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INTRODUCTION: Residual tumor cellularity (RTC) and pathologic complete response (pCR) after neo-adjuvant chemotherapy (NAC) are prognostic factors associated with improved outcomes in breast cancer (BC). However, the majority of patients achieve partial pathologic response (pPR) and no clear correlation between RTC patterns and outcomes was described. Our aims were to define predictive factors for pCR and compare different outcomes of patients with pCR or pPR and with different RTC patterns. MATERIALS AND METHODS: Baseline and post-NAC demographics, clinicopathological characteristics, post-operative data, survival and recurrence status were recorded from our institutional database. A multivariable analysis was performed using a logistic regression model to identify independent predictors of pCR. Disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) analyses were performed using the Kaplan-Meier method. RESULTS: Overall, of the 495 patients analyzed, 148 (29.9%) achieved pCR, 347 (70.1%) had pPR, and the median RTC was 40%. Multivariable analysis identified 3 independent factors predictive of pCR: tumor stage before NAC (cT1-2 84.5% versus cT3-4 15.5%), BC sub-type (HER2-positive 54.7% versus triple-negative 29.8% versus luminal-like 15.5%), and vascular invasion (absence 98.0% versus presence 2.0%). We found statistically significant longer DFS, DDFS, and OS in patients with pCR and with RTC

In the present world, there has been a great amount of improvement in medical services through technology and science. Developed methods and treatments are invented, and thousands of lives are also saved. Day by day, new doors of innovation and inventions are being opened in this sector. But in spite of these developments, there is also a black dot in that improvement which is adding to the health issues of the population, called "Medical Negligence". It's the breach of “duty of care" standard on part of the medical personnel in charge, having liability to fulfil the standard and eventually leading to the occurrence of "medical negligence ". The determination of liability in cases of “medical negligence", is a complex one. In this regard, this paper opts to discuss the determination of the liability of the medical personnel in question of medical negligence as well as the legal consequence of such medical negligence as violation of basic human rights under International Human Rights Law.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) are the leading causes of early cardiovascular morbidity and mortality especially in developing world. Recently more emphasis is given on the role of echocardiography for diagnosis of these diseases. Objective: Recent and reliable data and studies on RF and RHD are very limited in Bangladesh. Therefore, this study was done to diagnose rheumatic fever and rheumatic heart disease among clinically suspected patients. Methods: This cross-sectional study was conducted from February to June 2021 in National Center for Control of Rheumatic Fever and Heart Disease, Dhaka. A total of 250 patients irrespective of age and sex with complaints of joint pain and clinically suspected of RF and RHD were enrolled. Laboratory investigations including CBC with ESR, ASO titer, CRP, ECG and echocardiography were done. Results: Among the suspected patients, acute rheumatic fever without carditis was diagnosed in 10 (4%) patients and 15 (6%) had rheumatic heart disease with recurrent RF and carditis. Rheumatic fever with carditis were diagnosed in 63 (25.2%) patients; among whom 19 (7.6%) had clinical carditis and 44 (17.6%) were diagnosed as subclinical carditis. Acute rheumatic fever was diagnosed only within 5-20 years of age patient and 60% patients of RHD were found in 21-30 age groups. About half (49.20%) of the patients of rheumatic fever with carditis were between 11 to 15 years of age. Several abnormalities of heart valves were detected by Echocardiography; 78.2% of the patients of RF and RHD had mitral regurgitation and all the mitral stenosis cases were detected in patients with RHD. Combination of mitral regurgitation with aortic regurgitation and mitral regurgitation with mitral stenosis was also present. Conclusion: The findings of the study indicate that RF and RHD are not negligible in our country. Though the result does not indicate the prevalence or incidence; however, it highlights the need of systematic large-scale study with inclusion of echocardiography to find the prevalence of rheumatic fever and rheumatic heart disease in Bangladesh. Bangladesh Medical Res Counc Bull 2022; 48: 83-89

Objectives: To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. Methodology: This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Results: Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). Conclusion: The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia. Keywords: Preeclampsia; bolus dose; Hydralazine; Labetalol.

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group.

Petrochemical workers are exposed to many noxious substances present in their work places. The most dangerous effects are due to benzene which is mostly found in petrochemical vapours. The study was carried out in the Pathology department, Govt Medical College, Amritsar. 100 Petrol pump workers from different areas of the city were included as study group and 50 individuals from various departments in Government Medical College, Amritsar, were included as control group. Whole blood samples of the subjects were taken and analysed for complete blood count, liver function tests and renal function tests. The results showed statistically signicant increase in values of hematocrit, MCV, RDW, MPV, AST, ALT, ALP, GGT, Blood Urea, S. Creatinine, S. Uric Acid, Random blood sugar and statistically signicant decrease in values of MCH, MCHC, Platelet count, TSP, DSP with increased duration of exposure and in comparison to controls. However, there is seen statistically signicant increase in Hb, red blood cell count in initial years of exposure with subsequent decrease in their value after increased duration of exposure. There is seen neutropenia and lymphocytosis with PBF examination showing macrocytic RBC picture with no signicant difference in values of TLC, mid cell counts, PDW, PCT, S. Bilirubin (total and direct), S. Na+, PT, PTI with increased duration of exposure. The results of above parameters indicates that exposure to gasoline compounds over a long period of time may be the causative factor of hematotoxicity, hepatotoxicity and nephrotoxicity.

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Staphylococcus aureus is commensal and human pathogen both. The bacterium is one of the most common causes of food borne infections also in all over the world. C. copticum (Ajwain) is an aromatic spice used as a medicinal plant from ancient time for treating different human diseases including infectious diseases. The highest anti-staphylococcal activity in terms of inhibition zone was recorded 18.5 mm whereas 14.5 mm as lowest. The MIC range of ethanolic extract was evaluated amid 1.56 mg/ml to 3.12 mg/ml. The C. copticum (seed) extract might be useful as anti-staphylococcal agent as well as natural food preservative.

