Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Standardization of urinary tract infection diagnosis in the neonatal ICU: Experience at a tertiary care center

BACKGROUND

Urinary tract infections (UTIs) and antibiotic overexposure are common neonatal problems. Recently, evidence has emerged that a standardized approach to neonatal UTI can reduce unnecessary diagnosis without complications. This quality improvement project aimed to achieve those goals in our neonatal intensive care unit (NICU).

METHODS

A UTI diagnosis guideline was adapted from the literature with the goal of maximizing the proportion of diagnosed UTIs that conform to accepted diagnostic criteria: >10,000 CFU/mL of one organism with pyuria, or >50,000 CFU/mL of one organism regardless of pyuria. The guideline was implemented in a level III NICU. Adherence, results, and complications were monitored for 12 months.

RESULTS

Guideline adherence after implementation was favorable, as evidenced by increased adoption of urinalysis with microscopy. There was a non-significant increase in diagnostic adherence to criteria, 87% to 93%, and non-significant decrease in the rate of UTI diagnosis, 39% to 36%. Complications were not significantly changed. Most UTIs were due to gram-negative rods, especially E. coli; Enterococcus was a common contaminant.

CONCLUSIONS

A guideline for diagnosing UTIs can safely increase uniformity. In contrast to previously published results, no significant changes were seen in the rate of UTI or the proportion of diagnoses conforming to the criteria for UTI. It is likely that guideline effects depend on the established practices of NICU providers. Additionally, a consistent pattern was seen in which organisms were more likely to be judged the source of true UTIs or contaminated cultures, meriting further study.

Role of Intra-arterial Nitroglycerin (Post Procedural, Prehemostasis) to Reduce Radial Artery Occlusion after Transradial Catheterisation: A Doppler-guided Study

The study was intended to evaluate efficacy of Intra-arterial nitroglycerin through the sheath at the end of a transradial procedure to preserve the patency of the radial artery. This prospective observational study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2017 to April 2018, by including a total 200 patients undergoing coronary procedures (CAG and / or PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Doppler study. In this study 102 patients (Group I) received 200 mcg intra-arterial nitroglycerine, prior to trans-radial sheath removal. Another 98 patients (Group II) did not receive intra-arterial nitroglycerine prior to trans-radial sheath removal. Conventional haemostatic compression methods were applied (average 2 hours) in both groups of patients. Evaluation of radial arterial arterial blood flow by colour Doppler study was done on next day after the procedure in both groups. Results of this study in which RAO was determined by vascular doppler study showed that frequency of radial artery occlusion were 13.5% one day after transradial coronary procedures. We found the incidence was 8.8% vs. 18.4%, (p=0.04) in Group I and Group II respectively. The incidence of RAO was significantly lower in post procedural nitroglycerine group. From multivariate logistic regression analysis diabetes mellitus (p = 0.02), hemostatic compression time for more than 02 hours after sheath removal (p = <0.001) and procedure time (p = 0.02) was predictors of RAO. So, the administration of nitroglycerin at the end of a transradial catheterization reduced the incidence of RAO, as shown by 1 day after the radial procedure by doppler ultrasound.

A124 PERORAL ENDOSCOPIC MYOTOMY IS THE PREFERRED TREATMENT FOR PATIENTS WITH SYMPTOMATIC ZENKER’S DIVERTICULUM

Background

Zenker’s diverticulum (ZD) is a mucosal herniation at the pharyngoesophageal junction presenting with dysphagia, regurgitation and aspiration. While open surgical myotomy (OSM) is the conventional treatment option, select patients can undergo myotomy using endoscopic techniques.

Purpose

Evidence on third-space flexible endoscopy with myotomy is lacking, especially in North America. We aimed to assess the safety and efficacy of peroral endoscopic myotomy (POEM) for symptomatic ZD.

Method

Retrospective cohort study was performed of consecutive patients undergoing OSM and POEM completed in a tertiary hospital from 2010-2020. Only patients with accessible electronic medical records and at least 3 months of follow-up were included in this study. Data collected included: demographics, comorbidities, ZD characteristics, clinical and patient-reported outcomes.

