IntroductionTo evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3–35 months with suspected pneumonia in Sylhet, Bangladesh.MethodsEight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen’s kappa, and a prevalence and bias-adjusted kappa.ResultsAmong 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85).ConclusionPrimary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.

Sheehan's syndrome is a rare condition characterized by post-partal panhypopituitarism due to necrosis of adenohypophysis resulting from severe post-partum hemorrhage. Lethargy, amenorrhea and failure of lactation are the usual presenting features. Cardiac involvement in Sheehan's syndrome is rare. The case presented here describes dilated cardiomyopathy in a 36-year-old lady who failed to respond adequately to the standard anti-failure treatment. Further investigation revealed the diagnosis of Sheehan's syndrome. Besides other manifestations, cardiac function reverted to normal after giving replacement therapy with glucocorticoid, levothyroxine and sex hormone. Physicians, specially those in developing countries, should have high index of suspicion for the diagnosis of Sheehan's syndrome while dealing with a case of 'peripartal dilated cardiomyopathy'. Persistent amenorrhea and failure of lactation may be important clues in this context. Timely diagnosis and appropriate treatment can lessen the sufferings of the patients.

Ortner syndrome or cardiovocal syndrome is a rare condition characterized by hoarseness of voice associated with cardiovascular pathology. Compression of the left recurrent laryngeal nerve by the pulmonary artery or left atrium is usually responsible. Recurrent aspiration pneumonia may cause significant morbidity and mortality. Early recognition and treatment along with removal of the underlying cause, if possible, may change an otherwise poor prognosis of the condition. The case presented here describes a 35-year old female with hoarseness of voice in association with mitral stenosis and bronchiectasis. Presence of dual pathology contributed to the overall pathophysiology of the disease, and made its management difficult.

Cardiovascular diseases are the major causes of mortality and morbidity throughout the world. Treatment of these diseases is often incomplete, suboptimal and far from permanent cure. One of the reasons behind this is the nature of heart as a terminally differentiated organ. Preclinical and clinical research in the last few decades has put a challenge to this conventional belief regarding the inability of regeneration of the cardiomyocytes. Embryonic, foetal and a wide range of adult stem cells have been used so far. Differentiation of adult somatic cells has lead to breakthrough discovery of induced pleuripotent stem cells which may be a potential solution of controversy over embryonic stem cell issue. Stem cells specially those of bone marrow origin are already being used in a limited scale to treat acute myocardial infarction, chronic myocardial ischaemia and cardiomyopathy with efficacy, feasibility and safety. Mesenchymal stem cells and adult cardiac stem cells are on the way to bedside use. skeletal myoblasts have been associated with life-threatening ventricular arrhythmia. Stem cells combined with tissue engineering have produced prosthetic tissue valves, and hope for manufacturing whole heart ex vivo in near future. However, like other rapidly evolving modalities, there are more questions than answers. Exact indications, patient selection, cell selection, timing of therapy, efficacy of repeated therapies, co-administration of growth factors, and genetic modification of stem cells are yet to be determined with precision. International community is coming forward with enthusiasm and vigor to explore the enormous potential of stem cell therapy and regenerative medicine. Future research will hopefully facilitate more versatile application of stem cells in treating the life-threatening and disabling ailments of mankind. Keywords: Stem cell; regenerative medicine DOI: 10.3329/cardio.v3i1.6429Cardiovasc. j. 2010; 3(1): 66-80