Chronic Morbidities Overrule Acute Morbidities in Determining Self-Reported Health in Rural Bangladesh

Self- rated health (SRH) is a valuable screening-level measure of a community's health status. A better understanding of the factors that influence SRH is time-demanding and challenging. This study aims to examine the determinants of SRH by investigating health morbidities, demographic and socio-economic factors in Bangladesh perspective. This cross-sectional study was conducted among 908 adults (aged 18 years and above) in Manikganj district of central Bangladesh from 2nd January to 13th January 2017. Chi-square test was performed to test the association and binary logistic regression was performed to predict the relationship of SRH with all potential variables. The present study reveals the balance of bad health versus good health which was 27.2% and 72.8% respectively. Participants had at least one or more chronic diseases reported 3.40 times (p<0.001) bad health compared to those who did not have any chronic illness. In contrast, acute morbidity was not a significant determinant for SRH (OR=1.379, p=0.063). Older population aged 60 years and above had 3.96 times (p<0.001) higher chance of having self-reported bad health than the younger population. In addition, depression was also found a significant contributor (OR=2.05, p<0.001) to bad health. Chronic morbidity, older age and depression are the significant predictors of SRH. If SRH is used as a screening-level measure for the rural communities then the chronic disease status of rural Bangladesh will be identified quickly and easily.

Prevalence of Thyroid Dysfunction in Type 2 Diabetes Mellitus

The level of thyroid hormones is often changed in uncontrolled diabetic patients. Screening for Thyroid dysfunction (TD) among patients with Type 2 Diabetes mellitus (T2DM) should be performed considering the increased prevalence of thyroid disorders. This cross-sectional comparative study was conducted in outpatient department of Endocrinology and Medicine, Mymensingh Medical College Hospital, Mymensingh (MMCH) from 1st March 2020 to 30th August 2021. One hundred (100) patients with type 2 diabetes along with 100 (hundred) non-diabetic controls of same age group were enrolled in the study. After taking clinical data, patients were investigated to estimate Fasting plasma glucose (FPG), serum free tri-iodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) level to see thyroid dysfunction. Patients were selected with purposive sampling. Thyroid dysfunction was found to be more in T2DM (15.0%) in comparison with non-diabetic controls (5.0%) and this difference was statistically significant (p=0.018). In both diabetic and non-diabetic groups, subclinical hypothyroidism and hypothyroidism were the most common thyroid dysfunction. Thyroid dysfunction was found more in 40-60 years that suggests the prevalence of thyroid dysfunction are increasing in diabetic patients with advancing age. Thyroid dysfunction was found more among overweight and obese patient in both groups. Mean BMI was found higher among diabetic patient with thyroid dysfunction. Logistic regression showed significant association of Thyroid dysfunction with age >50 years and high FPG level. We found thyroid dysfunction was more prevalent in patients with T2DM than non-diabetics. So, screening for thyroid dysfunction among type 2 diabetic patients by estimating Serum TSH, FT4 level should be performed.

Mental Health Assessment of Health Care Providers of Bangladesh during Covid-19 Pandemic: A Cross-Sectional Web-Based Study

SARS COV 2 raised immense agony to everyone. As health care workers remains direct contact with patients, they are vulnerable to mental health disorder. The study was done to identify mental health status of health care providers of Bangladesh. It was a cross sectional web based survey among health care providers of bangladesh. A structured web based questionnaire was prepared both in Bangla and English version for better understanding. Total 2594 health care workers responded to online survey. Male were 1303(50.2%) and female were 1291(49.8%). Occupational demography shows 98.5% were physicians. Mean value of patient health questionnaire 9 (PHQ9) and generalized anxiety disorder (GAD) were 8.43±6.082 and 8.27±5.234 respectively among healthcare providers. To overcome anxiety and depression, 93.4% of HCW didn't receive any psychological material and 85.6% HCW didn't find physiological resources even through media. Despite many lacking, healthcare workers were resilient in our study.

A review on brain tumor segmentation based on deep learning methods with federated learning techniques

Brain tumors have become a severe medical complication in recent years due to their high fatality rate. Radiologists segment the tumor manually, which is time-consuming, error-prone, and expensive. In recent years, automated segmentation based on deep learning has demonstrated promising results in solving computer vision problems such as image classification and segmentation. Brain tumor segmentation has recently become a prevalent task in medical imaging to determine the tumor location, size, and shape using automated methods. Many researchers have worked on various machine and deep learning approaches to determine the most optimal solution using the convolutional methodology. In this review paper, we discuss the most effective segmentation techniques based on the datasets that are widely used and publicly available. We also proposed a survey of federated learning methodologies to enhance global segmentation performance and ensure privacy. A comprehensive literature review is suggested after studying more than 100 papers to generalize the most recent techniques in segmentation and multi-modality information. Finally, we concentrated on unsolved problems in brain tumor segmentation and a client-based federated model training strategy. Based on this review, future researchers will understand the optimal solution path to solve these issues.

Parallel CNN-ELM: A multiclass classification of chest X-ray images to identify seventeen lung diseases including COVID-19

Numerous epidemic lung diseases such as COVID-19, tuberculosis (TB), and pneumonia have spread over the world, killing millions of people. Medical specialists have experienced challenges in correctly identifying these diseases due to their subtle differences in Chest X-ray images (CXR). To assist the medical experts, this study proposed a computer-aided lung illness identification method based on the CXR images. For the first time, 17 different forms of lung disorders were considered and the study was divided into six trials with each containing two, two, three, four, fourteen, and seventeen different forms of lung disorders. The proposed framework combined robust feature extraction capabilities of a lightweight parallel convolutional neural network (CNN) with the classification abilities of the extreme learning machine algorithm named CNN-ELM. An optimistic accuracy of 90.92% and an area under the curve (AUC) of 96.93% was achieved when 17 classes were classified side by side. It also accurately identified COVID-19 and TB with 99.37% and 99.98% accuracy, respectively, in 0.996 microseconds for a single image. Additionally, the current results also demonstrated that the framework could outperform the existing state-of-the-art (SOTA) models. On top of that, a secondary conclusion drawn from this study was that the prospective framework retained its effectiveness over a range of real-world environments, including balanced-unbalanced or large-small datasets, large multiclass or simple binary class, and high- or low-resolution images. A prototype Android App was also developed to establish the potential of the framework in real-life implementation.

Detection of various lung diseases including COVID-19 using extreme learning machine algorithm based on the features extracted from a lightweight CNN architecture

Around the world, several lung diseases such as pneumonia, cardiomegaly, and tuberculosis (TB) contribute to severe illness, hospitalization or even death, particularly for elderly and medically vulnerable patients. In the last few decades, several new types of lung-related diseases have taken the lives of millions of people, and COVID-19 has taken almost 6.27 million lives. To fight against lung diseases, timely and correct diagnosis with appropriate treatment is crucial in the current COVID-19 pandemic. In this study, an intelligent recognition system for seven lung diseases has been proposed based on machine learning (ML) techniques to aid the medical experts. Chest X-ray (CXR) images of lung diseases were collected from several publicly available databases. A lightweight convolutional neural network (CNN) has been used to extract characteristic features from the raw pixel values of the CXR images. The best feature subset has been identified using the Pearson Correlation Coefficient (PCC). Finally, the extreme learning machine (ELM) has been used to perform the classification task to assist faster learning and reduced computational complexity. The proposed CNN-PCC-ELM model achieved an accuracy of 96.22% with an Area Under Curve (AUC) of 99.48% for eight class classification. The outcomes from the proposed model demonstrated better performance than the existing state-of-the-art (SOTA) models in the case of COVID-19, pneumonia, and tuberculosis detection in both binary and multiclass classifications. For eight class classification, the proposed model achieved precision, recall and fi-score and ROC are 100%, 99%, 100% and 99.99% respectively for COVID-19 detection demonstrating its robustness. Therefore, the proposed model has overshadowed the existing pioneering models to accurately differentiate COVID-19 from the other lung diseases that can assist the medical physicians in treating the patient effectively.