Result(s)

14 patients underwent OSM and 18 patients underwent POEM. 10 of the patients undergoing POEM were considered for but were not able to get stapled endoscopic myotomy, the most common reasons were related to the technical limitations (ZD size too small, unable to hyper-extend neck, unable to position suspension laryngoscope). There were no significant differences between groups in age (p=0.35), BMI (p=0.38), Charlson comorbidity index (p=0.26) and size of ZD (p=0.92). Length of stay was significantly lower for POEM (0.4 vs. 3.1, p<0.01). Complications were more common and severe with OSM (36%, n=5) versus POEM (11%, n=2). The only complications post-POEM were contained esophageal perforations. Complications post-OSM included esophageal perforations requiring open cervical drainage, surgical site infections, recurrent laryngeal nerve injury/paresis, esophageal strictures requiring multiple dilatations. All patients undergoing POEM had 100% technical success with post-treatment barium esophagogram showing 100% resolution of obstruction/hang-up. The median follow-up time post-POEM was 11 months. Over the follow-up period there was a significant improvement of patient-reported outcomes, with a mean decrease of Eckardt score (4.7 to 1.1, p<0.001) and mean increase of Dakkak-Watson score (20.7 to 41, p<0.001). Only one patient had persistent ongoing symptoms of dysphagia post-POEM and was subsequently diagnosed with ineffective esophageal motility on high resolution manometry.

Conclusion(s)

POEM is a minimally invasive treatment option for ZD with high treatment success as well as reduced length of stay and complications. It is less invasive than OSM, more versatile than stapled endoscopic myotomy and is less prone to technical limitations.

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Disclosure of Interest

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Molecular prevalence of Anaplasma marginale in ruminants and Rhipicephalus ticks in northern Pakistan

Anaplasma marginale is the most prevalent tick-borne haemoparasite of cattle and causes huge economic losses to the dairy industry worldwide. This study aimed to determine the occurrence of A. marginale infection in blood and tick samples collected from livestock animals in the districts located in Khyber Pakhtunkhwa (KPK), Pakistan. A total of 184 blood and 370 tick samples were included in this study. It has never been reported that sheep, goats, and cattle in Tank, Ghulam Khan, Birmil and Miran Shah areas were infected with A. marginale. All samples of blood and ticks were collected through random sampling from March 2021 to January 2022 from cattle, sheep and goats and screened through PCR for anaplasmosis by using primer pairs of Anaplasma spp. Three hundred and seventy ticks were collected from infested hosts (120/184, 64.21%). Among the four morphologically identified tick species, the highest occurrence was recorded for Rhipicephalus sanguineus (n=138, 37.29%), followed by Rhipicephalus microplus (n=131, 35.4%), Rhipicephalus annulatus (n=40, 10.81%), Hyalomma anatolicum (n=31, 8.37%), and Hyalomma marginatum (n=30, 8.1%). The occurrence of female tick was highest (n=160, 43.24%), followed by nymphs (n=140, 37.38%) and males ticks (n=70, 18.9%). Among these ticks, A. marginale was detected in female ticks of R. microplus, and R. sanguineus. Molecular identification of A. marginale was confirmed in 120 out of 184 blood samples and 6 out of 74 tick samples. Overall, occurrence of A. marginale in blood and tick samples was found to be 65.21% and 8.1% respectively. Species-wise occurrence in blood samples of goats were 71.11% followed by sheep 68.31% and cattle 50%. Specie-wise occurrence of A. marginale in tick samples of cattle were 12.5% followed by goats 6.89%. The obtained sequence showed similarity with A. marginale reported from Kenya and USA. We report the first PCR based detection of A. marginale infection in blood samples and in R. sanguineus ticks of goats simultaneously.

H9N2 avian influenza virus dispersal along Bangladeshi poultry trading networks

Avian influenza virus subtype H9N2 is endemic in Bangladesh's poultry population. The subtype affects poultry production and poses a potential zoonotic risk. Insufficient understanding of how the poultry trading network shapes the dissemination of avian influenza viruses has hindered the design of targeted interventions to reduce their spread. Here, we use phylodynamic analyses of haemagglutinin sequences to investigate the spatial spread and dispersal patterns of H9N2 viruses in Bangladesh's poultry population, focusing on its two largest cities (Dhaka and Chattogram) and their poultry production and distribution networks. Our analyses suggest that H9N2 subtype avian influenza virus lineage movement occurs relatively less frequently between Bangladesh's two largest cities than within each city. H9N2 viruses detected in single markets are often more closely related to viruses from other markets in the same city than to each other, consistent with close epidemiological connectivity between markets. Our analyses also suggest that H9N2 viruses may spread more frequently between chickens of the three most commonly sold types (sunali-a cross-bred of Fayoumi hen and Rhode Island Red cock, deshi-local indigenous, and exotic broiler) in Dhaka than in Chattogram. Overall, this study improves our understanding of how Bangladesh's poultry trading system impacts avian influenza virus spread and should contribute to the design of tailored surveillance that accommodates local heterogeneity in virus dispersal patterns.

