bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Shadow Education System: Studentsâ€™ Responses to Private Tutorial Learning
Authors: K Jayaraman , Koon Seow Soo , Annamalai Nagaletchimee 
Published: April 2021

Purpose - In Malaysia, many families devote a portion of their income to private tutorial learning fees. Many parents, especially those who stay in urban areas, send their children for private tutorial learning. This research investigated the challenges of a shadow education system by analysing Malaysian secondary school studentsâ€™ reactions to private tutorial learning. Methodology - A survey instrument with a structured questionnairewas designed on a webpage and delivered via email and Virtual Learning Environment through Frog Asia, which is the first company to connect Malaysian schools through a single cloud-based learning platform. The online survey approach was chosen as a convenient and cost effectiveness means of interacting with respondents who were dispersed in various geographical locations across the country. 148 respondents from three Malaysian states, Penang, Perak and Johor, were identified using convenience sampling. Findings - The results showcase the reasons for choosing private tutoring from both studentsâ€™ and parentsâ€™ perspective. Significant findings revealed that the factors influencing studentsâ€™ choice to attend private tutorial learning were the school environment, social influence, rigidity of the school system, studentsâ€™ learning attitude and affordability for parents. The study also indicated that parents were exercising excessive force on studentsâ€™ academic choices, which increased tension and anxiety among their children. Parental influence can be stressful and have a traumatic impact on childrenâ€™s learning abilities. Furthermore, it was found that students were missing extra-curricular activities. Significance - The secondary school syllabus is too crammed and its scope is too wide, leading school teachers to complete it without in-depth teaching and learning activities. Due to peer influence, private tuition becomes a routine activity, causing school students to miss extra-curricular activities. Ultimately, a good outgoing school student is a potential candidate for higher education, and educationally qualified and skilled persons are needed for the future economy of Malaysia. It is suggested that education policy makers should not introduce a rigid curriculum as rigidity leads to rote learning and produces poorly talented children.
A study on the quality of life among stroke survivors: A cross sectional study
Authors: Sahu Rajesh Kumar , Kumar Sunil , Yadav Pankaj 
Published: April 2021

Background: The World Health Organization defines - Health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Methodology: A cross sectional study on 96 patients with stroke aged more than 30 years was carried out NIMS Hospital, Jaipur for a period of 4 months from 1st January 2018 to 30th April 2018.
Results: Out of 96 patients, Mean quality of score of patients with stroke was 65.04±9.982 there was significant difference seen in quality of life score according to sex, side of lesion, duration of stroke, socioeconomic status, occupation and hypertension.
Conclusions: It can be said that quality of life is a multidimensional concept. As stroke cases is among the most devastating of health aspect, having multiple and profound effects upon all aspects of life, hence evaluation of quality of life is very important. Each and every effort should be made to improve these aspects and in turn to activity daily living (ADL) and improve the overall quality of stroke patients.
Filipino Adolescents’ Experiences of Abusive Parent-Child Relationship in Low Socioeconomic Status Families
Authors: Sabarre Jess , Villareal Paulo Louis H. , Arcinas Myla 
Published: April 2021

This phenomenological-qualitative study aimed to describe how an abusive parent-child relationship of selected Filipino adolescents from an intact family of low socioeconomic status affects the perceptions of their potential romantic partner, marriage, and family. The study also uncovered their coping mechanisms and support system. The seven informants were identified using a purposive sampling technique. The researchers devised an open-ended interview guide to elicit information from the informants and were conducted with a guidance counsellor. With the use of content analysis, the study revealed that their abusive experiences with one or both parents have significantly affected their perceptions. Most of them have resorted to using negative coping strategies and that their grandparents stood as their extended family support system with their friends as their non-family support system. The informants displayed a significantly entrenched position on the characteristics of their future marital partner and family. However, they have shown disapproval of marriage due to their experiences. The study also exposed that mothers have been more present in the abusive parent-child experiences than the fathers, which contradicts expectations that fathers act as strict disciplinarians and mothers being the child's protector in Philippine Culture. The study exposed the experiences of children in verbal and physical abuse in their homes from intact families with low socioeconomic status in Metro Manila, wherein expounds on the type of social support these children have been given and the kinds of coping mechanisms that are prevalent in their experiences and how these abusive parent-child experiences reflected with either positive or negative on their perception of marital partner, the concept of marriage, and concept of family, wherein provides substantial knowledge on how these experiences can be handled and faced in terms of treatment.
Hand hygiene skills of the health care workers and the effect of training and educational intervention: A single center cross-sectional study
Authors: Shrestha Gentle Sunder , Shrestha Manjit , Sharma Roshan , KC Ramchandra , Shrestha Bibeka , Pradhan Rojika , Joshi Pankaj 
Published: April 2021

