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The objective of this study is to investigate the prescription pattern of proton pump inhibitors (PPIs) in association with patients’ age, gender and type of hospital visited (government or private), location of the hospital and doctors’ specialty in major divisions of Bangladesh. The secondary objective of this study was to analyze the current market size, share and growth of PPIs in the antiulcer drug market. A crosssectional survey of drug prescriptions was done at hospitals and clinics (private practices) between April 2021 to June 2021 of 7 divisions in Bangladesh. A total of 386 prescriptions, containing 2354 medicines, from 21 districts/areas of 7 divisions in Bangladesh were reviewed to determine the trend of prescribing PPIs. Market data of PPIs were collected from a secondary source (IQVIA). The data collected from the survey were tabulated, analyzed and graphically presented using Microsoft Office Excel 2016. Collected data were entered into the SPSS19.0 statistical software “R” and analyzed. Prescribed antiulcer drugs included Esomeprazole (70.2%), Rabeprazole (7.8%), Omeprazole (4.7%), Dexlansoprazole (4.4%), Pantoprazole (3.1%), and Lansoprazole (0.3%); and 9.3% of collected prescriptions had no anti-ulcerant. There was no association between gender and PPIs prescribed, nor across the type of hospital visited. Only the regression coefficient relating to the patient's age is statistically significant (β=0.01, p

A growing trend of cardiovascular disease is a threat to national health. The objectives of the research are to analyze the association between prescribed generics with doctors’ gender, academic degrees, location of practice and categories of generic medicines. A descriptive cross-sectional Dhaka-based study design was used to assess the prescriptions data. As a primary source of data, 403 prescriptions were collected for twelve months from six different locations of the cardiologists’ practice chamber in Dhaka. A two-stage cluster sampling technique was used to collect prescriptions at a 95% confidence level with a 5% margin of error. For proportional to population size (PPS) sampling, cluster weight of specific areas was determined from a secondary source of data. Chi-Square (2) goodness fit test revealed that gender, academic degrees, location of practice, therapeutic class of cardiovascular generics are statistically significant in association with prescribed generic medicine at a 5% level of significance (pvalues

Soil phosphorus (P) fractions indicate the P-supplying capacity to plant, which could be affected by fertilizer management systems. Information regarding the changes in P pools under different fert...

Proper nitrogen (N) management of high yielding rice varieties is crucial for obtaining their potential yield benefit. In this study, we compared the effect of different N rates on rice growth, yield, and N use efficiency of two high yielding rice varieties (BRRI dhan58 and BRRI dhan75) in a Boro (dry season)-fallow-T. Aman (wet season) cropping pattern. The N rates were: 0, 25, 50, 75, 100, 125, 150 and 175 kg ha−1 which were assigned in randomized complete block design with three replications. In Boro season, BRRI dhan58 showed higher response to applied N compared to BRRI dhan75 in T. Aman season. The calculated optimum N dose to maximize yield of BRRI dhan58 and BRRI dhan75 were 142 kg ha−1 and 82 kg ha−1, respectively. The agronomic N use efficiency and fertilizer N recovery efficiency were comparatively higher in BRRI dhan58 grown in Boro season than BRRI dhan75 grown in T. Aman season, while in both seasons, the N use efficiencies decreased with increased N rates. This study results suggest that variety-specific N fertilization with respect to growing season is the best N management practice to maximize rice yield avoiding the excess use of N fertilizer.