Study of Changes in Serum Copper Level in Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) commonly known as heart attack is defined pathologically as the irreversible death of myocardial cells caused by ischemia. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol and excessive alcohol intake. The major cause of acute MI is coronary atherosclerosis with superimposed luminal thrombus, which accounts for more than 80% of all infarcts. Micronutrients and trace elements are very essential for normal functioning of the body. Even though they are required in very small amount, an alteration in the level of this element may lead to serious diseases like CAD and its consequences. The injury induced by reperfusion of the ischemic myocardium could result partially from the cytotoxic effects of oxygen free radicals. Copper is involved in several of the reactions in the protection from free radical damage. So, this study was designed to evaluate serum cupper level in AMI patients. This case-control study was conducted in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh from July 2016 to June 2017. Total number of subjects was 120 in number. Among them 60 were diagnosed case of acute myocardial infarction and 60 were apparently healthy volunteers. Data were collected using pre-designed data collection sheets. After proper counseling informed written consent was taken from the study population. The study revealed that mean serum copper level was higher in case group as compared to control group. The mean±SD values of copper were 105.44±24.15μg/dl and 146.49±23.52μg/dl in control and case group respectively. The level of significance was 0.001 (p<0.05). After analyzing the results of the study it is concluded that serum copper level was significantly higher in Acute Myocardial Infarction patients than normal individuals. Therefore, estimation of serum copper level in AMI patients might be useful to take appropriate measure to prevent free radical induced reperfusion injury.

Occurrence of ticks and tick-borne mixed parasitic microbiota in cross-bred cattle in District Lahore, Pakistan

The present study was focused on the incidence of ticks and tick-borne diseases (TTBD) in cross-bred cattle (Friesian x Sahiwal) of two farms (n = 2548) in district Lahore, Pakistan. We collected total of 572 ticks (adults and nymphs) and blood samples (10 ml) for microscopic i.e., blood smear test - Giemsa Stain (BST) and molecular analysis; Reverse Line Blot-General Primer-PCR (RLB-PCR) and Specie Specific Primer PCR (SP-PCR) from infested cattle (n = 100) from months of April to September. Results: The tick specie identified was Rhipicephalus microplus at both farms, with significant difference in infestations rate amongst both farms (p< 0.0001). The cross-bred cattle having higher ratio of Friesian blood and lower ratio of Sahiwal blood were mostly infested by ticks (p < 0.0458) and haemoparasites (p <0.474) and vice versa. The SP-PCR showed higher number of haemoparasites infection than BST, which revealed 16% T. annulata (p < 0.0001 and k value 0.485, 0.0001), 51% B. bigemina (p < 0.0001 and k value 0.485, 0.0001) and 15% A. marginale (p < 0.001 and k value 0.207, 0.001), respectively. The single infection with B. bigemina was 34% (n = 34/100) and A. marginale 6% (n = 6/100). The double infection with T. annulata/B. bigemina was 8% (n = 8/100) and B. bigemina/A. marginale 1% (n = 1/100). Whereas the triple infection with T. annulata/B. bigemina/A .marginale was 8% (n = 8/100). The phylogenetic study of isolated sequence of T. annulata revealed close homology to isolates from Iran (87%), B. bigemina to isolates from Cuba (94 to 100%) and A. marginale with isolates from Pakistan (99 to 98%).

Distribution and Pattern of Anti-Tubercular Drug Resistance in Patients with Pulmonary Tuberculosis in Mymensingh Region of Bangladesh

Globally, the emergence of multidrug-resistant strains of Mycobacterium tuberculosis is an increasing problem that adversely affects patient care and public health. This cross sectional descriptive study was carried out in the Department of Microbiology, Mymensingh Medical College from January 2010 to December 2010 to isolate M. tuberculosis from smear-positive sputum samples by Lowenstein-Jensen (L-J) media and investigate the drug resistance pattern. Among 101 smear-positive cases 80(79.20%) yielded growth of Mycobacteria, 5(4.95%) were contaminated and 16(15.84%) showed no growth. Among 80 isolates 76(95.0%) were M. tuberculosis and the remaining 4(5.0%) were Non-tuberculous Mycobacteria (NTM). Out of 76 M. tuberculosis 27(35.52%) were resistant to at least one drug, 4(5.26%) to Isoniazid (INH), 1(1.32%) to Rifampicin (RMP), 8(10.53%) to Streptomycin (SM) and 0(0.0%) to Ethambutol (EMB) and multi-drug resistant tuberculosis (MDR-TB) was 9(11.84%). The present study creates the impression that fairly high rate of anti-tuberculosis drug resistance among the tuberculosis cases and also high MDR-TB (Resistant to both Rifampicin and Isoniazide). The emergence of MDR-TB poses significant trouble to TB control activities throughout the world. The complexity of MDR-TB operation makes it essential to produce new skills to design, plan, application and monitor interventions for the management of MDR-TB. More surveillance and immediate remedial interventions should be performed to combat the trouble of MDR-TB to the general population.

