We conclude that WBITs continue to represent a leading cause of potential mistransfusions at our institution. Changes in nursing (two witnesses to correct ID) and/or blood bank policy (check-type with a second specimen) may reduce, but not eliminate, this persistent problem. Clearly, additional safety measures are required to prevent WBIT-type errors.

IntroductionReversible cerebral vasoconstriction syndromes (RCVS) compromise a group of disorders characterized by prolonged but reversible vasoconstriction of the cerebral arteries. RCVS has been reported to occur in various clinical settings and although the pathophysiology remains unclear, a disturbance in the regulation of cerebral vascular tone has been the prevailing hypothesis. We report a case of ipsilateral reversible cerebral vasoconstriction following carotid stenting. To our knowledge, this is the first report of RCVS following carotid stenting in the literature.Case report/imaging findingsA 49-year-old female with a past medical history of hypertension, hyperlipidemia, and migraines underwent carotid angioplasty/stenting for a symptomatic 70%–80% left internal carotid artery origin stenosis at our institution. Although the procedure was uncomplicated, the patient complained of a significant constant left frontal headache post-stenting. Serial CT head and CTA neck studies however, revealed a patent left carotid stent with no evidence of in-stent stenosis, thrombosis, or intracranial hemorrhagic complications and the patient was discharged. The patient returned to the ED 14 days later due to transient ischemic episodes of right upper and lower extremity weakness and right facial numbness. Interestingly, these symptoms occurred 1 day after commencing new antihypertensive therapy and an associated resolution of her headache. MR brain studies demonstrated 2–3 punctuate foci of restricted diffusion in the left fronto-parietal lobe consistent with acute infarcts. Brain MR perfusion studies revealed an elevated mean transit time and mild compensatory increase in relative cerebral blood volume suggesting autoregulatory vasodilation. Although subsequent CTA head and neck studies re-demonstrated stent patency with no residual stenosis, there was suspicion of irregularity in the distal intracranial vasculature of the left anterior intracranial circulation, and left posterior cerebral artery, prompting a cerebral angiogram. Cerebral angiogram results confirmed diffuse segmental narrowing in the distal intracranial vasculature of the left anterior, middle, and posterior cerebral arteries. This finding was restricted to the left hemisphere. The vasoconstriction resolved immediately following the administration of intra-arterial verapamil and a repeat MR perfusion showed near complete normalization. The patient's neuorologic symptoms did not recur although her headache had returned during the IA verapamil administration. The patient was placed on 120 mg verapamil daily and discharged. Upon follow-up, the patient continued to suffer from persistent headaches, which were partially resolved with verapamil. Subsequent CTA/MRP studies; however, demonstrated complete reversal of the left-sided vasoconstriction.ConclusionThe mechanism by which carotid revascularization procedures precipitate cerebral vasoconstriction is not well understood; however, a direct mechanical relationship is suggested based on the observation of i...

Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality.

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Acute coronary syndrome is a lethal condition. Treatment modality and success mostly depend on time yielded since onset of symptoms. It is known for more than 30 years that delay between symptom onset and treatment of less than 60 min are desirable, but pre hospital delays remain unacceptably long worldwide including Bangladesh. A greater understanding of the contributing factors may help to reduce delays. A number of sociodemographic, clinical, social and proximal factors have been associated with pre hospital delay. The total pre hospital delay period consists of two component: time taken by patients to recognize that their symptoms are serious and to contact medical help (decision time) and the time taken from requesting help to admission where emergency coronary care is available (time to hospital delay). Different factors may affect these two components. In hospital delay also known as door-to-treatment, is defined as time from arriving to hospital to initiation of reperfusion therapy. Regardless of how to shorten in hospital delay, if the pre hospital delay is not reduced, then reperfusion therapy cannot achieve the best results. We set out to discover what factors are specifically associated with three components: decision time, home to hospital delay and First Medical Contact (FMC) to revascularization delay. This review may help the National health management system to identify the factors associated with treatment delay in ACS and thus reduces ACS related morbidity and mortality. University Heart Journal Vol. 15, No. 2, Jul 2019; 79-85

Conclusions: TFTC core-needle liver biopsy should be considered for the biopsy of hepatic masses in patients with contraindications to percutaneous liver biopsy or with intrahepatic lesions that abut or are adjacent to the IVC.

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.

Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management. Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not. Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p<0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p<0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p>0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%). Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found. University Heart Journal 2022; 18(1): 3-9