Background: Hand hygiene is one of the most effective preventive measures in the transmission of infection. Proper hand hygiene strategies in health care facilities can reduce nosocomial infections and antimicrobial resistance.
Objectives: This study aims to assess the baseline hand hygiene skills among health care workers and the impact of education and training on it.
Design: Interventional cross-sectional single center study.
Method: It was conducted among 181 health care workers of Alka Hospital Pvt. Ltd. During both pre and post-test, participants were asked to perform hand hygiene with soap and water as per WHO guidelines. Pretest was conducted to assess baseline skills of health care workers regarding hand hygiene. An observer would score whether each of the steps were performed correctly, using a checklist. It was followed by intervention in the form of training, education and demonstration of hand hygiene. Post-test was conducted to assess the changes in skills after intervention.
Results: There was an overall improvement in the hand washing skills post intervention indicated by an increase in median score, which was 8 for pre-intervention and 9 for post-intervention. Doctors and nurses had better practice regarding hand hygiene in comparison to other participants. Those participants who had prior training on infection prevention and control, were found to have better hand hygiene skills post-intervention.
Conclusion: Training and educational interventions are the effective tools to improve hand hygiene skills of the health care workers. Performing such interventions at regular intervals can be helpful.
Bangladesh Crit Care J March 2021; 9(1): 12-15
Evaluation of Percutaneous tube Thoracostomy Performed by Trainee in both Trauma and non-Trauma Patients
Authors: Maula Kulsum , Alam Md Kamrul , Khalil Md Ibrahim , Hasan Md Nazmul , Faruq Mohammad Omar 
Published: April 2021

Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save life now and then in different traumatic and non-traumatic conditions. But still it is an enigma; how our trainee surgeons are at home in this procedure.
Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainee in both trauma and non-trauma patients.
Study design: Prospective, Observational study. Duration of study was September, 2019 to February, 2019.
Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Data regarding clinical and surgical outcome profile were recorded. Data were compiled, edited, analyzed.
Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and lowest 9.37% belonged to age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and rest 26(27.08%) were indicated PTT for non-traumatic chest condition where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% patients had right sided intercostal chest tube (ICT) insertion whereas 46.87% had left sided ICT insertion. In our study, 89.55 % tube was placed at normal anatomical position. Besides, 10.41% tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients 75(78.13%) showed uneventful outcome whereas 21(21.87%) had complications including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had non-functioning drain and empyema with ascending infection respectively (p=<0.05).
Conclusion: PTT is a life saving procedure that is most frequently implemented in chest trauma patients of our country. In majority cases, outcome of PTT were uneventful (78.13). Besides this more than one third of patient had length of incision more than 3 cm that needed extra stitches and 10.41% cases PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospital are doing well in their performance of PTT insertion but still some anatomical orientations are necessary to avoid operative and post-operative complications
Bangladesh Crit Care J March 2021; 9(1): 28-33
Effect of low dose Methotrexate in newly diagnosed Rheumatoid arthritis case
Authors: Sobhan Fauzia , Moiz Khaza , Siddiquee Naima , Debnath Aditi , Haque Fazlul , Rahman Zanifar 
Published: April 2021

Rheumatoid arthritis is a painful debilitating joint disease with the proliferation of the synovium and progressive erosion of cartilage and bone. Methotrexate (MTX) has been used for the treatment of Rheumatoid Arthritis (RA) for about 3 decades. It is most effective and commonly used Disease Modifying Antirheumatic Drugs (DMARDS) because it improves symptoms, signs, disease activity and functions. This study was done from January 2016 to December 2016 for a period of 1 year under Physical Medicine and Rehabilitation department, Jalalabad Ragib-Rabeya Medical College (JRRMC), Sylhet. Here we treated the patients with low dose methotrexate. Study was done to see the effect of low dose MTX in newly diagnosed RA patients by clinical examination and DAS 28. DAS stands for disease activity score and 28 joints that are examined in this assessment. The result concluded low dose MTX improves the symptoms, signs, disease activity and functions of the patients.
Bangladesh Crit Care J March 2021; 9(1): 34-37
Early Outcome of Minimally Invasive Direct Coronary Artery Bypass Surgery- A hospital based study
Authors: Akhter SM Quamrul , Rahim AM Asif , Azad Quazi A , Maruf MF , Ahsan NA Kamrul 
Published: April 2021