Inherited tubulopathies are a heterogeneous group of genetic disorders making whole-exome sequencing (WES) the preferred diagnostic methodology.This was a multicenter descriptive study wherein children (18 years) with clinically suspected tubular disorders were recruited for molecular testing through WES. Multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing were done when required. Variants were classified as per American College of Medical Genetics 2015 guidelines and pathogenic (P)/likely pathogenic (LP) variants were considered causative.There were 77 index cases (male =73%). Median age at diagnosis was 48 months (IQR 18.5 to 108 months). At recruitment, the number of children in each clinical group was as follows: distal renal tubular acidosis (dRTA) = 25; Bartter syndrome = 18; isolated hypophosphatemic rickets (HP) = 6; proximal tubular dysfunction (pTD) = 12; nephrogenic diabetes insipidus (NDI) = 6; kidney stone/nephrocalcinosis (NC) = 6; others = 4. We detected 55 (24 novel) P/LP variants, providing genetic diagnoses in 54 children (70%). The diagnostic yield of WES was highest for NDI (100%), followed by HP (83%; all X-linked HP), Bartter syndrome (78%), pTD (75%), dRTA (64%), and NC (33%). Molecular testing had a definite impact on clinical management in 24 (31%) children. This included revising clinical diagnosis among 14 children (26% of those with a confirmed genetic diagnosis and 18% of the overall cohort), detection of previously unrecognized co-morbidities among 8 children (sensorineural deafness n = 5, hemolytic anemia n = 2, and dental changes n = 1) and facilitating specific medical treatment for 7 children (primary hyperoxaluria n = 1, cystinosis n = 4, tyrosinemia n = 2).WES is a powerful tool in the diagnosis and management of children with inherited tubulopathies in the Indian population. A higher resolution version of the Graphical abstract is available as Supplementary information.

Long term fertilization from manure and fertilizer influences crop yield as well as soil nutrient cycling. Therefore, a field experiment was conducted from 2010 to 2014 in order to observe the long term effects of integrated application of manure and fertilizers on rice yield, soil nitrogen dynamics and soil biochemical properties. The field experiment was carried out in a rice-fallow-rice cropping pattern under wetland condition with four fertilizer management practices: NPKS fertilizer as soil test based (STB), Cow dung (CD) @ 3 t ha-1 + NPKS as integrated plant nutrition system (IPNS) [CD+IPNS], Poultry manure (PM) @ 2 t ha-1 + NPKS as IPNS [PM+IPNS] and N control. The rice grain yield, soil N dynamics and the biochemical properties assessed in our study significantly varied with the organic sources used in IPNS system. The annual grain yield of double cropped rice with PM+IPNS was similar to the STB treatment over the five cropping years while CD+IPNS responded from the third year. After five years of rice cropping PM+IPNS showed better impact on soil nitrogen dynamics and biochemical properties compared to STB fertilizer management. Considering the soil health, our study suggests that PM+IPNS could be a good practice for sustainable rice production in long run reducing the use of chemical fertilizer.

High soil temperature due to climate change may influence nutrient mineralization and soil biology. An incubation study was conducted at Bangladesh Rice Research Institute to determine the effect of temperature (28°C and 45°C) on nutrient mineralization and soil microbial population of two different soils (terrace and saline soil) having different nutrient management practices (chemical fertilizer and integrated nutrient management). Terrace soil was clay loam and saline (6 ds m-1) soil was sandy loam in texture. Total N and organic C content was significantly high in terrace soil compared to saline soil. High temperature (45°C) enhanced C mineralization by 33% in integrated nutrient management (INM) of terrace soil and 41% in chemical fertilizer treatment in saline soil. The NH4+-N mineralization was increased by 3 fold in saline soil at 45°C as compared to the same at normal temperature of 28°C. Temperature and nutrient management options also significantly influenced phosphorus (P) and potassium (K) mineralization. High temperature significantly enhanced P mineralization in INM compared to chemical fertilizer amendment. In terrace soil, at 28°C temperature K mineralization was high in chemical fertilizer amended soil as compared to INM treatment. Temperature and nutrient sources affected soil bacterial population significantly compared to fungi, and actinomycetes. Phosphate solubilizing bacteria (PSB) were more resistant to high temperature compared to free-living N2 fixing bacteria. In general, high temperature and nutrient management practices affected C, N, P, K mineralization and soil biology; although mode of action varied and depending on soil types and nutrient management practices.

