Frequency of Hyponatremia in Adults with Acute Bacterial Meningitis

Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.

A Retrospective Study of Covid-19 Patients: A Real-Life Experience in a Secondary Care Hospital, Jashore, Bangladesh

Covid-19 was first detected on 8th March of 2020 in Bangladesh after the global pandemic being started. As a new virus and disease there are scarcity of data of SARS-CoV-2 and Covid-19 respectively in our country. Aim of this study is to assess the demographic characteristics, clinical profiles, underlying co-morbid conditions, treatment pattern and outcome of the SARS-CoV-2 positive patients in Jashore, Bangladesh. This retrospective study recruited 208 RT-PCR positive Covid-19 patients from 1st April 2020 to 15th May 2020 who appeared at Flu corner centre, 250 Bedded General Hospital, Jashore, Bangladesh. Data was collected online through telephone, mobile and email due to the high contagious property of Covid-19. Out of total 208 Covid-19 patients, the mean age of the participants was 37.0±15.0 years with a male and female ratio of 2.06:1. Underlying comorbidities were documented in 36.5% of total Covid-19 patents of which hypertension in 16.3%, diabetes in 14.4%, respiratory diseases in 8.7% and pre-existing coronary arterial diseases in 6.3% patients. Though 17.8% Covid-19 patients were asymptomatic, the most common symptoms were fever (68.8%), cough (30.8%), myalgia (30.8%), sore throat (22.1%), vertigo (21.6%), respiratory distress (20.7%), anorexia (17.8%), nasal congestion (16.3%), nausea or vomiting (13.9%) and diarrhoea (13.0%). Whereas, the symptomatic patients were classified as flu-like illness (77.9%), mild to moderate pneumonia (2.4%) and severe pneumonia (1.9%). Many patients (19.2%) recovered spontaneously and 22.1% patients cured by the only simple symptomatic treatment. The most commonly received antibiotics were Azithromycin and Doxycycline. Home stay management was demonstrated in 73.1% patients, whereas, 26.0% patients required general ward admission and only 0.9% patients required referral for the HDU or ICU management with an average duration of hospital stay of 16±6 days. A high satisfactory outcome was found as evident by complete recovery in 98.08% of Covid-19 patients, complications (0.48%) and fatality (1.44%) even in this secondary care center. Therefore, we can conclude that the disease was well managed with highly satisfactory outcomes even in the low resource health care setting in the early stage of Covid-19 pandemic era. Hence, the early case detection, identification of the high-risk groups and proper management may mitigate to develop complications and fatalities of Covid-19.

An Aspen plus process simulation model for exploring the feasibility and profitability of pyrolysis process for plastic waste management

Plastics, integral to various human activities, have led to a surge in production, posing substantial challenges in waste management. The persistent non-biodegradability of plastics, taking over a century to decompose, necessitates exploration into technologies for their conversion into sustainable fuels. Pyrolysis, an oxygen-free thermal decomposition process, emerges as a promising avenue for producing liquid fuels from plastic waste. This study's primary objective is to create and validate an Aspen Plus simulation model, enabling techno-economic evaluation and sensitivity analysis of pyrolysis for converting waste plastics into liquid fuels. Critical parameters-temperature, retention time, and particle size-are examined for their impact on product yield and quality. The methodology involves model development, validation, and subsequent simulations with various waste plastic types under different pyrolysis conditions. Experimental investigation using waste high-density polyethylene (HDPE) in an auger reactor yielded an oil yield of 61.29%, char yield of 10.98%, and syngas yield of 27.73% at 525 °C. Post-validation against this data, the model explored four plastic types, revealing significant influences of plastic type and reactor temperature on product yields. Polystyrene (PS) at 500 °C produced the highest oil content at 83.69%, with temperature affecting yield before secondary cracking. Techno-economic evaluation for a pyrolysis plant processing 10,000 tons of waste HDPE annually indicated a minimum selling price (MSP) of $302.50/ton, a net present value (NPV) of $12,594,659.7, and a 1.03-year payback period. This study provides crucial insights for designing an economically viable and sustainable pyrolysis process, guiding further research and industrial implementation.

Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh

BACKGROUND

Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh.

AIM

Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh.

METHODS

We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities.

RESULTS

The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level.

CONCLUSION

The integrated intervention package improved IPCAF score in all facilities.

Advances in identifying and managing emerging contaminants in aquatic ecosystems: Analytical approaches, toxicity assessment, transformation pathways, environmental fate, and remediation strategies

Emerging contaminants (ECs) are increasingly recognized as threats to human health and ecosystems. This review evaluates advanced analytical methods, particularly mass spectrometry, for detecting ECs and understanding their toxicity, transformation pathways, and environmental distribution. Our findings underscore the reliability of current techniques and the potential of upcoming methods. The adverse effects of ECs on aquatic life necessitate both in vitro and in vivo toxicity assessments. Evaluating the distribution and degradation of ECs reveals that they undergo physical, chemical, and biological transformations. Remediation strategies such as advanced oxidation, adsorption, and membrane bioreactors effectively treat EC-contaminated waters, with combinations of these techniques showing the highest efficacy. To minimize the impact of ECs, a proactive approach involving monitoring, regulations, and public education is vital. Future research should prioritize the refining of detection methods and formulation of robust policies for EC management.

