Introduction: Causes of divorce may range from factors as diverse as the personal psychological characteristics of one or both spouses to the stresses of economic hardship and community disintegration. From a larger perspective, the role of divorce in modern societies and its relatively high incidence both flow from the same complex factors that have made good marriages so much more central to people's happiness than through most of the past and deterioration of a marital relationship so much more distressing. Methods: This study adopted a cross-sectional design, in Sylhet city, from 2019 to 2020 and it was mainly quantitative. However, qualitative data were collected from policymakers, i.e. the responsible person in Sylhet city, and discussion and documents. Quantitative data were collected from rickshaw pullers who were divorced by their wives from different areas in Sylhet city. A structured questionnaire was used for data collection from rickshaw pullers. Result: The mean age was found 36.25±SD years. The majority 39(48.8%) rickshaw pullers had primary education. All rickshaw pullers were in low-income group status. Out of the total study population, 47(58.8%) had ≤10 hours of working time, and 33(41.3%) had >10 hours of working time. As multiple responses were accepted, there were rickshaw pullers who reported many types of misconduct from passengers and police. Almost all rickshaw pullers reported that the passengers belittled them. This was closely followed by “scolded” 86.3%, “paid unjust fare” 68.8%, and 48.8% of rickshaw pullers had “quarrel over fare” with passengers. It was evident that 36.3% and 40.0% of rickshaw pullers were “physically assaulted” and compel sitting, holding their ear by the passengers and police respectively. The majority 60(75.0%) of wives divorced their husbands due to domestic violence, 56(70.0%) due to too much conflict and arguing, 52(65.0%) due to substance abuse, 50(62.5%) due to lack of commitment, 48(60.0%) due to ...........

Background: Pulmonary arterial hypertension (PAH) is a severe condition marked by a progressive rise in pulmonary vascular resistance (PVR), which leads to right heart failure, and mortality. Combining medications is an appealing approach for treating PAH patients. The current study sought to compare the outcomes of monotherapy, and combination therapy after a short period of follow-up. The study aimed to compare the short-term outcome of monotherapy and combination therapy in the treatment of pulmonary hypertension.Methods: This randomized control trial study was conducted at the department of pediatric cardiology, Bangabandhu Sheikh Mujib medical university, national institute of cardiovascular disease, and national heart foundation, Dhaka, Bangladesh, from January 2018 to December 2018. During this period, a total of 70 participants were selected for the study following the inclusion, and exclusion criteria. The selected participants were then divided into two groups of 35 each through random selection.Result: There were no significant differences between the two groups in terms of mean age, and sex. The 34.3% in Group A, and 28.6% in group B had ventricular septal defects (VSD, followed by AVSD at 20.0% in group A and 25.7% in Group B. After 3 and 6 months of follow-up SpO2 per exercise, 6MWD, SpO2 post-exercise, and alanine aminotransferase showed statistically significant differences between single and combined groups. There was no statistically significant difference regarding adverse effects between the two groups. PASP was significantly decreased in the combined group than monotherapy group.Conclusions: Combination therapy is more successful than monotherapy in PAH with CHD. Combining bosentan with oral sildenafil medication in patients with CHD-related PAH is safe, and well tolerated at follow-ups.

Background: Pulmonary arterial hypertension (PAH) is a serious condition characterized by an increase in pulmonary vascular resistance (PVR) that leads to right heart failure and death. The study aimed to compare the side effects of monotherapy and combination therapy in the treatment of pulmonary hypertensionMethods: This randomized control trial study was conducted at the department of pediatric cardiology, Bangabandhu Sheikh Mujib medical university, national institute of cardiovascular disease, and national heart foundation, Dhaka, Bangladesh. The study duration was 1 year, from January 2018 to December 2018. During this period, a total of 70 participants were selected for the study following the inclusion, and exclusion criteria from those diagnosed case of pulmonary hypertension with congenital heart disease admitted to the pediatric cardiology department, Bangabandhu Sheikh Mujib medical university, NICVD, NHF.Result: Maximum patients had ventricular septal defects (VSD) (34.3% in group A, and 28.6% in group B). Followed by AVSD. 20.0% in group A and 25.7% in group B. Atrial septal defect (ASD) were 14.3% in group A, and 17.1% in group B. After three, and 6 months of follow-up SpO2 per exercise, 6MWD, SpO2 post-exercise, and alanine aminotransferase showed statistically significant differences between single and combined groups. There was no statistically significant difference regarding adverse effects between the 2 groups, but group B patients had slightly higher incidence of some side effects. PASP was significantly decreased in combined group than monotherapy group.Conclusions: This study concludes that combination therapy is more successful than monotherapy in PAH with coronary heart disease (CHD). Our findings demonstrate that combining Bosentan with oral Sildenafil medication in patients with CHD-related PAH is safe, and well tolerated at 3-, and 6-month follow-ups, resulting in a significant improvement in clinical status, effort SpO2, exercise tolerance, hemodynamics, and PASP.