Decomposed organic materials, in combination with plant growth-promoting bacteria (PGPB), are environmentally friendly and reduce synthetic fertilizer use in rice production. A bio-organic fertilizer (BoF) was prepared using kitchen waste (79%), chita-dhan (unfilled rice grain) biochar (15%), rock phosphate (5%), and a consortium of 10 PGPB (1%) to supplement 30% nitrogen and to replace triple superphosphate (TSP) fertilizer in rice production with an improvement of soil health. PGPB were local isolates and identified using 16S ribosomal RNA partial gene sequences as Bacillus mycoides, Proteus sp., Bacillus cereus, Bacillus subtilis, Bacillus pumilus, Paenibacillus polymyxa, and Paenibacillus spp. Isolates could fix N2 by 0.7–1.4 g kg–1, solubilize 0.1–1.2 g kg–1 phosphate, and produce 0.1–40 g kg–1 indoleacetic acid. The performance of BoF was evaluated by 16 field experiments and 18 farmers’ field demonstration trials during the year 2017–2020 in different parts of Bangladesh. Performances of BoF were evaluated based on control (T1), full synthetic fertilizer dose of N, P, and K (T2), BoF (2 t ha–1) + 70% N as urea + 100% K as muriate of potash (T3), 70% N as urea + 100% P as TSP + 100% K as muriate of potash (T4), and 2 t ha–1 BoF (T5) treatments. At the research station, average grain yield improved by 10–13% in T3 compared with T2 treatment. Depending on seasons, higher agronomic N use efficiency (19–30%), physiological N use efficiency (8–18%), partial factor productivity (PFP)N (114–150%), recovery efficiency (RE)N (3–31%), N harvest index (HIN) (14–24%), agronomic P use efficiency (22–25%), partial factor productivity of P (9–12%), AREP (15–23%), and HIP (3–6%) were obtained in T3 compared with T2 treatment. Research results were reflected in farmers’ field, and significant (P < 0.05) higher plant height, tiller, panicle, grain yield, partial factor productivity of N and P were obtained in the same treatment. Application of BoF improved soil organic carbon by 6–13%, along with an increased number of PGPB as compared with full synthetic fertilizer dose. In conclusion, tested BoF can be considered as a green technology to reduce 30% synthetic N and 100% TSP requirements in rice production with improved soil health.

It is crucial to explore knowledge, attitudes and perceptions (KAP) about rabies among the people in the community, the personnel dealing with animal bite management and suspected rabies patients, including humans and animals, to facilitate intervention in improving rabies elimination strategies. In 2016, we conducted an interactive face-to-face survey in three different districts of Bangladesh to understand the extent of KAP towards rabies in the community peoples (CPs), human healthcare professionals (HCPs) and veterinary practitioners (VPs). A set of prescribed questions was employed to measure what proportion of each group possessed sufficient knowledge, positive attitudes and adequate perceptions about rabies. A total of 1133 CPs, 211 HCPs and 168 VPs were interviewed by using a standard questionnaire comprising both closed and open-ended questions. Of the CPs, 49% identified the disease correctly (i.e. rabies is caused by an animal bite or a scratch). Only 29% of the CPs were aware that a wound should be washed immediately with soap and water after an animal bite or a scratch. However, only 49% of the CPs, 65% of the HCPs and 60% of the VPs felt that it is important to consult a physician and receive post-exposure vaccine as the first line of treatment following an animal exposure. Among the HCPs, 23% of the respondents did not possess sufficient knowledge about animal bites as categorised by the World Health Organization (WHO), and 12% of the respondents did not possess the knowledge on how to manage an animal bite properly. Out of 52% of the VPs who previously treated suspected rabid animals, only 29% had a history of taking rabies pre-exposure prophylaxis (PEP). Lack of formal education and rural subsistence were found to largely contribute to poor rabies KAP level among the CPs (P ≤ 0.01). There has been a high demand for proper training to be provided to HCPs and VPs for the effective management of an animal bite incidence in human and animals, respectively. Multi-sectoral collaboration through integrated One Health initiatives including community education, awareness programmes, facilitation of rabies PEP, and dog vaccination as well as its population control are critical in the way forward to control rabies in Bangladesh.

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of post-exposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n = 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy., Epidemiology; Public health; Infectious disease; Bangladesh; Rabies; Vaccine; Verbal autopsy.

Co-composting of urban wastes (UWs) and plant residues with rock phosphate (RP) produces quality compost and reduces the use of chemical phosphorus fertilizer. Biochemical process of three compost ...