Savonius wind turbine blade design and performance evaluation using ANN-based virtual clone: A new approach

The drag based Savonius wind turbine (SWT) has shown immense potential for renewable power generation in built-up areas under complex urban wind conditions. While a series of studies have been conducted on improving SWT's efficiency, optimal performance has yet to be achieved using traditional design approaches such as experimental and/or computational fluid dynamics methods. Recently, artificial intelligence and machine learning have been widely used in design optimization. As such, an ANN-based virtual clone can be an alternative to traditional design methods for wind turbine performance determination. Therefore, the main goal of this study is to investigate whether ANN-based virtual clones are capable of determining the performance of SWTs with a shorter timeframe and minimal resources compared to traditional methods. To achieve the objective, an ANN-based virtual clone model is developed. Two sets of data (computational and experimental) are used to validate and determine the efficacy of the proposed ANN-based virtual clone model. Using experimental data, the model's fidelity is over 98%. The proposed model produces results in one-fifth the time of the existing simulation (based on the combined ANN + GA metamodel) method. The model also reveals the location of the dataset's optimized point for augmenting the turbine's performance.

Development of cell culture based peste des petits ruminants (PPR) virus vaccine candidate from Bangladeshi isolates

This study was conducted to develop a cell culture based PPR virus vaccine candidate using recent Bangladeshi strain of peste des petits ruminant's (PPR) virus. PPR virus was isolated from field outbreaks, confirmed by RT-PCR and used as viral inoculum for serial passaging in Vero cells for adaptation and attenuation. 60th serial passage had completed and RT-PCR and real time RT-PCR were done in every 5 passages for confirmation of PPR virus in tissue culture fluid (TCF). To assess the adaptation and attenuation cytopathology, virus titration, sequencing of both F and N genes and live animal experimentation were done. Different cellular alterations produced by PPR virus in infected Vero cells including syncytia formation, development of both intranuclear and intra cytoplasmic inclusion bodies and finally cell degradation are the indications of adaptation. The virus titre was found 2.5, 3.31, 3.55, 4.44, 4.71 and 6.5 Log₁₀ TCID₅₀/ml at 10th, 20th, 30th, 40th, 50th and 60th passages level respectively. In F gene sequence analysis it has been observed that few nucleotide (nt) and mino acid (aa) has been substituted as the effects of serial passaging of PPR virus in Vero cells. TCF at 60th passage level was found effective to produced protective antibody (Ab) titre in live animal experimentation. It is concluded that serially passaged and Vero cells adapted PPR virus TCF could be used as a vaccine candidate for further use to develop a potent & effective vaccine against PPR diseases.

Revealing the diversity of internal body temperature and panting response for feedlot cattle under environmental thermal stress

Core body temperature (CBT) regulation is crucial for mammalian wellbeing and survival. Cattle pant to dissipate excess heat to regulate CBT when ambient conditions exceed thermoneutral zones. However, to date, neither the variability in cattle heat response, the lagged response of CBT to thermal indices, nor the diurnal patterns of thermal indices, CBT and panting have been reported in the literature. We decomposed thermal indices, CBT and panting time-series data for 99 feedlot heifers across three discrete heat events into diurnal, trend and residual components. Both raw and decomposed data were analysed to explore the lagged CBT and panting responses and the association between series. We show ambient thermal conditions impact CBT with a 1-h lag despite a lag of between 1.5 to 3 h from raw data. Average individual panting scores were used to identify heat-susceptible and heat-tolerant cattle. Heat-susceptible cattle showed greater CBT (P < 0.01) between 8:00 and 23:00 and greater panting duration (P < 0.05) between 10:00 and 18:00 than heat-tolerant cattle under the same thermal conditions and these variations followed a similar pattern despite differences in cattle breed. This new information enables targeted amelioration and selection of individuals against heat susceptibility.

Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference?

OBJECTIVES

We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender.

STUDY DESIGN

Cross-sectional nationally representative household-based survey.

METHODS

We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes.

RESULTS

In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM.

CONCLUSIONS

In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.

Serum Magnesium Level and It's Relation in Predicting Adverse In-Hospital Outcome in Patients with First Attack of Myocardial Infarction

Acute myocardial infarction (AMI) patients characterize a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. Hypomagnesemia is a long-term risk factor for incident of both myocardial infarction and arrhythmia. We assessed whether serum magnesium levels at admission is associated with arrhythmias and in-hospital mortality in patients with acute myocardial infarction (AMI). The aim of the study was to evaluate the prognostic implications of serum magnesium level in patients with acute myocardial infarction. This cross-sectional observational study was conducted in the department of cardiology in Mymensingh Medical College Hospital from October 2017 to March 2019. Total 259 acute myocardial infarction patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with acute myocardial infarction with serum magnesium ≥1.82mg/dl. Group-II: Patients with acute myocardial infarction with serum magnesium <1.82mg/dl. Serum magnesium level was measured on admission, and the incidence of in-hospital major cardiac events was assessed. In this study mean serum magnesium level of Group-I, Group-II were 2.21±0.14mg/dl, 1.60±0.15mg/dl respectively. It was statistically significant (p<0.05). In-hospital outcomes of the study group revealed that low risk group patients were uneventful outcome during hospitalization period, they had no any complication. In Group-I patient, 9(4.8%) were developed arrhythmias, 26(13.9%) were developed heart failure, 9(4.8%) were developed cardiogenic shock and 3(1.6%) were died and in Group-II patient, 44(61.10%) developed arrhythmias, 9(12.50%) were developed heart failure, 7(9.7%) were developed cardiogenic shock and 12(16.7%) were died out of them which was statistically significant (p<0.05). Mean duration of hospital stay of the study population according serum magnesium level was in Group-I, 4.27±0.68 days, in Group-II, 5.84±1.05 days which was statistically significant (p<0.05). In conclusion patient with serum magnesium level less than 1.82mg/dl increased the risk of in-hospital arrhythmia and death.

Platelet Count as a Prognostic Factor in Stage IV Non-Small Cell Lung Cancer

Increase platelet count can accompany various cancers including lung cancer. This finding has recently been suggested to indicate poor prognosis. In patients with malignancies, thrombocytosis has previously been related disease stage, histological type and survival. In this study, the prevalence of thrombocytosis and the prognostic information provided by platelet count were analyzed in patients with stage IV Non-Small Cell Lung Cancer (NSCLC) with an aim to assess elevated platelet count as a prognostic factor in patients with stage IV NSCLC and to investigate whether there is relationship between thrombocytosis, other clinico-pathologic factors and median survival. This prospective observational study was conducted in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh from September 2019 to August 2020. A total of 108 patients were enrolled purposively. Detail history taking, thorough physical examination was done along with relevant investigations. Data were collected by semi structured questionnaire and analysis was done with the help of Statistical Package for Social Science (SPSS), version 21.0. The mean age of the patients was found 56.4±12.2 years with range from 35 to 75 years. Majority (79.6%) patients were male, 52.8% patients came from low income and 36.1% were farmer. Majority (40.7%) were symptomatic; in bed >50.0% of day. Almost two third (59.3%) had <5.0% weight loss. Almost three fourth (69.4%) had squamous cell carcinoma. At the time of first assessment 75(69.4%) patients had normal and 33(30.6%) had elevated platelet count level. Age, sex and histological type were statistically not significant between normal and elevated platelet count level groups. But performance status, weight loss were statistically significant (p<0.05) between two groups. According to univariate analysis, age, performance status at presentation, weight loss more than 10.0% for 3 months and platelet count prior the start of treatment were all significant predictors for the overall survival. In multivariate analysis age, performance status at presentation and initial thrombocytosis were independent prognostic determinants for overall survival. Median survival time was significantly higher for the normal platelet count group and elevated platelet count group (7.5 months versus 5.5 months) respectively (95% CI, 5.5-7.5), p<0.001. The frequency of thrombocytosis in patients with stage-IV NSCLC at first presentation was 30.6% and median survival time in these patients was significantly shorter compared in patients without thrombocytosis. These results concluded that an elevated platelet count could be a useful prognostic factor for survival in patients with stage-IV NSCLC.