Sustainable Utilization of Textile Dyeing Sludge and Coal Fly Ash by Brick Production Through Traditional Kilns

The fundamental purpose of this study was to evaluate the technical feasibility of incorporating fly ash (FA) and dyeing sludge (DS) in the production of brick. An attempt was taken to replace 10% to 100% clay by DS and FA in brick-making by volume. A brick firing kiln was used to burn the uniform-shaped bricks after replacing clay with DS and FA. Size and shape, hardness, soundness, water absorption, efflorescence, dry density, loss of ignition, firing shrinkage, specific gravity, compressive strength, and leaching tests were carried out to study the properties of these bricks. The compressive strength of the brink ranged from 6.25 MPa to 0.33 MPa and indicates a decreasing pattern in strength with the increase in the volume of DS and FA. Only 18.8% water absorption capacity was found in control bricks without DS and FA, while a maximum absorption of 40.19% was found for a particular combination of DS and FA. Similarly, dry density decreased with the increase in the volume of DS and FA. Besides, efflorescence in bricks was found within the allowable limits for certain combinations of DS and FA, which exceeded the allowable limits for other combinations. The presence of heavy metals (Ni, Zn, Cr, Cu, and Pb) in the extraction solution was insignificant. Based on the results of this study, we recommend that up to 10% clay can be substituted with DS and FA without substantially affecting the quality of bricks.

Drying kinetics and quality aspects of bitter gourd (Momordica charantia) dried in a novel cabinet dryer

An attempt was taken to investigate the effect of drying air temperature and slice thickness on the drying kinetics and quality of bitter gourd (Momordica charantia) dried in a novel cabinet dryer (HSTU Fruit and Vegetable Dryer). Fresh bitter gourd was sorted, cleaned, and sliced at 4 mm, 6 mm, and 8 mm thickness. All the samples were blanched in boiling water at 100°C for 3 mins. Then the slices with an initial moisture content of 96.47±0.6% were dried, spreading as a thin layer in the trays of the cabinet dryer using three drying air temperatures of 60, 70, and 80°C until the desired final moisture content (MC) of 4.66±0.4% was obtained. The results indicated that the shortest drying time (2.08 hrs) was required by the sample of 4 mm thickness, which was dried at 80°C to reduce moisture from 96.47±0.6% initial (wet basis, wb) to 4.66±0.4% final moisture (wb). The sample of 8 mm thickness dried at 60°C took the longest drying time (6.67 hrs). The higher drying rate (34.32 gm H2O/min.cm2 ) was noticed at a constant drying rate period in the case of a 6 mm thick slice at 70°C. Whereas a lower drying rate (9.29 gm H2O/min.cm2 ) was observed for drying 8 mm slices using 60°C air temperature. Even though, the effect of blanching on drying characteristics of bitter gourd was not noticed so much, the drying rate was found to be increased slightly of pretreated bitter gourd thus drying time was shorter. A comparison on colour analysis of both fresh and blanched bitter gourd showed that a 6 mm slice dried at 70°C was found better in retaining green colour than other samples. The rehydration ratio (6.63±0.62) and the percentage of water uptake (86.75±0.58) of rehydrated pretreated bitter gourd were also higher in a dried sample of 6 mm. Therefore, pretreated bitter gourd is suggested to dry quickly using 70oC in a cabinet dryer slicing at 6 mm thickness to obtain a better quality dried product.

Malignant Infantile Osteopetrosis with Bone Marrow Involvement

Osteopetrosis (Marble bone disease) is a very rare congenital genetic disease of skeleton, resulting from defective bone resorption, due to functionally defective osteoclast, leading to accumulation of excessive bone mass. Malignant infantile osteopetrosis (MIO) is one of the varieties of osteopetrosis, which is fatal and is diagnosed in early infancy. Malignant infantile osteopetrosis is present with abnormal bone remodeling, hematological abnormities, features of extramedullary hematopoiesis. Radiology is the key of diagnosis. In this case, we present a 5-monthold male infant diagnosed as malignant infantile osteopetrosis, who presented with bronchopneumonia, anemia, thrombocytopenia, hepatosplenomegaly, failure to thrive (FTT).