Rice crops uptake large amounts of potassium (K), which is mainly supplied from inorganic fertilizer. Alternate K sources are essential to preserve natural reserves and to recycle unused K containing stubbles. We have evaluated the performance of rice straw (RS) in farmers’ field following integrated plant nutrient system (IPNS) for supplementing K requirement of rice and compared with agro-ecological zone (AEZ)-based chemical fertilizer and farmers’ practice in Tista Meander Floodplain soils of Bangladesh during 2013–2015. Application of RS @ 4.5 t ha−1 + IPNS-based fertilizer replaced full dose of chemical K fertilizer without significant reduction in grain yield of Boro rice. The K uptake with RS incorporation was similar to AEZ-based chemical fertilizer use. Considering soil health and environmental issue, RS + IPNS-based fertilizer management was the best option for growing wetland rice.

Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p

Background: This study was carried out to identify important zoonotic diseases of beef cattle at slaughter in Bangladesh. Methods: A total of 20 slaughtered cattle of both sexes, different ages and breeds were taken under investigation from Nilphamari, Rajshahi and Mymensingh district, Bangladesh during July to October, 2017. Detailed ante-mortem and post-slaughter lesions were inspected and the tissues from the lungs, liver, kidney and spleen were collected aseptically for histopathological examination. The tissue sections were processed and stained with hematoxylin and eosin (H&E) stain, acid fast stain and Gram stain. To detect the presence of specific microorganism in the tissues, the genomic DNA was extracted and polymerase chain reaction (PCR) was carried out. Results: Grossly, liver appeared as most affected organ followed by lungs, kidney and spleen. Wide spread necrosis and pipe steam liver due to fascioliasis (n=4), hydatidosis in lungs (n=3), congestion in the kidney (n=4) and petechial hemorrhage (n=2) in the spleen were the predominant lesions observed in the slaughtered cattle. H&E staining of tissue sections revealed granulomas in two liver and one lungs. Lung section stained with acid fast stain detected the acid fast bacilli in a case. Tissue sections stained with Gram stain showed cocci bacteria in the liver of two cattle. The PCR confirmed the presence of Mycobacterium tuberculosis in a cattle. Conclusions: Fascioliasis, hydatidosis and important zoonotic disease like tuberculosis are prevalent in the slaughtered cattle in Bangladesh. PCR technology appeared as a sensitive and specific screening test to diagnose tuberculosis. However, screening of large number of samples is necessary to detect the presence of important zoonotic diseases in cattle for safe beef production.

Background Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. Objectives We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. Methods A retrospective chart review of children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchange was undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis. Results Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5–15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody–associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96–7.85] mg/dL with a mean eGFR of 43 (IQR 27.54–56.7) mL/min/1.73 m2. Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5–26), dialysis and immunosuppressive therapy. The mean duration of follow-up was 4 months (range 2–24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and another was lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73 m2, while eGFR was 15–60 mL/min/1.73 m2 in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.

The effect of eight Trichoderma based substrates viz. rice bran, wheat bran, lentil bran, gram bran, black gram bran, mustard oil cake, grass pea bran and saw dust in mixing with peat soil and water were used in the formulation, these were evaluated for sporulations of Trichoderma harzianum and acting against Sclerotium rolfsii for the management of damping off of eggplant seedlings with control. The effect of the treatments varied significantly in terms of production of Trichoderma spore and reducing damping off and tip over increasing germination percentage, plant height, seedling vigor and fresh weight of eggplant seedlings in comparison to control. Among the treatments soil application with T5 (Trichoderma + Black gram bran + Peat soil + Water), T7 (Trichoderma + Grass Pea bran + Peat soil + Water) and T4 (Trichoderma + Gram bran + Peat soil + Water) showed the promising effect in controlling pre-emergence damping off, post-emergence damping off, tip over and increasing germination percentage, plant height, vigor index and fresh weight of seedlings. The highest germination percentage (78.00%) was observed in treatment T5 at 16 days after sowing (DAS). The lowest percentage (6.33%) post- emergence damping off was observed in T5 in eggplant seedling at 16 DAS. The lowest pre- emergence damping off and tip over were observed in T5 in eggplant (2.33% and 1.33%).