Wound Infection in Surgical Ward of a Tertiary Care Hospital in Dhaka City: The Identification of Organisms and Their Sensitivity Pattern

Wound infection is one of the most important causes of morbidity and mortality worldwide. The aim of this study was to identify the organisms and their sensitivity pattern from wound infection patients attending in a tertiary care hospital in Dhaka city. This cross-sectional study was carried out in a total of 240 aseptically collected wound swab samples from wound infection suspected patients visiting Bangladesh Medical College Hospital, Dhaka, Bangladesh were analyzed from July 2017 to June 2019. Bacteriological culture of the samples, colony morphology, Gram's staining, and biochemical tests were done following standard microbiological techniques. The antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion technique following clinical and laboratory standards institute guidelines. Out of 240 wound swab samples from suspected patients of wound infection, 126(52.5%) showed bacterial growth whereas 114(47.5%) were culture negative. No sample yielded more than one organism. Among 126 culture positive cases 75(59.52%) were male and 51(40.48%) were female. The higher rate of bacterial infections 26.19% was noted in the age group of 21-30 years, followed by the age group of 31-40 years, 41-50 years, 51-60 years. Among 126 culture positive cases, 74.6% were Gram negative and 25.4% were Gram positive bacteria. Out of total 126 isolates, E. coli was the most prevalent pathogen 31(24.60%) followed by Staphylococcus aureus 29(23.01%); Pseudomonas 27(21.43%); Klebsiella 18(14.29%); Enterobacter 12(9.52%); Acinetobacter 4(3.17%), while Coagulase negative Staphylococcus 3(2.38%) and Proteus 2(1.59%) were least detected isolates in wound swab. Highly effective antibiotics against Staph aureus were vancomycin 100.0%; imipenem 100.0%; linezolid 100.0% and meropenem 89.65%. Amikacin; gentamicin; netilmicin; imipenem and meropenem showed higher sensitivity in E coli, Klebsiella and Enterobacter species. Colistin was 88.88% effective against Pseudominas spp. followed by imipenem 81.48%, piperacillin-tazobactam 77.78%, meropenem 70.37% and amikacin 51.85%. Acinetobacter spp. showed 75.0% and 50.0% sensitivity to netilmicin and colistin respectively. Injectable and reserve drugs were sensitive to bacterial populations among patients of wound infections in our hospital. It is a wake-up call for clinician to treat wound infections. To prevent the increase resistance to antibiotics, it is necessary to avoid the administration of uncontrolled and unnecessary antibiotics available.

Digital Gangrene is a Rare Presentation of Takayasu's Arteritis

Takayasu's arteritis is a chronic large vessel vasculitis that mainly affects the aorta and its major branches such as brachiocephalic, carotid, subclavian, vertebral, renal, coronary and pulmonary arteries. It most commonly occurs in female at child bearing age and female to male ratio is 8:2. Initial presentations of Takayasu's arteritis may be nonspecific like fever, malaise, weakness, fatigue, arthralgia, myalgia and weight loss but in advanced stage there may be features of vascular inflammation like segmental stenosis, occlusion, dilatation and/or aneurysm. It is a sub acute process over months to years and usually with good collateral formation. So, critical limb ischemia due to acute onset of vascular stenosis is very rare. Here we are reporting a case of a 50-year- old male patient who presented with digital gangrene due to critical limb ischemia. Though the age of onset was at 50 years and the patient lacks clinical features like constitutional symptoms, bruit, claudication, asymmetrical blood pressure, the patient was diagnosed as a case of Takayasus's arteritis. The patient dramatically improved with oral glucocorticoid treatment. Although rare, takayasu's arteritis can presents only with digital gangrene without having other clinical features. The physicians should be aware of this unusual but limb threatening presentation and more studies are needed to find out the exact mechanism of this presentation.

Advancements in algal membrane bioreactors: Overcoming obstacles and harnessing potential for eliminating hazardous pollutants from wastewater

This paper offers a comprehensive analysis of algal-based membrane bioreactors (AMBRs) and their potential for removing hazardous and toxic contaminants from wastewater. Through an identification of contaminant types and sources, as well as an explanation of AMBR operating principles, this study sheds light on the promising capabilities of AMBRs in eliminating pollutants like nitrogen, phosphorus, and organic matter, while generating valuable biomass and energy. However, challenges and limitations, such as the need for process optimization and the risk of algal-bacterial imbalance, have been identified. To overcome these obstacles, strategies like mixed cultures and bioaugmentation techniques have been proposed. Furthermore, this study explores the wider applications of AMBRs beyond wastewater treatment, including the production of value-added products and the removal of emerging contaminants. The findings underscore the significance of factors such as appropriate algal-bacterial consortia selection, hydraulic and organic loading rate optimization, and environmental factor control for the success of AMBRs. A comprehensive understanding of these challenges and opportunities can pave the way for more efficient and effective wastewater treatment processes, which are crucial for safeguarding public health and the environment.

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.

Design and operation of a hybrid LED/LD-pumped phosphor-converted white-light lamp

Illumination sources based on phosphors, pumped by laser diodes (LDs), have seen rapid developments over the past decade. Here, we present a new, to the best of our knowledge, design that features both spectral richness and the capability for high brightness. Complete design details and operational characterization have been described. This basic design can be extended in various ways to customize such lamps for different operational requirements. A hybrid arrangement of both LEDs and an LD is used to excite a mixture of two phosphors. The LEDs, in addition, provide a blue fill-in to enrich output radiation and to tune the chromaticity point inside the white region. The LD power, on the other hand, can be scaled up to generate very high brightness levels that are not achievable with pumping from LEDs alone. This capability is gained using a special transparent ceramic disk that carries the remote phosphor film. We also show that the radiation from our lamp is free from speckle-producing coherence.

A 60-year-old Man Presented with Relapsing Polychondritis with Haemophagocytic Lymphohistiocytosis

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

A Case of Bilateral Middle Cerebral Artery Stenosis with Unilateral M1 Stenting

Stroke is not only the third leading cause of death in Bangladesh but it also causes a high number of disability adjusted life years loss (485 per 10,000 people). Appropriate treatment of recurrent stroke has to be established. Here we present A 60 year's old male patient with history of recurrent stroke who came in our out patient department. He had progressing bilateral middle cerebral artery atherosclerotic stenosis (100.0% on right side and 52.0% on left side) which was less severs but symptomatic at dominant hemisphere (left). Percutaneous transluminal angioplasty with stenting was done to prevent further ischemia and to increase the blood supply of remaining brain parenchyma. On post stenting follow-up patient did not suffered from any new event of stroke for about 22 months. Percutaneous transluminal angioplasty with stenting is an effective procedure to prevent recurrent stroke for intracranial atherosclerotic disease.