Objectives: To collect all studies on acute kidney injury, even with their limitations, done in South Asia to draw a picture about the types of acute kidney injury prevalent in the region. Method: The meta-analysis was conducted in June 2022 and comprised search on PubMed, Medline, Cochrane Library and Google Scholar databases for studies on acute kidney injury done in South Asia regardless of time limit, and published in the English language. Combinations of key words used were ‘community acquired acute kidney injury’ or ‘acute renal failure’ with using individual names of ‘different countries’ in South Asia. Data was extracted and analysed. Results: Of the 31(67.4%) studies subjected to detailed analysis, 17(54.83%) had been done in India, 10(32.25%) in Pakistan, 2(6.45%) in Nepal, and 1(3.22%) each in Bangladesh and Sri Lanka. Overall, there were 16,584 patients with acute kidney injury. There were 16(51.61%) studies focussing on community-acquired acute kidney injury, while 15(48.38%) also included hospital-acquired acute kidney injury. Also, 17(54.83%) studies were prospective and 14(45.16%) were retrospective. Pattern of defining and classifying acute kidney injury varied in the studies. Need for renal replacement was not mentioned universally. Complete recovery reported varied 40-80% and mortality 2.2-52% in the studies analysed. Conclusions: The number of acute kidney injury patients was considerable. Despite variations in definitions, study designs and outcomes, the meta-analysis provides useful information about the pattern of presentation and major causes of community-acquired acute kidney injury in South Asia. Key Words: Acute kidney injury, Community-acquired, South Asia, Meta-analysis.

The present study assessed if salivary crystallization pattern (ferning pattern formed as a result of the higher levels of salt content in the dried sample) could be used for estrus detection and for diagnosis of pregnancy/non-pregnancy in dairy cows. Saliva and blood samples were collected from non-pregnant cycling cows (Sahiwal breed; n = 20) on alternate days from the day of estrus till next estrus. Then, all the cows were inseminated and saliva and blood sampling were continued further for a period of 22 d post-insemination. Pregnancy diagnosis was carried out on day 45 post-insemination and eight cows were found to be pregnant. The salivary crystallization pattern and estradiol:progesterone ratio during estrous cycle and during pregnancy were compared among these cows. Six types of salivary crystallization patterns were discerned; distinct patterns such as branch-like, fern-like, fir-like and combinations of these. Fern-like pattern was observed in all the cows on the day of estrus (first measurement day) and furthermore, all of the cows that subsequently became pregnant had fern-like salivary crystallization pattern at the time of insemination. Saliva of all the pregnant cows showed branch-fir type of crystallization pattern on day 16 post-breeding while only 50% of non-pregnant cows showed this pattern on day 16 of estrous cycle. The appearance of fern-like pattern was positively and significantly related to estradiol:progesterone ratio (r = 0.86; P < 0.001). The findings were validated on a separate group of cycling cows (n = 32). We can conclude that salivary crystallization pattern might serve as a non-invasive and cost effective and easy-to-use cow-side tool for estrus detection and early pregnancy/non-pregnancy diagnosis in cows upon validation on a larger sample size.

Objectives: To determine the impact of high-energy nutritional supplements on appetite, appetite regulators, energy intake and macronutrients level among underweight primigravidae. Method: The single-blind randomised controlled trial was conducted from April 26, 2018, to August 10, 2019, in tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan, after approval from the ethics review committee of Khyber Medical University, Peshawar, and comprised underweight primigravidae who were randomly allocated to high energy nutritional supplement group A and placebo group B. Appetite questionnaires were filled and blood samples were obtained in fasting state, at 30, 60, 120, 210 and 270 minutes to measure blood glucose, insulin, peptide YY and cholecystokinin. Breakfast and lunch were served at 30 minutes and 210 minutes after supplementation, respectively. Data was analysed using SPSS 20. Results: Of the 36 subjects, 19(52.8%) were in group A and 17(47.2%) were in group B. The overall mean age was 18.66 ± 2.5 years. Energy intake in group A was significantly higher than group B (p

Activated charcoal possesses small pores that help in the increment of the surface area available for chemical reactions. In this study, coal samples were taken from Kalimati, Dharan, and Eastern Nepal with the goal of determining the antibacterial activity of activated charcoal against Escherichia coli. This study also measured the moisture content, volatile substances, fixed carbon, and pH of coal using proximate analysis. This study was carried out by the activated carbon impregnation with silver nanoparticles by varying with the different AgNO3 concentrations: a) 0.1 mol/liter (mol/L) b) 1 mol/L c) 1.5 mol/L one at a time. By the proximate analysis, it was found that the moisture content was 2.2%, the volatile matter was 15%, the fixed carbon was 53.8%, and the pH was 5.83. The antimicrobial activity was performed by agar well diffusion methods. With 25 mg nanoparticles the zone of inhibition against E. coli was found to be 7 mm, 8 mm and 10 mm respectively and with 50 mg nanoparticles the zone of inhibition against E. coli was found to be 9 mm, 9 mm and 12 mm with concentration 0.1 mol/L, 1 mol/L and 1.5 mol/L of AgNO3 respectively. According to Pearson correlation (r = 0.697) and a simple linear regression (R2 = 0.798), there was a positive relationship between the concentration of AgNO3 and the zone of inhibition observed against E. coli. The highest zone of inhibition (ZOI) of activated charcoal impregnation against E. coli was 12 mm at 1.5 mol/L of AgNO3 with 50 mg silver nanoparticles, which was comparatively less against seven standard antibiotics (13-29 mm ZOI).

The present experiment was carried out to standardize drying methods for Rose (Rosa L.), Carnations (Dianthus caryophyllus L.), and Gerbera (Gerbera L.), and to assess the influence of the drying quality of the dried flowers to make various value-added products. Flowers of Rose, Carnation, and Gerbera Aster were subjected to five different drying methods viz., shade drying method without embedding medium (T1), with sand embedding (T2) and with silica gel embedding (T3), microwave oven drying with sand (T4) and silica gel embedding (T5). Data were statistically analyzed in Completely Randomized Design. The results indicated that in physiological parameters significantly maximum reduction of weight was observed in Rose (1.14g), Carnation (3.44g), and Gerbera (3.44g). Whereas significantly maximum flower perimeter reduction in Rose (11.14cm), Carnation (11.64cm), and Gerbera (18.17cm) was observed in the shade drying method. Maximum quality score regarding color, appearance, texture, and no shattering of dried flowers of Carnation (15.7) was recorded in microwave oven drying with silica gel as embedding medium, in Rose’s highest score (15.7) was observed in microwave oven with sand as embedding medium and in Gerbera (15.51) was given to microwave oven drying within silica gel embedding treatment while shade dried without embedded flowers showed minimum quality score in Rose, Carnation, and Gerbera (3.6, 1.5, 2.52) respectively. Best results were obtained with overall acceptability, quality of flowers, and flower preservation in Rose –treatment T3 (shade drying with silica gel as embedding medium), Carnation- treatment T5 (microwave oven drying with silica gel as embedding medium), Gerbera T4 (microwave oven drying with river sand as embedding medium).

