Search

Introduction: Hanging is a very common method of suicide in Bangladesh as well as around the globe. The rate of suicide cases by hanging is increasing daily in Bangladesh. Suicide by hanging means killing oneself intentionally by suspending themselves from an anchor point by a ligature or by jumping from a height with a noose around the neck. As hanging is a simple method that does not require any complicated techniques, and the materials are also easy to come by, many choose this as their suicide method. The objective of this study was to observe the demography of hanging cases, its distribution according to age group, sex, and common ligature materials used by victims, observe post-mortem findings, and in this way, try to identify the causes and develop the preventive measures that are essential to reduce death due to hanging. Methods: This was a retrospective study done on the basis of the 3rd copy of postmortem reports preserved at the Department of Forensic Medicine, Pabna Medical College Hospital, Pabna, Bangladesh from January 2018 to December 2018 for the period of 1 year with proper permission from the autopsy surgeon. Result: 72% of the suicide victims were female, and 53% of those 115 victims were married. Most of the victims were from the age group of 21-30 years. Marital disharmony was the biggest common cause. The commonly used ligature material was Orna (dupatta). Conclusion: The number of deaths by suicide is on a rise, and to reduce this, a well-designed program is needed. This can help identify the causative factors f suicide by hanging and could help in preventing suicide cases.

Introduction: Sudden infant death syndrome (SIDS) occurs when a seemingly healthy newborn under the age of one year dies unexpectedly while sleeping. SIDS is often known as crib death because neonates usually die in their cribs. Even after a thorough forensic examination and death site investigation, the general diagnosis of SIDS is made when the cause of infant death cannot be determined. According to the 1969 definition, SIDS is still an excluding diagnosis. Despite the fact that this syndrome has various distinguishing characteristics, such as an age distribution that only affects children under the age of one year and an apparent incidence during sleep, there has been a reluctance to include these characteristics in the classification. The aim of the study was to better understand the risk factors of sudden infant death syndrome (SIDS). Methods: This cross-sectional analytical study was conducted at the Department of Forensic Medicine, Pabna Medical College Hospital, Pabna, from March 2020 to April 2021, and the participants of the study were 25 sudden and unidentified infant death cases at the study hospital whose guardians had given authorization for inclusion in the study. Result: The male: female ratio of the present study was 1.27:1. 60% of the participants had died while at home, and no information regarding the activity of infant at time of death was available for 56% of cases. Initial forensic analysis confirmed SIDS in 76% of the cases. Among the SIDS cases, majority had no observable risk factors, but family history of ailments and habits such as heart disorders, respiratory distress and smoking were determined as possible risk factors. Previous history of SIDS in family was also considered as a risk factor. Conclusion: The location of the infants at the time of death is very important in properly determining cause of death. Better observation of the infants can help in conducting a proper forensic analysis.

PSMA PET is a recent advance used in the evaluation of prostate cancer and current literature has a paucity of studies comparing it with MRI which is extensively used for clinical evaluation of prostate cancer. The aim of this study was to compare these modalities and understand the agreement between the two for the clinical staging of prostate cancer.Study population included 72 patients referred the Urology and Uro oncology department, Amrita Institute of Medical Sciences, Kochi from June 2018 to 2021 with PSA 7 or more referred for simultaneous PSMA PET MRI. The PSMA PET results were interpreted by a nuclear medicine specialist and the MRI report was interpreted by a radiologist and TNM staging was done for both modalities. Available sextant biopsy data was collected in 43 patients. Quantitative data were expressed as mean ± SD and the qualitative data was expressed as proportions and percentages. Diagnostic measures such as sensitivity, specicity, predictive value positives, negatives and accuracy were also calculated with 95 % condence interval. A p value of

Right from 2019 to the present (2021), the whole word is suffering from pandemic situation due to COVID-19, thus India has enforced lockdowns from 24th of March 2020 to stop faster spreading of the disease. The COVID-19 has resulted in schools shut all across the world. Globally, more than 1 billion children are out of the classroom. Physical distancing of atleast 1 meter between individuals is needed for security measures, thus Indian government had implemented many schools and colleges to quarantine peoples separately from their family. As a result, education system has changed from class room learning to virtual learning, whereby teaching is undertaken remotely with the help of digital platforms on mobile phone. But pervious literatures shows that excess use of mobile phone is affecting on students academic performance and it may lower academic performance of students as well. In this study researcher analyze the impact of Covid-19 on education and also check whether virtual learning is better than class room learning.