Comprehensive molecular characterization of lung tumors implicates AKT and MYC signaling in adenocarcinoma to squamous cell transdifferentiation

BACKGROUND

Lineage plasticity, the ability to transdifferentiate among distinct phenotypic identities, facilitates therapeutic resistance in cancer. In lung adenocarcinomas (LUADs), this phenomenon includes small cell and squamous cell (LUSC) histologic transformation in the context of acquired resistance to targeted inhibition of driver mutations. LUAD-to-LUSC transdifferentiation, occurring in up to 9% of EGFR-mutant patients relapsed on osimertinib, is associated with notably poor prognosis. We hypothesized that multi-parameter profiling of the components of mixed histology (LUAD/LUSC) tumors could provide insight into factors licensing lineage plasticity between these histologies.

METHODS

We performed genomic, epigenomics, transcriptomics and protein analyses of microdissected LUAD and LUSC components from mixed histology tumors, pre-/post-transformation tumors and reference non-transformed LUAD and LUSC samples. We validated our findings through genetic manipulation of preclinical models in vitro and in vivo and performed patient-derived xenograft (PDX) treatments to validate potential therapeutic targets in a LUAD PDX model acquiring LUSC features after osimertinib treatment.

RESULTS

Our data suggest that LUSC transdifferentiation is primarily driven by transcriptional reprogramming rather than mutational events. We observed consistent relative upregulation of PI3K/AKT, MYC and PRC2 pathway genes. Concurrent activation of PI3K/AKT and MYC induced squamous features in EGFR-mutant LUAD preclinical models. Pharmacologic inhibition of EZH1/2 in combination with osimertinib prevented relapse with squamous-features in an EGFR-mutant patient-derived xenograft model, and inhibition of EZH1/2 or PI3K/AKT signaling re-sensitized resistant squamous-like tumors to osimertinib.

CONCLUSIONS

Our findings provide the first comprehensive molecular characterization of LUSC transdifferentiation, suggesting putative drivers and potential therapeutic targets to constrain or prevent lineage plasticity.

Outcome of Danis-Weber Type-B ankle fracture treated by Pre-contoured Distal Fibular Locking Plate

Danis-Weber type-B ankle fracture is one of the most common injuries in young and active individual. This fracture offers a considerable challenge to orthopedic surgeon. Though there are several options for treating such type of fracture, ORIF by Pre-contoured Distal Fibular Locking Plate is the preferred option in the recent years. This descriptive type of observational study was performed from July 2017 to June 2019 in NITOR. Thirty (30) patients, 22 male and 8 female with an average age of 39 years with Danis-Weber type-B ankle fracture underwent ORIF by Pre-contoured Distal Fibular Locking Plate for fractured fibula and ORIF by 4.0mm cannulated cancellous screw for fractured medial malleolus. All the patients were initially managed by analgesic and short leg posterior slab. Average follow up was 24 weeks. Final outcome was assessed by AOFAS score. The main cause of injury was RTA (56.67%). Mean operation time was 1.2 hours. Mean duration of Hospital stay was 16.43±1.73 days. Superficial infection was in 3.33% and skin necrosis in 3.33% patient. Mean duration of radiological healing was 12.73±0.39 weeks. At final follow up, mean dorsi flexion was 10.93°±0.357° and plantar flexion was 50.93°±0.357°. Ninety percent (90%) patient had no difficulties in walking on any surface; 96.67% patient had stable ankle hind foot; 86.67% patient had good. Ten percent (10%) had fair and 3.33% patient had poor alignment of foot. The mean score in this study was 88.67±2.31. Satisfactory outcome was observed in 86.67% patients and 13.33% had unsatisfactory results. On the basis of results in the present study, it can be concluded that treatment of Danis-Weber type-B ankle fracture by Pre-contoured Distal Fibular Locking Plate is an effective and reliable method.

Multi-omic analysis of lung tumors defines pathways activated in neuroendocrine transformation

Lineage plasticity is implicated in treatment resistance in multiple cancers. In lung adenocarcinomas (LUADs) amenable to targeted therapy, transformation to small cell lung cancer (SCLC) is a recognized resistance mechanism. Defining molecular mechanisms of neuroendocrine (NE) transformation in lung cancer has been limited by a paucity of pre-/post-transformation clinical samples. Detailed genomic, epigenomic, transcriptomic, and protein characterization of combined LUAD/SCLC tumors, as well as pre-/post-transformation samples, support that NE transformation is primarily driven by transcriptional reprogramming rather than mutational events. We identify genomic contexts in which NE transformation is favored, including frequent loss of the 3p chromosome arm. We observed enhanced expression of genes involved in PRC2 complex and PI3K/AKT and NOTCH pathways. Pharmacological inhibition of the PI3K/AKT pathway delayed tumor growth and NE transformation in an EGFR-mutant patient-derived xenograft model. Our findings define a novel landscape of potential drivers and therapeutic vulnerabilities of neuroendocrine transformation in lung cancer.

Temporal trends in between and within-country inequalities in caesarean delivery in low- and middle-income countries: a Bayesian analysis

OBJECTIVE

To provide updated information about between-country variations, temporal trends and changes in inequalities within countries in caesarean delivery (CD) rates.

DESIGN

Cross-sectional study of Demographic and Health Survey (DHS) during 1990-2018.

SETTING

74 low- and middle-income countries (LMICs).

POPULATION

Women 15-49 years of age who had live births in the last 3 years.

METHODS

Bayesian linear regression analysis was performed and absolute differences were calculated.

MAIN OUTCOME MEASURE

Population-level CD by countries and sociodemographic characteristics of mothers over time.

RESULTS

CD rates, based on the latest DHS rounds, varied substantially between the study countries, from 1.5% (95% CI 1.1-1.9%) in Madagascar to 58.9% (95% CI 56.0-61.6%) in the Dominican Republic. Of 62 LMICs with at least two surveys, 57 countries showed a rise in CD during 1990-2018, with the greatest increase in Sierra Leone (19.3%). Large variations in CD rates were observed across mother's wealth, residence, education and age, with a higher rate of CD by the richest and urban mothers. These inequalities have widened in many countries. Stratified analyses suggest greater provisioning of CD by the richest mothers in private facilities and poorest mothers in public facilities.

CONCLUSIONS

CD rates varied substantially across geographical locations and over time, irrespective of public or private health facilities. Changes in CD rates continue across wealth, place of residence, education, and age of mother, and are widening in most study countries.

TWEETABLE ABSTRACT

Increasing caesarean delivery rates were greater among the richest and urban mothers than their counterparts, with widened gaps in LMICs.