Ocular Manifestation and Correlation with CD4+ T Cell Count among Adult HIV/AIDS Patients in Bangladesh

Patients with HIV or AIDS suffer from wide varieties of complications that are related to infection. The eye as an organ is not spared from HIV-related manifestations. The ocular manifestations can be the presenting sign of a systemic infection in an otherwise asymptomatic HIV-positive person. The disease can have adnexal, anterior segment, posterior segment, orbital and neuro-ophthalmic manifestations. The objective of the study was to evaluate the ophthalmological manifestations among adult HIV infected patients of Bangladesh and co-relate the findings with CD-4+ T cell count. This cross sectional study was conducted in the department of Community Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to September 2015. Purposive sampling technique was applied to enroll the patients. Total 110 patients were enrolled regardless of their immunological status by inclusion and exclusion criteria. Relevant clinical evaluation including history & physical examinations, laboratory investigations and some ocular examinations like- visual acuity, slit lamp biomicroscopy, IOP, indirect ophthalmoscopy with +90D (diopter) and +20D were done. The age of the study population ranged from 20-58 years with mean±SD 37.63±8.16 years. Among the study population 67(60.9%) were male and 43(39.1%) were female. According to ART status, 58(52.7%) were on ART and 52(47.3%) were ART naive. The mean CD4+ T- cells count was 410±281.65 with minimum to maximum was 6-1266 cells/μl. Among them 53(48.2%) had HIV related ocular findings and 57(51.8%) had no HIV related ocular manifestation. In relation with CD+ T- cells count, highly significant relation was found with lower CD4+ T- cells count and ocular manifestation (p=0.001).

Complex features extraction with deep learning model for the detection of COVID19 from CT scan images using ensemble based machine learning approach

Recently the most infectious disease is the novel Coronavirus disease (COVID 19) creates a devastating effect on public health in more than 200 countries in the world. Since the detection of COVID19 using reverse transcription-polymerase chain reaction (RT-PCR) is time-consuming and error-prone, the alternative solution of detection is Computed Tomography (CT) images. In this paper, Contrast Limited Histogram Equalization (CLAHE) was applied to CT images as a preprocessing step for enhancing the quality of the images. After that, we developed a novel Convolutional Neural Network (CNN) model that extracted 100 prominent features from a total of 2482 CT scan images. These extracted features were then deployed to various machine learning algorithms - Gaussian Naive Bayes (GNB), Support Vector Machine (SVM), Decision Tree (DT), Logistic Regression (LR), and Random Forest (RF). Finally, we proposed an ensemble model for the COVID19 CT image classification. We also showed various performance comparisons with the state-of-art methods. Our proposed model outperforms the state-of-art models and achieved an accuracy, precision, and recall score of 99.73%, 99.46%, and 100%, respectively.

Predictors of Malignancy in Thyroid Nodules

Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.

Antimicrobial Resistance of E Coli Causing Urinary Tract Infection in Bangladesh

Rapid spread of multidrug resistant microorganisms is a matter of great concern throughout the glove including Bangladesh. The objective was to identify the causative organisms for urinary tract infection (UTI) and their sensitivity patterns to antibiotics. This descriptive cross-sectional study was conducted on patients admitted with UTI (n=60) at a tertiary level hospital in Dhaka, Bangladesh from March 2019 to September 2019. Data were collected through clinical record reviews. Data of all these 60 cases were analyzed for socio-demographic characteristics. Of the 60 patients, culture and sensitivity report was available for 42 patients. Therefore, data were further analyzed for these 42 cases. Median age of patients was 35 years and 80% were female. The main organisms isolated from urine culture of UTI patients were E. coli (64%), Klebsiella (12%) and Enterococci species (10%). Susceptibility to antibiotics was analyzed only for E. coli (n=27) since the number of isolates of other organisms were small. E. coli was found to be resistant to most of the first- and second-line antibiotics, such as Amoxicillin (100%), Amoxyclav (72%), Co-trimoxazole (89%), Nalidixic acid (78%), Ceftazidim (94%), Ceftriaxone (73%), Cefuroxime (100%), Ciprofloxacin (59%), Cephotaxime (80%), Cefixime (100%) and Moxifloxacin (100%). E. coli was the predominant organism responsible for UTI and was resistant to most of the first- and second-line antibiotics. Immediate action is needed to develop empirical guideline for empirical management of UTI and establish surveillance system for monitoring.

Recommendation and Roadmap of Mass Vaccination against Coronavirus Disease 2019 Pandemic in Bangladesh as a Lower-Middle-Income Country

Low-income countries (LICs) and lower-middle-income countries (LMICs) are still deprived of the optimum doses of coronavirus disease 2019 (COVID-19) vaccines for their population, equal access and distribution, as well as mass immunization roadmaps to be implemented for achieving herd immunity and protection from the ongoing pandemic. In this short report, we are interacting with the world public health experts, as well as national and global leaders for warranting the mass vaccination drive to be more progressive against COVID-19 with equitable access of vaccines to LICs or LMICs to save the lives of the poorest country people and refugees. From several scientific databases, such as Google Scholar, PubMed, as well as national and international news websites, the data were collected data by utilizing appropriate keywords regarding the topic. Bangladesh might be exemplified in this brief communication as the representative of LMIC. As of October 14, 2021, 48% of the world's people have received at least one dose of the COVID-19 vaccine. In contrast, only 2.5% of people from LICs have come in under COVID-19 vaccination for at least a single shot. Both LICs and LMICs need far more vision and ambition, including political, administrative, and diplomatic progress along with enhancing the vaccination drive for their population to be immunized through simultaneous mass vaccination progress of other countries with implementing public health safety measures against the COVID-19 pandemic.

Efficacy of Clotrimazole 1% Solution Compared to Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% Cream in Patient with Otomycosis

Fungal infection of the ear canal is called Otomycosis. It is more common in hot and humid condition. There are many modalities of treatment or therapeutic agent for treatment of otomycosis. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream is a topical antifungal agent described to be effective in the treatment of otomycosis. This study was performed to compare the efficacy of topical application clotrimazole 1% solution and Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream in the treatment of otomycosis. A controlled, randomized and open clinical trial was carried out in ENT department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to July 2020. Patients diagnosed with fungal otitis externa who were treated with topical antifungals were included in this study. They were randomized into two treatment groups: i) Clotrimazole 1% solution, 2) Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream. Patients were microscopically evaluated at two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed, follow up and final outcomes (absence of infection) were compared between two groups. One hundred & two (102) patients were included, 51 in the clotrimazole 1% solution group and 51 in the Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group. Predominant symptoms are pain, pruritus, aural fullness and hearing loss. Aspergillus organism was isolated most frequently (63.73%). Treatment with clotrimazole 1% solution groups resulted in 88.23% resolution vs. 80.39% resolution with Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream at 2 weeks of treatment. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group demonstrated higher treatment failure 11.76 and 19.60 respectively. Clotrimazole 1% solution is more effective than Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream for uncomplicated otomycosis. More study is needed to corroborate our results.