The effect of extracorporeal shockwave myocardial revascularization therapy to myocardial perfusion and function in indicated CABG-stable angina pectoris patients: case series

OBJECTIVE

Many studies have found a beneficial effect of Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy for refractory angina patients. However, clinical studies ESMR therapy for indicated coronary artery bypass grafting (CABG)-stable angina pectoris (SAP) patients are limited.

PATIENTS AND METHODS

Four indicated CABG-SAP patients CCS class I-III reviewed in this study. All patients refuse to CABG procedure. Data of myocardial perfusion and function from medical records were collected.

RESULTS

After ESMR therapy, summed rest score was improved in patient 1 from 14 to 8, Patient 2 from 10 to 5, and Patient 3 from 6 to 4. Summed stress score was improved in patient 1 from 31 to 19. Left ventricular ejection fraction was improved in patient 1 at rest from 59 to 67% and stress from 39 to 57%. The global longitudinal strain was improved in patient 1 from -16 to -20.9 and Patient 3 from -14.8 to -18.2. Diastolic dysfunction severity was improved in patient 2 and patient 3 from grade 2 to grade 1.

CONCLUSIONS

In our case series, ESMR therapy for indicated CABG-SAP patients might improve myocardial perfusion and function, especially for patients with a high ischemic burden.

Prevalence and control status of T2DM in Bangladesh: finding from a nationally representative survey

Background

With around 10 million diagnosed patients, Bangladesh remains at the forefront of the global type 2 diabetes mellitus (T2DM) epidemic. A comprehensive understanding of the current T2DM scenario is required to curb the disease burden. In this study, we aimed to identify the prevalence, associated factors, and control status of T2DM in Bangladesh.

Methods

This cross-sectional survey was conducted in 15 randomly selected community-based clusters in Bangladesh. Around 1,000 adults aged ≥18 years from each cluster were selected. Face-to-face interviews, anthropometric measurement, biospecimen collection, and point of care blood test were performed. Individuals with Fasting Blood Sugar (FBS) ≥126 mg/dl or previously diagnosed with T2DM by a qualified health provider were considered T2DM cases. Multivariate logistic regression analysis was performed to identify factors associated with T2DM.

Results

Data of 13,674 individuals were analysed for this study. The overall prevalence of T2DM was 10.0%, among whom 29.2% were undiagnosed. Among previously diagnosed patients, 64.9% had uncontrolled diabetes (FBS≥126 mg/dl). The prevalence of uncontrolled diabetes was higher among elderly, female, and urban participants. Patients with hypertension, high waist-hip ratio and high serum cholesterol had 2.20 times (95% CI: 2.17-2.23, p &lt; 0.001), 3.53 times (95% CI: 3.47-3.59, p &lt; 0.001) and 2.53 times (95% CI: 2.48-2.59, p &lt; 0.001) higher odds of having T2DM, respectively.

Conclusions

One out of every ten adults in Bangladesh had T2DM, and a substantial proportion of them had undiagnosed and uncontrolled diabetes. This finding indicates the lack of preparedness of the country's health system to address the problem. Pertinent stakeholders should adopt a multi-sectoral approach to develop comprehensive policies and implement target-specific interventions, e.g., population-based screening program, primary care based T2DM service, and community mobilisation to combat the T2DM epidemic.

Key messages

As the T2DM burden is high in Bangladesh, policy makers should adopt a collaborative approach to develop and implement effective public health programs for prevention and control of T2DM. As the burden of uncontrolled T2DM is high in Bangladesh, the country’s health system should ensure early diagnosis and provision of quality care at affordable cost for T2DM patients.

Demographic and Clinical Profile of COVID-19 ICU Patients of Bangabandhu Sheikh Mujib Medical University, Bangladesh

Corona viruses are a group of RNA viruses that cause infection in humans and animals. In human Corona viruses cause respiratory tract infections ranging from mild to critical illness. Corona virus disease 2019 (COVID-19) is caused by strain of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The disease was first identified in Wuhan city, of China, in December 2019 and since spread all around the world. In Bangladesh first case has been declared by Institute of Epidemiology, Disease Control and Research (IEDCR) in 8th March, 2020 and first death on 18th march in an ICU and by 13th December total 489,178 cases and 7,020 deaths occurred in this country. The main objective of this study was to determine the Demographic and Clinical Profile of COVID-19 ICU patients in Bangladesh. This retrospective descriptive study on clinical profile along with short term treatment outcomes of COVID-19 patients conducted from COVID-19 dedicated Intensive care unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh during July 2020 to November 2020. Total 300 ICU patients was included in this study. The age range of the patients was from 15 to 91 years. The highest percentage of patients about 49.00%, which was 147 patients were belonged to 61-75 years age group. The patients mean age was 62.80 years. Regarding gender distribution, among those 300 patients; 77.00% which is 231 were male and only 23.00% which is 69 were female. Patients admitted with symptoms like, respiratory distress/shortness of breath (100.00%), persistent worsening cough (60.00%), fatigue (55.00%) and fever (40.00%). Patients were also present with sore throat (35.00%), rhinorrhea (30.00%), altered mental status (20.00%), diarrhoea (10.00%) and chest pain (5.00%). Regarding co-morbidities, around half of the patients were suffering from Diabetes (60.22%) and Hypertension (53.44%). Significant amount of patients were also suffering from chronic obstructive pulmonary disease (27.00%) and bronchial asthma (16.78%). Ischemic heart disease was (10.33%), chronic kidney disease (10.89%), hypothyroidism (9.78%) and multiple co-morbidities (15.12%) at the time of admission. Mortality rate in this case were 71.00% and most of the death cases were in between 61 to 75 years of age group (40.00%). After improvement 27.00% patients were transferred to cabin for further management. We could discharge to home directly only 2.00% of patients.

