Arsenic-Induced Cardiovascular Diseases and their Correlation with Mitochondrial DNA Copy Number, Deletion, and Telomere Length in Bangladeshi Population.

Arsenic contamination is a global health concern, primarily through contaminated groundwater and its entry into the food chain. The association between arsenic exposure and cardiovascular diseases (CVDs) is particularly alarming due to CVDs being the leading cause of death worldwide. Arsenic exposure has also been linked to changes in telomere length, mitochondrial DNA copy number (mtDNAcn), and deletion, further increasing the risk of CVDs. We aimed to determine whether arsenic exposure alters telomere length and mtDNAcn and deletion in a total of 50 CVD patients who underwent open heart surgery hailed from known arsenic-affected and unaffected areas in Bangladesh. Amount of arsenic was determined from the collected nails and cardiac tissues. Relative telomere length and mtDNAcn and deletion were quantified by qRT-PCR. The patients from arsenic-contaminated areas had higher average arsenic deposits in their fingers and toenails (P < 0.05) and higher cardiac tissue injury scores (P < 0.05). Moreover, approximately 1.5-fold shorter telomere length (P < 0.05, r = - 0.775), 1.2-fold decreased mtDNAcn (P < 0.05, r = - 0.797), and an 81-fold higher amount of mitochondrial DNA deletion (P < 0.05, r = 0.784) were observed in the patients who had higher arsenic deposition in their nails. Higher levels of arsenic exposure were found to be linked to shorter telomere length, decreased mtDNAcn, and increased mitochondrial DNA deletion in the patients from As-affected areas. It can also be anticipated that the correlation of arsenic exposure with telomere length, mtDNAcn, and deletion can be used as biomarkers for early diagnosis of arsenic-induced cardiovascular diseases.

Four Decades of Cardiac Surgery in Bangladesh: A Noble Journey That Started with the Help of Japan.

The first-ever open-heart operation in Bangladesh was performed on the 18th of September 1981. Although a few cases of finger fracture closed mitral commissurotomies were performed in the country in the 1960s and 1970s, full-fledged cardiac surgical services began only in Bangladesh after the establishment of the Institute of Cardiovascular Diseases at Dhaka in 1978. A Japanese team that includes cardiac surgeons, anesthetists, cardiologists, nurses, and technician came to Bangladesh and played an important role in the initiation of such a Bangladeshi endeavor. Bangladesh is a South Asian country with more than 170 million people living only in an area of 148460 square kilometers. Information was sought from the hospital records, old newspapers, books, and memoirs written by some of the pioneers. Pubmed and Internet search engines were also utilized. The principal author had personal correspondence with the available pioneering team members. The first open-heart operation was performed by visiting Japanese surgeon Dr. Komei Saji along with Bangladeshi surgeon duo Prof. M Nabi Alam Khan and Prof. S R Khan. Since then, cardiac surgery in Bangladesh has made a significant progress although it may not be enough to serve 170 million people. In 2019, twenty-nine centers performed a total of 12926 cases in Bangladesh. Remarkable advancement in cardiac surgery has been made in terms of cost, quality, and excellence in Bangladesh, but the country is lagging behind in the number of operations, affordability, and geographical distribution, which needs to be addressed for a better future.

Global geographical discrepancy in numerical distribution of cardiovascular surgeries and human resource development in South Asia.

Objective: The region South Asia is in the south-central part of the Asian continent. The 8 countries of the area, Afghanistan, Bangladesh, Bhutan, India, Nepal, The Maldives, Pakistan, and Sri Lanka collectively possess 1.8 billion people living in 5.1 million square miles. Covering 2.96% of World's surface, this area is inhabited by 23.9% of the world population. The objective of this study was to observe the number of cardiac operations in South Asia and the human resource development facilities of cardiac surgery in the region. Methods: Information was collected from the surgeons and anesthetists through personal visits, phone calls, and emails. The websites of various organizations were also checked. Results: The estimated number of cardiac operations collectively performed in the South Asian countries was between 250,000 and 300,000 as of 2019. With more than 6 times the US population, these nations combined performed less than half of the annual number of cardiac operations performed in the United States. The number of operations per million population ranged from 62 to 271 in different countries. This indicates that there should be more capacity-building of surgeons to meet the growing demand of operations. India, Pakistan, Bangladesh, Sri Lanka, and Nepal have their own education and training systems for cardiovascular surgeons. A substantial portion of the seats available for cardiovascular surgery courses remained vacant in South Asia these days. Conclusions: Five countries have their various surgical education and training programs. There should be coordinated efforts to increase the production of new cardiac surgeons in the region.

