Background: Observational and small randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. Methods: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI) (99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary endpoints: all-cause death, cardiovascular death, MI, and stent thrombosis. Results: Due to the Covid-19 pandemic, the data safety and monitoring board decided to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across eight countries; 1290 assigned to influenza vaccine and 1281 to placebo. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72; 95% confidence interval, 0.52 to 0.99; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59; 0.39 to 0.89; P=0.010), of cardiovascular death 2.7% and 4.5%, (hazard ratio, 0.59; 0.39 to 0.90; P=0.014), and of MI 2.0% and 2.4% (hazard ratio, 0.86; 0.50 to 1.46, P=0.57) in the influenza vaccine and placebo groups, respectively. Conclusions: Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, as well as a lower risk of all-cause death and cardiovascular death at 12 months compared with placebo. Clinical Trial Registration: URL: http://www.clinicaltrials.gov Unique identifier: NCT02831608

Abstract:The study is conducted to find out the impact of foreign direct investment (FDI) on economic growth of Pakistan. Time series data is utilized which is comprises from 1981 to 2010, collected from the world data bank. Multiple regression technique is used in which gdp is dependent variable while foreign direct investment (FDI) and consumer price index (CPI) are independent variables. The result indicates that there is a positive relationship between the FDI and GDP and have a negative relationship with CPI. When FDI increase the GDP of Pakistan will positively affected by FDI.

Abstract:Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired)

Introduction: Cardiac myxoma is a benign neoplasm that represents the most common primary tumour of the heart. Because of nonspecific symptoms, early diagnosis may be a challenge. Although the left atrium is the most commonly involved site of origin in 75% of cases, it can arise from any of the cardiac chambers. Symptoms from a cardiac myxoma are more pronounced when the myxomas are left-sided, racemosus, and over 5 cm in diameter. Symptoms are produced by mechanical interference with cardiac function or embolization. Being intravascular and friable, myxomas account for most cases of tumor embolism. The site of embolism is dependent upon the location (left or right atrium) and the presence of an intracardiac shunt. Most atrial myxomas are benign and can be removed by surgical resection.Objectives: To see clinical presentation and echocardiographic profile of cardiac myoxomas.Methods: 90 cardiac myxoma patients who admitted both in cardiology and cardiac surgery departments of National Institute of Cardiovascular Diseases (NICVD), Dhaka from August 2003 to July, 2014 were studied clinically and by echocardiogram. Clinical histories were reviewed, noting age, gender, and clinical presentation.Results: There were 30 males and 60 females, ages ranged from 17 to 76 years. The commonest clinical feature was dyspnoea (94.44%), followed by palpitation (76.67%), chest discomfort (74.44%), constitutional symptoms (50%), pedal oedema (20%), syncope (14.44%), and embolization (7.7%). The mean duration of symptoms was 09.7 months.Conclusion: The clinical presentation of cardiac myxoma is often nonspecific, so high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.Bangladesh Heart Journal 2016; 31(1) : 18-22

Family adjustment to a new country plays a significant role in expatriate success. This paper investigates the reasons behind expatriate failure relative to personal characteristics of partner, family characteristics, and cultural distance. The authors discuss family related issues and contribute to the better understanding on the problems that cause expatriate failure through identity theory and investigate how organizations could support the expatriate experience by taking into consideration the role of the spouse and family, along with cultural distance to the expatriate destination. There are only a few studies that link experiences of expatriate family and partner to international assignment success. We add to this research by examining the spouse and family adjustment process through the use of identity theory. We provide guidelines on the impact of family adjustment in expatriation literature to help organizations better equip both the expatriate employee and their family with sufficient cross-cultural training and social learning opportunities. Our contribution provides a level of analysis on determining expatriation success factors and guiding organizations in facilitating the cultural adjustment of expatriates and their families. The paper provides implications to industry and practice on key success factors needed to reduce failure.

Abstract

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI).Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed.Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15).Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles.Cardiovasc. j. 2018; 10(2): 113-120

Background:Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater short-term adverse events than young men. There is a scarcity of data on the short-term adverse outcomes between young Bangladeshi males and females with ACS undergoing PCI.Objectives: This study was conducted to compare the short-term outcomes of PCI between young males and females presenting with ACS.Methods: This prospective observational study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD) fromApril 2016 to March 2017. 190 young patients with ACS and undergoing PCI were enrolled. They were equally divided into two groups, group I (young females <55 years) and group II (young males <45 years).Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively. Young women had significantly higher risk factors of hypertension (62.1% vs 33.7%, p<0.0010) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Overall, young women experienced significantly greater incidence of short-term adverse events in comparison to young men (14.7% vs. 6.3%, p=0.04) and had significantly higher rates of severe bleeding (6.3% vs 1.1%, p=0.04), vascular access site complications (8.4% vs 2.1%, p=0.04) and recurrent ischaemia at 30 days (7.4% vs. 2.1%, p=0.04). Major adverse cardiac events (MACE) were higher among young females, in comparison to young males (4.1% vs 2.1%, p=0.4). Young females experienced significantly higher rates of short-term net adverse clinical events (NACE) than young males (10.5% vs 3.2%, p=0.04). Female gender (odds ratio [OR] 11.7), diabetes (OR 2.5), hypertension (OR 1.78), decreased ejection fraction (OR 1.41) and smaller stent diameter (OR 1.15) were identified as independent predictors of adverse short-term outcomes among young ACS patients undergoing PCI.Conclusion: Young women experienced significantly more adverse short-term outcomes after PCI. They had significantly greater NACE, largely driven by increased rates of major bleeding. Female gender was an independent predictor of adverse short-term outcomes among young ACS patients undergoing PCI.Bangladesh Heart Journal 2018; 33(1) : 1-9