Effects of DBD air plasma treatment on the enhancement of black gram (Vigna mungo l.) seed germination and growth

Effects of black gram (vigna mungo L.cv. Barimash 3) seed treatments with 400 torr dielectric barrier discharge (DBD) air plasma on seed surface morphology, seed germination, seedling growth and antioxidant enzyme activities in the roots, shoots and leaves were investigated. The plasma discharge voltage, frequency, electrode spacing, gas temperature and power were 5kV, 4.5kHz, 60mm, 310K and 45W, respectively. The seeds were treated for the duration ranging from 20 to 180 s. Seed germination rate, seedling growth, total chlorophyll content, total soluble protein and sugar concentrations in the seedlings grown from the treated seeds were found to increase 13.67%, 37.13%, 37.26%,53.60% and 51.71%, respectively, with respect to control. This study reveals that the DBD air plasma was involved in the enhancement of nitrogen complex in the seed coat of black gram which upregulated the protein through nitrogen conversion that was ultimately responsible for the increased seed germination and seedling growth of black gram.

Bacterial leaf blight resistance in rice: a review of conventional breeding to molecular approach

Breeding for disease resistant varieties remains very effective and economical in controlling the bacterial leaf blight (BLB) of rice. Breeders have played a major role in developing resistant rice varieties against the BLB infection which has been adjudged to be a major disease causing significant yield reduction in rice. It would be difficult to select rice crops with multiple genes of resistance using the conventional approach alone. This is due to masking effect of genes including epistasis. In addition, conventional breeding takes a lot of time before a gene of interest can be introgressed. Linkage drag is also a major challenge in conventional approach. Molecular breeding involving markers has facilitated the characterization and introgression of BLB disease resistance genes. Biotechnology has brought another innovation in form of genetic engineering (transgenesis) of rice. Although, molecular breeding cannot be taken as a substitute for conventional breeding, molecular approach for combating BLB disease in rice is worthwhile given the demand for increased production of rice in a fast growing population of our society. This present article highlights the recent progress from conventional to molecular approach in breeding for BLB disease resistant rice varieties.

Incidence and Prevention of Biliary Leakage after Partial Liver Resection in a Tertiary Level Hospital

Biliary leakage is a postoperative complication of liver resection which may have considerable consequences. The aim of this study is to evaluate the incidence of post hepatectomy biliary leakage and to find out the preventive measures by systemic literature reviews. This observational study was conducted on 500 patients who required various forms of hepatic resection at the Department of Hepatic Surgery - 4, Eastern Hepatobiliary Surgery Hospital of The Second Military Medical University, Shanghai, China from September 2014 to July 2016. Out of 500 cases 413(82.6%) were males and 87(17.4%) females with female to male ratio 1:4.75. A total 23(4.6%) patients developed biliary leakage after surgery. Incidence of biliary leakage was more 21/440 (4.8%) in malignant diseases. Intrahepatic cholangio carcinoma had highest 4/23 (17.4%) incidence of biliary leakage among malignant diseases. It was lowest 2/60 (3.3%) in benign diseases. Non anatomical resection found to have higher incidence 5/17 (29.4%) of biliary leakage. Among the anatomical resection left extended hepatectomy found more porn 2/6 (33.3%) to develop biliary leakage. No biliary leakage test was done in 111(22.2%) patients to prevent biliary leakage. In other patients biliary leakage tests were carried out and there was not much variation in incidence of biliary leakage. Maximum patients 380(76%) were discharged from the hospital within 11-15 days after operation. Patients with biliary leakage had higher hospital stay. There are still no standardized methods to prevent biliary leakage because of the lack of clear evidence that support their use. Therefore, the development of novel technical strategies to reduce biliary leakage is required.

Evaluation of Intraoral Burning Sensation in Response to Heat-Cured and Self-Cured Acrylic Resin Denture Base Material

The objective of this prospective experimental clinical trial was to evaluate intraoral burning sensation in response to heat-cured and self-cured acrylic resin denture base material and carried out in the department of Prosthodontics of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from February 2014 to September 2015. Forty eight patients were evaluated in this study; of them 35(72.92%) patients were male and 13(27.08%) patients were female with age range from 24 to 70 years. In this study 48 patients were evaluated in term of burning sensation, of them 24 patients were provided with heat-cured acrylic resin denture and were considered as Group A and 24 patients were provided with self-cured acrylic resin denture and were considered as Group B. In Group A 14(58.4%) at 1st week, 2(8.4%) at 1st month, 10(41.8%) at 3rd month and 5(21.0%) at 6th month developed burning sensation. On the other hand the values were 18(75.0%), 22(91.6%), 14(58.2%) and 2(8.4%) at 1stweek, 1st month, 3rd month, and 6th month respectively. Chi-square test was done for statistical analysis and p value was <0.05. So, results were statistically significant.

Heavy ion-acoustic rogue waves in electron-positron multi-ion plasmas

The nonlinear propagation of heavy-ion-acoustic (HIA) waves (HIAWs) in a four-component multi-ion plasma (containing inertial heavy negative ions and light positive ions, as well as inertialess nonextensive electrons and positrons) has been theoretically investigated. The nonlinear Schrödinger (NLS) equation is derived by employing the reductive perturbation method. It is found that the NLS equation leads to the modulational instability (MI) of HIAWs, and to the formation of HIA rogue waves (HIARWs), which are due to the effects of nonlinearity and dispersion in the propagation of HIAWs. The conditions for the MI of HIAWs and the basic properties of the generated HIARWs are identified. It is observed that the striking features (viz., instability criteria, growth rate of MI, amplitude and width of HIARWs, etc.) of the HIAWs are significantly modified by the effects of nonextensivity of electrons and positrons, the ratio of light positive ion mass to heavy negative ion mass, the ratio of electron number density to light positive ion number density, the ratio of electron temperature to positron temperature, etc. The relevancy of our present investigation to the observations in space (viz., cometary comae and earth's ionosphere) and laboratory (viz., solid-high intense laser plasma interaction experiments) plasmas is pointed out.