Objectives Present-day pathologists may be unfamiliar with the histopathologic features of measles, which is a reemerging disease. Awareness of these features may enable early diagnosis of measles in unsuspected cases, including those with an atypical presentation. Using archived tissue samples from historic patients, a unique source of histopathologic information about measles and other reemerging infectious diseases, we performed a comprehensive analysis of the histopathologic features of measles seen in commonly infected tissues during prodrome, active, and late phases of the disease. Methods Subspecialty pathologists analyzed H&E-stained slides of specimens from 89 patients accessioned from 1919 to 1998 and correlated the histopathologic findings with clinical data. Results Measles caused acute and chronic histopathologic changes, especially in the respiratory, lymphoid (including appendix and tonsils), and central nervous systems. Bacterial infections in lung and other organs contributed significantly to adverse outcomes, especially in immunocompromised patients. Conclusions Certain histopathologic features, especially Warthin-Finkeldey cells and multinucleated giant cells without inclusions, allow pathologists to diagnose or suggest the diagnosis of measles in unsuspected cases.

Objective: Determine the frequency of Helicobacter pylori (H. pylori) infection in our population, the response to triplequadruple regimen and resistance to clarithromycin. Study Design and Setting: Study design is case-series, Medicare Cardiac & General Hospital, Karachi- 2020-2021. All patients (N=110) were selected from outpatient department (OPD) of the Jinnah Medical College Hospital (JMCH) and Medicare Cardiac and General Hospital. Methodology: Patients with nausea, abdominal pain, diarrhea and IgG positive were included, and ELISA was done for detection of H. pylori infection.. IgG negative for H. pylori and having other gastrointestinal infections were excluded from this study. Patients positive with infection were prescribed the initial triple /quadruple regimen (triple regimen therapy including Proton pump inhibitor (PPI) 20 mg, Metronidazole 400mg, Amoxicillin 250 mg or Quadruple therapy by adding Bismuth subsalicylate). In ten cases of relapse Sequential / Rescue therapy were continued after a gap of 6 weeks included PPI 20 mg, metronidazole 400mg ciprofloxacin 200mg BD or Levofloxacin 400 mg OD. The qPCR was performed for the detecting resistant to clarithromycin in patients with H. pylori IgG positive after therapy. Result: During the follow-up, 60 (54%) cases were recovered from initial triple regimen, whereas 40(36%) cases recovered quadruple therapy and remaining 10 (7%) had clarithromycin resistance and were prescribed sequential therapy replacing clarithromycin by fluoroquinolones. Conclusion: The study showed that majority of H. pylori infected patient in our population recovered from initial triple/quadruple regimen. The alternate option with clarithromycin resistant was sequential and rescue therapy with high eradication rate

A prospective, observational study was conducted in the Department of Obstetrics & Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between July 2008 and January 2009 to compare position and attachment of the babies during breastfeeding before and after counselling the mothers. Our study samples include 100 healthy mothers and 100 term healthy babies. Initially, all the mothers and babies were observed for their position and attachment during breastfeeding within 24 hours of the delivery and documented in a standard data sheet. Then the mothers were shown the wall chart of nursing mothers and breastfeeding manual and taught practically by the investigators. Mothers were requested to come after 15 days for follow-up visit so that they become physically fit by that time and improve their skills. At follow-up visit, documentation of the position and attachment during breastfeeding was done in the data sheet. Comparison of each of the components of positioning and attachment was done with first observation (i.e., within 24 hours of the birth of the baby) and follow-up observation (i.e., after 15 days). The mean age of the mothers was 29.40±4.71 years. In all components of the position and attachment of the babies, the difference between before and after counselling the mothers was statistically significant (P0.05). CBMJ 2022 July: vol. 11 no. 02 P: 102-107