Background: All women go through menopause stage after a certain age and menopause women suffer from different medical problems which needs specific attention. Aim: The aim of the study is to find out the consequences of postmenopausal women attending in the hospital for medical treatment. This study also identifies the outcome of different consequences in those patients. Methods: Among 105 patients were selected for the study purposively those who were admitted in the gynecological ward in Kumodini Women's medical college from March 2008 to February 2009. All patients were undertake clinical examination and find out the consequence of menopause in one year observation period. A structured questionnaire was used to interview the patient and information also collected from patient's treatment file. Statistical analysis was performed by using statistical software SPSS 11.5 window. Results: Among 105 patients, age was above 40 years. Most of the patients were coming from low and low middle income society having maltiparous We have examined that most of the menopausal women developed uterovaginal prolapse was 63.8%, genital malignancies was found among 17.4% patients and rest were faced other benign disorders (19%) which includes leiomyoma, pelvic inflammatory diseases (PID), uncontrolled bleeding, urinary tract infections (UTI) and ovarian cysts. Conclusions: In Post menopausal phase of women in Bangladesh suffered from different health consequences like uterine prolapse, benign diseases and carcinoma which causes of hospital admission for better management. KYAMC Journal Vol. 3, No.-2, January 2013, Page 290-293 DOI: http://dx.doi.org/10.3329/kyamcj.v3i2.15169

Selective recognition of anions has received a tremendous attention in recent years because of their significant importance in biology and environment. This article highlights our recent research on a thiophene-based azacryptand that has been shown to effectively bind anions including iodide, bromide, chloride, nitrate and sulfate. Structural studies indicate that the ligand forms inclusion complexes with chloride and iodide. On the other hand, it forms cleft-like complexes with nitrate and sulfate, where three anions are bound between the cyclic arms. The ligand binds each anion with a 1:1 binding mode in water, exhibiting strong selectivity for sulfate; which is further supported by ESI-MS and DFT calculations.

Methotrexate, the mainstay of treatment in Juvenile idiopathic arthritis, might not be effective in a few patients of polyarticular and systemic onset juvenile idiopathic arthritis. Use of biologicals like TNF-a blockers, the next line of preferred drugs is constrained by the high cost. We successfully used leflunomide in four patients.

The cytotrophoblast (CTB) cells of the human placenta have membrane receptors that bind certain cardiotonic steroids (CTS) found in blood plasma. One of these, marinobufagenin, is a key factor in the etiology of preeclampsia. Herein, we used synthetic receptors (SR) to study their effectiveness on the angiogenic profile of human first trimester CTB cells. The humanextravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. Culture media of CTB cells treated with ≥1 nM SR level revealed sFlt-1 (Soluble fms-like tyrosine kinase-1) was significantly increased while VEGF (vascular endothelial growth factor) was significantly decreased in the culture media (* p < 0.05 for each) The AT2 receptor (Angiotensin II receptor type 2) expression was significantly upregulated in ≥1 nM SR-treated CTB cells as compared to basal; however, the AT1 (Angiotensin II receptor, type 1) and VEGFR-1 (vascular endothelial growth factor receptor 1) receptor expression was significantly downregulated (* p < 0.05 for each). Our results show that the anti-proliferative and anti-angiogenic effects of SR on CTB cells are similar to the effects of CTS. The observed anti angiogenic activity of SR on CTB cells demonstrates that the functionalized-urea/thiourea molecules may be useful as potent inhibitors to prevent CTS-induced impairment of CTB cells.

Background Tacrolimus has gained acceptance in the management of steroid-resistant nephrotic syndrome (SRNS) in children.Due to limited data, therapeutic range is extrapolated from pediatric renal transplant recipients. This study was designed to assess therapeutic efficacy of tacrolimus in children with SRNS and its correlation with inter-dose area under concentration curve (AUC0–12 h) and trough concentration (C0). Methods Pre dose, 0.5,1.0,1.5,2.0,2.5,3,4,8,and 12h after drug administration blood samples were collected in 25 children who were on tacrolimus for a minimum of 3 months and AUC0–12 h was calculated. Results There was an 80 % (20/25) response rate with 64 % (16/25) children achieving complete remission. Median C0 in remission was higher than in relapse group (2.95 ng/ml, versus 1.20 ng/ml, p=0.005). Median AUC0–12 h in remission was higher compared to those in relapse group (79.75 versus 35.15 μg×h/l; p=0.025). Maximum concentration after drug administration (Cmax) among the groups was not significantly different. There was a significant correlation between C0 and AUC0–12 h (r=0.79); and Cmax and AUC0–12 h (r=0.84). Fivepatientshadariseinserumcreatinine,ofwhichfourwere still proteinuric and had lower C0 and AUC0–12 h .N o other adverse effect was noted. Conclusions Tacrolimus had beneficial clinical response in SRNS. Target C0 and AUC0–12 h level for treatment remission was higher than those in relapse in children with SRNS but was lower than required in transplant recipient.