Case report - Introduction Rheumatoid Arthritis is associated with an increased risk of lymphoma. The relative contribution of cumulative disease activity versus immunosuppressive treatments, in particular anti-TNF, to the overall risk remains controversial. Awareness of this complication is important as most such lymphomas are highly treatment-sensitive when diagnosed early. We report a case of orbital mucosa-associated lymphoid tissue (MALT) lymphoma in a patient with established rheumatoid arthritis with secondary Sjogren’s syndrome with quiescent disease treated with methotrexate and etanercept for many years. We discuss the risk factors, clinical signs and rationale for subsequent treatment decisions, including consideration of rituximab to treat both conditions. Case report - Case description A 72-year-old lady with longstanding rheumatoid arthritis and secondary Sjogren’s reported a 1-year history of unilateral painless left watering eye and lid swelling. Vision was unaffected. There was no systemic upset or B-symptoms. Her rheumatoid arthritis was quiescent on methotrexate and etanercept. Past medical history consisted of asthma, hiatus hernia, subtalar arthrodesis and granuloma annulare. Other medications included folate, naproxen, lansoprazole, rosuvastatin and salbutamol and beclomethasone inhalers. She was a current smoker with a 40 pack-year history. On examination, there was a palpable mass on the nasal aspect of her left upper eyelid. Ocular examination was otherwise unremarkable and she had no lymphadenopathy. Inflammatory markers were normal: CRP 2 mg/L and ESR 28 mm/hr with unremarkable full blood count, urea and electrolytes and liver function tests. LDH of 252 IU/L was at the upper limit of normal. Gadolinium-enhanced MRI revealed a 38mm x 20mm x 8mm soft tissue mass within the extraconal compartment of the left orbit, raising the possibility of lymphoma. CT chest, abdomen and pelvis showed no distant metastases. Orbital biopsy revealed evidence of a kappa-restricted low-grade B-cell lymphoma with morphology and immunophenotype in keeping with MALT lymphoma. The MDT decision was to actively monitor with interval re-imaging. Etanercept and low-dose methotrexate were continued. Follow-up MRI at 4 months revealed near complete resolution of the left orbital mass. Her ocular symptoms had also spontaneously resolved. Etanercept was stopped at this time due to concerns around recent malignancy, with a plan to switch to rituximab. Her joints flared after stopping etanercept, but the first cycle of rituximab was very effective in controlling her arthritis. The patient is now awaiting a second cycle after a flare 9 months later. She has had no recurrence of ocular symptoms and remains under close and active surveillance for lymphoma. Case report - Discussion This case illustrates the increased risk of non-Hodgkin’s lymphoma in rheumatic disease, which may relate to impaired T-cell function in chronically active disease. MALT lymphomas account for around 8% of these; they originate from B cells and can affect nearly any mucosal site. Both chronic inflammation and immunosuppressive treatment contributed to increased risk here. Tumours are usually low-grade with onset in the 60s and 70s, with localised symptoms but minimal constitutional upset. Orbital MALT lymphomas present with a range of ocular symptoms; however, pain is rare and vision is usually preserved. There are no specific treatment guidelines; management is patient-specific and can include active monitoring, treating infection, immunotherapy, radiotherapy and chemotherapy. Prognosis of lymphoma associated with rheumatic disease is similar to the general population ( Evidence is conflicting as to whether anti-TNF agents increase the risk of lymphoma. Determining a causal link has proven difficult, due to the rarity of lymphoma and confounding factors, but mechanisms such as decreased activation of natural killer cells, a key defence against lymphoma, have been proposed. This contributed to the decision to stop etanercept in our patient. However, interestingly the lymphoma spontaneously resolved whilst the patient was still taking etanercept, which perhaps argues against the drug being a driving pathogenic factor. Another consideration in the decision to switch treatment was the potential overlapping benefit of rituximab. Cells of MALT lymphomas express CD20 antigen on their surfaces, and indeed this was observed in our patient’s immunostaining. Such tumours are exquisitely sensitive to rituximab, and consequently it is often used first-line particularly in areas such as the orbit where radiotherapy can be problematic. It was therefore decided that rituximab would be the best treatment to optimise both conditions, despite there being no immediate need for immunological treatment of the lymphoma itself. Case report - Key learning points This case highlights the need to be aware of the increased risk of lymphoma in autoimmune rheumatic diseases such as rheumatoid arthritis and Sjogren’s syndrome. The risk is elevated further in patients over 60 and those with chronically active disease. One must be vigilant during clinical assessment as patients often present with localised symptoms only, which could be dismissed as non-significant. In our case, signs and symptoms were limited to the left eye. Certainly, if any suspicious clinical features are detected, we advise a low threshold for prompt imaging studies followed by biopsy. Most such lymphomas are low-grade with effective treatment options, but do carry a small risk of high-grade transformation. Therefore, early recognition and treatment is vital and can be life-saving. Use of anti-TNF agents is recommended in patients with risk factors for developing lymphoma, especially given that cumulative inflammatory disease activity itself may represent a greater risk. Nevertheless, a low threshold of suspicion should be maintained. Based on uncertainties in the evidence, current expert consensus is to avoid anti-TNF agents in patients with current malignancy or any prior melanoma, and to exercise caution with a history of malignancy in the last 5 years. The safest course of action after a diagnosis of lymphoma is to stop anti-TNF agents. We suggest consideration of rituximab as a safe alternative biologic treatment, given its efficacy in both conditions. Here, it was rationalised that using rituximab to treat the patient’s rheumatoid arthritis could have an added protective effect on her risk of lymphoma recurrence. To investigate this theory further, an interesting opportunity for further work would be to observe a cohort of such patients and compare the lymphoma recurrence rates of those who continued anti-TNF treatment against those who switched to rituximab or stopped biologics altogether.