Malnutrition and non-communicable diseases among Bangladeshi women: an urban-rural comparison

BACKGROUND/OBJECTIVES

This study aims at examining the urban-rural differentials in the effects of socioeconomic predictors on underweight and obesity of ever-married women in Bangladesh. The effect of malnutrition and other risk factors on non-communicable diseases is also examined.

SUBJECTS/METHODS

The information regarding nutritional status, socioeconomic and demographic background, and non-communicable diseases of ever-married women was extracted from the nationally representative, cross-sectional Bangladesh Demographic and Health Survey (BDHS 2011) data set. Both bivariate (χ2 test) and multivariate (multinomial logistic regression model) analyses were performed in determining the risk factors of malnutrition. The effect of malnutrition and associated risk factors on non-communicable diseases was determined using binary logistic regression models.

RESULTS

The overall prevalence as well as the effects of individual risk factors of malnutrition differ in urban and rural settings. Regional differentials in the prevalence of underweight were statistically significant only for rural areas. In rural and urban settings, women from households with poor economic status were 67% (odds ratio (OR) 0.33, 95% CI 0.26-0.43) and 81% (OR=0.19, 95% CI 0.13-0.29) less likely to be overweight, respectively, with respect to those from affluent households. Women from the Rangpur division were significantly more likely to suffer from anemia (OR=1.41, 95% CI 1.13-1.77) and hypertension (OR=1.67, 95% CI 1.19-2.34) than those from the Sylhet division (reference division). With respect to those considered as underweight, women who were categorized as overweight were 0.47 (OR=0.53, 95% CI 0.43-0.65) times less likely to suffer from anemia, and 1.83 (OR=2.83, 95% CI 1.99-4.02) and 1.70 (OR=2.70, 95% CI 2.09-3.50) times more likely to suffer from diabetes and hypertension, respectively.

CONCLUSIONS

Rural-urban differentials in the effects of individual risk factors of malnutrition were observed. Wealth status of households and nutritional status of women showed significant effect on the prevalence of anemia, diabetes and hypertension.

Exceptional Multiple Foreign-Body Ingestion by a Patient with Schizophrenia

Swallowing foreign body in adult is uncommon. This mostly occurs accidentally or in psychologically unsound patient. A 32-years-old male patient with abdominal pain admitted in surgery department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with a history of swallowing various objects. After endoscopic confirmation and psychological evaluation he underwent laparotomy and 29 different objects were removed from his stomach by Gastrotomy. He was psychiatrically evaluated after recovery from operation and was found to be suffering from Schizophrenia with cannabis use. The aim of reporting this case can raise awareness at the patients complains should be taken seriously to prevent morbidity and even mortality.

Serum Zinc, Copper, Magnesium & Phosphorus Level in Children with Severe Acute Malnutrition (SAM)

Malnutrition is widely prevalent among hospitalized children in most developing countries including Bangladesh. Though malnutrition accounts for the high rate of under 5 mortality sometimes it is overlooked. Keeping in this in mind A comparative cross sectional study was done in Mymensingh Medical College Hospital from 1st October 2009 to 31st May 2011. Children aged 1-5 years with presence of one or more criteria WHM <70%, WHZ-score <-3SD, Bipedal edema & Mid upper arm circumference <110mm were taken as study group and children aged 1-5 years with normal growth allowable normal range of variation is between 3rd and 97th centile curve or median (50th centile) ±2SD of weight for age growth chart (CDC growth chart, USA, 2000) were taken as reference group. Persistent diarrhea, Patients taking medications containing zinc, copper, magnesium, phosphorus & calcium, PEM with shock were excluded from study group. Nutritional assessment was done according to WHO criteria of SAM. Serum Zinc, Copper Magnesium and Phosphorus level were determined by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer, model no. 969, Spain. Total 120 study populations were taken. Ninety Out of 120 were taken as a study group (SAM) & 30 were reference group. In reference group serum Zn, Cu, Mg, P value was 103.80±8.86μg/dl, 135.92±13.57μg/dl, 2.31±0.18mg/dl, 3.96±0.22mg/dl respectively. In study group serum Zn, Cu, Mg, P value was 60.33±11.08μg/dl, 80.60±15.46μg/dl, 1.47±0.22mg/dl, 2.00±0.52mg/dl respectively. All these results show that there is significant difference between study group & reference group. Considering the decreased level of these parameters, close biochemical monitoring and follow up should be emphasized for the children with SAM.

Catch assessment of artisanal marine fishing gears in Cox’s Bazar and Teknaf of Bangladesh

Studies were conducted on catch assessment of some artisanal marine fishing gears operated in Cox’s Bazar and Teknaf areas from April 2014 to April 2015. Sixteen types of fishing gears were identified, of which gill net, beach seine net, estuarine set bag net, marine set bag net and trammel net occupy major fishing activities. Although estuarine set bag net (ESBN) is a legally restricted fishing gear recorded the highest catch per unit effort (CPUE) (110 kg/gear/day) in July followed by marine set bag net (MSBN) (105 kg/gear/day) in Cox’s Bazar and the highest CPUE was recorded 100 kg/gear/day by ESBN in June followed by MSBN (90 kg/gear/day) in Teknaf. Out of 52 species of fishes, the major fish species abundantly caught by these gears were Poa (Otolithoides argenteus), Churi (Trichiurus haumela), Loittya (Harpadon nehereus), Ranga choukha (Lutjanus johni), Lal poa (Johnius argentatus), Olua (Coilia dussumieri), Rup chanda (Stromateus chinensis), (Stromateus argenteus) and Ilish (Tenualosa ilisha). Besides these fish species, 10 commercially important shrimp species and 3 important crab species were also recorded during the study period. The peak season of availability of most fish species was June and July while lean season was December and January. This study indicated that Otolithoides argenteus) was the dominant fish species followed by Trichiurus haumela, Harpadon nehereus and Coilia dussumieri.Progressive Agriculture 27 (2): 228-234, 2016

Comparison between azithromycin and cefixime in the treatment of typhoid fever in children