Surgical Treatment of Atrial Myxomas: Outstanding Outcome of a Treacherous Tumor.

BACKGROUND: Primary cardiac tumors are quite rare and mostly benign in nature. Most of the benign heart tumors are myxomas. These might present with a wide range of symptoms from being completely asymptomatic to having life-threatening complications like stroke, heart failure, or even sudden death. This study summarizes our 6-year clinical experience with surgical resection of cardiac tumors at Chittagong Medical College and Hospital, Chattogram, Bangladesh. METHODS: Twenty patients who underwent surgical excision of primary intracardiac myxoma between February 2014 and February 2020 were included in the study. Seventeen (85%) of them were female and 3 (15%) were male. Mean age was 43.4 ± 14.1 years. The tumors were located in the left atrium in 19 patients and in 1 patient it was in the right atrium. The most common attachment site was the interatrial septum. Most of the patients presented with dyspnea. Preoperative diagnosis was established using transthoracic echocardiography with colour Doppler. Surgery for all patients was via median sternotomy. RESULTS: All 20 patients survived the surgery. Mean tumor dimension was 4.6 ± 3.5 cm in the longest diameter. Solid tumors were detected in 13 patients (65%) whereas papillary myxomas were found in 7 patients (35%). On follow-up of these 20 patients, there was no perioperative death. One patient presented with recurrence 28 months after the surgery. CONCLUSIONS: Although cardiac myxomas carry the risk of serious systemic and cardiac symptoms, prompt surgical excision gives excellent outcome.

INTRODUCTION: Les tumeurs cardiaques primitives sont assez rares et pour la plupart bénignes par nature. La plupart des tumeurs cardiaques bénignes sont des myxomes, qui pourraient se manifester sous diverses formes allant de l'absence complète de symptômes à des complications mettant la vie en danger telles que les accidents vasculaires cérébraux, l'insuffisance cardiaque, voire la mort subite. La présente étude résume les six années d'expérience clinique en résection chirurgicale de tumeurs cardiaques au Chittagong Medical College and Hospital, Chattogram, Bangladesh. MÉTHODES: Vingt patients qui avaient subi une excision chirurgicale d'un myxome intracardiaque primitif entre février 2014 et février 2020 ont fait partie de l'étude. Dix-sept (85 %) étaient des femmes, et trois (15 %), des hommes. L'âge moyen était de 43,4 ± 14,1 ans. Dix-neuf patients avaient une tumeur située dans l'atrium gauche, et un patient avait une tumeur située dans l'atrium droit. Le site de fixation le plus fréquent était le septum interauriculaire. La plupart des patients accusaient une dyspnée. Le diagnostic préopératoire était établi par échocardiographie Doppler couleur transthoracique. Tous les patients opérés ont subi une sternotomie médiane. RÉSULTATS: Les 20 patients ont survécu à l'intervention chirurgicale. La dimension moyenne de la tumeur était de 4,6 ± 3,5 cm dans le plus grand diamètre. Treize (65 %) patients avaient des tumeurs solides, et sept (35 %) patients, des myxomes papillaires. Aucun décès périopératoire n'a été observé durant le suivi de ces 20 patients. Un patient a eu une récidive 28 mois après l'intervention chirurgicale. CONCLUSIONS: Bien que les myxomes cardiaques comportent un risque de symptômes systémiques et cardiaques sérieux, l'excision chirurgicale rapide apporte d'excellents résultats.

Association of arsenic-induced cardiovascular disease susceptibility with genetic polymorphisms.