Introduction. The problem of treatment of newborns with congenital malformations of the anterior abdominal wallremains relevant due to the increasing number of malformations such as gastroschisis and omphalocele in newborns as wellas high complications and mortality.The aim of this work is to improve the effectiveness of treatment of newborns suffering from gastroschisis andomphalocele by optimizing pre-, intra- and postoperative management of patients.Material and research methods. The results of examination and treatment of 55 newborns with gastroschisis and 22 newbornswith omphalocele were analyzed for the period from 1993 to 2021. Examination algorithm included: antenatal counseling ofpregnant women, postnatal consultation and transportation of the newborn to the institution where the defect correction, clinical,laboratory and instrumental examination, bacteriological examinations, histological examination of surgical material, measurementof intra-abdominal pressure will be performed to determine adequate surgical correction of the malformation.Results and discussion. Studies in infants suffering from gastroschisis and omphalocele and viscero-abdominaldisproportion have shown an increase in the intra-abdominal pressure at all stages of correction, which significantly affectedthe mechanical properties of the lungs and manifested a decrease in lung distension, increased airway resistance andincreased inspiratory pressure. During surgical correction of viscero-abdominal disproportion at all stages of the study, themechanical properties of the newborn's lungs changed (compliance decreased, airway resistance increased), being directlydependent on the level of intra-abdominal pressure, as evidenced by the main groups of patients suffering from omphalocele.The maximum change in the mechanical properties of the lungs was observed at 24-48 hours after correction of visceroabdominal disproportion and coincided with the maximum figures for the increase in intra-abdominal pressure in newborns.Adequate lung ventilation under conditions of maximum increase in intra-abdominal pressure in newborns was achievedby increasing PIP to high numbers (up to 20-22 cm of water column) at 24-48 hours after correction of viscero-abdominaldisproportion with a gradual moderate decrease and retention of PEEP within the limits of 4-5 cm of water column.In the main groups of patients suffering from gastroschisis and omphalocele, normalization of disturbance of themechanical properties of the lungs (compliance and resistance) was faster than in the comparison groups. This was due to thefact that the level of intra-abdominal hypertension was taken into account when choosing the method of surgical correctionand infusion therapy in the mode of normovolemic hemodilution. In the study of peripheral hemodynamics (abdominal bloodflow) it was found that in the comparison groups in patients suffering from gastroschisis and omphalocele, higher indicesof resistance in the superior mesenteric and renal arteries, indicating impaired blood flow in the above vessels. In the main groups of patients suffering from gastroschisis and omphalocele, these indicators were significantly lower, which indicatesa better abdominal blood flow in patients in whom the choice of surgical correction method was taken into account whenchoosing the method of surgical correction.Intra-abdominal hypertension is one of the important reasons for the development of negative consequences when closingthe malformation of the anterior abdominal wall in newborns suffering from gastroschisis and omphalocele. Therefore,one of the main directions of improving the results of treatment of newborns with congenital malformation of the anteriorabdominal wall is the development and introduction of new methods for diagnosis of intraabdominal hypertension in practicalneonatal surgery and taking measures to prevent abdominal compartment syndrome.Depending on the condition of the child and the type of congenital malformation of the anterior abdominal wall, thetreatment tactics foresaw the following three options:1. Primary radical operation.2. Stage-by-stage surgical treatment.3. Conservative treatment followed by surgery.While analyzing the results of the study, it can be noted that a total of 26 newborns died of congenital defects of theanterior abdominal wall after surgery, including 18 children from the comparison group (1993-2004) and 8 from the mainstudy group (2005-2021), which amounted to 52,94% and 18,60% respectively. The main causes of death were neonatalsepsis, profound prematurity and severe comorbidities.Conclusions:1. Taking into account the results of treatment of newborns suffering from gastroschisis and omphalocele, it can bestated that the reduction of mortality in newborns by 3 times is primarily due to the introduction of neonatal surgery innew approaches to diagnosis, pre- and postoperative management, anesthesia and individualized surgical correction of thispathology.2. Intra-abdominal hypertension in case of congenital malformations of the anterior abdominal wall leads to a significantdeterioration of the mechanical properties of the lungs, hemodynamic disorders, oliguria, intestinal ischemia, decreasedorgan perfusion.3. Increased intra-abdominal hypertension was an indication for a change in surgical tactics - the abandonment of radicalplastic surgery of the abdominal wall and the transition to staged intervention or the use of surgical techniques that increasethe volume of the abdominal cavity.

Arsenic (As) traces have been reported worldwide in vegetables and crops cultivated in As-polluted soils. Being carcinogenic, the presence of As in edibles is of great concern as it ultimately reaches humans and animals through the food chain. Besides, As toxicity adversely affects the growth, physiology, metabolism, and productivity of crops. In the present study, Trigonella foenum-graecum (Fenugreek) was exposed to the As stress (0, 50, 100, and 150 μM sodium arsenate) for a week. Further, evaluation of As accumulation in roots and shoots, magnitude and visualization of oxyradicals, and thiol-based defence offered by Fenugreek was assessed. The root and leaf accumulated 258-453 μg g

Introduction. In the medical literature, there is not enough work on the impact of obstructive sleep apnea (OSA) on the development of atherosclerosis of the brachiocephalic arteries and venous dysgemenia. For the purpose of early diagnosis of vascular complications, further study of extracranial vessels in patients with OSA is necessary.Aim. To study the chances of changes in brachiocephalic vessels by ultrasound examination in patients with obstructive sleep apnea.Materials and methods. A survey was carried out of 88 patients. The results of anthropompetry, polysomnography and ultrasound examination of brachiocephalic vessels were evaluated.Results and discussion. New data were obtained on the severity of macroangiopathy, an increase in the peak systolic blood flow velocity in the internal jugular veins, and an increase in the diameters of the vertebral veins in patients with sleep apnea. It was also found that in patients with OSA, the chances of having a wide diameter of the common carotid artery (CCA) on both sides and the internal carotid artery on the left are more than 3 times higher, the probability of thickening of the intima-media complex in the area of the CCA and its bifurcation is more than on the left 3.5 times and the chances of macroangiopathy are 3 times higher in comparison with the examined patients without apnea.Conclusion. Timely assessment of the entire spectrum of pathological changes in the brachiocephalic vessels in patients with OSA will make it possible to diagnose early signs of atherosclerotic lesions of the arteries, venous dysfunction at the extracranial level.

Background: Antimicrobial resistance is a global health problem and the number of organisms developing resistance to commonly used antibiotics is increasing. Objective: The study was aimed to find out the pattern of common organism isolated from wound swabs and pus with their antibiogram. Methods: This observational study was conducted from September 2018 to January 2019 in a tertiary care hospital in Dhaka, Bangladesh. Culture and sensitivity tests were done for wound swabs and pus samples. Data regarding information of the patients, isolated organisms and culture and sensitivity reports were collected from the records of the department of microbiology. Results: Out of 1709 samples, 72.0% yielded growth of organisms of which 86.4% were gram negative and 13.6% were gram positive bacteria. Pseudomonas spp was the most commonly (43.8%) isolated organism from both wound swab and pus samples followed by Escherichia coli (16.6%), Staphylococcus aureus (11.8%), Klebsiella spp (9.8%). Among gram negative bacteria, 14.9% were ESBL producing organisms and Klebsiella spp were the most commonly isolated ESBL producers. Most of the bacteria showed high resistance to commonly used antibiotics. Gram negative bacteria were mostly resistant to amoxicillin followed by fluoroquinolones, co-trimoxazole, and cephalosporins whereas colistin, carbapenems and piperacillin/tazobactum were the most effective drugs against them. Majority of gram positive bacteria were resistant to fluoroquinolones and co-trimoxazole but 100% Staphylococcus aureus were sensitive to vancomycin, followed by linezolid (98.0%) and teicoplanin (86.0%) and 32.0% of them were Methicillin resistant (MRSA). Conclusion: The susceptibility pattern shows that some common antibiotics, especially antibiotics of oral form have very limited usefulness in treatment of infections and also highlight the need for regular reporting and antibiogram guided antibiotic prescription. Bangladesh Med Res Counc Bull 2021; 47(2): 181-187