Human Machine Interaction (HMI) in Offshore Drilling - oil rig workers’ opinion about their interaction with machines

Introduction: There are huge numbers of drilling platforms in the world and once the worker on those platforms meet with an accident, the situation could be very serious. The consequence of this could be environmental, economic and in some cases fatal. Middle East, being one of the oil rich regions hence some of the largest operator works here. Companies here own various types of jack up rigs ranging from old generation rigs to the latest cyber-rig. This paper addresses what oil rig workers have to say about their interaction with machines, and how Human Machine Interaction (HMI) in Offshore Drilling can be improved with design. Method: A case study approach was undertaken The analysis in this paper draws on the interviews conducted with two different employees involved in operating the drilling operations conducted in the driller’s cabin of newly designed offshore rigs. A semi-structured approach was adopted, using themes identified through analysis of the preceding. The interviews were transcribed by the research team. Each interview was analyzed thematically with existing system and reported discrepancy Results: The study on Human Machine Interaction (HMI) and Human Factor regarding this has been conducted in the latest generation cyber rigs. There are many aspects of HMI and ergonomics but in this study a special concentration has been given to deal with the ergonomic standpoint and evaluates the drillers console controls.  Conclusions: When comparison is done with the existing machinery, few modifications can be thought of for better human machine interaction. A better human machine interaction system will ensure a more productive environment for the oil-rig workers.

Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology

Purpose

PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm²/min) and using the 3D calculated stone volume (526.7 mm³/min).

Methods

Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective).

Results

One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm²/min or 945 mm³/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite.

Conclusions

We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

Pandemic Now and Then: A Historical Perspective of Non-Pharmaceutical Interventions Adopted In Covid-19

The coronavirus disease 2019 (COVID-19), first reported in Wuhan, China is now a major global health threat - a pandemic. Public health control measures are the cornerstones in the fight against COVID-19 in the absence of an effective vaccine or proven treatment. The aim of this review was to explore the historical use case of various public health measures adopted today to tackle COVID-19 spread. Although our knowledge about this novel coronavirus transmission is evolving over time, the fundamental non-pharmaceutical interventions e.g., handwashing, wearing a mask, physical distancing, isolation, quarantine and border control which are adopted globally at present are not new. This review highlighted that historically and religiously similar approaches were practised in the medieval past for controlling disease outbreaks. The successful implementation of the public health control measures largely depends on health systems resilience, community engagement and changes in population behaviour. Combined global efforts are essential to strengthen health systems, improve the capability of research and transparent information sharing with both public and international bodies to combat the pandemic.

Clinical evaluation of chemo-sterilization through histomorphology and hormonal changes in bucks

The study was aimed to evaluate methods for nonsurgical castration of Black Bengal bucks by intra-testicular injection of calcium chloride, sodium chloride, citric acid solutions or sterile deionized water. Twelve healthy bucks were randomly allotted to groups A, B, C, and D, consisting of three bucks each. The local anesthetic, 2% lidocaine hydrochloride, was infused into the spermatic cord of each buck, followed by bilateral intra-testicular injections of 30% calcium chloride (CaCl2), 25% sodium chloride (NaCl), 50% citric acid (C6H8O7) solutions, and sterile deionized water dosed at 2 ml per testis in groups A, B, C and D respectively. To evaluate the efficacy of chemical agents on the inactivation of testes, clinical parameters, changes in scrotal circumference, testicular fine needle aspiration (TFNA), histopathology and serum concentration of testosterone and LH were monitored. A significant decrease in the scrotal circumference was observed between the intra-testicular injection and day 14 in all the bucks. Absence of spermatogenic cells and spermatozoa in the testicular biopsy was observed on day 14 post injection in the bucks, except for one in group C. Histopathology revealed massive destruction of seminiferous tubules and disorganization of the testicular parenchyma. Serum testosterone concentration declined significantly on day 14 compared with day 0. Consequently, the gradual elevation in serum LH concentration was significant. Thus, intra-testicular injections of CaCl2 and NaCl were more effective than C6H8O7 in inducing chemical-based nonsurgical castration.