An intervention study was carried out in the department of paediatrics of Mymensingh Medical College Hospital, Mymensingh to compare the clinical efficacy of Azithromycin in the treatment of childhood typhoid fever with that of cefixime for a period of one year from January 2011 to December 2011. A total of 60 cases of typhoid fever were enrolled in to a randomized clinical trial and was divided into two groups. The inclusion criteria of the cases were: Documented fever for more than 4 days plus two or more of the following clinical features: toxic physical appearance, intestinal complaints, coated tongue, ceacal gurgling, hepatomegaly and splenomegaly, diarrhoea and constipation plus positive Widal test and/or blood culture positivity. Patients who had complication like GIT heamorrhage; intestinal perforaion and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg/day for a period of 07 days Cefixime was given at a dose of 20mg/kg/day in two divided dose for 14 days. The mean time of defervesence was 4.05+1.14 days with azithromycin and 3.41+0.95 with cefixime respectively. The minimum defervesence time was 02 days and maximum defervesence time was 07 days. Clinical cure rate was 87% in azithromycin group and 93% in cefixime group. No serious adverse effect was noted related to azithromycin and cefixime therapy except nausea, vomiting, diarrhoea and jaundice. It was found that azithromycin is almost as effective as cefixime in the treatment of typhoid fever.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Environmental Issues of Emerging Pangas (Pangasianodon hypophthalmus) Farming in Bangladesh

Pangas farming is one of the fastest growing types of aquaculture in Bangladesh. A study was conducted to understand environmental issues of emerging pangas farming in Bangladesh. Data were collected through questionnaire interview and focus group discussion (FGD) with pangas farmers. All together 40 farmers were interviewed and 6 FGD sessions were conducted in Muktagacha, Trishal and Valuka Upazila of Mymensingh district. Positive and negative aspects of environmental integrity were compared. Potential environmental impacts of pangas farming were assessed using certain parameters like land use pattern, water quality management and eutrophication, pond waste management, use of chemicals and antibiotics, and escape of fish. It was found that conversion of agricultural land and beels into pangas pond were remarkable which leads to the quick loss of agricultural land that reduces rice production. The unutilized feed portion accumulated in pangas ponds produced huge pond bottom waste and caused water quality deterioration. Eutrophication was found as a common problem along with discharge of highly nutrient rich water in the paddy field. Management of pond bottom waste was found quite poor though it has some good use in vegetable production in the pond dyke. Indiscriminate use of chemicals and antibiotics had an adverse impact on the environment and human health.DOI: http://dx.doi.org/10.3329/pa.v24i1-2.19118 Progress. Agric. 24(1&2): 159 - 170, 2013

Investigation of change in surface area and grain size of cadmium titanate nanofibers upon annealing and their effect on oxygen sensing

We have investigated the phase changes in CdTiO3 nanofibers as the annealing temperature of nanofibers was increased from 600 to 1200 °C. The nanofibers annealed at 600 °C were ilmenite with a very small amount of CdO. Upon annealing at 950 °C, CdO was completely removed. Annealing at 1000 °C yielded pure perovskite nanofibers, and at temperatures above 1100 °C rutile TiO2 nanofibers were obtained. Brunauer-Emmett-Teller (BET) analysis showed that with increase in annealing temperature the surface area of nanofibers was decreased. The nanofibers annealed at 600 °C have the higher surface area of ∼9.41 m(2)/g. Then oxygen sensors using CdTiO3 nanofibers annealed at 600 °C (ilmenite) and 1000 °C (perovskite) were fabricated. The sensitivity of the ilmenite nanofibers sensor was 2 times than that of the perovskite nanofibers sensor. The response and recovery times were 120 and 23 s, respectively, for the ilmenite nanofibers sensor, whereas response and recovery times were 156 and 50 s, respectively, for the perovskite nanofibers sensor. Better oxygen characteristics of ilmenite nanofibers are attributed to their large surface area and porosity. Therefore, we believe that ilmenite CdTiO3 nanofibers are potential candidates to develop practical oxygen sensors.

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

Morphometric study of thyroid angle in different age and sex in Bangladeshi cadaver

This cross sectional descriptive study was to measure the thyroid angle and to establish the difference between sexes of different age groups in Bangladeshi cadaver. A total 60 human larynges were collected by purposive sampling from October 2008 to March 2009. Among them 45(male 23 and female 22) were collected from Bangladeshi cadavers (9 to 60 years) at the autopsy laboratory of Department of Forensic Medicine and 15 (male 6 and female 9) from stillborn infants of viable age (28 to 40 weeks of gestation) from Gynaecology and Obstetrics Department of Mymensingh Medical College, Mymensingh. The thyroid angle was measured and significant differences of the dimensions between different age and sex groups were observed. In the present study observed findings was compared with those of other researchers. The mean±SD thyroid angle was found as 65.00±11.65 degree in age Group A (28 to 40 weeks of gestation), 73.69±6.56 degree in age Group B (9 to 16 years) and 77.76±7.76 degree in age Group C (17 to 60 years). The mean thyroid angle was higher in female (83.1667±5.78220 degree) than that in male (73.9412±7.09460 degree) and statistically moderately significant in Group C, where t = 3.853 and p = 0.001. In statistical analysis, differences between age and sex groups were calculated by using Students (unpaired) 't' test. The present study revealed that the value was significantly greater in adult female than male and the value increased with age.

Nutritional status among primary school children of Mymensingh

The school age is a dynamic period of growth and development. During this period physical, mental, social development of child takes place. The purpose of the study is to observe the nutritional status among the school aged children and to compare the urban and rural children. It is a descriptive cross sectional study. Data were collected from 600 children of primary school in Mymensingh district for a period of one year from October 2009 to September 2010. Among the primary school children in Mymensingh, Bangladesh 15.1% were wasted, 22.1% were stunted, 2.3% were both stunted and wasted and 60.4% children were within normal limit. Malnutrition was more in rural area in comparison with urban area. In rural area severely underweight, moderately underweight children were 62.1%, 65.6%, and corresponding result in urban area were 37.9%, 34.4% respectively. In rural area severely stunted, moderately stunted children were 100%, 58.6%, and in urban area they were 0%, 41.4% respectively. Again severely wasted and moderately wasted, children were 62.5%, 59.5% in rural area and 37.5%, 40.5% in urban area respectively. Malnutrition among girls were more then the boys.