Background: coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs.
Methods: This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG.
Results: Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p<0.05) number of grafts were also statistically significant (p< 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p<0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p<0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p<0.001). However, mortality and quality of life at three months were similar in both groups.
Conclusion: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG.
Cardiovasc. j. 2021; 13(2): 135-143
Study on Heart Failure Patients Admitted in National Institute of Cardiovascular Diseases
Authors: Alam Nur , Majumder Abdullah Al Shafi 
Published: April 2021

Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. There is a paucity of data on characteristics of the patients of heart failure admitted in hospitals in terms of demographic and etiological information. So, this study aimed to see the disease burden of heart failure patients and the age and sex specific prevalence of heart failure among patients admitted into NICVD and to identify the etiological pattern of diseases leading to heart failure with associated comorbid factors.
Methods: It was a cross sectional study carried out at National Institute of Cardiovascular Diseases (NICVD) Dhaka Bangladesh and was conducted from January 2015 to December 2015. Total 400 heart failure patients were taken.
Results: The mean age of the patients were 54 ± 14 years ranging from 16 to 95 years with a high preponderance of male. Most the patient population was in the age group of 51- 60 years (29.5%). 79% of the cases were male & 21% female by gender specification. Ischaemic cardiomyopathy (ICM) was found to be the common cause of heart failure (n=153, 40.75%) followed by Acute coronary syndrome (32.5%) and Valvular heart disease (18.25%). The patients with heart failure having acute coronary syndrome (n=107) had hypertension (46.8%) as the most prevalent major risk factor. In the present study only 11% patient had heart failure with preserved ejection fraction. Mortality rate of the study population were 6.3%.
Conclusion: In this study, the most common cause of heart failure is ischaemic heart disease. So, patients of acute and chronic ischemic heart disease patients should be treated and follow up with care. Clinical and epidemiological studies are needed to explore further.
Cardiovasc. j. 2021; 13(2): 172-176
Early Outcome of Mitral Valve Replacement in Patient Having Mitral Stenosis with Moderate Pulmonary Hypertension
Authors: Zaman MH , Rahim AM Asif , Rashid MZ , Hasan MK , Islam MS , Sharker MK 
Published: April 2021

Background: Mitral valve replacement (MVR) plays a central role in the management of patients with mitral stenosis with moderate to severe pulmonary hypertension. Pulmonary hypertension has an impact on short term outcome of MVR. It can influence left ventricular function (low output syndrome), incidence of arrhythmia, ARDS leading to respiratory failure and right ventricular failure which may be irreversible.
Methods: The immediate postoperative hemodynamics in 40 patients with moderate to severe pulmonary arterial hypertension who underwent mitral valve replacement (BLMV) between July 2010 and June 2012 were studied prospectively. Patients were divided into two groups: Group A (n=20): Patient having MS with moderate pulmonary hypertension (PASP: 40-59 mm-Hg) and Group B (n=20): Patient having MS with severe pulmonary hypertension (PASP e” 60mm-Hg). Total two follow up were done- 1st follow up after 10 days and 2nd follow up after 1 month of MVR. Each patient was assessed by medical history, clinical examination & color doppler echocardiogram.
Results: It was shown that surgery can be beneficial for the patients if MVR is done in the state of mild PAH irrespective of age but beyond this level of PAH, the patients may still remain with mild pulmonary hypertension which may trigger the cascade of pulmonary vascular Disease may be the cause of unsatisfactory outcome. So, early surgical outcome of mitral stenosis with moderate pulmonary hypertension is better than mitral stenosis with severe pulmonary hypertension.
Conclusion: We conclude that MVR in patients having MS with moderate PAH is a safe and effective measures for preventing pulmonary hypertension related complications.
Cardiovasc. j. 2021; 13(2): 177-182
Vitamin D Status and Acute Coronary Syndrome – A Single-Centre Study
Authors: Rahman Mohammad Saidur , Alam Muhammad Badrul , Islam AKM Monwarul , Ahmad Tanveer , Md Wareshuzzaman - , Shimu Ishrat Jahan 
Published: April 2021