A 12-year-old boy, previously well, presented with increasing pallor, lethargy and intermittent gross haematuria for 1 month. He also had a history of haemoptysis for the previous 5 days. His blood pressure was normal and he had pedal oedema. There was no hepatosplenomegaly, joint swelling or skin rash. Laboratory investigations (Table 1) revealed anaemia, hypoalbuminaemia and elevated serum creatinine (estimated glomerular filtration rate by Schwartz formula: 13 mL/min/1.73 m). His white cell count, platelet count and clotting profile were normal. His urine analysis showed 2+ protein, 3+ blood and coarse granular casts. He had nephrotic-range proteinuria. His chest X-ray showed bilateral nodular infiltrates (Figure 1A) and a CT of the chest revealed bilateral diffuse ground glass opacities consistent with alveolar haemorrhage (Figure 1B). A kidney biopsy was performed for further evaluation.

We report a 3 months old child who presented with severe anemia due to pure red cell aplasia (PRCA). After ruling out other known causes of PRCA, congenital cytomegalovirus (CMV) infection was diagnosed to be the cause. The child responded to Ganciclovir and is doing well. CMV infection should be considered as differential diagnosis in PRCA during infancy.

To compare Power Color Doppler and Spectral Doppler ultrasonography indices (Resistive index and color fraction) in cases of Juvenile Idiopathic Arthritis (JIA) with healthy controls and evaluate their correlation with clinical and laboratory parameters. A cross sectional study was done over a period of 16 mo. Thirty patients of JIA and 30 age and sex matched healthy children were enrolled. Swelling and tenderness scores were evaluated and hemoglobin, total leukocyte count, erythrocyte sedimentation rate and C-reactive protein were done. A total of 112 diseased joints and 135 healthy joints were evaluated by USG by the same radiologist, and color fraction and RI were recorded. Statistically significant higher color fraction and lower RI (Resistive Index) were found in diseased joints as compared to healthy joints. Also the value of color fraction increased significantly with increasing grade of tenderness and RI decreased significantly with increasing grade of swelling. Power Color Doppler and Spectral Doppler ultrasonography (USG) indices (RI and color fraction) are significantly different in JIA patients. These might find a place in early diagnosis, monitoring of disease activity and response to therapy in JIA patients.

To determine the effect of glucocorticoids on lipid profile, endothelial function and arterial wall mechanics in children. Thirty patients who had received glucocorticoids for 4 to 8 wk were compared with 30 age and sex matched healthy controls. Baseline evaluation included weight, height, body mass index (BMI), blood pressure (BP), lipid profile and Ultrasonographic evaluation of brachial artery for endothelial dependant as well as endothelial independent vasodilatation and evaluation of common carotid artery for intima media thickness (IMT) and arterial wall mechanics. All of these parameters were evaluated two more times- after 4 wk of steroid therapy and 2 wk after stopping the drug. Patients were found to have significant increase in BMI; systolic and diastolic BP; total and LDL cholesterol and carotid IMT and also a decrease in cross sectional compliance (CSC) after 4 wk of steroid therapy (oral prednisolone). However, all these parameters returned towards baseline, 2 wk after stopping the drug. No endothelial dysfunction was observed in these patients. Four to eight wk of glucocorticoids use in children leads to reversible changes in BMI, systolic and diastolic BP, total and LDL cholesterol, carotid IMT and CSC.

Power control is an essential radio resource management method in CDMA cellular communication systems, where co-channel and adjacent-channel interferences are the primary capacity limiting factors. Power control intends to control the transmission power levels in such a way that required quality of service for the users is guaranteed with lowest possible transmission powers. In this paper, a modulation of power control algorithm is proposed for the 3G WCDMA system. The algorithm is figured on a modification of the transmitted power update step size. Instead of the fixed value presently suggested, the step size is modified dynamically in order to obtain more adapted power variations as well as the step is also represented as a function of the difference between the target and estimated SIR of the MS to obtain more stability of the system. A general form of this algorithm is presented and it is then studied in a simple simulation. Performance of the algorithm was evaluated with the outage percentage, which is the percentage of the number of MS's whose received SIR falls below the fixed threshold. The focused requirement, which had been tried to achieve by this algorithm, is the stability, which was studied and represented through simulation.