Objective Breast arterial calcifications (BAC) are a sex-specific cardiovascular disease biomarker that might improve cardiovascular risk stratification in women. We implemented a deep convolutional neural network for automatic BAC detection and quantification. Methods In this retrospective study, four readers labelled four-view mammograms as BAC positive (BAC+) or BAC negative (BAC−) at image level. Starting from a pretrained VGG16 model, we trained a convolutional neural network to discriminate BAC+ and BAC− mammograms. Accuracy, F1 score, and area under the receiver operating characteristic curve (AUC-ROC) were used to assess the diagnostic performance. Predictions of calcified areas were generated using the generalized gradient-weighted class activation mapping (Grad-CAM++) method, and their correlation with manual measurement of BAC length in a subset of cases was assessed using Spearman ρ. Results A total 1493 women (198 BAC+) with a median age of 59 years (interquartile range 52–68) were included and partitioned in a training set of 410 cases (1640 views, 398 BAC+), validation set of 222 cases (888 views, 89 BAC+), and test set of 229 cases (916 views, 94 BAC+). The accuracy, F1 score, and AUC-ROC were 0.94, 0.86, and 0.98 in the training set; 0.96, 0.74, and 0.96 in the validation set; and 0.97, 0.80, and 0.95 in the test set, respectively. In 112 analyzed views, the Grad-CAM++ predictions displayed a strong correlation with BAC measured length (ρ = 0.88, p Conclusion Our model showed promising performances in BAC detection and in quantification of BAC burden, showing a strong correlation with manual measurements. Clinical relevance statement Integrating our model to clinical practice could improve BAC reporting without increasing clinical workload, facilitating large-scale studies on the impact of BAC as a biomarker of cardiovascular risk, raising awareness on women’s cardiovascular health, and leveraging mammographic screening. Key Points • We implemented a deep convolutional neural network (CNN) for BAC detection and quantification. • Our CNN had an area under the receiving operator curve of 0.95 for BAC detection in the test set composed of 916 views, 94 of which were BAC+ . • Furthermore, our CNN showed a strong correlation with manual BAC measurements (ρ = 0.88) in a set of 112 views.

Aberrant expression of the WNT signaling pathway has been associated with cancer progression and recurrence. Research over the decades has led to development of WNT-targetable small molecules, but has faced challenges in translating to clinics. Unlike WNT/β-catenin inhibitors, WNT5A-mimicking peptide, Foxy5 has shown encouraging efficacy in impairing metastasis of cancers with low or absent WNT5A expression. Recent patent application US20210008149 advocates the implication of Foxy5 for treatment and prevention of cancer relapse. The inventors have demonstrated the anti-stemness activity of Foxy5 in mice xenograft model via suppressing the expression of colonic cancer stem cell markers. Foxy5 also exhibits non-toxic nature when administered alone or in synergy with standard chemotherapy thus strengthening its candidature in the field of cancer therapeutics.

Background: The triazole analogues are molecules of immense attraction because of their wide pharmacological applications. background: The triazole analogues are molecules of immense attraction because of wide pharmacological applications Methods: Present research deals with the synthesis of triazole-2-thione analogues and their QSAR study. The synthesized analogs are also evaluated for their antimicrobial, anti-inflammatory, and antioxidant effect. Results: It was revealed that the benzamide analogues (3a, 3d) and triazolidine analogue (4b) were found to be most active against P. aeruginosa and E. coli with pMIC values of 1.69, 1.69 and 1.72, respectively. The antioxidant study of the derivatives showed that 4b was the most active antioxidant with 79% protein denaturation inhibition. The highest anti-inflammatory activity was shown by 3f, 4a and 4f. method: Serial dilution method was followed for the antimicrobial evaluation. The antimicrobial assay of the synthesized compounds was conducted on three bacterial strains, i.e. Gram positive Bacillus subtilis and gram negative i.e. Eschercheria coli, Pseudomonas aeruginosa and two fungal strains, i.e. Asperigillus niger and Candida albicans respectively. In-Vitro Anti-Inflammatory Activity was evaluated by Inhibition of albumin denaturation. The free radical scavenging activity of the synthesized compounds was determined by using in vitro assay of 2, 2-diphenyl-1 –picrylhydrazyl (DPPH).We have also applied multiple linear regressions (MLR) which is a classical technique in solving QSAR problems to develop the QSAR models and variable selection was achieved with genetic algorithm using BUILDQSAR software. [18] Conclusion: This study provides certain potent leads for further development of more potential anti-inflammatory, antioxidant and antimicrobial agents. result: It was revealed that the benzamide analogues (3a, 3d) and triazolidine analogue (4b) were found to be most active against P. aeruginosa and E.coli with pMIC values of 1.69, 1.69 and 1.72 respectively. The antioxidant study of the derivatives showed that 4b was most active antioxidant with 79% protein denaturation inhibition. Highest anti-inflammatory activity was shown by 3f, 4a and 4f. conclusion: In the present work, a novel series of substituted triazolidine-2-thione analogues were synthesized in appreciable yields. The compounds were evaluated for their antimicrobial, anti-inflammatory and antioxidant activity. The antimicrobial activity was carried out against three bacterial strains and two fungal strains. It was found that 3c and 4d were potent antimicrobial agents against different bacterial and fungal strains. Also, the antioxidant study of the derivatives showed that 4b was most active antioxidant with 79% protein denaturation inhibition. other: This work includes the synthesis, QSAR study of triazolidine-2-thione scaffold and exploring its antimicrobial, anti-oxidant and anti-inflammatory potential, thus constituting it into a lead. Further, this paper will aid in the development of new drugs based on triazolidine-2-thione core.

Durch einheitliches Geodatenmanagement können digitale Geodaten für verschiedenste gemeinwohlorientierte Aufgaben durch die Verwaltungen optimiert zur Verfügung gestellt werden. Umsetzungsdruck, diese interoperabel und nutzer:innenfreundlich bereitzustellen, wird nicht nur durch die europäische INSPIRE-Richtlinie erzeugt, sondern zeigt sich sowohl in aktuellen Umweltkrisen als auch im wachsenden Bedarf der Bürgerschaft an einer zukunftsorientierten, datenbasierten Verwaltung. Rheinland-Pfalz positioniert sich hierbei mit bottom-up-orientierten Governance-Ansätzen: Ein landesweiter, quervernetzter Basisdienst könnte als Element eines einzurichtenden Geodatenverbundes Rheinland-Pfalz als ressortübergreifender Daten-, Dienste- und Kompetenzverbund gestaltet werden. Dies wurde im Projekt „Voruntersuchung zur Einführung eines einheitlichen Geodatenmanagements in Rheinland-Pfalz (rlp-GDM)“ des rheinland-pfälzischen Ministeriums des Innern und für Sport in Zusammenarbeit mit dem WITI-Innovationslabor an der Deutschen Universität für Verwaltungswissenschaften Speyer, dem Deutschen Forschungsinstitut für öffentliche Verwaltung und der Metropolregion Rhein-Neckar GmbH analysiert.