Inorganic arsenic (iAs) exposure has been reported to have an impact on cardiovascular diseases (CVD). However, there is not much known about the cardiac tissue injury of CVD patients in relation to iAs exposure and potential role of single nucleotide polymorphisms (SNPs) of genes related to iAs metabolism, oxidative stress, endothelial dysfunction and inflammation which may play important roles in such CVD cases. In this dual center cross-sectional study, based on the exclusion and inclusion criteria, we have recruited 50 patients out of 270, who came from known arsenic-affected and- unaffected areas of mainly Chittagong, Dhaka and Rajshahi divisions of Bangladesh and underwent open-heart surgery at the selected centers during July 2017 to June 2018. We found that the patients from arsenic affected areas contained significantly higher average iAs concentrations in their urine (6.72 ± 0.54 ppb, P = 0.028), nail (529.29 ± 38.76 ppb, P < 0.05) and cardiac tissue (4.83 ± 0.50 ppb, P < 0.05) samples. Patients' age, sex, BMI, hypertension and diabetes status adjusted analysis showed that patients from arsenic-affected areas had significantly higher iAs concentration in cardiac tissue (2.854, 95%CI 1.017-8.012, P = 0.046) reflecting higher cardiac tissue injury among them (1.831, 95%CI 1.032-3.249, P = 0.039), which in turn allowed the analysis to assume that the iAs exposure have played a vital role in patients' disease condition. Adjusted analysis showed significant association between urinary iAs concentration with AA (P = 0.012) and AG (P = 0.034) genotypes and cardiac iAs concentration with AA (P = 0.017) genotype of AS3MT rs10748835. The AG genotype of AS3MT rs10748835 (13.333 95%CI 1.280-138.845, P = 0.013), AA genotype of NOS3 rs3918181 (25.333 95%CI 2.065-310.757, P = 0.002), GG genotype of ICAM1 rs281432 (12.000 95%CI 1.325-108.674, P = 0.010) and AA genotype of SOD2 rs2758331 (13.333 95%CI 1.280-138.845, P = 0.013) were found significantly associated with CVD patients from arsenic-affected areas. Again, adjusted analysis showed significant association of AA genotype of AS3MT rs10748835 with CVD patients from arsenic affected areas. In comparison to the reference genotypes of the selected SNPs, AA of AS3MT 10748835, AG of NOS3 rs3918181 and AC of rs3918188, GG of ICAM1 rs281432, TT of VCAM1 rs3176867, AA of SOD2 rs2758331 and GT of APOE rs405509 significantly increased odds of cardiac tissue injury of CVD patients from arsenic affected areas. The results showed that the selected SNPs played a susceptibility role towards cardiac tissue iAs concentration and injury among CVD patients from iAs affected areas.

Know thy neighbors: The status of cardiac surgery in the South Asian countries around India.

OBJECTIVES: The South Asian neighboring countries of India include Bangladesh, Bhutan, Nepal, The Maldives, Pakistan and Sri Lanka. Interestingly all these countries possess either a land or a sea border with India and no border among themselves. These countries have historic, cultural, ethnic and genetic links with India. The paper describes the developmental history and current status of cardiac surgery in these countries. METHODS: Thorough search of the printed and electronic materials has been made. The authors visited all these countries and contacted the eminent surgeons personally or through mails. All the information is cross-checked and compiled. Record keeping is not well organized in most of these countries. Best information often came from unusual sources like Anesthetists' society or the corporate houses. RESULTS: Four of these countries Bangladesh, Nepal, Pakistan and Sri Lanka have their cardiac surgical programs. Collectively they perform around 38000 cardiac operations a year which is a quarter of the cases performed in India. These countries are important sources of medical tourism in India which is worth 3 billion US$ of business annually. CONCLUSION: When the number of operations per million populations is considered, Bangladesh and Nepal are lagging behind India where as Pakistan has a comparable figure. Sri Lanka with 265 cardiac operations/million populations has the best figures in the region. However when compared with the Western countries even the Lankan figures also look quite inadequate.

The Early Days of Cardiac Surgery in South Asia: The History and Heritage.

The 1.79 billion people of South Asia share common history and heritage. The fascinating stories of introducing cardiac surgery in this region would inspire the surgeons today. Information was collected for more than a decade from these countries through personal visits, interviews, and searching journals and the Internet. India was first to establish cardiac surgery chronologically, followed by Sri Lanka, Pakistan, Bangladesh, Nepal, and Afghanistan. South Asia did not lag far behind the Western world in commencing cardiac surgery. The pioneering surgeons deserve respect for their dedication and innovation overcoming the economic hardship and bureaucratic barriers ensuring service for one-quarter of the world's population today.