Open Label Randomized Controlled Comparison of Three Alternative Regimes of Ciprofloxacin, Azithromycin and Cefixime for Treatment of Uncomplicated Typhoid Fever in Bangladesh

Multi-drug resistant Typhoid fever (resistant to previously used chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole) has been commonly described in the South East Asia region and a recent report suggests that the salmonella typhi have reduced response to fluoroquinolones (nalidixic acid-resistant). The optimum treatment protocol for this type of serovar has not been established. This study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever which was conducted in the medicine ward of Dhaka Medical College Hospital (DMCH) and outdoor setting in private practice in Dhaka metropolitan city, Mymensingh and Sylhet town from January 2017 to December 2017. Bangladeshi adults with uncomplicated typhoid fever were included in this an open-label randomized controlled trial. Ciprofloxacin (20mg/kg of body weight/day for 14 days), azithromycin (20mg/kg/day for 14 days), and Cefixime (16mg/kg/day for 14 days) were compared. Of the 81 enrolled patients, 62 were eligible for analysis (61 S. enterica serovar Typhi, 1 Salmonella enterica serovar paratyphi A). Of the S enterica serovar Typhi isolates, 88.7% (55/62) were MDR and 93.5% (58/62) were nalidixic acid resistant (NAR). The clinical cure rate was 62% (13/21) with ciprofloxacin, 71% (15/21) with Cefixime, and 85% (17/20) with azithromycin (p=0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with cefixime (7.1 days [6.2 to 8.1 days]) and ciprofloxacin (8.2 days [7.2 to 9.2 days]) (p<0.001). All three antibiotics were well tolerated. A 7-day course of azithromycin can be successfully used in uncomplicated typhoid fever due to isolates of MDR S enterica serovar Typhi.

COVID 19 in Children: Gastrointestinal, Hepatobiliary and Pancreatic Manifestation

The most devastating pandemic of this era coronavirus disease-2019 (COVID-19) is caused by a novel virus named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Although it is primarily a respiratory pathogen, it can also result in several extra-pulmonary manifestations includes gastrointestinal symptoms, hepatocellular injury. Angiotensin-converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2), the entry receptor for the causative coronavirus SARS-CoV-2 is co-express in the gastrointestinal tract, hepatocyte, and cholangiocytes similar to the respiratory mucosa. The presence of these receptors facilitates the entry into the tissue and causes direct viral tissue damage, which is a proposed mechanism of injury. Diarrhoea, nausea, vomiting, abdominal discomfort are common gastrointestinal manifestations, whereas derangement of liver function tests is the most hepatic manifestation in COVID-19. In this article, we reviewed on SARS-CoV-2 disease COVID-19 regarding gastrointestinal, hepatic, and pancreatic manifestation, the mechanisms by which the virus may inflict damage, and their management perspective.

Synthesis and characterization of nanozeolite based composite fertilizer for sustainable release and use efficiency of nutrients

In this research work, we propose macronutrients incorporated slow-release based nano-fertilizer using nanozeolite as a carrier. A simple chemical approach was used to synthesis the proposed nanozeolite composite fertilizer (NZCF). To gain an insight into the properties, morphology and structure of the synthesized NZCF, it was further characterized by different techniques such as powder XRD, FT-IR, SEM, and TG/DTA. A considerable enhancement of the quality and the water retention capacity of the soil was observed as a result of applying the proposed NZCF when compared with a commercial fertilizer. Furthermore, the swelling ratio and the equilibrium water content of NZCF were compared to the commercial fertilizer and their effect on plant growth was observed. Slow-release studies were carried out for both NZCF and the commercial fertilizer. The results of these studies reveled that NZCF possessed a long-term release pattern of the macronutrients and that showed a great potential for promoting plant growth. Hence, the prepared nanocomposite fertilizer can be safely used as an environment-friendly source of nutrients to enhance plant growth.

Comparison between Efficacy of Combined Use of Hyaluronidise and Triamcinolone versus Hyaluronidise, Triamcinolone Acetonide and Oral Colchicine in the Treatment of Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a chronic complex potentially pre-malignant condition caused by chewing areca nut and other irritants. It is an insidious process characterized by Juxta-epithelial deposition of fibrous tissue in the oral cavity and pharynx. OSF is very common in Southeast Asia and also now a days increase in Europe and North America. The aim of this study to compare the effectiveness of intralesional injection of triamcinolone and hyalurunidase versus intralesional injection of triamcinolone plus injection hyalurunidase with oral colchicine. The study included 60 patients of clinically diagnosed case of oral submucous fibrosis. Patients were divided into two Groups A and B. Group A patients received combination intralesionsl injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml. 15 days interval in 3 months and Group B received intralesional injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml in each 15 days interval for 3 months with oral colchicine 0.5mg twice daily for 3 months. Diagnosis based on burning sensation of mouth, blanching of mucosa, ulceration in oral cavity and also reduced mouth opening. Follow up assessment was done at intervals 1st follow up on 21st days after starting of treatment then 2nd follow up after 3 months and last 3rd follow up after 6 months. Before starting of treatment all patients were properly explained about the study and took their written consent. Much more improvement occurred in Group B patients, reducing in burning sensation and also increases in opening of mouth. In both groups blanching mucosae were improved. Treatment regimen of Group B is more effective in increasing mouth opening and improves burning sensation of oral cavity. No side effects were seen in both groups' patients.

Timing of eating during transition impacts feedlot cattle diet and liveweight gain

The timing of eating, relative to when feed is offered, is affected by the social rank of feedlot cattle due to limited feed bunk space. As cattle can select feed based on dietary preference, the timing of eating for cattle in feedlot may be associated with the ingested diet composition. Our objectives were to determine the nutritive value and timing of feed ingested by 100 feedlot cattle during transition and the association of timing of eating with feeding behaviours and average daily gain (ADG). Cattle behaviour and timing of eating were determined on 100 feedlot cattle using accelerometer-based ear tag sensors from days 3 to 6 post feedlot induction (observation period), and the ongoing impact of this period on ADG was determined for the full feed period (75 days). To determine eating patterns at the time of feed offer, cattle were grouped according to the number of days they were recorded as eating within 1 h of feed being offered across 4 observation days, G⁰: not present across 4 days, G¹: present for 1 day, G²: 2 days, G³: 3 days and G⁴: present for each of the 4 days. Total mixed ration (TMR) samples were collected for nutritive value analysis from four locations along the feed bunk from the time feed was offered and at hourly intervals thereafter for 7 h each day during the observation period. The composition of feed in the bunk changed across the 7 h of measurement (P < 0.05). The DM and CP of feed increased from 65 to 70% and 15 to 16%, respectively, and the NDF decreased from 36 to 32%. Thus, the preferred TMR feed component was the fibrous dietary fraction. However, the overall composition of the ingested diet for 7 h post feeding was similar between groups. Cattle in G⁰ had reduced eating time (0.7 vs 4.8%; P < 0.001), rumination time (4.5 vs 19.5%; P < 0.001) and ADG (1.0 vs 1.3 kg/d; P < 0.05) across the study, as compared with cattle in G⁴. Offering a more fibrous ration during feedlot transition, and customised cattle segregation and/or customised feeding regimes based on sensor derived feeding behaviour profiles during acclimation to feedlot can optimise ADG, animal welfare and feedlot profit.

Frequency and Risk Factors of Diabetic Retinopathy among Patients with Type 2 Diabetes Mellitus: A Single-Center Study from Bangladesh

Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes mellitus (DM). DR remains a leading cause of blindness, currently accounting for 4.8% of the world's 37 million blindness cases. DR is one of the critical preventable causes of blindness. In Bangladesh, the number of studies reporting the prevalence and risk factors of DR in type 2 DM (T2DM) is limited. We conducted this cross-sectional study in a tertiary hospital in Bangladesh from March 2017 to August 2019 among 200 patients with T2DM for the presence and severity of DR by using color fundus photography in a dilated pupil. The diagnosis and grading of DR were made using the Early Treatment of Diabetic Retinopathy Study (ETDRS) Chart. Out of 200 subjects with T2DM, 35.5% had DR; the frequencies of NPDR and PDR were 19.0% and 16.5%, respectively. The mean age, diabetes duration, FPG, HbA1c, TG, TC, LDL-C, and serum creatinine were statistically higher, and eGFR was lower in the study subjects with DR than those without DR; BMI and HDL-C were indifferent in the two groups. The frequencies of males, subjects having monthly income of 10,000 Bangladeshi Taka (BDT) or more, smokers, hypertensives, and subjects having uncontrolled diabetes (HbA1c ≥7%), were higher in the DR group than the no DR group. Higher age (≥50 years), higher monthly income (≥10,000 BDT), urban residence, smoking, uncontrolled diabetes, and high LDL-C (≥100mg/dL) were found to be independent risk factors of DR in the study subjects. A large-scale nationwide study is needed to find out the actual prevalence of DR in Bangladesh.

Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma

This prospective study was conducted at Department of ENT, Mymensingh Medical College Hospital, a tertiary care center in Bangladesh January 2017 to December 2018 to report hearing results and post operative complications of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma where ossicular chain is eroded or has to be removed either partially or totally. Total 42 patients underwent Intact canal wall (ICW) tympanoplasty for cholesteatoma with at least intact stapes footplate and in conjunction, cartilage ossiculoplasty was done during the same procedure. Patients were followed up regularly at 1 week, 1 month, 3 month, 6 month and at 1 year as usual follow up protocol to note complications and hearing status in 1 year follow up. In intact stapes suprastructure group, in the preoperative period, the mean air conduction thresholds (AC), bone conduction threshold (BC) and air-bone gap (ABG) were 48.3db, 9.5db and 38.8db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG were 27.6db, 9.7db and 17.9db respectively. In missing stapes supra structuregroup, in the preoperative period, the mean air conduction thresholds (AC), Bone conduction threshold (BC) and air-bone gap (ABG) were 57.4db 13.5db and 43.9db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG, were 33.9db, 14.2db and 19.7db respectively. For management of cholesteatoma cases, cartilage ossiculoplasty can be done effectively in conjunction with of intact canal wall tympanoplasty in a single setting. Complications are a few and easily manageable. Hearing results are at least as good as with other prosthesis and helps in avoiding subsequent surgery, discomfort and cost to the patients.

Doppler Evaluation of Carotid Vessels in Type 2 Diabetes

Type 2 diabetes considered as a compound of metabolic syndrome. It can cause both micro and macrovascular complications. Diabetes is a strong risk factor in the development of atherosclerosis and likewise carotid artery disease. Carotid artery stenosis may cause stroke. Doppler ultrasound is the most common imaging technique for the diagnosis of carotid disease. Objective of the study was to assess the percentage of atherosclerotic carotid disease in asymptomatic Type 2 diabetics (T2D) by Doppler sonography and to find out the association of different risk factors of diabetic patient with atherosclerosis. A cross sectional study was done. A total of 43 type 2 diabetic patients (27 male, 16 female) referred from the out patient department and admitted patients in Mymensingh Medical College Hospital (MMCH) during January 2017 to December 2017 for the purpose of evaluation of intima media thickness (IMT) and carotid artery stenosis by Duplex color Doppler ultrasonography examination were enrolled in this study. Patients with previous history of recent stroke or transient ischemic attack (<6 weeks), history of carotid surgery or cervical radiotherapy were excluded. Carotid artery disease was found 65.1% in asymptomatic type 2 diabetics. Among them increased IMT in 48.8% and carotid stenosis was present in 37.2% and >50% stenosis (Peak systolic velocity >125cm/sec) was present in 9.3%. Age >50% years, smoking, duration of DM >10 years, hypertension, history of ischaemic heart disease and history of diabetic retinopathy were found to be associated with carotid atherosclerosis as well as carotid stenosis. High percentage of carotid artery disease (65.1%) was found in asymptomatic type 2 diabetes mellitus. This result suggests the need for carotid Doppler evaluation of all Type 2 diabetics as a first measure of stroke prevention, with the hope that timely intervention might avert stroke and its accompanying disability.

Relation of Obesity with Breast Cancer among the Patients Attending at National Institute of Cancer Research & Hospital

Breast cancer among women is gradually increasing in Bangladesh day by day. A number of breast cancer related etiological factors identified as age, reproductive factors, menarche, menopausal status, life style, hormone replacement therapy, genetics and alcohol intake. Obesity is an important factor for developing breast cancer in different countries. Obesity is one of the modifiable factors. The aim of the study was to find out the factors which might be associated with obesity among female breast cancer patients in Bangladesh. It was a case-control study conducted at the Department of Medical Oncology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh from August 2014 to July 2015. Ninety one case and equal numbers of age matched controls were included in the study. The mean age of the case was 42.99 (±9.24) years and that of the control was 44.11±8.97 years. Majority of patients i.e. 59.3% (n=54) in case group was in pre-menopausal state where as 52.7% (n=48) of respondents in control group were in menopausal state. Increased waist to hip ratio (>0.85) was associated with increased risk of breast cancer (OR: 8.1). This was also true for increased BMI of ≥25kg/m² (OR: 4.57), increased waist circumference (OR: 3.52) and ever OCP use (OR: 2.11). However, para >3, education and moderate to heavy work were found to be protective against breast cancer (OR: <1). In clinical setting waist-to-hip ratio, body mass index (BMI) and waist circumference (WC) can be used effectively to identify women with an increased risk of breast cancer.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.

Experience of Chikungunya in a Chikungunya Clinic at Tertiary Medical College Hospital in Bangladesh

A large outbreak of Chikungunya occurred in Bangladesh in 2017. It caused a serious impact on sufferers of the disease. Study aimed to assess the real scenario unfolding as case reporting to Directorate General of Health is less in Bangladesh by physicians. For this observational study a Chikungunya Clinic was set at Dhaka Medical College, Dhaka, Bangladesh and physicians were attached to the clinic who got training on Chikungunya by directorate General of Health from 9th July 2017 to 10th September 2017. A pre-tested questionnaire was supplied to all the physicians working at the clinic. Appropriate training was provided before data collection. Total 301 patients were enrolled. Most striking features were fever (99.3%), arthralgia (99.3%), rash 70.4%, Itching 64.8%, oral ulcer 23.9%, loose motion 18.6% and bleeding 8%.%. Most affected joints were MCP 76.9%, knee 74.9%, wrist 69.2%, Inter phalangeal joints of hand were 67.2%. Chikungunya was not very familiar with the physicians of Bangladesh. This was first time large scale experience by physicians of Bangladesh. Severity and chronicity of arthritis, rash, bleeding caused serious morbidity.

Comparison between Outcomes of Endoscopic Sinus Surgery and Surgical Excision in Case of Rhinosporiodiosis

Rhinosporiodiosis is a chronic granulomatous infection of the mucus membranes caused by Rhino sporidium seeberi that manifest as vascular friable polyps and arise in the nasal mucosa. The mode of infection is probably trans-epithelial penetration. Rhinosporiodiosis is endemic in India, Pakistan and Srilanka. It occurs sporadically in the United States of America. The aim of this study was to compare betweenthe outcomes of endoscopic sinus surgery andsurgical excision in rhinosporiodiosis. The cross sectional comparative study was conducted among 40 patients with rhinosporiodiosis from January 2018 to April 2019 in the department of Otolaryngology and Head-neck surgery of Mymensingh Medical College Hospital, Bangladesh. All the patients were following up to 6 month after surgery. Most of them are male 24(60.0%) and female are 16(40.0%). Age of the patients in this study was (Mean±SD) 34.8±13.5 years. More than half of the patients had rhinosporiodiosis in the inferior turbinate (25, 62.5%) followed by 8(20.0%) in nasal septum and 7(17.5%) in the nasal floor. Endoscopic Sinus Surgery was done purposively among 20 patients and surgical excision was done purposively among another 20 patients. At the time of operation no complication occurs in case of endoscopic sinus surgery but in case of surgical excision small of amount bleeding was present. All the patients were followed up to 6 month after surgery. No recurrence was found in patients with endoscopic sinus surgery but 7(35.0%) patients who underwent surgical excision had recurrence of rhinosporiodiosis at follow up after six months of surgery. Chi-square test showed that the incidence of recurrence after 6 months of surgery was significantly lower in endoscopic sinus surgery (p=0.004). The study results concluded that endoscopic sinus surgery is better option for rhinosporiodiosis.