Objectives: To identify the percentage of ovarian cancers with positive peritoneal cytology and to correlate the positive cytology with the prognostic factors. Methods: This retrospective, cross-sectional study, evaluated the data of surgical specimens of malignant ovarian tumors, received in the Department of Pathology, Dow University of Health Sciences over a period of three years. The peritoneal cytology was correlated with these prognostic parameters: the size of the tumor, stage, capsular invasion, omental, and lymph node metastasis. Results: Eighty malignant ovarian tumors were diagnosed. Serous carcinoma was the most common ovarian tumor, diagnosed in 24 (30.0%) cases, followed by endometrioid carcinoma in 17 (21.25%) and Granulosa cell tumor in 11 (13.75%) cases. The mean age of the patients was 41.91 years (range 7-71 years). The mean size of the tumors was 10.03 cm (SD 5.62 cm). The ovarian capsular invasion was present in 27 (33.75%) tumors. Peritoneal cytology was positive in 10/24 cases, with a detection rate of 41.66%. Omentum was involved in 12/34 (35.29%) cases. Lymph node dissection was performed in three cases, two were reported as positive for metastasis. Peritoneal cytology significantly correlated with the tumor size (p=0.045), and with ovarian capsular invasion (p=0.054) and omental metastasis (p=0.052). Most of the tumors were staged as FIGO stage IA. Conclusion: Peritoneal cytology correlates with the tumor size, stage, and omental metastasis of the malignant ovarian tumors. It should be routinely performed at the time of surgery for the optimal staging of the patients. doi: https://doi.org/10.12669/pjms.38.1.4393 How to cite this:Gulzar R, Shahid R, Mumtaz S, Hassan JA. Significance of peritoneal washing cytology in the accurate staging of malignant ovarian tumors. Pak J Med Sci. 2022;38(1):128-132. doi: https://doi.org/10.12669/pjms.38.1.4393 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Atlanto-occipitalization(AOZ) is one of the congenital anomalies related to craniovertebral synostosis. The clear understanding of its anatomical features and cranial foraminal variants plays a critical role in finding the possible coping mechanism with its pathogenesis such as segmental instability or neurologic deficits. Objective: This study aimed to investigate the incidence of occipitalization of Atlas and related variant foramina, as the baseline awareness of these conditions among the Nepalese population is yet to be documented. Methodology: A retrospective study was performed for the total 86 dry skulls available in the department of Anatomy in Katmandu University of Medical Sciences, Institute of Medical Science, and B.P. Koirala Institute of Health Sciences. The skulls were examined thoroughly to evidence the occurrence of cranio-vertebral variations. Result: Out of 86 human adult skulls, 2 cases (2.32 %) were found with partial AOZ presenting posterior spina bifida close to the midline. Sphenoidal emissary foramen (SEF) was also observed in 17 skulls (19.76 %), an additional foramen lying anteromedial to the foramen ovale. Moreover, one of the skulls (1.16 %) was found with the presence of pterygospinous bar creating an additional foramen ‘foramen of Civinini’ in the lateral pterygoid plate of the sphenoid bone. Conclusion: The incidence of AOZ and pterygospinous bar seems to be quite low as compared to the cases of SEF. However, the knowledge of such variations and the presence of additional foramina carry great significance for orthopedists and neurosurgeons to have prognostic implications and an accurate surgical approach.

BACKGROUND: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities. OBJECTIVE: Review the outcomes of Rh alloimmunization, including indications and possible complications. DESIGN: Retrospective cohort (medical record review). SETTING: Tertiary care center. PATIENTS AND METHODS: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations. MAIN OUTCOME MEASURE: Complications of IUT. SAMPLE SIZE: 119 mothers with 154 fetuses (154 different pregnancies). RESULTS: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations. CONCLUSIONS: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization). LIMITATIONS: Case series. CONFLICT OF INTEREST: None.

The incredible benefits of Alstonia scholaris are piquing researchers' attention in extracting its cellulose and utilizing it in further therapeutic applications. This study is based on cellulose extraction from its stalks and processed through chemical pre-treatments to manifest its cellulose content by using different bleaching reagents. A comparison was made on efficiencies of three reagents and it is found that the hydrogen peroxide exposed maximum cellulose than sodium hypochlorite and sodium chlorite. The experimental results revealed that A. scholaris possess 68–70% cellulose content. FTIR spectrum shows that OH- and CH- vibrations of cellulose appeared at 3320 cm−1 & 2892 cm−1 respectively whereas SEM images show fibrillation, rough surface, and lumens in bleached fiber that attributes to the removal of lignin and hemicelluloses and confirms cellulose extraction. The XRD pattern certifies the crystalline nature and compactness of cellulose whereas tensile properties and TGA help in understanding its flexibility, mechanical strength, and thermal stability at 370 °C respectively.