Background: Vitamin D are needed for normal functioning of cardiovascular system, and its deficiency has been linked to different cardiovascular disorders, including hypertension. However, the relationship between vitamin D deficiency and ischaemic heart disease is not yet clear. The present study was intended to find out the association between serum vitamin D level and acute coronary syndrome (ACS).
Methods: The cross-sectional analytical study was carried out in a tertiary care hospital of Dhaka, Bangladesh. Fifty-one consecutive ACS patients admitted into the Department of Cardiology of the hospital were considered as the cases and 51 apparently healthy subjects were considered as the controls. The exposure and outcome variables were serum vitamin D and ACS respectively. Vitamin D insufficiency and deficiency were defined as serum 25(OH) D <30-20 ng/ml and <20 ng/ml, respectively. Severe vitamin D deficiency was defined as serum 25(OH) D <10 ng/ml.
Results: Hypovitaminosis D was prevalent in both cases and controls; however, the mean serum 25(OH) D was significantly lower in the former than the latter (14.2 ± 5.9 ng/ml vs. 18.2 ± 6.3 ng/ ml, respectively; p <0.001). Vitamin D insufficiency and moderate deficiency (serum 25(OH) D <20- 10 ng/ml) did not differ significantly between the groups, but severe deficiency (<10 ng/ml) was significantly more common in patients with ACS compared to the healthy controls. The risk of having moderate and severe vitamin D deficiency was 1.9-fold (95% CI = 0.8 – 4.7) and 22.8-fold (2.9 – 180.4) higher for ACS patients than for healthy subjects (p = 0.173 and p <0.001, respectively).
Conclusion: Vitamin D deficiency is more common in patients with ACS compared to those without ACS. However, the independent association between vitamin D deficiency and ACS needs further evaluation.
Cardiovasc. j. 2021; 13(2): 183-188
Echocardiographic Evaluation of Pulmonary Haemodynamics - A Review
Authors: Kabir MS , Majumder AAS , Ahmed AFKU , Rubaiyat KA , Jhan A , Rabbani ASMG , Haque SMS 
Published: April 2021

Pulmonary haemodynamic status has got significant clinical and prognostic significance both in structural and nonstructural heart diseases. But diagnostic accuracy depends on much care in evaluation and logical correlation of different echocardiographic parameters. Though the Doppler studies play crucial role in estimating Pulmonary haemodynamics, careful observation of 2-D measurements of different structures as well as RV systolic and diastolic function are vital issues to be addressed and correlated for diagnostic accuracy. Tricuspid Valve, RVOT and Pulmonary valve pathologies also demand vivid correlation while estimating PA pressures and pulmonary vascular resistance. Mere presence of elevated pulmonary artery systolic pressure is not enough to define pulmonary hypertension (PH). Before declaring a patient having PH a comprehensive evaluation of right heart haemodynamics is to be performed carefully to avoid unnecessary cardiac catheterization or to avoid inadvertent initiation of PH therapy.
Cardiovasc. j. 2021; 13(2): 200-216
Patent Foramen Ovale Device Closure in a 27 Years Old Young Lady with Cryptogenic Ischaemic Stroke - First Case Report from Bangladesh
Authors: Reza AQM , Karim Aparajita , Khan Mahmood Hasan , Rahman Kazi Atiqur , Joarder Md Aliuzzaman , Talukder Shahab Uddin , Munwar Shams , Ali M Atahar , Ahmed Tamzeed , Islam AHM Waliul 
Published: April 2021

A patent foramen ovale (PFO) is highly prevalent in patients with strokes of unknown cause or cryptogenic strokes (CSs). It has been remained an unsolved question as to whether a PFO should be closed or not to prevent recurrent strokes in patients diagnosed with cryptogenic stroke (CS). A paradoxical embolism through a PFO is pointed as a leading cause of CS, especially in younger patients with low risk factors for stroke. It also remains an unsolved matter on type of anti-coagulation therapy, which would be better for patients with CS and a PFO. In addition, surgical and transcutaneous closure of a PFO has been proposed for the secondary prevention of stroke in patients with CS with PFO. Several randomized controlled trials have been conducted in recent years to test whether a PFO closure gives a significant benefit in the management of CS. Many investigators believed that a PFO was an incidental finding in patients with CS. However, meta-analyses and more recent specific trials have eliminated several confounding factors and possible biases and have also emphasized the use of a shunt closure over medical therapy in patients with CS. Therefore, these latest studies can possibly change the treatment paradigm in the near future. We are reporting a case of cryptogenic ischaemic stroke in middle cerebral artery territory due to paradoxical embolism through a PFO which was successfully closed with a device solely by a Bangladeshi Consultant & his team first time in Bangladesh.
Cardiovasc. j. 2021; 13(2): 227-234