A Modified Technique in Submandubular Salivary Gland Excision: Preservation of Facial Artery

Cutting and ligation of facial artery is the conventional practice for excision of submandibular gland. Facial artery is the main arterial supply to the lower face. Its preservation results in preservation of large proportion of vascularity to the lower face, preserves vascularity of platysma myocutaneous flap, allows repair of lower lip using Bernard's technique; facial artery is one of the most important recipient artery for microvascular free flap in modern reconstructive surgery in head and neck oncology. This prospective study was carried out in Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU), Dhaka, Bangladesh from October 2005 to October 2012 on 31 cases. Chronic submandibular sialoadenitis, benign submandibular gland tumours and cases of neck dissection where level I cervical lymph nodes were not involved by metastasis were included in this study. The facial artery was identified proximal to the gland and was dissected free from the gland by ligating or cauterizing its glandular branches to mobilize the gland. Appropriate anatomical aspects were noted and the time required for separation of the artery from the gland was recorded. Thirty-one consecutive cases were studied. The indications were chronic sialoadenitis (67.7%), pleomorphic adenoma (12.9%) and as a part of neck dissection for oncologic clearance of neck (19.4%). The mean duration of time for separation of the artery from the gland was 10.26 minutes. In two cases the facial artery could not be safely separated due to excessive adhesion from chronic inflammation. No significant complications were noted. Preservation of facial artery in submandibular gland excision is a simple procedure. So it should not be routinely sacrificed during this surgery.

Knowledge and Practice of Nurses on Pediatric Pain Management in Bangladesh

Among nurses due to inadequate pain management knowledge and practice skills, children's pain is often under treated. This study aimed to examine the level of knowledge and practice on pediatric pain management among nurses in Bangladesh. This was a descriptive survey study involving total 150 clinical pediatric nurses from two Medical College Hospital and a University hospital in Bangladesh. The data collection tool consisted of demographic data form, 32-items nurses' knowledge. There were 32 true and false questions related to nurses' knowledge on pediatric pain management in Bangladesh. The response formats to each item for correct answer was 1 and incorrect answer 0. The total scores were categorized into three levels including low (0-20), moderate (21-23) and high (24 and above). The data collection tool consisted of demographic data form, 19-item practice related questionnaire on pediatric pain management. Nurses' practice on pediatric pain management contained 19 items with 5-points Likert's scale ranging from 1=Never practice to 5=constantly practice. For each item, a score of 5 was accorded for constantly and 1 for never. The score ranged from 19-95. The total scores were categorized into three levels including low (19-38), moderate (39-76) and high (77-95). The results demonstrated that most of the nurses' knowledge score on pediatric pain management was at moderate level (mean=21.50, SD=2.35). Nurses' practice on pediatric pain management was also at moderate level (mean=75.45, SD=8.24). The relationship between nurses' knowledge and practice was not significant. In addition, nurses' knowledge and practice with demographic variables; there was significant relationship between nurse's knowledge and existence of pain management protocol, nurses' practice and their current position in unit and with reading nursing journal. This study showed moderate level of knowledge and practice indicating that they need to be enhanced the knowledge and practice skills in pediatric pain management.

The effect of temporal variation in feed quality and quantity on the diurnal feeding behaviour of dairy cows

The diurnal feeding patterns of dairy cows affects the 24 h robot utilisation of pasture-based automatic milking systems (AMS). A decline in robot utilisation between 2400 and 0600 h currently occurs in pasture-based AMS, as cow feeding activity is greatly reduced during this time. Here, we investigate the effect of a temporal variation in feed quality and quantity on cow feeding behaviour between 2400 and 0600 h as a potential tool to increase voluntary cow trafficking in an AMS at night. The day was allocated into four equal feeding periods (0600 to 1200, 1200 to 1800, 1800 to 2400 and 2400 to 0600 h). Lucerne hay cubes (CP = 19.1%, water soluble carbohydrate = 3.8%) and oat, ryegrass and clover hay cubes with 20% molasses (CP = 11.8%, water soluble carbohydrate = 10.7%) were offered as the 'standard' and 'preferred' (preference determined previously) feed types, respectively. The four treatments were (1) standard feed offered ad libitum (AL) throughout 24 h; (2) as per AL, with preferred feed replacing standard feed between 2400 and 0600 h (AL + P); (3) standard feed offered at a restricted rate, with quantity varying between each feeding period (20:10:30:60%, respectively) as a proportion of the (previously) measured daily ad libitum intake (VA); (4) as per VA, with preferred feed replacing standard feed between 2400 and 0600 h (VA + P). Eight non-lactating dairy cows were used in a 4 × 4 Latin square design. During each experimental period, treatment cows were fed for 7 days, including 3 days habituation and 4 days data collection. Total daily intake was approximately 8% greater (P < 0.001) for the AL and AL + P treatments (23.1 and 22.9 kg DM/cow) as compared with the VA and VA + P treatments (21.6 and 20.9 kg DM/cow). The AL + P and VA treatments had 21% and 90% greater (P < 0.001) dry matter intake (DMI) between 2400 and 0600 h, respectively, compared with the AL treatment. In contrast, the VA + P treatment had similar DMI to the VA treatment. Our experiment shows ability to increase cow feeding activity at night by varying feed type and quantity, though it is possible that a penalty to total DMI may occur using VA. Further research is required to determine if the implementation of variable feed allocation on pasture-based AMS farms is likely to improve milking robot utilisation by increasing cow feeding activity at night.

Hypertension in School Children of Dhaka City and Associated Risk Factors

Hypertension has its origin in childhood but goes undetected unless specially looked for detection of hypertension in children will increase the awareness and lead to preventive strategies. The objective of the study was to determine the prevalence of hypertension in school children. This cross sectional study was conducted among children aged 10 to 17 years in three secondary level schools of Dhaka city, Bangladesh. This study included 1146 participants (both boys and girls) by systematic random sampling. Blood pressure was measured and plotted in Blood pressure (BP) chart to define hypertension and structured questionnaire were used to collect socio demographic information. The prevalence of hypertension in school children was 1.8% (male was 1.68% and female was 1.99%). It was noted that there was a strong correlation between body weight and BMI of the children with hypertension. A significant portion of the respondents had family history of hypertension, diabetes and obesity. There was also a positive relation between hypertension and food habit that include low vegetables and more fast food. It was concluded that hypertension exists among secondary level school children in Dhaka, Bangladesh and it is related with obesity, increased BMI, family history and dietary habit.

Random fiber networks with inclusions: The mechanism of reinforcement

The mechanical behavior of athermal random fiber networks embedding particulate inclusions is studied in this work. Composites in which the filler size is comparable with the mean segment length of the network are considered. Inclusions are randomly distributed in the network at various volume fractions, and cases in which fibers are rigidly bonded to fillers and in which no such bonding is imposed are studied separately. In the presence of inclusions, the small strain modulus increases, while the ability of the network to strain stiffen decreases relative to the unfilled network case. The reinforcement induced by fillers is most pronounced in sparse networks of floppier filaments that deform in the bending-dominated mode in the unfilled state. As the unfilled network density or the bending stiffness of fibers increases, the effect of filling diminishes rapidly. Fillers lead to a transition from the soft, bending-dominated, to the stiffer, stretching-dominated, deformation mode of the network, a transition which is primarily responsible for the observed overall reinforcement. The confinement, i.e., the restriction on network kinematics imposed by fillers, causes this transition. These results provide a justification for the observed difference in reinforcement obtained in sparsely versus densely cross-linked networks at a given filling fraction and provide guidance for the further development of network-based materials.