Arsenic (As), a toxic trace element, is of great environmental concern due to its presence in soil, water, plant, animal and human continuum. Its high toxicity and increased appearance in the biosphere have triggered public concern. The present study measured As concentrations in soil, groundwater and rice plant samples of five selected blocks of Maldah district, West Bengal, India. Soil, irrigation water and rice plant samples were collected from the fields of the selected study areas. The results revealed the presence of As in higher concentrations than the maximum permissible limit of As in irrigation water (0.1 mg L−1 by FAO, 2010) in groundwater of Manikchak (0.553 ± 0.17 mg L−1), Kaliachak III (0.528 ± 0.20 mg L−1), and Kaliachak II (0.449 ± 0.15 mg L−1), Kaliachak I (0.207 ± 0.19 mg L−1). The soil As was also found higher in those four blocks. The As content in rice grain of the study area was positively correlated (r = 0.896**, p

Diagnosis of congenital heart disease (CHD) which is a structural abnormality of the heart or intra thoracic great vessels in the earliest possible time is very important. Identifying the various modes of presentation, early referral and appropriate intervention can save lives and reduce risk of complications. The objectives of this study were to determine the clinical profile, complication and immediate outcome of children with congenital heart disease in first year of life. This cross-sectional observational study was conducted from October 2011 to March 2012 among 50 children from zero to one year of age who was diagnosed as CHD by echocardiography admitted in Department of Paediatrics of ShaheedSuhrawardy Medical College, Dhaka and Department of Paediatric Cardiology of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Among 50 infants acyanotic CHD was detected in 70% and cyanotic in 30% infants. Major structural defects were venticularseptal defect 34%, patent ductusarteriosus 30%, tetralogy of fallot’s 14%, transposition of great arteries 12%, atrial septal defect 6%. Presenting features were cough 82%, dyspnea 80%, poor weight gain 70%, feeding difficulty 68% and fever 58%. Frequently observed complications were failure to thrive, pulmonary hypertension and heart failure. Among the outcome of CHD 8% cases closed spontaneously, case fatality rate was 8% and the rest were advised accordingly for surgery, intervention and medical management among which 14% had device closure within the study period. High index of suspicion, early diagnosis, close monitoring and timely intervention can reduce complication of CHD. Bangladesh Med J. 2020 Sept; 49(3) : 17-21

Integration of photovoltaic (PV) technologies with building envelopes started in the early 1990 to meet the building energy demand and shave the peak electrical load. The PV technologies can be either attached or integrated with the envelopes termed as building-attached (BA)/building-integrated (BI) PV system. The BAPV/BIPV system applications are categorized under the building envelope roof and facades as PV-roof, PV-skin facade, PV-Trombe wall, PV claddings, and louvers. This review covers various factors that affect the design and performance of the BAPV/BIPV system applications. The factors identified are air gap, ventilation rate, a tilt angle of PV shading devices, adjacent shading, semitransparent PV (STPV) glazing design, cell coverage ratio (CCR), transmittance, window to wall ratio (WWR), and glazing orientation. Furthermore, the results of the possible factors are compared to building locations. This review article will be beneficial for researchers in designing the BAPV/BIPV system and provides future research possibilities.

The fabrication of sensitive protein microarrays such as PCR used in DNA microarray is challenging due to lack of signal amplification. The development of microarrays is utilized to improve the sensitivity and limitations of detection towards primal cancer detection. The sensitivity is enhanced by the use of ZnO-nanorods and is investigated as a substrate which enhance the florescent signal to diagnose the hepatocellular carcinoma (HCC) at early stages. The substrate for deposition of ZnO-nanorods is prepared by the conventional chemical bath deposition method. The resultant highly dense ZnO-nanorods enhance the fluorescent signal 7.2 times as compared to the substrate without ZnO-nanorods. The microarray showed sensitivity of 1504.7 ng ml-1 and limit of detection of 0.1 pg ml-1 in wide dynamic range of 0.05 pg-10 μg ml-1 for alpha fetoprotein (AFP) detection in 10% human serum. This immunoassay was successfully applied for human serum samples to detect tumor marker with good recoveries. The ZnO-nanorod substrate is a simple protein microarray which showed a great promise for developing a low-cost, sensitive, and high-throughput protein assay platform for several applications in both fundamental research and clinical diagnosis.

In industrial areas, increased human activities generate high emissions of metals that contaminate the environment, and eventually affect human health. Therefore, this study aims to investigate the sources of toxic elements in indoor dust samples, and to evaluate possible health risks due to expose of human body through dermal contact, inhalation, and ingestion. A total 36 indoor dust samples were collected from the windows of twelve (12) industrial buildings, which are facing the main roads in the biggest export process zone (DEPZ) in Dhaka City, Bangladesh. The indoor dust samples were analyzed using X-ray fluorescence (XRF) technique for the determination of Cu, Zn, As, Pb, Fe, Cr, Co, Ni, K, Ca, Ti, Rb, and Sr. This investigation revealed that Cu, Zn, Pb, Fe, and Sr concentrations were slightly higher in various degree than that of the background value in soil recommended by the Chinese Environmental Protection Administration (CEPA). Subsequently, ANOVA (α = 0.05, p < 0.001) test and %RSD values (33% to 168%) showed that the concentrations of these metals were present non-homogeneously in different sampling points. However, statistical analysis and several geochemical indices have been proposed that these heavy metals might be come in indoor dust samples because of anthropogenic events. This investigation also showed that the most-extreme permissible hazard index (HIs) levels known as non-cancer risk for As, Mn, and Zn because of dust exposure in the study area were below than that of the safe limit (HI = 1) but with an exception of Pb (HI = 1.9E+00) for children. On the other hand, the degree of cancer-causing risk linked with exposure to arsenic in indoor dust (i.e., 0.502E-06 to 0.121E-05) falls within the range of threshold values (10−6 to 10−4). Therefore, following USEPA health risk models, it has been suggested that these metals present in indoor dust samples might not have significant impact on causing non-cancer and cancer risk to children and to adult at this moment in the DEPZ area, Bangladesh. However, a continuous monitoring should be needed to assess more accurately the non-cancer and cancer risk to children and adult.

Background and aim Excess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. Subjects and methods This was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. Results Out of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ± 13.79 and 50.38 ± 11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. Conclusion The findings from second NDSP (2016–2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

Background: Under-nutrition is a major public health problem worldwide. Several studies have documented the effects of vitamin D and calcium supplements in healthy children and in children with bone abnormalities but the effects of multiple micronutrients supplementation in underweight children is limited in literature. Methods: In this randomized controlled trial 38 participants were recruited and divided into two groups of 19 subjects. On the first day of experimental trial, in fasting state 5cc blood samples were collected from all subjects followed by their anthropometric measurements, and serum levels of calcium and vitamin D. All subjects of one group were given Lipid-based nutritional supplement (LNS) and whereas the other group was given the placebo. After one month of compliance the same measurements were repeated and compared. Results: After one month of supplementation mid-upper arm circumference (p=0.005), weight (p

Earlier, it was said that a bull is half of the herd because of its half contribution towards the genetic makeup in each subsequent generation. Nowadays, bulls are considered more than half of the herd because of the extensive use of frozen semen samples in artificial insemination. Bull's low fertility accounts for a major economic loss to livestock farmers. It is well known that fertility is a low-heritable trait governed by many factors such as genetics, epigenetics, climate, stress, and physical soundness. Apart from all these factors, the nutritional status of the bull also affects the semen quality. It has been seen that a bull given undernutrition at an early age is affected by androgen synthesis and semen quality. The nutrition given to the pregnant dam also affects the male progeny's postnatal semen quality. However, more studies are needed to elucidate the effect of periconception nutrition on the fertility of progeny as far as bulls are considered. This review focused on the effect of maternal undernutrition during the periconception period and undernutrition during the early growth phase of bull calves on the postnatal fertility of bulls.

