distribution and 3(12.5%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms or complications and usually were discovered as an incidental finding at the time of catheterization. Most of them were benign anomalies: i) separate origin of left anterior descending and circumflex from sinus of valsalva; ii) ectopic origin of circumflex from right sinus of valsalva; iii) Anomalous origin of left main coronary artery from right coronary artery; iv) anomalous coronary origin from ascending aorta; v) absent left circumflex; vi) double right coronary artery; vii) small coronary artery fistula. These anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. In this study large coronary artery fistula was found as potentially serious anomaly. So coronary artery anomalies require accurate recognition for the appropriate management of the patients.