Isolation and molecular identification of Lumpy Skin Disease (LSD) virus from infected cattle in Bangladesh

Lumpy Skin Disease (LSD) is a new disease of cattle in Bangladesh. It is endemic in Africa but through the last few years disease beings to spread to other countries of the world. The disease was widely spreaded in the many other countries in Asia and some parts of Europe. In Bangladesh, the disease was first time detected in April 2019, in southern part and then continued to spread all over the country.The disease caused enormous economic losses causing cutaneous and internal lesions, affecting milk production, hide quality and in some cases death of infected animal. LSD suspected samples were collected from different areas of the country during the period from July 2019 to January 2020. In this study, a total of 36 clinically suspected LSD samples of skin crustnodules, pus and ocular discharge were collected. Samples were examined by the published PCR protocol for LSD virus, GPV and SPV. Around 78% samples were found positive for LSD virus in PCR test. LSD virus was also identified from pus and ocular discharge of infected cattle. The virus can grow in the lamb testicular cell and clinically the disease is characterized by distinctive nodular lesions mostly on the skin of the affected animals.The results indicated that the LSD virus is circulating in the outbreak are as and is an emerging transboundary cattle disease in Bangladesh. Bang. J. Livs. Res. Vol. 26 (1&2), 2019: P. 15-20

Pattern of Infections and Antibiotic Sensitivity in Diabetic Patients Admitted in A Tertiary Care Hospital in Dhaka

Infections are well recognized cause of morbidity and mortality in people with diabetes. This study was done to observe the pattern of infections and microorganism with sensitivity pattern in patients with diabetes admitted at a specialized referral hospital in Dhaka. This cross-sectional study was carried out in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka from March 2014 to April 2015. It included 309 patients of diabetes (male-169, female-140; age mean±SD- 49.3±14.7 years) admitted in medicine or endocrinology department, who were screened for clinical evidence of infections according to revised McGeer criteria. Culture and sensitivity pattern of responsible microorganisms were sought from clinically appropriate specimen. Among the participants 25.9% (80 out of 309) had evidence of infection. The most common of them were urinary tract infection (53.8%) and respiratory tract infection (30.0%). E. coli and Klebsiella were the most common organisms that were isolated by urine (55.3% and 13.2%) and blood culture (57.1% and 42.9%). Acinetobacter was the most common pathogen in tracheal aspirate (80%) and Klebsiella in sputum (100%). Culture of wound swab exclusively revealed growth of Staphylococcus. E. coli was fairly sensitive to meropenem (100%), amikacin (93.5%) and nitrofurantoin (93.1%), while sensitivity of Klebsiella was almost similar to that of E. coli. Acinetobacter was fully resistant to ceftazidime, nitrofurantoin and meropenem while only modestly sensitive to ciprofloxacin and amikacin (25% and 20% respectively). Pseudomonas was 100% sensitive to ceftazidime, amikacin and meropenem, but 100% resistant to ciprofloxacin and nitrofurantoin. One in four admitted diabetes patient had evidence of infection, most commonly involving urinary and respiratory tracts. E. coli and Klebsiella both fairly sensitive to common antibiotics, were common isolates from urine and blood culture; whereas Acinetobacter isolated from tracheal aspirates and urine, was only modestly sensitive.

A257 NEW ONSET ULCERATIVE COLITIS IN A PATIENT WITH KNOWN AUTOIMMUNE HEPATITIS TYPE 1

Background

Elevated transaminases can occur in up to 17 per cent of cases of Inflammatory Bowel Disease (IBD)1, with many cases related to concurrent autoimmune conditions of the liver. Primary Sclerosing Cholangitis (PSC) is the most common autoimmune disease of the liver that is associated with IBD. Other causes of liver inflammation in patients with IBD can include Autoimmune Hepatitis (AIH).

Aims

We aim to report a case of new onset ulcerative colitis in a patient with autoimmune hepatitis type 1 in the absence of concomitant PSC.

Methods

Case report and review of literature.