Anatomical and congenital anomalies of extra hepatic biliary system encountered during cholecystectomy

Anomalous biliary anatomy is frequently encountered by surgeons during cholecystectomy. Importance of its recognition lies in avoiding serious biliary injuries. This study was carried out to assess the frequency of anatomical and congenital anomalies of extrahepatic biliary system in patients undergoing cholecystectomy. This is an observational study performed in the Department of Surgery, Combined Military Hospital (CMH) Momenshahi, CMH Ghatail and Mymensingh Medical College Hospital for a period of five years from June 2007 to June 2012. Two hundred and fifty diagnosed patients of cholelithiasis undergoing routine cholecystectomy were assessed for anatomical and congenital anomalies of extra hepatic biliary system as well as vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during cholecystectomy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries. Two hundred and fifty cases of cholelithiasis comprising 216(86.4%) females and 34(13.6%) males with mean age of 39.15 years were included in the study. Clinical presentation includes mainly pain in right hypochondrium (74.8%), pain in right hypochondrium and epigastrium (18.8%) and pain in epigastrium alone (7.6%). Laparoscopic cholecystectomy was done in 157 patients and 93 patients were treated by open procedure including conversion cases. Operative findings revealed variations in 38 cases (15.2%) mainly involving cystic artery (8%), cystic duct (4.4%) and gall bladder (1.6%). Postoperative complications includes bleeding 3.6%, biliary leak from drain 1.6% and CBD injury 0.8% giving rise to 0.8% morbidity, however, no mortality was seen in this series. Anatomical and congenital anomalies of biliary tree, are not common but may be significant during surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.

Antagonistic potentiality of Trichoderma harzianum towards seed-borne fungal pathogens of winter wheat cv. Protiva in vitro and in vivo

The antagonistic effect of Trichoderma harzianum on a range of seed-borne fungal pathogens of wheat (viz. Fusarium graminearum, Bipolaris sorokiniana, Aspergillus spp., and Penicillium spp.) was assessed. The potential of T. harzianum as a biocontrol agent was tested in vitro and under field conditions. Coculture of the pathogens and Trichoderma under laboratory conditions clearly showed dominance of T. harzianum. Under natural conditions, biocontrol effects were also obtained against the test fungi. One month after sowing, field emergence (plant stand) was increased by 15.93% over that obtained with the control treatment, and seedling infection was reduced significantly. Leaf blight severity was decreased from 22 to 11 at the heading stage, 35 to 31 at the flowering stage, and 86 to 74 at the grain filling stage. At harvest, the number of tillers per plant was increased by 50%, the yield was increased by 31.58%, and the 1,000-seed weight was increased by 21%.

Phosphine resistance in Tribolium castaneum and Rhyzopertha dominica from stored wheat in Oklahoma

Phosphine gas, or hydrogen phosphide (PH3), is the most common insecticide applied to durable stored products worldwide and is routinely used in the United States for treatment of bulk-stored cereal grains and other durable stored products. Research from the late 1980s revealed low frequencies of resistance to various residual grain protectant insecticides and to phosphine in grain insect species collected in Oklahoma. The present work, which used the same previously established discriminating dose bioassays for phosphine toxicity as in the earlier study, evaluated adults of nine different populations of red flour beetle, Tribolium castaneum (Herbst), and five populations of lesser grain borer, Rhyzopertha dominica (F.) collected from different geographic locations in Oklahoma. One additional population for each species was a laboratory susceptible strain. Discriminating dose assays determined eight out of the nine T. castaneum populations, and all five populations of R. dominica, contained phosphine-resistant individuals, and highest resistance frequencies were 94 and 98%, respectively. Dose-response bioassays and logit analyses determined that LC99 values were approximately 3 ppm for susceptible and 377 ppm for resistant T. castaneum, and approximately 2 ppm for susceptible and 3,430 ppm for resistant R. dominica. The most resistant T. castaneum population was 119-fold more resistant than the susceptible strain and the most resistant R. dominica population was over 1,500-fold more resistant. Results suggest a substantial increase in phosphine resistance in these major stored-wheat pests in the past 21 yr, and these levels of resistance to phosphine approach those reported for other stored-grain pest species in other countries.

Evaluation of PCR with culture for the diagnosis of pulmonary tuberculosis

Tuberculosis (TB) is a major public health problem in most developing countries. The present study was carried out among 100 clinically suspected pulmonary TB patients. One hundred sputum specimens were collected one from each of the suspects attending DOT'S corner of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The aim of the study was to evaluate the sensitivity and specificity of a polymerase chain reaction (PCR) based method detecting IS6110 sequence present in all Mycobacterium tuberculosis strains using sputum samples in comparison to culture on Lowenstein-Jensen mediums. The PCR was done using primers mtb1 & mtb2 which commonly target an insertion sequence of the organism (IS6110). Out of 100 samples, 18 (18%) showed PCR positive, whereas culture in Lowenstein-Jensen media were positive in 19(19%). In PCR 1 was false negative but none was false positive. In present study, sensitivity and specificity of PCR found 94.74% and 100% respectively. Analyzing the findings of the present study, it can be concluded that the PCR technique is a rapid and alternative method of culture on Lowenstein-Jensen medium for the diagnosis of pulmonary tuberculosis. In the present study, only presence or absence of M. tuberculosis was determined.

Comparison between ICT and PCR for diagnosis of Chlamydia trachomatis

Chlamydia trachomatis is an obligate intracellular gram-negative bacterium which is the most prevalent cause of bacterial sexually transmitted infections (STI). The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Immunochromatographic test (ICT) and Polymerase chain reaction (PCR). A total of 70 females were included in this study. Out of 70 cases 56 were symptomatic and 14 asymptomatic. Endocervical swabs were collected from each of the cases and examined by Immunochromatographic test (ICT) for antigen detection and Polymerase chain reaction (PCR) for detection of endogenous plasmid-based nucleic acid. A total 29(41.4%) of the cases were found positive for C. trachomatis either by ICT or PCR. Of the 56 symptomatic cases, 19(33.9%) were found ICT positive and 17(30.4%) were PCR positive. Among 14 asymptomatic females, 2(14.3%) were ICT positive and none were PCR positive. Though PCR is highly sensitive but a total of twelve cases were found ICT positive but PCR negative. It may be due to presence of plasmid deficient strain of C trachomatis which could be amplified by ompA based (Chromosomal gene) multiplex PCR.