Introduction Recurrence of inguinal hernia after surgery secondary to mesh fixation techniques still remains a complication of inguinal hernioplasty. This study focuses on evaluating the reflected inguinal ligament and its potential in surgical application. Method A total of 181 patients undergoing inguinal hernia repair at Travancore Medical College, Kollam, Kerala between 2015 to 2020 were included in the study. The reflected inguinal ligament was identified by tracing fibres passing upwards and medially from the pubic tubercle to the rectus sheath. The incidence of the ligament and its shape were documented. Results Of the 181 patients, the male to female ratio was 7.6:1. The average age of the study population was 55.1 ± 14.3. 37% had right sided inguinal hernia, 19% had left sided inguinal hernia and 44% had bilateral inguinal hernia. Intraoperatively, the reflected inguinal ligament was identified in all patients with 60% having a triangular shape and rest had rectangular shape. Rectangular shape is more common as age increases. Discussion Current literature rarely examines the reflected inguinal ligament in depth. Further ambiguity is caused by various authors using different nomenclature for the ligament. Accepting the limitations such as constrained geographical variation in our study population, the findings of our study in combination with those of existing literature warrants further studies specifically evaluating the reflected inguinal ligament. Conclusion The reflected ligament was identified in all of our patients. This study recommends that further studies evaluate the reflected inguinal ligament as a potential landmark to fix the medial end of the mesh during inguinal hernioplasty.

Objective: Overactive bladder (OAB) symptoms are due to detrusor over activity (DOA) which is characterized by involuntary detrusor contractions during bladder filling. It may co-exist with BOO due to benign prostate hyperplasia (BPH) in men. Hence, the study was designed to assess and compare the clinical efficacy of combination therapy of anti-muscarinics with α-blockers versus α-blockers monotherapy in BPH patients with OAB. Methods: This study was carried out in the urology department of a tertiary care hospital for a period of 4 months. Clinical and biochemistry reports of 90 patients were collected in designed case report forms. All statistical analyses were performed using IBM Statistical Package for Social Sciences 17 and Graph Pad Prism 7.0. Results: The perceived change from baseline values was comparatively better in patients who received combination of tamsulosin with tolterodine than other two groups. All the three groups were effective in reducing the symptoms. Conclusion: Tamsulosin with tolterodine at a recommended dosage has shown to be clinically more effective than oxybutynin after 12 weeks of treatment for men with OAB in BPH. Patients with increased urinary retention risk should be carefully monitored during the course of treatment

Object Oriented Programming (OOP) facilitates to create libraries of reusable software components. The reusability approach in developing a new system can be applied to an existing system with prior modifications. The reusability definitely decreases the time and effort required for developing the new system. To support reusability of program code, a proper code retrieval process is necessary. It makes possible to search the similar code component of java programming environment. OOP paradigm has specific style of writing the program code. The program code is a collection of objects, classes and methods. It is very easy to store the cases and reuse or revise wherever necessary. To get the similarity between the program code components, it is necessary to have an efficient retrieval method. The retrieval phase can retrieve the program code components as classes, methods, and interfaces depending on components selection by the user. A purely case-based approach is adopted for revising or reusing the existing cases to solve the new problems. Case Based Reasoning (CBR) is the process of solving new problems based on the experience coming from similar past problems.

Outlier detection is a significant research area in data mining. An Outlier is a point or a set of points in a data set that exhibit a different behaviour compared to other objects. In static data sets, these anomalous patterns or variability can be detected using the traditional outlier detection techniques. The detection of outliers in data streams is a challenging task as changes or updations may take place during data processing and from multiple sources at a high rate. Here conventional detection techniques cannot be applied directly to achieve the time and space requirements in data streams. Combined approaches of several techniques are essential to extract outliers from such knowledge set. This paper focused on various algorithms used in density, distance, clustering based outlier detection among data streams and portrayed the metrices used in outlier detection. Also proposes a generalised framework to detect outlierness of an object in datastreams