The majority of the population in Bangladesh is employed in manual handling tasks, but adequate protections for these workers do not exist. Conditions at a boulder handling site, saw mill, rice packaging plant and construction site show the need for comprehensive reforms in occupational safety and health legislation and practice in Bangladesh. New policies on training, industrial hygiene, safety equipment, and risk assessment are necessary to protect workers in a rapidly developing economy.

Given the history of failure to thrive and finding of severe rickets with normal anion gap metabolic acidosis with glucosuria, phosphaturia and aminoaciduria, the diagnosis of Fanconi syndrome was made. In the presence of hepatosplenomegaly and abnormal liver function test results, the differential diagnosis of tyrosinemia type 1, cystinosis, glycogen storage disease, Fanconi–Bickel syndrome was considered.

A two-and-half-year-old girl presented with a history of failure to thrive, increasing abdominal distension, bowing of legs, and excessive tiredness for the past 1 year. There was history of polyuria and polydipsia since birth. She had a history of fracture of the left femur following trivial trauma 6 months previously, following which she was unable to walk. Her parents were nonconsanguineous but there was a history of one male sibling death at 4 years of age with high-grade fever. He was also reported to have severe bowing of legs, pallor, and weakness. Upon examination, the child’s weight was 8.2 kg and height was 70 cm (both < third centile for age). She had clinical features of rickets, including a wide open anterior fontanel, widened wrists, rachitic rosary, and genu valgum. There was massive hepatosplenomegaly; liver 8 cm below costal margin, and spleen 6 cm below costal margin with ascites. Her eye examination was normal. Lab investigations revealed normal vitamin D levels (28 ng/ml), elevated serum alkaline phosphatase (2,458 IU/l), normal anion gap metabolic acidosis (pH 7.01, serum sodium 133 mmol/l, serum potassium 3.8 mmol/l, bicarbonate 17 mmol/l, chloride 106 mmol/l, anion gap-10) and severe hypophosphatemia (serum phosphate 0.7 mg%). Urine analysis revealed glucosuria, aminoaciduria, phosphaturia (elevated fractional excretion of phosphate: 63 %), and hypercalciuria. She had low platelet count (60,000/mm) and deranged clotting studies (prothrombin time: 17.7 s; INR: 1.62; activated partial thromboplastin time 40.9 s). The rest of the liver function was within normal limits. X-ray of the lower limbs showed pathological fracture of left femur shaft and severe osteopenia (Fig. 1). Ultrasound of abdomen showed hepatosplenomegaly with coarse echo-texture and multiple hypodense lesions in the liver. The kidneys were normalsized and there was no nephrocalcinosis.

Objective: Subjectivity in diagnosing arthritis by clinical parameters has led to the use of power color Doppler Ultrasonography (USG) indices color fraction and resistive index (RI) to objectively assess synovitis. Cut off levels of these USG parameters have also been derived in adult patients with rheumatoid arthritis. This study was performed in children with juvenile idiopathic arthritis ( JIA) using power color Doppler to find out diagnostic cut off values of color fraction and RI in diagnosing arthritis. Methods: A cross sectional observational study was conducted .Forty children of JIA having active arthritis and thirty four age and sex matched healthy controls were evaluated by power color and spectral USG .Their mean color fraction and resistive index (RI) were derived and compared . Using ROC curve, cut off values of these indices was derived. Finally, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of these cut off values were calculated. Results: A total of 187 diseased joints and 200 healthy joints were evaluated by power color Doppler and spectral Doppler USG. Color fraction was significantly higher and RI signifi cantly lower among cases than controls when both pooled and individual joint data were compared. Cut off level of color fraction and RI of all joints pooled together was 1.00 and 0.711 respectively. Similarly cut off value of individual joint group of these two indices and sensitivity, specificity, PPV and NPV were derived. Conclusion: A highly significant differ ence was observed in color fraction and RI between cases and controls. Color Fraction and RI were found to be very sensitive and specific in diagnosing arthritis in JIA patients with very high PPV and NPV.