ObjectivesPoor control of asthma in the majority of patients could be partly due to their lack of knowledge concerning disease management, its triggering agents and when to seek advice from the healthcare provider. This study aims to assess the impact of pharmacist-led educational intervention on knowledge of self-management among asthmatic patients.DesignA pre–post cohort study.SettingOutpatient department of a tertiary care hospital affiliated with Quaid-i-Azam University, Pakistan.ParticipantsApproximately 265 adult asthmatic patients selected through a spirometry process, aged ≥18 years, were approached. 240 patients gave consent to participate in the study and were divided into control and treatment groups.InterventionsThe educational intervention consisted of individual patient counselling using educational material with time varied according to each patient’s comprehension and previous knowledge.Primary and secondary outcome measuresAssessment consisted of a 14-item Asthma Self-Management Knowledge Questionnaire (ASMQ) quantifying a patient’s self-management knowledge through an ASMQ score and its change following an educational intervention.ResultsDisease self-management knowledge was low with an average raw ASMQ score of 4.1 (max 14); which equates to a transformed score of 29.34 (max 100) and the proportion of patients who correctly answered more than 50% of questions were 16.7% preintervention. More than half of the participants (55%) did not know that asthma cannot be cured. The administration of educational intervention protocols resulted in significantly improved level of knowledge of asthma self-management (ConclusionOn baseline visit, patients possessed a poor knowledge about asthma self-management. Educational intervention protocols had a positive impact on improving patients’ knowledge about disease self-management. This would suggest that education and self-management skills should be seen as an integral component of asthma management and should be incorporated in structured patient care to achieve optimal asthma control.

Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and barriers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods (97.2%) were more frequently reported as taught compared with complex SRHR topics such as sexual violence (63.8%), unsafe abortion (65.7%), and the vulnerability of LGBTQIA persons (23.2%). High SRHR content was associated with high-income level (P = 0.003) and low abortion restriction (P = 0.042) but varied within settings. Most respondents described teaching SRHR as essential to the health of society. Complexity was cited as a barrier, as were cultural taboos, lack of stakeholder recognition, and dependency on fees and ranking.

Online education appeared to be effective among stakeholders worldwide following the closure of educational institutions due to the COVID-19 pandemic. Though the technology used for online education has hardly been explored to such a massive extent earlier, stakeholders soon self-educated themselves in new technological skills. However, challenges became more complex when the issues of assessment arose. Maintaining the validity, reliability, fairness, and academic integrity in online-based assessment became an insurmountable task; again, there was a pressing need for endorsing resilience and empathy for the assessors and assesses, especially for those who faced discrimination due to COVID-19. This study draws on the findings of a nationwide survey of online programmes offered by Bangladeshi private universities during the late 2020. They reveal the locally adopted methods and supports for assessing learners online, identify several challenges of online assessment, including the use of assessment methods, inadequate assessment-related support, fairness, and reliability, and ensuring accessibility to the assesses. It also reveals the stakeholders' choices to deal with the challenges in assessment, including flexibility, designing questions, and adopting process approach among others. Resilience and empathy for the stakeholders towards each other were required to successfully deal with the challenges of an online assessment.

El presente trabajo de investigación, tuvo como objetivo evidenciar a través de vestigios antropológicos y arqueológicos quenuestra lengua materna macro regional, el kichwa del Chinchaysuyu, tiene un origen remoto. Tiene su origen en losmachay runa que fueron nuestros primeros ancestros, nuestros primeros aukillus del primer tronco del árbol genealógico. Apartir de los machay runa de Lauricocha considerado el hombre más antiguo de América, pasando por diversos periodos dedesarrollo evolutivo, de niveles inferiores a superiores se desarrolla nuestra lengua materna hasta configurarse como unalengua macro regional del Chinchaysuyu. El escenario geográfico donde se hablaba esta lengua macro regional fueron losterritorios que actualmente ocupa las regiones de Huánuco, Pasco, Ancash y Lima norte. El método utilizado fue el diálogocon los kichwa hablantes de las provincias andinas de la región Huánuco, que consistió en recoger información mediante laconversación y dialogo. Los resultados nos indican que primero se formaron las lenguas maternas locales de cada grupoétnico, luego por el sistema del trueque o intercambio de productos de una nación con otra, se fue configurando el kichwa delChinchaysuyu como una lengua macro regional. Nuestra lengua materna, surge y se desarrolla a partir de los machayruna que fueron nuestros primeros ancestros. En conclusión, diremos que nuestra lengua materna el kichwa delChinchaysuyu, que tuvo su origen con los machay runa, evolucionan pasando por diversos periodos evolutivos hastaconfigurarse como una lengua macro regional del Chinchaysuyu. El kichwa del Chinchaysuyu, fue una lengua macroregional muy distinto a la lengua aymara y cuzqueña.

An 11-year-old girl, a known case of left crossed fused renal ectopia and sacral hypoplasia presented to the gynaecological OPD in Karachi, Pakistan, in February 2019 with complaints of abdominal pain. On examination, she was found to have a septum covering her vaginal orifice. She was subsequently diagnosed with haematocolpos secondary to imperforate hymen. Incision and drainage was done. However, despite surgical management, she continued to have recurrent formation of haematocolpos for the next two months secondary to multiple complete and partial transverse vaginal septa and post-operative formation of adhesions. Definitive management was done with ultrasound guided needle puncture and drainage, followed by post-operative tampon use to maintain patency. Keywords: Haematocolpos, urogenital abnormalities, Continuous...