Sympathetic Ophthalmitis: A Rare Case Report

Sympathetic ophthalmitis (SO) is defined as bilateral granulomatous panuveitis occurring after penetrating ocular trauma or intraocular surgery. It is now rare due to micro-surgical repair of ocular injury and use of steroid. An 18 years old boy admitted into Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh on 2nd March 2018. He got penetrating corneal injury in R/E with sharp pointed object 01 month back. It was conservatively managed but his right eye became phthisical. After 04 weeks his left eye was affected in which VA became 3/60, features of panuveitis developed. It was managed with high dose steroid and immunomodulatory drug (Azathioprine). Ultimately his vision of left eye is fully preserved (6/6). So, after a trauma or surgery to one eye, another eye should be meticulously examined and followed up. Early diagnosis and prompt treatment of Sympathetic Ophthalmitis may prevent from blindness.

Diagnostic Accuracy of Refractory Shadowing from Uterine Leiomyomas: Sonographic-Pathologic Correlation

This cross sectional study was carried out in the Department of Radiology & Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh from July 2010 to June 2011 with a view to evaluate the diagnostic accuracy of refractory shadowing on transabdominal pelvic sonography for leiomyomas and in differentiating them from other pelvic masses. Histopathological examination of the surgically resected masses was taken as the standard diagnostic tool. A total number of 50 patients of pelvic masses were studied. It was observed that a pattern of sharp, discrete, shadow was typical of leiomyoma, which reduces diagnostic ambiguity. The mean age of the patients was 38 years. Mean size of the masses was 4.25±3.25cm. Taking histopathological examination as the Gold standard, accuracy of refractory shadowing on transabdominal sonography in diagnosis of leiomyoma was 65.1%. Specificity and sensitivity were 90.3% and 54.2% respectively. Positive predictive value was 92.9% and negative predictive value was 45.9%. Statistical analysis revealed strong association of refractory shadowing with diagnosis of leiomyomas (p<0.01).

Outcome of Transcanalicular Endolaser and External Dacryocystorhinostomy in Chronic Dacryocystitis

Nasolacrimal duct obstruction due to chronic dacryocystitis is the most common cause of epiphora. Dacryocystorhinostomy (DCR) is the treatment of choice for chronic dacryocystitis. This can be carried out by external, endoscopic and endolaser surgical approach. Though external DCR is still a gold standard and most popular method, the latest procedure of less traumatic DCR is transcanalicular approach. The study was done to evaluate the outcome of Transcanalicular Endolaser DCR regarding epiphora and surgery related complications by measuring anatomical success rate (patency assessed by irrigation), functional success rate (symptom free) and complication rate and to compare with External DCR (Ext-DCR). This prospective interventional study was conducted from October 2011 to September 2012 in Ophthalmology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 62 patients included in the study as per inclusion and exclusion criteria of them 31 for TCEL-DCR and 31 for Ext-DCR. But during follow-up one patient was dropped from each group and finally outcome of 30 patients analyzed in each group. Mean age of the patients TCEL-DCR was 38.3±11.54 and of Ext-DCR was 38.4±14.01. In both groups females were the most sufferer (female: male = 1.5: 1). Functional and anatomical success rate of TCEL-DCR showed 93.3% and 83.3% after 3 months; 83.3% and 76.7% after 6 months respectively. Statistically non-significant difference was observed about success rate in comparison between groups. Per-operative complications were pain excessive bleeding. In TCEL-DCR pain complained 13.3% and excessive bleeding occurred in 3.3%. Where as in Ext-DCR pain complained 16.7% and excessive bleeding occurred in 20%; difference was statistically significant (p=0.001). Post-operative complications were bleeding and scar formation. Bleeding occurred in TCEL-DCR 6.67% and in Ext-DCR 10%. So, TCEL-DCR could be an alternative option for the treatment of chronic dacryocystitis especially for those patients who are conscious about scar formation and afraid about Ext-DCR technique.

Effect of dairy milk, eggs, meat, fish and fruits intake on academic performances of secondary school students in Bangladesh

Background: Contribution of dairy milk and other food items and schools to academic performances of students are the important factors to build a peaceful meritorious nation with sound mental and physical health.Objective: This experiment was designed to study the contribution of dairy milk and other food item intake pattern and schools to academic performances.Method: Students of class nine in Bangladesh were enumerated using a preprescribed questionnaire during March 2016 to June 2016 by direct interview method. Collected primary data were analyzed using the Statistical Package for the Social Sciences version 14.015.Results: Male (69.63%) students and students of schools in the town (84.97%) performed better. Majority of the students in towns (46.85%; 49.65%) and villages (45.51%; 50.90%) drank dairy milk and ate meat respectively, once or twice in a week. Many students in towns (30.77%) and villages (38.92%) ate eggs for 3 to 4 days in a week. Maximum students in town (53.50%) and in village (46.71%) took fish for 5 to 7 days and 3 to 4 days in a week, respectively. Many students in town (39.86%) and in village (59.88%) took fruits 1 to 2 days and 5 to 7 days in a week, respectively. Most (74.31%) of the students who took dairy milk, meat (73.68%), fruits (66.67%), fish (65.81%) and eggs (64.71%) everyday in a week obtained A grade.Conclusions: Schools, availability of dairy milk, meat, fruits, fish and eggs, Tiffin intake status and gender affected the academic performances but educational institutions had no effect on weekly dairy milk, eggs and meat intake of the students but weekly fish and fruits intake status were affected.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.355-359

The effect of temperate or tropical pasture grazing state and grain-based concentrate allocation on dairy cattle production and behavior

Grain-based concentrate (GBC) supplement is of high cost to dairy farmers as a feed source as opposed to grazed pasture. Milk production response to GBC is affected by the composition and nutritive value of the remainder of the diet, animal factors, and interactions between forage type and level of GBC. In grazing systems, dairy cattle encounter contrasting pasture states, primarily because the social structure of the herd affects the timing of when each animal accesses a paddock after milking as a result of a relatively consistent cow milking order. However, the effect of feed management, namely pasture state and GBC allocation, on dairy cattle production and behavior is unknown. We examined the effect of varying GBC allocation for dairy cattle grazing differing states of kikuyu grass (Pennisetum clandestinum, a tropical pasture species; experiment 1) and annual ryegrass (Lolium multiflorum L., a temperate pasture species; experiment 2) on dry matter intake, milk production and composition, and grazing behavior. For each experiment, 90 lactating dairy cattle were randomly allocated to 2 consistent (fresh-fresh and depleted-depleted) and 2 inconsistent (fresh-depleted and depleted-fresh pasture state treatments (defined as sequences of pasture state allocation for the morning and afternoon grazing events) and 3 GBC treatments [2.7, 5.4, and 8.1 kg of dry matter (DM)/cow per day], giving 12 treatment combinations for each experiment. The duration of each experiment was 14 d, with the first 7 d used as adaptation to treatment. In each experiment, 3 cattle were selected from each of the 12 pasture type × GBC treatment groups within the experimental herd to determine herbage intake and total DM digestibility using the n-alkanes method (n = 36). There was no interaction between kikuyu grass or ryegrass pasture state and GBC level for intake, digestibility, or milk yield or components. Dairy cattle offered fresh-fresh and depleted-fresh ryegrass produced 9% more milk yield, in line with greater pasture intakes, compared with fresh-depleted and depleted-depleted pasture states. Dairy cattle offered fresh-fresh kikuyu grass had 8% more milk yield and 14% more milk protein yield than other pastures states, but there was no effect of pasture state on milk composition. Milk yield increased with GBC level for both pasture species (∼0.7-0.8 kg of milk/kg of DM GBC) as GBC level increased from 2.5 to 5.4 kg of DM/cow per day. There was a poor response (0.3 kg of milk/kg of DM GBC), and no response, when GBC levels increased from 5.4 to 8.1 kg of DM/cow per day for kikuyu grass and ryegrass, respectively, in line with pasture DMD. Time spent grazing, lying, and ruminating were not associated with kikuyu grass pasture state, GBC, or their interaction. Despite this, there was a linear increase in grazing time in the afternoon coinciding with a linear decrease in lying and rumination time for both kikuyu grass and ryegrass pasture. Together these findings reveal the effect of pasture state and GBC allocation on dairy cattle production and behavior. Tailoring GBC allocation to the state of pasture accessed by cattle appears unwarranted, but there is an opportunity to alter the timing of pasture access to increase herd-level milk production efficiency.