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500μl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.

Analysis of heat and mass transfer during condensation over a porous substrate

Condensing heat exchangers are important in many space applications for thermal and humidity control systems. The International Space Station uses a cooled fin surface to condense moisture from humid air that is blown over it. The condensate and the air are "slurped" into a system that separates air and water by centrifugal forces. The use of a cooled porous substrate is an attractive alternative to the fin where condensation and liquid/gas separation can be achieved in a single step. We analyze the heat and mass transfer during condensation of moisture from flowing air over such a cooled, flat, porous substrate. A fully developed regime is investigated for coupled mass, momentum and energy transport in the gas phase, and momentum and energy transport in the condensate layer on the porous substrate and through the porous medium.

Urbanization and the risk of asthma among schoolchildren in the Palestinian Authority

The aim of the present survey was to compare the prevalence of symptoms suggestive of asthma in boys and girls aged 6-7 and 13-14 years in a rural and an urban area in the West Bank. For this purpose, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was issued to 970 schoolchildren in the two regions. The response rate was 92.2%. The prevalences of ever wheezing in the urban and rural areas were 16.4% and 12.0%, respectively (p < 0.05); the 12-month prevalences of wheezing were 10.5% and 5.5%, respectively (p < 0.05); the prevalences of more severe wheeze were 4.5% and 1.7%, respectively (p < 0.05); and prevalences of diagnosed asthma were 4.2% and 2.8%, respectively (p = NS). When controlling for age by stratification, the significant association between prevalence rates and place of residence persisted in the 13-14-year age group. These results also show that the prevalence of asthma among Palestinian children is moderately high in comparison with that reported from developing countries, but lower than those reported from Western countries. This survey, the first epidemiological survey on asthma in the West Bank, demonstrates a marked difference between urban and rural areas. The findings emphasize the need for further study of the environmental determinants of the disease among Palestinian children.

Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience

BACKGROUND

To improve asthma disease management, the National Asthma Education Program (NAEP) Expert Panel published Guidelines for the Diagnosis and Management of Asthma in 1991.

OBJECTIVES

To compare the current status of asthma disease management among patients in a large health maintenance organization with the NAEP guidelines and to identify the factors that may be associated with medical care (eg, emergency department visits and hospital admissions) and adherence to the guidelines.

METHODS

Analyses of 1996 survey data from 5580 members with asthma (age range, 14 to 65 years) covered by a major health maintenance organization in California (Health Net).

RESULTS

In general, adherence to NAEP guidelines was poor. Seventy-two percent of respondents with severe asthma reported having a steroid inhaler, and of those, only 54% used it daily. Only 26% of respondents reported having a peak flowmeter, and of those, only 16% used it daily. Age (older), duration of asthma (longer), increasing current severity of disease, and treatment by an asthma specialist correlated with daily use of inhaled steroids. Ethnicity (African American and Hispanic) correlated negatively with inhaled steroid use but positively with emergency department visits and hospital admissions for asthma. Increasing age and treatment by an asthma specialist were also identified as common factors significantly related to the daily use of a peak flowmeter and, interestingly, to overuse of beta2-agonist metered-dose inhalers.

CONCLUSIONS

Although the NAEP guidelines were published 7 years ago, compliance with the guidelines was low. It was especially poor for use of preventive medication and routine peak-flow measurement. Furthermore, the results showed that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma. Combining the results of the regression analyses revealed that some of the variation in rates of emergency department visits and hospitalizations among some subpopulations can be explained by the underuse of preventive medication. This study serves the goal of documenting the quality of care and services currently provided to patients with asthma through a large health maintenance organization and provides baseline information that can be used to design and assess effective population-based asthma disease management intervention programs.

Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach

OBJECTIVES

The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay.

METHODS

California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals.

RESULTS

Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix.

CONCLUSIONS

Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach.

An intervention for enhancing compliance with screening recommendations for diabetic retinopathy. A bicoastal experience

OBJECTIVE

To determine whether an intervention at both the provider and patient level can increase the utilization of diabetic retinal examination among diabetic patients and to compare the results from a comparable study conducted on the East Coast.

RESEARCH DESIGN AND METHODS

For the regional intervention study, all diabetic patients 18 years or older who enrolled in a large network-based health maintenance organization (HMO) in California were identified (n = 19,397). The identified diabetic patients received educational materials and a notification of their prior diabetic retinal examination status. Also, their primary care physicians received the current American Diabetes Association (ADA) guidelines for dilated retinal examinations and a list of patients due for diabetic retinal examination.

RESULTS

There were 25 and 27% increases in the percentage of diabetic patients who received diabetic retinal examinations in 1995 compared with the percentages in 1993 and 1994, respectively. The increase in diabetic retinal examinations was most significant after the intervention (odds ratio = 1.4). Furthermore, the improvements in compliance after the intervention were almost identical between the studies implemented on the East and West Coasts.

CONCLUSIONS

This study and the prior study demonstrate that such a "reminder" intervention can improve compliance with diabetic retinal screening recommendations. A generalizable intervention, such as this, may be applicable on a national level. For these programs to be successful, however, HMOs and physicians must have a collaborative relationship.

Bioequivalence study of two capsule formulations of omeprazole

Bioequivalency of Omeraz, a test-product of Arab Pharmaceutical Manufacturing Company (Jordan) and Losec, a reference product by Astra (Sweden), was evaluated by a randomised crossover study on 22 healthy male volunteers. Serum concentrations of omeprazole were measured by an HPLC assay. There were no statistically significant differences between the two products in terms of serum profile and pharmacokinetic parameters including AUC, Cmax, Tlag, Tmax, MRT, Ke and T1/2. The AUC ratios (Omeraz/Losec) for 24 hours and for infinity were respectively 1.02 with a 90% C.L. of 0.88-1.16 and 1.00 with a 90% C.L. of 0.88-1.14. The two products may be considered as bioequivalent in terms of the extent of absorption as indicated by the AUC ratios. However, the confidence limits of Cmax fall outside the FDA accepted range.