Results

A 25-year-old male with painless jaundice and was found to have Autoimmune hepatitis type 1 with typical morphological changes, positive Antinuclear antibodies and elevated IgG levels. Histopathological exam of the liver did not show any direct changes to the bile ducts to suggest PSC. The patient was started on steroids and Mycophenolate Mofetil (MMF) and developed new onset diarrhea. Colonoscopy was performed and both endoscopic and pathological findings were suggestive of likely inflammatory bowel disease, although drug induced colitis (MMF) could not be excluded.

Conclusions

We conclude that there is a link between autoimmune hepatitis with IBD, in absence of concomitant PSC.

Funding Agencies

None

P1252 Left ventricular dysfunction masking symptoms of acute aortic dissection in a postpartum woman with peripartum cardiomyopathy: a case study

Acute aortic dissection carries a high mortality rate if left unrecognized and untreated, however only 60-70% of cases are accurately diagnosed in the early stages of hospital admission. This condition rarely occurs in young women but may manifest in the presence of predisposing factors such as pregnancy and preeclampsia; in which hormonal and hemodynamic alterations, exacerbated by high blood pressure, may adversely affect the aortic intima. Acute chest pain in pregnancy may caution physicians and warrant further examination, but left ventricular dysfunction can mask symptoms commonly associated with aortic dissection and delay timely diagnosis.

We present a 27-year old woman with acute aortic dissection confounded by peripartum cardiomyopathy. The patient was admitted for respiratory distress ten days after delivery by caesarean section due to severe preeclampsia. She had no complaints of chest or interscapular pain, and initially assessed with peripartum cardiomyopathy. Plain chest radiography showed cardiomegaly without mediastinal widening. Trans-thoracal echocardiography revealed severely reduced left ventricular function and a regurgitant, dilated aortic root with a visible intimal flap. Computed Tomography examination confirmed an aortic dissection Stanford Classification A extending up to the renal arteries.

Patients with acute aortic dissection may not always demonstrate classic signs or symptoms, especially when a different entity obscures the progression of disease. Nonetheless, acute aortic dissection is a life-threatening disease, and require immediate recognition. Pregnant women are at a risk towards developing a dissected aorta and different imaging modalities must be promptly utilized, even when present with atypical symptoms, to exclude such catastrophic events.

Physical activity and sedentary behaviour in Bangladesh: a systematic scoping review

OBJECTIVES

Lack of physical activity (PA) contributes to increasing prevalence of non-communicable diseases (NCDs) globally. However, little is known about PA and sedentary behaviour (SB) among populations in low- and middle-income countries (LMICs). This systematic review examined prevalence of PA and SB in Bangladesh.

STUDY DESIGN

Systematic review of the literature.

METHODS

A systematic electronic search in eight databases and a manual search of retrieved articles' references were conducted. Original research conducted in Bangladesh with PA- and/or SB-related outcome(s) were included.

RESULTS

Out of 1,162 retrieved titles, 33 articles (32 cross-sectional and one case-control study) met the inclusion criteria. Twenty-nine studies were with healthy populations: adults (n = 19); children and adolescents (n = 7); and children, adolescents and adults (n = 3). Five studies used nationally representative samples of adults and one of adolescents. Most studies (n = 26) assessed PA only; three only SB, and four both PA and SB. All studies used self-reported measures. Among healthy adults, prevalence of insufficient PA ranged from 5% to 83%. Occupational and transport-related PA contributed the most towards total PA with negligible contribution of recreational PA. Among children and adolescents, the prevalence of insufficient PA ranged between 20% and 67%. Females engaged in less PA compared to males. Limited evidence currently exists about the prevalence of SB, especially among adults.

CONCLUSIONS

PA and SB research has received little attention in Bangladesh. Critical knowledge gaps identified in this review should be taken into account when designing new research and programmes in Bangladesh and other LMICs with similar socio-economic and cultural settings.

Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291.

Complications Following General Anaesthesia in Paediatric Patients

Complications in paediatric anaesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with smell patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of cases malpractice claims. Both minor & major complication occurs most commonly in infants and children under three especially those with severe co-morbidities. Knowledge of risk profiles in paediatric anaesthesia is a starting point for the reduction of risk complication.

Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical Guide

Detailed case directed history and examination is the mainstay of dialysis access modality selection, ie site and type of access, as well as for maintenance of dialysis access for longevity. As a logical step following history and physical examination, duplex ultrasound evaluation (DUE) is the most cost effective and non-invasive screening tool for evaluation for access placement and for assessment of an established access. Pre-operative vascular mapping allows selection of the optimal dialysis access modality and site. In established accesses, duplex ultrasound testing will diagnose the majority of vascular access complications and direct proper surgical or interventional radiology management. This review outlines a practical decision-making algorithm using DUE for choosing and managing the dialysis access.