Effect of irrigation and genotypes towards reduction in arsenic load in rice

Arsenic (As) bioaccumulation in rice grains has been identified as a major problem in Bangladesh and many other parts of the world. Suitable rice genotypes along with proper water management practice regulating As levels in rice plants must be chosen and implemented. A field study was conducted to investigate the effect of continuous flooding (CF) and alternate wetting and drying (AWD) irrigation on the bioaccumulation of As in ten rice cultivars at three locations having different levels of soil As and irrigation water As. Results showed that As concentration in different parts of rice plants varied significantly (P<0.0001) with rice genotypes and irrigation practices in the three study locations. Lower levels of As in rice were found in AWD irrigation practice compared to CF irrigation practice. Higher grain As bioaccumulation was detected in plants in areas of high soil As in combination with CF irrigation practice. Our data show that use of AWD irrigation practice with suitable genotypes led to 17 to 35% reduction in grain As level, as well as 7 to 38% increase in grain yield. Overall, this study advances our understanding that, for moderate to high levels of As contamination, the Binadhan-5, Binadhan-6, Binadhan-8, Binadhan-10 and BRRI dhan47 varieties were quite promising to mitigate As induced human health risk.

Geographical variation and age-related dietary exposure to arsenic in rice from Bangladesh

An extensive number (965) of rice samples collected by household survey from 73 upazilas (i.e. sub-districts) in Bangladesh was analyzed to determine regional variation, distribution and associated health risks from arsenic (As). No previous study had conducted a study examining such a large number of rice samples. The mean and median concentrations of total As were 126μg/kg and 107μg/kg, respectively, ranging from between 3 and 680μg/kg. Importantly, total As levels of aromatic rice were significantly lower (average 58μg/kg) than non-aromatic rice (average 150μg/kg) and also varied with rice grain size. The variation in As content was dominated by the location (47% among the upazilas, 71% among districts) and rice variety (14%). Inorganic As content in rice grain ranged between 11 and 502μg/kg (n=162) with the highest fraction being 98.6%. The daily intake of inorganic As from rice ranged between 0.38 and 1.92μg/kg BW in different districts. The incremental lifetime cancer risk (ILCR) for individuals due to the consumption of rice varied between 0.57×10^-3 to 2.88×10^-3 in different districts, and 0.54×10^-3 to 2.12×10^-3 in different varieties, higher than the US EPA threshold. The 2-10 age group experiences higher carcinogenic risks than others and females are more susceptible than males.

Variation in arsenic bioavailability in rice genotypes using swine model: An animal study

An in vivo assay using swine was used to measure the absolute bioavailability (AB) of As from cooked rice of twelve genotypes commonly grown in Bangladesh. An assessment of both total As in rice and its bioavailability is crucial for estimating human exposure following dietary intake by the local community. Average As concentrations in each rice genotype ranged from 108±4μg/kg to 580±6μg/kg. Arsenic speciation shows that most of the rice genotype contains 73 to 100% inorganic As. Swine were administered with As orally and via intravenous method, i.e. injection and fed certain common Bangladeshi rice genotypes (cooked). Swine blood As levels were measured to calculate As bioavailability from rice. Pilot studies shows that for As(III) and As(V), 90.8±12.4% and 85.0±19.2% of the administered oral dose was absorbed from the gastrointestinal tract whereas organic As was poorly absorbed resulting in low bioavailability values 20.2±2.6% (MMA) to 31.2±3.4% (DMA), respectively. These studies demonstrates that rice genotypic characters influenced As bioavailability in rice grown in As-contaminated areas and the bioavailability varied between 25% and 94%. Arsenic in salt tolerant rice genotypes Binadhan-10 and BRRI dhan47 as well as brown rice genotypes Kheali Boro and Local Boro has lower bioavailability (<50%) compared to other rice genotypes. The most commonly cultivated and consumed variety (BRRI dhan28) has As bioavailability of 70%, which poses a significant risk to consumers. Calculation of maximum tolerable daily intake (MTDI) for humans due to consumption of rice based on bioavailability data was higher than those calculated based on inorganic and organic As concentration in rice genotypes.

Morphology and mechanics of fungal mycelium

We study a unique biomaterial developed from fungal mycelium, the vegetative part and the root structure of fungi. Mycelium has a filamentous network structure with mechanics largely controlled by filament elasticity and branching, and network density. We report the morphological and mechanical characterization of mycelium through an integrated experimental and computational approach. The monotonic mechanical behavior of the mycelium is non-linear both in tension and compression. The material exhibits considerable strain hardening before rupture under tension, it mimics the open cell foam behavior under compression and exhibits hysteresis and the Mullins effect when subjected to cyclic loading. Based on our morphological characterization and experimental observations, we develop and validate a multiscale fiber network-based model for the mycelium which reproduces the tensile and compressive behavior of the material.

Towards Attosecond High-Energy Electron Bunches: Controlling Self-Injection in Laser-Wakefield Accelerators Through Plasma-Density Modulation

Self-injection in a laser-plasma wakefield accelerator is usually achieved by increasing the laser intensity until the threshold for injection is exceeded. Alternatively, the velocity of the bubble accelerating structure can be controlled using plasma density ramps, reducing the electron velocity required for injection. We present a model describing self-injection in the short-bunch regime for arbitrary changes in the plasma density. We derive the threshold condition for injection due to a plasma density gradient, which is confirmed using particle-in-cell simulations that demonstrate injection of subfemtosecond bunches. It is shown that the bunch charge, bunch length, and separation of bunches in a bunch train can be controlled by tailoring the plasma density profile.

Avian influenza and Newcastle disease virusindead chickens in markets in Dhaka, Bangladesh in 2011-2012

A virological survey for avian influenza (AI) and Newcastle disease (ND) was conducted in two selected live bird markets (LBMs), namely Kaptan Bazar and Karwan Bazar in Dhaka city, Bangladesh from August 2011 to July 2012. A total of 513 dead chickens were collected. An immune-chromatographic rapid antigen test for Type A influenza virus and both conventional and real time RT-PCR were used for the detection and characterization of AI and ND viruses. All carcasses were first screened by the rapid antigen test kit and 93 were positive for Type A influenza virus. RT-PCR on a representative number of rapid antigen test positive samples (n = 24) confirmed the presence of Type A influenza virus and mostly H5 influenza virus (22 out of 24 tested samples). Influenza rapid test negative samples (n = 420) were subjected to routine necropsy. Heat stress, suffocation and physical injury were the most common cause of mortality (163 cases), followed by ND, suspected to be the cause of 85 deaths. On molecular investigation of these 85 samples, the presence of ND virus was confirmed in 59 and AI virus in 6; 15 were negative for both ND and AI viruses and 5 were unsuitable for investigation. Among the 59 ND confirmed cases 18 also contained AI virus. In summary, out of 513 carcasses 117 (22.81%) contained AI virus and 59 (11.50%) contained ND virus. Eighteen (3.51%) carcasses contained both AI and ND viruses. The findings suggest that both AI and ND should be considered as major threats to the poultry industry.Bangl. vet. 2016. Vol. 33, No. 1, 8-15